3 Tips for Getting the Most Out of Your Online PT Workshops

In-person workshops have proven to be the most effective way of converting the general public into direct access patients. 

During the COVID-19 crisis, many owners in the Breakthrough community have experimented with online PT workshops. Making the switch from in-person to virtual workshops isn’t as simple as you might expect, but the results have been similar. 

Here are some ways you can get the most out of your online PT workshops to make them even more successful and worthwhile:

1. More Engagement = More Appointments

Engaged audiences are more likely to become patients than passive participants. 

But holding someone’s attention is much easier when you are giving a presentation in front of them, face-to-face. With virtual workshops, attendees are at home watching on their computer screens and only one click away from checking social media or otherwise being distracted.

Giving simple directions like “Look at the screen” during your presentation can recapture their attention and pull them into what you’re talking about. Give them directives and keep them in the moment. 

2. Stick to the Format

It’s easy to go off course in an online workshop, which is why we recommend sticking to a format that logically moves you through each part. Download the free Online Workshop Template to discover a proven format for structuring your physical therapy workshops.

Practice it to get comfortable in teaching an audience that isn’t right in front of you. 

3. Focus on Your Final Five Minutes

No matter how long your workshop is, the last five minutes are always the most critical, as you’re giving your audience the call to action to move forward with you. The CTA should be clear so that people go right into scheduling an appointment with you.

Make sure your “next step” is congruent with the online format and avoid asking attendees to do anything that would require them to leave their computer. 

Other Ways to Set the Stage for Success

There are several moving parts to conducting a successful online workshop, and knowing these parts can help you get one step closer to your goal.

First, you need to have people in pain watching your workshop. This is where strong workshop marketing skills come into play. If you don’t have the right audience in seats (or the right eyes on your presentation), you’re not going to get the results you expect.

Second, you need to know what to say that’s going to trigger conversions. This is different from in-house workshops. It takes more engagement, more interaction, and more conversations to help people feel safe enough to come in for an appointment.

Also, you need a follow-up sequence to follow up with people who didn’t schedule an appointment right away. Again, this looks a little differently than it does for in-house workshops because it all takes place online. 

And finally, you need to understand the right levers to pull to get the most engagement from your workshop. 

If you’re like most practice owners, online workshops are new to you and you may be wondering how to get started.

That’s why we created a free Online Workshop Template that shows you how to create a presentation that will maximize conversions. At Breakthrough, we’re purpose-driven and want to help people get back to a pain-free life naturally, and the best way to do this is through private practice owners like you. 

Download the Online Workshop Template to get started today!

[Video] Using the “Scorecard Method” to Guide Your Hiring Process

Improve your management style, get your team aligned on goals, and create more time freedom when you start using scorecards as part of your hiring process.

Click here to grab a free copy of the scorecard used in this training. 

A scorecard is a personnel tool that you’re going to use in all of your personnel decisions. Hiring, incentivizing staff, firing, promotions, et cetera. 

Everything revolves around the use of this tool. 

Growing your practice beyond a certain point requires having the right team members on your staff. Autonomous, solution-oriented employees who get stuff done without hand-holding and micromanaging. 

Problem solvers who are fun to work with and who help your business hit new milestones and revenue goals. 

The ability to effectively hire is a skill most Practice Owners overlook. But its a skill that differentiates owners who are constantly stressed-out, overwhelmed, and time-starved…

From owners with an enviable level of time-freedom and the ability to take time off from their practice WITHOUT everything falling apart. 

The training above contains my “Scorecard” Method for hiring and managing PT staff. 

If you want to attract, train, and motivate rockstar private practice employees…

Who take problems off your plate and make life easier for you…

Then be sure to check this out.

And also download a free scorecard template to use at your practice. 

The State of PT During COVID-19

In the past, we’ve discussed the state of PT and our aspirations to Flip the Pyramid and make conservative care the first choice for people in pain – ahead of injections, medications, and surgery.

But the current state of PT looks a lot different than it did just a few months ago due to the COVID-19 pandemic and the chaos and uncertainty it’s created in the world.

The truth is that similar events and challenges have occurred throughout history. Case in point: just 12 years ago, the financial crisis of 2008 hit and shook PT practices everywhere. At Madden PT, we were already battling encroachment from HOPTs and POPTs practices and ended up losing $98,000 in a single quarter. Back then, we were focused on physician referrals, but that crisis made us realize the need to diversify our income and create systems that would put us in a much better position during a future crisis.

Understanding these events can help us to better shift our thoughts and behaviors that will allow us to thrive now and in the future.  

Exploring the Transition Curve

In the past, PT owners have typically followed a transition curve, where we start our PT practice with uninformed optimism that turns into informed pessimism when something goes wrong or business doesn’t come as easily or quickly as we’d hoped. Soon after, a crisis of meaning follows, where we explore what we really need and want from our practice. This leads to either crashing and burning or informed optimism, in which we are more aware of what it’s going to take to be successful and have new hope for the future of the practice. 

