Monday, October 29, 2007


Performance is never an accident: it is the result of high intention, sincere effort, intelligent direction and skillful execution: it represents the wise choices of many alternatives.

Aspiring to average performance inspires no one. Average is... well average. To aspire to achieve more it's essential to first know how much more is. The alternative is to become complacent with the status quo. If you want to jump high its aways good to have a high bar to aim for. How high is your bar?

Research has demonstrated that over 90% of professionals believe that they perform in the top 10% of their peers. The truth is that 50% are below average and another 40% don't make the top 10%. Statistical reality guarantees that 90% of professionals are not in the top 10%. So why do so many people persistently allow themselves to be fooled by themselves?

How is your Practice performing? Have you compared it recently to other Practice? Do you know where opportunities for better performance and better reward are in your Practice? Do you know what 90th percentile performance looks like in all of the performance dimensions of your Practice? How much reward are you leaving on the table day after day, year after year? Is your bar set too low? Are you fooling yourself? Are you professionally curious enough to ask?

Comparative performance data for your Practice is just a phone call away. Make wise choices. Performance Matters!


Copyright 2007
Performance Builders
Friday, October 26, 2007

Just say "NO"!

I’ve had several clients recently ask for help in decisions that ultimately led to their dropping out of low paying insurance networks. More Practices should be thinking about doing so!

There is good business and bad business. Its important to know the difference. Too often Practice owners are drawn into a poor paying insurance networks for the wrong reasons:

1. Fear of being left out of a market segment

2. Fear that a competitor will get the contract instead of them

3. The assumption that if other Practices are accepting the contract that it must be OK

4. Irrational justification that somehow there is value in volume even when it is not profitable

5. Worry that referral sources may not refer unless all referrals are accepted

6. The assumption that the fees offered are non negotiable

The rationale for not entering into poor contracts includes:

1. Less work can mean less expense while yielding the same profit - right size the Practice and enjoy some well deserved time off!

2. Let competitors have losing contracts since it diminishes their capacity to compete for more favorable business - go ahead burden the competition!

3. The acceptance of poor contracts reinforces payers behaviors that lead to further erosion of reimbursement - Every low rate accepted encourages all payers to do it again!

4. Word gets out... if you accept poor paying benefit plans your Practice will attract more such plans and clients and less of the rest - go after the market you want!

5. The time freed from serving poor paying plans can be used to innovate new services, enhance skills, and market for the more favorable clientele you want!

5. Social responsibility can be maintained by establishing a realistic budget for un-reimbursed care to limit the Practice’s financial exposure.

In order to make good decisions on what networks to participate in one must first fully understand their true cost of services and what a healthy profit margin is for their Practice.

It’s important to keep in mind that there may also be contractual complications to consider – e.g. favored nation clauses in other payer contracts and high risk Medicare compliance issues.

Its easy to "Just Say NO". But first, do your homework - know when "NO" is the right answer for your Practice and you know why you want to say it!

Its time to take a hard look at who is in your portfolio of payers. Like poor performers in a stock portfolio, it may be time to get rid of some of the dogs.


Copyright 2007 Performance Builders

Wednesday, October 24, 2007


Some headline considerations on business growth...

There are two types of growth
1. Internal – operational improvement
2. External – more customers / transactions

When to consider growth strategies
1. A change in the profit pool
2. A direct threat from a new competitive model / disruptive technology
3. The current growth formula stalls out

There are only 2 ways to grow
1. Improve innovation
2. Improve marketing

1. Commitment for growth (desire & motivation)
2. Cost of growth (investment, risk, and ROI)
3. Capacity for growth (asset allocation)
4. Competency for growth (training & experience)

“Life is defined by the capacity to move and grow.”

Is your Practice on the move?

Is it growing?

What are its signs of life?

In today's Practice environment if you are not growing you're dead!

By the way, I am constantly amazed at the number of Practice owners that are in a growth stall. While owners take significant risks to start their business they are hesitant to take modest incremental risks to grow it. Often it requires nothing more than a good idea or two and the commitment to free up the necessary time to pursue the opportunity. Growth is not something that can usually be delegated. What can be delegated are current responsibilities. Successful entrepreneurs have a unique and proven talent. They are generally capable of creating more value through strategic growth initiatives than through the direct delivery of services. Yet they allow themselves to become trapped by the routine responsibilities of their current book of business at the expense of creating a new and larger one.

There are an incredible number of new opporunities in today's evolving markets... Its time to grow!


