Marketing tips for physical therapists and chiropractors from the Evidence Based Chiropractor on the Grow Your Practice Podcast.

How to Grow Revenue and Help More People in Your Community

In a recent episode of the Grow Your Practice Podcast, chiropractic marketer Dr. Jeff Langmaid shares his top marketing tips for physical therapists and chiropractors. 

Known as the “Evidence Based Chiropractor,” Jeff is devoted to increasing chiropractic utilization. His great-grandfather was a chiropractor who studied under BJ Palmer nearly 100 years ago. His goal is to continue that legacy as a chiropractor himself and by highlighting the power of chiropractic adjustment through research and marketing. He believes it’s time for conservative care practitioners of all types to step up and create a healthier world by scaling their unique healthcare professions. 

Chad and Jeff discussed the top marketing tips for chiropractors and physical therapists. Some of Jeff’s key principles are to start with your patient database, lead with educational content, and create monthly recurring revenue. By implementing these practices, owners of chiropractic clinics, physical therapy practices and integrated wellness centers can improve profitability and generate consistent visits. 

Why should practice owners care about marketing? 

Dr. Jeff shared an unfortunate approach that he sees many clinicians make. He labels it the “journey of professional indifference.” 

Every day in your community, there are people undergoing unnecessary surgeries, taking unnecessary medications, and receiving unnecessary injections that affect them and their families for the rest of their lives. Opioid addictions are by far the worst they have ever been, largely due to doctors overprescribing opioid painkillers after surgery. 

The “journey of professional indifference” describes the approach where a practice owner passively waits for patients to come to them. These patients may have already undergone surgery or another intervention. They could have been referred by their physician or found you as a last hope. 

Whether you’re a PT, OT, or DC you are an integral part of a patient’s journey. You have the ability to get in earlier in a patient’s journey and help them take their health into their own hands. So they can avoid the fate that so many people in your community fall into. 

“If you care about the health of the people in your community, you need to get out there and tell your story,” Langmaid said. “You have to be proactively answering the questions people have about their health. The more you can build trust and rapport, the more you can help people in your community avoid the fate that so many have fallen into.” 

So you want to help more patients. Where to start? 

Dr. Jeff and Chad both recommend that you always start with your warmest audience. These are the people you have already seen. People who likely already know, like, and trust you. Reach out to your existing or past patient database. Email them consistently to let them know you’re around. 

Share educational content in your emails and invite them to something to learn more. A webinar, a workshop, or an appointment. Avoid using jargon or overly medical terms. For instance, if you’re writing an email to educate about radiculopathy, use terms like ‘how to tell if your arm pain is coming from your neck’ instead of the actual term ‘radiculopathy.’ Use patient-centric language and offer something of value. Then invite them to come in if they’re still not seeing relief. 

The key is to engage with your patient database consistently. Being consistent is what most practices struggle with most. Patient Demand software can help you automate this process, enabling you to choose from hundreds of pre-written and customizable campaigns. 

Top 3 Marketing Tips for Physical Therapists and Chiropractors 

When it comes to getting started with marketing, the lowest-hanging fruit is marketing to your past and existing patients. But that’s not where your marketing should end. To reach a broader audience and help more people in your community, you eventually need to create demand beyond your existing list. 

Here are the top 3 marketing tips for practice owners:

1. Lead with Patient Education: Teach and Invite

Jeff’s core philosophy is to teach and invite consistently. If you show up and teach, engage, entertain, and then invite – and you do that consistently – then you’re going to see success. Lead with educational content, then invite them to something: Say give us a call, hop on the schedule, join the webinar, or come to a workshop. 

This methodology applies to all audiences: past patients, existing patients, and cold traffic (people who haven’t interacted with you before). As practice owners, we often have this resistance to sales and marketing. We think we’re going to provide high quality-of-care and evidence-based practice, then just grow by word-of-mouth referral. But we need to be getting out there and educating, building marketing systems, teaching and inviting. The reality is that marketing is just educating people in your community and showing them how you can help solve their health problems. 

Most people equate marketing with paid marketing and discount advertising. That’s just a small piece. The majority of your marketing should lead with education.

2. Avoid Discount Advertising

Tens of thousands of providers are offering deep discount advertising on a regular basis. This is not a cost-effective marketing strategy. Why? Most often, patients that come in because they saw an ad for a discounted service are not the people that are going to stay, pay, and refer. They are deal shoppers. And what do deal shoppers do? They shop for deals! So when they take advantage of that offer, you’re going to notice that there’s a small percentage of them that actually stick around. You’re going to get dramatically fewer visits from someone who comes in from discount advertising compared to someone who comes in through educational content. In most cases, Jeff recommends sticking to the teach and invite methodology over discount advertising.

When IS it okay to offer discount advertising? If you’re doing it to keep your doors open in the short-term, that may be appropriate for you. Or, if you’re already doing everything else right, and you want to sprinkle on some discount advertising, that’s fine. But Jeff recommends first leverage free or lower cost options. This includes marketing to past and existing patients, teaching and inviting, and leveraging retargeted online advertising. 

3. Create Monthly Recurring Revenue

There are ways to create monthly recurring revenue and this is a great way to diversify your income stream. You can make your practice more durable and less vulnerable. The goal is here to create monthly recurring revenue that meets your minimum viable monthly expenses each month. If you can have recurring revenue that meets your expenses, working in your practice becomes a lot more fun and way less stressful. 

This does not mean changing your business model or giving up patient care. This is about diversifying income streams, reducing stress and increasing revenue in a patient-centric way. Dr. Jeff and his business partner Jason identified three primary ways that most clinicians can implement this in a way that makes sense:

  • Provide ongoing services

    This can look like a monthly movement assessment, a monthly check-in, or any type of maintenance care that makes sense for you. After your patients complete their plan of care, have them check in with you once a month. A majority of time this is warranted and is not overtreating. Your patients come in because they have a problem and they come back for accountability. It’s better for the patient and better for you. Many of us have movement-based facilities that can be leveraged for a monthly check-in, but most of us don’t do it. A monthly check-in is a great way to increase patient visits and create monthly recurring revenue.

  • Open an e-commerce store

    Sell items that supplement your services. Supplements are a great example of what you can sell in an online store. We know that between 50 to 70% of people going to conservative care providers take supplements each and every day, whether its a multivitamin, Vitamin D, Omegas, etc. Other options could include exercise props, therapeutic heating/cooling devices, ergonomic products for sleep or work as examples. The key here is to create auto-recurring revenue is to have an online store that drop-ships direct to your patient. This way, you don’t need to have the inventory and utilize space in your clinic. Better for the patient, better for you.

  • Offer online coaching

    This could look like anything from telehealth all the way up to lifestyle coaching. For many providers this may feel like very new territory, but there’s an avenue there to create monthly revenue by providing value on an ongoing basis. This can be leveraged at scale online. You can create courses that can be sold online without actually requiring significant amounts of your time on an ongoing basis.

Summarized Marketing Tips for Physical Therapists and Chiropractors

Practice owners wanting to grow revenue and help more people in their community can start by: 

  1. Consistently engaging your past and existing patient database. Lead with patient education. Teach and invite. 
  2. Avoid overusing discounts in your online advertising. 
  3. Come up with a strategy to create monthly recurring revenue. 

Would you like to be able to automatically create educational campaigns for your patients and community, without much effort? Patient Demand software can help. 

See How It Works. 

 

How to get more patients: Fix your funnel. Get more patients out of your advertising spend.

Recently, Breakthrough Co-Founder Chad Madden and Customer Success Manager Daniel Mina hosted a webinar on the biggest marketing mistakes made in private practice physical therapy and chiropractic clinics. And how to get more patients by fixing a leaky funnel. 

The majority of practice owners — although they often don’t know it — are losing money spent on marketing. Usually, the culprit is not the marketing tactics themselves. The mistake is in not setting up and maintaining an ineffective follow-up process on marketing leads. This mistake creates a leaky funnel. 

What is a Leaky Funnel?

A leaky funnel is the secret killer of new patient opportunities. In a perfect world, when you get a new patient inquiry (whether through online advertising, referral, your website, etc), someone follows up with that lead by phone within several minutes of the patient inquiry coming through. The person handling this could be your front desk or office manager. If they’re adhering to best practices, they have a good conversation with the individual and follow up as many times as necessary (up to seven times) until that lead comes in for an initial patient evaluation. It’s then your clinician’s job to sign them up for a plan of care. 

