Mission Statement

Champion the success of the physical therapist in business

Vision Statement

Society demands access to physical therapists' businesses

Download The Annual Report

Sections

Leadership

LEADERSHIP

Strategic Plan

STRATEGIC PLAN

Membership

MEMBERSHIP

Financials

FINANCIALS

LEADERSHIP

Officers

Terry Brown

Terry Brown
PT, DPT

President

Frankfort, KY
Dan Mills

Dan Mills
PT

Vice President

Salt Lake City, UT
Amy Snyder

Amy Snyder
MPT, DPT

Secretary

Wauwatosa, WI
Angela Wilson Pennisi

Angela Wilson Pennisi
PT, MS, OCS

Treasurer

Chicago, IL

Directors

Stacey Alberts

Stacey Alberts
PT, OCS, CSCS

Grinnell, IA
Mike Horsfield

Mike Horsfield
PT, OCS, MBA

Bettendorf, IA
Craig Johnson

Craig Johnson
PT, MBA

Oakdale, MN
Jeff Ostrowski

Jeff Ostrowski
PT

Philadelphia, PA
Ali Schoos

Ali Schoos
PT, OCS

Bellevue, WA 98005

President's Message

Dear PPS Members,

I am pleased to present to you the Private Practice Section’s Annual Report for FY2017 (July 1, 2016 – June 30, 2017), the year in which PPS celebrated its 60th Anniversary. Here you will find a financial overview and snapshots of the exceptional work being done by the Section. I am certain that, once you read about the work accomplished by the Section and its legion of volunteers, you will have an even deeper appreciation of the value you receive as a PPS member.

Highlights of this year’s report include:

  • An increase in Private Practice Section membership after several years of stagnant growth.
  • The Treasurer’s Report, showing continued financial strength and increased member value, all while keeping dues at the same level since 2002.
  • An excellent year on Capitol Hill, including active legislation on the therapy cap and "opt out" that is moving forward with the help of our robust Key Contact program.
  • A significant investment by PPS to demonstrate the value of private practice physical therapy by contracting for a major review of claims data to support the value of PT in the continuum of care for musculoskeletal conditions and private practitioners as cost-effective providers of that care.
  • Enhancements to the PPS Learning Center, with even more content from webinars, past Annual Conference presentations, and a third PPS Video Series on Operations and Key Performance Indicators.
  • Our flagship publication, Impact magazine, continuing to provide timely and useful information, and the online version is growing in popularity.
  • Record-setting attendance at the PPS Annual Conference and Exhibition in Las Vegas.

There has been much success this past year achieved by the 300+ members that have served on Committees, Task Forces, and as authors for Impact. Please join me in thanking them for their outstanding work.

I also wish to thank each one of you for your continued support of PPS and our profession. It is your membership that drives our efforts. Enjoy this report and find more information at www.ppsapta.org.

Respectfully,
Terry Brown, PT, DPT
President
Private Practice Section, PPS

Terry Brown, PT, DPT President - Private Practice Section, PPS

STRATEGIC PLAN

Goals

1. ADVOCACY: Actively represent physical therapists in business regarding federal, state, and association laws, regulations, and policies.
2. PAYMENT: Target and engage in opportunities to increase payment for physical therapists' services and reduce administrative burden.
3. CONSUMER DEMAND: Create and expand consumer demand for physical therapy.
4. BUSINESS ACUMEN: Deliver education and develop skills related to business management, profitability, and operational excellence.
5. BUSINESS INNOVATION: Facilitate the exploration and exchange of disruptive and innovative business practices.
6. MEMBERSHIP: Build and engage a large and diverse membership.

1. ADVOCACY:

Actively represent physical therapists in business regarding federal, state, and association laws, regulations, and policies.

