Physical Therapy in 2016 – Dominance of ACOs?

I am about to go on stage now to kick off the 2013 Private Practice Summit. Before we start, we’re going to observe a moment of silence for the victims in Boston. Let’s pray for them together, and try to make the world a better place through our thoughts and actions.

Life, like business, comes with it’s share of challenges, and as physical therapists, we must keep our head up and continue to serve our patients as best as we can.

We live in a changing world, and as a community, now more than ever, we need to come together and recognize our value as physical therapists for our patients, and as  individuals, for our family and friends. People look up to us and we have to lead the way. Life is meant to be cherished.

Recently on CNN, Anthony Robbins took over as host from Piers Morgan for one episode to conduct a fascinating interview with three business legends:

  • Mark Cuban – He is the owner of the National Basketball Association’s Dallas Mavericks, Landmark Theatres, and Magnolia Pictures, and the chairman of the HDTV cable network AXS TV.
  • Steve Wynn – He played a pivotal role in the 1990s resurgence and expansion of the Las Vegas Strip. His companies refurbished or built what are now widely recognized resorts in Las Vegas, including the Golden Nugget, The Mirage, Treasure Island, Bellagio, Wynn, and Encore.
  • T Boone Pickens – Pickens chairs the hedge fund BP Capital Management. He was a well-known takeover operator and corporate raider during the 1980s
  • The discussion centered on the future of American business, and more importantly, what allowed these tycoons to become successful in their business. Inevitably, the subject shifted towards the upcoming Presidential elections.

Robbins asked Mark Cuban about his opinion on the candidates in the Presidential race, and Cuban replied:

“They both scare the hell out of me,” he exclaims. “They really, really do … A lot of it comes down to the devil I know is better than the devil I don’t know.”

“I know [Barack] Obama,” explains Cuban.

“And I have a sense of what he’s going to do. It’s like any other ongoing business. I’m not gonna make someone I don’t know, who’s not being really forthcoming, who’s not giving me details, I’m not gonna hire him as a CEO of one of my companies.”

For more information about this CNN interview, please click here.

Steve Wynn, on the other hand, had an entirely different view.

“We are worse than we were four years ago. The President is a first rate orator and first rate campaigner, but he is a third rate President. Romney will be a first rate President”.

You can watch this video to learn more about Steve Wynn’s thoughts on the current economy and on the presidential campaign here.

I haven’t made up my mind yet, and will wait for the Presidential debates (the first one kicks off on October 3rd at 7 pm EST), but regardless of your choice (or lack thereof), the direction in which healthcare is heading America in 2016 is fairly obvious.

[headline_tahoma_small_left color="#000000"]What This Means For Your Practice[/headline_tahoma_small_left]

Regardless of the outcome of the election, the pressure to offer healthcare at competitive prices will affect every provider because the economics demand it. It’s already happening.

Soon, financial incentives and penalties will be directly linked to patient outcomes, according to a report by Capgemini consulting entitled “US Health Care Reform: The Emergence of Value Based Purchasing and Accountable Care Organizations”. The report does an excellent job describing the intention, models and challenges associated with  ACOs and you can click here to access this entire report. While significant challenges lie ahead for ACOs (and keep in mind that this report analyzed the impact of healthcare reform on pharmacy companies), ACOs represent a trend that cannot be ignored by the private practice owner.

With everything that’s going on around us, physical therapy private practice in 2016 will be very different than what it is today. In my opinion, there are THREE trends that you need to prepare for immediately to emerge as a stronger, more profitable private practice as you head towards 2016.

