Toolbox 2017-08-20T14:15:55+00:00

Practice TOOLBOX

Tools and Tactics EVERY Physiotherapist Should Know

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Do you know if your physiotherapy practice is as profitable as others? Do you know if your physiotherapists are treating as many patients per day as other practitioners? Do you know if you are paying your staff competitive wages? Are you paying too much in rent to run a profitable clinic? You should know the answers to these questions if you own a practice. It is beneficial to know how we are doing currently and then to compare our performance over time. It is even more valuable to be able to compare some of these measures to other industries as well as with other physiotherapy clinics. This is called Benchmarking.

Some of the key areas that we should be measuring in our Physiotherapy practices are: financial, productivity, accounts receivable and wages. This allows us to determine if our performance is reasonable and to set more accurate goals and budgets. It can help to identify areas for improvement and make evidence based decisions.

We really did not have any way of benchmarking our clinics with similar clinics in Canada until the CPA Cost of Business survey (COB) data became available in 2006. Prior to this time data was really only available in the United States. They have the Private Practice Section Best Practices Guide 2002 and a company called HCS Consulting who has been producing a report called PT Benchmarking since 2002. PT Benchmarking in the United States is available to clinics for $500 to participate and runs annually whereas the COB here in Canada is free but will not be run annually.

Examples of Benchmarking Data from the COB

In Western Canada most clinics treat about 10,000 patient visits per year. For every dollar billed for PT services, 45 cents goes to the treating therapist and 55 cents goes to pay for all other expenses. Most clinics bill about $200 per square foot of clinic space. Across Canada, clinics need to charge about $64 -$75 per patient visit depending on what it is to cover costs and run sustainable physiotherapy clinics.

The benchmarks you select for your business are a personal choice and need to make sense to you. For example if you own a multi-disciplinary clinic or sell products, you may choose measures that separate this information by revenue stream. To collect your data you need practice billing software and bookkeeping software that provides you with easy to generate and easy to understand reports.

Examples of benchmarking measures that are appropriate for a physiotherapy practice include any or all of the following:

Financial Benchmarks:

• Income (Income per hour, income per new patient and per visit, income per sq.ft)

• Expense (fixed, variable, and labour expenses) as a % of revenue, cost per visit, accurate owner management expense

• Profit (profit per patient claim, profit per visit, and profit as a % of income)

• Professional gross margin (% PTs are paid of gross billings)

 

Productivity Benchmarks:

• Number of new patients, number of visits, billings per PT, number of visits per hour

 

Accounts Receivable Benchmarks:

• size of A/R, aging A/R, net A/R as a % of revenue

 

Wage Benchmarks:

• wage for all positions, labour as a % of income

 

Once you have your “report card” of measures to compare monthly or annually, and to other practices you need to ask the question “Why?” It is the task of the clinic owner to be able to identify why some of these measures have increased or decreased over time. For example, are there fewer new patients because one of your primary referring physicians retired? Did your profit per visit decrease to a loss situation because your province decided to regulate automobile insurance rates? Are your reception staff leaving for other jobs because you are not paying a competitive salary? Once you can answer these questions you are half way to identifying a solution and improving your business.

References:

Charles Felder, Business Benchmarking to Improve Your Practice, PPS 2006 Annual Conference

John Wallace, Reimbursement Strategies: Practice Management by Numbers, PPS 2006 Annual Conference

– Submitted by Wendy Neidhardt, Private Practice Division Chair

This article was reproduced with permission from the Private Practice Division Newsletter, which is produced by the Canadian Physiotherapy Association. The goal of this division is to act as a forum for discussion and a resource on business management topics relevant to private practice physiotherapy. To join the Private Practice Division, go to the CPA website (www.Physiotherapy.ca) and follow the links to Divisions.

What to Know

For the most part, you will only want to approach your local media to get coverage for an issue or event that’s unique to your community or your clinic. Provincial associations’ issues media releases from time to time and give interviews on issues of provincial importance; CPA does the same at a national level.

