Streamline Your Business


5 steps to get all your practice locations on the same track.

By Brian Gallagher, PT

If you own a physical therapy practice with multiple clinics in a variety of markets, it’s possible you may find yourself struggling at times. A question you may have is “How can I get them all running exactly the same? What universal metrics should I be using that I can apply across the board to all of our offices?”

On the surface, such a goal seems attainable, but in reality it’s the opposite. Back in 1994–1995 when large corporate physical therapy companies were spreading across the nation, you might recall that they wanted a one-size-fits-all management approach. They were hiring consultants who were telling them that all patients with the same diagnosis could be treated with exactly the same protocol.

Most of us knew this would never work since we are not in the business of pumping out widgets; we are dealing with people who have individual needs, wants, capabilities, and underlying conditions. There is no one-size-fits-all protocol that would work universally among a wide range of patients, not to mention the tremendously diversified clinicians. This remains the same today, since each clinic has their own set of individuals and market conditions.

But here is what does work:

Learn what the key operational metrics are for the nation and then discover what they are for the region within the state where you are practicing to use as a benchmark.

Seek out the experts within the Private Practice Section (PPS) of the American Physical Therapy Association (APTA) to learn about all the compliance rules and regulations for both Medicare and commercial carriers.

Know these rules! This will better enable you to effectively and successfully manage your personnel. There is a lot of confusion over the interpretation of the regulations, and you need to be confident with your staff as to what your expectations are. So find a mentor or coach who can support you.

Spend some time and money on getting training on how to be an effective communicator and personnel manager. You cannot manage over disagreement. Most owners are not born with these skills and therefore have to learn them on their own. Knowing how to communicate, how to confront others, hold them accountable, provide consistent and clear direction, and know how to comfortably say “No” are skills vital to managing your office with confidence and certainty.

You must have a well-written policy and procedure manual that is easy to apply, not a legal dictionary version that no one looks at, let alone understands. These policies act as the rules of the road that everyone will follow as to what is or is not going to be considered acceptable within the practice.

Once you have completed these five steps, you can then start setting targets and holding people accountable to the standards you want to set for each specific office in order to meet the needs of “your public”—your patients and referral sources. Since the location, staff, and public of each office are going to be slightly different, your operating metrics will need to be adapted for each office.


It takes experience in multiple markets to know how to set these parameters so that you enable “your public” to win in your specific office environment, without alienating your staff. Here is an example: Some offices schedule their patients on alternating time slots, such as on the half-hour and three-quarters of each hour, while other offices are successful scheduling their patients to come in every 30 minutes.

In addition, knowing how to pro-rate a clinician’s salary and bonus based on value points—not visits—will enable unlimited income earning potential for the clinician while increasing your profit margins in the process.

When it comes to implementing the ideal compensation package for your staff, you need to understand the concept of keystone pricing. This well-known business principle used globally in manufacturing can play a significant role in your practice’s success as well. The basic premise is that you must learn how to successfully set up your corporate structure and system of operations to enable your production staff to generate a minimum of four times their cost. (This holds true no matter how big or small your practice.) I have been in offices where one physical therapy staff member is making $55,000 while others were making $120,000 per year. It’s crucial to have some set standards of operation to appropriately measure each individual’s outcomes/products as they pertain to quality, efficiency, and productivity.

Therefore, while seeking out the advice of an expert, it is imperative to find someone who understands that a one-size-fits-all approach simply does not work. Your advisor must have experience with applying what they preach, because a full and complete understanding of how it all interconnects is necessary. They must be knowledgeable in all areas of a physical therapy practice because today everything is interconnected. If the owner makes changes for environmental compliance reasons, they must consider proper staffing, charging, and coding as there might be a trickledown effect into all of your practice’s operations. Most importantly, you need to have confidence and certainty in what you know so that you can effectively allow your staff to get behind your leadership. It is only then that you will achieve your ideal business scene.

* Brian J. Gallagher, PT, has a vested interest in the subject of this article.


Brian Gallagher is the chief executive officer of MEG Business Management, LLC. With more than 24 years of experience in the field of rehabilitation and 19 years in business, he specializes in physical therapy practice billing and coaching nationwide. Brian supports the APTA through lecturing, writing articles, and performing webinars. He can be reached through his website at or via email at

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

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