We are tackling physical therapy's brand crisis head-on. From pop culture portrayals (yes, we're talking about that "Land Man" stripper scene) to CMS policy that treats PT as "substitute spend" for MSK digital health solutions, the evidence is clear: we have a public perception problem. We explore why professional identity matters, how specialization creates internal dissonance, and why evidence-based practice sometimes conflicts with how we want to be perceived. We talk about the importance of communicating our actual skill set, and why we need to stop being terrible at telling people what we do and why it matters. Why this matters right now: Value-based care and episode/bundled payment models are framed as the future: fewer visits, higher impact per encounter. But remaining the PT who serves as the primary provider for managing their patients' longitudinal spend. In those models, PTs “win” by preventing downstream costs (imaging, opioids, injections, surgery, prolonged disability). But that only works if we can show it. Key topics: professional branding, healthcare policy, payment models, public perception, advocacy, and the path forward for elevating the profession. Mentioned in the episode: <a href="https://read.amazon.com/kp/embed?linkCode=kpd&ref_=k4w_oembed_BQlFux8mQZjBCY&asin=042528462X&tag=danaprommelst-20&amazonDeviceType=A2CLFWBIMVSE9N&from=Bookcard&preview=inline" rel="noopener noreferrer" target="_blank">Nassim Taleb | "Skin in the Game" Hidden Asymmetries in Daily Life</a> <a href="https://hscrc.maryland.gov/Pages/Episode-Quality-Improvement-Program.aspx" rel="noopener noreferrer" target="_blank">Episode Quality Improvement Plan (EQIP)</a> <a href="https://www.cms.gov/priorities/innovation/innovation-models/access" rel="noopener noreferrer" target="_blank">ACCESS Model</a> <a href="https://www.cms.gov/priorities/innovation/access-technical-frequently-asked-questions" rel="noopener noreferrer" target="_blank">ACCESS Technical FAQs</a>

We are tackling physical therapy's brand crisis head-on. From pop culture portrayals (yes, we're talking about that "Land Man" stripper scene) to CMS policy that treats PT as "substitute spend" for MSK digital health solutions, the evidence is clear: we have a public perception problem.We explore why professional identity matters, how specialization creates internal dissonance, and why evidence-based practice sometimes conflicts with how we want to be perceived. We talk about the importance of communicating our actual skill set, and why we need to stop being terrible at telling people what we do and why it matters.Why this matters right now:Value-based care and episode/bundled payment models are framed as the future: fewer visits, higher impact per encounter. But remaining the PT who serves as the primary provider for managing their patients' longitudinal spend. In those models, PTs “win” by preventing downstream costs (imaging, opioids, injections, surgery, prolonged disability). But that only works if we can show it.Key topics: professional branding, healthcare policy, payment models, public perception, advocacy, and the path forward for elevating the profession.Mentioned in the episode:Nassim Taleb | "Skin in the Game" Hidden Asymmetries in Daily LifeEpisode Quality Improvement Plan (EQIP)ACCESS ModelACCESS Technical FAQs

Future-Proof PT

Episode 26: The PT Identity Project | The Problems Causing PTs Patients, Pay, and Progress

<h2>Explore the intersection of evidence-based practice, healthcare economics, and pseudoscience in rehab, plus practical strategies for clinicians who want to do better without going broke</h2> <h4>Is your physical therapy practice built on evidence, or just what pays? In this episode, we sit down with Paul Ingraham, science writer and founder of<a href="https://www.painscience.com/" rel="noopener noreferrer" target="_blank" style="color: rgb(44, 44, 43);"> </a><a href="https://www.painscience.com/" rel="noopener noreferrer" target="_blank" style="color: inherit;">painscience.com</a>, to challenge the line between evidence-based practice and pseudoscience in rehab. </h4><h4> </h4><h4>We explore why manual therapy needs a serious reframe, how economic pressures push clinicians toward uncertain treatments, and whether honest patient communication can coexist with running a profitable practice. </h4><h4> </h4><h4>Paul doesn't hold back: he argues that most PTs operate in a gray zone where research is weak, outcomes are unpredictable, and informed consent is virtually nonexistent. You might not agree with everything he says—but you'll hopefully question what you do and why you do it. Maybe you'll look into the scientific evidence behind your current common care plans.</h4> <h3>Topics include:</h3> <ul><li>Evidence-based practice vs. pseudoscience: where's the line? </li><li>Why manual therapy should be reframed as an experimental intervention in many cases</li><li>The role of informed consent in uncertain treatments (not unlike what we hope physicians do when prescribing a treatment plan whose results are uncertain)</li><li>How value-based care incentives better outcomes and discourages pseudoscience</li><li>The economics of PT: balancing integrity with income</li><li>Why strength training and exercise therapy are still key ingredients in PT treatment plans</li><li>Teaching intellectual humility and critical thinking in healthcare education</li><li>Practical strategies for clinicians who want to practice honestly without going broke</li></ul> Paul Ingraham is a Vancouver science writer and a former Registered Massage Therapist, a profession he left in 2010 over concerns about its pseudoscientific nonsense. Since then, he has been publishing PainScience.com full-time, a website about the science of pain and injury, known for its rich footnotes and anti-quackery activism. The site offers hundreds of articles and ten books, all based on a huge bibliography. Paul was an active amateur athlete for decades, especially in ultimate (the Frisbee sport), but has now retired from competitive intensity and “just” does a lot of running and cycling, despite grappling with his own chronic pain/illness problems since 2015. <h3>Here's where you can find Paul! </h3> <a href="https://www.painscience.com/subscribe" rel="noopener noreferrer" target="_blank" style="color: rgb(17, 85, 204);">https://www.painscience.com/subscribe</a> [free newsletter]<a href="https://www.painscience.com/ebooks" rel="noopener noreferrer" target="_blank" style="color: rgb(17, 85, 204);">https://www.painscience.com/ebooks</a><a href="https://www.facebook.com/painscience" rel="noopener noreferrer" target="_blank" style="color: rgb(17, 85, 204);">https://www.facebook.com/painscience</a><a href="https://www.threads.net/@painsci" rel="noopener noreferrer" target="_blank" style="color: rgb(17, 85, 204);">https://www.threads.net/@painsci</a><a href="https://bsky.app/profile/painsci.bsky.social" rel="noopener noreferrer" target="_blank" style="color: rgb(17, 85, 204);">https://bsky.app/profile/painsci.bsky.social</a><a href="https://x.com/painsci" rel="noopener noreferrer" target="_blank" style="color: rgb(17, 85, 204);">https://x.com/painsci</a> Sign up for <a href="https://future-proof-pt.beehiiv.com/subscribe" rel="noopener noreferrer" target="_blank">our newsletter</a>, where Alex shares weekly literature summaries and links relevant to therapy. Sign up for our sister publication, authored by Dana, <a href="https://www.timelessautonomy.com/subscribe" rel="noopener noreferrer" target="_blank">Timeless Autonomy.</a> Dana covers weekly health policy insights and tips on career growth for clinicians. <a href="https://www.youtube.com/@FutureProofPT" rel="noopener noreferrer" target="_blank">Subscribe to our YouTube Channel</a>

