2011 Financial Survival Strategies

Time for a good meaty discussion on PTManager:

Now that we actually know the Medicare playing field for 2011
(MPPR at 20% for sure, SGR delayed until 2012 for sure, Cap exception process in place until 2012 for sure), what strategies are you using to address the cuts in rehab reimbursement from Medicare that we face?

What have you done (or plan to do) to analyze the impact?

What have you done (or plan to do) to help staff understand what is going to happen?

What changes have you made (or plan to make) to your operations in 2011?

What have you found to be a successful strategy? What has been less than successful for you?

What are your plans if your first strategy is not fully successful?

Thanks for sharing

Peter Kovacek, PT, MSA, DPT
Harper Woods, MI


Healthcare Economist ?? Employer Health Benefits in California

How is your company stacking up for Employee Benefits?


PTManager - A Manager's Perspective. Part 1: Discussion Documents to Grow Your Management Skils - a 14 part series to help you grow your management skills

PTManager - A Manager's Perspective

Discussion Documents to Grow Your Management Skils

Peter R Kovacek, PT, MSA, DPT


This is a 14 part series to help you grow your management skills



Part 1. 

Overview of Healthcare. 



tc l2 "Highlights 

Introduction of characters.  Marty considers the advantages and disadvantages of becoming supervisor.  Chris is assigned to Marty as the clinical instructor. Staff and Sandy say goodbye at Sandy’s farewell party.

The Saga begins

tc l3 "The Saga begins 

As the story begins, a large group of healthcare workers are gathered in a festive environment.  The location is Memorial Hospital’s Physical Therapy Gym.  The occasion is a going away party for one of the staff at the hospital.  Although the entire staff is assembled to offer well wishes to Sandy, the department manager, there are conflicting feelings for the staff.  They liked Sandy well enough but there is also a feeling that Sandy’s leaving may be just what the department needed.

There are about 30 people in attendance.  Figure 1 shows the organizational structure for the physical therapy department at Memorial Hospital prior to Sandy’s departure. Over the course of this textbook, the reader will become familiar with many of them.  For now, here is a brief introduction to the key people in the room.


tc l3 "MartyMarty is a physical therapist with three years experience who is just now moving into a supervisory role.  Marty is a strong clinician who is well respected by peers. As Marty begins to assume more responsibility for management of the department, Marty feels poorly prepared for the new responsibilities.  Marty has very mixed emotions over Sandy’s departure.


tc l3 "DaleDale is a physical therapist with thirty years experience who has been a longtime manager and excellent role model to staff.  At the onset of the case studies, Dale is the manager of a hospital physical therapy department and has been Sandy’s right hand.


tc l3 "ChrisChris is a young student on affiliation from the local university’s physical therapy program.  Chris will soon graduate and become a physical therapist.  Chris has great potential.  Chris has a previous undergraduate degree in business administration and has worked in a medical office as an office manager. Chris is looking forward to graduation, becoming a physical therapist, and moving on to graduate business school. Chris does not know Sandy well but has heard terrible things about Sandy from the staff.  Chris is a bit uncomfortable at this party, but agreed to attend at Marty’s request.  Marty is Chris’s clinical instructor.


tc l3 "SandySandy, the guest of honor at this party, is a longtime physical therapy manager who has not kept up with changes in clinical or management practice.  Sandy has been a non attentive, disinterested manager for some time.  Sandy knows that the staff is frustrated with what they perceive as a lack of involvement, commitment, and interest. The staff has been told that Sandy is leaving voluntarily, but Sandy feels forced out by hospital administration. 


tc l3 "BrettBrett is a physical therapist who has been out of school 10 years and has never been to a continuing education course.


tc l3 "DJDJ is a physical therapist with twenty years experience who has attained a senior therapist status.  DJ is well respected by peers and is often sought as a resource in helping other staff manage their patients.  DJ is struggling with the new paradigms of physical therapy service delivery.  This is especially true in the areas of quality and productivity and how those two concepts interact with one another. DJ is very sorry to see Sandy leave.  Sandy has always supported DJ in pursuit of clinical advancement.  DJ is suspicious of what will happen next at the hospital, especially who will be the next boss and whether they will support DJ’s clinical activities.  DJ’s biggest concern is that the new manager will only care about finances. 


