RE: Re: Compensation question

January 20, 2012

It is great to see this conversation taking place as I think we all need to look at how we make this work. Rehab has to be a service that can survive and make money or our patients will be the ones who suffer the most. What I would like to know is, who is doing what for all of the percentages discussed? Overhead for a general practice includes building, gas/electric, maintenance etc. It also includes the support staff (receptionist, techs), the equipment gets covered with regular service & equipment fees and inventory takes care of itself.

I am going to be doing my own mobile rehab practice where I come into pre-existing hospitals and offer my services to that hospital's patients. I will make the appointments, do the appointments, bill the client & take payment from them, write the records and fax them to the practice for their own records. I am bringing in my own everything - computer, laser, E-stim, exercise equipment, handouts, brochures, camera, etc. I will also be providing my own insurance, licensing, etc. I will not use a tech initially. Once I have an established clientele and get busy then yes, I will take on an employee or two to help with the administrative side of things & treatments. All I'm using at that practice is the room they provide me and nothing else. They in turn will recieve a portion of the charges I take in. With this approach there is absolutely no way I can

survive if I only take in 20-30% of the charges. Obviously, I want the hospitals to make money so that they want me to keep coming back and providing rehab to their patients but, I also have to be able to cover all my costs, time & labor. 50% to me does not seem like it is asking too much at all for someone who is a one person show. 60% sounds even better. I don't think 75% is reasonable at all on the hospital's end but I wouldn't be ashamed to take it if that's what they offered me. They are merely providing a room that is already in existence and was not created for me. The get 100% profit and any money I give them. Yes, it likely won't be a huge amount regardless of the percentage but it's better than $0. Providing complete care, like rehab and alternative medicine (acupuncture, chiropractics), will also increase the client-hospital bond and potentially keep the high-end clients that are already

there and likely attract others. If you bring a new client to a practice for rehab and they enjoy the facility they very well may go back there for everything else. The hospital makes 100% from those cases and I think we have to consider that as well.

That's my 2 cents...we'll see hoe it works out for me in the long run

Jen Remensperger, DVM,, CCRT - candidate

To: VetRehab Sent: Friday, January 20, 2012 10:17 AMSubject: Re: Compensation question

To help clarify a little. I will recap my actual role in all of this. This a general practice and have been in business for 15+ years. I believe building, land, etc is paid for. They built some onto their existing building (a very small room for rehab really) and have purchased an UWTM. They already had the laser and have been using it. They have a vet who is going through the UT training for CCRP, but is not experienced, or finished with the courses yet. I am the only PT CCRP in the area. I am offering my knowledge and expertise and am consulting with them free of charge to get this started. I am creating forms, handouts, etc for them. I am an independent contractor and have to pay my own liability insurance, taxes, health insurance, etc. I will have access to the UWTM, but a tech will probably run the equipment. The answers I have been getting have been all over the board. Some that have emailed off list have said the 50/50 is good, or that

60/40 and even 70/30 if I bring my own patients. I initially was going to bring my own patients in, schedule them, do my own billing, not use any tech. But now, we are negotiating more along the lines of the same percentage of compensation for all patients and I get use of tech and equipment. I don't see how it is possible to make a living off of anything less than 50%. It is a time intensive and does not bring in much. Total of probably $70 an hour and this does not include any paperwork time, etc. If I was only compensated at 21% there would be no way it could work. I may as well work as a veterinary technician. I have a masters degree in physical therapy and bring in all that expertise as well as extensive experience working with animals. That being said, it obviously has to work for the clinic as well and if they are losing money, it will not work. This is something they did not investigate fully before taking on this venture. From PTs that have

responded it seems like 50/50 or 60/40 is fair and what most are getting. Many of the vets that have responded are responding that a much lower percent is reasonable.This has been a very interesting discussion and I look forward to hearing more input.> > > Given the aforementioned, at 50% you are being overcompensated.> > 60% is incomprehensible (or possibly trying to kick start it??). This may> > bode poorly for the long term survivability of the service in that practice> > because as soon as the owners realize they are actually subsidizing the> > service (or have had their fill of subsidizing it should their attempt at> > kick starting

