Business Innovation

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The benefits of adding a patient care representative to your team.

By Brian J. Gallagher, PT

Innovation is happening all around us today in the health care industry and typically results in greater efficiency and productivity. In private practice, we are always looking for ways that we can supersede yesterday to deliver a better, higher quality service and product to our patients. The idea that a service can and does produce a product is a new concept for some, but for others they have long since recognized they have been innovating new products.

Consider this innovative approach, broken down into four steps, to be completed in order:

  1. Environment: Do you have the best environment that is most conducive to producing your optimal products such as the best location, office access, internal spaces, and equipment?
  2. Structure: Do you have a company organization chart with all positions accounted for and specifically defined products that are needed from each position, as well as the statistics on how you are going to measure them?
  3. Personnel: So many of the owners tell me that they are tired of adult babysitting and need a method to change their staff’s behavior. This can easily be done when you are managing by statistics based on one’s production and not one’s personality.
  4. Systems of Operations: Knowing the products for each position and how to measure them statistically, so that each week your staff is operating off a weekly action plan, will enable them to confront and deal with their problems and barriers effectively and efficiently. You can finally forget about having to “micromanage” their actions because they are now accountable for reporting on what their results have been each week.

Positions—> Products —> Stats —> Battle Planning
So what do you need to do to be able to pull it off successfully? Well, when I graduated from physical therapy school in 1992 all that was needed for a thriving practice was a good team of therapists and someone at the front desk who was friendly, organized, and competent. That’s simply not enough today. The addition of a patient care representative (PCR) to your marketing and administrative team is required.

I could not imagine running my practice today without a PCR working as the patient liaison, social media coordinator, and statistical reporter. As a patient advocate they collect patient testimonials, new patient surveys, intracare and discharge surveys in addition to organizing all holiday parties, patient/staff games, and monthly contests. Their skill set should include working the social media lines and processing all reports and statistical data for the management team to battle plan off of each week. Creating a “weekly battle plan” that is not a “to do list” but is based on the key statistics you are measuring will maximize your staff efficiency.

Some of the most common products that we all track statistically are

  1. New Patients
  2. Patient Visits
  3. Production
  4. Collections

But do you know some of the most vital statistics that we should be tracking?

Gross income divided by staff: This tells us how productive each staff member is each week.

Number of reactivated patients: the number of patients who have fallen off the schedule, who we worked back into the schedule.

Percentage of new patients who are return patients: any past patient, or friend or family member of a past patient, who comes in.

Prescribed frequency ratio: the percentage of patients who are being seen three times a week, twice a week, or once a week.

Percentage of prescribed visits: the percentage of patients who actually adhere to their Plan of Care’s prescribed frequencies each week.

Practices that have set up their corporate structure in such a way that they now have a PCR to gather this data have a truly innovative system of operation. Yet there are still owners who are not tracking these vitally important statistics and who fail to have a PCR on board. I have seen this system firsthand and know it to be a true innovation that will help us succeed in today’s physical therapy environment. With a PCR in place, you will see an increase in gross revenue, as well as experiencing greater employee retention.

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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 brian@megbusiness.com.

Direct Contact

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Understanding opportunities in working directly with employers.

By Curt DeWeese, PT*

The entrepreneurial practice owner is challenged to identify ways to expand and diversify revenue-producing programs. Establishing relationships with employers is another opportunity to create unique service lines, guide referrals to the clinic, and market the practice. Getting training and gaining confidence in how to use the unique skill set we possess as therapists are the first steps in establishing mutually beneficial relationships with employers.

As clinic owners or therapists working in private practices, the current climate of reduced insurance reimbursement, higher patient copayments, and increased administrative demands to obtain payment for services all drive up the risks in maintaining a successful practice. Keeping visit volume at acceptable levels, successfully marketing the practice, and attracting and maintaining excellent staff add to the daily challenges of practice owners. Working directly with employers to expand your business, establishes a service line within your practice to guide patients to the clinic while also creating an opportunity for revenue generation. This initially feels like a big risk because it may negatively impact visit volume as you get started, and require time away from the clinic. However, the potential rewards are significant.

Opportunity
Each actively employed patient seen in the clinic is potentially affected at his or her job by the condition being treated. The injury does not have to be work related to influence that person’s ability to perform their job functions. Back pain related to moving furniture over the weekend impacts sitting tolerance at a computer workstation, and elbow pain from tennis or golf may limit use of hand tools in manufacturing. How do we use our abilities as musculoskeletal experts to understand the patient’s job demands, build a rehabilitation program to restore function, and bring these areas together for optimal outcomes? What opportunity exists for us to expand this relationship beyond the patient/employee to include the employer?

