Creating your success Preserving your success

Key to Success #1 Minimize Costs! Key to profit is NOT high income Key is low EXPENSES (esp. today!) You must take control !

Maximize income Maximize patient access* Early AM.. Late PM.. Sat?.. Eve? ASAP intake… same day-24hr Hurting bad = priority intake MD relations tactics Patient relations tactics

Maximize income Examine your EOB’s Reveals billing errors Reveals insur pay rip-offs Skip a day or a procedure* Tells you what they pay for what Rx Aetna-Medicare multiple procedures discount

Paying attention to business: Metrics-I Stats…. daily-weekly-monthly-annual Gross billing, collections, A/R aged Expenses, per category Know cost-per-visit, cost per-case Know what you need to break-even!! Monitor.. Assess.. Respond

Monitor.. Slowdown?.. RESPOND… e.g., marketing investments to increase patients (slower, bigger response) or, collection efforts: call payers, bill-dun patients (quicker response) or, immediate cuts in expenses (quickest response) Determine if problem temporary vs long-term!

Financial Crisis -I Is it a temporary shortfall ? If so, tap into savings… as you fix the problem. OR.. Is it a long-term trend ? If so, cut costs… and adapt to the change.

CRITICAL!! Diversify income streams 1/4 Insurance payers Employers Services MDs Dxs Diverse ‘product line’ Multiple income streams

Diversify income streams Multiple income streams Because whatever is working best for you, can & will go away one day

Diversify income streams WHY? …2/4 Your best MD dies or retires …or opens a POPTS Hospital plays hardball push on MDs, … or hires a good go-getter PT Private health insurances go bad (very bad) (Lethal contracts-rules)

Diversify income streams WHY? …3/4 Big employer switches to cheaper, bad insurance Big employer contracts another PT or Hosp Big employer closes down New PT – POPTS - DC opens shop Medicare imposes huge restrictions State socializes Worker Comp ACO-hospital monopoly

Diversify income streams HOW …4/4 Outlying underserved areas for branch office (overhead!) Special Dx (TMJ, vertigo, HA, runners, golf, women’s health, fitness) Special Rx (McKenzie, Manual Rx, laser, kinesiotape, orthotics, gym) Employers (Worker Comp, ergonomics, microstretching, RD, on-site) Schools (Spl Ed, ATC, preseason screen, coach-parent-athlete inservice) Build Private Pay base – value-added PT

Scams Yellow Pages Toner Equipment leasing Credit card processing Blind invoices Business loans

Chapter Three MARKETING Marketing Physical Therapy Marketing Your Practice

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MARKETING A Dirty Word ? An Evil Concept ? Or connecting those with needs to their solutions

MARKETING Why? You may be a great PT.. You may offer best, essential services.. But… You are useless if you cannot empower clients to access you

MARKETING An essential part of your skills set An essential part of your practice An essential part of your success & survival

MARKETING !! You have a responsibility to get your services to those who need them, to educate them re what you can do for them.

Marketing ~is ~ Education Educating your client re your services

MARKETING !! Essential Not ‘dirty’ a dirty word You must be good at this ! Without this skill, you will fail. PT Profession needs more of this.

MARKETING !! You are already doing this as you educate & motivate your patients to accept responsibility to do their HEP-ADL

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“Brand” crisis in PT (repeat visit) Kleenex Subaru Apple Plumber, carpenter, cosmetologist, massage therapist But… PT ?? What is that ????? (many bad examples)

Public’s perception of PT Vague Varied Distorted Inaccurate Incomplete Limits demand, utilization, value This is a major part of our challenge

“Branding” PT What is PT? (in the eyes of others) HP-US-ES… Massage… Walk Granny… Transfers Vision 2020… Movement Disorders You will need to Brand PT Then need to Brand YOU.. Branding YOUR practice.. YOUR uniqueness Patient tells MD they want to go to YOU for their PT Marketing PT

Build Your MARKETING PLAN around your Business Plan

Independent Practice marketing role You define your practice and create your customer base via marketing

Big deductible – copay make most patients ‘de facto’ private pay THIS marketing challenge ………… Many defer care altogether to avoid costs

Write your goals!.... your strategic plan your business plan! *Long-term goals* Short term objectives-steps with a timetable This leads to your Business Plan This requires a Marketing Plan

