101: Accountability


Steps to bring accountability into your private practice.

By Sturdy McKee, PT

We are moving toward payment systems with shared risks, quality measures, and increased accountabilities. Although some systems were designed with more subjective than objective accountabilities, there will be a continued movement toward measuring outcomes and patient satisfaction. We are moving away from payment systems, at least when looking at CMS (Centers for Medicare & Medicaid Services) that pay for activity and not results. But while this evolution is taking place around us, many of us work in environments where accountabilities are not made clear.

Accountability starts with what you, in your job role, and your employees, in theirs, are expected to deliver and how you and they will be measured. This can take many forms. Key performance indicators (KPIs), job accountabilities—things you do or don’t do—and core values or behaviors are a few examples. For a physical therapist, units per visit; visits per case; and visits per day, week, or month are examples of KPIs that might be used to define and measure success. For people working the front desk, KPIs might be percent of copay collections, or conversion rate: the number of new patients evaluated divided by the number of incoming leads or referrals. Examples of job accountability for a physical therapist are compliant documentation and adherence to HIPAA (the Health Insurance Portability and Accountability Act).


These are not really optional, as 90 percent–compliant documentation, or a single HIPAA breach, would be considered unacceptable. And then there are behaviors that we expect like courtesy, professionalism, and empathy. Creating a system to measure these behaviors and provide frequent feedback to employees is preferable to subjective assessment reviewed annually.

Many physical therapy companies lack a clear, written description of accountabilities for each role. The owners or managers might have some idea of what they expect, but the communication and structure may be lacking. Employees don’t have enough clarity around what their primary job is. If you ask your front desk person what their job is, you might get a long and rambling list. Or do you get a clear and concise response like “to schedule patients and collect copays”? The other things on the list might technically be parts of their job, but do they matter if the top two items are not delivered? If we don’t schedule patients, then all the faxing in the world doesn’t matter.

Articulating these things for each position in your organization is a great first step. It invites a conversation with your team members. The conversation will illuminate differences in your expectations and your team members’ perceptions and expectations. An example of how you can begin this process and keep it simple is to create a grid of the top five things you require in that job role (see table). Having a discussion around this and ensuring clarity is key to your team members’ success.


Why is any of this important? It creates a visual aid with real data that is helpful for seeing patterns and tracking progress. It helps give your team clarity. And in doing so, it reduces the emotion around performance, raises, and time off, to name a few examples. It makes your conversations easier. According to Andrew Ritchie of Results.com, “One of the biggest problems management has is simply communicating with employees in a constructive manner. So often, it seems, a manager’s best efforts at coaching can be misconstrued as unfair criticism or even as a personal attack.” Having clear and measurable accountabilities and expectations allows for the potential to shift that conversation, too. The manager can position themselves as the advocate, trying to help their team members achieve success. When employees have clarity, and have agreed to the accountabilities for the position, the conversation can shift to “How can I help?”, “What resources do you need?”, and “What can we do to make sure you succeed?” Instead of being perceived as unwanted criticism, the dialogue can become one of teamwork, cooperation, and advocacy.

We are moving inexorably toward external cultures of accountability. As businesses, we will be held to performance metrics and deliverables in order to get paid. Without internal cultures of accountability, how can we hope to succeed in future in these external environments of accountability?

Sturdy McKee, PT, is a physical therapist, business coach, and advisor who can be reached at www.SturdyMcKee.com or @Sturdy.

Is Your Brand an Experience?


The importance of the “how” in branding for physical therapy private practice.

By Benjamin Barron, Pt

In the eyes of the health care consumer, outpatient physical therapy is increasingly being viewed as a commodity rather than a specialized service or experience. In other words, many of your potential customers believe all physical therapy is the same with little to no differentiation in training, outcomes, service, or compliance. The same belief holds true for referring physicians, hospital networks, and insurance companies. In this type of environment, it becomes imperative that business owners and leaders find innovative ways to differentiate their business from their competition and prove value to their customers. One way that private practitioners can do this is by creating a branded experience that sets you apart.

Tracking for Success


Why outcome measures are essential to your practice.

By Heidi Jannenga, PT, DPT, ATC/L

Physical therapists have long operated in a system of restriction, and in some cases, that’s a good thing—after all, this is a profession that thrives on treating and healing patients within the confines of evidence-based practice. But in many ways the traditional system is broken—and that’s growing more apparent as the US health care system shifts to an environment of value-driven payment and care delivery.

Innovative Business Concepts Entrepreneurialism


How to redefine your business model for success in today’s market.

By Lisa Chase, PT, OMPT

In this ever-changing health care climate of higher deductibles, global payments, Health Insurance Portability and Accountability Act (HIPAA) regulations, and adjusted covered services, physical therapists are being pushed to redefine their business model to achieve success as private practice owners. The days of relying on third-party payments and doctors’ referrals are long gone and are now being replaced with a diversified portfolio of cash-based models, wellness services, product sales, and savvy social media strategies to drive business.

Winning Brand


Better branding for a sustained competitive advantage.

By Mike McTague, PT, DPT, OCS

In the competitive market of physical therapy, private practice owners and managers are trying to differentiate themselves from their physical therapy competition. In any competition, your goal is to win, and quite often other physical therapy practices in your area are trying to win the same way you are. You likely have the same service offerings of manual therapy, exercise, balance programs, and so on. If you are one of the lucky ones to have a successful business in a market where competition is scarce, you likely won’t be alone in that market for long. Other competitors will want a piece of that market.

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