Explore the intersection of evidence-based practice, healthcare economics, and pseudoscience in rehab, plus practical strategies for clinicians who want to do better without going brokeIs your physical therapy practice built on evidence, or just what pays? In this episode, we sit down with Paul Ingraham, science writer and founder of painscience.com, to challenge the line between evidence-based practice and pseudoscience in rehab. We explore why manual therapy needs a serious reframe, how economic pressures push clinicians toward uncertain treatments, and whether honest patient communication can coexist with running a profitable practice. Paul doesn't hold back: he argues that most PTs operate in a gray zone where research is weak, outcomes are unpredictable, and informed consent is virtually nonexistent. You might not agree with everything he says—but you'll hopefully question what you do and why you do it. Maybe you'll look into the scientific evidence behind your current common care plans.Topics include:Evidence-based practice vs. pseudoscience: where's the line? Why manual therapy should be reframed as an experimental intervention in many casesThe role of informed consent in uncertain treatments (not unlike what we hope physicians do when prescribing a treatment plan whose results are uncertain)How value-based care incentives better outcomes and discourages pseudoscienceThe economics of PT: balancing integrity with incomeWhy strength training and exercise therapy are still key ingredients in PT treatment plansTeaching intellectual humility and critical thinking in healthcare educationPractical strategies for clinicians who want to practice honestly without going brokePaul Ingraham is a Vancouver science writer and a former Registered Massage Therapist, a profession he left in 2010 over concerns about its pseudoscientific nonsense. Since then, he has been publishing PainScience.com full-time, a website about the science of pain and injury, known for its rich footnotes and anti-quackery activism. The site offers hundreds of articles and ten books, all based on a huge bibliography. Paul was an active amateur athlete for decades, especially in ultimate (the Frisbee sport), but has now retired from competitive intensity and “just” does a lot of running and cycling, despite grappling with his own chronic pain/illness problems since 2015.Here's where you can find Paul! https://www.painscience.com/subscribe [free newsletter]https://www.painscience.com/ebookshttps://www.facebook.com/painsciencehttps://www.threads.net/@painscihttps://bsky.app/profile/painsci.bsky.socialhttps://x.com/painsciSign up for our newsletter, where Alex shares weekly literature summaries and links relevant to therapy.Sign up for our sister publication, authored by Dana, Timeless Autonomy. Dana covers weekly health policy insights and tips on career growth for clinicians.Subscribe to our YouTube Channel

Episode 25 | Pain Science, Manual Therapy, and the Economics of PT with Paul Ingraham

<h2>How crazy is it that proven interventions in healthcare take so long to spread, even when they show clear economic and clinical benefits?</h2> Innovation in healthcare is painfully difficult to get into widespread adoption, even after proven successful. This episode discusses the results of a nine year-old study at Geisinger Health System on a PT-First "bundle" that's just as relevant today. But the disturbing part about it is it's not common to find a structure like this one, where a shift in incentives changed the care pathway for patients.<h4> </h4><h4>Here are major takeaways from the episode:</h4> <ul><li>PT-First Models Are Economically Proven: When properly structured with the right incentives, physical therapy as a first-line intervention for musculoskeletal conditions reduces costs and improves outcomes. This has been demonstrated at scale.</li><li>Risk Stratification Is Your Friend: Implementing tools that identify high-risk patients (for joint replacement, high utilization, poor psychosocial factors) helps you target PT-first interventions where they'll have the most impact.</li><li>Understand the Regulatory Landscape: Know the difference between what commercial plans can do versus Medicare constraints. This helps you understand why some innovations work in certain settings but not others, and where to focus your advocacy efforts. And don't forget to explore CMS Innovation Center Models! They are a key opportunity for Medicare to offer flexibilities outside of statute and PTs and OTs can 100% benefit from this!</li><li>Patient Incentives Matter as Much as Provider Incentives: Waiving or reducing copays for PT-first approaches changes patient behavior. Consider how your practice can work with payers to create these incentives.</li><li>Think Beyond Traditional Treatment: The food-as-medicine example challenges PTs to consider all drivers of health outcomes, not just manual therapy and exercise. What are the non-medical factors affecting your patients' success?</li><li>Health Systems with Their Own Plans Are Innovation Leaders: These integrated systems have the most flexibility and motivation to try new models. Consider targeting these organizations for partnerships or employment.</li><li>The "Why Not Everywhere?" Question: Just because something works doesn't mean it spreads quickly in healthcare. Understanding the barriers to adoption (regulatory constraints, organizational inertia, population mix) helps you be more strategic about implementing change.</li><li>Keep It Simple: As Alex notes - "kiss things" "(keep it simple, stupid"). The most successful innovations have clear, straightforward incentive structures that are easy for patients and providers to understand and act on.</li></ul> Find the article we discuss in this episode on a <a href="https://www.dovepress.com/impact-of-a-value-based-insurance-design-for-physical-therapy-to-treat-peer-reviewed-fulltext-article-JPR" rel="noopener noreferrer" target="_blank">PT-First payment model here.</a> Sign up for <a href="https://future-proof-pt.beehiiv.com/subscribe" rel="noopener noreferrer" target="_blank">our newsletter</a>, where Alex shares weekly literature summaries and links relevant to therapy. Sign up for our sister publication, authored by Dana, <a href="https://www.timelessautonomy.com/subscribe" rel="noopener noreferrer" target="_blank">Timeless Autonomy.</a> Dana covers weekly health policy insights and tips on career growth for clinicians. <a href="https://www.youtube.com/@FutureProofPT" rel="noopener noreferrer" target="_blank">Subscribe to our YouTube Channel</a> We also discussed in this episode the<a href="https://clinicaltrials.gov/study/NCT03718832?utm_source=copilot.com" rel="noopener noreferrer" target="_blank"> </a><a href="https://journals.sagepub.com/doi/10.1177/1559827620915425" rel="noopener noreferrer" target="_blank">"Geisinger Fresh Food Farmacy"</a> research. The pilot evaluated whether providing free, healthy food for the entire household of a food-insecure adult with Type 2 diabetes improves health outcomes and reduces healthcare use. In the podcast, Dana described what she recalled from memory. The study is found <a href="https://journals.sagepub.com/doi/10.1177/1559827620915425" rel="noopener noreferrer" target="_blank">here</a> but we can't find access to the article unlocked. Asking "Claude.AI," it said in this observational pilot study with 37 participants showed a 2.1% average drop in HbA1c levels and an 80% reduction in healthcare costs (from $240,000 to $48,000 per member per year). Additional research has recently been published put we can't locate it unlocked online. It looks like funding was from the 2018 Farm Bill.

