Message the value of your profession and your practice.
By Michelle Collie, PT, DPT, MS, OCS
The public’s perception of private practice physical therapy is generally disappointing. As a profession we have struggled to come up with terms or statements that truly help the public understand what we do and who we are. Therefore, when marketing and promoting our practices, messaging “the value of our profession and our practices” is essential.
The Merriam-Webster dictionary’s full definition of value begins with: a fair return or equivalent in goods, services, or money for something exchanged. In our practices, physical therapy is exchanged for money, and we expect fair payment for the care received. With the overall decline in reimbursement and the increasing costs of business, many believe we are not receiving payment that reflects the value of the care we provide. Commonly heard statements in private physical therapy practices include: “I can’t afford a $25 copayment,” “My insurance should pay for this,” and from physicians, “I just give patients with back pain an exercise handout so they don’t need to go to physical therapy.” These are consumers, our patients, our colleagues, and so many do not know or understand the value of what we do. Poor payment for our services may be the result of poor recognition and messaging of our value. Maybe this is not the fault of the consumers, patients, or payers, but of our own profession and practices.
Unfortunately, physical therapists often do not graduate from programs with the knowledge and ability to advocate and message the value of their services. This is highlighted with comments such as “Recommend treatment once a week due to the high copayment” and “I don’t like selling—we should just give away exercise bands.” In addition, devaluing comes from being paid for the time we spend with patients or the “things we do” rather than for the outcomes. Spending 30 minutes providing manual therapy, exercises, and education for a woman with low back pain has a significantly lesser perceived value than giving a new mother the ability to carry, transfer, and care for her newborn without pain.
Marketing and promoting a practice and our profession requires defining and messaging our value. A higher perceived value of the service or product will result in higher payment. A recent study in the Harvard Business Review identified 30 “elements of value.”1 These elements fall into four categories: functional, emotional, life changing, and social impact. In the study, generally the more elements of value a company had, the greater the customers’ loyalty and the higher the company’s revenue growth. Also, elements in the functional category (reduced costs, quality, saves time, informed) tended to be less influential than elements of value in the other categories (provides hope, reduces anxiety, motivation, affiliation and belonging, therapeutic value, and wellness).
In developing a marketing plan, determine the elements of value that define your practice. Ensure your team is comfortable speaking to these elements. Examples include: “Seeing low back pain patients in the acute phase reduces health care costs,” “Physical therapy will not only promote a safe return to sport but will also address and prevent future potential injuries’’ and “Even after this injury resolves, you can contact us at any time with questions—we are here to help.” Administrative staff, physical therapists, and support staff can all discuss the elements of value for your practice with patients, referral sources, and the community.
The elements of value of your services can be shared with social media, your website, brochures, and press releases. Writing a blog on “running a 5K,” for example, provides motivation and hope, promoting patient satisfaction scores reduces anxiety, and listing partnerships with schools and businesses adds the value of affiliation and belonging.
Physical therapy should be perceived to be of a high value if there is messaging that reflects the elements of the value of your practice. Maybe a grassroots effort with physical therapists being given the language and skills to message our value will lead to an improved understanding of our role and value in health care delivery.
1. Almquist, E, Senior, J, Bloch, N. The elements of value. Harvard Business News, September 2016.
Michelle Collie, PT, DPT, MS, OCS, is the chair of the PPS PR and Marketing Committee and chief executive officer of Performance Physical Therapy in Rhode Island. She can be reached at firstname.lastname@example.org.
Managing energy, not time, as the key to high performance and personal renewal.
By Jim Loehr and Tony Schwartz | Reviewed by Susan Nowell, PT, DPT
The Power of Full Engagement asserts that energy management is the key to high performance and improved health, happiness, and balance in the workplace. The number of hours in a day is fixed, but the quality of our energy is not. We live in digital times; we are simultaneously experiencing increased reliance on technology and increased time constraints. The authors claim “energy, not time, is the fundamental currency of high performance” and that “performance, health and happiness are grounded in the skillful management of energy.”
The authors, Jim Loehr and Tony Schwartz, have codeveloped the Full Engagement model and the Corporate Athlete Training System through extensive work with individuals in high-pressure situations: professional athletes, FBI hostage rescue teams, U.S. marshals, hospital critical-care workers, and Fortune 500 companies. Through this work, they discovered something unexpected: The performance demands that most people face in everyday life outweigh those of professional athletes. The reason for this is that a professional athlete’s life is built around managing energy in all arenas—eating and sleeping, calling on the appropriate emotions, mentally preparing and staying focused, and regularly connecting to their greater athletic purpose.
