Peer Education: Resources Help PPS Members Learn from Each Other

COVID-19 offered numerous challenges for business owners around the world. PPS responded to this challenge by offering a plethora of resources to its members, one of which was a three-part webinar series presented by practice owners of varying sizes in early April, May, and June.

Michelle Collie, PT, DPT, MS: Performance Physical Therapy. 13 locations, Rhode Island and Southeastern Massachusetts

Mike Horsfield, PT, MBA: CEO-Rock Valley Physical Therapy, 50+ locations in Iowa and Illinois

Mark Reitz, PT: Penn Therapy Assoc. Inc., two locations in the Philadelphia suburbs

Rob Worth, PT, DPT: Advanced Physical Therapy & Sports Medicine, 25 clinics and 35 industrial on-site locations in Wisconsin and Michigan

Kristen Wilson, PT, DPT: Action Potential Physical Therapy, two locations in Southeast Pennsylvania

Five months after the emergence of the pandemic, see how these owners handled the event and are planning for the future.

In response to COVID-19: In what ways did you alter or enhance your messaging to patients and staff and on what topics? Has this changed your method for typical communication?

Michelle: The real answer: We put everything we did before on steroids! Specifically, for patients, we moved to weekly e-newsletters and daily social media posts that provided tools and solutions to the challenges people were dealing with (Facebook Live and blog posts). In addition, I sent a personal email to all current patients and had a small group who called 1,500 past patients who were over the age of 65 to help organize groceries, provide solutions, etc. For our staff, we had daily meetings with senior leadership, 3x/week meetings with clinic directors, once a week town-hall style meetings with the entire staff, and a once a week company newsletter. We also had many round table meetings with small groups of my PTs to help problem solve the events affecting us. I realized that I needed to tell people things ‘a million’ times, so I kept repeating messages EVERY WEEK!

Mike: The pace of emerging information and decision making necessitated the need for our executive team to transition from weekly to twice-a-day meetings. Utilizing technology, we accelerated the dissemination of actionable information daily via Zoom to our clinic leaders and held weekly “Messages from Mike” to provide updates on the changing regulations and its impact to all team members. We have reduced the frequency of all of these meetings over time and are so excited to disband our COVID-19 Task Force and go back to our normal meeting schedule with the executive team. Realizing the value of frequent communication with the entire team, we have instituted a bimonthly Rock Talk that we plan on continuing until the next pandemic hits.

Mark: I gathered email addresses on ALL of my patients in the past two years and sent out a detailed email on our safety protocol. I also updated my website to include COVID-19 information, how our hours had changed, how our scheduling had changed, and our new sanitizing protocols so patients would hopefully feel safe in our new environment. I also enhanced our Facebook, Twitter, and LinkedIn presence to further spread our new messaging.

Rob: Throughout the entire COVID-19 pandemic response we provided the most up-to-date information available from the CDC and other reliable sources to our patients through in-person discussions at their therapy sessions, phone calls to their homes prior to their therapy sessions, and social media communications as appropriate. Messaging to our staff occurred through a combination of leadership meetings, team meetings, all staff meetings, and one-on-one communications. These meetings occurred virtually or in person, depending on the most appropriate venue for communication at the time. Though I feel we have always had good communication within our practice, during this pandemic we put our communication to the test and even further enhanced our capabilities.

Kristen: COVID-19 offered a unique opportunity to review our communication procedures both internally and externally. We provided weekly email and video updates to our clients with the latest safety precautions and clinic operations. In addition, we hosted weekly Facebook live and Zoom Lunch-and-Learn events to provide physical therapy-related content to our community. We also provided a weekly fax update to physicians notifying them of our clinic policies and telehealth offerings. Internally we held weekly Zoom town hall meetings and communicated pertinent changes via email as needed. Having never utilized videoconferencing prior to COVID-19, I was pleased to see how well our team adapted to the challenge and intend to continue using this platform for future company-wide meetings and marketing events.

How and when did you implement telehealth services following the emergency declaration and how do you see telehealth playing a role in the future delivery of PT care?

Michelle: On March 18, we went to 100% telehealth by choice. We closed clinics and maintained at about 40% patient volume. We re-opened clinics late April and now telehealth is down to about 25%. Assuming we continue to be paid, telehealth will be an adjunct to our in-clinic care. We feel it is a great tool for checking out patients in their home or when there are access challenges.

Mike: As soon as we saw what impact this was having from our friends out East, Mike Osler (VP of Growth and Development) stepped up and began exploring and implementing a telehealth option for our clinicians and patients. Mike was assisted by a couple of our young superstars and this definitely was one of the bright spots during this difficult time. Believing in someone’s potential gives hope. Watching them be awesome under extreme duress is inspiring.

