Hybridize to Thrive: Insights to Private Practice Success

The proverb, “Necessity is the mother of invention” takes on special meaning for rehab practices today. And if you’re looking to achieve private practice success in today’s financial climate, one relatively new invention that can help you thrive is a hybrid practice model. 

Morphing a traditional private practice into a profitable business with diverse revenue streams is challenging. So we asked Dr. Amber Schlemmer, PT, DPT, CSCS, the owner of Primary Prevention Physiotherapy (PPP), to share her hybridized private practice success story as well as some tips for those considering a switch.

Before your private practice success, what was your background leading up to starting a private practice?

I was a former Division I collegiate strength and conditioning coach with a Bachelor’s Degree in Kinesiology from Michigan State University. With over 15 years of experience in the sports performance field, I decided that physical therapy was the next logical progression, given my innate sense and general curiosity about human capacity. I earned my Doctorate in Physical Therapy from the University of Michigan and was very grateful for the leadership and guidance I found in their DPT program. 

What was the genesis behind starting a company like Primary Prevention Physiotherapy?

I knew I wanted to be a private practice owner throughout PT school. But in my practice, I desired to break free from the triple-booked, mill-style clinics seen in bigger chains and operate from more of a strength and conditioning perspective. I wanted to incorporate lifestyle modification, nutrition, and a love of movement in those who had no idea how great they could feel without surgery or medication. 

With a young family and the severe threat of burnout even before entering the field, I wanted to provide more for my family and patients. Primary Prevention Physiotherapy (PPP) works not only to help our patients with their aches and pains but to help our patients understand their bodies, how they work, and how they thrive. In PPP’s logo, you can visualize the Venn diagram of health—where movement, nutrition, and mental health create an optimal environment for our bodies to thrive. 

We would be doing our patient’s a disservice if we did not address topics like nutrition or sleep hygiene as they go through therapy because if we are “fueling our Ferraris with unleaded all while constantly running them full throttle,” our bodies are not going to last as long! 

What is the size of your practice (i.e., staff and buildings)?

We have a 6,000-square-foot facility with a welcoming area, a significant strength floor, three private treatment rooms, and three massage rooms. Our team has grown immensely since our grand opening in 2018, where we had only one of my current PTAs and one administrator. 

We now have seven PTAs, three orthopedic PTs, one neurologic PT, one pelvic health PT, three massage therapists (two of which are dual-licensed PTAs), three strength coaches, five administrative staff, two billers, a social media and events coordinator, and our clinic coordinator. We are quickly outgrowing our space! 

How have you leveraged private practice success differently from other traditional physical therapy practices in the industry?

PPP is a low-volume (at most two patients to one therapist ratio) PT clinic focusing on physical therapy and health behaviors. We also have a multitude of ancillary services that can help our patients recover, rebuild, and, most importantly, continue their habits after therapy which include:

• individualized coaching,
• in-house coaching, 
• group fitness classes, 
• massage, and 
• nutritional coaching. 

We are in the process of bringing on additional services as well, like occupational therapy, speech-language pathology, and chiropractic. 

PPP differs from traditional physical therapy clinics in that we focus on proactive care and injury prevention. We assess biomechanics, movement patterns, and lifestyle factors to identify areas of potential concern and develop personalized exercise programs, ergonomic advice, and lifestyle modifications to mitigate risks.

But of course, we also provide rehabilitation and treatment for injuries, conditions, or post-operative recovery. We take pride in restoring function, reducing pain, and improving mobility and strength in individuals who have experienced an injury or health issue. While both approaches are essential in physiotherapy, PPP emphasizes proactive care to minimize the occurrence—or reoccurrence—of injuries, promoting overall quality of life.

Does your practice take insurance? What about cash-pay or out-of-network patients?

While PPP began as a strictly cash-pay clinic, we noticed that it created a barrier between some of our patients and their ability to access the quality care they deserve. We now accept all major local insurances and many more. Sticking to our original mission, we continue to offer competitive self-pay rates for those under or uninsured. 

As a business owner, I am proud to say that no matter who pays for therapy, patients are treated no differently. Where some clinics cap sessions at two or three units based on what the patient’s insurance pays, we give our patients the time and the attention they deserve every session. 

