January/February 2006

The Dawn of a New Era

By Steve Percy, MS, ATC, PTA

The competitive arena of the rehabilitation industry encourages physical therapists to pursue new entrepreneurial options.

The 1980s and 1990s brought to our profession exciting, new, and aggressive therapeutic concepts neatly classified as “sports medicine rehabilitation.” During these decades, the necessity to quickly return high-profile injured college and professional athletes back to full playing status gave birth to the development of these philosophies. Modern surgical and therapeutic techniques were implemented along with the application of new modalities, which catapulted us to a whole new level of understanding of the human body and its recuperative powers.

The first of these innovations was the advent of lightweight fiberglass casting materials. Full-length leg casts were created with two electrode-size windows cut into them: one on the upper middle thigh and the second on the lower medial area of the vastus medialis. These windows allowed the utilization of neuromuscular stimulators to combat the negative effects of immobilization (primarily disuse atrophy). Next was the notion of affixing hinges to these new casts at the medial and lateral knee joint line, promoting limited but early flexion and extension range of motion. This modification also decreased the negative effects associated with 6 to 8 weeks of immobilization, primarily that of soft tissue adaptive shortening and myofibril cross-bridging. Remember, this was common procedure for medial and lateral meniscectomies prior to arthroscopic surgery and the future technology of anterior cruciate ligament (ACL) reconstruction.

These and many more technological advances have set the stage for the current physical medicine environment. Same-day surgery centers turn out masses of ambulatory patients—straight from meniscetomy and major ACL reconstructive procedures—shown the door with nothing more than removable Velcro splints and crutches, and headed for physical therapy the very next day. The times they are a-changin’!

Next came the onslaught of physician-owned sports medicine/physical therapy facilities. The newly developed treatment regimens often called for therapy three times a week for 8 to 12 weeks. This sports medicine approach, along with the doctor-owned physical therapy facility, soon led to overutilization of services, which set the wheels in motion for today’s managed care dilemma. Suddenly, physical therapists were scrambling for survival. Not only did they have to compete with the very physicians who once provided their main sources of patient referral, but they also were faced with the trials and tribulations of accessing and networking for managed care contracts that would assure their ability to exist. Fee for service went out the door, and the average hourly billable rate went down, down, and down. Those in California who survived these times did so because they were creative and progressive thinkers. They specialized, joined, or created networks or formed alliances that enabled patient access. With the improbability of practicing without physician referral, their hands were tied.

Now with the status of health care being under the microscope of the insurance company and use being overseen by claims representatives, consumers are beginning to seek alternative solutions. Just about this time the trickle-down effect begins to surface. With the arrival of sports medicine rehabilitation came the need to educate physical therapy aides and related care providers to perform the duties of postrehabilitation exercise specialists. They became the liaison between the physical therapist and the gym. During this time, patient education also expanded. Group and home exercise programs became more and more important to the continuation and success of the patient’s recovery. This educational process fostered the convergence of the sciences of physical medicine and physical fitness. This trend led to the rapid increase of knowledge available to athletic trainers, personal trainers, and strength coaches and subsequently the explosion of a new hybrid profession called personal training.

That brings us up to date on the new challenges which the profession faces today: lower hourly billable rates, increased numbers of managed care patients, reduced number of visits per incident, and competition from newly developed ancillary health care providers—most recently, the sports medicine personal training facility.

It is time to get creative again and fight to stay ahead of the curve. The California Physical Therapy Association (CPTA) has recognized these challenges and seen the need to become proactive; therefore, it recently submitted to the state Senate for approval an addendum to their practice act—on April 26, 2004, Senate Bill 1485 was ratified, stipulating the following:

SB 1485

Subject: Physical Therapy

Source: California Physical Therapy Association

Digest: This bill revises the definition of physical therapy to include the promotion and maintenance of fitness to enhance the bodily movement-related health and wellness of individuals through the use of physical therapy intervention.

This Bill: Revises the definition of “physical therapy” to include “the promotion and maintenance of fitness to enhance the bodily movement related health and wellness of individuals through the use of physical therapy intervention.”

Purpose: This bill is sponsored by the California Physical Therapy Association. According to the author’s office and the sponsor, the bill is intended to permit physical therapists to provide as part of their physical therapy practice, services to promote and maintain fitness, health, and wellness in populations of all ages.

Targeting the Demographic

The CPTA recognized the need to compete for this target demographic to the extent that they changed their Physical Therapy Practice Act. Not something they do every day, so it must have been proposed to have major significance to those for whom it was intended. I believe that intention was to solidify the expansion of their target market to include those people who are currently spending millions of leisure dollars seeking alternative forms of health care and “life fitness” coaching for wellness and disease prevention. Come on, people! Don’t you see the potential within our own facilities? We work so hard to gain provider contracts and establish doctor-therapist relationships for patient referral sources. Yet, once patients finally come through our doors, we are willing to treat them for an allotted number of visits and let them go. Why? Because typically physical therapists have not considered providing any type of secondary health care or wellness programs that could be implemented without a prescription. STOP! Let us use the entrepreneurial side of our business mind that shouts, “You don’t need prescriptions to treat people!” It is such a foreign thought process that few therapists explore its potential as an ancillary income source, or the inherent benefits for patient well-being. However, there has never been a more perfect time to begin to expand your thoughts and investigate creative possibilities. What potential does a personal-training, life fitness wellness concept present for you, your business, and your patients?

Three basic business models come to mind:

1. Large Physical Therapy/Sports Medicine facilities with a minimum of 1,000 to 1,500 square feet specifically designated for the development and integration of therapy and wellness. This atmosphere creates the greatest potential for a personal training or group exercise department.

2. Midsize Physical Therapy Center totaling 1,400 square feet with 600 to 800 square feet intended for integrated exercise programs.

3. Small Physical Therapy practice that can provide individuals with a limited yet guided discharge program aimed toward movement education, wellness, and an ongoing pursuit to achieve their highest level of function. A large percentage of physical therapy clients would fit the necessary profile demographic of those who are actively pursuing a higher quality of life through participation in affordable fee-for-service aftercare programs to substantiate these endeavors.

The going rate for personal training services ranges from $35 to $100 per session. Using even a low average fee of $50, 10 patients exercising two to three times per week would equate to $4,000 to $6,000 of gross revenue per month. This presents a substantial opportunity for therapists motivated to grow their business and progress with the times.

Steve Percy, MS, ATC, PTA, is an athletic trainer with 25 years of experience in the field of sports medicine rehabilitation and fitness. His expertise is formulating exercise prescriptions combining the science of sports medicine with the physiology of exercise and rehabilitation.

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