Objectives
  1. Promote access to physical therapists in business
  2. Drive advocacy efforts that support the economic viability of physical therapist-owned businesses
  3. Increase participation in leadership positions, including APTA governance, to promote and achieve PPS goals
  4. Develop alliances with other entities in the business and healthcare communities to promote and achieve PPS goals

In preparation for the current Congress, PPS’s legislative and advocacy priorities were updated in December 2016 by the Board of Directors and the Government Affairs Committee (GAC) and have been used by the Section’s lobbyists as the guide for PPS advocacy efforts. In anticipation of efforts to reform or replace the Affordable Care Act, a few health reform-related priorities were added for this Congress. These priorities are communicated to Congress as well as in other policy arenas, in particular the Centers for Medicare and Medicaid Services (CMS) and the Medicare Payment Advisory Commission (MedPAC). Repealing the arbitrary per beneficiary Therapy Cap on outpatient rehabilitation covered by Medicare is the highest priority for PPS. Because the current exceptions mechanism expires on December 31, 2017, corrective legislation must be passed before the end 2017.

ADVANCING LEGISLATIVE AND ADVOCACY PRIORITIES
  • Pursue favorable resolution including repeal or replacement of the arbitrary per beneficiary therapy cap on outpatient rehabilitation covered by Medicare. The Medicare Access to Rehabilitation Services Act (H.R.807/S.253) was introduced in both chambers. PPS is a member of the Therapy Cap Coalition, a group of provider- and patient-group stakeholders, in order to magnify our advocacy efforts for the common policy goal. PPS shared examples and argued alternatives to replace the outdated policy in a letter to the Energy and Commerce, Health Subcommittee before a July 2017 hearing. PPS Key Contacts lobbied their Members of Congress on this issue during the March 2017 APTA Federal Advocacy Forum.
  • Achieve legislation that allows physical therapists in private practice to opt-out of Medicare or privately contract with Medicare patients. Legislation has yet to be introduced in the new Congress. However, PPS is pursuing reintroduction of the bills and has been assured that physical therapists will be included legislation that will be introduced.
  • Continue to pursue the expansion of the locum tenens provision of Medicare to include physical therapists practicing in all communities. The bills to extend locum tenens privileges to physical therapists practicing in Health Professional Shortage Areas (HPSA), Medically Underserved Areas (MUA), and rural areas became law in December 2016. In May 2017 CMS issued regulations to allow outpatient PT services furnished by PTs in a HPSA, MUA, or rural area to be billed under reciprocal billing and fee-for-time compensation arrangements in the same manner as physicians, effective June 13, 2017. Sponsors of last Congress’ legislation have expressed interest in introducing legislation to expand the locum tenens privilege to all PTs.
  • Address and mitigate the negative effects associated with physician self- referral. Legislation has been introduced in the House; PPS endorsed and has gained cosponsors for the Promoting Integrity in Medicare Act (H.R.2066).
  • Achieve legislation that allows reimbursement through Medicare and federal health plans for physical therapy care through telehealth. The legislation introduced in both chambers was improved by including a provision that would allow all Medicare- enrolled providers and suppliers to be reimbursed for care which cost the same or less than traditional care and whose quality was as good as or better than in-person care. PPS endorsed and gained cosponsors for two relevant bipartisan bills: the CONNECT for Health Act (H.R.2556/S.1016) and the Medicare Telehealth Parity Act (H.R.2550).
  • Monitor and respond to Medicare payment reform proposals, and continue to fight for fair and equitable Medicare reimbursement for physical therapists in private practice. PPS shared critical comments regarding extending the Comprehensive Care for Joint Replacement Model (CJR) bundling provisions beyond hip and knee arthroplasty to include patients undergoing surgical hip and femur fractures treatment (SHFFT) episodes which contributed to the delay, then proposed cancellation of the plan to expand CJR to SHFFT. PPS supported expansion of the low-volume threshold exemption and bonus points to be provided to Merit Based Incentive Payment System (MIPS)-eligible clinicians in small practices as well as the creation of virtual groups to participate in the Quality Payment Programs. We challenged CMS’ failure to expand MIPS eligibility to physical therapists from the outset including examples of how application of the program as currently structured could result in additional obstacles for physical therapists.
  • Promote physical therapy as an essential health benefit (EHB) in all insurance plans. When the House’s attempt to pass healthcare reform included provisions that would allow states to reduce or eliminate the essential health benefits (EHB), which includes coverage for habilitative and rehabilitative therapy, two action alerts were sent to PPS Key Contacts. The first was coordinated with APTA; the second was a stand-alone, targeted action alert sent to PPS Key Contacts with the following template: “As a private practice physical therapist based in [your town name], and as a voter, I ask you to vote NO on the American Health Care Act. This bill allows the Essential Health Benefits (EHB) to be eroded by the states. Rehabilitative and habilitative therapy are a cornerstone of the EHBs and enable Americans to lead better and more productive lives. Please vote NO to protect the EHBs and access to affordable care for those with pre- existing conditions. Thank you.” PPS sent a letter to all Senators critical of the lack of process transparency and advocating for the protection of EHBs and other consumer protections.
  • Advocate to retain guaranteed access to insurance for those with pre-existing conditions as well as the ban on rescission for those who do have coverage. PPS lobbyists communicated this position to lawmakers and their staff throughout the healthcare reform debate. A PPS letter to all Senators included this priority. All of the reform bills retained some form of this protection.
  • Advocate to maintain requirements that children up to age 26 are able to remain on their parents’ health insurance. During the healthcare reform debate in the spring of 2016, PPS lobbyists communicated this position to lawmakers and their staff. A letter sent to each Senator thanked them for maintaining this protection in their legislative proposal. Each reform bill retained this guarantee for children up to age 26.
  • Promote the adoption by Accountable Care Organizations (ACOs) of quality measures that include functional health status. In comments to CMS regarding the implementation of MIPS, PPS argued that CMS should employ patient-centered measures that have robust psychometrics such as a patient’s functional status.
  • Pursue federal student loan repayment programs in underserved areas that enhance recruitment efforts of physical therapy private practices in these areas. Legislation was introduced in both chambers; PPS endorsed the Physical Therapy Workforce and Patient Access Act (H.R.1639/S.619), which would authorize physical therapists to participate in the National Health Service Corps (NHSC) Loan Repayment Program. This was one of the issues brought to Congress by PPS Key Contacts during the March 2017 fly-in.
  • Support opportunities for consumers to purchase health insurance across state lines. Legislation was introduced that would allow consumers to purchase health insurance coverage across state lines. However the GAC determined not to endorse the bill, called the Health Care Choice Act (H.R.314), based on concerns that this flexibility would result in a "race to the bottom" where the states with the lowest standards and requirements would be sought out and thereby the quality of insurance plans sold through this mechanism would be significantly lower.