How crazy is it that proven interventions in healthcare take so long to spread, even when they show clear economic and clinical benefits?Innovation in healthcare is painfully difficult to get into widespread adoption, even after proven successful.This episode discusses the results of a nine year-old study at Geisinger Health System on a PT-First "bundle" that's just as relevant today. But the disturbing part about it is it's not common to find a structure like this one, where a shift in incentives changed the care pathway for patients.Here are major takeaways from the episode:PT-First Models Are Economically Proven: When properly structured with the right incentives, physical therapy as a first-line intervention for musculoskeletal conditions reduces costs and improves outcomes. This has been demonstrated at scale.Risk Stratification Is Your Friend: Implementing tools that identify high-risk patients (for joint replacement, high utilization, poor psychosocial factors) helps you target PT-first interventions where they'll have the most impact.Understand the Regulatory Landscape: Know the difference between what commercial plans can do versus Medicare constraints. This helps you understand why some innovations work in certain settings but not others, and where to focus your advocacy efforts. And don't forget to explore CMS Innovation Center Models! They are a key opportunity for Medicare to offer flexibilities outside of statute and PTs and OTs can 100% benefit from this!Patient Incentives Matter as Much as Provider Incentives: Waiving or reducing copays for PT-first approaches changes patient behavior. Consider how your practice can work with payers to create these incentives.Think Beyond Traditional Treatment: The food-as-medicine example challenges PTs to consider all drivers of health outcomes, not just manual therapy and exercise. What are the non-medical factors affecting your patients' success?Health Systems with Their Own Plans Are Innovation Leaders: These integrated systems have the most flexibility and motivation to try new models. Consider targeting these organizations for partnerships or employment.The "Why Not Everywhere?" Question: Just because something works doesn't mean it spreads quickly in healthcare. Understanding the barriers to adoption (regulatory constraints, organizational inertia, population mix) helps you be more strategic about implementing change.Keep It Simple: As Alex notes - "kiss things" "(keep it simple, stupid"). The most successful innovations have clear, straightforward incentive structures that are easy for patients and providers to understand and act on.Find the article we discuss in this episode on a PT-First payment model here.Sign up for our newsletter, where Alex shares weekly literature summaries and links relevant to therapy.Sign up for our sister publication, authored by Dana, Timeless Autonomy. Dana covers weekly health policy insights and tips on career growth for clinicians.Subscribe to our YouTube ChannelWe also discussed in this episode the "Geisinger Fresh Food Farmacy" research. The pilot evaluated whether providing free, healthy food for the entire household of a food-insecure adult with Type 2 diabetes improves health outcomes and reduces healthcare use. In the podcast, Dana described what she recalled from memory. The study is found here but we can't find access to the article unlocked. Asking "Claude.AI," it said in this observational pilot study with 37 participants showed a 2.1% average drop in HbA1c levels and an 80% reduction in healthcare costs (from $240,000 to $48,000 per member per year). Additional research has recently been published put we can't locate it unlocked online. It looks like funding was from the 2018 Farm Bill.

Episode 24: The Economics of PT-First | Real Data on Cost Savings and Outcomes

Check out the <a href="https://youtu.be/148T540tyis?si=ZtcORILUOjT72eq8" rel="noopener noreferrer" target="_blank">You Tube version </a>of the podcast here. In this episode, Dana and Alex review the research articles Alex shared with Future Proof PT newsletter subscribers on January 4th, 2025, exploring what these studies reveal about healthcare transformation and what PTs can learn from them. They dive into the 4% screening tool study that dramatically improved outcomes by simply asking patients about their needs—a small intervention that created massive value. This leads to a bigger discussion: why are PTs starving on a shrinking fee-for-service diet when alternative models exist? The answer isn't that value-based care doesn't work—it's that most clinicians haven't tested it yet. We explore <a href="https://en.wikipedia.org/wiki/Richard_Feynman" rel="noopener noreferrer" target="_blank">Richard Feynman</a>'s principles of honest self-evaluation and scientific integrity, applying them to healthcare's reluctance to experiment. Alex shares that he recently reread The Alchemist by Paulo Coelho and that the story's message resonated with him differently this time around. He focuses on a key moment in the book where the shepherd's father gives him money to pursue his journey—not because the father expects his son to find treasure, but because the father himself never took that journey and wants something better for his son. Alex connects this to his own mindset as a parent: he wants his children to have opportunities and experiences he didn't have. This parallels the healthcare discussion because leaders and early adopters in value-based care are essentially doing the same thing—investing in a journey they may not fully benefit from themselves, but paving the way for the next generation of clinicians. The core insight Alex draws is that the treasure in The Alchemist wasn't the gold the shepherd was seeking, but the transformation and self-discovery he experienced along the way. Similarly, PTs who experiment with value-based care aren't just chasing financial models—they're undergoing professional transformation that makes them more valuable, regardless of whether any single model succeeds. This reframing positions the journey itself as the reward, and encourages clinicians to stop waiting for value-based care to be "proven" before they engage. Like the shepherd's father investing in his son's journey, today's leaders are investing in the profession's future. Other key points include: why you need a lottery ticket to win (you have to participate to benefit), how to A-B test your way into value-based care leadership, why leadership starts with one person taking action, and how systems thinking can help PTs break free from fee-for-service heuristics. Stop waiting for permission. Start leading from your clinic. The R&D phase of healthcare needs you. Key Topics in Episode 23: <ul><li>Reviewing research articles from Future Proof PT newsletter (Jan 4, 2025)</li><li>The 4% screening tool study and its implications for value creation</li><li>Why "it doesn't work" is invalid if you never tested it</li><li>The sheep analogy: surviving vs. thriving in healthcare</li><li>Richard Feynman's lesson on honest self-evaluation and scientific integrity</li><li>A-B testing your way into value-based care leadership</li><li>Why small experiments and lottery tickets matter in healthcare transformation</li><li>How the journey of experimentation IS the treasure (lessons from The Alchemist)</li><li>Systems thinking and recognizing our own fallibility in healthcare decision-making</li></ul> <a href="https://amzn.to/3YnACIf" rel="noopener noreferrer" target="_blank">"The Alchemist"</a>* <a href="https://amzn.to/49G6D4u" rel="noopener noreferrer" target="_blank">"Thinking Fast and Slow"</a>* <a href="https://amzn.to/3Z4Q24d" rel="noopener noreferrer" target="_blank">"The Almanac of Naval Ravikant"</a>* <a href="https://future-proof-pt.beehiiv.com/p/weekly-literature-review-starting-2026-on-the-right-footing" rel="noopener noreferrer" target="_blank">Alex's summary and takeaways of the five research articles we discuss on the episode.</a> <a href="https://www.cms.gov/priorities/innovation/data-and-reports/2024/ahc-3rd-eval-report-aag?utm_source=copilot.com" rel="noopener noreferrer" target="_blank">Accountable Health Communities Model Findings at a Glance</a> <h5>*affiliate link</h5>

