The first rule of the Graham Sessions is that you don’t talk about the Graham Sessions. Well, sort of. This annual “think tank” event isn’t quite as clandestine as Fight Club, but the rules are definitely a bit different than those associated with any other PT industry conference. After all, the point of this meeting is, quite simply, to talk—to have real, open, honest conversations about the controversial issues facing the physical therapy community. And to ensure attendees feel comfortable voicing their true opinions—however radical they may be—Graham Sessions organizers have, from the very beginning, strictly forbidden anyone from publicly attributing ideas or statements to specific speakers or audience members. That said, they encourage everyone in attendance to take what they’ve learned and use it to educate their peers and inform their future plans and decisions. Still, there’s no agenda—and no resulting task assignments (much to the chagrin of many action-oriented participants). So, as the self-appointed Graham Sessions minutes recorder—seriously, despite my conscious effort to exercise self-restraint in the note-taking department, I came home with 17 typed pages of raw, uncensored PT wisdom—I took it upon myself to spin up some collective to-dos:   

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1. Get your outcomes-tracking act together.

The call for PTs to unite in their data-collection efforts is nothing new. In fact, it was a very popular topic of conversation at both the 2015 and 2016 Graham Sessions. But, as one veteran attendee so pointedly observed during this year’s event, “Every Graham Sessions I’ve been to, we’ve talked about value and outcomes, but we’re still not together on it.” And part of the reason for therapists’ lack of harmony on the data front is their inability to settle on (1) a defined, universal set of tools and (2) a common place to store and access the resulting data. And that brings me to my first outcomes-tracking sub-action item.

Standardize the basic measures set.

Just as no two patients are alike, no two therapists are alike. They all see different types of patients with different treatment goals. But, that doesn’t mean they should use super-specific outcome measurement tools (OMTs) to track those patients’ progress—at least not exclusively.

Think beyond measures unique to physical therapy.

There are plenty of patient-centered OMTs that apply virtually across the board—even outside of the PT space. And with care integration and provider collaboration becoming increasingly important—thanks to the growing emphasis on holistic, episodic models of healthcare delivery and payment—therapists really can’t afford to measure their effectiveness in a way that resonates solely within their own community. They must think bigger and broader.

Be proactive—not reactive.

Of course, historically, PTs are slow to change. Look—I get it; why put your energy and effort into anything other than providing exemplary patient care unless you absolutely have to? The problem with that logic is that if PTs continue to put their outcomes-tracking strategy on the backburner, then by the time that sort of data is essential to their survival (i.e., when the payment landscape is dominated by a pay-for-quality philosophy), it’ll be too late. As one of this year’s attendees pointed out, the providers who will be successful in the new payment environment will be “not just those that can adapt, but those who have adapted.” After all, that attendee continued, therapists “can’t just flip the switch when the reimbursement changes.”

2. Get off the island.

One of the prevailing themes at this year’s Graham Sessions was the idea that PTs have relegated themselves to an island. In other words, they tend to isolate themselves from the rest of the healthcare community, because they see other providers—including physicians—as potential competitors, rather than potential collaborators. But, in the era of value-based health care, collaboration is the name of the game. One longtime Graham Sessions attendee summed it all up very succinctly: “Collaborate or die.”

Pull others off the island.

Once you’ve escaped the island, it’s up to you to help your PT peers see the light. That means sharing your strategies for success—and the data that backs those strategies up. If the industry remains fragmented and intra-competitive, no one wins. But, if PTs pool their resources and put their heads together, they can more strongly assert themselves as key players on their patients’ overall care teams.   

Stop with the siloes.

Speaking of sharing data: When it comes to getting a seat at the table where bigger healthcare conversations are happening, there’s major power in numbers. In other words, the more data therapists can amass, the stronger the conclusions resulting from that data—and the greater the chance that someone outside of the PT community will actually listen. Furthermore, in order to raise the bar on standards of practice—and eliminate the practice variation that has been a black eye on the PT brand for years—therapists must use their data to fine-tune evidence-based practice guidelines at scale.

3. Know your neighbors.

One attendee likened the healthcare community to a neighborhood—one in which it’s important to know your neighbors (and not just because you might need to borrow a cup of sugar one day). After all, it’s impossible to act as a care coordinator—and thus, own your role as a primary care provider—if you don’t know what each of your healthcare colleagues does. And the same goes for your colleagues: if they don’t know what you do and how well you do it—and if they’re unable to recognize which patients are best suited to your services—then they aren’t going to send those patients to you. So, if you want to be a respected member of the healthcare neighborhood—rather than a misunderstood shut-in with 15 cats and a weed-infested yard—then you have to:

Be willing to open your underwear—er, data—drawer.

Getting therapy providers to track their data is only half the battle. Many PTs are incredibly uncomfortable with the idea of putting that data out there, often because they are afraid that their so-called enemies—physicians, insurance companies, and the like—will identify their weaknesses and use that information against them. But, that’s a completely misguided—and shortsighted—fear. After all, one therapist’s strength is another’s opportunity, and if therapists aren’t sharing their data, then they’re missing out on the chance to learn from each other—to help one another improve and thus, move the entire profession forward.    