Copyright 2007
Performance Builders

"Your Practice is the sum total of all of the decisions you have made."

"You can't change the past but you can change the future."
Monday, October 22, 2007

Steering Practice Performance

"Numbers have a way of taking a man by the hand and leading him down the path of reason." - Pythagoras

Almost everyone in management has heard some derivative of the phrase, "What doesn't get measured doesn't get managed." Have you ever considered what numbers are critical to the performance of your Practice. Have you ever considered what doesn't get managed?

There are two kinds of measurements that are pertinent to Practices - leading and lagging indicators. Lagging indicators are those that get reported after operations, while leading indicators are those that get reported during operations.

Financial reports are a good example of lagging indicators - typically they arrive 4-6 weeks after the close of the month. They report what happened in the past tense. While they may provide important financial information, they are all past tense. They don't help manage in the present tense. They are about something that happened rather than about something that is happening. It's like driving with your vision focused on the rear view mirror... you wish you had not hit the skunk and run over that box of nails but there is nothing you can do about it. Its done.

On the other hand, leading indicators are like driving with your eye on the road ahead. They provide you with information about what is approaching and provides you with the lead time necessary to take corrective action. Such information allows you to steer the vehicle to an intended destination while avoiding those things that would prevent you from achieving your intent. This is the kind of real time information that is missing in most Practices. This is the information that prevents most Practices from achieving their inherent potential and reward.

There are 13 key pieces of performance data that every Practice should capture daily. That data generates 17 key performance indicators that allow a Practice to reliably navigate to their desired level of performance rather than operating in a reactive mode where every reaction is too little, too late - i.e. the damage has already been done or the opportunity has already passed. These kinds of leading performance indicators represent the difference between superior Practice performance and typical performance. It is a difference that is measured on the bottom line, in a good nights sleep, and an early retirement.

What are you measuring? Got leading indicators?


Copyright 2007
Performance Builders
Friday, October 19, 2007

Rhode Island APTA Workshop Download

RI friends... the link to the Workshop PowerPoint download has been deactivated. If you are still interested in a copy please contact me by email and I will be happy to send you the file via email. The same goes for documents pertaininig to Scheduling and Collection strategies.


Performance Builders
Wednesday, October 17, 2007

Money Matters

There is little doubt that more and more PT services will be paid for out-of-pocket over the next couple of years. Some will be cash paying clients who seek non-benefit services (assuming you provide them), others will be the uninsured, still others will pay out of their Health Savings Accounts. What ever the reason, they will be buying your services as demanding customers rather than as entitled patients.

So what?

Many Practices continue to struggle with cash policies and collection of deductables and co-pays at the time of service. If you have problems today with such collections the potential impact when an even higher percentage of your fees are paid out-of-pocket could be significant. Now is the time to tighten up your policies and your proceedures while the risk is still reasonably low.

On a related note, I remain amazed at the number of Practices who overlook potential Medicare compliance issues and related financial risk associated with not collecting deductables and co-pays. Then there is also the issue of favored nation status clauses in payer contracts that could also require providers to return payments to insurers.

These matters need to be on your radar screen! Together these are high stake Performance Matters that truely matter.


Copyright 2007
Performance Builders
Sunday, October 14, 2007

Evidence Based Practice

Much has been written in recent years about evidence based practice. It is a common topic in the physical therapy community as well as throughout all of health care. While there is much to be benefited from evidence based practice, there is also a dark side that gets little consideration and even less discussion.

One aspect of the dark side is the "potential opportunity" it provides insurers to deny payment for interventions that it deems not supported by scientific evidence. The exploitation of evidence based practice may / does provide a tempting justification for the denial of care / payment. Poorly designed or executed research can provide opportunity.

The threat lies in the reality that it is often in the financial best interest of insurers to deny treatment even though it may be in the patients best interest to receive it. It would be wonderful if this was merely a hypothetical risk... but it is not.

Keep in mind that insurers keep about 31% of all health care premiums for their own operations and profits; and the cost of health care continues to increase dramatically. I doubt that it will be the profits of insurers that will suffer in the years ahead.

Those who advocate on the part of the patients need be aware.


Copyright 2007
Performance Builders
Wednesday, October 10, 2007

The Land of Opportunity

I have had the privilege to work with hundreds of Practices over the past decade on a wide variety of business related issues and opportunities. Every engagement has one thing in common - that is, the owner's interest in being better rewarded financially for the their investment, risk, hard work, service to the community, sacrifice, and leadership.