Clinical Niche’s These succeed on marketing awareness.. demand.. dominate How will you market each of these niche ? patient-public … referral sources ? MSD.. Post-op.. Spine Care.. Orthotics-prosthetics Work Injury.. Prevent-Ergonomics.. Sports.. Fitness.. Podiatric.. Runners.. Golf.. Performing Arts PT.. Animal PT-canine-equine.. Women’s health.. Lyphedema.. Bladder & Pelvic Floor.. Dry needle Balance-falls.. Vertigo.. Wound care.. TMJ.. HA.. LLLT

Marketing… How it is done 35

MARKETING What is it ? Educate client base.. You help them to self-define their needs Educate them re. your roles re. meeting needs Guide them to decide they need & want you ‘You have needs… I can meet those needs’

MARKETING You already do this with each patient via patient education We market the patient to accept responsibility to do their exercises & ADL That is PT That is marketing

Service Advantages that give you a market edge Access… 24hr intake… early AM.. late PM.. WE ‘s Better outcomes … Fewer visits.. Lower cost Advanced specialty skills… EBP Take time… Educate… How to take care of yourself You excite & motivate patients!! MD communications (fax notes asap)

Branding: PT… You 38

Public’s perception of PT Review from day one… Vague Varied Distorted Inaccurate Incomplete Limits demand, utilization, value This is our marketing challenge

Public: what is PT? What is PT? (in the eyes of others) HP-US-ES… Massage… Walking… Transfers These impressions likely accurate, for some PTs Vision 2020… Movement Disorders

By 2020, physical therapy will by provided by physical therapists who are Doctors of Physical Therapy, *recognized by consumers and other health care professionals as the *practitioners of choice to whom consumers have direct access for the diagnosis of, intervention for, and prevention of impairments, functional limitations, and disabilities related to movement, function, and health. *Marketing objectives

“Branding” A brand is core essence of a person, company, organization, profession It is that single, ownable thought or "mindshare" that allows for creation of a meaningful bond with one's customer A solid brand allows its owner to deliver on a promise to customers or, in the case of the physical therapist, to patients. A strong brand builds trust and recognition …and grows business. e.g. Kleenex (or: in Dixfield = SmartCare)

“Branding” PT www.apta.org/brandbeat www.moveforwardpt.com In 2007, amid growing competition in the health care industry and shrinking budgets, the APTA Board of Directors determined a need to re-brand the physical therapist and the profession to better position us as the experts in restoring and improving motion in people's lives. www.apta.org/brandbeat www.moveforwardpt.com

Your Branding Challenge Brand PT Brand YOU Brand YOUR practice

WHAT ARE YOU BRANDING ? MARKETING ? SELLING ? 32

** What you are selling? -I Do not sell WHAT you offer: (PT, ther ex, etc) Sell the VALUE of what you offer: (outcome of PT) Not “PT”… it is “what PT does for you” Eliminate pain (patient) Restore function (therapist) “You will move better before you feel better” (pain versus function) Cont. 

** What you are selling? -II Better yet…(KEY ELEMENT!!) We TEACH... YOU… how to take CONTROL of your problem Personal control of your life. Control of your health care costs. Challenge : personal responsibility

What you are selling? -III OUTCOMES… Customer’s criteria for selecting you Track Record “SmartCare averages 5 visits per case, with 92% successful outcome” “IMPACC average 72% reduction in MSD, at 600 workplaces, since 1982”

What you are selling? -IV Confidence in you You are the best You are unique You are the ‘provider of choice’

What you are selling? –V KEY ! We TEACH you how to treat yourself… So you can take CONTROL of your problem… With less treatment sessions and COSTS… ** You get better, faster, at less cost ** Prevent and control recurrences… You LEARN to TAKE CARE OF YOURSELF .

What you are selling? -VI Differentiation from the others Your Uniqueness You are different from the rest Special services & value Value-added (you are more than the others)

What you are selling? -VII Relentless name recognition Become very well-known in community BRANDING YOUR PRACTICE Ads, sponsorships, web presence, PR, articles, etc.. Presentations, running clinic, Back School, UE School, office ergo, falls risk screen, fitness, scoliosis screen, etc..