The Full Engagement model proposes four primary principles to achieving greater work performance and balance:
- We must be “corporate athletes” pulling from four separate but related sources of energy: physical, emotional, mental, and spiritual.
- Because energy capacity diminishes with either underuse or overuse, we must balance episodes of energy expenditure with periods of renewal.
- To build greater capacities, we must push beyond our normal limits, training systematically the way that elite athletes do (we build emotional, mental, and spiritual capacity in precisely the same way that we build physical capacity).
- Positive energy rituals—highly specific routines for managing energy—are the key to full engagement and sustained high performance (a positive ritual is a behavior that comes from deeply held values).
The book outlines each of the proposed principles in great detail and provides a “Corporate Athlete” Personal Development Plan worksheet with additional resources in the index. The worksheet provides focused questions to assess values, strengths, personal vision, and career visions, to address barriers and to incorporate rituals of energy management for best performance.
As the health care climate is rapidly changing with increasing administrative burdens and declining payment for services, we are under greater time constraints to provide good services and demonstrate our quality and value. As a result of these increased time constraints, we are at greater risk to be overwhelmed, exhausted, and burnt out. As physical therapists, we are well aware of the importance of the mind-body connection in rehabilitating our patients. It’s important that we give the same care to ourselves so that we can better serve our patients. This means we need to focus on maximizing the strength, flexibility, endurance, and resilience of our mental, emotional, and spiritual energies as well as our physical. The Power of Full Engagement is a great resource for maximizing your energy management.
Susan Nowell, PT, DPT, is a PPS member and founder of Endurellect Therapies, practicing PT in San Francisco. She can be reached at email@example.com.
Establish shared goals of success for both patients and clients.
By Brian J. Gallagher, PT
In any field, improving performance and accountability depends on having a shared goal that unites the interests and activities of all. For many, a lack of clarity about what their goals are leads to complicated approaches that many times slow progress in production.
Achieving a high value for our patients must become the most important objective in our practice delivery system, with value defined as the health outcomes achieved for every dollar spent. This goal is what matters most, not only for our patients, but also the other players involved such as the providers and third-party payers.
Value is neither an abstract ideal nor a code word for cost reduction. Yet value in health care remains largely unmeasured and misunderstood. Value should always be defined based on our patients. In a well-run clinic, the creation of value for patients should be based within the systems of operations in such a way that the patients, the staff, and the practice are all winning at an extremely high level. Since value within your practice depends largely on results, not input, it is measured by the actual outcomes achieved, not the volume of services delivered. Therefore, we must have a shift in focus from volume to value, and therein lies a challenge for many practice owners.
This five-point system can be used objectively to improve outcomes and track value:
1. Access to Care
In order to maintain the maximum level of efficiency within our clinic when it comes to personnel utilization and patient accessibility to care, what we have found works best is to have every patient scheduled between two clinicians throughout their entire plan of care. This is virtually successful 100 percent of the time, so long as the evaluating therapist and the front desk personnel are coached appropriately on how and why we are scheduling in such a manner.
The Value: This will allow the patient more days and time slots to choose from and create a greater team approach with peer-to-peer self-learning occurring between the two treating therapists.
2. Scheduling Out the Entire Plan of Care
Your front desk should be scheduling every new patient for their entire plan of care at the end of their first visit. This should be done in accordance with the physical therapy (PT) frequency order slip given to the patient during their evaluation by the evaluating therapist. With this scheduling practice, you will see much greater overall patient compliance.
The Value: Because the patient perceives this as a physical order being given to them by their doctor of physical therapy, their compliance rate is much higher throughout the duration of care. You will also achieve the added benefit of having the patient making physical therapy a priority in their schedule over the upcoming weeks because they already have it booked in their schedule.
3. Management by Statistics
Managing statistics through a software system will allow for the measurement of pertinent statistical data to show the vital trends that can be graphed, so a weekly action plan can be applied accordingly.
The Value: Having the key operating metrics identified so that the outcomes can be tracked and graphed, one can be assured that everything from clinical efficiency to production, collections, patient reactivations, patient visits, new patients, and gross income divided by staff, can be acted on weekly.
4. Patient Surveys and Success Stories
Patient feedback in the form of surveys collected directly from the patients themselves at the time of their evaluation, two weeks into their care, and at discharge, can be scored to provide a qualitative evaluation of patient satisfaction. Another mechanism can be used to quantitatively measure the number of patients per therapist who are having an overall good patient care experience.