Correlation
When working with an athlete with a knee injury who plays a sport requiring planting and cutting, we work on removing swelling, increasing range of motion, and improving strength. As the program progresses, we can then introduce running in straight planes and then add activities for agility and the needed planting and cutting. We can build sport-specific rehabilitation programs based on our knowledge of the sport. We may have played the sport at a much lower level or even just watched a game, but we have an understanding of what this athlete will need to perform as they return to activity.

I once had a patient who was a press operator with a shoulder problem. I was able to work through the first stages of controlling pain and swelling, restored motion, and increased strength. I thought we were home free as he returned to work. But because I did not fully understand the essential functions of the press operator job position, I did not get into the work-specific exercises that were needed. He subsequently returned in a very short time with an exacerbation. I realized I needed to know more about his job functions, how he performed them, and the equipment used. I could only understand that by seeing his work environment; I had to get on site at his place of employment.

Relationships
When reaching out to employers, having a common interest is a great assist in getting the meeting. An employee out of work is that linkage; the employer wants them back, and that is the physical therapist’s ultimate outcome. Having a specific job to look at with a defined goal often makes getting the appointment easier than trying to establish a meeting to introduce yourself and your practice. This visit is for the therapist’s benefit; increased understanding of job demands and work postures will assist with better patient outcomes and satisfaction. These visits can be done at no charge as a way to establish the relationship with the employer. The outcomes are as simple as better understanding of what work-specific exercises are needed in the treatment program to more complex where the employer seeks a simple report of five ergonomic stressors and suggestions for improvement. It is the building block to the “know me” phase. Just as great outcomes and satisfaction of patients from a new referral source generate confidence, trust, and additional referrals, the relationship building with the employer becomes a source of new opportunity. Ongoing collaboration on site for ergonomics, education, and early intervention will produce results of decreased Occupational Safety & Health Administration (OSHA)–recordable incidents, reduce injury frequency, cut lost and restricted days, and drive cost savings. Those steps will lead to the “trust me” phase where the employer seeks input as a partner in safety, injury prevention, and assisting with claim management.

Skills
Our skill set makes us experts in the ergonomics of the human machine. We understand the stressors that lead to tissue breakdown or cause repetitive motion injuries. Providing onsite early intervention in the realm of first aid can prevent a small irritation from becoming a full-blown injury and claim. Workers will often persevere with discomfort because they need their job. They will give up hobbies and other leisure-time activities to be able to continue working. When the symptoms become so severe that there is disrupted sleep and inability to perform work functions, the issue will take greater intervention to correct. Being on site and correcting work postures, tool choices, and position of the work performed will abolish the soft tissue and repetitive motion stressors before the condition progresses. This is a benefit to the employee who wants to stay at work comfortably, the employer who avoids a lost time claim, and the therapist who is getting good outcomes and a direct pay revenue source from a new onsite contract.

How this is good for business
Establishing onsite presence with an employer is generally a fee-for-service relationship. There is an hourly or weekly charge for the services provided. This is a direct pay revenue source that supplements the established traditional insurance-reimbursed therapy services provided in the clinic. There are myriad other types of these arrangements being created by therapists such as wellness, sport performance training, and fitness centers. More and more, entrepreneurial practice owners are reaching new markets to diversify opportunities and create new revenue sources. Consulting with employers is another excellent option. Additionally, while providing onsite services, there is an entire population of potential physical therapy consumers who would benefit from seeing a physical therapist in the clinic. Those employees who do not respond to early intervention first aid care can be referred for formal treatment in the clinic. Trusting relationships are created with the workers, who seek input for nonwork-related symptoms or care for family members. All of these situations create opportunity for marketing and sharing the value of your practice.

Get Prepared
Gaining understanding of the criteria OSHA uses to classify the intervention provided is in the realm of first aid versus medical treatment. Working knowledge of the Americans with Disabilities Act Amendments Act (ADAAA) is also important. Consider offering job function analysis to objectively report the physical demands of job titles, identify ergonomic stressors and ways to correct them, and develop and administer functional testing for post-offer and return to work placement. There are resources online and continuing education programs to help you obtain the tools you need. The Private Practice Section has many members who are actively working with employers and various industries. Network, ask questions, and use the outstanding resources our section offers.

Curt DeWeese, PT, is a PPS member, COO of DSI Work Solutions, and president of Work Injury Solutions & PT, PC, in Webster, New York. He can be reached at cdeweese@dsiworksolutions.com.