it be unsuccessful), they may abandon Rehab.> >> > > This may well be true. However, it is hard to see how an independent> contractor (who must provide for his/her own benefits, SS taxes etc) could> make a living at much less than 50% , since the average rehab appointment> brings in what, $70 an hour? $150 maybe for first (evaluation) visits -- or> what are you guys charging?? (Our evaluation is $115 but an average hour> appointment runs around $60) 21% of $60 isn't going to pay the bills. In> contrast, the GP who is paid at 21% ( plus benefits) can expect to gross> $200 to $500 an hour, thus rendering the 21% a pretty reasonable salary.> > It's my understanding that 50% of gross is standard percentage for> acupuncture vets (of course they don't have any expensive equipement to> cover).> > This question-- of how an incredibly labor

and equipment intensive but non> lucrative profession can pay for itself -- vexes me a lot and I would love> to hear what others think.> > Pamela Mueller PhD DVM> > > > > >> >> > > >>

January 20, 2012

ï»¿

Great discussion,

I have been working with a PT for the last 3 years. We are in a small community but do draw from a much larger area.

He is taking between the 50-60%. He brings some of his own patients that occasionally convert to my general practice which is a bonus.

He brings his own equipment but I provide all of the billing services and appt scheduling for him. He mostly does not need an assistant. We do not have UWTM but provide Pulse magnetic, laser, US, acupuncture, manual therapy, etc.

He also has a very busy human practice where he makes much more money as he delegates and can have multiple patients receiving treatment at the same time which does not happen in a veterinary setting.

He only comes in weekends but is booked up with a waiting list. It works for us but it is not his primary source of income. It works for me because I have not made a huge investment into equipment that I have to pay off.

I dream of having an UWTM but I keep thinking back to my instructors talking about that sexy piece. ly digital xrays are first on the list. We get fantastic results from the manual therapy that PT's bring to the table that I don't have time to learn.

Just my 2 cents

Calverley DVM CCRT

Re: Compensation question

To help clarify a little. I will recap my actual role in all of this. This a general practice and have been in business for 15+ years. I believe building, land, etc is paid for. They built some onto their existing building (a very small room for rehab really) and have purchased an UWTM. They already had the laser and have been using it. They have a vet who is going through the UT training for CCRP, but is not experienced, or finished with the courses yet. I am the only PT CCRP in the area. I am offering my knowledge and expertise and am consulting with them free of charge to get this started. I am creating forms, handouts, etc for them. I am an independent contractor and have to pay my own liability insurance, taxes, health insurance, etc. I will have access to the UWTM, but a tech will probably run the equipment. The answers I have been getting have been all over the board. Some that have emailed off list have said the 50/50 is good, or that 60/40 and even 70/30 if I bring my own patients. I initially was going to bring my own patients in, schedule them, do my own billing, not use any tech. But now, we are negotiating more along the lines of the same percentage of compensation for all patients and I get use of tech and equipment. I don't see how it is possible to make a living off of anything less than 50%. It is a time intensive and does not bring in much. Total of probably $70 an hour and this does not include any paperwork time, etc. If I was only compensated at 21% there would be no way it could work. I may as well work as a veterinary technician. I have a masters degree in physical therapy and bring in all that expertise as well as extensive experience working with animals. That being said, it obviously has to work for the clinic as well and if they are losing money, it will not work. This is something they did not investigate fully before taking on this venture. From PTs that have responded it seems like 50/50 or 60/40 is fair and what most are getting. Many of the vets that have responded are responding that a much lower percent is reasonable.This has been a very interesting discussion and I look forward to hearing more input.> > > Given the aforementioned, at 50% you are being overcompensated.> > 60% is incomprehensible (or possibly trying to kick start it??). This may> > bode poorly for the long term survivability of the service in that practice> > because as soon as the owners realize they are actually subsidizing the> > service (or have had their fill of subsidizing it should their attempt at> > kick starting it be unsuccessful), they may abandon Rehab.> >> > > This may well be true. However, it is hard to see how an independent> contractor (who must provide for his/her own benefits, SS taxes etc) could> make a living at much less than 50% , since the average rehab appointment> brings in what, $70 an hour? $150 maybe for first (evaluation) visits -- or> what are you guys charging?? (Our evaluation is $115 but an average hour> appointment runs around $60) 21% of $60 isn't going to pay the bills. In> contrast, the GP who is paid at 21% ( plus benefits) can expect to gross> $200 to $500 an hour, thus rendering the 21% a pretty reasonable salary.> > It's my understanding that 50% of gross is standard percentage for> acupuncture vets (of course they don't have any expensive equipement to> cover).> > This question-- of how an incredibly labor and equipment intensive but non> lucrative profession can pay for itself -- vexes me a lot and I would love> to hear what others think.> > Pamela Mueller PhD DVM> > > > > >> >> > > >>