The marketing funnel is how a marketing leads becomes a paying patient in a physical therapy or chiropractic clinic.

But what happens when this process is not followed closely? You start to get leads falling through the cracks — your funnel becomes leaky. While a lot of practice owners *think* this process is working perfectly for them, they lack the visibility to know that something is wrong. They end up missing out on a lot of patient opportunities. For most, something is going wrong at some step of that process and this creates a leaky funnel. We frequently see practices that don’t realize they have a problem!

The fact is, most practices generate  leads that never get followed up on. Some leads get followed up with too late, and some aren’t followed up with enough times. Ultimately, an ineffective follow-up process produces numerous drop-offs amongst would-be patients. 

What’s the Impact of a Leaky Funnel?

By now, you probably get the message: A leaky funnel is incredibly common and most practice owners don’t know it’s a problem. You could be losing out on dozens of patients each month and not even realize it. 

If you have a leaky funnel, you’re wasting money and getting a lower return on investment (ROI) on your marketing spend. Plus, you hurt your own brand reputation by not following patient inquiries all the way through to a plan of care. Those leads may go elsewhere to your competitors. Worse yet, those would-be patients of yours never get treated and their problem gets worse until they need surgery, injections, or pharmaceuticals. For the sake of your practice and the community you serve, it’s important to be able to identify and fix a leaky funnel. 

How Do I Know If I Have a Leaky Funnel? 

As a practice owner, it may not be obvious that you have a leaky funnel. It’s unlikely you get into the weeds around tracking leads and their follow-up. Most practice owners have poor visibility into metrics around lead follow-up. They’re usually not involved in lead follow-up on a day-to-basis. And if your team is working out of spreadsheets, it’s near impossible to pull out  learnings from the data. 

There are warning signs you can watch for to help identify a leaky funnel. Here are the warning signs to watch for, and helpful tips for fixing your leaks:

  • If the front desk or marketer seems busy and has a very hard time keeping up, then make sure you have a clear process for following up on leads. 
  • Alternatively, it may seem like things are in control, but if there’s no accountability for those who are following up on leads – or if you don’t measure this – then follow-up can often be delayed or skipped completely.
  • Best practices are for your marketer to follow up on a lead within a few minutes of lead creation by giving them a call.
  • Many leads that could be patients never convert if you only call leads a couple of times before giving up. Inefficient processes like these result in a lower ROI on your marketing spend.

How to Get More Patients: Fix Your Funnel! 

Most practices miss out on potential new patients by thinking their funnel ends when an individual in need responds to an ad. But conversing with potential patients, giving them workshops or assessments, and reviewing the results are also crucial steps toward enrolling patients or members.

Poor calling practices reduce the number of appointments scheduled from a given number of leads. Poor follow-up processes reduce the share of scheduled appointments that are kept. Some owners think email blasts are enough, but email is for driving patient interactions – not for sending people to the homepage of your website for the first time. 

What Your Staff Needs to Know

  1. Follow-up conversations turn interested individuals into actual leads.

    Do confirmation calls within five minutes of signup. If at first you don’t succeed at connecting, keep trying! Seven attempts is the power number, so aim for that. After 7 failed tries, connection becomes very unlikely. But hit ‘em hard in the first few days following their signup, and be sure to use multiple channels – like text, phone, email – for best results.

  2. Never say “If…” on a follow-up call.

    From hundreds of hours of call tracking data, we’ve identified a key trend that does NOT perform well. Ending on “If” statements. What we’re talking about are statements like: “If you’d like to schedule an appointment, just let me know.” At the point that “If” statements are used, a lead has typically already inquired about your practice and demonstrated interest. So instead of saying “If you’d like to come in,” you can assume they want to schedule an appointment. 

  3. Have Patient-Centric Follow-up Calls.

    What should you train your staff to say instead of ‘If’ statements? After a short introduction, ask your potential patients questions about them and their pain. What’s their health concern? How long has it been going on? What have they tried for treatment? Patient-centric conversations turn leads into patients; talking about how great your practice is doesn’t. After plenty of discovery questions, your caller can ask, “Do you want to get that taken care of?” “When’s a good time to start the healing process? We have time on Monday at 11am or after 3pm, what time works for you?” 

  4. Use Initial Evaluations and Free Screenings as a Conversion Mechanism.

    The goal: to raise awareness and increase patient respect for the treatment plan. A killer exam begins by asking what their pain is stopping them from doing. Next, consider their history, including whether they’ve had PT before. Then test, treat, and re-test their issue. Help them understand the cause of the problem in lay language. Afterwards, formulate a treatment plan agreement, along with a financial plan and schedule for their treatment. Track who among your staff is best at converting new patients at this stage, so you can work to get your whole team to that level.

How Breakthrough Can Help 

Breakthrough offers a complete, all-in-one Patient Demand Platform that empowers practice owners and their staff to:

  1.  Attract patient leads through proven, top-performing marketing campaigns 
  2. Track leads through the funnel and easily identify stages of the funnel that need improvement. Plus, access hundreds of hours of training content to help your staff more effectively turn leads into patients.
  3. Gain visibility through measurement and intuitive dashboards.  Do more of what’s working and less of what’s not. 

A patient demand platform is the simple, repeatable way to consistently grow your practice by attracting leads, converting patients, and measuring success.

How would you like to have a team of experts audit and fix your funnel to fill up your practice?  

Request a free consultation today.  

 

How to get more patients with Google advertising and YouTube ads. Physical therapy marketing to get more patients. Chiropractic marketing strategies to get more patients.

Do Google and YouTube Ads Work for Attracting Physical Therapy and Chiropractic Patients?

Whether you’re a private practice physical therapist or a chiropractic clinic owner, you need to get more patients coming into your practice on a consistent basis. Consistency is the key. The alternative — busy periods followed by significant slow-downs — is simply not sustainable. Whether caused by seasonality, macroeconomic conditions, or changes in your marketing, this type of rollercoaster scenario makes financial planning for the future nearly impossible. 

Online advertising can help bring stability to your practice by increasing demand for your services in your community. Regardless of how marketing savvy you are or aren’t, you can get started with Google advertising and YouTube ads to reach people in your community who need your help. These platforms offer some of the most effective marketing plays available to you today.

Getting Started with Online Advertising 

Advertising can be overwhelming at the beginning and does require some management and upkeep. You can reach a massive audience with the click of a button, but it will burn money very quickly if you aren’t careful with your targeting. 

In this article, we will share do’s and don’ts of online advertising to help you get started. We’ll go over why you might choose one platform over another. Our focus will be on two of the biggest advertising platforms: Google Ads and YouTube. They’re both owned by Google, and they leverage respectively the largest and second largest search engine in the world. 

Hundreds of millions of people visit these websites every day, and among them, those who need your services. Thus, knowing when and how to use these platforms will give your practice a consistent patient flow. That way, you can focus on growing your business, rather than hunting for patients.

How to Choose Your Advertising Platforms

Picking the right advertising platform is a challenge in itself. Choices abound, and all of them offer powerful features that make reaching the right people a breeze. 

What you want from an advertising platform is:

  • People who need your service
  • Targeting option that lets you connect to these people
  • Reach them when they are interested in buying from you

The first step in choose where to allocate your marketing efforts is understanding who uses these platforms, and how

Let’s take Facebook for example. It is very likely that at least some of the people on it need your service, if not now in the future. But most of them are scrolling their feeds looking for entertainment. They will see various ads during their scrolling, but they probably aren’t looking for a solution to their problem while on Facebook. 

These people might notice your clinic’s ad, and even take a mental note of it, but the chances of them scheduling an appointment through a Facebook ad are lower than other platforms. Unless you are doing retargeting advertising on Facebook, this audience will likely be less familiar with physical therapy or chiropractic care. 

In contrast, someone conducting a Google Search for ‘chiropractic care near me’ indicates a much stronger awareness level and demonstrates higher intent to move forward with care. 

YouTube is similar to Facebook in that people use it primarily for entertainment. But it has advantages, such as being video-based. Videos tend to be more memorable than image or text. 

All three platforms can be effective tools for advertising your practice. To learn more about Facebook advertising, check out our earlier post on Facebook Marketing Strategies.  

