By Andrew Vertson, PT, DPT, ATC
Executive Summary: Having a specific mission, sharing your specific vision, and monitoring your practice formula work together to build a strong, viable practice.
They say if you know where you are coming from, you know where you are going to go. As a private practice owner and as pillar of your community, there is nothing more important than a powerful, grand vision that excites and motivates others. Here are five guidelines that will help you create a vision that will not only set you apart, but also helps you to define your goals, and create parameters to exceed them and surprise yourself in the process.
1) Make The Vision of Your Practice BIGGER and BETTER Than Everyone Else
Patients can go to any physical therapy practice they choose, and doctors can refer to any physical therapist, so what are you doing to INSTANTLY set yourself apart?
Here’s one example. You can make this a part of your vision:
To help 50,000 people in your community live pain free, healthy lives by 2015.
You should get every single patient; every single doctor involved in your mission right away, and explain to them why they should be a part of it.
The key words here are – RIGHT AWAY.
One of the mistakes a lot of private practice owners make with a mission is to make it a ‘free for all’. Your mission (and its followers) needs to have an air of exclusivity to it, almost like an insiders club. When the human brain perceives a bit of a barrier to entry, it becomes more likely to say “I want this” as opposed to when you think “I can do this anytime, and if I won’t then someone else will. I don’t have to do it RIGHT AWAY”
That’s exactly how most visions start with a bang, and the enthusiasm gradually goes go down the drain.
So, not only do you set it up so that a ‘select few’ can become a part of your mission, you also set up mechanisms for accountability so that the ‘insiders’ have to do something CONSISTENTLY for you to make strides towards the shared vision.
Notice that I said shared vision. Once a vision crosses over the ‘threshold’, it no longer becomes YOUR vision, it becomes OUR vision. It transcends you and gains a life of its own.
2) Explain Your Vision Using Multiple Modes Of Delivery; Printed Booklets, Audio, Video
People have different learning styles. To teach people what your vision is all about, make use of multiple modes of education. Be creative in the way you explain your vision. Examples include videos in your website, audio CD’s, DVD’s, and printed booklets.
For most individuals, video is a preferred medium for information consumption. A video on your website that explains your mission will be more powerful than anything you say or print.
3) Share You Vision With As Many People As Possible And Always Write A Future “Paced” Vision
Here is an example:
The year is 2015, and we just realized that we helped 50,000 people live pain-free and become healthier in the community. We conducted a patient appreciation event, which was attended by over 300 individuals in our community. We had a great time visiting old friends and meeting new ones.
It was an amazing experience, considering that a large number of our patients were suffering from chronic pain and were overweight.
Now they’ve gone on to become pillars of our community and have been able to help their friends and family live pain-free and healthier lives.
For most of our patients, it was like a family reunion, seeing friends they made all the way back in 2011 when they first met in our clinic. Since that first year, our community has grown exponentially and now reaches over 50,000 individuals across 7 counties speaking 5 different languages.
4) Make It Easy For People Explain You Vision To Other Individuals
Make it as easy as possible for people to explain your vision to others. They need to be able to explain “the who”, “the what”, and “the why” of the vision. Most importantly, they need to be able to tie in the vision with some aspect of their personal lives. When an individual has a deep, meaningful connection with your vision, they will become your most ardent supporters.
The reason we go to school and become physical therapists is usually because we want to impact and change people’s lives and be compensated fairly well in the process. We are taught to be excellent clinicians (as we all are), but when it comes to running a business, our expertise can fall short.
The truth is, there is a big difference between being a viable practitioner and a viable practice owner. Getting patients to walk in is one part of the equation. Treating them well (literally) and conditioning them to refer from day one will be a critical component of a successful practice in this new economy.
Post discharge follow up using a combination of email, text messaging on their mobile phones, direct mail, phone call follow ups is the differentiator between a clinic struggling for referrals and one that is overflowing with patients.
This isn’t just about ‘educating patients’ and doctors about the benefits of physical therapy, this is about becoming an important part of the patient’s day to day life.