Innovative Business Concepts

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How private pay allows for a truly patient-focused facility.

By Lisa Corsa, PT, DPT, MPT

Phrases like these are often used to differentiate one physical therapy practice from another. Of course we all want to provide the best possible care for our patients, but in light of today’s financial medical model, where insurance payments dominate the pay structure, owners of rehabilitation facilities have to make hard choices on the type and amount of care that can be administered.

When I started my physical therapy practice, 18 years ago, I set out to make a difference in the community with the kind of services my team and I could provide. That meant not accepting insurance of any kind and building my business strictly on a private pay model.

While some may view closing the door to insurance as a loss of significant revenue, we are all aware of the restrictions that insurance coverage can put on treatments and timelines. However, we found that the private pay model actually opened the door to the opportunity to provide elite rehabilitative services that are aligned more closely with the patients’ needs—and to me this is what defines a truly patient-focused facility. Having the freedom to make decisions beyond insurance barriers is enabling my team and me to rehab people to a level that is far beyond the standard outcomes, based on my experience. And I am proud to say that after nearly two decades in business, my clientele has been built strictly by word of mouth. We’ve never done any advertising.

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Going Beyond Traditional Equipment
The route we took with our practice meant acquiring rehab equipment that goes above and beyond the traditional, investing in machines that give personalized information for each patient so we can specifically tailor the treatment program while purposefully using all the modalities we have on site.

One piece of equipment we have chosen to invest in is our advanced therapy pool equipped with an underwater treadmill and cameras. We have found that our patients are greatly benefitting from the nearly weightless environment the water provides to optimize recovery. People in wheelchairs, those with limited mobility—the opportunities are endless! And in fact, we’re finding the therapy pool is useful 99 percent of the time for patient rehab.

One of the incredible aspects of offering aquatic therapy as part of our practice is that we are now attracting a broader population of conditions to our clinic—for example, people with neurological and/or degenerative conditions. For these folks, being able to perform specific body movements in the water and see themselves on camera—cameras that can allow them to have better control over their movements—not only helps the patients physically but mentally and emotionally as well. They are reporting a new sense of hope about their situation when they can get out of their wheelchair or take those first few steps in the pool. We see people more motivated and intentional about recovering when they feel what it’s like to move again.

Always Seeking New Solutions
One of the areas I see that’s underserved is the preoperative market or “prehab,” that is, rehabilitation before surgery. While the concept of rehabbing a patient before surgery is fairly new, I’ve been a fan for more than a decade. It’s not covered under insurance so many clinics don’t offer it. But again, for us, this is where not accepting insurance works in our favor.

Our aquatic therapy offering has been a boon for the prehab service we now offer. By putting a patient in the warm water therapy pool on the underwater treadmill, he or she is able to perform exercises and remain active in spite of the discomfort on land. We essentially keep the patient “strong” in the weeks leading up to surgery.

After surgery, the patient returns for two weeks of post-op therapy—a rehab timeline that’s often shorter because of the prehab. This has been keeping our staff very busy.

Sure, there’s a financial barrier for patients to overcome before committing to paying out of pocket for prehab treatment, but once they see it leads to improved muscular responses postsurgery, they realize the value. And that value is hard to contain. Former patients are our best referral sources. Not only will they return for prehab before their next replacement surgery, but they share their successful outcomes with their friends. Word has gotten out about our prehab aquatic therapy program, and people fly in from all over the world to be treated by us.

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Learning and Leading by Example
I am extremely passionate about my work and enjoy sharing my out-of-the-box ideas on the business side of owning a physical therapy clinic, including helping move the needle on new ways of thinking in our industry. I discovered early on that there is a segment of the population willing to pay you if you can improve the quality of their life and offer them a level of service not found in traditional medicine today. They appreciate and see real value in authentic one-on-one consultative physical therapy. Here’s a case study of how my flexible business model allowed me to transform someone’s life. A man came to me with a diagnosis of Parkinson’s disease. I started an exercise program for him based on that medical diagnosis, but he complained of a strange chest pain. He stated that he had had a routine stress test and cardiac workup, but the pain kept getting worse. I reviewed his past medical history, discovering he had never had a coronary CT angiography, so I contacted his cardiologist to discuss my concerns. The physician appreciated my extra attention and ended up ordering the test for the patient. The shocking results showed full blockage necessitating open-heart surgery, which saved the man’s life.