Read on to learn more about how to get more patients advertising on Google and YouTube.

Why Advertise on Google?

Google is the world’s biggest website. With 45.41 billion monthly visits (November 2021), you can expect basically the entire population to use it. Between 90% and 95% of online searches are done through Google. 

But the wide reach isn’t the main reason we suggest using Google Ads. What makes this platform so valuable is how you can target keywords that highlight a specific intent. For example, when a user types in the search bar “physical therapist near me” you know that—most of the time—they are looking for a PT to visit them.

Compare this with TV or Facebook advertising. You’re interrupting people’s activity (enjoying a movie or scrolling through their feed) to market your service. People who see these ads most likely don’t need your services at the moment, so you won’t see much new business as a result.

Not to say that these advertising methods don’t work, because they do; they just achieve different goals. 

With Google Ads you can reach the people who are looking to buy, and present them the solution they need. 

Why Advertise on YouTube?

YouTube is a completely different beast. It’s the world’s 2nd most used search engine, with over 126 million unique users just in the United States. 

Advertising your clinic on YouTube offers a unique set of advantages over other platforms:

  • Videos are more memorable than text or images
  • It’s cost-effective
  • People can see who is actually going to take care of them
  • People can get a feel for the experience they’ll get in your clinic

Advertising on YouTube is also more challenging than on other platforms. Good videos are harder to produce, but this is an advantage if you think about it. How many other clinics are willing to invest into video production? You have way lower competition on YouTube.

Common Advertising Mistakes 

Creating performing ad campaigns is a mix of art and science. It’s also quite complicated when you’re a beginner, but even beginners can start seeing results by knowing common pitfalls of online advertising.

The most common advertising mistake we see happen over and over is a lack of direction. We’ve seen clinics set campaigns that target everyone, and therefore they ended up targeting nobody. 

You need to know exactly who your ideal customer is, and how to best reach them. When you’re creating a campaign, do it with a specific target in mind. Targeting everyone will exponentially increase your costs and make you miss on a lot of clients. 

The second most common mistake we see is making the ads all about you/your service. People don’t really care about you or your clinic. They have a problem and want it solved as quickly as possible. Writing patient-centric copy is crucial to get people interested in your service. If you’re doing video ads, then start with a strong hook, don’t try to sell your service immediately.

Last, we see people who don’t test new ads regularly, or who give up too early. Your first few ads will most likely perform poorly, you need real world data to adjust your messaging and see what resonates with your patients. 

This might seem complicated at first, but creating an advertising campaign that gets you sales is easier than you think.  

How to Get More Patients: Online Advertising Best Practices

If you want to build a campaign that will grow your practice, you need to follow a few simple steps:

  • Spend a lot of time on keyword research: Keyword research is the most important step in creating online campaigns. Put yourself in your patients’ shoes. What would someone with their issues search on Google/YouTube? And of those searches, which ones are likely to bring you a sale? For example, if someone types “why does my back hurt” they’re most likely looking for exercises, not for a physical therapist. If, instead, they type “who can fix back pain” they’re way more likely to click on your ad.

 

  • Use geo-targeting: A person who lives far away from you is unlikely to come to your clinic. Keep the advertising targeted around you. Also think of what issue you’re dealing with. Someone with knee pain would rather get to the closest physician possible, and someone with shoulder pain would most likely avoid driving. 
  • Set up a sales funnel: Ads are only a small part of the customer journey. You can’t rely on them entirely. Make sure you have a system that takes people from not knowing you to becoming a loyal customer of yours. Your ads should get people to your clinic, and once they’re there, get them into an email/texting funnel. Another thing to consider is retargeting: not everyone who clicks on your ad will buy immediately, but if you keep poking at them, eventually they will. 
  • Tailor your messages for your ideal customers: You can’t please everyone. When you write your copy or video script, make sure it’s custom-made for your ideal customers. Don’t use generic ads like “We’re the best clinic in [location]”. Think about your customers: what do they need help with? Always create your ads with your ideal customer in mind.
  • If you follow all of these steps, you’ll create a strong marketing campaign that will bring in leads. But you must be careful, as Google’s ad guidelines are way more stringent when it comes to healthcare.

How to Avoid Setbacks and Ad Rejections

Google has a strict set of regulations regarding healthcare advertising. And every ad that doesn’t follow these regulations gets rejected, losing you money and visibility. 

Before publishing an ad, make sure it follows these guidelines. The main things to keep in mind are:

  • You aren’t allowed to hint at knowing the user has a certain medical condition, as it’s private data. Even if Google knows it, it can’t use it to target these people. Avoid asking things like “Hate your [condition]? Here’s how to treat it”.
  • You can’t promise results. Even if you are 100% certain your treatment will solve the user’s pain, you aren’t allowed to say it. You can say you’ll help them with managing pain, or with alleviating the symptoms, but 
  • Do not, under any circumstance, mention chronic medical conditions. Words like diabetes or cancer should never ever appear in your ads.

An important thing to note is that Google, unlike Facebook/Instagram, also scans your landing page (where users end up when they click your ad) in your ad’s evaluation. This applies to everything in your landing page, including testimonials. So, make sure your landing page also follows these guidelines.

How to Turn Advertising Leads Into More Patients

Once the right people have interacted with your ad online, they’ll schedule an appointment with your clinic. This is where your staff’s qualities have a chance to shine. People will get to your clinic, and interact with your front-office and doctors. 

You want your physicians to be top-notch and care for their patients. If a patient feels like they’ve received great treatment, they’ll gladly come back. They’ll also tell their relatives and friends about you. 

Want to create a constant patient flow through online advertising? Request a demo today to harness the power of online advertising and marketing automation.

 

What to know about the No Surprises Act and Good Faith Estimates. How to prepare for medical audits.

No Surprises Act, Good Faith Estimates, And How to Prepare for Audits

In a recent podcast episode, Breakthrough Founder Chad Madden, MSPT speaks with Mary Daulong, PT, CHC, CHP, President at Business & Clinical Management Services, Inc. (BCMS). Chad and Mary discuss what you need to know about the “No Surprises Act” and Good Faith Estimates. Mary and her team have worked hard on providing resources to help PT practice owners comply and thrive in the new regulatory landscape. 

Who is Mary Daulong?

Chad: Mary is the Queen of Compliance. She has more than four decades of private physical therapy practice experience. And I want to compliment and thank you for keeping us legal, compliant, and ethical.

Today, we’re talking about the “No Surprises Act,” which became effective as of January 1st, 2022. It’s being discussed in all of the online group forums at essentially every physical therapy or healthcare provider website that I’m on. There’s a lot of confusion about this new legislation amongst owners. Can you give us a summary of what it is?

Part 1 of No Surprises Act: Disclose Out-of-Network Charges at In-Network Care Facilities

Mary: Well, the “No Surprises Act” was a surprise, right? When it was first contemplated, it really was to protect patients from having “surprise” bills. Say they went to an in-network hospital for surgery, but there was an assistant surgeon or maybe an anesthesiologist there who wasn’t in-network. And as a result —surprise — the patient gets billed at out-of-network rates. That’s what part one of the “No Surprises Act” addresses, and I’m in favor of that. But it has kind of ballooned from there.

Part 2 of No Surprises Act: Application to Private Physical Therapy Practices

Mary: The idea in itself is good, but the dispute resolution system really doesn’t lean towards the provider. So if the patient complains about the bill in this process then you have arbitration, where someone decides what the fair amount is that the patient should pay. And that doesn’t always turn out to be favorable for the provider, as you might guess. Also, we have a lot of PTs who are out-of-network because they accept cash, and we don’t have any clarification about whether this will implicate them, but it could.

On “Good Faith Estimates”

Mary: This is the part where we’re all pulling our hair out and saying, you gotta be kidding me. Recently, I got a text from one of my dear clients that said, “I’m just going to sell my practice. I provide the services, I do the billing, I do all the administrative tasks. I can’t add this to my things to do.” And we’re hearing this all over. People are very frustrated. 

So, what does it mean? Basically, therapists have to tell patients who are uninsured—as well as those who are insured but choose to self-pay—what our best estimate is for how much the service is going to cost. And because we have repeat services, that makes it very, very complicated.