I agree with them - most deserve more than they are getting. What most fail to realize is that there is much more reward in their Practice's that they could tap into if only they knew how!

Statistically 75% of Practices under perform financially. Practically speaking, 100% of practices under perform in some aspect of their business! There is opportunity for greater Practice reward everywhere!

Consider this little exercise I shared in my presentation to the Rhode Island APTA last week...

*10 Visits / Day / PT
*3.5 Units / Visit / PT
*230 Work days / PT/ Year

That calculates to 9660 Units / PT/ Year.

Now, there are approximately 125,000 PTs in the USA.

Do the math... PTs conservatively deliver 1.2 Billion Units / Year. This happens year after year...!

Having benchmarked hundreds of Practices I can tell you with confidence that a 10% improvement in just expense performance is readily within the reach of most Practices - much greater improvements are achievable by a great many Practices! Keep in mind there are also vast opportunities to enhance revenue!

So to keep the exercise easy and conservative we went with an average of 10% improvement in expenses per unit of service. For the average Practice that represents about $2.42 / unit.

Lets do the math again. 1.2 Billion units times $2.42 equals $2.9 Million. That's about $23,200 per PT!

Now that's a lot of potential reward. Oh, and remember that achievable reward would be earned annually!

There is opportunity for greater financial reward inherent in virtually every PT practice. It simply requires a thoughtful business decision by leaders and owners to secure the reward.

It is the kind of financial reward that could change Practices and "Yes" - change the profession!

Are we provoking the full potential of our profession? Are you provoking the full potential and promise of your Practice? How much reward are we / you leaving on the table day after day after day? Does it matter?

All The Best!


Copyright 2007
Performance Builders
Monday, October 8, 2007

Chicago Chain Reaction Seminar

Just a brief note to let you know that I will be attending the Gray Institute Chain Reaction Seminar in Chicago this week (Oct 10 - 13). I'm looking forward to seeing old and new friends who have indicated an interest in getting together there for some one-0n-0ne time. It should be a great event as always... See you there!

By the way, if you appreciate that function lies at the heart of all of physcial therapy and training you owe it yourself to attend a Chain Reaction Seminar. And, if you are committed to becoming an accomplished expert in Applied Functional Science there is only one place to go - GIFT! Check out both at the Gray Institute link above. You owe it to yourself.

If you are interested in taking your Practice to new levels of growth, performance, and reward be sure to visit Performance Builders.


Thought for the day:

... Intelligent people are those who agree with you!
Saturday, October 6, 2007


I've been privileged over the past several months to have the opportunity to write a series of motivational articles named, "Matters That Matter". They total about 50 articles now and are intended to uplift, challenge, and motivate professionals by reflecting on a variety of topics that are applicable to Practice and to life in general. Perhaps one day they will find their way into book form...

The comments I have received from those who have been reading the articles have been most encouraging and much appreciated. At their suggestion, I am posting the following Matters That Matter article to give Blog Readers an opportunity to sample some of the writing. I hope you enjoy it...


“You use a glass mirror to see your face;
you use works of art to see your soul”
- George Bernard Shaw
“If you ask me what I have come to do in this world,
I who am an artist, I will reply,
I am here to live my life out loud.”
- Emile Zola

It has been told that Michelangelo, when asked about his sculpturing genius, responded that his work was simply about, “Releasing the creature trapped within the rock.”

He understood that he was not able to add anything what-so-ever to the rock; he could only remove that which obstructed others from perceiving and enjoying the creature that he envisioned within the rock.

His genius was in the removal of obstacles – the elimination of that which was superfluous - the discarding of the unnecessary.

His focus was on that which was relevant, and essential to his intent. Every chip of rock was either essential or worthless – that which would contribute to the truth of the creature or that which would belie the creature. The creature was a gift of the rock.

He began with intent. He knew what it was that he would bring forth; thus, not any rock would do. It needed to have characteristics that would be compatible with his intent – there were matters of type, size, color, density, and grain. In looking at the rock on the outside, he knew what to expect on the inside.

There was little room for error. Precision was critical – that which was removed could not be added back. Every cut of the saw and every strike of the mallet had purpose. Neither rock nor effort was wasted. His decision making skills and physical skills were practiced for hours, days, weeks, and months as each creature was painstakingly released and revealed.

His art was a matter of vision, decision, and precision.

