Nothing gives one pause or caution like the thought of an impending Medicare survey. As a rehabilitation agency, you know that every five to six years you are subject to an onsite unannounced Medicare recertification survey.
Your organization has been very successful, and you’re considering expanding. What steps should you take next? Often, physical therapy companies will, first, select a location where they think the clinic will be successful. They may research an area where their competition doesn’t have a clinic yet, or they may consider the big city next door as a good place to start up next.
Although location is a necessary consideration, these organizations will be missing a key component and the first step they should be taking. Instead of asking “where,” they should be asking “who.” Who is going to be employed at the clinic?
Good to Great by Jim Collins has been referenced many times in the past few years for this “bus” concept (I was even assigned to read it in physical therapy school) and for putting the “who” question above all else when it comes to hiring.1
Imagine potential candidates as passengers at a bus stop who can help your bus get to your destination safely and efficiently. Some important things to consider are how to get the right person on your bus, how to put that person in a seat where he/she can succeed, and how to make changes if you put someone in the wrong seat.
The interview process should look like the following: Asking questions that give you good information about how successful they will be in your specific organization, calling references to address any “yellow flags,” and looking closer into resumes and applications to identify community and extracurricular involvement. An article published by this magazine in March 2020, by yours truly, reveals questions that help you determine a person’s personality fit, performance capabilities, and team skills.2
Another tool at your disposal is seeing your potential employee in a clinical setting. Asking the interviewee to observe for a few hours in your clinic is a great way to get them around other team members and see their response to your current treatment style. We like to call this the “airport test.” If you had to spend 24 hours in an airport with this person, would your relationship be better or worse afterward? You should ask this question to yourself and each of your employees who spent time with the candidate during the interview process and clinic observation to gauge how your team feels about that person. If a candidate excels in the interview and observation processes, you may or may not choose to call references. If there are any mild concerns (i.e., “yellow flags”) then references should be contacted. Try to use references to further assess the candidate’s ability to build and maintain good relationships with coworkers and patients.
Something else you may want to include, as you are looking through a candidate’s resume and application, is community involvement. This could be pro-bono services through his/her former university, holding a leadership position in a club, or volunteering time at local events while in physical therapy school. According to an article published in 2020, we are seeing less than 20% of the roles posted are requiring GPA minimums. Recent data has shown that performance and GPA are rarely correlated, so we need to be looking elsewhere on applications and resumes.3 Community involvement will give insight into the candidate’s ability to multitask, work as a team, and give to something bigger than themselves.
The interview process not only allows you to see if the candidate is a good fit for your organization, but it also allows the candidate to make sure your organization is a good fit for her/him. To succeed as an organization and make sure that your new hire can help you do just that, there are a few things you need in place. According to Daniel Coyle’s Culture Code, to have a great group of people who succeed together you need to build safety, share vulnerability, and establish purpose.4 Just like Maslow’s hierarchy of needs demonstrates, employers should make sure work environments are safe zones for sharing ideas, challenging the status quo, and accepting feedback. Employees should clearly understand the purpose of the work they are doing.
Your organization should set clear expectations, so your employee knows what the goals are and the WHY behind them. These expectations should be attainable and realistic, connected to clear metrics, and reviewed regularly with the employee.
This is also a good time to assign a mentor for your new hire. Mentorship, aka socialization into your organization, can result in employee job satisfaction, internal motivation, and commitment to work.5 In practice, my organization has focused on the first month of mentorship on developing a personal relationship between the mentee and mentor. Eating lunch together, talking about the local area and community, and getting to know one another. Then, the relationship can evolve into clinical education and professional development guidance.
Most of this article has been focused on the first two points because if you do those well, hopefully you won’t end up here too often. A key component of this step is communication. Communicate the reason you think this person has not been put in a position to succeed, then review expectations and make an action plan for elements that are not being met. Set a date to reach these goals so everyone is on the same page moving forward. If goals have not been achieved within that timeframe, then you should move forward with staffing changes. This could be moving someone from a position like clinic director to staff therapist or removing a leadership role. Finally, if you think the person should no longer be on your bus, you should communicate this with them quickly and concisely. Then, evaluate if there is someone else on your bus who could do well in that role, or if that seat will remain empty until you find the correct passenger to fill it.
When you’re driving the bus and don’t know where you’re going yet, it can be scary. Just like when you’re starting an organization or expanding one, you may not know all the steps you need to take. Remember, putting the right people in the right seats is the most important thing you can do. Together, you will steer your organization in the correct direction. Utilize tools like the interview process, extracurricular involvement, and mentorship to make sure you put all your passengers in a position to succeed.
1Collins J. Good to Great. HarperCollins; 2001.
2Weinzapfel M. “How do you Know if You Hired the Hero or Just a Person in a Cape? The Guide to Hiring Slow and Firing Fast.” Impact. 2020;3:26-29.
3Maurer R. GPA Minimums May Be Spoiling Your Diversity Goals. SHRM. Published June 24, 2020. https://www.shrm.org/resourcesandtools/hr-topics/talent- acquisition /pages/gpa-minimums-may-be-spoiling-diversity-goals.aspx
4Coyle Dl. The Culture Code: The Secrets of Highly Successful Groups. Bantam Books; 2018.
5Kotter JP. “The Psychological Contract: Managing the Joining-Up Process.” California Management Review.1973;15(3):91-99.
Morgan Weinzapfel, PT, DPT, is a co-owner and director of recruitment with Rehabilitation & Performance Institute in Newburgh, IN. She can be reached at mweinzapfel@rehabilitationperformance.com or (812) 518-3246.