How to Prepare a Media Release

  • Keep it short; no more than a single page if at all possible. Double-space the text for best readability. Use your clinic or organization letterhead.
  • Include the most important information in the first paragraph. If it’s an event, include the “who, what, when, where, why.” If you are writing about an issue, include the most attention-grabbing information.
  • Write in short sentences and use bold text to call attention to important details, such as key names or events.
  • Conclude with contact information, including a name, phone number and email address.
  • Proofread, especially for dates, times, addresses and numbers.
  • Send to a person, not a station or company. If you don’t know who to send it to, phone and ask the receptionist. Ask whether they prefer to receive via fax or email, and double-check you have the correct numbers.
  • Follow up by phone two working days after sending the release. Ask if they received the release, and if they need any more information. Don’t ask if/when the person will be interviewing you/covering the event; editors make such decisions and it is often beyond the journalist’s control.

How to Give a Good Interview

When you are contacted by media for an interview, find out the reporter’s name, their media outlet and format (i.e. print, radio, TV) and what the interview will cover in general terms. Do not do an interview on the phone immediately; you need at least a few minutes to collect your thoughts.

  • Write down key messages that you’ll want to use during your interview. You will not be reading this, you should know what you want to say from memory.
  • Keep your answers short. Make your point, then stop speaking. This makes for better quotes and sound bites.
  • Never speculate about another person, group or organization, and don’t speak on behalf of someone else or an organization unless you have been asked to do so.
  • If you don’t know an answer, say so. Offer to find out and get back to the interviewer as soon as possible. If you can’t answer a question, say why. For example, “I can’t comment on that because it would breach client confidentiality.” Never say, “No comment.”
  • Remember, there is no such thing as “off the record.”

 

As private practice physiotherapists, we are constantly being confronted with the need to adapt and evolve according to the ever-changing challenges and opportunities around us.  In fact, the Cost of Business Survey results unveiled in 2006 revealed quite clearly that the clinics that ranked in the top 1/3 for net income per partner were the clinics that accomplished this by:

  • providing diversity in their services
  • demonstrating more efficient use of professional staff
  • utilizing their space efficiently
  • utilizing their staff efficiently
  • demonstrating greater revenue levels

The above list is only a few of the specific observations that arose from the COB survey, but the fist point is particularly important in that it demonstrates the necessity of private practice owners/managers to become more diversified in their services. Just as many clinics have more recently begun developing and implementing programs to address the issue of obesity within the client population, many clinics around the world are also developing programs for the Cancer Patient.

At WCPT, I had the opportunity to attend a pre-congress course on Physiotherapy Examination and Treatment for the Breast Cancer Survivor.  The course was attended by physiotherapists from around the world.  Therefore, not only was the clinical course content invaluable, but the dialogue amongst the course attendees was of equal value.  It was a diverse group of public and private based physiotherapists with varying degrees of experience and involvement with the cancer patient population.  Of particular interest, were the private practice owners who had already begun offering specific programming for the cancer patient in New Zealand, United Kingdom, Canada, Australia, and Switzerland.  Once again, the programming in these private clinics varied, but the underlying concept was the same.  That this is a growing client population and provision of service to this client population is also growing in the private sector to meet the demand.  

The following statistics provide a solid basis for why these private clinics are developing programming in this area.

1. High probability of developing cancer in lifetime

Sites                                 Males               Females

All                                     1 in 2                1 in 3

Breast                                                       1 in 8

Prostate                            1 in 6

Lung                                  1 in 12              1 in 17

Colorectal                          1 in 17              1 in 18

Greenlee:  Cancer Vol. 51: 1 Jan 2001)

 

2. Cancer Survivorship Increasing Dramatically

1900 – little hope

1930 – 1 in 5 (20%)

1940 – 1 in 4 (25%)

1960 – 1 in 3 (33%)

1990 – 4 in 10 (40%)

2007 – Relative Survival Rate- 66%!!!

3. Obesity is the most highly associated risk factor for developing lymphedema and is directly correlated to death rate.

BMI (Body Mass Index) Death Rates (100,000)
18.5 – 24.9 (normal) 39.1
25.0 – 29.9 51.13
30.0 – 34.9 60.65
35.0 – 39.9 67.56
>40 84.86

In summary

  •   ½ of all men and 1/3 of all women will develop cancer at some time in their lives eventually according to the present rates (life time risk), and
  •   5 year survival rate is estimated at 66% with approximately 10 million survivors (American Cancer Society, 2007)
  •   More survivors = more individuals dealing with physical & emotional problems as a result of the cancer and the treatment
  •   Physiotherapy works closely & collaboratively with the health care team to providing vital patient education and early screening & intervention for mobility/functional/lymphatic problems.