5) Introducing the “Private Practice Success Formula”
This is called the “Private Practice Success Formula” and it can be summarized as
PS + VP + AF + PM = Private Practice Success
The new economy practice will have the following components in place even before the practice opens its doors for the first time:
PS = Prospect Stimulators
A prospect stimulator is an educational tool (book, audio CD, DVD, online course) that helps educate patients and leads them back to the clinic for more information. For example, an audio program on “7 things you can do to overcome low back pain” which leads to an offer for an appointment in the clinic can function as a ‘prospect stimulator’. Every clinic should have at least 5, preferably 10 or more prospect stimulators that are constantly distributed using various channels in the community
VP = Valuable Prospects
A high school student without insurance and the means to pay for physical therapy may not be a good candidate for your services (from a business point of view) as compared to an executive with the right type of insurance, someone who will not hesitate to pay his copay and even an appointment cancellation fee (which should be mandatory in all practices). Your practice must maintain visibility in front of your most ‘valued prospects’ using a web presence (search engine optimization), social media (Facebook, Twitter, LinkedIn), print (strategically placed advertisements), direct mail (postcards to a targeted mailing list) and personal phone call follow ups (with selected patients) to drive them, their friends and family back to your clinic. This should not be a ‘once in a while’ thing. It has to be done for 2-3 hours every week, since this activity will sustain your practice during tough times.
AF = Ascension Funnel
The biggest mistake made by most private practice owners is the wrong offer. Patients are completely desensitized at the prospect of a ‘free consultation’. They don’t even care for a ‘complimentary evaluation’ in an ad filled with nice images and pictures of the physical therapist. Every advertisement should have one purpose and one purpose only – to get the contact information of the prospect and introduce them to your marketing funnel. Once the prospects information (name, email, phone number) is obtained, someone from your office, who is very experienced in ‘closing’ the patient so they NOW want to come in, is important. Too many practices waste tens of thousands of dollars trying to ‘close’ the patient right away with an ad. This is a cardinal sin – it’s like proposing on the first date. The chances of success are pretty slim.
The ‘new economy’ practice will patiently get the prospect to know, like and trust the practice and/or practitioners with personal stories and testimonials that elicit emotion and ‘human connection’ as opposed to color pictures, beautiful equipment in an ad that patients will spend 15-30 seconds reading.
PM = Patient Metrics
Every strategic private practice owner must keep an eye on important business metrics that pertain to each patient.
The success of a ‘new economy’ practice is measured by the following ‘patient metrics’
a) The ‘LVP’ or lifetime value of the patient. This can be increased significantly by offering more products and services. It can also be increased by raising your prices for such products and services, which are not price regulated and independent of insurance reimbursements
b) The ‘PL’ or patient longevity – is the patient coming back to you or referring their family and friends? How many of your patients are becoming your ambassadors and coming back to you or driving more people to your door? Increasing patient longevity through patient conditioning is the fastest way to grow a practice. It yields greater results and take less time, money and effort than trying to ‘schmooze’ doctors and build new referral relationships
c) The ‘TS’ or therapist status, with regards to the importance of physical therapy – Are you constantly (yet delicately) reminding patients about your expertise, authority and the benefits of physical therapy? Patients lose enthusiasm for ANY service over a period of time and you need to build systems to keep them constantly engaged, enthused and motivated to come in for treatment and become your ambassadors. You must promote the ‘concept’ of wellness and how physical therapy can help, NOT the ‘brand’ or the ‘company’ that provides it. Patients are interested in the process of treatment, but this interest wanes dramatically after the first few visits, leading to an inevitable decline of therapist status
d) The number of patient visits each week. This is directly related to ‘volume’. Most practices assume that increased volume equals increased profits. While this may be true, it’s possible to increase net profits WITHOUT increasing patient volume by increasing LVP, PL and TS
Andrew Vertson, PT, DPT, ATC, is a PPS member, founder, and CEO of Intecore Physical Therapy in Orange County, CA. He can be reached at email@example.com.
Intecore Physical Therapy
26700 Towne Centre Drive, Suite 120
Foothill Ranch, CA 92610
Looking outside the realm of physical therapy to other businesses can offer solutions in our own field of expertise.
By Sandra Norby, PT
Last night, my business partner and husband, Kim, and I attended an event, “DMStartUpDrinks.” This organization brings Des Moines, Iowa, entrepreneurs and start-up enthusiasts together. We like to attend events such as this one for a couple of reasons. The first being my assumption that an entrepreneur in any field faces similar challenges, and the second being that Kim is an idea guy and needs a network of like-minded people to help guide him to turn his ideas into reality.