With the start of the New Year, there are ample opportunities to act on the year before. Whether through networking, attending events, or advancing private practice ownership as a field, APTA Private Practice has a path toward any destination fit for an “active” year. As such, January’s resources lean into planning for your best year yet.
Many private practice owners believe if their practice is not growing, it is regressing. Physical therapy is a growing industry nationwide which means our businesses need to continue to grow year-over-year to stay relevant in our markets. A challenge is balancing the desire for growth with the right opportunities while maintaining quality patient care and keeping high levels of team engagement.
How would a practice owner know their upward trajectory could be faster than they are ready for, or maybe worse, the growth is too fast to sustain, and disaster is ahead? When cars approach an intersection, a traffic light shows yellow as a sign of caution. Even if a few of us step on the accelerator, the intended response is to slow down! Just like a yellow traffic light, owners will benefit from creating a process to monitor “yellow” caution lights along the way that indicate slight adjustments or coaching needs to be made. The key is to identify when the practice is starting to drift off course before the practice is completely off course.
First, owners need to determine which key performance indicators (KPIs) are most meaningful for their practices and then establish targets for those KPIs. To ensure a private practice is fulfilling its mission for our communities and our teams, KPIs should speak to Patient Experience, Patient Outcomes, and Team Experience in addition to Financial Success. Success in each of these categories is necessary for a healthy journey so the growth journey never ends and is paced optimally. If a practice exceeds its Net Income targets at the expense of Patient and Team targets, the ability to continue growing may be sacrificed by a disengaged community and team members. Likewise, if a practice exceeds Patient Experience and Outcomes targets at the expense of Net Income, growth will be stunted by a lack of funds and resources.
Notice these KPIs are results — lagging indicators which cannot be changed once reported. They will tell an owner when they’ve gone off course or remained on course, but they will not tell an owner when they are on an optimal trajectory. Owners are best served to act on lead measures which allow adjustments to be made to fine-tune our trajectory to optimize our growth.
Establishing daily and weekly processes to identify leading indicators drives the results. Let’s look at a few key areas and how to respond when they may be turning “yellow.”
One primary patient outcome KPI in our practice is Visits per New Patient. We know a patient completing their plan of care is directly related to their outcome and experience. A strong leading indicator to improve Visits per New Patient is “Days Scheduled at Eval.” Focusing on scheduling as a leading indicator holds our teams accountable to actions that will improve results and drive optimal growth. Clinic leaders at each office have a weekly process to monitor scheduling habits for each new evaluation performed in their office. This process check gives us the ability to forecast expected results. If a patient is not scheduled consistently, we are unable to support them in their POC journey to get the outcomes our community deserves. If growth exceeds the capacity of each clinician, it is easy to feel too busy or lose track of a patient. Using “Days Scheduled at Eval” serves as a yellow light that patient engagement is drifting off track.
Another patient experience KPI is Net Promoter Score (NPS) response rate. This is definitely a lag measure even when the survey is sent just a few days after the evaluation. There are a couple lead indicators to having success with this KPI. The first is an accountability check within our teams informing each patient they will be receiving a survey and we appreciate their feedback on how we are performing. A second lead indicator used successfully in our practice is what we call “White Board Wisdom” (WBW) at a patient’s initial evaluation. The number one positive NPS attribute recognized by our community on NPS has been the knowledge shared by their therapist. WBW involves the therapist taking time with each patient to outline a clear roadmap to successfully complete the patient’s journey. When a practice is growing quickly, providers are susceptible to paying less attention to detail and a decrease in WBW indicates patient satisfaction may be in the “yellow.”
Poor clinician retention would definitely curb growth potential. All the shuffling around in the PT world over the last two years has made it difficult for many practices. Clinician Retention Percentage is another lag measure that is likely to decrease in a practice growing too quickly or growing revenue at the expense of supporting the team. Team Engagement is a clear lead indicator to predict clinician retention but can be tricky to measure objectively. The number of planned team events and the number of educational opportunities that require sign-ups and commitments in advance provide objective measures. An employee engagement survey can be another valuable leading indicator with objective data. On the qualitative side, clinic leaders can gauge and help create the local buzz and excitement behind planned events. If teammates are not signing up or showing up, we need to work on relationships within our walls.
The lack of an engaged clinical team would certainly limit a practice’s ability to take great care of patients. As mentioned above patient and team engagement must be balanced with financial and business success of the practice. Net Income is a top measure for business growth. When Net Income is reported, there is nothing that can be done to change it making it a lag measure. However, waiting for a month or quarter-end report to determine our growth success is trouble.
Utilizing procedures per visit as a lead measure provides an indication of how much direct time clinicians are able to spend with each patient. Time spent and appropriate billing and coding forecast revenue per encounter and tend to be an impactful lead indicator clinicians can often influence. Revenue collection teams utilize lead indicators to identify issues with our revenue coming in matching our services provided and is filtered by insurance line and over-the-counter payments. Ensuring the daily revenue average look backs at one, two, and four weeks follow the visit trend indicates visits are turning into dollars properly. If there are any discrepancies between visit trends and the daily revenue trends, the billing team can make adjustments to keep the business on track.
Yellow lights exist to be helpful to drivers and to private practice owners. Optimal growth requires the daily and weekly process of checking gauges and knowing how to make fine-tune adjustments to improve results. When done well, growth can be accelerated at a fast pace without jeopardizing our services, team, or business.
Eric Herman, PT, is a partner and the CCO of Buffalo Rehab Group which serves western New York with 13 locations. Eric can be reached at eric@buffalorehab.com and on Instagram @ericherman.pt.
In the early 2010s, I was trying to print out a home exercise program from my desktop, to my company’s printer. It wasn’t working.