This year PPS submitted the following advocacy letters on behalf of the membership to the Centers for Medicare and Medicaid Services (CMS)— Department of Health and Human Services:

  • Commented on a proposed rule (CMS-5522-P) regarding the Quality Payment Program, established under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), which supported the expanded definition of the low-volume threshold and the creation of virtual groups, but challenged CMS’ failure to expand MIPS eligibility to physical therapists from the outset by including examples of how MIPS, as currently structured, runs the risk of creating additional obstacles for physical therapists to participate once they are required to do so.
  • Facilitated PPS member comments on a proposed rule (CMS-1676-P) supporting the Medicare Physician Fee Schedule’s proposed work and practice expense values for the specified physical therapist CPT codes, as well as advocating for CMS to recognize the value and impact of physical therapy to improve the health and functional status of Medicare beneficiaries.
GROWING THE KEY CONTACT PROGRAM AT THE FEDERAL LEVEL

PPS’s Key Contact Program has expanded rapidly since its establishment in 2013. The goal of the program is to have a PPS member assigned to every Member of Congress in leadership or on a committee of health jurisdiction (Senate Finance Committee, Senate Health Education Labor and Pensions (HELP) Committee, House Ways and Means Committee, and House Energy and Commerce Committee). Now more than 250 members strong, PPS has filled its top-tier recruitment needs for 26 states. 1 Twenty-two states 2 have a PPS Key Contact for each member of its delegation serving on a committee of jurisdiction. In seven 3 states there is a PPS Key Contact assigned to each Member of Congress from that state.

A monthly Legislative Update has been distributed to PPS Key Contacts since January 2016 to ensure they have the most up-to-date news regarding the legislative efforts and activity on Capitol Hill. These updates include a hyperlink to the list of cosponsors for each bill to enable the Key Contact to readily determine whether their target legislator has cosponsored the bills discussed.