How to Make this Information Public

Mary: One thing we do know absolutely for sure is that we have to post a notice with all the information about good-faith estimates, timelines, and dispute resolutions. And that’s the easiest thing we have to do. The notice needs to be posted in your clinic in a prominent area, where a patient would be likely to see it. It needs to be posted in areas where you collect for services rendered or do billing. And it needs to be posted on your website. (CMS provides a standard form for good-faith estimates here and details on what should be included in the notice here.)

Chad: What exactly does the notice need to say? 

Mary: The notice is for people who are uninsured or who were not using their insurance—with the exception of federal payers. It basically says that we’re required to tell them what the services for episodic care are expected to cost. I’d suggest basing it on a plan-of-care period, because you might change things at that point. And you can certainly charge them less than that. But you have to tell them that if the estimate is exceeded by $400, they have a right to dispute it. And you have to tell them how to dispute it, and who to contact. So it’s a simple notice; that’s the most clear thing. What becomes unclear is it doesn’t apply to patients who have benefits with federal payouts.

So as healthcare providers, we have to post this notice in all our clinics. It should be in the waiting rooms with licenses or certificates of occupancy or something like that, in prominent display. If you’re an owner and you don’t have it, you can contact BCMS for a template. Medicare also has a template on its website. So you can go to cms.gov and they have a “No Surprises Act” webpage and their own template as well. Number one on everybody’s checklist is we have to get that done.

How to Train Your Staff on the No Surprises Act

Chad: The next thing is that we really have to train our staff, especially reception. If somebody asks how much this is going to cost, we have to be able to tell them.  Regardless of whether they’re in-network or out-of-network. Is that true?

Mary: That’s right. First, we ask if they’d like to file insurance. If not, we’re required by federal law to give them a good faith estimate for the services that we would render for this condition.

Chad: At my practice, we’ve been doing cash pay. I’m guessing our rate is exactly $100. It might be $104. And we’ve always said, $100 per visit. Is that sufficient? Or do I need to say, you’re coming in for an ankle sprain, and that’s likely going to be six visits, so $600. Or: you’re coming in for a whiplash injury or something like that, and that’s going to be 16 visits, so that’s $1600.

Mary: Right. They created “required elements” for the good faith estimate form. So what you have to do is tell them how much it’s going to cost. If you’re flat-fee, or if you do fee-for-service, or whatever, you’re going to have to make sure your estimate gives you enough latitude to not go over by $400. On the form we have, it will give you some options. The thing is, you have to identify what you’re doing. This is the hidden consequence that we’re going to have to deal with. For years, we’ve tried to discourage third-party administrators and payers from saying they’re going to authorize X number of visits or X number of CPT codes. Are we supposed to always have a crystal ball to know exactly how we’re going to treat them? We don’t, so that’s problematic for sure.

Good Faith Estimates Should Mirror Your Plan of Care

Regardless of how you’ve set up your estimate, you’ll have to do some prognosticating about what you’re going to need from the patient. So the more inclusive you are, the better. But the important thing is that the good faith estimate really mirrors your plan of care. If they’re going different directions, that’s a problem. And if you decide the patient isn’t responding well, and you want to change things dramatically, then you have to go back. But if you’re under your estimate, that’s not a problem.

When you evaluate somebody, that’s when you determine how you’re going to treat them. So it necessitates two good faith estimates. There’s one for the evaluation, and then you have to create another one because you have to give it to them in advance of treatment. Now, is there a consequence for not giving it to them in advance? If the patient says, “I want to be treated right now,” then it shouldn’t be a problem. Also, we don’t know yet what the penalties are because they’re not anywhere to be found. We don’t know if it’s fines, penalties, or administrative sanctions. But it’s the law, so we have to comply.

Show Intention to Comply

Chad: In your SIPA summary, you mentioned the importance of the intention. As business owners, we need to show that we’re attempting to comply with the law. What do you mean by that?

Mary: Well, there are some providers who totally defy what’s logical. When HHS tells you what should be in the notice and you choose not to include it, that’s pretty purposeful. You have to tell the customers that there’s a dispute resolution if it goes over by $400, and that applying for this costs $25. Those things have to be in the notice, or else you’re not compliant.This is especially for all of those who have been audited or are thinking that they want to protect themselves.

Green Envelopes: What to Do When You Get an Audit

Chad: So let’s switch over to the Supplemental Medical Review Contractor (SMRC) audits. What is that?

Mary: The notice comes in a notorious neon green envelope. Typically, it comes in the middle of an episode of care. It’s not uncommon for auditors to request one day to service records, maybe 30 or 40 charts. We’ve been flooded with people asking what to do for their initial evaluation.

Chad: Got it. So I get one of these fluorescent green envelopes in the mail. What should I do?

Mary: First, pull up all the resources in the SMRC packet. It tells you exactly what to do. We have one that says how to respond to a payer’s request for records. It’s quite lengthy, but it has some graphics, so it’s not terrible reading. Do not throw the envelope away. Read the letter, then read the letter again. Look at who’s sending it to you. Go through the SMRC packet step-by-step. You want your submission to be organized, legible, and easy to follow.

At BCMS, we produced a template for a table of contents. We have a template cover letter and a form for identifying the billing personnel they asked for. We also have provided some clips from the Medicare benefit policy manual that says we don’t have to have long-term goals. If you need further support, you can email Alicia at [email protected]

Chad: Mary, Alicia, and the BCMS team have put together other training sessions for you that are highly recommended on billing and coding, and also on documentation. So if you’re looking for any of the resources that we’re talking about, you can email Alicia and she can set you up with that. And if you  contact Alicia, they’ll also get the FAQ for the SMRC audits, which is pretty extensive.

What’s Changes Can We Expect in the Future?

One final question for you here. And thank you for extensively reviewing the good faith estimate and also the SMRC audits, because I know a lot of owners are paying attention to those two things right now. Is there anything else in store for us as private practice owners in 2022 that you see coming down the pipe? Is there proposed legislation or anything like that on your radar right now?

Mary: Well, we all know the PTA payment differential is a killer, but I want to tell you, it’s not going away. Sorry if I’m the fun sponge on this, but our colleagues, the nurses, PAs, all of them have been dealing with this for years, if not decades. So it’s going to be very hard for us to say, “hey, this shouldn’t apply to us.” 

So let’s put our endeavors where we’re gonna get the least resistance. Let’s get rid of the plan of care certification. Let’s get general supervision across the board. Then we won’t have problems with somebody signing something that they’re not enrolled in. I’d encourage everyone to look at some of those important things. That’s my little soapbox.

Chad: I appreciate the look into the crystal ball, Mary, and into what’s coming down the pipe for us in the future as private practice owners. Another quick reminder: if you’re looking for any of the resources that Mary mentioned in this episode, you can email Alicia Mahoney, at [email protected]. You can also check out the BCMS website, BCMScomp.com. 

Well, Mary Daulong, Queen of Compliance, thank you very much for being here and helping us as private practice owners.

Looking for more resources to help you manage your practice? Visit Breakthrough’s Resources Hub for free content on marketing, hiring, financing, and more.

PT marketing strategies to fill your new hire's schedule

Conquer hiring fears with PT marketing strategies that create a steady stream of new patients.

As a Private Practice Owner, there are several tell-tale signs when it’s time to hire. 

  • You consistently have a full patient load
  • Or you spend all your time treating and not enough time working on your business
  • You may even have a waitlist (this could mean it is far past-time to start!) 

Yet even when the signs are apparent, many practice owners still harbor doubts when it comes time to hire. 

You may wonder if you can attract enough clients to your clinic. Or think that your patients have grown attached to you and your current staff. That they wouldn’t want to be treated by someone new. You may fear the costs of hiring would exceed the increased revenue.  

Many practice owners experience these fears of expanding their business. But there are plenty of successful practice owners who are able to grow, hire, and expand each year. Their secret? Implementing effective systems and repeatable processes to consistently produce a steady stream of new patients. 

In this article, you’ll get a blueprint for how to never run out of patients. The strategies in this article will help you consistently attract patients, scale your business, hire more, and keep growing your practice. 

Once you build a system that works for consistently getting more patients to your clinic, you can hire without fear. You can even open new practices and use the same tactics to grow them.

The State of PT Hiring in 2022

Before diving into PT marketing strategies, let’s look at the the hiring landscape for physical therapists now and in the future. 

