3 Tips for Growing Your Practice During Hard Times

From 1929 to 1939, the world endured a severe economic downturn that would later be referred to as the “Great Depression.”

This economic turmoil resulted in a difficult period for most companies…but not all of them.

Some brands where able to make great strides during this time. These successful companies were different sizes and came from different industries. What they had in common was the fact that they kept investing in growth while others cut back.

Right now, the entire world is dealing with the effects of the coronavirus pandemic. So we are sharing 3 tips for private practice owners looking for ways to grow their practice during hard times.

Trim the Fat

Now is the time to be brutally honest about the necessities in your business…

And to cut anything that is unnecessary.

This sounds simple, but it’s a task that many business owners struggle with. Particularly when it comes to making hard decisions about personnel. Or past investments that have yet to produce a return.

Now is the time to take a deep dive into your numbers to find areas to cut back.

Marketing expenses are often the first thing put on the chopping block when it comes to trimming the fat. But eliminating marketing will also impact your revenue and may slow your recovery. Keep the big picture in mind before making the call to stop or cut back on marketing.

Realize that Everything is Cheaper Now

Be fearful when others are greedy. Be greedy when others are fearful.

Warren Buffet

Over the past few months, the hiring market for PTs has completely flipped. In the past, some owners struggled for months to fill PT job vacancies. Many private practice owners expressed how hard it was to compete with HOPTs and POPTs practices when it came to hiring new grads.

Now, that situation has flipped. And the same is true for the real estate market. Now is a great time to hire new PTs and/or renegotiate the terms on recurring expenses like rent.

Plan Ahead Now

No one can predict exactly what will happen in the economy. But, it’s a given that there will continue to be cycles of growth punctuated by periods of decline.

In the last two decades, the U.S. experienced recessions in 2001, 2007, and right now in 2020. And there will likely be another recession approximately 10 years from now.

Again, the exact time and circumstances are unknown, but that doesn’t mean you can’t plan ahead.

One exercise is to develop a “Grey to Black” plan for your practice. This Grey to Black plan is a financial forecast that looks at what would happen if you lost 25%…50%…or even 100% of your revenue.

How much time could your practice remain open? What steps would you take to minimize the damage?

Taking the time to plan ahead now will help you make better decisions during an actual crisis. Don’t let yourself be caught off-guard a second time.

Right now, times are tough for businesses. But growth is still possible.

PTs provide a vital service helping people in pain. It’s important that PT owners do what they can to ensure their practice survives hard economic times so you can continue to provide this service to your community.

We’ll be going more in-depth on the topic of Growing Your Practice During Hard Times during the upcoming Breakthrough Virtual Summit.

Tickets for the Summit are free, and the event will take place 100% online. Click here to reserve your spot.

[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.

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:

Sleep

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

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.

Meditate

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.

Finance

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.

Marketing

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.

Personnel

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.

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
What Private Practice PT Owners Should Focus on in Times of Crisis

What Private Practice PT Owners Should Focus on in Times of Crisis

It’s not an easy time to be a small business owner. COVID-19 is temporarily changing the way many industries do business, and private practice Physical Therapy owners are feeling its effects, too.

Depending on where you live, you may find many non-essential businesses around you shutting down. Your phone may be ringing less, and you’re likely experience more missed appointments and cancellations.

No one asked for a pandemic, but now that it’s here, practice owners must do everything they can to weather the storm as safely as possible. 

To Close or Not to Close During the Coronavirus Pandemic?

One thing many practice PT owners are wrestling with is the decision as to whether or not to close for safety reasons. It’s a valid argument—businesses around you are doing the same, and your staff may fear potential exposure.

We were in the midst of making this decision for Madden PT and consulted the CDC and local legislative websites to see what information they were sharing. These resources said that any healthcare facility or provider, specifically physical therapy, has a social obligation to maintain normal business hours. That made the decision a lot easier for us.

Your main focus, then, should be on the relationships you’ve been building for your entire career and the level of care you provide. Specifically, these are the relationships with your patients, your staff, and your community. As a practice owner, you need to be in the mindset of putting yourself in the best position to maintain those relationships. Here’s how.

Control the Controllable

You can’t control whether people show up for appointments, how they’re reacting to the pandemic, or how long the pandemic lasts. But during times of crisis, it’s important to focus on what you can control—and give those things all of your energy.

What you’ve always been able to control is the experience in your PT clinic. You can control how your staff interact with patients, the impression people get when they walk through your doors, and the level of care they receive. Those things are now more essential than they were before because there’s so much outside of your control that could influence your business.