By Tom DiAngelis, PT, DPT
When was the last time you fired someone? What is it exactly that takes you to the point that you terminate a person’s employment, benefits, and possibly change their lives forever?
I suspect that if an employee could not complete their job and continuously did a temporary fix to a problem, you would eventually tell them enough, and they would be out of a job. Yet we have members of Congress—many of whom are repeatedly elected to office—who since 2003 have provided 17 temporary fixes to the Sustainable Growth Rate (SGR) instead of coming up with a permanent fix. In March of this year, they once again failed to perform on the SGR problem and gave us another temporary patch. Please see the column by our lobbyist, Jerome Connolly, in this issue of Impact for the gory details of this never-ending saga.
At some point, the American people have to realize that we have a combined group of useless elected officials who just cannot do their jobs. They cannot do what we have elected them to do, and we continue to tolerate their mediocre performance and elect them into office over and over. How many businesses in this country would tolerate employees who perform at the dismal level our Congress does? I know not one of you reading this column would tolerate it.
For those of you that have been around for a while, I am sure you can remember a time when Congress actually figured out how to work together to move this country forward. I have often questioned what has happened to make the best democracy in the world devolve to be led by a group that is immature, divided, and totally partisan in their actions and deliberations.
I have had the opportunity to ask this of some past members of Congress who have long since stepped down, but still have their finger on the pulse of Congress. They have offered a couple of explanations as to why the members find it so difficult to work together.
The first thing they tell me is that members do not live in D.C. any more. In the past, they would move their families to D.C. and as a result they would see each other more—socialize more. And even though they disagreed on issues, they developed relationships that enabled them to figure out a solution. Now, members leave D.C. at the end of the week and return after the weekend, leaving no time to get to know their colleagues and work together on solving the problems they face.
One of the other reasons offered has to do with redistricting—often a member’s district is either blue or red, but not both. So, a member only has to keep their constituency happy in their district to be reelected; they do not have to worry about their constituents being in the other party. This makes it easier for them to go with the party line instead of doing what they often know is the right thing.
Well, this might provide some explanation for them being unable to perform their jobs, but it is no excuse. It is time that we take a strong look at our elected officials and fire them. Eleven years and 17 temporary fixes is enough for me to vote for anyone other than an incumbent—and fire the ineffective body of people that we employ. How about you?
By Angela Wilson Pennisi, PT, MS, OCS
Many times in this column, I have reflected on and encouraged my fellow physical therapists in how fortunate we are to play such an important role in people’s lives. We help them return to independence, the activities they love, and teach them to be better body owners in ways that will benefit them and their families for years to come.
However, recently I was thinking of examples of how interacting with my patients has affected my own personal development. Very few careers will put you in contact with so many people, from every walk of life, in a situation that facilitates in-depth conversation and understanding of another’s perspective.
I remind myself of this when I interact with people who clearly have never been exposed to perspectives beyond their own and recognize that I have had a personal interaction with someone from the exact group they are either demonizing or praising. Being a physical therapist has led to an appreciation for the complexities in life that I could not have gained in many other ways outside my professional experience.
We have all treated patients in their eighties or nineties and recognize the difference a healthy lifestyle of physical activity across the lifespan makes in the quality of life at that age—which is a powerful influence on our own lifestyles. If only it were easier to communicate this reality to others in our lives who are resistant to adopting the health habits we teach every day!
As a physical therapist, I have worked with accomplished leaders who affected my perception of what I could accomplish in life. I have observed every variation of “how to balance work and family,” which provided me with a clearer view of how I wanted to answer that question. In my early years, I also took no shame in bouncing a business question off the unsuspecting executive while he or she was on the treatment table, adding to my business acumen one shoulder or knee injury at a time.
Finally, I also remember some of the school kids I cared for in the Bronx after I graduated from physical therapy school and the multitude of resource-based and physical challenges they faced, along with those patients whom I could not help and others who have passed away. We continue to carry all of them with us, each patient contributing to the health care professionals and people we have become.
Perhaps today is a good day to not only thank your patients for their business, but for what they add to your practice and your life.
HIPAA Omnibus rule enforcement era—what providers want to know.