On March 26-28, 2017, as part of APTA’s Federal Advocacy Forum, 61 PPS members came to DC, 37 of whom were sponsored by PPS to attend. During an exclusive PPS Key Contact break-out session, PPS lobbyists provided highlights and insights into the PPS legislative priorities, activity, and progress, as well as the “nuts and bolts” of lobbying Members of Congress. Key Contacts then successfully lobbied their Members of Congress, sharing their perspective on PPS’s legislative priorities: the Medicare therapy cap (H.R. 807/S. 253), adding PTs to the National Health Service Corps (S. 619/H.R. 1639), concussion management, as well as the impact healthcare reform proposals (including the removal of the Essential Health Benefits [EHB] requirement) would have on their patients. These visits and conversations resulted in additional cosponsors on key bills and the protection of the EHB policy.

2. PAYMENT:

Target and engage in opportunities to increase payment for physical therapists' services and reduce administrative burden.

Objectives
  1. Educate members and provide tools for achieving successful negotiations with payers
  2. Increase awareness, influence, and participation in evolving payment models

In FY2017, PPS decided to make a significant investment in the fight to influence the financial resources that are allocated for physical therapy and positively shift payment and decision- making power in our direction. PPS contracted with Milliman, a consulting group, to provide our members with persuasive, valid data to support the value of PT in the continuum of care for musculoskeletal conditions and private practitioners as cost-effective providers of that care. The project is designed to provide members with the tools needed to advocate for themselves and their businesses when it comes to negotiating with payers and highlighting the value private practice physical therapists bring to the healthcare system and to patients.

The first phase of the project, currently underway, consists of analyzing commercial claims data and collecting research and evidence on the effect of PT on several conditions. Once the data is collected and analyzed, it will be used in an effort to influence policymakers and third- party payers to improve care design and delivery of services in an optimized clinical pathway that promotes private practice physical therapy as the highest value intervention for musculoskeletal conditions.

While PPS works with policymakers and stakeholders at the national level, members will also be able to play an active role in spreading the value message to the people and entities who influence payment. Education, tools, and other resources will be rolled out to PPS members so that they will be armed to take the message to local markets and establish strategic partnerships with relevant stakeholders who will benefit from the value physical therapy brings to their beneficiaries, subscribers, patients, or participants

In addition to playing a significant role in the above-mentioned project, the Payment Policy Committee also developed resources to educate about changes in payment and arm members with tools and knowledge to negotiate favorable contracts. The Committee has several work groups focused on relevant reimbursement topics, including telehealth, payer contracting, administrative simplification, member education, and vertical integration and joint venture partnerships.

PPS worked with Hall Render, a health care law firm, to develop model language for payer contracts. The Committee drafted a document describing “pro-provider” versus “pro-payer” language, which can be used when negotiating contracts and which offers numerous practical suggestions. A webinar with the attorney was presented featuring the document and highlighting practical strategies for payer negotiations.

A survey was conducted to assess member involvement in vertical integration and joint venture partnerships. The outcome of the survey and testimonials from the members participating in partnerships with health systems was presented in an article in Impact magazine.

A new focus of the Committee this year was telehealth. Its work resulted in new resources and training for members on how to operationalize telehealth within their practices and assure that telehealth services are provided legally and reimbursed correctly. PPS also cosponsored a webinar on the topic with APTA’s Health Policy Administration Section.

The Committee continues to present its very popular Payment Workshop as a preconference program the PPS Annual Conference, and is working in conjunction with APTA on a number of fronts in the area of administrative simplification.

3. CONSUMER DEMAND:

Create and expand consumer demand for physical therapy.

Objectives
  1. Develop, implement, and promote marketing and public relations educational programming
  2. Provide marketing and public relations tools for individual member implementation with local media and communities
  3. Compile and communicate data which demonstrates the comparative effectiveness of physical therapy

The Marketing & Public Relations Committee set its own series of objectives and tactics in order to accomplish the above goals. Additionally, the committee is divided into three functioning task forces who each carry responsibility in realizing the initiatives put forth.