What you are selling? -VIII Identify & build niche market(s) Dominate your marketplace Be foremost... be best Be first

What you are selling? -IX First impressions Appearance & demeanor Very professional Very motivated Very excited

Marketing the Doc’s? no… market the Public Traditional focus: marketing the MDs? No… instead.. market the patient-public The patient tells MD where they plan to go for PT ! This fights POPTS & HOPTS with their captive markets

Marketing the Workplace also…. Traditional focus: marketing the MDs? No… instead.. market the workplace. The workplace tells MD where their workers go for PT ! …regarding Worker Comp care (lots of POPTS-corp competitors)

Counter Your Competitors Hospital Health Care Systems MD’s as hospital employees Physician-owned PT Corporate PT Occ Health Other PTs

Counter Your Competitors Differentiate yourself-your clinic Unique niche(s) Unique service Access-intake Cost-quality Become THE local PT brand

Relentless Name Recognition I Ads that catch the eye… unique size-shape-text Press releases, articles Full-page educ-ad Diner place mat ad Sponsorships Card mailer On-line local news ads Public BS-UE-HA-Ergo-wellness ‘classes-schools’

NOTE: title addresses their needs, not what you do

NOTE: title addresses their needs, not what you do

Relentless Name Recognition II P2P…’word-of-mouth’ Tell your friends & your MD about your experience with us Call after evaluation visit Thank-you card after D/C Here are my cards (very) nice brochures Patient satisfaction survey Testimonials

Relentless Name Recognition III Fax eval & notes to MDs Heads-up call-fax to MD Professional-looking notes (WebPT) MD office mgr.. Nurse.. Referrals person Ergo consult MD offices

Marketing Objective -I PT is the Provider of Choice for mvt disorders YOU are that PT provider of choice They view you as the VERY BEST choice Relentless PT brand & your name recognition

** Marketing Objective -II two messages… “We teach you how to take care of yourself” Independence.. Control.. Cost “YOU can choose your PT provider”

Mary Smith, DPT, joins SmartCare LH, DPT, of SmartCare in Dixfield, announced yesterday that Mary Smith, DPT, of Carthage, Me, has joined the SmartCare as an orthopedic physical therapist. Mary received her graduate education at UVM, graduating with a DPT in 1999. She underwent internships at xxxx, xxxx, and xxxx. Her specialty skills include care of people with back and neck pain, TMJ, vertigo and women’s health issues such as post-mastectomy lymphedema. Mary grew up in Rumford and resides in Carthage with her husband and two children. Physical Therapy is treatment of people with pain and movement disorders of the musculo-skeletal system through the use of carefully designed simple exercises, gentle joint mobilization-manipulation, and pain control modalities such as cold laser and electric stimulation. The primary treatment emphasis is on teaching patients how to take care of their problem themselves, so they can control their pain, restore function, and avoid the costs of ongoing health care. Using this approach, SmartCare averages only 6 treatment sessions compared to the national average 12-14 sessions. Physical therapists now undergo 6-7 years of university education and clinical internships leading to a Doctor of Physical Therapy degree. The physical therapy profession had undergone a transformation to a Doctorate level education based on extensive research to develop Evidence-Based Practice, whereby PT treatment is based on clinical research evidence that assess treatment effectiveness and defines the most effective treatment methods. For details on this see www.moveforwardpt.com SmartCare is an independent PT-owned outpatient Physical Therapy clinic specializing in musculoskeletal pain problems, work and sports injury, headache and TMJ, and post-orthopedic surgery rehabilitation. SmartCare is located at 94 Weld Street in Dixfield and on Route 4 in Turner. For details go to www.smartcarept.com

Marketing Objective -III Do the doctors send their spouse-kids-mom to you?!

Ads… examples1 Odd size… 3-column Bold border.. Shading design Multiple ads… w/ varied messages

Ads… examples2 Address their needs-benefits Unique.. Uniqueness sells (rather than your features) Unique.. Uniqueness sells Direct to web site and FB friend for details Interesting-informative-educational

Pictures personalize What is PT? Patient needs Puff us up a bit; Qualified experts

Counter the Chiro’s ! 80

Answers a challenge Patients pressured to go to hospital PT?

*

Version 1/2

Version 2/2

USPS Every Door Every Box mailing 17.5 cents each 5 cents each print Dixfield 2000 boxes.. $450

Vistaprint.com !! CONT….

What is PT LBP TMJ Headache Vertigo Sports Work Injury

Press Releases -I Headline Who-What-When-Where Contact person-phone Who-What-When-Where Background on who-what-etc What is PT, and this topic defined SmartCare located at Weld St, Dixfield, Me 300 dpi photo.. good pose!

