The proverb “necessity is the mother of invention” has special meaning for today’s rehabilitation practice. If you want to succeed in private practice in today’s financial environment, a relatively new invention that can help you thrive is the hybrid practice model.

Transforming a traditional private practice into a profitable business with diverse revenue streams is challenging. So we asked Dr. Amber Schlemmer (PT, DPT, CSCS), owner of Primary Prevention Physical Therapy (PPP), to share her hybrid private practice success story and some advice for those considering the switch.

What was your background in starting private practice before your private practice became successful?

I was a collegiate Division I Strength and Conditioning Coach with a BS in Kinesiology from Michigan State University. With over 15 years of experience in the field of athletic performance, and given my innate senses and general curiosity about human capabilities, I thought physical therapy was the next logical step forward. I received my Ph.D. in Physical Therapy at the University of Michigan and am very grateful for their leadership and guidance in the DPT program.

What was the motivation behind starting a company like Primary Preventive Physical Therapy?

I knew I wanted to be the private practice owner for the entire PT school. But in my practice, I’m looking to move away from the triple-appointment, factory-style clinics that are common in larger chains and operate more from a strength and conditioning standpoint. I want to incorporate lifestyle changes, nutrition, and a love of exercise into people who have no idea how good they can feel without surgery or medication.

With a young family and a serious threat of burnout prior to entering the field, I wanted to provide more for my family and patients. Primary Prevention Physical Therapy (PPP) not only helps our patients relieve pain, it also helps our patients learn about their bodies, how they work, and how they grow. In PPP’s logo, you can see the Venn Diagram of Health, where exercise, nutrition, and mental health create the optimal environment for our bodies to thrive.

We do our patients a disservice if we don’t address topics like nutrition or sleep hygiene while they’re in therapy, because our bodies won’t last as long as we “feed our Ferraris on unleaded fuel while constantly driving full throttle” !

How large is your practice (i.e. staff and buildings)?

Our 6,000 square foot facility features a pre-function area, an important strength floor, three private treatment rooms and three massage rooms. Our team has grown tremendously since we opened in 2018, when we had only one current PTA and one administrator.

We now have 7 PTAs, 3 Orthopedic PTs, 1 Neurology PT, 1 Pelvic Health PT, 3 Massage Therapists (2 of which are Dual Licensed PTAs), 3 Strength Coaches, 5 Administrators, 2 1 biller, 1 social media and events coordinator, and our clinic coordinator. We are running out of space soon!

How can you capitalize on the success of your private practice, unlike other traditional physical therapy practices in the industry?

PPP is a small (maximum two patients to one therapist ratio) PT clinic focused on physical therapy and healthy behaviors. We also offer a variety of ancillary services that help our patients recover, rebuild, and most importantly, continue their habits after treatment, including:

• individualized counseling,
• internal counseling,
• group fitness classes,
• massage, and
• Nutrition Counseling.

We also offer other services such as Occupational Therapy, Speech Pathology and Chiropractic.

PPP differs from traditional physical therapy clinics in our focus on proactive care and injury prevention. We evaluate biomechanics, exercise patterns, and lifestyle factors to identify potential areas of concern and develop an individualized exercise program, ergonomic recommendations, and lifestyle adjustments to reduce risk.

Of course, we also provide rehabilitation and treatment for injuries, illnesses or post-operative recovery. We take pride in restoring function, reducing pain, and improving mobility and strength for individuals who have experienced injury or health issues. While both approaches are important in physical therapy, PPP emphasizes proactive care to minimize the occurrence or recurrence of injury, thereby improving overall quality of life.

Does your practice have insurance? What about cash payments or out-of-network patients?

While PPP began as a strictly cash-based clinic, we noticed that it created a barrier between some of our patients and their ability to receive the quality care they deserve. We now accept all major local insurances and more. True to our original mission, we continue to offer competitive out-of-pocket rates to those who are uninsured or uninsured.

As a business owner, I can proudly say that patients are treated no differently regardless of who pays for their treatment. While some clinics limit sessions to two or three units based on how much a patient’s insurance pays, we give patients the time and attention they deserve during each session.

How do you manage the administrative aspects of your practice, such as billing and insurance claims?

I knew I wanted to avoid billing and dealing with insurance companies, so started by paying with cash only. But when we started accepting more insurance, I turned the bill over to a local third party company.

Fighting insurance companies for top-notch quality of care is not something I want to focus on, nor is it a business plan I want. I love treating my patients and know someone who loves medical billing.