PT during Covid

But today, the transition curve looks much different. We’re now on a cycle of market emotions.

But now, just within the last week, we’re starting to see the bounceback. Patients are trickling in once again. They’re wearing masks and acting with caution, but we’re finally starting to see some hope for normalcy. 

Learning How to Pivot (and Pivot Quickly!)

Just two months ago, our goals at Breakthrough looked drastically different than they do now. As a rule, our goals have always been to help private practice PT owners become successful while helping our own patients get back to normal naturally and make PT the first option they think of when they’re in pain.

We haven’t lost sight of those goals, but we immediately shifted our focus so that we could help other owners and the PT industry at large survive this crisis. We’re doing this by focusing our content and training on things to do during the pandemic, such as where to turn for financial relief and how to stay connected to your team and patients (even if you’re not treating them at the moment). 

Just like we have four seasons in a year, we also have four “seasons” of the economic cycle in a given year. And it’s important to understand these seasons so that you can be in the best financial position when the market starts going up again. There will be an “end” to this pandemic, and when that end finally comes, PT owners should be prepared for the rebound.

The State of PT and the One Goal to Set Moving Forward

Bob Kowalick from Revenue Cycle Solutions shared some interesting stats with us recently on the financial state of private practice. His research found that about a third of practice owners are not in a financial position to survive this crisis. They’re in the same boat with about 43% of small business owners throughout the country that are saying they’ll likely not be able to reopen their doors when the pandemic is over. 

For PT owners, avoiding this situation might mean not taking a salary for a little while. You still need a staff, a facility, and a way to pay for these things, so you might have to make the ultimate sacrifice. 

Kowalick also found that almost half of owners only have a partial financial bridge. Of those, the majority are about 5% off their goal. If they need $50,000 in total to make it through, they are likely just $2,500 short of their goal. Some may be able to cut enough corners to come up with what they need, but if you can’t, your goal should be to do what you need to do to get into this next group of owners—the 19%.

Roughly one in five owners have a clear financial runway to the end of this crisis. Those 19% are at a major advantage because they’re going to be able to advertise and gain market share when the majority of their competitors cannot. They’re going to be in a better position to rebuild and hire the best staff and continue to grow their practice, both now and when the pandemic is over. 

For the remaining 81% of owners, it should be the goal to become among the 19% that can weather tough storms like COVID-19 and be in a better position to continue growing. 

For us to do this during the financial crisis of 2008 and the following months, we shifted our focus to three things:

  • Marketing direct to the consumer to become less dependent on physician referrals
  • Learning how to influence your payer mix and build a financial bridge
  • Building a better culture through personnel

When the pandemic conditions started rising earlier this year, these are the same three things we focused on. That’s because physician referrals have been in a tailspin, along with declining reimbursements. And since many people aren’t hiring right now, we’re using this opportunity to attract top talent to the practice to create an optimal patient experience.

PT practice owners can put these same ideas into motion to become one of the 19% (and ideally turn that 19% into 100% by the next time crisis strikes). To start, you need to know where you are right now, then understand where you need to go. 

We have tons of resources available at Breakthrough University that can help you take the necessary steps to connect your present situation to your ideal destination― learn more about Breakthrough University today.

[Video] Attracting New Patients with Online Workshops

This video is for Private Practice owners looking for strategies to get new patients in the current market.

Social distancing and quarantine measures mean that hosting in-person workshops isn’t an option for most practice owners.

And even as more and more states open back up, it will still take time for the general public to feel safe in group settings.

At Madden PT, my team and I have been experimenting with virtual workshops. The process was modeled after our traditional in-person events, and we invited people from our social media and email list.

We had about 60 register, and from that we had 10 people sign up for an initial evaluation.

I know a lot of owners are considering hosting online events, so I decided to create a short video training to share my tips for getting the best results from this new style of workshop.

I’m also making my Online Workshop Presentation Template available to download for free.

[expand title=”Click to Read Full Video Transcript”]
Chad Madden:
Hey, everybody. Chad Madden here with Breakthrough. This is simply attracting new patients with online workshops. This is specifically for private PT practice owners who want to grow in today’s marketplace with everything that’s going on right now. So essentially, we’re taking the offline, the in-house success that you’ve seen hundreds of owners do, all 50 States, 12 countries internationally, and we’re taking that and transitioning it to an online format to adapt with the times and be able to continue to attract new patients that need our help.

Chad Madden:
So some quick success here. You can see Luke and Ashton down at Texas adapting this already, and then in Michigan, Andrew Gorecki, Andrew applied this, did the online workshop, ended up with 17 free assessments. And by the way, Andrew is a pioneer in this, adapted very early on, took this, ended up doing his own stuff and did really well. So, our hope is that you can get the same exact thing out of this.

