PT Classroom - Bridging the Gap: Employer Based Cash Services ׀ by Jim Mecham, MSIE, OTR/L, CPE


Jim Mecham has dedicated his career to developing comprehensive industrial rehab programming that returns an injured worker to work as soon as possible and providing organizations with injury cost reduction services that positively influence their bottom line. His background in Occupational Therapy and Industrial Engineering provides a perfect fit to prevent work related injuries through engineering controls and rehabilitate workers following an injury. Jim is a board certified ergonomist and has been awarded this certification through the Board of Certification in Professional Ergonomics. Jim’s extensive experience in the field of industrial ergonomics includes providing consulting within manufacturing and office environments nationwide while developing and implementing comprehensive ergonomic initiatives for large and small employers. Jim developed the OccuPro’s Online Assessment Application software which includes the highly profitable Functional Progress Notes and Functional Discharge Summaries.

Bridging the Gap: Employer Based Cash Services

There are numerous employer based services a private physical therapy practice can offer locally or nationally. Many of them are cash based services that get paid exactly what you bill for. Many of the most successful private practices throughout the US, and abroad, are clinics that work with employers and provide either reactive or proactive services to help them lower worker’s compensation cost and injury exposure. When looking at these successful practices there are some common threads.

The most common thread is that many of the successful private practices, who provide injury cost reduction services for local employers, provide clinic based industrial rehab services. Before you can be successful working with employers you need to be successful rehabbing the injured worker and getting them back to work. Clinics that specialize in the treatment of the injured worker will be recognized in their market as the clinic of choice for their injured employees. Once you are recognized as such, the transition to providing those employers with cash based injury reduction services is quite simple.

Another common thread is having a clinician who is interested in providing and has further education in these cash based areas. This is not something therapists are taught in school and requires further training to achieve high success. Without high success providing injury cost reduction services the employers are not going to keep you on. You need to show that you are making an impact on injuries within the first year. Their reduction in insurance premiums will not kick in for 3 years based on insurance policies so a focus on reduced injuries needs to occur quickly to demonstrate success.

The cash based services you can typically provide employers, can also be categorized as proactive injury reduction services. These include:
 On-Site Injury Prevention Services
 Ergonomic Consultation Services (Industrial and/or Office)
 Training and Education for OSHA compliance (Back Schools)
 Pre-Placement Post-Offer Testing
 Medical consultation on Safety and/or Ergonomic teams
 Ergonomic Injury causation specialist

The primary reactive service you could also provide local employers includes on-site rehabilitation services. This takes some considerable cost analysis consideration secondary to determining if it makes sense to set up a clinic on-site at a company or just have the employees come to your brick and mortar clinic. This service and its development are for a separate article.

When considering these common threads your first step in building cash based injury reduction services for local employers is to first build your clinic based worker’s compensation treatment specialty. Many practices feel this is implementing Functional Capacity Evaluations and Work Hardening/Conditioning. These services can certainly be a part of your menu of clinic based services but your solid foundation needs to start earlier in the inured worker process.

Success starts with being a practice that specializes in the treatment of the injured worker and begins with the initial outpatient evaluation. Seventy five percent of your initial worker’s compensation outpatient evaluation long term goals should be return to work goals. At about the half way point of the patients rehab stay the therapist should begin assessing the clients return to work functional ability to determine if the initial long term goals have been met. Clinicians should begin considering minimizing musculoskeletal documentation towards the end of an injured workers treatment stay as range of motion and manual muscle testing poorly correlates to function. This return to work function then needs to be provided to all parties involved in the injured workers care. This includes the physician, insurance carrier, case manager but most importantly the employer.

Clinicians would never send a musculoskeletal progress note to the employer since the employer would say “What the heck is 3+/5”. “What does 45 degrees of ROM mean?” However, an employer would greatly understand a functional progress note that focuses on return to work ability. “I did not know that Frank was lifting 35 pounds in therapy. Why isn’t Frank back to work on light duty? Who is this ABC Physical Therapy clinic? This is the first physical therapist who has ever communicated with us in regards to one of our employees return to work abilities.”

Advertising man hours and brochures can be expensive while attempting to gain business with local employers. We need to fill a basic need of theirs before we can approach them for cash based services. An employer’s basic need is to get their employees back to work as soon as possible. By providing an employer with written documentation on their employees return to work functional improvement during outpatient therapy helps to not only fill a basic return to work need but it is also a perfect branding/advertising opportunity for your practice. Why spend thousands of dollars on marketing to these employers when you can just provide a higher quality communication service in regards to their employees return to work ability but make sure that the documentation you use has your logo and contact information all over this functional return to work report.

When selling services it takes 7 to 13 times before someone will remember what you have to offer. You can use this sales approach by providing the employer with functional progress notes every time you have an employee from a specific employer and you will easily exceed the 7 to 13 rule. You will be communicating a basic return to work need an employer craves while solidifying your foundation as the local clinic that specializes in the treatment of the injured worker and when you call or walk in to meet with someone in regards to selling cash based services they will already know you since no one else in your physical therapy market does anything like this.


To learn more about industrial rehabilitation please contact Jim at or (866) 470-4440.
Last revised: March 15, 2011
By Jim Mecham, MSIE, OTR/L, CPE

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