Over the past few months, I have spent significant time with very distinct physical therapy private practice groups. The groups have included the Physical Therapy Business Alliance Unencumbered conferences, EIM’s executive management in private practice program (full disclosure, I am a partner in EIM), and Private Practice Section’s National Conference. There are two ice breakers that I am fond of doing with my colleagues and comrades at these presentations. The first is I ask a series of questions to these practice owners along the following lines and ask for a show of hands:
-How many of you have had your business harmed by a medical home?
-How many of you have suffered financial losses because of an ACO in your area?
-How many of you have been offered a pay for performance contract?
-How many of you have been offered a value based or post acute bundled contract?
5 states, hundreds of private practice owners and exactly the same number of hands-ZERO.
Second exercise is that I have them write down or identify the three biggest challenges facing their physical therapy business. I then have them discuss amongst a table of about 8-10 of their colleagues these top three challenges. I then ask for how many of theirs overlap with each other. It’s typically about 80% and includes the challenges of decreasing reimbursement, referral for profit (including hospital employed physicians), productivity, excessive regulations, and recruitment/hiring of new PT’s. There are regional variations of course but nonetheless the common challenges are consistent and compelling.
I raise this to suggest that there is a significant rift in our profession. The questions I ask are all the items that many in our profession (and in particular our national organization) are promoting or declaring as the wave of the future. They are not reality for private practices who are typically excellent at visionaring but are more pressed and concerned with challenges affecting them daily. Is there any wonder why private practice and non private practice PT’s have any trouble talking to one another? Perhaps this provides additional insight into the general disdain private practice PT’s have towards the House of Delegates reactionary reversal of RC 2-12 setting our practice back by embracing prescription and declaring by rules and regulations what decisions a PT can and cannot make.
The good news for private practices is the on-going communication and collaboration on issues that they have in common are indeed helping. Independent Provider Associations (IPA’s) are forming in many states around the regional issues impacting them. PTBA and PPS have been facilitating and assisting. Private practices have found they have more relevance with their competitors than they do with the so called wave of the future concepts that have served mainly as scare tactics. There are less “lousy” contracts being executed and more and more are not caving to the specialty benefit managers (middlemen’s middleman or Misaligned Networks of the world ).
While the challenges are daunting, the future has never been better for us in private practice as long as we ignore the futurists and deal with today’s challenges in a united front.
Thoughts?
@physicaltherapy