Chad Madden:
The purpose and our purpose here at Breakthrough is to help people in pain get back to normal naturally. The best way for us to do that is to work with practice owners like you in your community and help you do these online workshops. So, this workshop deck, where they call it a deck because it’s like a deck of slides, was designed with the same, exact six-step process that I personally use in my own online workshops. And another big point that you should realize is online workshops are different than in-house workshops. For example, we’re going to talk about engagement. Right? When I’m doing an online presentation, I can’t really see what my audience is doing. They could be texting on their phone, they could stand up and go to the bathroom, and come back, and I would never know that. Right? They could be watching a TV program with, I’m in the background. That’s not the case with an in-house workshop.

Chad Madden:
So, we want to be able to change our strategies for online workshops because it truly is different than hosting an in-house workshop or a live workshop. And also, I have training for you which will help you get the most out of this tool in your online workshops. We’ll talk about that here in a minute.

Chad Madden:
So, three tips to get the most out of your online workshops. Number one, we talked about this already, but more engagement equals more appointments. So, very important that you’re bringing people back to the screen. Pay attention to this, write this down. You’re giving them directives in terms of, basically, paying attention. And when you do so, when you get them to share, you’re going to be able to schedule more appointments. We learned that… Significantly, it was a huge change from our first workshop to our second.

Chad Madden:
Number two is it’s going to be easy to deviate when you have online, when you’re doing an online workshop, maybe you get lost in a story or something like that. You want to stick to this exact format that I’m showing you here. Six steps, very, very simple, and most importantly, in sticking to the format is you want to focus on and pay attention to, you want to practice this the most, what you say in the last five minutes because that is the thing that you must nail. You can’t deviate and go into answering questions at that point. You have to have a very call to action so that people are going right to scheduling an appointment.

Chad Madden:
And when I taught in-house workshops, and we’ve been teaching that for the last five or six years, again, with hundreds of owners from everywhere, when we’re teaching that, we talk about the last five or 10 minutes is the most important point. It’s even more so. It’s even more accentuated right now. There is more stress on this in an online workshop than there is in-house, and it was the most important thing, the primary thing to practice and focus on. And in an in-house workshop, it’s even more so important right now.

Chad Madden:
There’s some other things that you need to be successful. I’m going to give you four other steps here. Number one, you need people in pain that are actually watching your workshop. Right? So, you have some workshop marketing where, when we were doing this in house, it was called Butts in Seats. Right? Getting people in the room? Right now, you want eyes watching your presentation. Right? You want people watching your presentation.

Chad Madden:
Number two, is you want to know exactly what to say to increase engagement into conversions. It’s different than in-house workshops, especially during this time. We call it, the pay line has been pushed back. So in an in-house workshop, 60 days ago, 90 days ago, people would register for the workshop, and somewhere between 10% and 25% would schedule an appointment and a plan of care before the workshop even happened. That low hanging fruit is not there in these times right now. We pushed the pay line back. It’s going to take more engagement, more conversations for people to ultimately feel safe enough to come in, regardless of the area of the country that you’re in.

Chad Madden:
Also, you want a follow-up sequence after to convert those who did not schedule right away. That’s really, really important. And also, there are three key levers that you should be pulling to get the maximum leverage out of your workshops. And if you’re not doing these, yes, you can run an online workshop. You can check the box, but pretty good chance nobody’s going to schedule. You want to make sure you’re pulling these three leavers so that you’re getting the most out of your workshops.

Chad Madden:
What I’ve done for you is I created a special training called, How to Deliver an Online Workshop that Converts. And in this, we’re going to be talking about how to market your workshop. By the way, we have the former head of online Facebook learning, who actually worked for Facebook, walking you through this in addition to her, Kathy Borkowski, she’s also sharing and presenting with you in this training with Carl Mattiola, the co-founder here at Breakthrough who was the head of online sales at Tesla. So, they have huge experience there marketing your workshop. That is in this course, avoiding the most common work workshop mistakes. We talked through that as well in this training. And then a step-by-step guide and presentation so you know what to say and why you’re saying it for maximum conversions.

Chad Madden:
Now, normally, we would sell something like this for $500. We’ve sold trainings like this for a thousand dollars or more. But because of the times, because we want you to succeed and remember we’re purpose-driven, so we want to help people in pain get back to normal naturally. Again, the best way for us to do that is to work with you. Dedicate a private practice owner who’s helping people right now. So, we want to give this to you for free, and it’s free for everybody that joins Breakthrough University. What is Breakthrough University? It’s training and content, and it spans your entire organization.

Chad Madden:
The key thing here is that it’s not outdated, ivory tower philosophy, it’s not theory. This is what is working right now in the trenches of private practice PT. Just like you saw Luke, and Ashton, and Andrew sharing their wins of people that are implementing and applying right now. It’s the same thing here. It’s training and content that is up-to-date. This is what is working today. We have that for you at Breakthrough University. You also get access to a community of like-minded private practice owners. And right now, in this group, there are over 1300 owners, again, from all 50 States, 12 countries internationally. I know we’re all different. We all feel like our business is unique. However, whatever stage of business you’re in right now, there’s likely somebody in your area already learning in there and sharing, and they’re likely at the same stage that you’ve been at. Right?