  • Develop a Monthly Marketing Toolkit and send one per month. The Monthly Marketing Toolkit launched in February 2017 and has been steadily growing in traction ever since. Since launching the newly designed member-wide email, engagement has increased significantly with more than 2,000 page views and 1,000+ clicks on toolkit files.
  • Develop educational and/or promotional content for each of the marketing and public relations tools targeting PPS members, PPS Administrators' Network members, non-PPS APTA members, and students. The Committee developed a new social media presence, called @MyPhysTherapist, as a marketing tool to promote Monthly Marketing Toolkit content to members in a more accessible way. In addition, other relevant content has been posted for easy access by members in a format they can easily share in their communities. This new series has ignited cross-collaboration between PPS committees, other APTA sections, and social media influencers, and has positioned PPS as spokespeople in the online PT community.
  • Design a promotional strategy to increase consumption of each of the marketing and public relations tools. A series of articles and advertisements were placed in Impact magazine to promote the Monthly Marketing Toolkit and the Fit Factor website, and an email is sent to members every month promoting the resources available via the Monthly Marketing Toolkit.
  • Define the 99 Marketing Ideas project. The 99 Marketing Ideas Task Force determined that online video vignettes accompanied with supportive documentation when applicable would be an effective way to push Marketing Ideas out to the membership and optimize consumption. The Task Force filmed 15 marketing-focused video vignettes featuring different members during the 2017 Peer2Peer Summit.
  • Establish parameters for sharing collected Fit Factor data with membership and develop strategies for member-use of said data in marketing efforts. Based on member feedback, a plan is in place to customize the Fit Factor to an individual clinic/practice. This will provide additional value to members in their marketing efforts.

4. BUSINESS ACUMEN:

Deliver education and develop skills related to business management, profitability, and operational excellence.

Objectives
  1. Obtain and provide key practice benchmarking data
  2. Provide and promote an educational series that establishes and advances business aptitude for physical therapist-owned businesses
  3. Utilize technology to organize educational resources for ease of member access

PPS entered into a partnership with APTA which resulted in PPS becoming the first Section to create a microsite on the APTA Learning Center. All PPS recorded content has been integrated with the APTA Learning Center, resulting in a dramatically increased audience for our content. By joining up with APTA, our content will appear in search results from the PPS website as well as from the APTA website and Learning Center. The drastically wider audience will help to spread the Private Practice Section as the source for business-related content and reinforce the Section’s value proposition.

The Education Committee continues to work to address the knowledge needs of PPS members. New content is continually added to the PPS Learning Center, including archived webinars, recordings from past PPS annual Conferences, and the PPS 101 Video Series, which is free to members. A third video series on Operations and Key Performance Indicators joined the Marketing and Financial Management series, which were added in 2016. A total of 21 webinars were delivered in FY2017, many of which are free to PPS members and provide an excellent source of value for membership dues. Archived programs are available in the Learning Center.

In addition to continued oversight of the Section’s monthly webinar series, the Education Committee continues its long-term management of PPS’s two preconference courses at the Combined Sections Meeting, The Essentials to Starting a Private Practice and Taking your Practice to the Next Level. These courses continue to receive positive reviews every year and attract attendees from both PPS and other sections.

The Annual Conference Program Work Group continues its streak of presenting an outstanding program to attendees of the Section’s marquee educational event. The 2016 PPS Annual Conference in Las Vegas set a new attendance record at 1,743 attendees. Programming decisions are made utilizing member survey data, the substance and frequency of calls to the PPS office, and monitoring PPS social media channels, member webinar purchases, and other feedback mechanisms to predict the hot topics for presentation at Annual Conference.

The Combined Sections Meeting (CSM) Program Work Group has worked diligently over this past year to provide educational content at CSM that not only strengthens the PPS brand but also adds to the business knowledge of our members and attendees. PPS presented two 2-day preconference courses and nine educational sessions at the 2017 Combined Sections Meeting, resulting in a total of 940 attendees being exposed to PPS content.

5. BUSINESS INNOVATION:

Facilitate the exploration and exchange of disruptive and innovative business practices.

Objectives
  1. Support the growth of the Peer2Peer Networks program
  2. Provide forum(s) for discussion to foster innovation in physical therapists' businesses
  3. Inform members about innovative business models

The Peer2Peer Networks program doubled in size in FY2017 to 76 practices in 12 peer groups. The two cohorts— known as the Class of 2016 and the Class of 2017—met in person and remotely to share best practices and expertise, discuss hot topics, analyze operations, and work toward helping each other improve the bottom line of their practices. New in FY2017 was the collection and analysis of data for 11 key performance indicators from program participants representing 224 clinic locations.