January 21, 2012

I absolutely agree about the manual therapy that the PT brings to this situation. That is why I did not invest in an UWTM and instead collaborated with a PT. My profit margin is very skinny on rehab but I am am definitely not subsidizing it and it builds my practice and I have fun.

You may be entering into a situation where you skills are not going to be understood, much less appreciated,

Good luck going forward.

DVM CCRT

Re: Compensation question

I do understand that the business must be profitable, or it is obviously not worth entering into. But I strongly feel that all of the treatments should not be designated to a technician. While I am sure there are many well trained technicians that can perform skilled treatments, these dogs benefit greatly from the skills that a manually trained physical therapist can bring to the table. I have seen impressive results from utilizing manual treatments that I have learned through years of schooling and continuing education in the human physical therapy world. Things that a technician even with a lot of experience would not effectively be able to perform. That, and in addition, there is a significant amount of ongoing evaluation that should be performed regularly through the treatment sessions. I can outline a treatment plan that a technician can perform consisting of exercise progression, following a laser protocol, UWTM protocol, but when I do a treatment session, I am constantly changing my plan of care as I see how the patient is responding. I feel quite strongly about quality of care and the providing the patients with the best possible treatment. That being said, there needs to be a way to make it work financially too. These very expensive pieces of equipment that are so well marketed and advertised are part of the problem I think. Everyone wants an UWTM, but at $50,000, and with these class IV lasers that everyone seems to think they need at another $20,000, this is probably where most of our profit margin is going. The reps for these pieces of equipment must be doing very, very well, and are quite good at their job to make everyone feel that they need one. Very effective therapy can be performed and is performed with just the use of skilled hands and a few inexpensive pieces of exercise equipment. Physical therapy is first and foremost a hands-on profession and the use of equipment and gadgets is just bonus. That is my two cents. Day, MPT, CCRP-pending> > Given the aforementioned, at 50% you are being overcompensated. 60% is incomprehensible (or possibly trying to kick start it??). This may bode poorly for the long term survivability of the service in that practice because as soon as the owners realize they are actually subsidizing the service (or have had their fill of subsidizing it should their attempt at kick starting it be unsuccessful), they may abandon Rehab. > > > > > > This may well be true. However, it is hard to see how an independent contractor (who must provide for his/her own benefits, SS taxes etc) could make a living at much less than 50% , since the average rehab appointment brings in what, $70 an hour? $150 maybe for first (evaluation) visits -- or what are you guys charging?? (Our evaluation is $115 but an average hour appointment runs around $60) 21% of $60 isn't going to pay the bills. In contrast, the GP who is paid at 21% ( plus benefits) can expect to gross $200 to $500 an hour, thus rendering the 21% a pretty reasonable salary.> > > > It's my understanding that 50% of gross is standard percentage for acupuncture vets (of course they don't have any expensive equipement to cover).> > > > This question-- of how an incredibly labor and equipment intensive but non lucrative profession can pay for itself -- vexes me a lot and I would love to hear what others think.> > > > Pamela Mueller PhD DVM> > > > > > > > > > > > > > > >>