Educate others in the neighborhood about what you do.

This means forming relationships with other members of the healthcare ecosystem—even those who aren’t traditional sources of direct referrals. It means networking and sharing data. It means showing large health organizations—especially hospitals—proof that therapy is a valuable, cost-effective route to helping patients achieve their goals. In essence, it means getting the word out—so PTs don’t get overlooked.

4. Teach payers how to buy your services.

Speaking of forming relationships, one enduring theme of this year’s Graham Sessions was the idea that payers aren’t necessarily “out to get” PTs. Rather, in many cases, “The payers do not know how to buy your service,” one attendee explained. That same speaker urged therapy providers to take a more aggressive, proactive approach to securing more favorable rates—one built on educating insurance companies on how to align their payment models with the value therapists provide.   

Put skin in the game.

And that attendee was speaking from experience: by approaching a payer with a proposal for an alternative payment model that held his practice financially accountable for the outcomes therapists achieved, he was able to secure a contract that raised payment rates by 30%.

Fill the data gap.

Now, you’re going to have a tough time convincing a payer to embrace a different payment model—or offer better rates—without data. As it stands, payers typically have data around service utilization rates—and that’s it. So, it’s no wonder they see rehab therapy solely as a cost to be reduced. And in most cases, they’re not going to make the effort to collect any other data—but that doesn’t mean they won’t pay attention to the data you bring to the table on your own. In fact, they often appreciate providers’ willingness to share such valuable information with them. “When we bring the data, there’s a lot more power in that,” the speaker continued. “You’re filling hole they have.”

5. Bring something sellable to the insurance negotiation table.

When you’re negotiating with a payer, you are essentially trying to sell that payer on your value—and how that value aligns with the payer’s goals. But, what are those goals? What do insurance companies really want? Well, first and foremost, they want to make a profit. And one of the biggest barriers to ensuring profitability is lack of predictable cost.

Think beyond fee-for-service.

And therein lies the problem with the fee-for-service system: there is no predictable cost. Providers are incentivized to bill more—not fewer—units. And that opens up a whole other can of worms that insurance companies would rather keep closed: waste, fraud, and abuse. But, therapy providers can help payers on all of those fronts by coming to the table with alternative payment models that disincentivize overutilization and offer much more predictable costs per episode.

Track not only your outcomes, but also the cost of delivering those outcomes.

Before you can develop those models, though, you’ll need to have an idea of your own costs. That way, you can make sure that the accountability factor is mutually beneficial. After all, you wouldn’t want to set cost standards that you aren’t actually capable of achieving.

6. Invest in the next generation of therapists.

The organizers of this year’s event decided to try out a new speaking format with a debate-style discussion on the topic of PT education. During this session, two speakers with opposing viewpoints on what needs to be done to advance the state of DPT programs took to the stage to argue their cases.

Reconsider the established DPT program structure.

One speaker urged industry leaders to rethink the structure—and length—of the traditional DPT program, arguing that those programs often include unnecessary units that do nothing to raise the quality and clinical preparedness of PT school grads. Furthermore, he explained, programs should help ease the burden of student loan debt—most DPT program grads enter the workforce with upwards of $100,000 in debt—by allowing students to gain licensure after two years and then placing them in paid residencies during the third year.

Take clinical instructor roles seriously.

Another widely recognized issue with the PT education status quo is the lack of investment and engagement on the part of clinical instructors. Furthermore, because there’s little standardization around students’ clinical units, they emerge from their clinical rotations with a wide range of experiences. “Clinical education needs to be more integrated with the academic program,” said one of the speakers.

Be a mentor.

Whether or not you are formally involved with an academic institution, if you are a practicing therapist or therapy business leader, then you have a duty to help develop the next generation of PTs. Students need more engaged mentors—ones who spot and nurture clinical and leadership potential, push students to get involved in advocacy efforts, and encourage innovation and out-of-the-box thinking. After all, as one speaker stated, if PTs don’t work to improve their educational programs, they “break [their] fundamental contract with the public.”

7. Recognize your blind spots.

We all have individual biases—and often, we aren’t even aware of those inclinations. But, they can have a huge impact on the decisions we make. As one speaker pointed out, “That’s why [as PTs] we have evidence-based practice.” From a business leadership standpoint, though, it’s a little tougher to solve for potentially skewed judgment. Whether we realize it or not, we all have preconceived notions about the qualities that define great leaders. And often, those notions prevent women from ascending to leadership positions in the rehab therapy industry. While the gender disparity discussion is nothing new in the PT world, the same speaker said she felt the need to bring it up again, because in the years since that conversation started, not much has changed. Men still hold the vast majority of leadership positions in the PT business world, despite the fact that the profession at large is overwhelmingly female.    

Cultivate leadership potential.