At the macro level, an aging population and advancements in medicine are helping people live longer. This creates increased demand for physical therapy and other types of conservative care. Physical therapy is also becoming more accessible as more states open up for direct access

As a result, The APTQI estimates that the US will need 27.000 new physical therapists by 2025 and the Bureau of Labor Statistics projects that by 2030, there will be a 21% growth in PT job openings. Currently, there are around 13,000 people graduating with a physical therapy degree in the US annually. 

What does this mean for your practice? A couple of things:

  • The demand for physicians will keep growing for the foreseeable future. 
  • Because of increasing demand, the job market will become very competitive (it already is). Finding new hires that fit your needs will get harder.
  • With increased demand, salaries will go up. This means that each clinician you add to your staff is more valuable than they were a year ago.
  • A competitive job market means you’ll have to attract the best clinicians. You’ll face stiff competition by the hospital system.

How to Compete in Today’s Hiring Market

The key here is to make your practice an appealing place for people to work. More patients equals the ability to deliver higher salaries and better benefits. A demonstrable track record of consistent patient demand will show potential hires that they’ll have job security. You also want to be able to paint a clear picture of future growth. This motivates future and current staff members. 

Being able to quickly and consistently attract patients and fill a new hire’s schedule helps make your practice attractive to potential hires. In fact, you should start attracting new patients even before onboarding new staff.

When Should a New Hire Have a Full Schedule?

The timeline for having a full schedule for a new hire depends on various factors, like your practice’s location and popularity. Many successful practices follow a timeline such as this: 

  1. 90 days before hiring: If you’re not already at full capacity, this is a good time to implement a patient demand system to create a steady stream of patients for your new hire. A patient demand system includes solutions for marketing across platforms such as online advertising, email automation, and two-way texting.
  2. First 90 days after hiring: Once you’ve hired someone, it usually takes about 90 days to fully onboard a clinician.  This includes getting the PT used to their operations, acquainted with the front office, and taught to deliver the standard of care expected from the clinic. It’s normal to have a new PT work at lower capacity during this time.
  3. After 90 days on the job: After this first probation period, the new hire should be working at full capacity (or close to it). They should be integrated with the system, and visit as many patients as possible. A great way to structure your staff’s schedules is to have experienced clinicians seeing existing patients, and to fill your new hire’s schedule with new patients from cold traffic. 

PT Marketing Strategies for Attracting a Steady Flow of Patients

You have way more control over the client acquisition practice now than in the past. Back in the day, clinics relied on word-of-mouth and referrals to keep their practices working. These tactics are great to keep in the mix, but should not be relied on for all of your business.  

Nowadays, a complete recipe for growth goes beyond referrals and word of mouth. It includes a plethora of channels and tactics for reaching potential customers, including online and offline strategies. 

Typically, growing practices should budget around 10% of revenues for marketing. Marketing includes strategies to engage existing and past patients, such as automated email blasts, two-way texting and direct mail. It also encompasses advertising (both online and offline) for cold traffic. You can advertise online on platforms like Facebook, Instagram, Google, YouTube. A comprehensive direct-to-consumer marketing strategy should also include automated lead management and follow-up to ensure a strong ROI for your ad spend. 

 Creating a Successful PT Marketing Campaign

It may feel a little overwhelming at first, but with the right processes and system in place, you can generate a constant influx of patients. You can avoid the dreaded feeling that you are continually reinventing the wheel each month by implementing plug-and-play campaigns that repeat throughout the year

Here is a 5-steps process for creating a successful marketing campaign:

  • Start by defining your audience. For example, if your clinic serves an older demographic, you’ll want to focus on means of communication favored by older folks. Things like snail mail and phone texts can yield amazing results for you. Conversely, younger audiences are easier to reach with digital marketing. 
  • Your messaging should be patient-focused. Most of your patients don’t know what latissimus dorsi is, or that they have tendonitis. They know they have pain, and only care about fixing it. And that’s how your marketing messaging should be. Make it patient-focused by using everyday language. 
  • Identify the channels you’ll start testing for both cold traffic and past patients. Different media types can be appropriate for different stages of the patient journey. For instance, Facebook and YouTube ads are great for cold traffic. They help educate a large, unaware audience that you have a solution for them. Google is more appropriate for advertising to a more aware audience that is already looking for physical therapy clinics in their area. Email, direct mail, and two-way texting are great tools for engaging past patients. 
  • Design a compelling offer. “Attend a workshop on solving back pain.” “Give the gift of a free screening to a friend or family member.” “Schedule an appointment easily online.” These are examples of call-to-actions, or compelling offers, that you can promote in your campaigns. Each campaign should highlight one clear call-to-action. For cold traffic, workshops are an incredibly powerful offer to promote online. This strategy lets you showcase your clinicians’ expertise on the workshop’s topic. Instead of telling people you can solve their health issues, you get to show them. And you enhance efficiency by driving multiple potential patients into your clinic at once. 
  • Measure how your campaigns are doing. Set targets for each of your campaigns, and ways of tracking how they are doing. This is all data that you’ll use in the future to refine your marketing strategies and prove ROI. A patient demand software like Breakthrough will have easy-to-understand reporting and dashboards built-in. 

Patient Demand Systems for Consistent and Predictable Growth

You can’t rely exclusively on referral marketing anymore. If you want your practice to thrive and grow, you must build a system that takes people from being unaware of your services to paying customers. 

In marketing speak, this is called a funnel. Patients are either unaware of your service, aware of it but unsure if it’s the right one for them, or ready to buy. The perfect marketing system gets people from all of these places, and gently accompanies them to the bottom of the funnel, which is purchasing a care plan. 

That’s why here at Breakthrough we built an all-in-one platform that does the heavy lifting for you. Its beauty lies in how it sustains itself. It starts by giving you the right tools, like our powerful online advertising tools and done-for-you campaigns to attract clients to your practice. Then, through email automation, two-way texting and lead management tools, it converts them into paying customers. This process generates lots of data you can then use to optimize your messaging throughout the customer acquisition process and beyond.

Do you want to learn more PT marketing strategies for consistently increasing patient growth? Request a demo today. 

See how our platforms can help you create a self-sustaining marketing system that makes filling a new hire’s schedule easy. 

Breakthrough Marketing Technology

Get More Patient Visits and Make Life Easier on Your Staff

Running your own physical therapy practice is extremely rewarding, but also challenging. Caring about patients is only  part of the business. You have to hire the right staff. Build a profitable business. And to do all of that, you have to consistently attract patients. Physical therapy marketing technology can help. 

The name of the game is no longer about physician referrals. Nowadays, people are searching for healthcare services online. It’s the perfect time to establish your online presence and use the power of physical therapy marketing to grow your practice.

Make marketing technology work for you. Leverage automation to improve your processes, so your team can spend less time on activities like following up with leads, and focus more time on delivering the best possible customer experience.

In this article, we are going to see how marketing technology can impact your business, and why you should embrace technology to increase your staff’s efficiency.

Identifying the Right Technology for You

Technology simplified our life, and keeps simplifying it with each passing day. What once took lots of people and inefficient processes can now be automated. Automatic systems aren’t prone to error—unlike humans—and free up people to work on higher value tasks.

You have likely had both good and bad experiences implementing new technologies in your practice. Learning a new system takes effort, and some are overly complex and time-consuming. One good rule-of-thumb for avoiding this problem is to identify technology that is designed specifically with the physical therapy practice in mind. These technologies have the best chance of integrating seamlessly with your existing processes and operations. 

So what can technology do for your practice? 

5 Benefits of Using Marketing Technology in Your Physical Therapy Practice 

There are 5  main benefits to using marketing technology to increase your business’ efficiency:

  1. You attract more patients

Technology simplifies the customer’s decision making process. If I have some sort of pain and I’m unsure if I should bother getting it checked out, the last thing I want to do is call 4 different practices to figure things out.

But if I regularly see educational advertisements from your practice about my condition, then I know to think of your practice when I’m in pain. I will think of you as the authority on the subject, and look up your practice when in need. 

Relying on a single channel—be it referrals or ads—is risky. You never know when it will stop working. But with technology, you’ll build up multiple acquisition channels. 

Make it easy for people to find you and get an appointment, and you’ll notice that your practice will grow on autopilot. 

