Last week, I joined hundreds of amazing physical therapy professionals, students, and vendors (including yours truly, WebPT) at this year's PPS Annual Conference in Orlando, Florida. Despite the uncomfortable combination of tropical heat and humidity outside—and near-freezing conference rooms inside—everyone was in high spirits. Though I never made it to Disney World, I still felt like I was in the most magical place on Earth, thanks to the inspiring and informative presentations I saw and the thought-provoking conversations I had. A lot of what I heard at PPS revolved around how to position PTs to be successful in a changing world—whether those changes are coming in the form of healthcare regulations or increasing consumer power (especially as it relates to social media use). If you were there—or were following my live Twitter coverage—then you know what I mean. If not, here's a recap of my biggest takeaways:

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1. "If you want the audacity of owning your own business, you might as well put in the work." - Gary Vaynerchuk

That quote sounds a little harsh, but Gary Vaynerchuk—marketing guru, public speaker, angel investor, venture capitalist, future New York Jets owner, wino, and #cougarselfie connoisseur—isn't in the business of pulling any punches—just jabs, which is how he describes building relationships through social media engagement. He may not be a boxer, but he does know that keeping your clinic in business isn't about defense; it's about offense.

Vaynerchuk also understands that "we are living through the biggest cultural shift ever." As the PPS 2015 opening keynote speaker, he gave a rousing speech about the importance of social media in business, declaring that "the quickest way to go out of business is to be romantic about the way you do it"—which probably explains why Vaynerchuk assessed that most PTs "are marketing like it's 2007...2003...1998."

The way Vaynerchuk sees it, "it doesn't matter if you think social media is bad or good...Social media is the foundation of how you will do business." Why? Because it's 2015: "time is the asset [and] the Internet is the middleman" between you and your patients. Thus, Vaynerchuk asserts that "if you aren't challenging yourself to understand this mobile society," you will get left behind.

2. "Social media is the 21st-century water cooler." - Gregory Grant, Esq.

As we learned from Gary Vaynerchuk, social media is a must for a successful business—but in his humorous presentation, Gregory Grant, Esq., gently reminded us that "once things get on the Internet, there's no going back." That's why it's just as critical to implement a "clear, specific, and regularly and uniformly enforced social media policy [to] protect your practice from legal ramifications."

"Social media is now an extension of the workplace," Grant informed the attendees. Hence, he advised that "companies need to properly counsel...employees that just because harassment occurs on social media, it still affects the workplace...or you, as the employer, can be held legally liable for your employees' action (even on personal accounts)." Furthermore, Grant counseled businesses to "create and enforce an intellectual property policy that includes references to social media."

3. "Like it or not, we're all in the persuasion, sales, and influence business now." - Daniel Pink

As Meat Loaf once sang, "The future ain't what it used to be"—and that sentiment certainly applies to the art of selling. Daniel Pink—the breakfast keynote speaker and respected author of bestselling books about business, work, and behavior—explained that "most of what we know about sales comes from a world of information asymmetry where the seller always has more information than the buyer [but] we're getting closer and closer to information parity."

For PTs to survive in what Pink refers to as a "seller beware" landscape, providers must start thinking of themselves as salespeople. Here are Pink's tips for successfully persuading, selling, and influencing in an information parity world:

  1. Increase your effectiveness by briefly reducing your feelings of power.
  2. Use your head as much as your heart.
  3. Don't worry about changing the nature of your personality.
  4. Remember that context drives our behavior more than we think, so give people an off-ramp.
  5. Help patients understand all the information they now can access.

One final tip from Pink: Instead of focusing their expertise on solving current problems (i.e., providing rehabilitation services) providers need to capitalize on their expertise by identifying hidden problems (i.e., providing wellness services) which was another common theme at PPS 2015.

4. "Patients are starting to look at and experience health care and healthcare delivery systems in a whole new way." - Jonathan Fleece, JD.

Healthcare attorney Jonathan Fleece, JD, began his presentation with a pretty powerful statement: "America's state of health, the economic models driving healthcare choices and costs, and America's healthcare delivery systems do not adequately foster the right incentives for American stakeholders to 1. increase the quality of their health, 2. improve health care service to everyone, or 3. control healthcare costs."

Or, to put it more concisely, "Our state of health is in crisis." (Case in point: 5% of the patient population accounts for roughly 50% of healthcare expenditures. Yikes.) That's why we're entering a new health age. Fleece pinpointed nine dynamic flows that are—and will continue—reshaping how we think about health care, how we deliver health care, and the economics of health care:

  1. The focus on sickness is evolving into a focus on wellness.
  2. Ignorance of health is transitioning into awareness and understanding.
  3. Patients, providers, and payers will stop opposing each other and come into alignment.
  4. Treatment is becoming prevention.
  5. Reactive is becoming proactive.
  6. Episodic is becoming holistic (partly due to bundled payments).
  7. Emphasis on the number of procedures performed is shifting to a focus on the performance—or outcomes—of those procedures.
  8. Isolation is turning into integration.
  9. The inefficient healthcare system will become efficient—largely because of "the migration to electronic medical records."