Changing the leadership landscape in the PT profession isn’t something that can be legislated, the speaker went on to explain. No—this is a change that “must happen from within.” That means today’s leaders must identify—and confront—their biases. Then, they must make a conscious effort to provide leadership opportunities to anyone—man or woman—who demonstrates the qualities necessary to lead.

Challenge your individual biases.

The speaker even shared a personal story about hesitating to promote a woman who had children, because she didn’t think that woman would be able to handle the stress of starting a brand new clinic with the burden of family obligations. But, that candidate was successful—and it inspired the speaker to look inward and challenge her own assumptions and thought processes.

8. Jump on market opportunities.

To say that health care is changing would be an understatement. With so many forces working toward a complete system overhaul, providers—especially big healthcare players like hospitals—can’t afford to stick to the status quo. In fact, as one speaker stated, “The status quo has been put on notice; it’s not gonna cut it.”

Find out what’s on the chopping block.

As part of that transformation, many hospital systems are looking to trim the fat, so to speak, on their service offerings. “The hospital of tomorrow is going to look markedly different than the hospital of today,” one attendee noted. “And that’s our opportunity.” That attendee spoke from experience: his practice created a cardiac rehab program that replaced the local hospital’s, because the hospital determined that it wasn’t cost-effective. As major healthcare players lean out, it’ll open up more market share to other providers—which is exactly why, as that same audience member pointed out, PTs “need to figure out what’s going to be cleaved off of these large organizations.”

Sell to the consumer—but don’t sell out your profession.

If we’re talking about market opportunities, I’d be remiss to omit one of the largest—and fastest-growing—markets in the American economy: wellness services and technology. The explosion of consumer-focused wellness offerings—combined with the trend toward insurance plans that place more financial burden on patients—means more people are approaching their healthcare decisions the same way they go about making any other buying decision. They are also increasingly taking their health into their own hands. PTs are well positioned to capitalize on these trends, and many practices have successfully incorporated wellness services into their business models.

But, one Graham Sessions attendee cautioned against moving too far away from “what we do best”—that is, restoring function in people with physical movement problems. The way that attendee sees it, PTs who provide wellness services are, in essence, devaluing the PT profession, because there are “lots of people with less education than us that can do that.” Another attendee echoed that sentiment, saying there is “danger in considering a patient a consumer” because consumers are always looking to pay less—which could exacerbate the commoditization problem that has plagued the PT community for years. Furthermore, that participant noted, treating patients as consumers can lead them to “not seek care when they should because they don’t want to pay…[and that] goes against prevention.”   

9. Find a brand message that means something.

This one is easier said than done—as attendees discovered during an interactive session in which they divided into groups of five to ten and put their heads together to try and craft a single outward brand message for physical therapy. Some resulting taglines included:

  • What’s stopping you? See a physical therapist.
  • Problem + PT = Solution
  • Work better, live better, play better—through physical therapy.
  • PT: Your Body’s Mechanic

Stop boxing yourself into one value prop.

Some groups argued that therapists should worry less about settling on one all-encompassing brand message—and more about finding a message that resonates with their specific target market. After all, a sports PT caters to a much different audience than a geriatrics PT. The key, these participants argued, is coming up with a value prop that actually means something to the people whose attention you’re trying to get.  

Speak your audience’s language.

On that note, it’s important to align your vocabulary with your potential patients’. That means steering clear of industry buzzwords and clinical terms. As one attendee pointed out, “the public doesn’t know what direct access is; we need to stop using those two words.” So, rather than saying, “We accept direct access patients,” you probably need to spell out what that means to the patient (e.g., “Book your first appointment today—no need to see your doctor first.”).

Don’t just publish; publicize.

Data—especially the kind associated with published research studies—is a powerful branding tool. But, it’s not going to make an impact if no one sees it. That’s why, as one attendee said, therapists need to make an effort to expose the masses to that research. As another attendee pointed out, a lot of the data PTs need to better market themselves is already available. Now, it’s just a matter of leveraging that data effectively: “We’ve done a lot of research; we don’t use it well,” he said.

10. Bring the change; don’t sit back and receive it.

Complacency is the Achilles heel of the PT community. For too long, PTs have sat back and let change happen to them. They’ve left themselves out of important conversations. And as a result, they’ve been burdened with all sorts of legislation and regulation that has made it even more difficult to get not only the payments—but also the respect—they deserve. But, with the US healthcare system—which one speaker described as “the greatest existential threat to our society”—poised for a radical overhaul sooner rather than later, now is the time for PTs to get proactive. For most therapists, that means breaking free of the norm. In the words of one attendee, “We can bang our heads against what we’ve been doing forever and ever, or we can do it a different way.” And to do it a different way, PTs have to step up and make their presence known. After all, as another participant said, “You can’t affect a system if you’re not in that system.”


What do you think are the most important action-items in the fight to position PTs as the valuable, effective, patient-centered providers that they are? What’s the biggest challenge holding them back from success in the changing healthcare landscape? Let’s keep the conversation going in the comment section below.

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