New Relationships


A great time to partner in health care.

By Sean McEnroe, PT, SCS

The U.S. national debt is over 100 percent of Gross National Product (GDP)!
Health care has grown to more than 17 percent of GDP!
ICD-10, Functional Measures, Multiple Procedure Payment Reduction (MPPR)

Whatever your worry or concern, today is a great day to be in health care. This month’s Impact magazine is dedicated to heady topics including compliance, reporting, and the struggle for profitability. Even so, today’s evolving health care marketplace offers us the greatest opportunity to effect change and build the business we desire—if we are willing to explore the new models of delivery.

In October 2013, the Harvard Business Review published an article by Michael Porter and Thomas Lee titled, “The Strategy That Will Fix Health Care.” The authors suggest that providers must lead the way in making value the overarching goal of health care. Of the multiple strategies and tactics prescribed to change toward a patient-centered system, step 1 was termed “Integrated Practice Units” (IPUs). IPUs fundamentally shift the idea of a practice from “what the clinician does” to “what the patient needs.” It involves a change from specialty of professional designation to a specialty of patient designation. In an IPU, a team of clinical and nonclinical personnel deliver the full continuum of care for a patient’s condition.

Physical therapy has seen this model before. You may be familiar with the Virginia Mason spine program in Seattle. You may even recognize this as the model of a well-run surgical floor in any top performing medical center. Most private practice therapists can visualize an ideal setting where everyone’s voice has a place in managing the patient’s outcome. How do we reconcile that with the historical demand that this environment can and should be achieved with autonomy and independence preserved for the business relationship?

Are we as private practices achieving our best business position when we fight to preserve independence? Are we as clinicians practicing at the top of our license when we insist on being autonomous? If the strategy of the broader health care market is consolidation and integration, how do we firmly grasp our spot by resisting entry into that system?

Surely, the legal and business systems can find a way to keep the structure of private practice in place within these integrated relationships, but at what cost? Steps 2 to 6 of the Harvard Business Review article outline the need for everything from an enabling information technology platform to a commonly bundled payment system. Imagine the level of trust (and contracts) required for disparately owned groups to align and invest enough to create this level of integration. How can these consortium type organizations compete while supporting multiple overhead models? In an age when cost reduction remains the priority for most legislative, commercial, and patient-centered endeavors, consolidated and integrated models will have a significant advantage.

There will always be a need for private practice physical therapy. Great physical therapists making a difference in their community will remain a cornerstone of the medical model. To quote John O’Leary, the opening night keynote speaker at the Private Practice Section (PPS) Annual Conference, “What more can we do?” Screen Shot 2015-01-30 at 9.50.22 AM

What would we have to change to be able to do more? What if a PPS member could ethically and legally become an equity partner in an IPU? What business relationship would attract the other members of the medical community into the IPU? What level of autonomy and independence are we willing to transfer to a commonly held organization in an effort to transform both the business and the practice of patient-centered medicine?

Today is a great time to be in health care. The Private Practice Section is ideally positioned to encourage and explore new relationships in health care for our members. My recent experiences at the PPS Annual Conference tell me that the energy of private practice remains entrepreneurial, inventive, and creative. The progressive practices seek out ways to broaden their footprint in health care, strategically partner with larger players, and ultimately utilize private practice to reform the patient’s experience. If we expand our view of the business of private practice physical therapy, we have the opportunity to embrace the changes facing health care. We have long touted the value of physical therapy. Perhaps when we loosen our grip on being independent, we will allow the rest of the medical world to appreciate that value.


Sean McEnroe, PT, SCS, is a PPS board member and the chief executive officer of Proaxis Therapy in Greenville, South Carolina. He can be reached at

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

Are you a PPS Member?
Please sign in to access site.
Enter Site!