tc l3 "PatPat is a 15 year experienced physical therapist who owns a private practice.  Pat has received great financial reward for ownership of the private practice but has begun to notice that financially the environment is changing rapidly.
Pat and Sandy started working together at the hospital many years ago. Pat left to start a private practice 10 years ago. Pat has worked with Sandy on various projects over the years and was invited to this party by the staff.  Sandy is happy that Pat is here.  Pat can’t help but contemplate the career choice differences that Pat and Sandy made to get to this point.


tc l3 "AndyAndy is a physical therapy aide who was trained on the job at the local hospital. Andy has been a staff member in the department for many, many years. Andy is unsure what Sandy’s leaving will mean to aides at the hospital.  Andy is glad to be a union member.  To Andy, that means job security.


As the scene unfolds, Marty is involved in an intense conversation with Dale.  Marty has expressed concern about the advantages and disadvantages of becoming more and more involved in the management of the department.  Marty is concerned about how to balance these time requirements with the need to continue to develop as a clinician. A major concern for Marty is the potential to focus so much time on the departmental needs that the clinical needs of Marty’s patients might become secondary.  This is something that Marty has seen happen to Sandy.  Dale encourages Marty to consider both the advantages and disadvantages of being a supervisor. 


Question 1A. If you were Marty, what would you consider to be the advantages of becoming a supervisor?  List at least five. 


Question 1B. If you were Marty, what would you consider to be the disadvantages of becoming a supervisor?  List at least five. 


 Dale reviews the list of advantages and disadvantages that Marty has compiled.  One of the key points for Dale’s success as a manager has been to find ways to build upon the advantages and to minimize the disadvantages.


Question 1C. Given the list of advantages created above, what can be done to build upon these advantages to make a supervisory role most successful? 


 Question 1D. Considering the disadvantages listed above, what can be done to minimize these factors?


In another corner of the room, Chris is thinking about the future, as students often do.  Chris’s clinical instructor is Marty. The relationship between Chris and Marty is excellent.  Marty seems to be a very good therapist and supervisor. Chris is planning to attend business graduate school after completing physical therapy school.  Chris has a strong interest in becoming a manager and supervisor.  As Chris reflects on the role that Marty has as clinical instructor, there are many of Marty’s attributes that Chris would like to emulate. 


Question 1E. Considering supervisors from the past and present and those that have been successful and those that have not been as successful, what attributes are needed for someone to be successful as a supervisor in physical therapy?



Question 1F. Again considering past and present supervisors, what attributes must be avoided to be successful as a supervisor in physical therapy? 


 As the farewell party for Sandy winds down, it is time for the staff to present Sandy with a farewell gift.  In addition to the traditional watch engraved with appreciation, the staff has decided to give Sandy an additional gift - the gift of advise.  Each person attending this party has been requested to prepare a brief (2-3 sentence) statement to be read to Sandy as a means of wishing Sandy well and imparting some advise for future success.


Question 1G. Review what is known about the party goers and indicate what they might wish to say in these statements to Sandy.

























It is now Sandy’s turn to address the audience. 



Question 1H. What might Sandy wish to say as a means of expressing appreciation and imparting advise to those present?





Question 1I. Considering the changing health care environment of our characters, project scenarios for the future of hospital physical therapy care and private practice physical therapy.



Hospital based physical therapy




Private practice physical therapy




The party ends with out incident.  The department does not have a plan of succession to replace Sandy.  Until a final action is taken, Dale will be acting manager for the responsibilities that Sandy had.



Next:  Part 2.

Management & Values 



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I wish you all the best.




Peter R. Kovacek, PT, DPT, MSA

President, KovacekManagementServices, Inc.



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