Finding a Better Way


Innovation is key to creating a successful physical therapy clinic.

By Jerry Henderson, PT

“Without tradition, art is a flock of sheep without a shepherd. Without innovation, it is a corpse.” —Winston Churchill

IN CASE YOU HAVE NOT NOTICED, THE CENTERS FOR MEDICARE AND MEDICAID Services (CMS), the nation’s largest payer, have been busy. They are releasing aggressive health care reform programs at a breathtaking pace. Equally astounding are the regulatory hoops that rehabilitation practices must jump through to remain CMS compliant: continued therapy caps, manual medical reviews, functional limitation reporting, and multiple procedure payment reduction (MPPR). The list goes on.

As predicted, other commercial payers are beginning to follow suit, compounding the burden and risk. Noncompliance is not an option, but few therapists can see patients and keep an eye on every regulatory nuance without working around the clock.

Something’s gotta give.

All of the best innovations, like the discovery of electricity or the first rocket to the moon, share one thing in common: They were born out of a need to find a better way. As physical therapists, the future of our profession depends on finding a better way.

Innovate or Die

In health care, the status quo is no longer an option. The United States spends more on health care than Japan, Germany, France, China, the United Kingdom, Italy, Canada, Brazil, Spain, and Australia combined. This does not necessarily translate to better quality in return.

When the terms “Health Care Reform” and “Outcomes” started becoming popular buzzwords in the mid-90s, I predicted that reimbursement would soon be closely tied to patient outcomes.

It took much longer than I thought, but I was right. Functional limitation reporting and PQRS programs from Medicare are just the tip of the iceberg. Changes are happening continually and at an accelerating pace. Pay for performance is on the horizon.

Maintaining professional independence depends on your ability to comply with the new regulatory environment. In my view, this means fully innovating your processes, systems, and— most importantly—people.

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Innovation Tips

Trash the Policy Manual
At my first position as a staff physical therapist at a large hospital, I was asked to review the Policy and Procedure Manual for our department on my first day at work. It was full of, uh, stuff—including detailed step-by-step instructions on how to search for bombs in case of a terrorist threat.

After reviewing the manual, my supervisor asked if I had any questions. I politely told her that I was not qualified for my new position. She, of course, asked, “Why?” I answered that I was not brave enough to enlist for bomb-searching duties in the hospital.

Her response led me to believe she had not read the manual herself, so I showed her. She asked me to stay on anyway, and said that I could follow my cowardly instincts in case of a bomb threat without fear of losing my job.

You probably have an equally impressive policy and procedure manual in a three ring binder sitting somewhere in your office. You may not have opened it in years. You probably created the manual because of regulatory requirements, but you probably do not use it in your day-to-day operations.

Ditch your policy and procedure manual. Replace it with an operations guide, which articulates your practice’s critical administrative activities. Create checklists based on this guide that set expectations about specific tasks to be completed on a daily, weekly, and monthly basis.

This is different than a system that optimizes therapist workflow. This simple checklist maps out the key routine administrative tasks necessary to running a healthy compliant practice.

Think daily and weekly routine—not protocol for every situation under the sun.

Automate, Automate, Automate
Even with a good operations guide in place, it is still almost impossible to keep up with regulatory requirements without a system that automates as much of your workflow as possible.

An automated system cannot think for you, but it can provide helpful guidance. For example, establishing and documenting medical necessity requires the decision making of a trained physical therapist. A well-designed workflow software should embed processes that automatically track and alert physical therapists to tasks that they must complete to be compliant.

An automated workflow system must also be totally integrated, meaning all of the information from your clinical documentation, claims, and patient accounts lives in one place. This system integration is important because it makes sure that clinical documentation supports claims.

Integration is not enough. Your automated system must also provide instant access to the information. How can you tell if you have enough access? If you find yourself calling, emailing, walking to the front desk or billing office to access information routinely, you don’t have a good system.

Workflow automation takes the guesswork out of Medicare compliance and frees your therapists up to provide great care. They should not waste their time understanding the intricacies of the 8-minute rule and national correct coding initiative edits.

Invest in Clinical Leadership
The most refined processes and best workflow automation are useless without great clinical leadership. My tenure at Clinicient has afforded me a unique opportunity to observe the management of hundreds of physical, occupational, and speech therapy practices all over the country. These practices range from small to large and represent a wide variety of clinical specialties. The one thing that distinguishes successful, innovation-friendly practices is the quality of their clinical leadership.

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Great clinical leaders must be clinicians. The most brilliant nonclinical business strategist or accomplished business manager cannot get a group of clinicians to adopt new processes or systems. Clinical leaders must translate the “big picture” to clinical staff, which is nearly impossible to do without being a clinician yourself.

Great clinical leaders must also communicate with transparency. They should never try to shield staff from all of the “dirty details” about the decision-making process that led up to changing a system or process. Instead, their communication should be grounded in experience and at least some scientific rationale.

Great clinical leaders also know what they do not know. When it comes to introducing new processes and systems, they will seek out the advice of other business and management professionals. They will hire a knowledgeable compliance consultant when needed. They will make sure they hire the best people for their billing office and front desk. They know it is worth it to pay a little more to build a staff that can embrace innovative ideas.

Innovate for Practice Independence
I knew that I wanted to be a physical therapist at the age of 14. But after I finally became one, I was not able to provide the care my patients deserved because documentation, compliance, and general bureaucracy ate up all of my time.

In hindsight, this frustration was a blessing, because it gave me the inspiration I needed to innovate. You do not have to start your own company to help colleagues find a better way. You just have to be willing to do things differently. Investing in fresh processes, workflow automation, and good people is the first step.

Jerry Henderson, PT, is vice president of Therapist Success at Clinicient. He can be reached at

Copyright © 2018, Private Practice Section of the American Physical Therapy Association. All Rights Reserved.

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