[headline_tahoma_small_left color="#000000"]My Vision For Physical Therapy 2016.[/headline_tahoma_small_left] [red_tick_list width="100%"]
  • Specialization with niche services will allow the private practice to become a participating provider in an ACO and contribute to improved outcomes, cost savings and collaborate more effectively with hospitals and local physicians. In the absence of niche services, the practice will not be able to compete with comparable services offered by the hospital or physicians office. Clinics that refuse to adapt will be marginalized and will have to work harder to get the same patient and to generate the same profit or maintain the same quality of life. The old adage “You have a choice – choose us as your physical therapist” can only go so far. In fact, this message doesn’t work anymore. It’s the old school way of doing things. We are heading towards an age of “We are the choice for _____ because we specialize in _____”
  • Diversification of services, so additional services are offered to the patient, improving the patient’s quality of life and minimizing reinjury. This allows the PT clinic to increase revenue per patient and consequently lifetime value of a patient, which can be increased substantially with ancillary services. The clinic is not completely dependent on physical therapy income alone. The implementation of the classic ‘upsell’ model (would you like fries with that) will become commonplace in physical therapy practices in 2016. I’ve written several articles on this blog on how you can provide additional services to patients. Do a search or go through past archives.
  • Preventive services. Early diagnosis, leading to faster treatment and lower healthcare costs will make the private practice owner a valuable player in the inevitable healthcare continuum in 2016. The ACO concept, if it becomes a reality, will require a fundamental change in the way the primary care physician in your community functions. This will create a once in a lifetime opportunity for physical therapists to position themselves as ‘preventors’ or ‘prehabilitators’ in addition to ‘rehabilitators’ since the focus of Medicare and insurance companies will be “What can you do to lower costs?”. This will require significant education within the patient community. From a billing and reimbursement standpoint, physical therapy private practices will need special training to create the infrastructure (organizational, documentation and billing) to get paid. Physical therapy practices that fail to take the lead with billing services may see other healthcare professionals like fitness trainers, athletic trainers and chiropractors take the lead in ‘preventive services’ in the eyes of the community.
The Bottom Line

I know you’ll do what’s best for your practice, and your patients. I encourage you to look into the future as a business owner. From a ‘life standpoint’, it’s best to live in the ‘here and now’, but as a private practice owner, it’s a luxury we cannot enjoy, not in this new economy. In his business blog, Seth Godin (one of my favorite business authors) has said “Before a marketer or organization can sell something that works in the future, she must sell the market on the very notion that the future matters.”

If you think that specialization, diversification and preventive services are ‘ahead of their time’, I can tell you this – the political and fiscal winds around us will move physicians and hospitals towards innovative, cost saving measures as we head towards 2016. Irregardless of politics, the writing is on the wall.

The question is – how prepared will you be?

I’ll be discussing some of these trends in my presentations with specific strategies on how to stay competitive in the new economy in my presentation this weekend in Las Vegas.

Thanks for reading. I appreciate your input and comments – what do you think?

 

 

4 Comments

  • Great article Nitin! I agree, it will be very important to specialize and to be "preventors" as rehab professionals. The increase in the managed cares and Medicare advantage plans demonstrate also the change in future reimbusements.

  • Stanley says:

    I am ambivalent on this ACOs. I have not made up my mind whether it is an advantage or disadvantage to us private practitioners. One sure thing though is it will happen.

    Your blogpost somehow eased my mind because this means we can still continue profitably in this industry. As they say, if you cannot lick 'em, then join 'em.

    Thanks, Nitin, for always thinking ahead and sharing your wisdom.

  • Debbie Stern says:

    A well-thought out discussion on ACOs, Nitin. The advocates are very optimistic on what ACOs can do and predicts that even if the law is struck down for whatever reason, the healthcare industry will continue working towards ACOs.

    The upside of ACOs is patient growth because patients will be very satisfied with the quality of care they are getting and private practitioners can take advantage of this opportunity. The strategies you outlined here would go a long way in doing that.

  • [...] This week, I watched one of my all-time favorite business interviews once again, one in which Anthony Robbins interviews Steve Wynn, owner of the Wynn hotel (and others) in Las Vegas. I’ve written about this interview and it’s implication to your practice in the new environment of ACO’s here. [...]

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