Some thoughts…

What creature would you release? Are you learning to read the rock? Will you accept the gift of the rock? What obstacles need to be removed? What is ultimately essential and what is waste? What are the decisions to be made?

Will you persevere? Will your work endure?

Does it matter?

These are questions that touch the mind, the body, and the spirit of matters.

We are sculpting - our lives and those of others – family, friends, co-workers, clients...

What truths will we hold? What behaviors will we shape? What decisions will we make? What practices will we engage? What will be preserved and polished? What will be chipped away?

Too often we attempt to be a creature we are not. Too often we struggle to somehow put the creature of our imagination into others. Too seldom do we remove the obstacles that entrap us and them – obstacles of the mind, the body, and the spirit.

Each person has been gifted. Each person has hidden gifts and promise waiting to be released, and polished, then treasured.

All of this takes us back to Michelangelo. It would appear that our calling is similar to his …we are sculptors. We work not with rock but with flesh and bone. We remove obstacles that imprison creatures to reveal their natural gifts. We polish them, place them in good light, and treasure them.

May you never forget that you are a gifted creature, shaped from the rock, and treasured. And, may you bring that understanding to those touched by the artistry of your mind, your hands, and your spirit.

All the Best,


Copyright 2007
Performance Builders

Friday, October 5, 2007

Rhode Island Workshop Power Point Download

Rhode Island Physical Therapy Association Workshop Participants, thank you for your participation today.

I enjoyed the opportunity to discuss the business of physical therapy with you and to share future trends, performance benchmarks, and the Performance Matrix. I hope that you will find them useful and rewarding in your Practice.

You may download the Presentation PowerPoint in pdf format by clicking the following link: Download PowerPoint. Remember you will need to use the password supplied at the course to down load the file.

Please email me if you would like a copy of the scheduling attendance and Accounts Receivable collection strategies check lists. I'll send them out to you via email upon request.

Your Workshop comments are most appreciated.

This Performance Matters Blog is new and will be growing in the weeks ahead. It will include a mix of topics that will hopefully encourage, enable, empower, and embolden you. You are invited to stop back from time to time to see what's new.

Be well. Do Good. Dream BIG!


Performance Builders
Thursday, October 4, 2007

Getting Simple

Business and Practice is complex, ever changing, and always challenging. It is easy sometimes to miss the forest for all of the trees. It's easy to get trapped in complexity. Take a short walk with me on the simple side of complexity...

There are only 10 words needed to understand one's purpose:

“Only a life lived for others is a life worthwhile.” - Einstein

There are only 9 words needed for finding understanding:
“The beginning of wisdom is the definition of terms.” - Socrates

There are only 8 words needed to understand leadership:
“Living systems always react, they never obey” - Wheatley

There are only 7 words needed to understand one's priorities:
“Remember your humanity & forget the rest.” - Einstein

There are only 6 words needed for an apology:
“I admit I made a mistake.”

There are only 5 words needed for encouragement”
“You did a good job!”

There are only 4 ways to improve financial performance:
1. Improve Revenue
2. Improve Expense
3. Improve Asset Utilization
4. Improve Risk

There are only 3 ways to improve relationships:
1. Touch the mind
2. Touch the body
3. Touch the spirit

There are only 2 ways to improve business volume:
1. Improve Marketing
2. Improve Innovation

There is only 1 way to improve outcomes:
1. Improve function

All The Best!


Copyright 2007
Performance Builders
Tuesday, October 2, 2007


It seems our world is filled with celebrities, super heroes, and super models. There are those who work so hard to appear to be more than they really are and those who admire them or wish to emulate them. Its just super, don't you think?

Let's be real... REALLY. Who needs another super star? Who needs yet another persona? Who needs more illusions. What happened to authenticity?

What we really need are more people who know themselves and who are comfortable and secure in being themselves. People who respect and admire each other not because of predictability found in their similarities but because of the mystery that lies in their differences. People who are willing to put their real-self out there and who are willing to let others deal with it.

"Far better to fail at being yourself than to succeed at imitating another" - Herman Melville

“Seek not to walk in the footsteps those who came before you but rather seek what they sought” -Covey

“Do not follow people. Follow truth.” - Anonymous

You be You! Let them be them! Celebrate the differences!

When it comes to performance its not about putting on a performance by appearing to be something you are not. Rather it is about being effective and efficient at being who you are, getting the best results you can, showing your concern for others; and setting others up for success.

Those are the performances that really matter.