Check out the You Tube version of the podcast here.In this episode, Dana and Alex review the research articles Alex shared with Future Proof PT newsletter subscribers on January 4th, 2025, exploring what these studies reveal about healthcare transformation and what PTs can learn from them.They dive into the 4% screening tool study that dramatically improved outcomes by simply asking patients about their needs—a small intervention that created massive value. This leads to a bigger discussion: why are PTs starving on a shrinking fee-for-service diet when alternative models exist? The answer isn't that value-based care doesn't work—it's that most clinicians haven't tested it yet.We explore Richard Feynman's principles of honest self-evaluation and scientific integrity, applying them to healthcare's reluctance to experiment. Alex shares that he recently reread The Alchemist by Paulo Coelho and that the story's message resonated with him differently this time around. He focuses on a key moment in the book where the shepherd's father gives him money to pursue his journey—not because the father expects his son to find treasure, but because the father himself never took that journey and wants something better for his son.Alex connects this to his own mindset as a parent: he wants his children to have opportunities and experiences he didn't have. This parallels the healthcare discussion because leaders and early adopters in value-based care are essentially doing the same thing—investing in a journey they may not fully benefit from themselves, but paving the way for the next generation of clinicians.The core insight Alex draws is that the treasure in The Alchemist wasn't the gold the shepherd was seeking, but the transformation and self-discovery he experienced along the way. Similarly, PTs who experiment with value-based care aren't just chasing financial models—they're undergoing professional transformation that makes them more valuable, regardless of whether any single model succeeds.This reframing positions the journey itself as the reward, and encourages clinicians to stop waiting for value-based care to be "proven" before they engage. Like the shepherd's father investing in his son's journey, today's leaders are investing in the profession's future.Other key points include: why you need a lottery ticket to win (you have to participate to benefit), how to A-B test your way into value-based care leadership, why leadership starts with one person taking action, and how systems thinking can help PTs break free from fee-for-service heuristics. Stop waiting for permission. Start leading from your clinic. The R&D phase of healthcare needs you.Key Topics in Episode 23:Reviewing research articles from Future Proof PT newsletter (Jan 4, 2025)The 4% screening tool study and its implications for value creationWhy "it doesn't work" is invalid if you never tested itThe sheep analogy: surviving vs. thriving in healthcareRichard Feynman's lesson on honest self-evaluation and scientific integrityA-B testing your way into value-based care leadershipWhy small experiments and lottery tickets matter in healthcare transformationHow the journey of experimentation IS the treasure (lessons from The Alchemist)Systems thinking and recognizing our own fallibility in healthcare decision-making"The Alchemist"*"Thinking Fast and Slow"*"The Almanac of Naval Ravikant"*Alex's summary and takeaways of the five research articles we discuss on the episode.Accountable Health Communities Model Findings at a Glance*affiliate link

Episode 23: The Alchemist and Healthcare | Why Your Journey is the Treasure

Fee-for-service PT reimbursement isn't viable. It's just math. In this episode, we bring our second physician guest to the Future Proof PT studio to explain. For Episode 22, we are joined by sports medicine surgeon and Protera Health co-founder Dr. Eric Makhni, MD, MBA, who also explains what physical therapists can do about our "math problem." We explore the economics of MSK care, who actually bears financial risk in healthcare, why your clinical reasoning matters more than your manual therapy skills, and how digital health (when done right) can extend your reach without replacing your value. Eric shares stories from 20 years studying and practicing value-based care in orthopedics, including how patient-reported outcome measures changed a surgical decision in real-time and why the 2020 telehealth pivot separated true clinical experts from customer service providers. We hope this conversation challenges how you think about your career, your compensation, and your profession's future. Key Topics: <ul><li>PTs' effectiveness in treating MSK conditions</li><li>The "Healthcare Factory" metaphor for fee-for-service physical therapy</li><li>Using patient-reported outcome measures (PROMs) as a clinical GPS tool for shared decision-making, not just compliance</li><li>The 2020 telehealth pivot that separated clinical experts from customer service providers in digital health</li><li>The difference between tech companies and true clinical integration in digital MSK care platforms</li><li>The shift from "hands to brains" - why clinical reasoning and movement expertise is more valuable than manual techniques</li><li>Understanding who bears financial risk in healthcare and why PTs should align with and target employers directly</li><li>How to pitch directly to employers instead of chasing insurance panels</li><li>Patient case study as an example of a functional use of PROMs: How patient-reported outcomes changed a surgical decision and prevented an unnecessary procedure</li></ul> More about our guest, Dr. Eric Mahkni, MD, MBA: Dr. Eric Makhni is a sports medicine orthopedic surgeon and Associate Professor at Henry Ford Health, with nearly 20 years experience in value-based orthopedic care. He has taken that experience and co-founded Protera Health, which helps health plans improve quality and costs of MSK care for their populations. He is also the team physician for the Detroit Lions. We asked him what PTs, and other healthcare professionals need to hear. Here's what he shared: "Lot of organizations doing MSK VBC that are welcoming PT's with open arms. Really great opportunity to shift gears from the clinic grind to thinking - and practicing - more holistically!" Here's why he thinks this episode is important to tune into: "Digital MSK is one of the hottest spaces for health tech. With so many players in the space, it's important to learn how to untangle the web and see how each solution fits in the spectrum of delivery options." Here's a "hot take" from Dr. Makhni: "Health plan leaders have very little to lose by trying out new innovation solutions, provided these solutions use high quality clinical delivery models and pass the "sniff test." There is much more to gain by trying to improve quality of care as opposed to being scared that it might not work out." Resources: Protera Health - <a href="https://www.proterahealth.com/" rel="noopener noreferrer" target="_blank" style="color: inherit; background-color: initial;">proterahealth.com</a>Henry Ford Health - <a href="https://www.henryford.com/" rel="noopener noreferrer" target="_blank" style="color: inherit; background-color: initial;">henryford.com</a><a href="https://www.linkedin.com/in/eric-makhni-md-mba-2b28032b/" rel="noopener noreferrer" target="_blank" style="color: inherit; background-color: initial;">Dr. Eric Makhni on LinkedIn</a> Please subscribe to the Future Proof PT podcast and share it with a friend! Here's the <a href="https://youtu.be/4OHlbzGySXE" rel="noopener noreferrer" target="_blank">YouTube version</a> of Episode 22

Fee-for-service PT reimbursement isn't viable. It's just math. In this episode, we bring our second physician guest to the Future Proof PT studio to explain. For Episode 22, we are joined by sports medicine surgeon and Protera Health co-founder Dr. Eric Makhni, MD, MBA, who also explains what physical therapists can do about our "math problem."We explore the economics of MSK care, who actually bears financial risk in healthcare, why your clinical reasoning matters more than your manual therapy skills, and how digital health (when done right) can extend your reach without replacing your value. Eric shares stories from 20 years studying and practicing value-based care in orthopedics, including how patient-reported outcome measures changed a surgical decision in real-time and why the 2020 telehealth pivot separated true clinical experts from customer service providers.We hope this conversation challenges how you think about your career, your compensation, and your profession's future.Key Topics:PTs' effectiveness in treating MSK conditionsThe "Healthcare Factory" metaphor for fee-for-service physical therapyUsing patient-reported outcome measures (PROMs) as a clinical GPS tool for shared decision-making, not just complianceThe 2020 telehealth pivot that separated clinical experts from customer service providers in digital healthThe difference between tech companies and true clinical integration in digital MSK care platformsThe shift from "hands to brains" - why clinical reasoning and movement expertise is more valuable than manual techniquesUnderstanding who bears financial risk in healthcare and why PTs should align with and target employers directlyHow to pitch directly to employers instead of chasing insurance panelsPatient case study as an example of a functional use of PROMs: How patient-reported outcomes changed a surgical decision and prevented an unnecessary procedureMore about our guest, Dr. Eric Mahkni, MD, MBA:Dr. Eric Makhni is a sports medicine orthopedic surgeon and Associate Professor at Henry Ford Health, with nearly 20 years experience in value-based orthopedic care. He has taken that experience and co-founded Protera Health, which helps health plans improve quality and costs of MSK care for their populations.He is also the team physician for the Detroit Lions.We asked him what PTs, and other healthcare professionals need to hear. Here's what he shared:"Lot of organizations doing MSK VBC that are welcoming PT's with open arms. Really great opportunity to shift gears from the clinic grind to thinking - and practicing - more holistically!"Here's why he thinks this episode is important to tune into:"Digital MSK is one of the hottest spaces for health tech. With so many players in the space, it's important to learn how to untangle the web and see how each solution fits in the spectrum of delivery options." Here's a "hot take" from Dr. Makhni:"Health plan leaders have very little to lose by trying out new innovation solutions, provided these solutions use high quality clinical delivery models and pass the "sniff test." There is much more to gain by trying to improve quality of care as opposed to being scared that it might not work out."Resources:Protera Health - proterahealth.comHenry Ford Health - henryford.comDr. Eric Makhni on LinkedInPlease subscribe to the Future Proof PT podcast and share it with a friend!Here's the YouTube version of Episode 22

