Practice Makes Perfect


How to bring about disruption by mastering the basics.

By Subha Nagasubramanian, PT, DPT, MS

A few years ago I went through a fellowship program and one, often repeated phrase stuck with me: “Experts do the basics extraordinarily well.” When I viewed running a practice through the same lens, it completely changed my perspective. Just as a complicated dance routine or an athletic performance is a conglomeration of simple pieces practiced to perfection and layered together to achieve something incredible, so is running a practice. I realized what is needed to excel: get back to the basics, master them, and then put it all together.

Clinic operations can be broken down into two basic components, front and back office, which can further be broken down into various subcomponents.

Front End Management

Client Management

This is a very important aspect of any service-based industry. Don’t waste a patient’s time (or your own)! Be concise. Focus on creating a minimal, hassle-free experience for the client starting when they make first contact through email or a phone call. Be precise, easy to understand, and pleasant. This is a continuously repeated process until the patient is discharged.

Paperwork and Financial Obligations

Make paperwork clear and easy to fill out, whether in electronic or paper form. Asking patients to fill out the forms beforehand is helpful as it minimizes their time at the clinic. The outcome forms can be filled in at the time of the appointment to assist in accuracy. Verify benefits and eligibility, and explain them along with other financial obligations patients might incur.

Treatment and Follow-up

Treating patients appropriately isn’t just what occurs at the clinic, you also need to monitor their home exercise programs. Be sure to follow up with them about their progress through emails or phone calls. Make them feel that they are special to you and you care deeply about them and their well-being.

Back End Management

Use either analytical software or simply plug in some of the key metrics to see how the practice is performing. This helps track the performance of the clinic from an operational standpoint to improve efficiency and enhance profitability. It also helps you discern your strengths and shortcomings. Some common metrics you can look at include:

  • Patient visits, cancellations, reschedules
  • Monthly charges versus sales
  • Monthly inflow
  • Average charge per visit and reimbursement per visit
  • Adjustment per visit
  • Patient balance
  • Accounts receivable
  • Days sales outstanding (aging reports)1

Although bigger, more established practices already have systems in place, newer practices need to work on this. In the realm of bigger chain practices and established clinics, there are good opportunities for these smaller practices to cause a “disruption.” Disruption describes a process whereby a smaller company with fewer resources is able to successfully challenge established incumbent businesses. Specifically, as incumbents focus on improving their products and services for their most demanding (and usually most profitable) customers, they exceed the needs of some segments and ignore the needs of others. Entrants that prove disruptive begin by successfully targeting those overlooked segments, gaining a foothold by delivering more-suitable functionality—frequently at a lower price.”2

Action Item

By paying attention to simple details and doing the basics extraordinarily well, any small practice can create disruption. Since they are small, they are more amenable to change (have less to lose) and hence can make changes quickly to adapt to market needs. Once they capture the intended segment of the market, they can move into the mainstream market, the difference now being that they have the basics mastered.


1 8 Metrics to Track Your Medical Practice’s Performance. Retrieved August 21, 2018, from Accessed August 2018.

2 What Is Disruptive Innovation? Harvard Business Review. Retrieved August 21, 2018, from Accessed August 2018.

Subha Nagasubramanian

Subha Nagasubramanian, PT, DPT, MS, is a PPS member and owner of Capitol Physical Therapy LLC, based in Washington, D.C. She can be reached at

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

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