The Value: No other mechanism can be used to more accurately depict the patient care experience better than surveys and testimonials/success stories, so long as they are numerically weighted.
5. The Delivery of an Abundance of Care
The need is higher now than ever before to deliver more care per visit. This is largely due to the fact that more costs associated with the patient’s PT care are being passed on to them from their insurance carrier, in the form of higher deductibles and copayments.
The Value: High-quality clinics are striving to ensure the maximum number of units of care can be delivered to patient per visit according to their condition. This is often easily tracked within the practice’s electronic medical records (EMR) system.
The failure to prioritize the sequence of actions that bring about the greatest value is one of the most common mistakes that physical therapy owners make. Lacking a weekly action plan that addresses the statistical results of your production simply keeps you busy devoting time to “putting out the fire” closest to you. We can no longer afford to perform our services without measurable outcomes, which ensure high-quality care while at the same time meeting the production and efficiency needs of our practices.
Brian J. Gallagher, PT, is the chief executive officer of MEG Business Management, LLC, in Severna Park, Maryland. With more than 24 years’ experience in the field of rehabilitation and 19 years in business, he specializes in physical therapy practice management and executive coaching nationwide. He can be reached at firstname.lastname@example.org.
Michael Wah, PT, OSC, is the owner of Active Life and Sports Physical Therapy in Maryland. He can be reached at email@example.com.
Practice location; size; years in practice: Baltimore, Maryland; 3 locations, 19 employees; 34 years in practice and independent for the past 14 years.
Most influential book: Stephen Covey, The Seven Habits of Highly Effective People
What do you like most about your job? I love to create things. Private practice offers a playground for creation. Being able to make a difference in people’s lives is a privilege. I’m inspired by ambitious individuals who want to grow. I’m grateful for the opportunity to contribute to their growth. I also enjoy being able help patients get back to doing the things they’re passionate about.
What do you like least about your job? Dealing with drama that sometimes finds a way to creep into our space.
What is the important lesson you’ve learned? Finding joy in your life comes from serving others and being grateful for what you have.
Describe your essential business philosophy: Surround yourself with talented people who share your passion and vision for what physical therapy is supposed to be and then do your best to provide them with the tools and work environment they need to succeed. It’s much easier to help motivated people succeed than it is to motivate middle-of-the-road individuals.
Describe your management style: I’ve always been a “lead by example” kind of person. There’s nothing that I will ask others to do that I wouldn’t do. I’m a work in progress—and a natural introvert—but I work at being better at communication and leadership.
Best way you keep a competitive edge: It is good to celebrate your successes but never get too comfortable. And always be ready and willing to step out of your comfort zone.
How do you measure your success? Making a reasonable profit, having patients tell me on a regular basis how great our staff and their care was and being able to enjoy my work each day.
What is your goal yet to be achieved? I want to be integrated within a health care system.
What was your best decision? Opening up my current business by myself. I was originally looking at opening up as a partner of another practice. In hindsight, I think that would have been a disaster. My second best decision was bringing in my current business partner. It meant giving up equity but we complement each other’s talents, hold each other accountable, and are accomplishing more together than either of us would have by ourselves.
What was your worst decision? I’ve certainly made my share of bad decisions that either cost time and/or money and/or aggravation. Mostly around hires that were not a good match.
What was your toughest decision? It was always related to hiring. People are complex. Difficult to predict how they will play out once they are hired. We have carefully thought through our values and the attitudes we are looking for, but there’s no perfect formula.
How do you motivate your employees? I’m not sure that we motivate people as much as we help our motivated people do what they do best. We do this by challenging them to grow, facilitating their growth, and letting them spend most of their time doing what they love. We try to remove or minimize aggravations.
If you could start over, what would you do differently? Nothing.
Describe your competitive advantage: I have a bright, talented, and ambitious team. I have strong community relationships and a commitment to always getting better at what we do.
Describe your marketing strategy and highlight your most successful action: Our patients are our best sales people. They tell our story to their friends, their family, and their doctors. Satisfied patients want to tell other people and they want to help you. We ask them to help and we thank them for helping.
What unique programs do you offer that set you apart from the competition? Our internal training process, our vestibular rehabilitation, and our balance and falls program.
What are the benefits of Private Practice Section (PPS) membership to your practice? I always read and get ideas from Impact magazine. We always get a lot of good information from networking at the PPS meeting.
What worries you about the future of private practice? Upcoming changes to the payment system. Physical therapy can be a force in improving health care efficiency and effectiveness but needs to be financially viable to do so.