Chad Madden:
So, you can find people that are at the same stage as you, whether you’re a startup or whether you’re a private practice vet, you’ve been in there for four decades. Or, there’s likely somebody that’s in your same marketplace or a similar marketplace like you somewhere else in the country or even somewhere else in the world. There’s also accountability. We have these inside circle implementation calls where we hop on with a group of owners, and we help you implement whatever it is that you’re stuck on. So again, they’re called the inside circle calls.

Chad Madden:
And in the big picture of marketing, what we’re really trying to do is we’re going from a trickle. We’ve all at least been affected in some way by our current crisis and situation, right? So we’re going from a trickle, and we’re rebuilding to a flood. There is an exact sequence of how we do that. And workshops are actually step number four. And online workshops fit in there as well. So, realize that this is part of a bigger picture for you, and we want to make sure you’re able to fill in all those gaps and ultimately, get the most out of, not only your online workshops, but be able to grow and leave an impact in your area, again, far beyond, far stronger than what you were before this crisis. Right? So, very cool stuff there. Again, this is Chad from Breakthrough. Thank you for watching, and I’ll see you in the next video.


How Private Practice PTs Can Help More People During The Pandemic

On a recent Breakthrough webcast, we talked about flipping the pyramid in the healthcare industry to capture more of the spend on health services.

Right now, about 72% of what’s spent on healthcare each year goes to surgery, injections, medications, and diagnostic imaging. Just 2% goes to physical therapy, occupational therapy, and speech combined. We want to be the number one skilled healthcare expert of choice, and to do this, we must become the foundation of skeletal and neurological health.

The recent pandemic has thrown a monkey wrench into this mission. Many practices are seeing declining appointments and revenues, which means you may not be helping as many people as you can. But if we’re going to push the PT industry forward and continue our greater objective to help people get back to normal naturally, we must survive the current crisis.

Let’s look at how you can do this on three different levels and be better prepared to help others:

Step #1: Managing Yourself

There’s a reason why airline companies tell you to put your own oxygen mask on first in the event of an emergency. You can’t help others if you’re not in a position to first take care of yourself. 

The times we’re living in are unprecedented. Many of us are experiencing extreme levels of stress and added worry about the future. It’s changed our entire way of living, even if it’s only temporary. If you’re not taking care of yourself first, it can put you in a dangerous position if you try to reach out and help others.

Right now, there’s a common fear of what this increased isolation will do to us as a society in the long term. Some people may not be mentally handling these changes well. The best thing that each of us can do is take care of ourselves so that we can continue to reach out and be valuable to others:


Matthew Walker’s Why We Sleep is an excellent resource that talks about how sleep is a daily detox of the brain and the way it affects the rest of your health. Ideally, you can use this extra time away from work to catch up on sleep and build healthier sleep habits.

Eat Well

Prioritizing the right foods can help us take care of ourselves for the short and long term. Some resources to check out are The Switch, Boundless, and Peter Attia’s podcast.


Exercise and nutrition go hand in hand for a healthy lifestyle. Take this time to build more exercise and movement into your day, even if it’s “just” walking. At the very least, it can help combat the effects of stress eating.


Finding clarity and making mental space in your day can help promote positive feelings and crowd out any stress caused by the coronavirus. 

Socially Distance But Stay Connected

Socially distancing yourself doesn’t mean you have to cut all forms of communication. Stay connected with your employees, family, and even your patients via text, Zoom, phone calls, or social media to maintain the human element.

Step #2: Managing Your Family

We’ve talked about this before at Breakthrough, but if you’re not taking care of your family, you won’t be able to handle the highest responsibilities of being a practice owner. 

Staying on a schedule can help everyone in your home maintain a sense of normalcy. Also, showing your spouse, children, and even parents your love and gratitude can make a difference in the dynamics within your home. Gary Chapman’s The Five Love Languages is a powerful resource for helping identify ways in which we give and receive love that is well understood by others.

Step #3: Managing Your Business

When you and your family have put on your oxygen masks, you’ll be in a much better position to help your practice, employees, and patients. We talk a lot about the three pillars of a successful practice: Finance, Marketing, and Personnel. These pillars are just as important during the pandemic as ever, but the way in which you approach them may need to be adjusted.


You’ll want to focus on financial planning. How are you going to bridge gaps and survive until things get back to “normal?” Before the crisis, one of our top concerns was figuring out finances with declining reimbursements. Today,  a new challenge we have to factor in is what our income will look like based on grants, loans, and accounts receivables, as well as any new expenses you may have incurred due to loans, personnel changes, and potential vendor negotiations. One thing worth mentioning is that you may be able to negotiate some relief on your lease. Right now, not a lot of people are renting commercial property, and the last thing a landlord wants is to lose a tenant because they can’t afford rent due to closure.