By Nancy Beckley, MS, MBA, CHC and Paul J. Welk, PT, JD
We are officially under the era of enforcement for the Health Insurance Portability and Accountability Act (HIPAA). Our previous column addressed the September 23, 2013, enforcement date for the HIPAA Omnibus Final Rule (“Final Rule”) and took a look at five key issues of preparedness: business associates, notice of privacy practices, breach notification, risk analysis, and risk management and training. Within that context, we addressed compliance requirements, enforcement examples, and best practices for the physical therapy practice. This column takes a closer look at enforcement, addresses some common HIPAA questions from providers, and presents related resources to assist practices in achieving HIPAA compliance.
HIPAA enforcement is under the auspices of the Office of Civil Rights (OCR), a federal agency at the Department of Health and Human Services (HHS). HIPAA is not a Medicare compliance obligation, but is applicable to all providers who meet the definition of a covered entity under HIPAA, as well as to all business associates. The OCR is charged with enforcing “the HIPAA Privacy Rule, which protects the privacy of individually identifiable health information; the HIPAA Security Rule, which sets national standards for the security of electronic protected health information; the HIPAA Breach Notification Rule, which requires covered entities and business associates to provide notification following a breach of unsecured protected health information; and the confidentiality provisions of the Patient Safety Rule, which protect identifiable information being used to analyze patient safety events and improve patient safety.”1
For those providers who believed HIPAA enforcement was only a concern for large providers, OCR sent a clear message in early 2013 that it would also take strong enforcement action against small providers. Specifically, a hospice provider in Idaho agreed to pay $50,000 to HHS to settle potential violations of the HIPAA Security Rule. The breach occurred when an unencrypted laptop used in field-work was stolen from an employee’s car. The breach involved the protected health information of fewer than 500 patients. Nonetheless, OCR took strong action against this provider and required the hospice to enter into a Resolution Agreement, in large part because the organization failed to conduct a required security risk assessment. Additionally OCR found that the hospice did not have policies and procedures in place to address mobile device security, which is a requirement of the HIPAA Security Rule. This represented the first settlement involving a breach of unsecured electronic protected health information (ePHI) affecting fewer than 500 individuals.
Large data breaches reported over the past holiday season at national retail merchants have created a great deal of public attention, heightening the awareness of personal and financial security and identify theft. These breaches have also brought HIPAA security to the forefront of many physical therapy practice owners’ minds. Practice owners, it seems, have yet another reason to lose sleep at night worrying about HIPAA non compliance and the potential of a data breach. There is good reason to be concerned about this topic and to raise appropriate questions. The following address some of the frequent questions being asked by physical therapy practices in the areas of HIPAA enforcement and security.
- Is there a checklist or specific format that my practice should use to conduct the risk analysis that is required under the HIPAA Security Rule?
HHS provides rather extensive guidance on satisfying the risk analysis requirement under the HIPAA Security Rule. Specifically, the Security Rule requires that a practice conduct an accurate and thorough assessment of the potential risks and vulnerabilities to the confidentiality, integrity, and availability of ePHI held by a physical therapy practice. The HHS website reviews in detail the risk analysis requirements as well as the specific elements of a risk analysis.2 This website is an excellent starting point for practices that are completing a HIPAA Security risk assessment.
- How do I determine whether my practice is a covered entity subject to the privacy and security requirements of HIPAA?
The HIPAA Administrative Simplification Regulations define a covered entity, in general, to include a health care provider that conducts certain transactions in electronic form. As a practical matter, the vast majority of physical therapy private practices are therefore covered entities under HIPAA. To assess whether your specific practice is a covered entity, HHS has developed a decision-making tool to assist in the analysis.3 In addition to considering whether a particular practice is a covered entity, the practice should also consider whether it may also be subject to the HIPAA compliance requirements, either through acting as a business associate or through any contracts in which it has agreed to comply with HIPAA.
- I visit patients in their homes for outpatient home therapy. I use a laptop and write my notes contemporaneously on the laptop. What do I need to think about to keep patient information secure?
HHS acknowledges that mobile devices are often used to store or transmit protected health information. Given the frequency of mobile device use by health care providers, HHS has published guidance dealing with health information privacy and security in connection with mobile device usage.4 Some specific protection mechanisms to consider when using a mobile device include the use of a password, the encryption of health information, utilizing a remote wiping or disabling program for use on lost or stolen devices, installation of a firewall or security software, and maintaining physical control of devices.