Don’t worry about what other businesses are doing and what’s going to happen in the world tomorrow. Those things are not things you can control, so they shouldn’t claim your energy. 

Focus on the Value You Provide

We’re providing an essential service to our patients, even though it doesn’t relate to COVID-19. Our mission as PT providers will never change, even in the face of a crisis. Though fewer people may want to leave their homes during this time, they still need us now just as much as they always have.

At Madden PT, we’re checking in on patients via telehealth, email, texts, and phone calls to continue the relationships and make extra touch points. We’ll also use Facebook Messenger if that’s how a patient prefers to communicate. We’re not just talking physical therapy in these interactions but checking on their well-being and whether they need anything. We’ve also seen some practices that send people out with deliveries if their patients need anything (typically older patients), truly going above and beyond the call of duty.

Another thing you could do is to create a home exercise video or one with tips on how to safely work at home (e.g., good posture). Think about where you can provide value to your patients during their times of need—it might not give you an immediate ROI, but it will pay dividends in the long run.

Connect with Your Team on a Personal Level

Staying open during slower times comes at a price that practice owners need to anticipate. For some practices, this could mean temporarily downsizing to make up for lost revenue. You may have staff that choose to remove themselves from the practice to lower their risk of exposure, but in some cases, you may have to make the decision to cut hours or reduce payroll.

Before this becomes the case, go ahead and do some research and put together resources that can help your staff. This way, you’ll be able to assist them in the event that you have to reduce hours or make other changes that will impact your employees.

Connecting with your PT team on a personal level is your clearest path to encouraging them to step up as leaders in the practice. Have one-on-one conversations with every member of your staff and meet them where they’re at. Be realistic with them about the present outlook of the practice and how it may affect them in the coming days and weeks.

On a similar note, now is a good time to do a thorough self and staff evaluation to make sure you have the right pieces of the puzzle in the right place. Sniff out how your team members are feeling about the current climate. Are they nervous? Are they taking it in stride? Most importantly, can they continue to serve your patients with confidence?

You need your best employees on your front line. Maybe this means that you’re putting one of your physical therapists at the front desk answering phones and greeting patients if they’re better equipped to interface with patients and handle their questions and concerns than your front desk person. Whatever path you need to take, be honest and open with your team. They’re likely to reciprocate, which will help you work together toward common goals.

Plan for the Rebound

What Private Practice Physical Therapy Owners Should Focus on in Times of Crisis

Remember that our current conditions aren’t going to last forever. When we come out on the other side of the pandemic, our patients will still be here to support us, and we must be prepared to return the favor. This means having enough staff in place to continue serving patients, as well as continuing with marketing just like before to bring in new patients.

Pain doesn’t go away in the face of a crisis. Now could be an excellent opportunity to ramp up marketing efforts while more people are at home in front of devices. They might not want to reach for help during this time, but when it’s over, you could find yourself facing a much greater demand and should be prepared to serve new patients as quickly and efficiently as possible.

For more insights and resources to navigate these strange times, join our free Facebook community—Private PT Practices: Standing Up Through Crisis.

Best Practices For Navigating Your Physical Therapy Clinic Through Crisis

Best Practices For Navigating Your Physical Therapy Clinic Through Crisis

The past few weeks have been a whirlwind with new information and an ever-changing landscape for everyone including our admins, Physical Therapists, Staff and PT practice owners. 

A lot of hard decisions are being weighed and getting the right and most up-to-date information about our PT community is key. To help you and the community, we have created a free Facebook Community to speak with other PT practice owners.

Please join by visiting: www.CovidPTGroup.com

COVID PT Group

There are a number of free PT resources in the group and we will be hosting free web-casts with other industry experts going over topics such as telehealth billing and employment. 

Together we can manage and get through this crisis – we have to… because people in pain need our help.

Below is a guide that we put together with 4 Best Practices For Navigating Your Physical Therapy Clinic Through Crisis. 

These same strategies helped us through the last recession and continue to help our practice today. 

Again, we understand that there are extremely hard decisions to make in these uncertain times… please reach out if you’re not sure what to do or if you have any questions.

Download the Best Practices For Navigating Your Physical Therapy Clinic Through Crisis PDF   

Overview:

There’s an informative summary about COVID-19 as it relates to Physical Therapy…

We touch on how to provide care for patients while minimizing exposure and ensuring peace of mind…

And then finally, the top strategies and pitfalls many owners are overlooking.