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

Billing and dealing with insurance companies was something that I knew I would like to avoid—hence, beginning with cash payments only. But as soon as we began to accept more insurance, I relinquished our billing to a local third-party company. 

Fighting insurance companies to get paid for best-in-class quality of care was not something I wanted to focus my efforts toward—nor was this a business plan I wanted. I love treating my patients and know someone who loves medical billing. 

That’s where our clinic coordinator, Rachael Marko, has been integral in leading our administrative and billing department. She has single-handedly taught, trained, and continues to coach our billing and administrative team. By bringing our billing in-house, we saved money and increased our employee benefits! 

What does it take to establish a cash-based PT practice? How does that differ from traditional insurance-based clinics?

To establish a foothold in your area, be willing to talk to every human in your area about your services and how they could benefit from a different approach to therapy. Most of my original patients who paid out-of-pocket had exhausted other traditional and conservative care methods and were considering either surgery or giving up the activity they loved. 

We have a low-budget marketing plan because I prefer to put profits back into my team’s pockets to help build the brand. Because of this, our marketing operates mainly by word-of-mouth and via social media and a good website for patients to land. I rarely participate in print marketing or luncheons, and instead, I prefer to send a patient back to their physician with a glowing review and top-notch outcomes. 

That is how true relationship-based marketing happens. Our largest referral sources have come from years of quality care and mutual respect from physicians and patients. If the focus is patient-centric, it shouldn’t matter who pays, the patient or the insurer. My goal is to help the patient reach their goals. 

What makes a successful private practice model?

Our compassion and drive to make a difference in every person’s life that we come across is what drives private practice success. I firmly believe that if you focus on what is most important—the people walking through your front door (your patients) and the people you surround yourself with every day (your team)—the rest will follow. 

I am very grateful for my team—most of whom we have either rescued from other clinics that do not have the same views on patient care and were on the verge of burnout or were hired directly out of school after a clinical rotation with our practice. 

What are some of the biggest challenges you face in running a hybridized physical therapy practice, and how do you overcome these challenges?

Running a hybridized physical therapy practice presents several challenges, including:

• navigating complex insurance processes and policies; 
• managing varying and declining reimbursement rates; and 
• scheduling effectively to ensure low-volume quality care while always keeping sight of our team's priority of work-life balance. 

A knowledgeable and dedicated administrative team can help overcome these challenges, where they can handle insurance verification, billing, and claims efficiently. They also need to communicate clearly with patients about insurance coverage and out-of-pocket costs. 

Implementing streamlined billing systems, contracting fair rates with insurers, and offering competitive cash-pay options can help strike a balance and ensure the financial viability and accessibility of services in a small private practice.

How do you market your services to potential clients, and what strategies have most effectively attracted new patients?

We market direct-to-consumer via value-based posts on social media, sending handwritten thank-you cards after each evaluation to ensure our patients know how much we appreciate them choosing our clinic and through community events and sponsorships.

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

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

What sort of private practice tips do you have for someone who is just starting their clinic?

Initially, there is no such thing as work-life balance—or a 40-hour work week. For nearly three years, I worked from the early morning to late at night—sometimes 7 to 8 PM—but I always made time for my kids’ after-school activities. Front-load your drive and operate within your means until the revenue can generate additional funds to invest back into the clinic. 

Once you grow to have a team, teach them so well that they could work anywhere and make as big of a difference as they do with 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 generate the best service possible! 

What are your plans for the future of your practice, and how do you see it evolving over the next few years?

The future looks bright at PPP. We focus on our community student-athletes, making us the premier clinic for athletic injuries. Long term, we are also looking at a more extensive development with a building that would fulfill a lifelong goal of mine. My original plan has been to have a one-stop-shop for health that includes: 

• primary care, 
• pediatric medicine and rehabilitation, and
• eventually an orthopedic urgent care facility. 

With intelligent business and financial decision-making, PPP will likely complete the new development in phases to continue on the same path. 

I would be remiss if I didn't mention our friends at the Institute of Clinical Excellence for their inspiration and education—and for giving me the confidence to know this model can be not only successful but should be the model for physical therapy going forward as our country approaches its most unhealthy state to date.

Driven by a mix of patient needs, personal and professional goals, and sheer perseverance, the group at PPP has pioneered a growing movement of creating hybrid business models 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 comment section below, and we will do our best to answer them.