2) You convert more leads into paying patients

Nobody likes calling a physical therapy practice and finding a busy landline. People are used to setting up appointments online, where they can see a range of available hours. That way, they don’t have to plan their day around the visit but can pick a time that works best for them.

Plus, calling comes with other inefficiencies. Your front-desk operators could make mistakes when writing down customer information, or the call could drop at any moment. These moments are extremely frustrating for all parts, but technology like two-way texting can help you avoid them. A study conducted by Avochato showed that across all generations over two-thirds (69 percent) of respondents would prefer an unfamiliar company to contact them via text rather than a phone call. Research shows that 3 out of 4 consumers actually get frustrated when they can’t text a business back. 

Imagine what could be possible with technology like an automatic messaging system. For example, a patient could call you, find a busy line, and get a text that suggests visiting your site to schedule an appointment. These types of process improvements can go a long way in helping get more patients in the door.  

3. You can centralize lead and customer data

What we’ve seen from businesses all over the country, is that most are quite disorganized. They have customer data scattered through emails, drawers, and Excel sheets. That’s fine when you’re just getting started, but it gets confusing real quick.

This is particularly important in physical therapy marketing because your messaging determines how well your ad campaigns will perform. And it’s impossible to get the messaging right without in-depth knowledge of your customers.

But with technology, you can centralize your data in a single hub. No more wasting time and energy combing through your records to find your customers’ information. With Patient Demand Software, you can see all your leads with actionable guidance on who to follow up with and when. Your front desk will be grateful for this.

4) You gain a better understanding of what’s working and what’s not 

Phone calls and traditional flyers have a huge weakness. They don’t give you any data on their effectiveness. Digital marketing solutions like ads and patient demand platforms solve this issue by giving you ROI intelligence and metrics tracking. Clear insights into marketing and staff performance allow you to ditch the spreadsheets and see the performance of your marketing efforts all in one place. 

5) You improve employee satisfaction and make it easier to hire

Aside from preventing mistakes, your front desk operators have more intellectually stimulating tasks to do. Starting at spreadsheets all day is mind-numbing and time-consuming. It’s also a low-value activity that lowers their productivity. 

Is your front desk spending most of their time on the phone booking appointments? That could easily be improved with technology. 

Use QR codes to get people to book appointments from you. Redirect people to your website when you can have online forms to automate data collection. Automate Insurance eligibility verification.

All of these activities are performed by front desks of inefficient practices. But with a little investment in the right technologies, you can get computers to perform then. This will lift a huge weight off your front desk’s shoulders.

Since these people are the face of your practice, you want them to always be in top shape.

By automating processes, you free up lots of time that your staff can spend on more fruitful activities. They’ll also be more satisfied with their work because you’ll have lifted them from tasks that nobody enjoys doing.

The Big Picture: Why Technology Matters

Implementing a solid physical therapy marketing strategy will make your practice thrive. You’ll be able to open more offices, add more clinicians, and improve your practice value. There is something special about seeing your business grow. 

You’re not only improving your patients’ lives, but you’ll also make your employees’ lives better. Everybody wins.

Technology, if used well, will drastically grow your practice. You can improve your services, attract more people who can benefit from your services, and streamline your processes. But, the key phrase  is “if used well.” You need everyone who works in your practice to understand the advantage of using technology, and must be trained accordingly. 

For physical therapy practices, technology can be looked at as a tool to improve your patients’ lives. If your patients are satisfied, they’ll gladly suggest your clinic to their peers, and become your best marketers.

It’s an investment for the future. Technology will turn your clinic into a sustainable business that grows on autopilot. 

Are you interested in giving your business the boost it deserves? Request a demo today, and see how Patient Demand Software can help you make your practice thrive.

 

Mike Fink on what to look for when hiring an entry-level DPT, and the latest advancements in physical therapy research, including the evolution of manual therapy

Plus, the Latest Advancements in Physical Therapy Research

In a recent podcast episode, Breakthrough Founder Chad Madden, MSPT speaks with Mike Fink — Physical Therapist, CMPT, and Department Chair at Lebanon Valley College. In this conversation, Chad and Mike discuss the latest advancements in physical therapy research, the evolution of manual therapy, and what to look for when hiring an entry-level DPT.

Who is Mike Fink?

Chad: Mike and I have been good friends now for the last 13 years. He is the Department Chair Head of the Physical Therapy Program at Lebanon Valley College here in Central Pennsylvania. We also work together at Madden and Gilbert Physical Therapy. Today we’re going to talk about the latest in physical therapy research, specifically around the evolution of manual therapy. And since Mike teaches DPT students, I’ll ask him about what practice owners should know about hiring entry-level DPTs and what to look for.

But first, can you tell everyone about yourself? I think our audience would find your background in the military really interesting. 

Origins as a Physical Therapist in the Military

Mike: Sure. I’ll take you through a brief history of my Air Force career. I first graduated from Thomas Jefferson University in 2000, then joined the Air Force after graduation. I saw a benefit to serving my country as well as being a PT in the military, and heard the military was where you can grow as a physical therapist. There’s a lot of autonomy and you get to treat patients at the first point of care. 

So I was stationed  in California at the Travis Air Force base, and eventually deployed in Iraq. It was in that arena that I realized the value of manual therapy and hands-on care, and what physical therapists can offer as that first point of care. I was the only physical therapist in a base population of about 5,000 airmen, soldiers and sailors. As the single busiest provider at the camp, I saw more patients than any other healthcare professional, including the surgeons and physicians. 

After my deployment, the military offered continued education. I went to the West Point Sports Medicine Residency in New York, and from there was stationed at the United States Air Force Academy in Colorado Springs. 

Chad: So you were in Colorado Springs and I recall in the early days when we were talking, you said you would walk in at 6 in the morning and there was a line of like 35 waiting to be seen by you. You also mentioned the significant autonomy that you have as a physical therapist within the air force and the armed services. Then you rejoined civilian life and private practice. What were some of the major differences between working in the military and working in private practice? 

Differences between military PT vs. private practice PT

Mike: Okay, so I think one of the biggest differences that I saw was in the mindset of the other clinicians in the private practice sector compared to those in the military. 

In the military, I was used to having a lot of autonomy and responsibility, and that was the mindset of other clinicians too. When I came to the civilian sector and private practice, I saw that not everybody wants that level of responsibility as a professional or believes in the value that they could bring to patients soon after injury. I think they hadn’t realized that job satisfaction increases when you have more responsibility and can see positive patient outcomes. 

By the way, almost everything that’s coming out of the latest literature shows that the sooner we as physical therapists can treat after the point of injury, the better the outcome. So that’s what we always want to do, is get close to the point of injury. 

The evolution of manual therapy 

Chad: As we’re now 20+ years into our professions, I know we’ve both seen a lot of change. I’m not sure what amount of manual therapy training that you had at Thomas Jefferson, but as for me and my peers, we didn’t get a lot of manual therapy training in college. What changes have you seen over the last 20 plus years within physical therapy education and the services we provide? 

Mike: Chad, I’m much like you. I did not have a lot of manual therapy coming out of a physical therapy school.  Most, if not near all of my manual therapy training came through the military. Historically, before you or I graduated, manual therapy had a pretty significant place in physical therapy. However, I think many of the individuals that were leading the way in manual therapy really put it on a pedestal, and made traditional physical therapists feel like it was almost unattainable without decades of practice. That was part of the problem.

Because of this, many physical therapists felt like we had enough other resources that could get patients better and could get away without it. Then we realized we gave away the golden ticket and we needed to bring it back. Today, we’re still evolving our understanding of manual therapy. A lot of the research that’s come out is around how we pick the right technique for a particular patient.  

Chad: That’s great. So there’s a more developed and mature decision tree today than we had 10, 20 years ago. 

Mike: Absolutely, yes.

The latest advancements in physical therapy research

Chad: So the other thing I want you to talk about is the trends you’re seeing from the latest research. I know you do quite a bit of research yourself. How has physical therapy research evolved and where is it going? 

Mike: Okay. The latest research today is looking at manual therapy, its immediate and long-term effects, and the difference between those. But more importantly, how do we select techniques to yield the best outcome? That has created a whole generation of what we call clinical prediction rules. How do you select the right patient, how do you select the right treatment and match those two together? That’s where the research is right now. We have a lot of great clinical prediction rules that lead us down that pathway of what the best technique is for any given patient. 

