PT Classroom - Observations from the 2016 Graham Sessions - Private Practice Physical Therapy׀  by Chad Novasic, PT


Chad Novasic is the President and CEO of Alliant Physical Therapy Group. He is a 1988 graduate of Marquette University. His focus has been in the field of outpatient orthopedic rehabilitation and injury prevention. Chad has been an independent Physical Therapist since 1989. He is proud to be active in the community having served as President of the Wisconsin Independent Physical Therapists, and on the Board of the Racine Founders Rotary and the Wisconsin Physical Therapy Association. Over the years, Chad's passion for physical therapy and helping others has complimented his capacity to help fellow physical therapists open and run successful private physical therapy practices.  

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


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

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