What are you optimistic about? Physical therapy is the best first option for so many conditions, including most musculoskeletal disorders, balance and fall problems, and vestibular dysfunction.
What are your goals for the next year? We have a contract with a hospital system and are about to open a joint venture outpatient location with that system. We know what private practice physical therapy has to offer patients. We have a number of goals related to educating the various components of the system on how physical therapy can contribute. We hope to integrate physical therapy into the hospital system to help it meet its global goals of improving outcomes, improving efficiency, and improving patient experience.
What do private practitioners need to do to thrive in today’s health care environment? Help organizations, institutions, practitioners, and individuals see the value that physical therapy has to offer.
By F. Mark Amundson, PT, DPT, DSc, MA, ATC, SCS, CSCS
The World Health Organization (WHO) recognizes health is on a continuum ranging from; the worst of health conditions to the best of health, the lowest functional ability to the highest.1 WHO developed the International Statistical Classification of Diseases and Health Related Problems (ICD) to describe health conditions.2 Currently the United States health care system uses the tenth edition of the ICD, ICD-10. However, WHO recognized that describing a health condition by solely utilizing ICD-10 terminology does not adequately define the impact health conditions have on function.1
To have a common language for describing the effect health and health related states have on function, WHO developed the International Classification of Functioning, Disability, and Health (ICF).3,4 ICF is a complimentary language to ICD-10.1 Used together ICD-10 and ICF provide a better description of an individual than applied separately. Whereas ICD-10 classifies health conditions that includes injury or illness, ICF classifies the extent those health conditions have on the functional ability of a person. By using ICD-10 and ICF together, health care providers gain a better understanding of an individual’s health status.3, 4
In 2001 the ICF was endorsed by 191 nations including the United States as the standard language and framework for describing health and health-related states. Since then, national health care organizations including the American Physical Therapy Association (APTA).6 Function rather than disability is the cornerstone for ICF that is used as a classification system not a clinical measurement tool.3 ICF terminology is the core to the Centers for Medicare and Medicaid billing codes for physical therapy evaluation and re-evaluation proposed to take effect January 1, 2017.7
A fictional story of Mr. J and Mr. L illustrates how ICD-10 and ICF complement each other in describing the functional difference between two individuals who have the same primary diagnosis. Mr. J and Mr. L are two men with similar personal demographics. Also, in ICD-10 terminology, each has a primary diagnosis of M16.11; Unilateral Osteoarthritis Right Hip. Using that information alone there seems to be little difference between the two men. However, Mr. J is able to go about most of his typical activities with minimal restrictions. Mr. L, on the other hand, experiences severe hip pain that limits his ability to sleep and walk. Hip weakness coupled with the pain results in restricted hip movement and a noticeable lateral sway to the involved lower extremity. He is unable to participate in most of his typical activities at home and in the community.
Here are two men that are similar in many ways including a diagnosis in ICD-10 terms, yet they are very different. ICD-10 is dichotomous, the person either has or does not have a specific health condition.3,4 Little can be learned in regard to the apparent variance in treatment and potential outcomes between the two men by merely referencing a diagnosis. Understanding the current and preferred functional level of the person is required to effectively treat that individual.1,3 In the current example ICF language can provide information to illustrate the differences between these two men with an ICD-10 diagnosis of M16.11.
ICF is based upon health not being dichotomous.3,4,8 Instead of being classified solely by the presence or absence a health condition, health is recognized to be on a continuum from extremes of disability and function.3,4,8 Disability and function are umbrella terms that together span the entire continuum.3,4,8 Disability involves impairments, activity limitations, and participation restrictions.3,4,8 Function is based upon body functions, body structures, activities, and participation.3,4,8 An understanding of these and other ICF terms is required to discover the functional capability of individuals.9 Definitions of some ICF foundational terms as provided by the WHO ICF Research Branch 8 are:
- Disability is an umbrella term for impairments, activity limitations, and participation restriction. It denotes the negative aspects of the interaction between an individual (with a health condition) and that individual’s contextual factors (environmental and personal factors).
- Functioning is an umbrella term for body functions, body structures, activities, and participation. It denotes the positive aspects of the interaction between an individual (with a health condition) and that individual’s contextual (environmental and personal factors).
- Health Condition is an umbrella term for disease (acute or chronic), disorder, injury or trauma. A health condition may also include other circumstances such as pregnancy, ageing, stress, congenital anomaly, or genetic predisposition. Health conditions are coded using ICD-10.