And when we’re looking at most clinical prediction rules, they have one common criteria: The time from onset of injury or onset of symptoms and time of treatment. Meaning patients have better outcomes with hands‑on care manual therapy, if it’s closer to that onset point. So that really plays into the argument of why direct access is so necessary because direct access saves us time. It helps us get closer to treating soon after the onset of injury. 

Hiring challenges

Chad: That’s a great overview of the latest research and the overall evolution of manual therapy. The other thing that I wanted to ask you about is hiring entry-level DPTs. A lot of private practice owners are really struggling with hiring right now. It’s a real problem. We have a shortage of workers across the board but particularly in healthcare. Moving forward, demand for physical therapy services is increasing greater than the supply of DPTs that are graduating.

So, I know you understand both the private practice sector as well as the educational sphere, and you interact with students every day. Can you help us tap into their minds? What we should be looking for in an entry level DPT? 

The disconnect between PT clinicians and academia 

Mike: Yes. So there’s two mindsets that are usually on polar opposite sides of the spectrum that create this lack of communication between private practice and academia. There’s the private practice clinician who thinks that academia is full of out-of-touch professors that live in an ivory tower. And they’re teaching things from this textbook as their tech level, but they have no understanding of how the rubber meets the road. That’s one side.

The other side is from the professor side that says, “Oh, the clinician is just worried about one thing, the almighty dollar. They’re not worried about treating patients; they’re not looking at research. They’re still the dinosaur running off what they learned 20 years ago.”

It’s this opposition that keeps people from coming into conversation with one another. So what needs to happen is to bridge that gap between private practice and academia. There are ways to build that relationship, rather than work in silos and wall yourselves off from each other.

Bridging this gap will help you attract new DPTs to your practice. Many clinicians are lab instructors or TAs, so they’re embedded into the academic system. And if you have any individuals that have any interest in that, I would encourage you to foster that connection because that can be your hiring pipeline. 

I always tell students, “Many of you will work for companies that are staffed by your instructors. And what you don’t realize is that you’ve been going on a three‑year interview where your future employer saw your true colors, your work ethic, and your intellect.” Making inroads into academia is a great way to build relationships with future DPTs. 

What should practice owners look for when hiring an entry-level PT?

Chad: Very well said. So if I’m an employer and I’m going to hire a DPT, how can I evaluate their manual therapy skills?

Mike: I have very strong thoughts on this, as I do with many things, Chad. The first thing is to ask them about their program’s curriculum itself, and where manual therapy was introduced. What you want to see is that it’s introduced in the earlier stages. That’s because when hands-on manual therapy is introduced earlier, there’s less fear of it. We’re seeing that this new generation doesn’t fear it like our generation did. 

So the question that I would ask would be, where is it layered into the program? Earlier is better. It’s also a good idea to test their skills, because manual therapy can mean different things to different people. It’s an umbrella term that can be anything from massage type strokes all the way to thrust techniques at the cervical spine. So what level of manual therapy have they been taught? It’s a good idea to actually test their skills on this.  

Manual therapy certification and courses

Chad: Great. So Mike, I know you actually offer various manual therapy courses. Do you have any manual therapy courses coming out? 

Mike: Yes, we do. We are filling up for the spring, but we have our cervical-thoracic level 1 and 2 courses, along with our lumbar-pelvic level 1 and 2 courses. We have upper and lower extremity courses as well. These courses funnel into a certified orthopedic manual therapist certification. What a lot of practice owners like about this is it creates a level playing field for their clinics. So rather than having one therapist’s schedule be super full and in-demand while another is lighter, these courses help create parody so you can universally fill schedules.

Chad: What’s the best way for somebody to get in contact with you or learn more about those courses? 

Mike: You can find them on Breakthrough’s manual therapy course list, or you can reach out to me by email at [email protected]

Chad: Thanks, Mike. You’ve covered a lot of ground from the whole scope of manual therapy and how it’s evolved over the last 20 plus years, to what employers should look for in entry-level DPTs. Thank you!

2022 medicare reimbursements and guidelines

CMS Releases the 2022 Fee Schedule and Final Rule

Earlier this month, CMS published the final 2022 fee schedule and complete final rule for Medicare payment policies. Chad Madden, Breakthrough cofounder, teamed up with Mary Daulong, President and CEO at Business & Clinical Management Services (BCMS) to discuss the new rules shortly after they were finalized, on a Live Q&A with hundreds of private practice owners and therapists. 

This article summarizes a number of questions and answers that came up around the fee schedules and new 2022 Medicare rules. We have been inundated by questions on Medicare PTA reimbursements, Medicare PT guidelines, and more upcoming cuts and implications. 

If you’re in the process of planning for the impacts of the 2022 Medicare cuts, check out Breakthrough’s 2022 Planning Tool for Private Practice Owners. As private practice owners, it’s important to regularly assess the financial health of your practice and identify strategies to increase top-line revenue. Use this tool in your annual planning process to develop strategies that will boost profitability in spite of declining reimbursements. 

We held a webinar recently that covered a number of user questions and had a really great turn out. Take a look at the replay below:

Q: What are the key changes in the 2o22 fee schedule and final rule?

A: Here’s the big picture:

  • PTs will see ~3.7% reduction in payment and OTs will see ~3.9% reduction in payment.
  • PTAs using the CQ modifier and OTAs using the CO modifier will see a 15% payment reduction
  • PTAs and OTAs may be virtually supervised using A/V communications until 2023.
  • Remote Therapeutic Monitoring (RTM) codes can be billed by physical & occupational therapists, nurses, etc.
  • Therapy KX Modifier Threshold = $2,150 PT/SLP & $2,150 OT.
  • Medical Review Threshold = $,3000. Hitting the threshold does not provoke an audit automatically – they are looking for aberrant billing behavior.
  • MIPS changes: Multiple adjustments to the program, but they re-established Q 154 Falls Assessment.

Q: What is the order of payment reductions on a claim with the CQ or CO modifier? 

A: For the therapy services to which the 15% reduction applies, payment will be made at 85% of Medicare’s (80% payment). This is based on the lesser of the actual charge or applicable fee schedule amount for claims with a CQ or CO modifier. The beneficiary’s co-insurance is deducted after the application of the MPPR to the PE Payment for all “always therapy” codes. The 2% sequestration reduction is always applied last.

Q: Regarding Remote Therapeutic Monitoring…can patients self-report their medical data? What about non-physiological data? 

A: Yes, patients can log their own data into RTM portals using a medical device. Patients can report non-physiological data such as their home program compliance, pain level, medication, etc.

Q: Do we still have the direct supervision rule where a PT has to be present in an outpatient private setting? 

A: The physical therapist is required to be onsite with the PTA as part of the Direct Supervision rule in a private practice under Medicare. During the pandemic, therapists were granted a form of “general supervision” which allows audio visual supervision as an alternative to direct supervision. General supervision is expiring at the end of 2022, meaning the A/V supervision option will be eliminated and therapists in private practice will be required to utilize “direct supervision” i.e., on-site. Changing this rule would require legislative action. 

Follow and support the bill for PTA/OTA General Supervision, called the HR 5536 “SMART” ACT. Write and talk to your congressman about it. It makes no sense for therapists in private practice to be held to the direct supervision requirement, while other comparable settings have general supervision prerogatives.

Q: How many evaluations can we bill in a year? What length of time? ex: every 30 days, 60 days etc. 

A: There are multiple considerations to keep in mind, including:

  • What does your Practice Act state regarding the therapist’s responsibility/requirement for evaluating new patients and/or conditions? If it stipulates specific requirements, those must be followed regardless of payment for services.
  • An evaluation or reevaluation is required by Medicare if the patient presents with new conditions or diagnoses. These can impact the Plan of Care Goals and Treatment Plan and should be performed and billed accordingly. Medicare typically expects a change/modification in an existing Plan of Care if an Evaluation or Reevaluation is billed. Of course, recertification of the new Plan of Care is also required.

Q: We’ve noticed that the G0283 CPT code is being denied as not medically necessary. Is this a trend for the future? Is there some other way we should be billing this code? 

A: The G0283 modifier is not a bundled code, so that is not the problem. Have you affixed the appropriate other modifiers i.e., GP or KX, if applicable?