Mark: We started using telehealth in early April despite the lack of Medicare approval because I had a strong feeling that they would eventually come to their senses as the private insurance companies did. If we didn’t get paid moving forward, we certainly would get good PR by reaching out to our patients without the guarantee of payment. I figured we weren’t going to get paid without treating them, so may as well take the chance and hope for the best.

Rob: We had been casually exploring telehealth for a few years though the emergency declaration accelerated our exploration of this mode of care. Within a period of a week we assembled a team and put together a 10-page manual on implementing telehealth for our clinicians, which was extremely valuable in helping them feel comfortable with providing telehealth, though certainly there was still a learning curve. During the most acute times of the pandemic our telehealth visits increased though still never exceeded more than 10% of our overall practice visits. Part of this may have been our geographic location in the Midwest which was not hit as hard as the east and west coast and some of the more densely populated urban areas.

Kristen: On March 17 we promoted our previously developed telehealth services via video message to our existing clients. Within a week we were performing 100% telehealth visits after closing our two locations due to stay at home orders in our state. When we reopened on April 2, we continued telehealth services and they remained the bulk of our visits until mid-May where we finally were able to surpass these visits with our in-office volume. Stay-at-home orders were not lifted until June 5 and, therefore, we had to rely heavily on telehealth access to maintain continuity with our patients. In the future, we will continue to utilize this tool as an adjunct to in-office therapy to minimize care disruptions.

Given the significant reduction in clinic revenue during March, April, May, and June, how have you altered your clinic operations or financial planning to recover?

Michelle: We extended our office hours during the week and on Saturdays and increased the expectations of physical therapists for hours worked. Due to spreading out/longer visit times, our clinicians are working additional hours to see the patients needed to be financially secure. We had to decrease our support staff, which offers physical therapists the opportunity for extended time with patients.

Mike: Thanks to a great start of the year, a generous PPP loan and an understanding team, we have been able to manage cash flow effectively through the low point (40% of expected volumes) and are now coming back out of the negative cash flow with volumes reaching 70-80% of budgeted. The combination of voluntary furloughs, voluntary reductions in pay for clinical staff, and furloughs of our team who no longer had work to do (primarily ATCs and exercise specialists) we were able to lower our costs enough that we have been able to give, those who worked, their voluntary pay cuts back and also share additional pay with the support team who worked so hard during this time. We were able to do this because although we are unsure what the future may bring we are 100% confident our team will step up to meet the next challenge.

Mark: The biggest change I made was furloughing all of my part-time employees. Only my physical therapists, my one physical therapist assistant, and office manager have continued to work. The PPP money and the HHS grant look like they will be enough to carry me through until we are busy enough to carry my expenses. I hope to gradually bring back some of my part-time help but at least two positions will be eliminated permanently.

Rob: Like many practices we were trying to respond to the immediate situation while also trying to plan for the unknown future. Within a course of two months we went through literally five phases of response based on the environment of the pandemic and responding to the quickly evolving federal legislation and changes to the rules of the relief programs. One of the changes we made in our practice was converting all of our staff to hourly so that we could, as a practice, best respond and adapt to the significant fluctuations in volume acutely as well as plan for future developments (e.g., a second wave of COVID-19 infections that would again significantly reduce our patient volumes). One of the key themes throughout all this was making sure we took care of our staff in the best way possible while also ensuring that as a practice we survived and came out viable on the other side.

Kristen: Our second location opened two weeks before the pandemic was declared, providing an incredibly tight cash flow situation as we had invested all of our 2019 profits into the buildout of the new clinic. After closing the offices in mid-March, we furloughed our entire staff, and fortunately brought everyone back full-time mid-April when our PPP was funded. We also attained an EIDL to cover the outstanding build-out costs from our second clinic. We have since started a State Job Share program, which will allow us to fluctuate our staffing based on the volume of patient return. Beginning in the fall, we intend to move to an alternative compensation model consisting of a base rate plus commission to allow us to manage future fluctuations more deftly. Given our one-on-one treatment model, we do not plan to alter our clinic operations or staffing.

Given the potential for a new surge of COVID-19 cases in the Fall or Winter, what safeguards will you implement to mitigate increased stress levels for you and your team? If you’ve developed a contingency plan, what does that look like?

Michelle: Ensuring everyone continues to be very comfortable with telehealth will be paramount in the event of a recurrence. We will continue to encourage people to do at least one telehealth visit with every patient during their course of care. Currently we are planning vacations to ensure everyone takes some time off this summer to minimize stress and burnout.

