Wednesday, September 30, 2009


It seems almost everyone is looking for answers these days - preferably short and soon! We live with information overload and the pace continues to accelerate.

"Just give me the bottom line." To make a long story short..." "Just make it quick!" "I don't have time." Just the facts ma'am." "I want an answer now!" "Is that your final answer?" "I'm waiting!" Just keep it short and sweet." "

Answers that are short and soon run a high risk for being wrong. If in doubt, try calling the IRS three times in a row with a single question and see how many different answers you get.

Talk is cheap. Think productivity. Where's the accountability?

Perhaps we are getting it backwards. Our need for solutions may be better served with better questions than with quicker answers.

Measure the quality of ones contributions not by the answers they give but by the quality of questions they ask! Measure the progress one is making by the questions they ask.

On reflection...

"One may lead perhaps with not more than a question in hand. " –Richard Foster

“The function of genius is not to give new answers, but to pose new questions - which time and mediocrity can solve.” - Hugh Trevor-Roper

Sometimes the questions are complicated and the answers are simple.” - Dr. Seuss quote

“Mistakes come from not asking the right questions” -Anonymous

"We do good science when we ask new questions” -Anonymous

"In questions of science, the authority of a thousand is not worth the humble reasoning of a single individual. - Galileo

“If we are asking the right questions, we are probably living the right answers” - Rilke

Are you asking the right questions? Are you taking the time neccesary to formulate the right questions? Do you need better answers or better questions? Is opportunity more often found in answers or hidden in questions? What is your next big question? What new questions are awaiting you on the back side of beyond?


(c) copyright 2009
Performance Builders
Friday, September 25, 2009


I have had the incredible privilege to serve on the faculty of Gray Institute for Functional Transformation (GIFT) for the past 3 years. There is nothing like it in the industry!!!

GIFT is a ten-month, distance-learning, mentorship program that focuses on physical transformation and human performance through chain reaction biomechanics. Its holistic approach incorporates mind, body, and spirit.

This years cohort of students will be graduating in mid October as Fellows in Applied Functional Science (FAFS). GIFT Fellows come from around the world - they are physical therapists, medical doctors, chiropractors, and personal trainers. Each leaves with a distinctive knowledge and skill set that allows them to transform the lives of others through movement.

If you are a professional that is committed to the health, well-being, and physical performance of others check out GIFT. Participation will create in you the ultimate competitive edge. It will transform how you think, problem solve, treat, and train.

GIFT puts the "PRO" professional. Fellows are uniquely confident, qualified, and competent in all aspects of the neuro-muscular-skeletal system. They are uniquely capable of enhancing function and performance.

Join me in 2010 - Now is the time to register for classes starting in January 2010. Change your life and change the lives of others.

By the way, GIFT Fellows have special access to Performance Builders tools, consultation, and resources...


(c) copyright 2009
Performance Builders
Tuesday, September 22, 2009


"Build your world around your dreams rather than trying to fit your dreams into the world you know." - Alan Cohen
Saturday, September 19, 2009

There's a Bend Up Ahead

Regardless of the outcome of the national health debate over the coming weeks, the fact is that financial realities demand that something change... e.g. Medicare running out of money by 2017 as just one example.

Is change coming? You bet it is! What it looks like is still up in the air but one thing is for sure - reimbursement will continue to erode and costs will continue to go up. Businesses will be pinched - healthcare providers and community employers.

There will be winners and losers. Those who are not productive and efficient will be the first to suffer. One need only look back to the Balanced Budget Act of 1998 and long term care sector to appreciate the scramble that was caused and the losses incurred by so many.

Was there recovery. Sure there was... for some but not for others. Business changed hands. Business that inefficient providers could no longer afford to do shifted to those providers who could do more for less and still make a profit. While some were going out of business others were taking the opportunity to grow theirs.

Times of change are times of opportunity for those who are prepared. Now is the time to be preparing. Those who are business savvy and prudent are doing just that - PREPARIING.

"A bend in the road is not the end of the road unless you fail to make the turn."