Episode 22: Redefining Our Worth | How Physical Therapy Professionals Fit Into the Future of Value-Based Care

<h2>How to Benefit from Value-Based Care Strategies While Treating in Fee-For-Service</h2> "Why should I care about value-based care TODAY?"If you're not in a risk contract and your clinic runs on fee-for-service, this question probably hits home. The answer? You don't need a value-based contract to win with value-based thinking. Alex and Dana welcome Cody Lee and Jonathan Smith, two physical therapists who've turned podcast concepts into practice - building provider relationships, growing referrals, and demonstrating value before entering any formal risk arrangements. They share the "Accept, Change, or Leave" decision framework that ended their career stagnation, how understanding ACO language became their referral secret weapon, and why the lack of a playbook is actually your competitive advantage. This is the bridge between healthcare theory and clinic reality - no jargon, no fluff, just practitioners sharing what actually works when you're trying to build something better than the status quo. For clinic owners frustrated with traditional practice models, new grads looking for alternative paths, and any PT or OT who's ever thought "there has to be a better way" - this conversation delivers immediate, actionable insights you can use Monday morning. <h3>Key Takeaways:</h3> <ul><li>Start without a playbook. There's no perfect formula, so learn from others, be curious, and experiment with applying concepts</li><li>Speak the same language. Understand the goals of ACOs or other VBC models and the participating providers' needs to help you become their trusted partner</li><li>Short-term benefits. Even without the VBC payment model in place for a therapy department or practice, you can increase fee-for-service revenue by becoming the preferred referral destination because you create value through trust, access, consistency, and strong communication and collaboration</li><li>Sales is not a dirty word. Build relationships directly rather than relying only on salespeople. Authentic connections drive referral behavior change. Successful salespeople are masterful at authentic relationship-building</li><li>Upstream PT and OT care reduces downstream costs. More PT and primary care engagement with patients naturally reduces the use of ERs, unnecessary imaging, and specialist utilization</li><li>Growth enables opportunity. Increased volume allows you to hire team members you want to work with and create more positions</li><li>Change is curvilinear. Success won't be immediate or linear. Persistence leads to exponential growth over time.</li></ul> <a href="https://future-proof-pt.beehiiv.com/subscribe" rel="noopener noreferrer" target="_blank">﻿Subscribe</a> to the Future Proof PT newsletter and receive exclusive resources that grow with every episode!<a href="https://www.youtube.com/@FutureProofPT" rel="noopener noreferrer" target="_blank">Subscribe to our YouTube Channel</a><a href="www.timelessautonomy.com/subscribe" rel="noopener noreferrer" target="_blank">Subscribe to Timeless Autonomy </a>for health policy news and insights distilled for industry professionals. Written by Dana Strauss, PT, DPT

How to Benefit from Value-Based Care Strategies While Treating in Fee-For-Service"Why should I care about value-based care TODAY?"If you're not in a risk contract and your clinic runs on fee-for-service, this question probably hits home. The answer? You don't need a value-based contract to win with value-based thinking.Alex and Dana welcome Cody Lee and Jonathan Smith, two physical therapists who've turned podcast concepts into practice - building provider relationships, growing referrals, and demonstrating value before entering any formal risk arrangements. They share the "Accept, Change, or Leave" decision framework that ended their career stagnation, how understanding ACO language became their referral secret weapon, and why the lack of a playbook is actually your competitive advantage.This is the bridge between healthcare theory and clinic reality - no jargon, no fluff, just practitioners sharing what actually works when you're trying to build something better than the status quo.For clinic owners frustrated with traditional practice models, new grads looking for alternative paths, and any PT or OT who's ever thought "there has to be a better way" - this conversation delivers immediate, actionable insights you can use Monday morning.Key Takeaways:Start without a playbook. There's no perfect formula, so learn from others, be curious, and experiment with applying conceptsSpeak the same language. Understand the goals of ACOs or other VBC models and the participating providers' needs to help you become their trusted partnerShort-term benefits. Even without the VBC payment model in place for a therapy department or practice, you can increase fee-for-service revenue by becoming the preferred referral destination because you create value through trust, access, consistency, and strong communication and collaborationSales is not a dirty word. Build relationships directly rather than relying only on salespeople. Authentic connections drive referral behavior change. Successful salespeople are masterful at authentic relationship-buildingUpstream PT and OT care reduces downstream costs. More PT and primary care engagement with patients naturally reduces the use of ERs, unnecessary imaging, and specialist utilizationGrowth enables opportunity. Increased volume allows you to hire team members you want to work with and create more positionsChange is curvilinear. Success won't be immediate or linear. Persistence leads to exponential growth over time.﻿Subscribe to the Future Proof PT newsletter and receive exclusive resources that grow with every episode!Subscribe to our YouTube ChannelSubscribe to Timeless Autonomy for health policy news and insights distilled for industry professionals. Written by Dana Strauss, PT, DPT

Episode 21: What's In It For Me Right Now?