Before the crisis, one of the biggest marketing concerns was declining physician referrals. Many PTs are diversifying by going direct to the consumer and trying to influence their payer mix.

Staying in touch with patients will be key. Some practices may even consider offering telehealth options to give patients another option. The virus hasn’t taken pain away. If anything, it’s probably caused a lot of patients who were undergoing treatment to regress. Continue to provide value to your patients to stay connected.


You should think through your current salary cap and how you can continue to employ your people and still be able to afford them. The PPP and the Cares Act offer some valuable help here, which we covered in an earlier blog post.

If you’ve had to lay off or furlough employees, you’ll want to consider how a reduced workforce will affect your ability to serve patients once you reopen. The good news is that not many people are hiring right now, so it should be relatively easy to build a pipeline of PTs and related personnel. Be transparent about your projections to rebuild and grow after the pandemic. 

We have a hiring course in Breakthrough University and other resources that support the three pillars of a successful PT practice. Visit LearnWithBreakthrough.com to learn more about Breakthrough University.

How PT Owners Can Navigate Employment Law Issues Related to COVID-19

Physical therapy practices across the country are facing unique working conditions during the COVID-19 pandemic.

Some practices are closed altogether, while others are operating under limited conditions. In either case, the situation is giving way to several employment questions and potential issues. In addition, the federal government has rolled out a stimulus package available to small businesses under certain conditions.

We recently spoke with Scott Leah, an attorney who specializes in employment law, to answer important questions that will help PT owners make sense of handling employment changes during COVID-19. 

What Are the Two Types of Paid Leave?

Two new paid leave types have been introduced by the federal government: paid sick leave and the FMLA (note: the FMLA isn’t new, but the rules surrounding it have been changed during the COVID-19 pandemic).

Paid Sick Leave

Paid sick leave provides qualified employees with up to 80 hours of pay if they meet one or more of the following criteria:

  • They’re under quarantine
  • They’ve been ordered by a medical doctor to stay at home for a certain period of time
  • They’re receiving testing for COVID-19
  • They’re caring for a family member who is getting testing for COVID-19 or is under quarantine
  • They’re taking care of a child whose school or daycare is closed due to COVID-19 concerns

There are a few differences to consider when it comes to the amount your employees will receive. In some cases, they’ll be eligible to receive their full salary. Under other circumstances, they’ll get two-thirds of their normal salary. Employees must have been working for you for at least 30 days to be eligible.

There’s a lot we still don’t know regarding this pay—such as how employees can apply for it—and more details will hopefully emerge soon.

There’s also a provision for employers to get a dollar-for-dollar credit on their payroll taxes if they provide this benefit to their employees. Again, there are still a lot of unknowns about getting this tax credit, so it’s a good idea to bring this situation to your accountant. There will probably be a special form to fill out and documentation to provide before taking advantage of the tax credit.

Family Medical Leave Act (FMLA)

The FMLA has also expanded to accommodate more employees. Historically, most PT practices didn’t have to concern themselves with the FMLA unless they have more than 50 employees in a 75-mile radius. 

The FMLA provides up to 12 weeks of paid leave under new circumstances:

  • Caring for a family member
  • Caring for a child under the age of 18 because school/daycare is closed

The first two weeks are unpaid, while the remaining weeks are at two-thirds of the normal pay. Under the new law, the employee can get paid during the first two weeks using the new paid sick leave (which is 100% or two-thirds of their salary). They can also leverage any existing PTO, vacation, or sick time (although you can’t require they use their PTO).

The amount paid during the FMLA is a refundable tax credit, which is significant for small business owners. This means that if you pay out $1,000 in benefits and owe $750 in taxes, you’ll get a net of $250 back from the government.

What Are the Two Types of Unemployment?

Many practices are facing tough decisions in choosing to lay off or furlough employees. These are dire circumstances we’re in, and while you want to do what’s best for your employees that take care of your practice, you also want to do right by your practice.

The government is helping to provide small businesses with funds that can help them avoid both laying off and furloughing staff, including a stimulus package (which we cover in another blog post) and paid leave requirements for employees. 

The problem is that many practice owners may not be able to afford to keep all employees on long enough to take advantage of these options. Yes, you get back the money you pay for leave as a tax credit, but you have to be able to front the money first. 

In this case, many owners wonder which is more beneficial: layoffs or furloughs?

In a layoff, the employee is no longer working for your company, and they are eligible to collect unemployment. Furloughs allow the employee to remain employed and work on a reduced schedule (even down to zero hours per week). They’re still eligible for the paid leave options and benefits, and they should also be eligible for unemployment compensation. Once the pandemic conditions lift, they can come back to work and handle business as usual. 

The one caveat with furloughing employees is to check with your insurance broker to see how many hours an employee needs to work to maintain their benefits coverage. In some cases, reducing them to zero hours may not save their insurance benefits.