Do you have your hands on the wheel?


(c) copyright 2009
Performance Builders
Wednesday, September 16, 2009


About a dozen years ago I had the privilege to introduce the American Physical Therapy Association (APTA) to performance benchmarking at one of its Leadership Conferences (LAMP). The presentation was about using objective comparative performance data as a tool in discovering best practices and providing evidence based practice. It was a presentation about enhancing the performance of the profession.

Over the past 15 years I had the privilege to benchmark hundreds of physical therapy operations - both hospital and private practice based. Benchmarking provides a disciplined statistical methodology t0 identify and assess variance in business performance - financial, operational, productivity, utilization, etc. The bottom line for a practice owner or manager is that benchmarking provides an efficient and economical system for optimizing clinical outcomes, competitive advantage, and profitability.

In working with the data on individual practices I found another story that was being told by the aggregate data. It was a financial story of physical therapy performance across the nation. It was a multi-billion dollar story told on the back of a napkin! Here's that story...

First lets make a few conservative assumptions that are readily supported by benchmarked industry data.

  • Each therapist provides 12 patient visits per day
  • Each visit consists of 3.5 service units (CPTs)
  • Each therapist works 230 days per year
  • There are about 125,000 PTs in the US
  • Expense per unit of service is improved by 10%
Doing the math:
  • Each therapist provides 9660 service units per year for a total of 1.2 billion units per year.

The Impact:

  • A 10% improvement in average practice expense across the US would generate an additional $2.9 billion in profit/margin. That equates to $23,200 per therapist ANNUALLY!

A 10% improvement across the industry would not be difficult considering the lack of attention that business performance gets in most practices and the high variance in financial performance that is shown by benchmarking.

What could such a an improvement in profitability (discretionary income) have on professional development, enhanced services, competitive advantage, compensation, political influence, and social responsibility?

Most physical therapy practices in the US are under performing. The performance of the top quartile of practices (25%) prove what can be achieved. They also demonstrate how it can be achieved (best practices).

Its right there in the numbers! That is what benchmarking and best practice is all about. Time consuming and costly scientific studies are not necessary. The answers are already in.

The opportunity does not offer just a one-time payoff, but one that is repeated annually! Think of what a decade of improvement would produce. Think how practice values would increase when sale prices are based on MULTIPLES of profitability. Think how performance, reward, and influence could be transformed.

The potential for the industry is nothing short of transformational!

In a period of skyrocketing health care costs and national policy debate on health care reform, isn't transformation what the PT industry needs?

Will ignoring the issues/threats with business as usual or complaining about health policy change your reality? The solution and the reward will go to those within the industry who take matters in their own hands and within their own practices to change their performance reality.

The risk is low and the return on investment great.

So, how are you doing? What are you waiting for?


(c) copyright 2009

Performance Builders

Tuesday, September 15, 2009


"The future enters into us, in order to transform us, long before it happens." - Ranier Maria Rilke
Friday, September 11, 2009

Performance Tool - Order Now for 2010

You asked for it and here it is...

Performance Master 2010 (PM) is ready for distribution to physical therapy practices and personal training studios. PM is a simple to use powerful software application that empowers business owners and managers with critical control over the performance of their practices.

Want top performance and profitability in your practice? Try Performance Master.

PM convenienty takes you through the establishment of 13 critical performance assumptions that are unique to your business situation. It then uses those assumptions to automatically calculate 16 powerful performance standards that are the key to performance in your business.

Each week you enter 15 performance data points into the program - takes just a minute or two. PM graphs 52 weeks of performance plus year to date performance against each of your performance standards. For the first time you have a business dashboard that will take you to your chosen level of performance.

Superior performance is all about identifying emerging issues and makeing timely decisions based on knowledge. PM assures that what needs attention gets attention. The results are transformational!

Not measuring up? Well PM also points you to the key business processes that drive each standard, allowing you to get back on track in real time!

If you don't know what your 16 performance standard are and how you measure up, your business performance is falling short of its potential.

A one recent Performance Master business owner said, "For the first time I have confidence that I'm in control of my business and it feels so good!" D.S.

