Real Magic Begins With Entrepreneurs

Entrepreneurs. The physical therapy profession benefits from a rich history of innovators and entrepreneurs. We all have been blessed by pioneers like Florence Kendall, Robin McKenzie, Shirley Sahrmann and many more. These therapy entrepreneurs(before entrepreneurship was hip) saw health problems in their patients and despite resistance created innovative ways to solve them.

Why Entreprenuers will save

The physical therapy profession exists to make a distinctive difference in the lives of individuals and society. This is the starting point and ending point of our mission–changing lives for the better. It always has and will always be the mission of our profession.

Any professional group is composed of individuals that are its representatives on a daily basis. It’s important for every therapist to think carefully about answering a central question.

What is my mission?

It’s such a simple question but it goes right to the heart of how our profession stays effective and relevant during these tumultuous times. Every truly great profession demonstrates the ability to preserve its core mission while it responds to changing realities.

A new reality that therapists must adapt to is how therapy services are paid for in the new healthcare economy. Without sacrificing our core mission we must adapt our educational programs, delivery methods, strategies, clinical practices, marketing, business models etc.

The New Healthcare Customer

Healthcare reform has brought market realities to bear on the healthcare industry to contain costs and supposedly improve quality. Healthcare consumers are gradually being transformed into healthcare customers. You may be wondering, aren’t consumers and customers the same thing?

The basic difference is that customers spend their own money. It’s like your teenager using his own money to buy his new jeans versus his old man paying for them. In the former he merely consumes in the latter he’s more apt to be a selective buyer.

Not long ago, the word customer was rarely heard in the healthcare industry. Leaders of hospitals and large nonprofit health corporations would say  ‘We have patients or guests not customers. Customers that’s a marketing term.’

For decades both healthcare givers and receivers gave little regard to how bills were paid. Third party reimbursement systems allowed both parties to live in an alternative world where someone else was responsible for paying the bill. I think all of us have had patients who wanted to extend treatment beyond what was necessary just because insurance was paying for it.

Oh, how times have changed.

Now there are tens of millions of Americans who are either uninsured, have high-deductible health insurance, or just want an alternative to bureaucratic medicine. These Americans are often referred to as ‘self-pay patients’ but in reality, they are the new customers of healthcare. They want to get the best quality for their money without an insurance company or the government being involved in their choice of providers.

Rather than debate language on what we call the recipients of our care, let’s answer another question.

Who must be satisfied for our profession to achieve its mission?

When we answer this question we begin to define our customer as someone who values our service. They are someone who wants want we offer and is willing to pay for it. It is these individuals who should be our primary focus.

They will be the means by which we live out our core mission– making a distinct difference in the lives of individuals and society. Hospital administrators, governmental bodies, insurance companies and referral sources are secondary customers. They are important to society and to our professional livelihood but they are not our primary customers.

Jack Welch, former CEO of General Electric makes this point clear: ‘Nobody can guarantee your job. Only customers can guarantee your job.’

'Nobody can guarantee your job. Only customers can guarantee your job.'-2

The physical therapy profession needs entrepreneurs to create new customers.

Customers are constantly changing. Therapists that know and adapt to the changing needs and desires of customers are keys to our professional livelihood. In the Internet age where customers have unprecedented instant access to information, it takes agile professionals to stay in the game.

The good news is that these trends are our friends. They create opportunities where therapists can take their knowledge and expertise directly to their primary customers. Fortunately, there is a bold breed of therapists who are doing just that and our profession desperately needs them.

There is a movement of bright therapy entrepreneurs who are creating new ways of delivering physical therapy. Instead of standing behind the velvet rope waiting for someone to let them into the party these therapy entrepreneurs are creating new ways to make a distinct difference people’s lives. These innovators in action need to be championed and supported by our profession.

Bias Against For-Profit Therapy Businesses

Wrong assumptions about healthcare economics and a bias against for-profit therapy businesses have caused our profession to lag behind the entrepreneur revolution that has created a ruckus in the business world.

During my 35 years as a physical therapist, I’ve observed many talented leaders in our profession fail. Not because of poor leadership skills or wrong intentions but because of an incorrect core assumption that guides many of their strategies. This tightly held belief has caused many of the decisions that our leaders made have contributed to the competitive status of physical therapists to worsen.