Alex and Dana met on LinkedIn, started a podcast, and only met in person in October of 2025. They use their milestone 20th episode to issue an urgent call: 270,000 physical therapists must each become agents of change, starting today. They cover these topics and more: -The economic reality is unsustainable. Therapists graduate with up to $200K debt (three-quarters of medical school) to earn a $120K salary ceiling. Compare that to nurse practitioners makin $150K with two years of training. -The fee-for-service model traps therapy professionals. Many now leave between years 3-5, before their investment even pays off. But everything needed to transform exists right now. -Physical therapists aren't physician extenders—they're doctoring professionals with their own licensed and supportive extenders (PTAs, health coaches, PT aides, etc.). The solution mirrors how surgeons often collaborate with physician associates: PTs should evaluate, plan care, and intervene when expertise is required, while delegating execution to skilled and/or trained team members. -Time directly providing one-on-one patient care doesn't equal quality. -High-quality clinicians redirect inappropriate referrals instead of accepting them like "manna from heaven." -Setting realistic patient expectations based on prognosis and comorbidities IS the professional expertise that defines doctoring professionals. Yet the profession never fully claimed the direct access promise. -Alex's recent experience with his father's hospitalization exposed for him healthcare's fractured reality: disciplines that don't communicate, 10+ daily errors, and systems where only patients with physician quarterbacks receive optimal care. Despite seamless technology enabling collaboration, hospitals remain unsafe places. -Fee-for-service creates no incentive for safety or communication—but value-based models like TEAM (hitting 25% of hospitals in January) are shifting the landscape by making hospitals accountable for 30-day spending and outcomes. Therapists--this creates massive opportunity. For example, therapists can help ensure anyone who may be able to return directly home actually CAN go home, and can advocate for that on behalf of patients in collaborating with the multidisciplinary team. -Complaints aren't actionable—they're just "the what." Action emerges when individuals realize they can move the needle in their own clinical settings, with their own patients, and with their own teams. -Value-based care is the path to sustainable, higher PT and OT incomes in clinical roles. -What Alex is excited about for the APTA PPS event this week! And more! Join them for Episode 20. Like it? Please give them a thumbs up and subscribe! <a href="https://future-proof-pt.beehiiv.com/subscribe" rel="noopener noreferrer" target="_blank">﻿Subscribe</a> to the Future Proof PT newsletter and receive exclusive resources that grow with every episode!<a href="https://www.youtube.com/@FutureProofPT" rel="noopener noreferrer" target="_blank">Subscribe to our YouTube Channel</a>

Alex and Dana met on LinkedIn, started a podcast, and only met in person in October of 2025. They use their milestone 20th episode to issue an urgent call: 270,000 physical therapists must each become agents of change, starting today. They cover these topics and more:-The economic reality is unsustainable. Therapists graduate with up to $200K debt (three-quarters of medical school) to earn a $120K salary ceiling. Compare that to nurse practitioners makin $150K with two years of training. -The fee-for-service model traps therapy professionals. Many now leave between years 3-5, before their investment even pays off. But everything needed to transform exists right now. -Physical therapists aren't physician extenders—they're doctoring professionals with their own licensed and supportive extenders (PTAs, health coaches, PT aides, etc.). The solution mirrors how surgeons often collaborate with physician associates: PTs should evaluate, plan care, and intervene when expertise is required, while delegating execution to skilled and/or trained team members. -Time directly providing one-on-one patient care doesn't equal quality. -High-quality clinicians redirect inappropriate referrals instead of accepting them like "manna from heaven." -Setting realistic patient expectations based on prognosis and comorbidities IS the professional expertise that defines doctoring professionals. Yet the profession never fully claimed the direct access promise.-Alex's recent experience with his father's hospitalization exposed for him healthcare's fractured reality: disciplines that don't communicate, 10+ daily errors, and systems where only patients with physician quarterbacks receive optimal care. Despite seamless technology enabling collaboration, hospitals remain unsafe places.-Fee-for-service creates no incentive for safety or communication—but value-based models like TEAM (hitting 25% of hospitals in January) are shifting the landscape by making hospitals accountable for 30-day spending and outcomes. Therapists--this creates massive opportunity. For example, therapists can help ensure anyone who may be able to return directly home actually CAN go home, and can advocate for that on behalf of patients in collaborating with the multidisciplinary team.-Complaints aren't actionable—they're just "the what." Action emerges when individuals realize they can move the needle in their own clinical settings, with their own patients, and with their own teams. -Value-based care is the path to sustainable, higher PT and OT incomes in clinical roles. -What Alex is excited about for the APTA PPS event this week!And more! Join them for Episode 20. Like it? Please give them a thumbs up and subscribe!﻿Subscribe to the Future Proof PT newsletter and receive exclusive resources that grow with every episode!Subscribe to our YouTube Channel

Episode 20: Expertise, Delegating, and Team-Based Care in Physical Therapy

<h3>Why your best play is calling the shots, not running them all</h3> Alex and I recently talked about the physical therapist income floor and ceiling. And in this episode, we talk with Dr. Marc Gruner, who offers a framework for a solution to that seemingly impenetrable ceiling. Here's the punchline. The income ceiling in PT isn't about reimbursement rates. It's about your practice model. Dr. Gruner created the RTM codes, which are the first new codes for PT in 20 years. Now we can absolutely make the strong argument that the PT billing codes don't adequately reimburse therapists for the value we create, and that the income ceiling should not be tens of thousands below providers who don't have doctoral degrees as the required minimum educational level. But in this episode, Dr. Gruner explains why team-based care and value-based arrangements are the only path to sustainable income growth while providing access to care to our communities. We talk about RTM in this episode, and about how RTM wasn't designed as simply another billing code. It's infrastructure for the glide path to value-based care for physical therapists. So tune in to hear much more from Dr. Gruner, a true physician champion for the physical therapy profession. Learn how to stop top playing every position and start calling the plays. RTM Strategic Deep Dive: Subscribe below for the full article on how remote therapeutic monitoring serves as a facilitator for value-based success, and why we make the argument that it is crucial for therapists to think of it that way. When you subscribe, you have access to the full archive of newsletter articles and to exclusive access to a supplemental set of resources that will hit your inbox after you subscribe (for free!). <a href="https://future-proof-pt.beehiiv.com/subscribe" rel="noopener noreferrer" target="_blank">Subscribe</a> to the Future Proof PT newsletter and receive exclusive resources that grow with every episode!<a href="https://www.youtube.com/@FutureProofPT" rel="noopener noreferrer" target="_blank">Subscribe to our YouTube Channel</a>

Why your best play is calling the shots, not running them allAlex and I recently talked about the physical therapist income floor and ceiling. And in this episode, we talk with Dr. Marc Gruner, who offers a framework for a solution to that seemingly impenetrable ceiling.Here's the punchline. The income ceiling in PT isn't about reimbursement rates. It's about your practice model.Dr. Gruner created the RTM codes, which are the first new codes for PT in 20 years. Now we can absolutely make the strong argument that the PT billing codes don't adequately reimburse therapists for the value we create, and that the income ceiling should not be tens of thousands below providers who don't have doctoral degrees as the required minimum educational level. But in this episode, Dr. Gruner explains why team-based care and value-based arrangements are the only path to sustainable income growth while providing access to care to our communities. We talk about RTM in this episode, and about how RTM wasn't designed as simply another billing code. It's infrastructure for the glide path to value-based care for physical therapists.So tune in to hear much more from Dr. Gruner, a true physician champion for the physical therapy profession. Learn how to stop top playing every position and start calling the plays.RTM Strategic Deep Dive: Subscribe below for the full article on how remote therapeutic monitoring serves as a facilitator for value-based success, and why we make the argument that it is crucial for therapists to think of it that way. When you subscribe, you have access to the full archive of newsletter articles and to exclusive access to a supplemental set of resources that will hit your inbox after you subscribe (for free!).Subscribe to the Future Proof PT newsletter and receive exclusive resources that grow with every episode!Subscribe to our YouTube Channel