Press Releases -II New PT joins practice (What is a PT) New equip-device (cold laser) New Service (bladder control) Seminar: new technique (manual; tape) Award (OCS, CHT) Student (PT internship) Presentation (APTA, chapter, seminar) Teaching at Univ… (like this class)

Print Articles ! Buddy up to the ad exec… Weekly column What is PT? Sitting hazards PT for Headaches Managing Vertigo Six Types of Back Pain Stop Computer Work Pain Female athlete knee injuries… Runner’s feet Bladder control…Balance-Falls…Lymphedema… etc. (niche list)

Print Articles ! Maine Sportsman… THE HUNTER WITH A BAD BACK by LH, DPT, RMG (Then do press release re this article) Monthly column ?

Your web site -1/3 HAVE ONE !! EXPLORE examples !! Hire a teen ? Mac iWeb template Blog– WordPress.com FB page

Note… testimonials.. free clinics.. our services

Have a Facebook Page ! Similar content re web page One for YOU, then.. Link to another for your CLINIC Check Lauren Hebert… SmartCare.. IMPACC

Branding your practice.. Specifics.. Branding you & your clinic………………... Memorable descriptive name brand SmartCare…WorkSmart…IMPACC…No-Lost-Time Results PT.. Dragonfly.. Proactive.. Innovative Again do web search for examples Get creative

Why should they come to you? You are good.. very good. Good means results in fewer sessions (cost) Outcomes data support that. You are different.. special. You are confident.. You make that contagious. Why are you the best choice? 

Why will they ask for you? You have ‘secret weapons’ for great outcomes……….… Non-TMJ C-txn McKenzie enhanced by Dontigny SIJ LLLT; non-needle acupoint stim TOC input to UE-NVC hip inputs to knee LB inputs to plantar fasc Three-exercise rule Simplified TMJ PT for HA MWM; kinesiotape; SCS Vertigo & BPPV protocols; balance-falls Piriformis inputs re LB-SI-Hip-Troch bursa

Outcomes -I Quality-improvement-excellence-marketing Track your strengths & weaknesses Address improved quality & capabilities TE-PFasc: MWM, laser, kinesiotape…. LB: MET-SI ….. Market to MDs, insur, employers, public Bragging rights re outcomes (eg, SR) FOTO.. or.. Homegrown

Outcomes -II Homegrown, roll-your-own approach At discharge = score 8/A: 8 visits… ‘A’ outcome Number of PT sessions A-B----C-D outcome Diagnosis group Per group (WComp; Sunday River) 107

Outcomes -III Quality-improvement-excellence-marketing Per Dx group… Published functional outcome measures PSFS.. SPADI.. NDI.. LEFS.. DASH.. Oswestry OPTIMAL… APTA

Outcomes -IV SmartCare averages 6.2 visits per patient, (compared to national average of 12-14 visits) With average outcomes success (A-B) rate of 87% FOTO named SmartCare to the top 5% nationally for outcomes costs / success

Outcomes -V real-life perspective We are cheaper than a root canal.. and more fun Cost per case.. root canal.. contacts.. eyeglasses.. set of tires.. dog

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Physician Relations Timely intake Same day slots They reciprocate? Mutual referrals Staggered hours-days MD Office mgr, staff, nurses! Fax eval… Fax notes… Excellent notes (eg, Joe C.) Heads-up alert notes Thank-you notes & calls ‘He said, she said’ risks Does MD send you their family members?!

Patient Relations -I Timely access Staggered hours Initial eval follow-up call Convenience, warm setting, welcome Focus on their goals, mutual goals Educate, Motivate Thank you at D/C Thank you… Tell your friends… Ask P2P referrals Cards-brochures

Patient Relations -II Time! Listen! Exude confidence Be excited “I love treating this problem” Motivate them “You will move better before you feel better” Objective measurements to assure them

confidence.. valid expert

My patient Lorraine She said, “tell your students about me… When I called, you said, “Good, I love treating that problem. It is a specialty of ours.” That gave me confidence, rather than fear. When you examined me, you were excited about what you found and that you thought you could help me. That made me excited. That made me know that you cared about me and my outcome. You explained what you found and showed me visuals (skeleton & pics). You taught me how to take care of myself. At D/C, you told me I may have setbacks and that it was OK. You assured me you would be available for calls for questions anytime.”