The defining belief that virtually all leaders today subscribe to is that if we stockpile enough evidence we will justify our professional value.

This defining belief undergirds virtually all the strategies to satisfy secondary power brokers such as insurance companies, governmental agencies, and gatekeepers. They are all people who can say no. Unless they are satisfied then they can block access to patients and funding. They cannot be ignored. We should develop partnerships with them to contribute to the greater good. However, we must not fall into the trap having more than one main customer.

We must not confuse these partners with our primary customers–individuals whom we can make a distinct difference in their lives.

There is nothing wrong with having rock-solid evidence as the basis for our interventions. I’m not saying that we should not conduct high-quality research and integrate the evidence into our clinical practices.

What I am saying is that we shouldn’t prioritize this data over listening and serving our primary customers. I don’t think our leaders consciously set out to do this but there is a natural tendency to drift away from the truly important.

Over-Reliance on Data To Justify Our Value

Let me illustrate my point. Twenty years ago there was a major push in physical therapy to provide objective evidence that patients were making measurable progress with physical therapy. Therapists painstakingly documented every degree of motion gained, every meter walked and the slightest change in muscle strength to prove to insurance companies that treatment costs were justified. Let’s call it the microdata movement.

Equipment manufacturers sold new machines to help therapists be more precise with their objective measurements. Patients were strapped into all sorts of contraptions to capture objective measurements. Huge amounts of time and effort were given towards justifying physical therapy effectiveness through capturing microdata.

One of the most extreme examples was the Cybex isokinetic backtesting and rehabilitation equipment. These transformer-like machines promised to test dynamic back movements that simulated normal everyday work. These evidence-based pieces of testing equipment were so gigantic and noisy that hospitals often had to build separate rooms to house them. They were very expensive costing hundreds of thousands of dollars each.

They were a huge waste of time and money.

The machines did what they were supposed to do– produce streams of objective data. But many hospital administrators and clinic directors discovered something too late–referring physicians, insurance companies and employers really could care less about the data. Spine surgeons mostly wanted surgical cases. Insurance companies were driven my shareholder value and employers wanted employees back on the job as quickly and safely as possible.

Physical therapy’s assumption about precise data justifying our seat at the table was wrong. It was out of touch with how business operated in the outside world. The more our leaders executed on their assumption the more we became out of touch with the healthcare market.


Big Data Is Not The Answer

Big data and evidence-based policy are dominating healthcare reform at the moment. Government agencies and insurance companies represent big data as the key driver to bring real social and economic progress in healthcare. Therapists must be careful not to get swept up in the wave of optimism of the analytical superpowers of big data.

It is very easy to miss the big picture and the opportunity cost to objectively measure and interpret “what works”. Just ask any therapist how Medicare’s Functional Limitation Reporting System has impacted their workload and improved patient care. Medicare’s good intentions of collecting and interpreting outcome data might not only missed key factors but may have impacted therapist’s attitudes and behavior for the worse.

Many important questions are not easily answered by quantitative analysis and never will be. Answering the vital questions we asked earlier calls for judgment informed by conversations with our primary customers, not quantitative metrics. Using big data to solve these quandaries not only risks getting it wrong but it risks having someone else shape our professional destiny.

Real Magic Begins with Entrepreneurs

Innovation is essential and our profession needs it. But the real magic begins with entrepreneurs. Entrepreneurs take great ideas and turn them into new customers, new businesses and great jobs for physical therapists. Of course, we need innovation. Any profession if it is to remain viable needs tons of ideas and innovators. The physical therapy profession has a solid historical foundation to build upon for the future. However, what’s worked in the past needs to progress to what will work in the future.

To fulfill our core mission we need to ask the right questions about every single aspect of what we do.

Does this help me fulfill my mission?
Does this serve my primary customer?
Can I “sell” this idea?

As a group, I believe therapy entrepreneurs are uniquely gifted and positioned to answer these questions to help our profession transform from the inside out.

Who are our modern day Florence and Henry Kendall and Robin McKenzie that will carry physical therapy into the future?

In subsequent blog posts in this series I hope to create a conversation about how the therapy community might foster a grass roots effort to identify and support therapy entrepreneurs. Physical therapy needs ruckus makers who are committed to making the world a better place and will take the profession along with them.

What’s your reaction to my call to champion and support therapy entrepreneurs?