PT as Quarterback, with Dr. Marc Gruner, DO, MBA, RMSK

Drowning in student debt? Feeling undervalued as a PT? Here's why: You're trapped between an artificial floor and a glass ceiling. The floor? PT school costs more than an MBA at MIT—that's your barrier to entry. The ceiling? The AMA's physician-dominated board literally decides what you're worth. And between those two forces, you're stuck. Today we break down the economic trap keeping PTs fragmented, underpaid, and powerless—and what you can actually do about it. You're not alone, and the problem runs way deeper than you may think. What You'll Learn:<ul><li>Why PTs earn less than other providers for the same skills - Discover how the American Medical Association controls your reimbursement rates </li><li>The hidden economic barriers keeping PTs fragmented - Learn why our 400,000-strong profession has less influence than professionals with a smaller number of providers</li><li>Why your PT school education failed you - The critical finance and regulatory knowledge gaps that leave new grads unprepared (and how to fix them yourself)</li><li>The private practice opportunity - Understanding debt structures, consulting fees, and why smaller clinics actually have MORE freedom to innovate</li><li>Your path out of fee-for-service dependence - Practical strategies for recouping your investment beyond insurance reimbursement</li><li>Why certifications actually DO matter (despite what cynical colleagues say) - How specialization opens doors beyond your clinic job</li></ul> Our guest today is Jon Lee, PT, DPT, MBA, the co-founder of Pickle, former pro sports PT, and someone who's navigated from clinical practice to Oxford MBA to vaccine development to healthcare tech It's a conversation about the structural economic problems facing PTs—and actionable knowledge you won't get in school. You will enjoy how the three of us challenge each other throughout this hour-long conversation. We keep it real and it's ultimately optimistic. This episode is great for new grads struggling with debt, mid-career PTs feeling stuck, clinic owners questioning their business model, and anyone wondering if they made a mistake choosing their healthcare profession. <a href="https://future-proof-pt.beehiiv.com/subscribe" rel="noopener noreferrer" target="_blank">Subscribe</a> to the Future Proof PT newsletter and receive exclusive resources that grow with every episode!<a href="https://www.youtube.com/@FutureProofPT" rel="noopener noreferrer" target="_blank">Subscribe to our YouTube Channel</a>

Drowning in student debt? Feeling undervalued as a PT? Here's why: You're trapped between an artificial floor and a glass ceiling. The floor? PT school costs more than an MBA at MIT—that's your barrier to entry. The ceiling? The AMA's physician-dominated board literally decides what you're worth. And between those two forces, you're stuck. Today we break down the economic trap keeping PTs fragmented, underpaid, and powerless—and what you can actually do about it. You're not alone, and the problem runs way deeper than you may think.What You'll Learn:Why PTs earn less than other providers for the same skills - Discover how the American Medical Association controls your reimbursement rates The hidden economic barriers keeping PTs fragmented - Learn why our 400,000-strong profession has less influence than professionals with a smaller number of providersWhy your PT school education failed you - The critical finance and regulatory knowledge gaps that leave new grads unprepared (and how to fix them yourself)The private practice opportunity - Understanding debt structures, consulting fees, and why smaller clinics actually have MORE freedom to innovateYour path out of fee-for-service dependence - Practical strategies for recouping your investment beyond insurance reimbursementWhy certifications actually DO matter (despite what cynical colleagues say) - How specialization opens doors beyond your clinic jobOur guest today is Jon Lee, PT, DPT, MBA, the co-founder of Pickle, former pro sports PT, and someone who's navigated from clinical practice to Oxford MBA to vaccine development to healthcare techIt's a conversation about the structural economic problems facing PTs—and actionable knowledge you won't get in school. You will enjoy how the three of us challenge each other throughout this hour-long conversation. We keep it real and it's ultimately optimistic.This episode is great for new grads struggling with debt, mid-career PTs feeling stuck, clinic owners questioning their business model, and anyone wondering if they made a mistake choosing their healthcare profession. Subscribe to the Future Proof PT newsletter and receive exclusive resources that grow with every episode!Subscribe to our YouTube Channel

Episode 18: The PT Education ROI Crisis with Jon Lee, PT, DPT, MBA

<h3>What happens when the only physical therapist to serve two U.S. Presidents shares his unfiltered blueprint for transforming PT into a primary care powerhouse?</h3> Dr. Drew Contreras, PT, DPT, SCS—Lieutenant Colonel (retired), former White House Medical Unit PT to Presidents Obama and Biden, and current APTA Vice President of Strategic Affairs—delivers a masterclass in professional evolution that will fundamentally shift how you view your career trajectory. This is surgical precision strategy from someone who's operated at the highest levels of American healthcare. Dr. Contreras dismantles the "comfort crisis" plaguing PT, where professionals complain about constraints while avoiding the uncomfortable work of actual transformation. His brings up a great point, too: venture capitalists are flooding PT because they see massive opportunity that many therapists are too comfortable to seize. The Analogy-Based Insights You'll Gain: <ul><li>The Tree-Cutting Analogy: How value-based care mirrors service industries you already understand—and why PTs must stop being "branch pickers" and become strategic planners</li><li>The Netflix Model of Healthcare: Why flexible, on-demand PT delivery (including treating astronauts in space) represents the future of patient engagement</li><li>From Skilled Laborer to Expert Consultant: The mindset shift from counting clamshells to providing high-level clinical consultation that commands premium pricing</li><li>The Spider-Man Principle: Why ordering imaging and labs comes with great responsibility—and how embracing this elevates PT to true doctoring status</li></ul> Strategic Intelligence from the Inside:Contreras reveals how political and healthcare leadership actually views PT's potential, sharing insights from Pentagon health clinics to White House medical operations. His perspective on "old guard versus new guard" leadership offers a roadmap for navigating professional transition without burning bridges. The Uncomfortable Truth: Healthcare's shift is here and we already risk being late to the game. PTs equipped with "coloring-book anatomy knowledge" (it will make sense when you listen to the episode) successfully operated in primary care roles decades ago. Today's DPT graduates possess exponentially superior tools and knowledge, yet many lack the courage to step into their full scope of practice. And the "old guard" has to step up and embrace this too, even if it means adding to your knowledge base. This episode will arm you with the strategic framework to thrive in healthcare's inevitable transformation. For therapists ready to evolve beyond traditional treatment rooms into primary care leadership roles, this conversation provides the roadmap. For those comfortable with the status quo, it serves as a wake-up call to the professional reckoning already underway. <a href="https://futureproofpt.notion.site/Dr-Drew-Contreras-PT-DPT-SCS-Bio-2025-2672cee6a6d98022bc30f1b38f1cb12f" rel="noopener noreferrer" target="_blank">Read Dr. Contreras' bio here</a> <a href="https://future-proof-pt.beehiiv.com/subscribe" rel="noopener noreferrer" target="_blank">Subscribe</a> to the Future Proof PT newsletter and receive exclusive resources that grow with every episode!<a href="https://www.youtube.com/@FutureProofPT" rel="noopener noreferrer" target="_blank">Subscribe to our YouTube Channel</a>