Had I been constrained by the need to base all my time with him on standard protocol exercises focused solely on Parkinson’s, I would not have delved deeper to get to the cause of his chest pain. This is why I’m a firm believer of taking a whole body systems approach to health care—really focusing on patients, seeing them beyond the diagnosis that brought them through my doors. My advice is to listen to their story. Stay focused solely on them. Never allow complacency to creep in. When you push beyond your facility’s perceived limitations, even just a little, the results can be transformative.

By Lisa Corsa, PT, DPT, MPT, is the owner of Premier Therapy Services in Boca Raton, Florida. She can be reached at lisa@ptviphealth.com.

Telehealth Today

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An overview of telemedicine services in health care today as well as some specifics related to physical therapy practice.

Kelly Sanders, PT, DPT, OCS, ATC

Advances in both medical as well as communication technology have paved the way for the rise of telehealth. According to the American Telemedicine Association, more than 15 million Americans received some type of medical care remotely last year, and that number is expected to grow by 30 percent this year. Communication technology is allowing physicians and other health care providers to be accessible to patients for urgent care as well as specialty care when it may not otherwise be immediately locally available. This health care delivery medium has also increased the convenience of not having to physically visit a health care provider’s office or a specialty health facility. In addition, it is allowing for health care providers to access colleagues within the medical community, specifically in rural or underserved areas where a specialist may not be available locally for consultation. Telehealth becoming mainstream will make a significant impact on health care and should afford the health care community the ability to improve care delivery, access, and cost.

Taking Steps

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5 steps to recharge your marketing strategy.

Ben Fung, PT, DPT, MBA*

Marketing is a world filled with words like timing, precision, intent, purpose, metrics, outcomes, sales, profits, growth, sustainability, hacks, strategies, tactics, methods, segments, striation, analysis, data, social, end user, consumer-facing, and many times, luck. As is true in physical therapy, marketing is both an art and a science, yet evidence-based business practices must guide decisions. Fortunately, as business becomes more digital, things become infinitely more measurable. The key is to track the right things, at the right time, for the right purposes, in order to execute the right strategies.

When any given business applies their executive seal of approval to their marketing strategy, it is because they are convinced that the channels, methods, segments, venues, tactics, and campaigns set forth will lead to positive growth and improve sales. Growth can mean a great many things (consumer awareness, brand positioning, market share, etc.). Sales can also mean a great many things (expanding product/service lines, increased accounts landed, user acquisitions, new customers versus returning customers, etc.). Both eventually converge into the multidimensional space of customer relationship management (CRM) and corporate social responsibility (CSR), along with the strategic planning principles that have been thoroughly interwoven within the framework of the grand marketing strategy.

Still, even the best marketing strategies require renewal and revival. Some even require a little rehab. Ultimately, it is best for a business owner to regularly reevaluate their marketing strategy and give it a full recharge. As the customer lifecycle and digital business cycles continue to accelerate, recharging your marketing strategy will become a regular and welcome exercise that will lead to sustainable growth and true marketplace significance. This article centers on the unified focal point between traditional business principles, digital marketing, and startup entrepreneurialism with five steps to recharge your marketing strategy.

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1. Draft Your Dream Team
If you have ever played fantasy sports, you know that this is the longest step in the process before things start getting fun. Popularized by the “Bullseye Framework,” this method is a functional staple of product launches and startup companies. Rather than obsessing over inbound or outbound strategies, this first step is all about gathering the full spectrum of opportunities for your business. Some of these opportunities may be ideal. Others may be truly foolish. The purpose of this step is not to make some definitive choice. Rather, the purpose of this step is to consider the big picture of how each marketing channel jives with your overall business direction and synergizes with each other.

While the Bullseye Framework lists 19 channels, I have condensed two of their channels and added two that have become increasingly relevant to the millennial economy. The 20 ubiquitous marketing channels are:

  1. Traditional (offline) Ads
  2. Traditional (offline) Events
  3. Search Engine Optimization (SEO)
  4. Search Engine Marketing (SEM)
  5. Social and App Ads
  6. Special Engagements
  7. Trade Shows and Conferences
  8. Sales
  9. Guerrilla Marketing
  10. Community Building
  11. Content Marketing
  12. Blogging
  13. Business Development
  14. Public Relations (PR)
  15. Existing Platforms, Channels, and Venues 16. Email Marketing
  16. Function and Features-Based Marketing 18. Affiliate Marketing
  17. The Crowd
  18. Corporate Social Responsibility (CSR)

Now, it is time to draft your dream team among these 20 channels. Rather than just pick four or five channels to test out, choose a dozen. To do this strategically and systematically, be sure that your draft includes channels that have a natural congruence with your company’s direction. However, be sure to also include an oddball and wild card in the mix. You never know what might happen. Just as in baseball, players who may not otherwise have been thought of as having All­Star potential have been known to rise to the occasion and surprise us. Pick a few obvious players, one or two wild cards, and then move on to Step 2.