Best Practices for Navigating Your PT Clinic Through A Crisis

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


1. Continue Marketing.

a. Provide value to current patients by checking in on their well being. Keep in touch via emails, texts or phone calls. Make lists of who you’ll need to get re-engaged and when.

2. Reserve Cash.

a. Take a look at your books and trim expenses where you can. Talk with your vendors and try to negotiate better terms.

3. Think Through the Hard Questions.

a. What does a reduction in income look like for 60 or 90 days?What are the repercussions of that? How are you making it to the end of this crisis?

4. Communicate With Your Staff.

a. Maintain trust by being honest with your staff during this crisis. Let your staff know that you are available to talk with them about any issues weighing on them.


What are the business best practices for continuing to safely treat patients in the clinic right now?


1. Respect Boundaries.

a. If someone isn’t comfortable coming in, don’t push them. Support their decision. This applies to patients and staff members.

2. Follow Guidelines.

a. Take a look at your local guidelines. Reference the CDC guidelines. Print and post guidelines and steps you are taking so patients can read as well.

3. Clinic Set-Up.

a. Keep doors propped open to avoid touching handles, hand washing stations, sanitizer on the walls, sanitize all equipment, remove lobby chairs to space people out, offer masks during manual therapy, etc.

b. Rearrange your clinic to follow 6 foot social distancing guidelines and ensuring all equipment is washed and put away by staff only is essential. Be intentional about having staff cleaning in front of patients so they feel more comfortable.


How best to assess and approach implementing Telehealth as an option?


1. Understand Reimbursement Rates.

a. There is a misconception that practice can use telehealth to replace lost income. Make sure you understand the reimbursement rate for telehealth in your area before making the switch.

2. Keep Patients In Mind.

a. It is unlikely that all your patients will have the technological know-how to fully utilize telehealth. Plan with this in mind.

3. Find an Expert with Experience.

a. If telehealth is a must for you, only take advice from therapists who have done telehealth before this crisis. This is a very hot topic within our industry so watch for misinformation.

4. Madden PT Case Study

a. Madden Pt is using telehealth with no expectation of reimbursement. We are not billing insurance companies and are using this as an avenue to check in with patients and engage with them. Maintaining relationships with patients is where we are currently seeing the most value in telehealth.


How to work through the decision as an owner to temporarily close doors or not?


1. Safety First.

a. Ask yourself, “Are you, your staff and facility physically able to provide a safe environment for patients? Is it reasonable to do so?”

2. Follow Local Laws.

a. Many states consider physical therapy an essential business that is allowed to stay open, but this may change at any time. Reference credible sources before making any decisions and follow the advice of your area’s Department of Health.

3. Balancing Production vs Relationships.

a. Focus on maintaining relationships with your staff, patients and the community. 

b. Sometimes great leadership means delegating to internal staff who may have more experience in management/leadership/etc. if you feel overwhelmed or too stressed.

And then shifting gears….

Focus Points and Pitfalls to Avoid

  1. Control the Controllables.

    – Focus on things that are within your control.

    – What can you control? Patient experience in the clinic and your staff’s interactions with them.

  2. Focus on the Value You Can Provide to Patients.

    – Emails, text messages, phone calls. Have a conversation with patients and see what they need help with.

    – Many people are working from home. You can provide material, videos, messages that are helpful to the community during these times, like exercises or correct posture. Consider sharing on clinic and personal social media pages.

  3. Focus on Your Team at a Personal Level.

    – Have conversations on the right things to do for each individual. This may be time off or extra precautionary measures. Meet them where they’re at.

    – Research resources to be able to guide them through potential changes in their employment. Have a plan to help them get through this.

    – Create an open door policy so staff feels comfortable coming to leaders about issues they’re facing. Never have an “I told you so” approach.

  4. How to Plan for “The Rebound”

    – Maintain relationships with patients. This will be the foundation after the crisis.

    – Support the local community. You can ask your patients if they have or know anyone who has a small business you can support.

    – Social distancing can create a lack of movement. There’s a decrease in mobile activity. People’s problems aren’t going away so realize there’ll be a big demand after the crisis. Be ready to serve as quickly as possible.

And there you have it.

We are fortunate to have such a dedicated and strong group of PT owners in our community, like you, to keep moving our industry forward. 

Good times or bad.

We hope this information helps.

Here for you,

Chad Madden & The Breakthrough Team

  Download the Best Practices For Navigating Your Physical Therapy Clinic Through Crisis PDF

 
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This hasn't been the first crisis facing private physical therapy clinics, and it won't be the last. History has told us that it is possible to come …