January 22, 2012

As a PT I have worked in many departments over the years and now I am a small business owner in my canine rehab business. In large institutions the relationship between employee output and profit, and the added factor of third party payors, gets skewed but the principles are (or should be) the same. This is a risk/reward relationship and both parties should be incentivized to continue. In most PT depts. There are 2 groups – the producers and the sitters – all with great credentials after their names and sometimes the more letters, the LESS productive they are! Unfortunately this breeds resentment and incentivizes mediocrity…the “why should I work so hard for the same pay response.” My point is, it must be beneficial for both parties. So I am an advocate for either percentages (whatever is fair depending on financial risk of the business owner and time/productivity of the service provider) or a low base pay and an incentive or bonus program on top based on revenue produced…In other words – the harder you work – the more you make. In a small business the last person to get paid is the owner, and in bad times the owner may not take home a check at all. As a PT I agree that we bring a skill set to the table that cannot be taught in a certification class or continuing ed, but is a result of years of schooling and practice….But, if we are to be invested in and gambled on, we must produce as well, not just results but financially as well. These are tough times for everyone. I have always, and still do , maintain hours in a human job to supplement my income and benefits. There are many opportunities to do so – I probably get 2 recruiter calls a week. So rather than go for the whole enchilada, why not start small and prove yourselves to each other. Then you can expand as the need grows and you both benefit. Sorry if this is “soap boxy” but just a few thoughts I had. Pavlakos, PT, CCRP From: VetRehab [mailto:VetRehab ] On Behalf Of waghabptSent: Saturday, January 21, 2012 9:27 AMTo: VetRehab Subject: Re: Compensation question I do understand that the business must be profitable, or it is obviously not worth entering into. But I strongly feel that all of the treatments should not be designated to a technician. While I am sure there are many well trained technicians that can perform skilled treatments, these dogs benefit greatly from the skills that a manually trained physical therapist can bring to the table. I have seen impressive results from utilizing manual treatments that I have learned through years of schooling and continuing education in the human physical therapy world. Things that a technician even with a lot of experience would not effectively be able to perform. That, and in addition, there is a significant amount of ongoing evaluation that should be performed regularly through the treatment sessions. I can outline a treatment plan that a technician can perform consisting of exercise progression, following a laser protocol, UWTM protocol, but when I do a treatment session, I am constantly changing my plan of care as I see how the patient is responding. I feel quite strongly about quality of care and the providing the patients with the best possible treatment. That being said, there needs to be a way to make it work financially too. These very expensive pieces of equipment that are so well marketed and advertised are part of the problem I think. Everyone wants an UWTM, but at $50,000, and with these class IV lasers that everyone seems to think they need at another $20,000, this is probably where most of our profit margin is going. The reps for these pieces of equipment must be doing very, very well, and are quite good at their job to make everyone feel that they need one. Very effective therapy can be performed and is performed with just the use of skilled hands and a few inexpensive pieces of exercise equipment. Physical therapy is first and foremost a hands-on profession and the use of equipment and gadgets is just bonus. That is my two cents. Day, MPT, CCRP-pending> > Given the aforementioned, at 50% you are being overcompensated. 60% is incomprehensible (or possibly trying to kick start it??). This may bode poorly for the long term survivability of the service in that practice because as soon as the owners realize they are actually subsidizing the service (or have had their fill of subsidizing it should their attempt at kick starting it be unsuccessful), they may abandon Rehab. > > > > > > This may well be true. However, it is hard to see how an independent contractor (who must provide for his/her own benefits, SS taxes etc) could make a living at much less than 50% , since the average rehab appointment brings in what, $70 an hour? $150 maybe for first (evaluation) visits -- or what are you guys charging?? (Our evaluation is $115 but an average hour appointment runs around $60) 21% of $60 isn't going to pay the bills. In contrast, the GP who is paid at 21% ( plus benefits) can expect to gross $200 to $500 an hour, thus rendering the 21% a pretty reasonable salary.> > > > It's my understanding that 50% of gross is standard percentage for acupuncture vets (of course they don't have any expensive equipement to cover).> > > > This question-- of how an incredibly labor and equipment intensive but non lucrative profession can pay for itself -- vexes me a lot and I would love to hear what others think.> > > > Pamela Mueller PhD DVM> > > > > > > > > > > > > > > >>

January 22, 2012

I have been reading this discussion with considerable interest and have enjoyed

the comments of all, however, I must admit some of the statements have been

disturbing. I wish to embolden all, to provide comments and opinions, in a

professional and respectful manner for the benefit our discipline of

rehabilitation and the advancement of all parties involved.