Fleece asserted that physical therapy clinics—like Fyzical Therapy and Balance Centers—are "part of the solution" in what he called the new "health management system" (goodbye, "health care"), which he suggests will include medical homes, integrated delivery systems, accountable care organizations and employee accountable care organizations (ACOs/EACOs), Star Rated Medicare Advantage Plans, and health insurance exchanges. On a more serious note, Fleece encouraged PTs to keep an eye on integrated delivery systems in their communities because "as these drivers of change are becoming a reality, the silos are going away. If you can't find a way to connect...you will be left behind in this new health age."

5. "ACOs are really locking out the private practices." - Gwen Simons, Esq., PT, OCS, FAAOMPT

Not everyone was on board with the vertically-integrated healthcare train. In their discussion of insurer and hospital/ACO anti-competitive alliances, Gwen Simons, Esq., PT, OCS, FAAOMPT, and Deborah Winegard, Esq., boldly stated that "private practices are the casualties" of these organizations and explained the potential legal pitfalls associated with these groups. According to Simons and Winegard, the acquisition of private practices benefits larger entities—and "locks out" the private practices—because:

  • Referrals mostly stay in-network.
  • They gain bargaining leverage with payers.
  • By paying higher salaries to employed physicians, they avoid anti-kickback and Stark violations.
  • They can bundle hospital, physician, and ancillary services so the consumer has little choice.

But because of their very structure, these groups open themselves to antitrust issues like per se violations, including price-fixing, concerted refusals to deal (boycotting), reciprocal dealing, and tying arrangements/monopoly-leveraging—which are illegal regardless of whether market/monopoly power exists. And when lawsuits are involved, the little guys get hurt, too, because antitrust enforcement laws apply to otherwise independent providers and provider groups that constitute the ACO as participants—including PTs.

The good news is that Simons believes "the pendulum is swinging back in favor of private practice." One very good reason for that? That whole cost-savings benefit of vertically integrated systems may not even exist, as it appears "vertically integrated healthcare systems (physicians are employed) result in 3.2% higher costs in a recent study published in Health Affairs."

6. "Solutions-based entrepreneurship may be the saving grace for private practice PTs." - Maury Hayashida, PT, DPT, OCS, SCS, CSCS

The founder or co-founder of several successful health and wellness businesses (and one research institute), Maury Hayashida, PT, DPT, OCS, SCS, and CEO/President of Hayashida & Associates Physical Therapy, knows a thing or two about entrepreneurship (and time management). In addition to his traditional outpatient practice, Hayashida established a concierge cash-pay practice, a health and fitness development company, a corporate athlete consulting company, a post-rehab and sports medicine cash-pay practice, a movement lab (including consulting and an R&D cash-pay practice), and a research and community service organization. How did he achieve his success? He employs a solutions-based entrepreneurship business model, which allows PTs to capitalize on recent healthcare trends, including the increasing popularity of smaller, personalized gyms; the growing field of entertainment fitness; and the rise in public health education.

Hayashida explained that solutions-based entrepreneurship involves identifying—and integrating—the three Ps: problem (your business opportunity), product (movement and education), and purpose (the one thing that drives you). He advises providers to:

  • "think big, but go small" when identifying and defining the problem and
  • "know what the consumer wants and how to show it to them."

But part of the product are the PTs themselves; hence, Hayashida asserts that PTs should "become the quality, be the resource, and provide the access" to what consumers need and want.

While it does offer its challenges—greater legal and accounting expenses, initial time and effort, learning curve, and risk exposure, to name a few—Hayashida also indicated that his model solves many traditional private practice problems, such as:

  • patients being discharged too early and without a path to wellness
  • staff turnover
  • capped salaries
  • pre-injury access to PT
  • physician and public misunderstanding of PT
  • practice infringement
  • inequality of access to PT based on socio-economic status
  • ineffective marketing

And because his model addresses both the forward (i.e., "where patients are going") and backward (i.e., "where patients are coming from") needs of each patient, solutions-based entrepreneurship can result in more referral sources. However, Hayashida warned PTs that their product must be good enough to warrant those referrals.


Well, that was a long post, wasn't it? And it doesn't even begin to cover everything I learned at PPS 2015. Perhaps my biggest takeaway is how much physical therapists care about their patients. If you're a physical therapist, you do what you do because you want to help others. Of course, you have to help yourself, too, because all your passion for people will go to waste if you can't stay in business. While you may not be a salesperson, marketer, or business person at heart, societal changes demand that you adapt if you want to maintain or grow your practice. In the words of Gary Vaynerchuk, "It's either offense or defense—you choose."

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