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2. Put Them Through Spring Training
You have finally picked out your team; now it’s time to see how they do. The resource to testing hypotheses is your marketing budget. In the world of marketing, you have got to spend money to make money. At this first step, there is no need to optimize, adjust, or tweak the players on your dream team. Here the goal is to see how the team plays naturally, both as individuals and as a team of marketing channels. Make a careful note of who is naturally excelling. Also note the underperformers. Take special note of two players who seem to work very well together. Be sure to give an equal chance for each player to shine. Don’t be surprised if your first pick doesn’t do so hot. Also, don’t be surprised if your wild card ends up being the All­Star. During this step, the key is to see how they do on their own without coaching and without changing how they naturally play. That is the task in Step 3.

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3. Focus on Your Starting Players
Spring training is done. You know who the winners are. You know who is lagging behind. Now that you have thrown a little chunk of your marketing budget at them to see how they play, it’s time to make them play well. It’s time to coach them, train them, strengthen them, and understand their behaviors.

Step 3 is all about taking the top performers and seeing how they do under pressure. This is a phasing step before true optimization can begin. At this point, you probably have a metric-based or instinct-based idea of who your All­Stars will be. Some of them are completely intuitive; one of them is probably not. During this step, take on small, incremental improvements on each marketing channel that you have selected as your starting players. For a set period of time (a month, a quarter, or whatever your business cycle determines), start small improvements on your marketing channel based on the bit of data that you have and what your instinct tells you to do. This is the last step before you choose the final two or three marketing channels to call your All­Stars.

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4. Optimize Your All­Stars!
It is finally time. Optimization. It’s a favored word among marketers for an important reason. A single, optimized marketing channel can easily do what four or five suboptimal channels will try to achieve. Once you have identified two or three All­Star marketing channels in your mid­phase testing period, it is time to truly make them your stars.

If you have identified the winners to be a combination of social media marketing, email marketing, and content marketing, then you need to sit down and figure out the strengths and weaknesses of each, how each player affects the other, and ultimately the grand effect on your consumer base. If one or two of your channels have obvious synergistic effects, be sure to pour extra resources into refining their teamwork; however, if you find that one of your All­Star channels does not play nicely with others, it may be a good idea to separate out your audience into channel segments. Alternatively, you could reach back into your starting players for another All­Star who may not have made the first cut.

Optimizing your marketing channels means you need to collect, analyze, test, and re­test all of your metrics. From your open rates, engagement ratios, click-throughs, total attendance, satisfaction surveys, focus groups, readership, sales conversion, and other metrics, the key to optimization is to base your actions on data and truly measure the consequences of each iterative change for each marketing channel. That is how you get evidence-based business improvements. On to step 5.

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5. Go. Fight. Win!
Execute. Reassess. Redeploy. By now, you are two or three business cycles in. You have more or less optimized your All­Star marketing channels. You are getting good returns on your investment, your marketing budget has grown, your sales have improved, and life seems good.

It is not time to get cozy. It is time to reassess your strategic position and redeploy the troops. This is an excellent time to look back at your starting lineup to see if there were any gems that may not have had their time to shine due to poor timing, bad luck, or otherwise. Consider your backup players who did not make the cut as starting players. Many times, missed opportunities, false negatives, or false positives have left diamonds in the rough—unattended, uncut, and unpolished. Since you now have the momentum and capital for exploring growth channels, you also have the opportunity to creatively strengthen and optimize channels that were less attractive during Steps 1 through 3. If you avoid this step of looking back and reevaluating your options, you risk developing tunnel vision and may be quickly overtaken by competitors who remain agile and ready to move. By following these five steps, and most importantly, making these five steps a habitual business practice, you set yourself up for success to enjoy sustainable growth and a competitive edge across the marketplace.

Ben Fung, PT, DPT, MBA, is the chief content officer and partner at UpDoc Media. He can be reached at ben@updocmedia.com.

Suggested Reading

http://business-ethics.com/2015/05/05/does-corporate-social-responsibility-increase-profits

www.amazon.com/Traction­Startup­Achieve­Explosive­Customer/dp/1591848369

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