Can You Qualify for Unemployment as an Owner?

Unemployment is largely state-driven, so each state will have its own rules surrounding eligibility for unemployment. In Pennsylvania, the general consensus is that business owners are not eligible for unemployment benefits. 

In essence, unemployment is designed for employees, not employers. The idea is that if employers could receive unemployment benefits, then anyone could start up a business, fail, and collect benefits. 

An exception would be someone who owns a small portion of a practice that doesn’t have much say in how the business is run from day to day. Alternatively, if you’re a C corp, you may be able to file, as you’re not technically the “owner” of the company. These are rare cases, but they do happen.

However, we’re in unique times, so there’s a possibility that some states may allow small business owners to file for benefits. The best step to take is to work with an employment lawyer who can look at the specific state requirements and help you support your case. 

Finding Ongoing COVID-19 Support

We know these are challenging times to be a practice owner, and we’re committed to helping you get answers to your most complicated questions and navigate new legislation. Join our free Facebook community – Private PT Practices: Standing Up Through Crisis for more resources.

Understanding the Paycheck Protection Program as a Private Practice Owner

As many practice owners continue to struggle financially during the COVID-19 crisis, the new Paycheck Protection Program may offer a ray of hope.

The PPP is part of a $1 trillion+ stimulus introduced by the federal government that provides a financial cushion for small businesses in the form of a loan—some or all of which may be forgiven.

As you explore ways to pull your practice through declining revenue, the PPP should be among your options. Here’s what we know about the PPP so far:

What Is the Paycheck Protection Program Intended For?

The PPP was introduced as part of the larger CARES Act as a means to help small business owners continue to keep employees on their payroll, even if they had to bring business to a grinding halt. The alternative, of course, is to lay off employees, which would allow them to draw unemployment benefits. The goal is to continue to compensate employees through the PPP, regardless of whether there’s work for them to do. 

What Determines Loan Eligibility

To qualify for a PPP loan, you’ll first need to determine what your payroll costs are on a month to month basis. Then, you’ll multiply those costs by 2.5 to get the maximum amount you’ll be eligible for. You will need to provide supporting documentation of payroll costs so that your lender can determine your eligibility. 

Nearly every bank and credit union is now approved to issue PPP loans, but your own bank is the best place to start. It’s advisable to apply wherever you already have a strong banking relationship, as most banks are not taking non-customers for this loan. 

How SBA Loans Relate to PPP

The PPP is part of the larger CARES Act, and many small businesses may have already applied for an SBA loan in addition to the PPP. If you’ve already received an SBA loan, you should be able to roll that loan into your PPP. For example, if your PT payroll costs are $50,000 per month, and you received a $25,000 SBA loan, then your total loan amount would be $150,000 ($50,000 x 2.5 + $25,000). 

How Are You Allowed to Use the Loan?

Once you receive your loan money, you begin an eight-week period in which you must spend your loan. This period is also used for comparative purposes to determine how much of your loan is going to be forgiven. Ideally, a large part of this loan will essentially be free money for PT owners. 

The allowable use covers payroll costs and other operating expenses, including rent, utilities, mortgage interest, and debt service. You’ll be required to provide documentation of these expenses. During the eight weeks, the amount of loan money you spend on qualified expenses becomes the amount that is potentially forgivable.

How Much of the Loan Can Be Forgiven?

Once you have a potentially forgivable sum, you’ll need to calculate how much of the loan can actually be forgiven. To do this, you’ll compare your FTE from February 15 to June 30 to this same period one year ago (another option is to review FTEs in January and February before the pandemic began). You’ll also need to compare how much you’re paying in wages during this time compared to this same time frame a year ago.

This goes back to the PPP’s intention: to keep people on payroll instead of cycling through unemployment.  

The forgiveness process has yet to be defined, but you will need to apply for loan forgiveness. It’s advisable to work with your accountant to help you accurately calculate payroll costs that can affect your loan eligibility and forgiveness.

You can watch Bob Kowalick from Certified Reimbursement Solutions do a full training on PPP in the free Facebook community, Private PT Practices: Standing Up Through Crisis.

How Private Practice Owners can Create Opportunity from a Crisis [Video]

The fact is undeniable: we are in a crisis right now. And while it’s true that this situation is unique, similar events have happened throughout history.

And we can learn a lot if we take a step back, look at what has happened historically and understand the bigger picture. 

From there, it’s important to adjust our thoughts and behaviors accordingly so we not only survive this, but we can bounce out the other end and rebuild more quickly and help more people.

Cycle of Market Emotions

For a short-term view of this crisis, you can use the Cycle of Market Emotions.

Right now, we are spiraling down. But there comes a point where we reach the bottom and this is also when you reach the point of maximum financial opportunity. 

And this is reinforced when we combine this with a long-term view of this crisis in the context of history. You can see from the last 100+ years of the S&P 500 that peaks never last forever and valleys never continue on forever.

In other words, this too shall pass.