 Furthermore, the added reality of ever growing waiting lists in the public sector necessitate for these services to be offered by a private practice in the community.

Opportunity

Many private clinics are already seeing an increase in the number of these clients seeking treatment often by self-referral.  This client population is easily reached by providing education to local physicians with regards specific programming, by contacting the local cancer agency, radio/newspaper advertising, clinic web site (if available), and advertising within your clinic.

In summary, private practice clinicians have an opportunity to play an effective role in the management of this client population: pre-operative assessment and education; treatment of secondary sequelae; instruction and progression of home programs; biomechanical restoration; early screening, detection, and treatment of lymphedema; follow-up screening for late onset sequelae; group exercise classes; and development of appropriate individual aerobic exercise programs.

Remember, diversity may be your key to success!

–  Submitted by: Suzanne Funk BMRPT, Executive Member of PPD- CPA

Conflict at work with colleagues, suppliers or clients may seem like something to avoid but it doesn’t have to be. It’s usually the avoidance of conflict that causes problems. Effective conflict management creates better relationships.

Conflict has two major components – 1) the issue at hand, and 2) the relationship involved between those involved. Think of conflict as an opportunity to make a positive change.

Suggested strategies:
Acknowledge the problem. This means facing up to the fact that a problem exists and won’t go away unless it is addressed. It’s better to confront the problem sooner than later.
Focus on the issue. If the problem is complex, focus on one issue at a time. By concentrating on one issue at a time, a satisfactory solution will seem attainable.
Discuss the matter privately. Decide on a specific time and place to meet, preferably on neutral ground. Keep the issue private until you have had a chance to discuss/resolve it.
Choose your words carefully. Use “I” statements : I think… I find… and I sense; this technique focuses on the issue and avoids placing blame.
Be positive. After all, you are trying to resolve the conflict. Stay away from the role of the naysayer – someone who offers criticism and pessimism about all proposed solutions. Speak your mind and stick to the facts.
Be direct. Say what you mean in a clear and direct manner. Don’t be ambiguous. When you communicate your wants or needs clearly, the other person will know where you are coming from. Back up your statements with examples and provide explanations of why you need something or feel the way you do. Do not argue. You want to find a solution rather than prove that a person is wrong.
Try to keep your emotions in check. Failure to do so could mean that you won’t express your views logically. If the situation seems negative or explosive, wait for another opportunity to discuss the matter.
Listen. Be sure to listen to what the other person is saying.
Be Curious: Seek to understand the other person’s point of view. Ask questions to help your know what the other person’s needs and concerns are. Pay attention to body language. When you approach things with a clear understanding of the other person’s perspective, you will probably agree to a solution.
Put your heads together. Jointly find a solution. See if you can agree on such an approach. Once your agree on this common goal, you are off to a great start.
Seek help. If the problem is too big to handle alone, or you just can’t seem to reach an agreement, consider seeking help form a third party. Such a person could set down some ground rules for meaningful discussion that promotes respect for both parties.
Take action. Once you have identified a solution, follow through with a course of action, and follow up. Tension will remain high if the lines of communication don’t stay open.
Be willing to compromise. Recognition that you and the other person each have something at stake. Find ways to meet in the middle, if necessary. Compromise is most effective when each person feels right, to a certain degree, despite differing opinions. Immediately make clear which issues are negotiable and which are not.
Accept personality differences. You might find yourself repeatedly clashing with the same person over minor issues. Accept that there is a personality conflict but try to keep your differences from affecting your working relationship.
Above all, keep things in perspective. Is the solution something you can live with? To figure that out consider the test of three: Will this matter to you: in three hours? In three days or? Three weeks?

Private Practice Business Success is Contingent on Three Things:

Clarity, Capabilities, Confidence

Without exception, we all have the potential for greatness. Yet most people realize less than 10% of their potential. A few others lead extraordinarily lives, being fulfilled and financially successful. What makes the difference between the 10% and the few others?

Whatever other business guru’s may say, I believe with great conviction that you cannot be truly successful in your life and physical therapy private practice unless you have these three attributes: clarity of purpose, business capabilities, and confidence that you can be a successful business owner.