This a very unique discipline in veterinary medicine, in that for the first

time, a profession, Physical Therapists, not formally educated in veterinary

medicine, are an integral part in the advancement of the discipline. I

absolutely agree with Jeannie, in that PTs do bring a set of skills to

veterinary rehabilitation that are not acquired in the formal veterinary

education process or certification courses. Without PTs, this discipline that

we all share a passion for, would not be what it is today.

’s comments, in my opinion, degrade the role of the trained and experienced

veterinary technician in veterinary rehabilitation and ignore how vital the

technician has become in the delivery of veterinary health care. Veterinary

rehabilitation is more than physical therapy and more than possessing expertise

in a certain group of manual skills.

The DVMs around the country like Pam, ph and myself, are not practicing

physical therapy but rather physical medicine and rehabilitation employing many

modalities to assist in managing pain and rehabilitating patients. The

experienced veterinary technician not only plays a vital role in PM & R but has

become a necessity as they are in other veterinary disciplines. I am very proud

of my certified veterinary technician, Kari Koudelka, that has developed

considerable expertise in veterinary rehabilitation. She has considerable

manual skills in the palpation of muscles, joints and the localization of pain.

Sessum’s efforts at Texas A & M have propelled rehabilitation to recently

become a clinical service rather than just an underwater treadmill for postop

orthopedic cases. ’s frequent lectures provide education for the

veterinary profession on the benefits of rehabilitation and aide to further the

understanding our discipline.

I am of the opinion, veterinary physical medicine and rehabilitation can provide

the patient the best outcome if delivered by an experienced team of DVMs,

certified RVTs and certified PTs. I am of the opinion, a successful financial

business model does not currently exists within this discipline to promote that

team. My fortunate success in primary care veterinary medicine enabled my

entrance into this discipline, and to some degree, still enables my continuance.

I cannot compete with the financial packages provided PTs in the human medical

market. Current and previous discussions of PTs seem to indicate, that it is

their passion for veterinary rehabilitation and compassion for the veterinary

patient that motivate their participation rather than the financial reward. My

wish is to see and help this change.

It is indeed our advantage to conduct this discussion group with a team concept

as well, by encouraging participation of all, to better assist the veterinary

rehabilitation patient. Constructive criticism and professional questioning

must remain part of these discussions. Opinions on treatments, therapies and

conditions are desired in this still mostly anecdotal driven discipline. The

establishment of the American College of Veterinary Sports Medicine and

Rehabilitation may eventually serve as an entity to provide evidence but

currently it is very weighted towards sports medicine. Until such time, groups

such as this must grow for the benefit of the discipline and that will not be

possible by questioning any of the professions’ skills or importance to

veterinary rehabilitation.

Rick Wall, DVM

Certified Canine Rehabilitation Practitioner

Diplomate, American Academy of Pain Management

Certified Myofascial Trigger Point Therapist

Center for Veterinary Pain Management and Rehabilitation

The Woodlands, TX

www.vetrehabcenter.com

January 22, 2012

Hi ph,

I am truly appreciating this whole conversation, thanks for your input. I am still in the process of certifying, so excuse me for jumping in here.

I could post many articles that are randomized clinical trials demonstrating the efficacy of manual therapy over modalities in the human population. Attached is one article on ex vs manual therapy. Admittedly, this is not how most of us would treat (ex alone vs manual therapy alone), most PT's do both.

Attached is an RCT of manual therapy vs ex in hip OA, along with a CAT (Critically Appraised Topic) review.

Sheri Morrow, PT, DPT, OCS, FAAOMPTWorking on Canine Rehab Cert

To: VetRehab Sent: Sunday, January 22, 2012 6:23:38 AMSubject: Re: Compensation question

,

I find it easier to respond in the fashion of direct response to an individual statement. I know some people do not care for this type of response so my apologies in advance:

> I do understand that the business must be profitable, or it is obviously not worth entering into. But I strongly feel that all of the treatments should not be designated to a technician. While I am sure there are many well trained technicians that can perform skilled treatments,

My personal experience over the last 30 years with trained technicians in the ability to learn and execute veterinary medicine, Rehab, cross sectional imaging and radiation therapy has been nothing less than stellar.