And if you want to see how to best position your clinic to survive this crisis and come back stronger than before, make sure to watch the video above. 

3 Pillars for Helping Your Practice Survive the COVID-19 Crisis

COVID-19 is on a lot of owners’ minds these days, and for good reason: it’s a threat to the health and well-being of our loved ones and the businesses we’ve worked hard to build over the years.

Many practice owners are struggling in different ways during the pandemic: cancellations might be at an all-time high. You may have had to lay off personnel to cut costs. The venues you relied on for your marketing workshops may have temporarily closed, which will impact your new patient flow.

At Breakthrough, we talk a lot about the three pillars of a successful private practice: personnel, finance, and marketing. These three pillars haven’t disappeared during this crisis, but the way in which you approach them has certainly changed. Let’s look at what you can do with each of these pillars during the COVID-19 crisis to help your practice survive the storm with as little damage to your bottom line as possible.

Fixing Finances

The majority of PTs are having dramatic reductions in visits, which means we’re also seeing a drop in how much we’re billing out. Most PTs we’ve spoken with have seen a loss of about 75% of their business, while others are completely closed. 

Under normal circumstances, billing is about managing accounts receivables, posting accurate balances to patient accounts, and submitting claims. Right now, claims submissions and posting balances are down because patient visits are down. If you’re looking for a silver lining, you now have more time to focus on your accounts receivables and invest enough time to devote to converting AR to cash. 

Bob Kowalick shared with us a breakout he uses to determine where his monthly revenue is coming from in terms of the age of the claim. Through his research, he found that about 50% of revenue comes from claims made within 0-30 days of treatment; about 34% comes from a month ago; about 10% comes from 2-3 months ago; and the rest comes from 120+ days ago. He notes that once you hit 60+ days, the majority of that revenue isn’t attainable unless you have someone actively trying to do something about it—that’s at least 25% of your revenue that would be lost without someone working those claims for you.

Instead of laying off your entire billing staff, you can reallocate those hours to focus on accounts receivables and satisfy unpaid claims.

Managing Personnel

PT practice owners are facing numerous options when it comes to their employees. Some practice owners are entertaining layoffs. Others may opt for furlough, which allows employees to remain employed and receive benefits, but with a reduction in earnings.

But at the end of the day, we’re talking about making decisions that make the most sense for your business. Usually the biggest expense in a practice is payroll, and even though practices can’t survive without people, there are fewer patients to treat, less work to go around, and declining revenue—none of which can justify maintaining a full staff.

The natural, responsible action from any business owner is to preserve cash when times are tight. The stimulus bill issued by the government is designed to help fill the gap between the cost of your staff and the loss of revenue. Ideally, the funds you receive from the bill will help you avoid making any major personnel changes that will negatively impact your people (and later, your practice). The goal is to stay connected to your employees in a way that keeps them paid and retained. 

The biggest moving part to consider is how much of these funds you’re eligible to receive, what you can do with them, and how much of the loan can be forgiven. 

Fueling Your Marketing

In loose terms, marketing refers to how you position your services. You rely on marketing to get patients through the door, but we’re in a time where new patient flow is proving difficult for many practices due to shelter in place orders and general fear.

Right now, there’s a lot of interest among PT owners in telehealth, and at a time where people are wary of going out in public, it seems like a much-needed answer. 

However, I will say that not many PTs have had much success in turning telehealth into a revenue-generating service. Reimbursements are much lower for telehealth, which is why I tried to use it as a cash-pay service several years ago. (At the time, legal and compliance were very grey, so we shut it down.)

But for practices that want to offer telehealth as an option for patients (especially if you’re completely shut down), it’s important to look not only at the service itself but also how to implement it and what to expect as far as revenue goes.

One option would be to offer an e-visit to connect with existing patients virtually to discuss their health. You’re already treating them, so this is just like another communication with your patient. E-visits can be billed over a 7-day period of time using different codes that are related to the duration of the visit. However, reimbursements are substantially lower—starting at about $13 for a 10-minute visit. I wouldn’t go into any great expense if you plan on offering this as a service to existing patients. 

Telehealth is essentially doing an in-clinic visit outside of the clinic (e.g., exercises). Reimbursements are all over the place, so it’s essential complete verification for any kind of virtual services. You can have new patients become telehealth patients, provided you get prior approval. 

From a marketing perspective, it’s important for practice owners not to look at e-health or telehealth as income replacement options but rather as tools to keep in touch with existing patients. Once we’re on the rebuilding end of COVID-19, we’ll still have these relationships that will reactivate and continue to come to us for their PT.

The situation with COVID-19 is changing every day. To help owners get ongoing support and resources, we’ve created a free Facebook Community.

Click here to join the Facebook community – Private PT Practices: Standing Up Through Crisis today.

Mitigating the Impact of COVID 19 as a PT

Mitigating the Impact of COVID-19 as a PT Private Practice Owner

COVID-19 is affecting businesses of all industries and sizes, and private practice is certainly not exempt.

