On January 14-16, 2016 I had the honor of attending the 9th annual Graham
Sessions sponsored by the Private Practice Section and the APTA. The Graham
sessions are in essence the “Think Tank” for the APTA and PPS in addressing
issues facing Private Practice.
Last year the Graham sessions focus was on
the vision of the future, “Disruptive innovation”, “Transformational Change” and
“Big Data". (click here for last years observations). This year the five
topics were surrounding the viability of a cash practice, The next generation of
Private Practitioners, The future of Stand alone Private practice, There was a
Womens issues forum, A look at future Business Models, and a Multigenerational
panel discussion about the state of private practice.
My observations and take-aways from this aggressive debate and discussion was
enlightening.
1. Cash based services are viable, but not scalable. What is more
important is the mind set and approach. What is the value of your expertise?
What makes people place a value on your services to pay fully in cash, or pay a
$20, $35, or $60 co-payment per visit? Part of the value proposition is the
value to payors, using data to demonstrate value. However, more importantly is
the public’s perception of our value. In general the public does not know what
Physical Therapy is. There was even discussion about the APTA and PPS purchasing
a Superbowl commercial.
2. Education discussion surrounded the “Triple Aim”. 1/3 Global Health
(Population health) or clinical Skills, 1/3 the patient experience, and 1/3 cost
containment or the “value proposition”. In many ways the system falls short in
training students in the later two areas.
3. Stand alone private practices will struggle to get business as health care
purchasing progresses. Market consolidation (ATI, Athletico) allows the
bigger players to work with larger provider systems and insurance companies on
innovative programs. ATI has spent over $2 million on a computer system that can
integrate with hospital systems. Smaller practices as a part of a group or
Managed Services Organization (USPT, Benchmark) have similar success working
with insurance companies. The ACO model as well as exclusive contracts limit
access to the whole population.
4. Private practice is still dominated by Males. Why is this? The whole
system needs to focus on what it is that will attract more women into the
Private Practice system. There continues to be a perception among referral
sources that Private Practice is a “Man’s thing” Also, The private practices
themselves seem to lack mentoring for Female PT’s in a manner to encourage the
private practice mindset.
5. Business models are rapidly changing and evolving. Much of this is
driven by payment models and some if this is developed through visionary
Thinking. There is the evolution within the ACO model, Bundled payments,
prospective payment, Primary Care teams. The question is if referrals within
groups improves care and reduce costs, where is the problem?
Overall Private Practice is going through some struggles. Decreased
reimbursement, higher co pay’s and deductibles, shrinking access, higher
compliance cost, and a need for demonstrated outcomes. Many are going to fail
and some are going to succeed. However I am reminded about the HMO scare,
Hillary Care, and numerous other challenges to our profession. Private practice
has always come through with the strong surviving.
If you are thinking about starting a private practice, NOW
is a great time to go into private practice! For more information on starting up
a private practice you can visit the
Private Practice Section of the APTA or contact Chad at
chadnov@aol.com.
Other Private Physical Therapy Practice related
articles by Chad
-
Starting a Private Physical Therapy Practice
-
Basic Equipment for Starting a Private Physical Therapy
Practice
-
Physical Therapy Private Practice Tips - Red Flag Rules
Last revised: February 21 2016
by Chad Novasic, PT