- Impairment is a loss or abnormality in body structure or physiological function (including mental functions). Abnormality here is used strictly to refer to a significant variation from established statistical norms. (ex: as a deviation from a population mean within measured standard norms) and should be used only in this sense.
- Body Functions are the physiological functions of body systems, including psychological functions. “Body” refers to the human organism as a whole, and thus includes the brain. Hence, mental (or psychological) functions are subsumed under body functions. The standard for these functions is to be the statistical norm for humans.
- Body Structures are structural or anatomical parts of the body such as organs, limbs, and their components classified according to body systems. The standard for these structures is considered to be statistical norm for humans.
- Activity is the execution of a task or action by an individual. It represents the individual’s perspective of functioning.
- Activity Limitations are difficulties an individual may have in executing activities. An activity limitation may range from a slight to severe deviation in terms of quality or quantity in executing the activity in a manner or to the extent that is expected of people without the health condition.
- Participation is a person’s involvement in a life situation. It represents the societal perspective of functioning.
- Participation Restrictions are problems an individual may experience in involvement in life situations. The presence of a participation restriction is determined by comparing an individual’s participation to that which is expected of an individual without disability in that culture or society.
- Environment Factors constitute a component of ICF, and refer to all aspects of the external or extrinsic world that form the context of an individual’s life and, as such, have an impact on that person’s functioning. Environmental factors include the physical world and its features, the human made physical world, other people in different relationships and roles, attitudes and values, social systems and services, and policies, rules and laws.
- Personal Factors are contextual factors that relate to the individual such as age, gender, social status, life experiences and so on, which are not currently classified in ICF but which users may incorporate in their applications of the classification.
Now by applying ICF terms in the story of Mr. J and Mr. L their differences become more obvious. Simply put, Mr. J functions at a higher functional level than Mr. L. Activity limitations are the primary concern of Mr. J. He has impairments, however their severity is low. Meanwhile Mr. L is experiencing much more severe impairments that include pain, weakness, and decreased movement. Due to these impairments he is significantly more limited in activities including sleeping and walking. Participation in many of his typical activities is severely restricted to being out of the question. Upon reviewing this preliminary information, the variations between these two men begins to evolve.
Currently there is clearly a difference between these two, essentially identical men, who have been given the same diagnosis in ICD-10 terminology of M16.11; Unilateral Osteoarthritis Right Hip. By adding in ICF terminology their disparity begins to evolve. Now the challenge is to narrow in on these impairments, activity limitations, and participation restrictions to understand each man’s current and desired functional capability. Linking ICD-10 diagnosis to ICF information is an initial step to learn where the functional capability of an individual is on the health continuum. Knowledge that helps to determine the right level of health care for each individual.
1. Stucki G, Cieza A, Melvin J. The international classification of functioning, disability and health: a unifying model for the conceptual description of the rehabilitation strategy. J. Rehab Med 2007; 39:279-285.
2. World Health Organization. International Statistical Classification of Diseases and Related Health Problems – 10th revision, Vol. 2. Geneva: World Health Organization; 2010.
3. Towards a Common Language for Functioning, Disability, and Health (ICF). Geneva: WHO; 2002.
4. World Health Organization. International Classification of Functioning, Disability and Health: ICF. Geneva: World Health Organization; 2001.
5. World Health Organization. How to use the ICF: Using the International Classification of Functioning, Disability, and Health (ICF). Exposure draft for comment. October 2013. Geneva: WHO.
6. Bemis-Dougherty A. Practice matters: what is the ICF? PT Magazine of Physical Therapy. 2/09
7. Centers for Medicare & Medicaid Services: Medicare Program; Revisions to Payment Policies Under the Physician Fee Schedule and Other Revisions to Part B for CY 2017; Medicare Advantage Pricing Data Release; Medicare Advantage and Part D Medical Low Ratio Data Release; Medicare Advantage Provider Network Requirements; Expansion of Medicare Diabetes Prevention Program Model. (Section II.L.5.b.36). Proposed Rule: 7/15/16
8. World Health Organization. ICF Research Branch. ICF e-Learning Tool Glossary of Terms. Accessed: 8/11/16.
9. Rauch A, Cieza A, Stucki G. How to apply the international classification of functioning, disability and health (ICF) for rehabilitation management in clinical practice. Eur J Phys Rehabil Med 2008:44;329-342.
F. Mark Amundson PT, DPT, DSc, MA, ATC, SCS, CSCS, is a PPS member and chief clinical officer of Twin Boro Physical Therapy a private practice with 22 outpatient clinics in New Jersey. He can be reached at firstname.lastname@example.org.