Let’s take a closer look at these three attributes for physical therapy private practice success.

1. Clarity

You must have clarity about your vision for your business, your business strengths, and your reason for being, and you must be propelled by these, with conviction and perseverance, to make it happen for you.

Here are some coaching questions to give you clarity.

____________________________________________________________________

What are your greatest strengths and what are you passionate about doing?

What is your compelling “why” for building your business?

What core values do you and your business stand for?

How can your core values differentiate your business in the marketplace?

____________________________________________________________________

Defining your personal and professional vision and purpose, and knowing how to achieve them are fundamental to your success as the owner of a physical therapy private practice. Clarity enables you to distinguish between making good decisions and making the best decisions in any situation. It also helps you identify where your mind set or habits are getting in the way of managing and growing your business effectively.

 

Three key benefits of improved clarity are:

  • the ability to be driven by clarity of purpose rather than reactionary thinking
  • the ability to make effective decisions faster, even under great pressure
  • the motivation of knowing you are moving in the right direction.

2. Capabilities
As the owner of a private practice physical therapy clinic, the value of your technical skills declines, while the value of your business capabilities increases.

Here are a few of the most important business capabilities you should have:

  • Planning and thinking strategically
  • Maintaining a focus on your key business objectives
  • Moving from managing to leading your organization and business
  • Building effective business relationships
  • Having a business owner mindset!

 

Coaching questions for your consideration

____________________________________________________________________

Which of the above business capabilities do you have today and exercise regularly?

Which business capabilities would you like to become skilled at, how can you acquire them?

____________________________________________________________________
3. Confidence

The business world has plenty in it that promotes fear and anxiety.

True confidence is the ability to transform fear into focused and relaxed thinking, communication, and action. It turns dangers into opportunities, obstacles into innovations, weaknesses into advantages, and set-backs into breakthroughs.

Confidence is neither a factor of personality nor emotion.

It is the key that enables you to utilize your capabilities. When you learn to create confidence yourself, you can have it in endless supply.

Many incredibly gifted individuals could be doing so much more with their natural ability, but something always seems to hold them back. The missing factor is nearly always confidence. It’s the ability to appreciate the resources they have, see their past progress, and create a compelling vision of the way forward.

Your coaching questions on confidence.

____________________________________________________________________

What beliefs about myself and what’s possible may be hindering my success?

What current habits may be getting in the way of my business success?

What attitudes and behaviors should I change to realize different outcomes?

What decisions am I currently making about my business success?

___________________________________________________________________

Behind every extraordinary person and achievement are daily success habits. Athletes can attest to their days filled with endless hours of hard work and practice. Success, as you know, doesn’t occur overnight but rather is a culmination of small steps and persistence over time.

Success is a decision. Make a decision about the future you want to create today!

About the Author

Erika Trimble is a professional business coach and business owner always developing new strategies to grow her own business. Private practice business success is her business purpose and focus.

For a Special Report on The Top 10 Marketing Strategies to Grow Your Physiotherapy Practice go to www.prosperousphysicaltherapy.com — a website dedicated to giving private practice physical therapy clinic owners the tips, tools, and strategies they need to successfully grow their businesses.

Copyright © 2008 by Erika Trimble All Rights Reserved

1. The timing: You should plan your exit strategy right from the beginning. If you plan on selling to key employees or to an outside buyer there are different things to consider for each scenario.

2. The preparation: You should run your practice like it is always for sale by ensuring that it is the most efficient business and as effective clinically as possible. Your business should be so attractive to a buyer – that you would buy it!

3. The decision: You must decide why you want to sell and what are realistic goals are for your lifestyle after the sale. For example, if you are selling because running a business is not providing the work life balance you expected, you may be able to sell only a portion of your business by bringing in a management partner. If you are selling because you want to retire, then to maximize the sale proceeds you need to start the process several years ahead. Often you will fetch a higher price if are willing to stay working in the clinic for several years after the sale closes.

4. The performance: To have a good understanding of your clinic and business you should collect all of your clinic’s data. This should include financial statements, clinic visit statistics such as the number of new patients and number of visits per week. It is also useful to know the performance of each of your clinicians over the past several years.