We’re in the midst of an unprecedented event with no clarity on the best path forward. There are a lot of unknowns, particularly concerning the long-term impact of the coronavirus and how owners can start planning now to mitigate any negative effects on their business.

Private practice owner Mike Lewis (whose PT practice is located in Seattle where the first cases of coronavirus were confirmed in the US) joined us recently to share some insights for other owners regarding how we can deal with COVID-19’s impact on business. Here are the answers to the most pressing questions we tackled.

How can I best plan for ensuring my business can survive the financial impact?

Plan for ensuring my PT business can survive

First and foremost, practice owners should plan on keeping their marketing alive. Many owners make the mistake of pulling back on marketing when money is tight because it’s a cost they can control (unlike overhead, for example). But the fact remains that you still need new patients coming in, you still need to hold onto current patients, and people still need PT. Pain doesn’t take a holiday when a crisis emerges, and you need to be there during times of need.

The situation isn’t going away in two weeks, and it’s anyone’s guess as to how long it will last. Regardless, you need to put on your own oxygen mask first. Take care of yourself and your family. Get enough sleep, go outside for a walk, eat well, and stay vigilant of any changes every day. This is going to be a marathon, not a sprint, so it’s best to prepare mentally and financially for the long term.

You also need to think about how you’re going to take care of your practice. This might mean cutting expenses at some point. Dialing back payroll and operating hours, reducing staff, and cutting any unnecessary spending can help you make up for any potential loss of revenue if your phones aren’t ringing as often or patients are missing appointments.

I recommend using our Gray-to-Black planning methodology. I go into more detail at our Facebook PT group, but this plan focuses on less-than-ideal scenarios: what would happen if you had a 50% reduction in income over the next 60-90 days?

Mike recommends talking with vendors or creditors to see if you can get some leeway on payments or pursuing lines of credit to keep business going. Also, make sure you’re reaching out to current patients to see how they’re doing to encourage them to continue with their plan of care. Now is a critical time to engage with them and show them you’re invested in their progress and are here for them.

What are the best practices for continuing to treat patients safely?

We don’t want to put patients or staff in a compromised position, so it’s important to respect boundaries. It’s not our job to convince or coerce staff or patients to come in, so be respectful if they decide not to come into the practice.

Follow reliable guidelines from the WHO, CDC, and local authorities to ensure you’re taking all the right precautions – we have put together a COVID Physical Therapy Guide to help PT Therapists and practice owners here. Look at how your clinic is set up to make sure clients can safely distance themselves from other patients. Consider steps like installing a hand-washing station, putting out hand sanitizers, and propping open the front door so people don’t have to touch it to open it. Limit visitors that accompany patients.

Anything you can do in accordance with expert recommendations will help create a safer environment and instill confidence in your patients and staff.

How would you go about implementing telehealth as an option?

TeleHealth for Physical Therapy

Telehealth in PT (and the medical industry at large) is an extremely hot topic at the moment. Telehealth isn’t a new concept, but it’s also not widely implemented just yet. During COVID-19, many PT practice owners have expressed interest in offering telehealth as an option to keep patients safe and continue to provide care to their patients.

Here’s the reality: several years ago, we actually offered telehealth as a cash-pay option. We ended up shutting the program down because, at the time, the rules and laws around telehealth were very grey. The laws are better defined now, but there are still misconceptions surrounding the service.

One question that’s come up many times recently is whether you can use telehealth to replace income loss. What I recommend is looking at the codes that CMS just put out. You might be surprised to learn that the reimbursement rate is considerably low—anywhere from $15 to $37 per visit. If you’re getting $90 per visit in the clinic, you’re not likely to replace that loss with telehealth.

Another thing to consider is that patients may not be able to adapt as quickly as you. This is a drastic change, and you may not be able to get your older patients to hop on a Zoom call. 

The way you might consider using telemedicine is with no expectation of reimbursement from the insurance company. You can use it for a check-in or follow-up with a patient (which is what we do at Madden PT) or if someone wants to hop on a call because they took themselves out of care.

Ideally, only take advice from PTs who had done telehealth before the COVID-19 crisis. There’s too much misinformation out there right now to dive in head-first with the wrong expectations.

How do you work through the decision as an owner to close or remain open?

There are two sides to this: first, you want to realistically look at your practice to see if you’re set up to provide a safe environment for your patients and staff. And second, you should follow the directives of your state authorities. Every state is a little different at this point, so make sure you’re tracking updates as they become available.

Even if the decision is made for you, and you’re forced to close temporarily, doing so isn’t easy. You worry about the well-being of your patients and employees and have no time frame to give them as to when you will reopen. But remember that it’s essential for you to keep their safety (and your own) as a top priority.

We’re all finding our way through these strange times. For more support, join our free Facebook community—Private PT Practices: Standing Up Through Crisis.

COVID-19 PT Facebook Group