A one year Performance Master license costs just $365. Its a small investment with a great return! ...more profit, less worry, better sleep! Satisfaction is guaranteed.

Now is the time to lay the foundation for a productive and profitable 2010 in your business.

Order your Performance Master today! Email Please put Performance Master in the subject

When business performance counts - Count on Performance Builders!


(c) Copyright 2009
Performance Builders
Thursday, September 10, 2009


"The best way to find out if you can trust somebody is to trust them.” - Hemingway

Economics In Practice

The current practice economics are not stable, secure, scalable, or sustainable in institutions or private practice.

Reimbursement has and will continue to erode. Compensation expectations are and will continue to build. The only way out of that scenario is enhanced productivity amongst fewer people.

Innovative compensation strategies and incentives are part of the equation but not all of the equation. Professionals want autonomy of practice, mastery of skills, and purpose in their work.

What is needed is reconceptualization of the challenge and the solutions.

Pay-for-performance has proven challenging in healthcare on multiple levels. That said, professional autonomy demands both clinical and economic accountability.

It's time that the concept of "pay-for-performance" be migrated to "variable compensation" within the framework of autonomy.

Are practices and professionals ready for it? NO, but they need to take it seriously if they intend to remain economically viable. Those that adopt "variable compensation" effectively will enjoy a substancial competitive advantage in the coming months and years. Those who can deliver good service and productivity will have unique opportunities that will pass the rest by.


(c) Copyright 2009
Performance Builders
Monday, September 7, 2009

Diggin for Gold

I recently finished a consulting project with a client who was interested in a practice tune-up for performance and strategy. The practice was a one therapist operation.

One of the first things we did was go back and review a few key agreements the practice had signed. One of those agreements was a contract with an outsource service provider.


The service contract referenced a certain deliverable that the provider had not delivered and that resulted in the practice assuming the cost for the overlooked service. It was an incidental clause that had remained overlooked for 5 years during which it had approximately a $76,000 ($15,000 annual) negative impact on the practice's bottom line!

We are hopeful those dollars will be recovered from the outsource provider. Return on investment for the practice owner? About 3,700% - not a bad investment in a punk economy!

What is being overlooked in your practice? What's right there just waiting to be discovered? In my experience with hundreds of practices, every practice is overlooking something! Most are overlooking multiple things. Every dollar discovered is new found profit.

"Thar's gold in them thar hills!"

It's a good time to go prospecting! And, that is particularly so in a down economy. It's all about knowing where to dig - a reliable map and experience has proven helpful. At Performance Builders we have both - could you use some help digging?


(c) copyright 2009
Performance Builders
Thursday, September 3, 2009


Richard - thanks for your comments to my recent "Compete" post.

Yes, differentiation is important for branding, reputation, competition, and growth particularly in crowded markets. It is even more critical if one's practice is not a "leading" competitor.

Yes too, a lot of the juice has been squeezed out of price competition with third party reimbursement and related matters. And there remains little transparency in pricing. Having said that, there remain some spectacular opportunities to Zag by price differentiation on both the high end and low end but few practices see or understand those opportunities.

Yes, superior competency, outcomes, and service are always in demand and most practices "claim" to have that as a priority. Unfortunately too many are satisfied with their own definition of "superior". Too few are objective in assessing or allowing themselves to be assessed relative to their true ranking... a common condition in most professions it seems.

The first responsibility of a professional is competency, outcomes, and service; but I would suggest that is often not sufficient for private practices that do not have the economic backing and resources of a large health care system or its clout in steering patient referrals. Their competitive advantage is often found at the intersection of innovation and entrepreneurism - thus Zagging.

In identifying opportunity, competitiveness and reward through innovation (Zagging) I am not suggesting that practices abdicate their first responsibility and opportunity as professionals. Rather, I'm suggesting that there is unlimited potential that lies outside of the box of currently perceived constraints of traditional practice models.

For those interested in Zagging, the book Innovators Dilemma by Christensen is a worthwhile read.