5. The market: Understand the size of the buyers’ market. Physiotherapy clinics are not like other business that anyone can buy – your market is much smaller. In some provinces the buyer must be a Physiotherapist or own a certain percentage of the shares. Your market becomes even smaller when you consider that everyone is not business minded or entrepreneurial and may not want to be a clinic owner. Lastly not everyone has the financial means to make this type of large purchase.

6.The legal team: Business consultants and lawyers are there to protect you and are necessary for a business transaction of this size, but sometimes they can get in the way of making a deal happen. They are paid a handsome hourly rate but may not understand the specifics of the Physiotherapy business. Try to recognize decisions that are made on good simple logic in contrast to ones that will cost you time and money and possibly the deal. Look for nitpicking, multiple meetings on the same subject, calling in another “specialist” in the area just to reaffirm something you already know to be true.

7.The financial team: Accountants are important in the valuation of the clinic. Have your accountant “normalize” your income statement. Find all the expenses that are not directly related to running the clinic or that would not normally occur if another owner were to take it over. This would include car expenses, meals and entertainment, courses and seminars, etc. Also the salary you have taken out should be normalized to what you would have paid another Physiotherapist and manager for the same work.

8.The value: Most physiotherapy clinic sales are private so there is not much information available unless you look at publically traded clinic sales in the US. From our experience clinic valuations are anywhere from 2.5-4 times EBITDA (Earnings before interest, tax, depreciation and amortization). A higher multiple will be applied if the clinic is low risk and is likely to maintain or increase profits without you involved in the long term. This can be determined by looking at the diversity of referral sources, diversity of revenue streams, multiple locations, strong brand equity, a longer term on the lease, new or well-maintained equipment, the staff is likely to remain after the sale, a high volume of new patients, a great location, and lots of potential for growth.

9.The process: Once you have decided to sell, organized your clinic information, determined the value, and advertised to potential buyers there are set processes that typically occur. Firstly you will share information with your buyer. You will tour the buyer around the clinic, have the buyer sign a confidentiality agreement, and share your financials and clinic information. The buyer will then provide you a letter of intent that outlines the offer and negotiables. You buyer will then be provided more detailed financial information and access to your billing software to complete their due diligence. If all is satisfactory an Offer to Purchase or a Share Purchase Agreement will be signed. You should have a change management or transition plan for your staff, patients, and yourself to ensure that the quality of serves and employee satisfaction remains high throughout.

10.The deal: Decide if you want to be paid in full up front. Note that a higher price will be set if a performance based payout is negotiated. This is when a portion of the money is paid on closing and then a portion is paid in the future if you reach certain targets, typically net profit targets. This means you will stay on as a clinician and manager and help to transition and grow the clinic. You would have to negotiate the term of how long you have to reach the targets. A term that is too short may not give you enough time to meet the targets. If the term is too long then it would make more sense to keep the clinic or just get all payment of front. You also need to be clear if the incoming owners will help you increase the profitability. Assuming that you were doing the best to increase profitability prior to the sale, you will need assistance to increase it further to hit the higher targets. Ensure there is logic behind the targets set in the deal.

11. The fine print: Make sure that you understand the non-comp., non-solicit, and confidentiality clauses that all buyers will put in the agreement. If you are planning on selling and working elsewhere, make sure that you understand what areas are restricted. For example you may not be able to work for a 10 km. radius from the clinic for several years after the sale. Also understand that you will likely not be allowed to recruit your patients into your new place of employment. Most aspects of the transaction and any propriety information that you learn from the buyer will be considered confidential and you will be signing away the right to discuss any of it.

12. The references: If the purchaser has bought clinics before, ask for the references of those that they purchased from. It is not proper etiquette and not likely allowed in the confidentiality agreement, to ask for the specific pricing details of the reference’s sale, but the generalities of the deal can be discussed. Was it fair? How long did the process take? When did you get lawyers and accountants involved? What were the owners like during the process? Do you have any regrets? Would you deal with the purchaser again?

If you are planning on selling don’t be intimidated by your lack of business experience in this area. There are resources available and ask for help. Have a prosperous year!

Paul Moon, PT Health, pmoon@pthealth.ca

Wendy Coombs, Past Chair Private Practice Division, wendycoombs2006@gmail.com