Some Medicare Administrative Contractors (MACs) have Local Coverage Determinations (LCDs) that limit the frequency of certain modalities. Visit your MAC’s website to see if there is an LCD for Physical Therapy/Therapy Services.

There is no other way to bill G0283, and doing so could constitute a False Claims Act violation. Always bill according to the CPT code’s definition.

Q: If the owner/PT signs all notes, will there be any reductions for PTA’s?

A: An owner or other therapist cannot circumvent the intent of this rule by signing notes for services performed by a PTA/OTA. If the owner is not the person providing the service, that could become a False Claims Act violation. There is CQ or CO exemption by cosigning for services provided by an assistant. 

If the PTA treats the patient, you must comply with the regulation that specifies when the CQ or CO modifiers must be used. There are a number of scenarios that are included in the Medicare Physician Fee Schedule Proposed Rule (July 2021) which you can reference. 

Q: What is Locum Tenens? 

A: Locum Tenens (Fee-for-Time) is the use of a substitute provider to cover for an enrolled provider in his or her absence in specific situations. There is an important bill on the Hill entitled Nationwide PT/OT Access to Locum Tenens, S2612 & HB1611, which we encourage you to support. 

Access to Locum Tenens would give therapists the ability to be in compliance with Medicare rules in situations where they need someone to cover for them. Just like any other type of provider, therapists run into situations where they have emergencies, personal matters, or are short staffed, and have to get another therapist to provide care to active patients. Today, therapists don’t have that prerogative. If you’re using a PRN therapist who is not enrolled and you choose to bill under someone’s number who is not the providing therapist, you have a potential False Claims Act violation.

If this bill goes through, therapists would be able to utilize another therapist who is not enrolled in Medicare. The clinic would bill under the therapist being replaced and would pay the locum tenens therapist for the time or per visit. If you’re using a PRN therapist who is not enrolled and you choose to bill under someone’s number who is not the providing therapist, you have a potential False Claims Act violation.

Q: If the Access to Locum Tenens bill goes through, will it be available for Medicaid as well?

A: We don’t know. Medicaid has state policies, and those policies have to be dealt with on the state level. Policies can vary from state to state and that may be one area that may not follow Medicare coverage policies.

Q: What is the status of Sequestration going into 2022? Will the sequestration be reinstated?

A: Sequestration is a 2% reduction in payment that has been mandated since 2013. It was suspended during the pandemic, but yes, it will eventually be reinstated. It is legislatively required and would take congressional action before 2022 to be halted. 

Q: What if you choose to go non-par w/ Medicare and/or refuse to see Medicare patients? 

A: You can choose non-participation, but you still must be enrolled in Medicare. Therapists do not have the prerogative to “Opt-Out” of Medicare. You can either enroll or not enroll. If you are enrolled, you can participate by accepting assignment of benefits. If you choose not to participate, you are choosing not to accept assignment, but you still must be enrolled and file claims for the patient. Under non-participation enrollment, you may bill up to the limiting charge, which is 15% more than Medicare. In order for that to work, you have to be prepared to collect cash at the time of service. 

Those therapists with cash-based practices typically have a population of patients that are willing and able to pay cash upfront. In the non-participation situation, the patient will get reimbursed at 95% of the Medicare allowable within a few weeks of claim submission by the clinic. Remember, they will also be paying up to the additional 15% allowable upcharge. 

The success potential of choosing to be a non-participating provider is slim if your practice serves patients on a fixed or limited budget. The result of electing this payment strategy will limit patient access due to financial constraints. 

Q: Is there any update from Medicare and/or other commercial or federal payers regarding covering telehealth (or virtual visits) for PT?  

A: Today, telehealth services provided by therapists are allowed through the end of the year in which the year the pandemic is declared over. Since the Public Health Emergency was extended on October 15th, telehealth services by therapists will be permitted through 2022. If there is no congressional action and the pandemic is declared over in 2022, therapists will no longer be able to provide services via telehealth in 2023. We are not statutorily listed as telehealth providers. 

Q: Does the Emergency Regulation Requiring COVID-19 Vaccination for Health Care Workers apply to outpatient clinic employees, regardless of # of Employees? If so, does it apply to ALL employees, regardless of contact with patients?

A: What we know right now is that OSHA’s COVID-19 Vaccination Emergency Temporary Standard took effect upon its publication in the Federal Register (November 4, 2021). Employers must comply with most requirements within 30 days of the publication and with testing requirements within 60 days of publication. Employees will have the option of vaccination or weekly testing. There are medical, religious and other exceptions. Employer fines for non-compliance are massive.

Unsure how to plan for 2022 given the looming reimbursement cuts?

Download the 2022 Planning Tool for Private Practice Owners.

breakthrough employees Jordana Knoblauch

Get to Know Breakthrough Employees

Meet Jordana Knoblauch, our Strategic Account Manager and Queen of Questions (she always asks the best ones).

Q: What is your job at Breakthrough? 

A: I’m the Strategic Account Manager for existing customers who want to explore new products and opportunities, such as beta programs and expansion to other locations. I help facilitate those conversations. I also work to identify which customers are high adopters and which ones are lower. To help turn low adopters into more active users, I share best practices so they can get a high return on investment. 

Q: Tell us about you and your background. 

A: I’ve been on the Breakthrough Team for two and a half years. I’m from Canada and have a background in Finance and Marketing. Out of university, I worked at a SAAS company in sales, and quickly became a sales manager overseeing a sales team. This was a fantastic experience, but one thing I missed in that role was having a long-term relationship with customers. I would build up great rapport with a customer during the sales process, and then have to pass them off to the customer success team. It made me realize that customer success might be a better fit for me, because it would allow me to build long-term relationships. 

Breakthrough was my first experience with customer success. I loved it! Now, the company has empowered me to grow into a role where I am both supporting customers and identifying expansion opportunities for them. It’s the perfect mix of what I’m good at and what I enjoy. 

Q: What’s different about working at Breakthrough compared to previous employers? 

A: Its leadership team. The amount they care for the employees and the level to which they involve us in the strategic vision of where we’re going is unlike anything I’ve experienced. They ask for our opinions and involve us in the process of designing and implementing the company’s strategic initiatives. There’s a lot of business transparency. They’re upfront with us about where we’re missing the mark and where we’re killing it. 

Another thing is the flexibility and trust the company offers the Breakthrough team. You can really design your schedule in a way that works best for you so you can have work-life balance. As long as you’re hitting your metrics and getting your work done, leadership across the board wants you to be happy and live the life that works for you- whether you want to work remote from Turkey or work as a night owl!

Q: What are the most exciting trends you’re seeing in the field of healthcare SAAS and marketing? 

A: The most exciting trend I see is private practices becoming less reliant on physician referrals. Working with customers, they’re typically highly reliant on physician referrals when they start with us. Like 90% of their business is from referrals. A year or two into working with us, they start to say, “Wow, I’m now only 30% reliant on physician referrals.” They feel like their destiny is within their control rather than at the beck and call of someone else. Plus, we enable them to focus on their speciality and become known as a local ACE (Authority, Celebrity, & Expert) for that niche. 

We have a dialed-in system of how practices can become profitable in the first year, and it works. I’ve had multiple practices launch new clinics and they’re profitable in the first year. That’s almost unheard of without our marketing.  

Q: Any advice for younger professionals in this space? 

A: Some advice for students of all ages – get involved in your local community. This helps you build great communication, networking and leadership skills. For example, I was a student leader for 3 out of the 5 years that I was at university. I learned a lot of my communication and leadership skills there that I apply to my career today. 

Q: What would you want our customers and partners to know about Breakthrough? 

A: We’re more than just workshops. Breakthrough brings a LOT of value to practices you might not think of, such as discounted rates with other vendors we have partnerships with. Or access to our community where you can learn the good, the bad, and the ugly so you don’t have to make the same mistakes as others.

We create processes and standardization within your clinic so you can scale and have a consistent plan to execute against, and you’re not just shooting from the hip. And we help you utilize your biggest asset, which is your past patient list, something a lot of people don’t leverage. When we help customers tap into this list, there’s an immediate value we bring that’s usually a “WOW!” moment. 

Most importantly, when it comes to our customers, they should know the engagement for us is not just a business transaction. They’re true partners in helping us “flip the pyramid” of healthcare. The Breakthrough team truly cares and wants to help them overcome anything they’re struggling with so they can get big wins.