- Our practice has a Facebook page and I am concerned that a patient might reveal protected health information when he or she makes a comment or post. Is our practice liable for a HIPAA violation if a patient posts his or her own protected health information?
As a general matter, the practice would not be liable if a patient chooses to post his or her own protected health information electronically. However, practitioners should give careful consideration to any responsive messages. Should a representative of the practice’s workforce post protected health information in an area that is publicly assessable, the practice is at risk. Practices should consider establishing policies and procedures governing the use of social media by their workforce and all staff should be trained on the established policies and procedures. An additional issue to consider in connection with the use of social media by a health care provider is whether medical advice is being provided and whether this is appropriate or legally permitted. Finally, practices should consider auditing their social media outlets to assure compliance with policies, procedures, and applicable law.
- Our practice is updating all of our Business Associate Agreements (BAA), and we want to clarify if we should provide our BAA to the other party (in this instance our billing company) or if we should sign the other party’s BAA. What is the best practice to protect our practice?
As with any contract, BAAs set forth certain rights and obligations of the parties. Presumably, a form of BAA utilized by a physical therapy private practice is going to be more favorable to the practice than a BAA presented to the practice by a vendor. For this reason, the practice should utilize its more “provider friendly” BAA whenever possible. If a Business Associate is insistent on using its form BAA as a starting point for negotiations or otherwise unwilling to change the terms of its BAA, the provider should be certain to understand the risks and benefits associated with signing that particular document. HHS has published a number of FAQs directly related to Business Associates that may serve as an additional resource for common questions.5
- Our practice provided our external audit consultant with patient records maintained on a thumb drive. The thumb drive was subsequently lost. How do we determine if this is a reportable breach?
HIPAA provides that breach notification is required if the breach involves unsecured protected health information. Unsecured protected health information is that protected health information which has not been rendered unusable, unreadable, or indecipherable to unauthorized persons through the use of a specified technology or methodology. These technologies and methodologies include encryption or destruction of the protected health information. HHS provides specific guidance for rendering unsecured protected health information, unusable, unreadable or indecipherable to unauthorized users.6 The specific requirements for protecting such information relate to factors such as whether the information is in electronic form or hard copy.
- I have heard that I can buy insurance to protect against the risks associated with a HIPAA breach. Is this correct?
A number of insurance providers that service the physical therapy market offer information privacy or similar coverages. There may also be coverage available for HIPAA violations under current policies already maintained by private physical therapy practices. In performing the practice’s individual risk assessment under HIPAA, a prudent step would be to speak with the practice’s insurance provider regarding current information privacy coverage and options available to mitigate HIPAA risk through appropriate insurance coverages.
HIPAA Privacy and Security Compliance is an area where regulation and enforcement have steadily increased over time. As the scope and breadth of the requirements on covered entities and business associates have increased, so has the potential for non compliance. Through the performance of a risk assessment, practices can seek to mitigate potential losses due to HIPAA non compliance. Hopefully, the above resources and sample questions provide a good starting point for an analysis.
Nancy Beckley, MS, MBA, CHC, s certified in Healthcare Compliance by the Compliance Certification Board and is a frequent speaker and author on outpatient therapy compliance topics. She advises practices on compliance plan development and audit response. She can be reached at firstname.lastname@example.org.
Paul Welk, PT, JD, s a Private Practice Section member and an attorney with Tucker Arensberg, frequently advises physical therapy private practices in the areas of corporate and health care law. He can be reached at email@example.com.
1. U.S. Department of Health and Human Services. Website http://www.hhs.gov/ocr/privacy/index.html. Accessed February 13, 2014.
2. http://www.hhs.gov/ocr/privacy/hipaa/administrative/securityrule/rafinalguidance.html. Accessed February 23, 2014.
3. http://www.healthit.gov/providers-professionals/how-can-you-protect-and-secure-health-information-when-using-mobile-device. Accessed February 23, 2014.
4. http://www.healthit.gov/providers-professionals/your-mobile-device-and-health-information-privacy-and-security. Accessed February 23, 2014.
5. http://www.hhs.gov/ocr/privacy/hipaa/faq/business_associates/index.html. Accessed February 23, 2014.
6. http://www.hhs.gov/ocr/privacy/hipaa/administrative/breachnotificationrule/brguidance.html. Accessed February 23, 2014.