This is where our Clinic Coordinator Rachael Marko plays an important role in leading our administrative and billing department. She alone teaches, trains and continues to mentor our billing and administration teams. With internal billing, we save money and increase employee benefits!

What does it take to establish a cash-based PT practice? How is this different from traditional insurance-based clinics?

To get a foothold in your area, be willing to talk to everyone in your area about your services and how they could benefit from different treatments. Most of my initial out-of-pocket patients have exhausted other traditional and conservative care options, are considering surgery, or are giving up their favorite activities.

We have a low budget marketing plan as I prefer to put the profits back into the pockets of my team to help build the brand. Because of this, our marketing is primarily through word of mouth and social media and a good website for patients to land on. I rarely attend print marketing or luncheons, instead I prefer to bring patients back to their doctors with glowing reviews and top-notch results.

This is how true relationship-based marketing happens. Our greatest source of referrals comes from years of quality care and the mutual respect of physicians and patients. If the focus is on the patient, it doesn’t matter who pays, the patient or the insurance company. My goal is to help patients achieve their goals.

What makes a successful private practice model?

Our compassion and drive to make a difference in the lives of everyone we meet is what drives the success of Private Practice. I am a firm believer that if you focus on what matters most – the people who walk in your front door (your patients) and the people you surround yourself with every day (your team) – the rest will follow.

I am so thankful for my team – most of them were either rescued by us from other clinics that had a different view on patient care, were on the verge of burnout, or were directly after clinical rotations at our clinic Hired from school.

What is the biggest challenge you face in running a hybrid physical therapy practice? How do you overcome these challenges?

There are several challenges to conducting a hybrid physical therapy practice, including:

• Familiar with complex insurance processes and policies;
• manage changing and declining reimbursement rates; and
• Manage time efficiently to ensure quality care in small batches, while staying focused on our team’s work-life balance priorities.

These challenges can be helped with a knowledgeable and dedicated management team who can efficiently handle insurance verification, billing and claims. They also need to communicate clearly with patients about insurance coverage and out-of-pocket costs.

Implementing a simplified billing system, contracting with insurance companies for fair rates, and offering competitive cash payment options can help strike a balance and ensure the financial viability and accessibility of services for small private practices.

How do you market your services to potential clients? Which strategies are most effective in attracting new patients?

We market directly to consumers through value-based posts on social media, send handwritten thank you cards after each assessment to ensure our patients know how grateful we are for choosing our practice and through community events and sponsorships.

Word of mouth marketing has many benefits for a small private physical therapy practice. It’s a free marketing method that relies on satisfied patients spreading the positive word of mouth to their friends, family and acquaintances. This organic referral system builds trust and credibility for the clinic, as people tend to trust recommendations from people they know.

Another benefit is that it allows for personalized and targeted advertising as we tailor it to an individual’s specific needs and concerns. With a growing reputation in the local community, it has proven to be a powerful tool for generating a steady stream of new patients and sustaining clinic growth.

What private practice advice do you have for someone just starting a clinic?

Initially, there was no work-life balance or a 40-hour workweek. For almost three years, I worked from early morning until late at night, sometimes 7-8pm, but I always made time for my kids’ after-school activities. Preload your drives and operate within your means until revenue can generate additional funds to invest back into the clinic.

Once you have a team, teach them well enough that they can work anywhere and be as powerful as they are in your practice, but treat them so well that they never want to leave. If you invest in your people, they will invest in you and provide the best service possible!

What are your plans for the future of your practice? How do you see it developing in the next few years?

The future of PPP is bright. Our focus on community student-athletes makes us the clinic of choice for sports injuries. In the long run, we are also thinking about a wider development, building a building that fulfills my life goals. My original plan was to create a one-stop health service that would include:

• primary health care,
• Pediatric Medicine and Rehabilitation, and
• It eventually became an orthopedic urgent care facility.

Through intelligent business and financial decisions, PPPs are likely to complete new developments in stages, continuing down the same path.

I would be remiss if I did not mention the inspiration and education of our friends at the Institute for Clinical Excellence – they have given me the confidence that this model can not only be successful but should be the model for the future of physical therapy. Our country is approaching its unhealthiest state to date.

Driven by a combination of patient needs, personal and professional goals, and sheer perseverance, the PPP team has spearheaded a growing movement to create a hybrid business model for private practice success. But, as Dr. Schlemmer mentioned above, you need a little intention and planning to get your private practice off the ground.

Have any burning questions for Dr. Schlemmer or the WebPT team? Leave them in the comments section below and we’ll do our best to answer them.