Monday, December 24, 2007
I came across the following short video earlier this year. Its heart warming and inspiring...

Go To Service Video

I think it has special meaning in this holiday season.

Do you have a Johnny Strategy for your Practice?

How are you making your Practice special to every patient and client?

Is everyone doing their part to make it special?

Something to think about...


Performance Builders
Wednesday, December 19, 2007

A Christmas Wish for You!

(Please click on the Card above to enlarge)

Medicare Reprieve - What will you do?

Well the word out of Washington and the APTA today is that Medicare has again temporarily amended the pending Medicare Physician Fee Schedule for 2008 that governs physical therapy reimbursement. What was to be about a 10% reduction will instead be a .5% increase for the next 6 months.

While this is temporary good news for the industry it should not breed complacency, which it will of course do in too many Practices. For several years now this cyclical threat and retreat has been an annual end of the year circus in the physical therapy community.

Of course it is all about politics - this time we "won" next time we may not. Keep in mind that with 3.5% annual inflation the past several years even the small increase in the Fee Schedule is in fact a real loss.

Also keep in mind that Medicare is under severe financial pressure with rising healthcare costs, the expansion of coverage (drug benefits) and an exploding increase in the number of seniors thanks to the baby-boomer generation. 2008 is the inflection point where the US will begin to seriously feel the impact of that generation retiring.

The good news is that rehab utilization increases by about 50% for those over age 65. The bad news is that the likelihood of further erosion of benefits and reimbursement is all but guaranteed when the combined effects of Social Security and Medicare come to bare in the coming years. It is not a financially sustainable situation for the federal budget.

The bottom line is that Practice expenses are going up due to labor shortages and will continue to do so for the foreseeable future. Meanwhile reimbursement will continue to erode through a combination of actual cuts (by all payers) and the lack of cost of living increases. Those pressures will certainly be measured in profit erosion for all Practices.

So there are two options... some Practices will celebrate today's transient victory. Others, more astute, will recognize the inevitable trend and take this temporary reprieve as an opportunity to restructure their Practices for future sustainability and profitability. It is not time to budget but instead for plan for profits.

What is your profit plan for the next 5 years? How will you respond? Will you wait to act and sacrafice intrim profits, or will you take action to protect and enhance future profits beginning today? Profits that are not harvested are lost for ever.

What is your choice? Your Practice future is at stake.


Copyright 2007
Performance Builders
Thursday, December 13, 2007

Compensation and Incentives

First a brief note that I'm back in the office after taking a couple of weeks away with international travel. As always, a different culture stimulated lots of new ideas and opportunities to innovate in both clinical and business matters.

Next, a few thoughts on a discussion I had with a client today about opening a new practice location and his desire to incentivize an employee in the management of that operation. The discussion essentially came down to business options to optimize profitability, reward performance, and retain talent. This is a discussion that has come up frequently over the past couple of years and may be on your mind. Here are a few things to consider...

The potential for creativity is of course infinite, but at the core there are a handful of options that provide a starting point for finding just the right solution. The core range of options looks something like this:
  1. Fixed compensation including wage and benefits - not the best option for either employee or employer but perhaps the most common solution chosen due to a lack of appreciation for alternatives.
  2. Variable compensation including base wage, benefits, and a performance based bonus - this is an option that employers should seriously consider for all clinical staff.
  3. Either of the two options above plus a deferred income plan - a particularly useful option to simulate ownership asset accumulation benefits in a non-profit environment or a non ownership position.
  4. Phantom stock plan to simulate ownership without capital investment by the employee and without loss of control or certain tax penalties for the employer. An arrangement too often overlooked.
  5. Equity ownership - perhaps the ultimate tool to align interests but not without significant drawbacks pertaining to minority interests and employee readiness to assume the responsibilities and obligations that come with ownership. Too often existing owners lose out.

Business performance is highly dependant upon compensation structures, yet too few Practices fully understand the consequences or alternatives. Understanding them and making the best selection have significant impact on Practice innovation, productivity, reward, and recruitment and retention of talent.

All The Best!


Performance Builders