"Physical therapy is not a subspecialty of the medical profession and physical therapists are not medical doctors; we are a separate profession that provides a unique service that physicians are unable and untrained to provide."

Letter to the AMA from the APTA, Dec 2009

Friday, December 9, 2011

The Process of Profitability

Physical therapists can learn from this highly successful company. They sell 10% af all the furniture in the world, they made $30 BILLION in revenue in 2010 and their estimated profit margin is 10%.

This company has created a process for customers to buy their products, become loyal customers, leave their stores highly satisfied and eagerly look forward to coming back and spending more money.

The customer is encouraged to browse the store, selecting what they want to purchase while following a SPECIFIC PATHWAY.

Who is this company? Follow the arrows to find out.

The "process" is easy - this company paints arrows on the floor of their HUGE stores to help customers navigate through the thousands of products they offer.

Not every product is costly - you can spend as little as 50 cents on some items. You may also spend thousands of dollars in their store. The average customer spend $85 dollars per visit. A single trip to one of their stores may take 3-4 hours so the company has a full-service, sit-down gourmet restaurant for when you get hungry.

What does this company have to do with physical therapists? Physical therapists can learn from them how to make the process of physical therapy easier, more fun and more rewarding for our patients. And, not mention, more profitable for physical therapists.

The "process" of physical therapy is one of the quality measures defined by the National Quality Measures Clearinghouse (NQMC) of Clinical Quality Measures. The five domains are generally described as follows:
  • Process
  • Access 
  • Outcome 
  • Structure 
  • Patient Experience
The process-of-care is defined as a health care-related activity performed for, on behalf of, or by a patient.
"Process measures are supported by evidence that the clinical process—that is the focus of the measure—has led to improved outcomes. 
These measures are generally calculated using patients eligible for a particular service in the denominator, and the patients who either do or do not receive the service in the numerator. 
Example: The percentage of patients with chronic stable coronary artery disease (CAD) who were prescribed lipid-lowering therapy."

Physical therapy in the United States is unusual in that many of the processes we traditionally perform, such as the following:
  • Physician certification of the Plan of Care 
  • Written Progress Notes 
  • Discharge Summaries 
  • Episodic treatment for chronic conditions (eg: three time per week for 1 month) 
  • etcetera 
...are NOT supported by evidence that they lead to better outcomes, lower costs or a better patient experience.

Innovative physical therapists will need to find a way to get these Medicare-mandated processes performed while improving the patient experience.

Innovation is what drives this company. They are the global arbiters of style in home furnishing.

Additionally, they have discovered that customers don't really want furniture - we want a place to sleep, something to write on and something to sit on. The actual pieces of wood that this company sells are not the highest "quality" - as defined by contemporary standards of furniture quality.

But, customers buy them.

Who is this company?


What innovations can physical therapists propose, within the Medicare-mandated process-of-care, to improve the patient experience in the United States?

Please comment.

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Tim Richardson, PT owns a private practice at Medical Arts Rehabilitation, Inc in Palmetto, Florida. The clinic website is at MedicalArtsRehab.com.

Bulletproof Expert Systems: Clinical Decision Support for Physical Therapists in the Outpatient Setting is a manager's workbook with stories, checklists, charts, graphs, tables, and templates describing how you can use paper-based or computerized tools to improve your clinic's Medicare compliance, process adherence and patient outcomes.

Tim has implemented a computerized Clinical Decision Support (CDS) system in his clinic since 2006 that serves as a Reminder, Alerting, Prompting and Predicting CDS using evidence-based tests and measures.

Tim can be reached at
TimRichPT@BulletproofPT.com .

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