What they want, need, appreciate the most.. Patient Education ! Understand pathomechanics-biomechanics Less fear.. Re-assurance Confident.. Committed.. Motivated Avoids nocibo Part of Pain Neuroscience Education

SHOW them exactly what their problem is and how we will fix it.

PDF emails

Patient Relations -III Post & explain billing & fees Help contact (LH or Debbie) Warn of insurance difficulties Unaccepted insurances explained (Copies of examples for those dis-believing) Waive co-pays/deductibles? ..NO.. illegal kickback Intake form: rules-issues-DC criteria-compliance No-show… Late-show

Employer Relations - I We can save you money. We can help your people & your company. Treatment.. Preferred provider 10-day HCP… Prevention ! Your clinic’s occupational health services (W.Comp) Taking care of employees & families (Health Plan) Ergonomics-Prevention Programs

SmartCare IMPACC Primary Care Direct Access Occupational Health PT practice IMPACC Injury-claims prevention W. Comp cost reduction No-Lost-Time Irving Sunday River Ethan Allen CMP.. Cianbro Willis

Community Relations Back School for public NAS for public Office ergonomics inservice FMS.. HA.. Bladder Control.. Osteoporosis Runners School.. Golf health Office ergo screens… MD, insur, many workplaces, schools! BS-NAS for EMS, schools, fire, police, charity, food pantry High school sports: pre-season, ATC, weekly rounds

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Marketing Tactics -I Display ads Press releases Annual full page.. educate Local diner place-mats Articles series Open house Art exhibit

Marketing Tactics-II WORKSHOPS ! Public BACK SCHOOL Public TENDINITIS SCHOOL Public STOP COMPUTER PAIN SCHOOL Public HEADACHE SCHOOL Dentist-ENT… TMJ SEMINAR Local employer BACK SCHOOL Local employer OVERUSE MSD SCHOOL (esp. school-fire-EMS-police-town employees-DOT)

Computer work pain Falls Risks Screen Avoid Fitness Training Injuries Back School Tendinitis School Headaches TMJ seminar

Seminar for EMPLOYERS Treatment Prevention

Marketing plan philosophy 132 You have to actively pursue this! My good work will attract patients? WRONG! Make a Plan.. Follow it.. Keep it going

Becoming an Employer -I Now… your world changes! $$ risks… Legal risks Taxes (lots), benefits, insurances, salary, laws-rules-regs Selection process… ADA, EEOC, broken ‘promises’

Becoming an Employer -II Now… your world changes! New responsibility for: Leadership, set examples, enforce discipline, say no Are you a push-over; avoid conflict, need to be liked? You’re fired… versus putting up with marginal-problems A business is not a social democracy… it must be a dictatorship Lawsuits

Becoming an Employer -III Family employees? Sister, mom, deadbeat in-law, spouse Can you-will you fire them??

Becoming an Employer -IV PT, PTA, ATC, aide, secretary, billing person What if only mediocre, barely adequate? Would you rather keep that expense as profits or retirement fund?

Policy & Procedures Manual Legal document that defends your business and practice Defensible business practices Medicare & HIPAA compliance manual Employee manual Employees sign they have read it

Policy & Procedures Manual Patient processes CPT-ICD codes Referral mgt Correct coding-CCI Patient scheduling Billing claims processes New pt register-intake Bill agency procedures Insur-payment verify Payment processes Info-Records Mgt Billing authorize-consent Records retention mgt Discounts-writeoffs-adjustments HIPAA compliance Refunds to pts-payers PHI mgt-protection Coinsur-copayment mgt Fess schedules-hardship determine Patient confidentiality Credit card processing Identity Theft red flag compliance Check processing-deposits Physical records protection EOB Electronic records protection Pro Bono care BA mgt-controls Private pay Security incident mgt Coding-Billing

Policy & Procedures Manual Patient safety Outcomes measures Incident reports MD protocols Infection control PT protocols Blood-borne pathogens Confidentiality Patient supervision-protection Clinic Privacy Patient care Intake Specific modalities procedures History Health screen EMPLOYEE MANUAL Expected performance Pain diagram Functional measures Accountability-discipline Initial evaluation Initial eval follow-up call Number system Progress reports Staff education-compliance-signoff Discharge summary Updates MD-etc. fax report Sign plan-of-care Fax log