The Impact Editorial Board built upon the success of FY2016 by continuing outreach and engagement efforts across social media, which in turn have played an important role in driving traffic to Impact issues online. This year, the most popular magazine issues included “How to Prevent, Avoid, and Recover from Burnout” (July), “Social Media” (May), and “Branding and Defining PT” (January).

Publishing Impact takes advance planning, which is why the Impact Editorial Board met in spring 2017 to analyze online content and plan the 2018 editorial calendar with guidance received from Impact membership surveys. With over 160 volunteer authors, Impact continues to thrive with the support of our Editorial Board and general membership.

The Institute of Private Practice Physical Therapy’s annual “think-tank”-style event, The Graham Sessions, completed its 10th year. The Graham Sessions presents topics within and affecting the business management, clinical, and educational components of physical therapy practice, and provides an environment where physical therapists from all practice settings can openly and productively engage in discussion, share views, ask questions, and listen to others. The FY2017 Annual Graham Sessions took place January 19 - 21, 2017 in St. Pete Beach, FL.

6. MEMBERSHIP:

Build and engage a large and diverse membership.

Objectives
  1. Recruit new members, including APTA members, who identify as business owners
  2. Market business education to all APTA components

The Membership Development Committee continued to analyze membership data and developed personas to make outreach efforts more salient to our audience. The committee focused on understanding and defining the ideal membership experience. FY 2017 resulted in a 2.5% membership growth, keeping in line with membership goals.

In collaboration with the Combined Sections Meeting (CSM) Program Work Group, Membership Development Com- mittee members focused on membership recruitment at CSM. The PPS reception proved to be a welcoming environment for prospective members to network and learn about the benefits of the section.

The Membership Development Committee also focused on marketing and standardizing the annual Student Business Concept Contest. Now in its 11th year, the student contest allows the winning students the opportunity to attend the PPS Annual Conference and gain exposure to the physical therapist-owned business community. The student involvement at the conference provides them with a unique opportunity to volunteer, network, and participate in committee meetings.

The PPS Administrators' Network (our non-PT administrators’ subscriber program) has liaisons actively participating in the Annual Conference Program Work Group, Government Affairs Committee, Impact Editorial Board, Marketing and PR Committee, and Payment Policy Committee. The Network now provides newsletter updates and free webinars to furnish education and networking opportunities for the practice administrators of PPS members. Netork subscriptions grew by 22% in 2017 and continue to increase as section members and administrators/office managers recognize the importance of maximizing the opportunities afforded by the Network.

And finally, the Nominating Committee presented a slate of outstanding candidates for the PPS Board while the Awards Committee selected the best of the best to receive the Section’s highest honors.

MEMBERSHIP

Secretary's Report

Amy Snyder

Amy Snyder

Secretary

PPS Membership by Region

Total PPS Membership by Fiscal Year

PPS Membership by Years in Practice

Oner / Member

FINANCIALS

Treasurer's Report

Dear PPS Members,

Fiscal year 2017 was a year of bold moves and big investments as PPS works to support your success in business. PPS has continued to support projects and programs to help build your businesses, including Peer2Peer Networks and Marketing, Finance, and Operations 101 videos, as well as supplying members with ongoing and high quality tools to market their practices.

PPS has also made significant financial commitments to advocacy, including continued growth of the Key Contact program, development of a data-driven value proposition for physical therapy around several musculoskeletal conditions, and by awarding grants to support the legal fight against anti-competitive practices in third party workers’ compensation benefits administration.

As you will see on the following pages, PPS's revenues have continued to grow steadily, and our efforts are also supported by consistent returns on PPS investments. The PPS Board is committed and determined to move the needle on payment and regulation for our members, yet remains fiscally and monetarily conscientious, focused on sustainable investments that result in high impact for you and the profession.

Respectfully,
Angela Wilson Pennisi, PT, MS, OCS
Treasurer
Private Practice Section, APTA

Angela Wilson Pennisi, PT, MS, OCS Treasurer - Private Practice Section, APTA

PPS Statement of Financial Position - June 30, 2017

FY Statement of Activities (P&L) Comparison

PPS Statement of Activities - June 30, 2017

The average PPS Practice Annual Gross Revenue averages $1 to $1.9 million