Richard, I think we are more on the same page than not, and that our differences are more likely a matter of emphasis, markets, and resources. Thank you for your relevent comments.


(c) copyright 2009
Performance Builders


"Success will never be a big step in the future. Success is a small step taken just now." - Jonatan Martensson

"Success is a self-fulfilling prophecy." - H.H. Swami Tejomayananda

But, success is never achieved alone...

Structured For Success

In a conversation with a practice owner this week we talked about business performance in physical therapy and personal training practices. I made the comment that most practices are not structured for success. That comment raised the question to me, "What do you mean by structured for success?" Good question!

First let's define success... It involves five elements: reputation, profitability, scalability, sustainability, and giving back to the community served. If one achieves those five elements satisfaction will likely also be found.

It seems that too many practice owners are satisfied with making a wage. Too many overlook the need and benefit of earning a profit and a return on investment for their financial and time investments and for the risk they take in launching and operating a business. Profit is that return on invest. It is important and prudent. We focus on the success factor of profit because it is the fuel that makes the the other four elements possible.

"So, how does one structure for success?"

Structuring is multi-faceted. There are matters of the legal structure of the business including, contracts, partners/members, rights, responsibilities, obligations, understandings, tax status, capitalization, governance, etc. There are operational structures related to marketing, utilization, productivity, staffing, billing and collections, communications, etc. There are also matters of financal structures such as budgets, loans, line of credit, leases, fees, discounts, provider contracts, compensation, distributions, and profit.

Profit is too often an after thought, i.e. what's left over at the end of the year. It gets far too little consideration. How little? I find very very few practice owners that know what their profit margin is. And, it is equally rare that an owner can tell me what their intended profit margin is for the year. Here's a simple test for you? What is your current profit margin for the year and what was it intended to be? If your answer is, "I don't know", then you are not structured for success and you are not alone.

Profit is not something one can manage directly because it represents the sum total of all of the decisions one makes. Profit represents your score in the game of business. it tells you how well you're playing, how competitive you are, and what league you are playing in. As a point of reference, 25% of practices earn 10% profit or less. The remaining 75% earn more - the top 25% of practices earn much more!

Why? Because they are structured for success. All of the moving parts of the business are aligned, and integrated toward one end - superior service and profit. Practice owners need to stop making excuses and being embarrassed to talk about profit. Sure service comes first, but service without profit is foolish. Even not-for-profit organizations recognize the need and appropriateness of operating with a surplus (profit). Nonprofits can get by for a while on a smaller margin (profit) only because they have a tax advantage and the ability to accept charitable contributions.

Without profit one can not grow and provide better and better services to their community. Profit rocks!

Here's the underlying insight one must understand. Unless there is an intended profit target and unless one knows whether they are on target or off, they can have no idea what decisions need to be made or what solution to a problem is optimal! And, unless such decisions are routinely being made proactively in a timely fashion one can assume that there is no one managing the business.

The budgeting and managing of expenses are particularly critical since they are the only financial variable that management can actually control. Volume and revenue are dependent on the decisions of others to engage one's services. Bottom line profit is simply the calculation of the difference between one's top line revenue and their middle line expense. Thus, how expenses are structured and managed in relationship to conservative revenue expectations are critical to profit achievement.

It all begins with planning. Planning begins with an honest appraisal of how well the business side of the practice is currently performing in comparison to other practices. How competitive is it? Only then can one learn what is possible. Only then can the practice be structured for success. Only then can one find structured success.

Restructuring can take anywhere from a few weeks to a year or so, but it is the most important thing one can do for their practice, for their staff, for their community, and "yes for themself"!

Back in the 1800's Webster's dictionary defined Success as: prosperous, fortunate, happy, kind. It's important tonot forget the elements of fortunate (blessed) and kind (grateful) in our understanding of success. It is also important to keep in mind that prosperity favors those who are pro-active and prudent in their preparation. And, happy like profit is an outcome that can not be controled directly.

Are you structured for success or just getting by?

All The Best!


(c) copyright 2009
Performance Builders