Beyond Units & Visits: A Discussion with Dan Vapne, DPT (RTS Newsletter #15)

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Finding the Middle Ground in a Changing Healthcare System

With changes in administration and uncertainty around Medicare and Medicare Advantage plans, rehab therapy practice owners face crucial decisions about their future. Daniel highlights a key dilemma: align with larger health systems or payers?

"We're at a strange point where practitioners need to decide how to position themselves," Daniel explains. Historically, many have followed their referral sources into health system networks, but this can result in patients paying 8-10 times more for the same services due to institutional billing.

Daniel is working to find a middle ground where "patients can pay a fair rate" without hitting their deductible in the first five visits, while practitioners can run sustainable businesses without sacrificing quality care.

Moving Beyond Traditional KPIs

Many practice owners remain stuck in outdated metrics—units billed, visits per day, productivity percentages—while missing the bigger picture. As healthcare shifts toward value-based care, Daniel suggests practices need to demonstrate their impact on reducing downstream costs.

"It's no longer about minutiae like units per clinician," he notes. "It's about showing how your service limits downstream costs." This explains the industry trend toward consolidation and verticalization, as larger groups can better demonstrate value to employers and payers.

Patient Retention: The Overlooked Gold Mine

One of Daniel's most powerful strategies was remarkably simple: reactivating past patients. When he joined his practice, rather than pouring money into marketing, he had clinicians reach out to former patients.

"We were full within six weeks," he shares. "It's so much easier to reactivate a person that already has a warm tie with you than creating a new one."

This approach aligns with research showing that acquiring a new customer costs five times more than retaining an existing one. Yet surprisingly few practices systematically engage former patients.

Creating Better Patient and Staff Experiences

Daniel emphasizes the importance of environment in creating positive experiences for both patients and staff:

"Outpatient physical therapists pick that place because they didn't want to work in scrubs," he explains. Everything from ceiling height to wall colors can differentiate a practice from the clinical hospital feel that many patients and therapists want to avoid.

For new hires, Daniel focuses on reducing friction in administrative tasks through technology, allowing clinicians to focus on the skills they actually went to school for. His practice is developing clinical pathway programs that teach soft skills not covered in school—how to present yourself to patients, verbiage to use or avoid, and how different generations prefer to experience PT.

New Best Practices for 2025

Daniel offers several forward-thinking approaches for practice owners:

1. Invest in referral relationships beyond clinical discussions: Talk to your referral sources about business challenges like payer negotiations. "These MDs are savvy—they're figuring out how to make it work in healthcare in 2025."

2. Focus on the critical first five visits: "If a patient doesn't complete their first five visits, the drop-off rate is much higher," Daniel explains. Creating exceptional experiences in those initial interactions builds trust and dramatically increases completion of plans of care.

3. Explore unconventional partnerships: "Think about people that typically don't send to physical therapy—general surgery, oral facial surgeons," Daniel suggests. Creating pilots with these specialists can feed your clinic "three to five fold" while improving patient outcomes.

4. Consider embedding PTs in referring practices: Rather than waiting for referrals to come to you, consider placing a physical therapist in busy primary care offices to evaluate patients on the spot.

Looking Ahead

As we navigate the changing healthcare landscape, practices that think strategically about their place in the ecosystem will thrive. Whether it's demonstrating value to payers, creating exceptional patient experiences, or building stronger relationships with referral partners, innovation doesn't have to mean radical transformation—sometimes it's just applying smart business principles to clinical practice.

See you in two weeks!

-Eddie

P.S. Want to streamline your business, improve margins, boost patient outcomes, and energize your staff? Reply to this email or click the link below to schedule a time to chat.

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