>these dogs benefit greatly from the skills that a manually trained physical therapist can bring to the table. I have seen impressive results from utilizing manual treatments that I have learned through years of schooling and continuing education in the human physical therapy world.

Can you give some veterinary case study examples (or list) of what types of hands on treatments you are referring to?

Things that a technician even with a lot of experience would not effectively be able to perform.

I completely support your regard for your qualifications, I hope you did not intend to demean the veterinary professions's invaluable profession of Technicians. Without them, the veterinary Team does not function and veterinary medicine would never be where it was today. As I said before, my experience with serious, qualified technicians has been nothing but stellar. Aside from their qualifications, they have incredible resilience in truly caring for our veterinary patients. They are a unique group of people whom I respect and have learned to trust throughout my career. Many of them have worked hard to further their education and qualifications as the field of veterinary medicine morphs into specialization.

>That, and in addition, there is a significant amount of ongoing evaluation that should be performed regularly through the treatment sessions. I can outline a treatment plan that a technician can perform consisting of exercise progression, following a laser protocol, UWTM protocol, but when I do a treatment session, I am constantly changing my plan of care as I see how the patient is responding. I feel quite strongly about quality of care and the providing the patients with the best possible treatment.

Excellent, as I imagine most of us care about quality in this group. Your statement supports the tactical allocation of human resources of the veterinary health care delivery team, of which the PT should be a part of.

> That being said, there needs to be a way to make it work financially too. These very expensive pieces of equipment that are so well marketed and advertised are part of the problem I think.

Very, very true and I know of several recent, first hand examples of precisely what you are referring to. Hence, the poorly though out entry into the delivery of rehabilitation services on the part of many veterinary practices, including referral centers.

>Everyone wants an UWTM, but at $50,000, and with these class IV lasers that everyone seems to think they need at another $20,000, this is probably where most of our profit margin is going.

By way of introduction: speaking as an owner of several successful veterinary practices through the last 30 years, the founding and managing member of the Veterinary MRI and RT Center of NJ (3 million dollars worth of equipment), someone who has been doing veterinary rehabilitation for the last 10 years and as an individual who has performed exhaustive financial analysis for several practices, I disagree with your conclusion that this is where "our profit margin is going".

> The reps for these pieces of equipment must be doing very, very well,

Not entirely accurate. If you speak to equipment reps on a personal level, they are having the time of it trying to make their investment in the super costly manufacturing process pay through the sale of equipment in the veterinary market. To illustrate, the veterinary market for Pfizer represents 14 hours of Pfizer's total gross billable sales for the year!

>and are quite good at their job to make everyone feel that they need one.

Agree 100%.

>Very effective therapy can be performed and is performed with just the use of skilled hands and a few inexpensive pieces of exercise equipment. Physical therapy is first and foremost a hands-on profession and the use of equipment and gadgets is just bonus. That is my two cents.

Can you share a few case studies of exactly the manualities you used that support the comment that the "equipment and gadgets is just a bonus".

ph

2 of 2 File(s)

Group Bravo-Final CAT.docx

Hoeksma.pdf

January 22, 2012

Hi Rick,

In 's defense, we have NOT had the same experience with PT Technicians

(which require no schooling at all, just on the job training). I have found it

rare to be able to trust in Techs at the clinics I have worked. I now work

without Techs and find my treatment outcomes are much better. PT Assistants

have more training, but still don't seem to have the " eye " for watching the

subtle cues in patients. Many a time I have had patients told " don't do that

exercise " because it hurts. When I instruct the patient...I teach them how to

do the exercises WITHOUT pain.

It is also NOT within most PT Assistants practice act that they can perform

manual therapy (except here in CO, and maybe a couple other states). Due to the

fact that they are not " evaluators " and are to follow the PT's plan. I

personally don't mobilize unless I have evaluated that joint/muscle/soft tissue.

I cannot speak to Vet Techs, as I have no experience with them, but I am sure

did not mean to degrade, she is just speaking from experience in our own

profession.

Sheri Morrow, PT, DPT, OCS, FAAOMPT

Re: Re: Compensation question