Mike: Uncertainty seemed to bring about most of the fear and stress. Although we cannot predict the course back to “Normalville” we continue to share openly how we will respond to the ups and downs. We’ve been transparent on our staffing plan and the triggers that will impact staffing and pay. Coupling this with regular volume updates allows them to focus on what they have control over and not wonder how we will respond to the ever-changing environment.

Mark: Drink heavily! I really haven’t put much time into this possibility. That alone keeps my stress level down. I have always performed and thought more clearly with dealing with the known vs. hypotheticals. I also go with my gut that rarely lets me down and my gut tells me we will not have a huge uptick this Fall. Maybe an increase, but treatment options will be enhanced and a vaccine will be close to fruition. Should I be proven to be wrong, I will deal with it then but will not stress over it now. Kind of like I was never too worried over not earning forgiveness for my entire PPP loan (although I will have it all forgiven especially with the new Senate bill). If I was stuck with a 1% loan I was thinking that was a lot better than my 4.25% line of credit.

Rob: We certainly learned from the first wave how we can optimize communication and alleviate fears. We also appreciate the potential range of response among our staff relative to their perceptions, fears, and personal and family health situations that may affect how they feel about the COVID-19 environment. As a leadership team, we strive to respond to their individual situations in the best way possible. We have many contingency plans and they continue to evolve based on the changing local and national environment, both from the standpoint of science as we know it balanced with perceptions and social expectations by our patients and staff.

Kristen: We were diligent about outlining our responses to this pandemic and formulating that outline into an infectious pandemic policy and procedure. In the event of a recurrence, we’ll calmly refer to our policy, implement the necessary action steps, and then quickly proceed to the nearest liquor store. All kidding aside, I’m proud of the steps my team has taken to mitigate their stress using open communication, healthy dialogue, and lifestyle adaptations. I am confident should this happen again (please no!) we will weather the storm in the same manner we are currently handling it: as a team.

Name a couple positives that came out of the COVID-19 crisis that you weren’t anticipating.

Michelle: I lost almost 10lbs (although it’s starting to return!). Strengthening of our culture. Improved communication (as we had no choice!). Any staff who were not a 100% “culture fit” have not and will not make it! We already have a much stronger team now than we did three months ago.

Mike: There have been so many positives come out of this difficult time. In addition to the ones mentioned earlier, the fact that being apart would bring us together caught us by surprise. We anticipated that doubling down on professional development with our “Off Season Training Program” via Zoom would pay long-term benefits, but what we didn’t anticipate was how much putting a face and voice to a name on an email would unite our regions. We have seen more collaboration across our clinics than ever before and this is something that we definitely plan on continuing after the pandemic.

Mark: I have greatly enhanced my social media presence; I have fine-tuned my personnel requirements; I think my employees are even more indebted to my practice as they see how hard I have worked to keep them on full salary; my patients truly appreciate that we REALLY do care about them and their health and wellbeing; and it has reassured me that I am so glad that I never wanted to have a large practice with multiple sites and dozens of employees. Being small allows me to make quick decisions and discuss them with the seven employees who are still working. We are able to come to group decisions that make us all happy and not have to run everything by an HR department or a management team.

Rob: Being an eternal optimist, several silver linings have emerged. These include at the personal/family level, being semi-quarantined at times with my wife and kids with nowhere to go has resulted in deeper family relationships. At the practice level, to see so many of our team members rise to the occasion to make our practice better than it ever was before in developing programs and going above and beyond to serve our patients during the evolving pandemic. And at the professional level, to see how APTA and the Private Practice Section put together an amazing cadre of resources to help physical therapists and physical therapist assistants around the country respond in the best way possible for their patients and help practice owners figure out the best way to take care of their staff and keep their practices viable. I was fortunate to be part of the PPS COVID-19 Advisory Committee, which met twice daily during the initial stages, I can honestly say I’ve never been part of a more high-functioning group making an amazingly significant impact on our profession with lightning-quick response time so that we could all come out better on the other side of this.

Kristen: As much as I never expected it to be the case, COVID-19 left its mark in a positive way on our practice. As a result, we are more fiscally conscious. I was able to negotiate all of my existing vendor contracts and employee benefits and will save over $10,000 this year as a result! We developed a new marketing outreach program and successfully hosted a virtual telethon that raised $800 for a local food bank. Most important, our culture has been strengthened and fortified beyond what I ever could have imagined. We always knew who we were, but now others see it and fully appreciate it.