What happens when the only physical therapist to serve two U.S. Presidents shares his unfiltered blueprint for transforming PT into a primary care powerhouse?Dr. Drew Contreras, PT, DPT, SCS—Lieutenant Colonel (retired), former White House Medical Unit PT to Presidents Obama and Biden, and current APTA Vice President of Strategic Affairs—delivers a masterclass in professional evolution that will fundamentally shift how you view your career trajectory.This is surgical precision strategy from someone who's operated at the highest levels of American healthcare.Dr. Contreras dismantles the "comfort crisis" plaguing PT, where professionals complain about constraints while avoiding the uncomfortable work of actual transformation. His brings up a great point, too: venture capitalists are flooding PT because they see massive opportunity that many therapists are too comfortable to seize.The Analogy-Based Insights You'll Gain:The Tree-Cutting Analogy: How value-based care mirrors service industries you already understand—and why PTs must stop being "branch pickers" and become strategic plannersThe Netflix Model of Healthcare: Why flexible, on-demand PT delivery (including treating astronauts in space) represents the future of patient engagementFrom Skilled Laborer to Expert Consultant: The mindset shift from counting clamshells to providing high-level clinical consultation that commands premium pricingThe Spider-Man Principle: Why ordering imaging and labs comes with great responsibility—and how embracing this elevates PT to true doctoring statusStrategic Intelligence from the Inside:Contreras reveals how political and healthcare leadership actually views PT's potential, sharing insights from Pentagon health clinics to White House medical operations. His perspective on "old guard versus new guard" leadership offers a roadmap for navigating professional transition without burning bridges.The Uncomfortable Truth: Healthcare's shift is here and we already risk being late to the game. PTs equipped with "coloring-book anatomy knowledge" (it will make sense when you listen to the episode) successfully operated in primary care roles decades ago. Today's DPT graduates possess exponentially superior tools and knowledge, yet many lack the courage to step into their full scope of practice. And the "old guard" has to step up and embrace this too, even if it means adding to your knowledge base.This episode will arm you with the strategic framework to thrive in healthcare's inevitable transformation.For therapists ready to evolve beyond traditional treatment rooms into primary care leadership roles, this conversation provides the roadmap. For those comfortable with the status quo, it serves as a wake-up call to the professional reckoning already underway.Read Dr. Contreras' bio hereSubscribe to the Future Proof PT newsletter and receive exclusive resources that grow with every episode!Subscribe to our YouTube Channel

Episode 17: PT Without Walls | A Conversation with Dr. Drew Contreras, PT, DPT, SCS

<h2>Explorers, Innovators, and the Future of Therapy Practice</h2> What distinguishes an explorer from a maintainer in the therapy profession? Why are outside disruptors capturing market share while traditional practices struggle? How can clinicians leverage cutting-edge research on mitochondrial DNA and movement disorders to revolutionize treatment approaches? We tackle these questions and more in a dialogue that bridges clinical excellence with business innovation. Alex offers a provocative parable about buying lottery tickets that perfectly captures our profession's hesitation to proactively engage with healthcare transformation. "We're losing workforce," he warns, "but we're still failing to see that we need to go out and look into these risk-based contracts, at least explore, at least understand what they are and how to operationalize them."We examine the stark contrast between traditional care models and patient-centered approaches that leverage technology. Is it better to "hold a patient's hand" through dozens of visits, or transition to guided self-management after fewer sessions? This question gets to the heart of therapy's value proposition in an evolving healthcare ecosystem. The irony doesn't escape us: therapists expertly help patients recognize and build upon their strengths, yet we collectively struggle to do the same for our profession. The gap between the actual value therapists provide and our ability to communicate that value creates the perfect opportunity for disruption – either from outside forces or, ideally, from innovative thinkers within. External disruptors aren't succeeding because they provide better clinical care. They're succeeding because they've packaged therapy expertise in ways that solve specific problems for stakeholders, speaking the language of value, efficiency, and outcomes that resonates with payers and health systems. This conversation isn't meant to be comfortable – it's meant to be catalyzing. The explorer's mindset we advocate requires questioning established practices, reimagining care delivery, and having the courage to venture into unfamiliar territory. As Alex puts it: "I'm optimistic because I think the better days are ahead, because that's my nature, but I'm also realistic that it may take a catastrophe for those models to be absorbed. We just want to be on a good hill when the catastrophe hits." Are you ready to climb that hill? To join us as explorers charting new territories in healthcare transformation? To balance rigorous clinical standards with business innovation? Listen now to discover how adopting an explorer's mindset could transform your practice and ensure our profession remains central to healthcare's future. Because the future of therapy will be written by those willing to explore it – and we believe you have an important chapter to contribute. <h3>Takeaways</h3> <ul><li>The explorer's mindset encourages seeking new horizons in therapy.</li><li>Therapists must adapt to changing healthcare delivery models.</li><li>Curiosity and innovation are essential for professional growth.</li><li>Understanding value-based care is crucial for therapists.</li><li>Therapists need to articulate their value to stakeholders.</li><li>Research consumption strategies can enhance clinical reasoning.</li><li>Collaboration with other healthcare providers is vital.</li><li>Growth can be achieved through efficiency and subtraction.</li><li>Therapists should prepare for risk-based contracts.</li><li>The future of therapy depends on adaptability and exploration.</li></ul> #TherapyLeadership #HealthcareInnovation #PhysicalTherapy #ValueBasedCare #PracticeManagement <a href="https://futureproofpt.notion.site/Future-Proof-PT-Episode-16-Transcript-2592cee6a6d98047a022d3828d6a376d" rel="noopener noreferrer" target="_blank">Link</a> to the transcript here. <a href="https://future-proof-pt.beehiiv.com/subscribe" rel="noopener noreferrer" target="_blank">Subscribe</a> to the Future Proof PT newsletter and receive exclusive resources that grow with every episode!<a href="https://www.youtube.com/@FutureProofPT" rel="noopener noreferrer" target="_blank">Subscribe to our YouTube Channel</a> Check out our friend and colleague's *<a href="https://www.aiforpts.com/a/l2oym" rel="noopener noreferrer" target="_blank">course on AI for PTs </a>(and so many others!) by Cody Lee, PT, DPT *affiliate link

Explorers, Innovators, and the Future of Therapy PracticeWhat distinguishes an explorer from a maintainer in the therapy profession? Why are outside disruptors capturing market share while traditional practices struggle? How can clinicians leverage cutting-edge research on mitochondrial DNA and movement disorders to revolutionize treatment approaches? We tackle these questions and more in a dialogue that bridges clinical excellence with business innovation.Alex offers a provocative parable about buying lottery tickets that perfectly captures our profession's hesitation to proactively engage with healthcare transformation. "We're losing workforce," he warns, "but we're still failing to see that we need to go out and look into these risk-based contracts, at least explore, at least understand what they are and how to operationalize them."We examine the stark contrast between traditional care models and patient-centered approaches that leverage technology. Is it better to "hold a patient's hand" through dozens of visits, or transition to guided self-management after fewer sessions? This question gets to the heart of therapy's value proposition in an evolving healthcare ecosystem.The irony doesn't escape us: therapists expertly help patients recognize and build upon their strengths, yet we collectively struggle to do the same for our profession. The gap between the actual value therapists provide and our ability to communicate that value creates the perfect opportunity for disruption – either from outside forces or, ideally, from innovative thinkers within.External disruptors aren't succeeding because they provide better clinical care. They're succeeding because they've packaged therapy expertise in ways that solve specific problems for stakeholders, speaking the language of value, efficiency, and outcomes that resonates with payers and health systems.This conversation isn't meant to be comfortable – it's meant to be catalyzing. The explorer's mindset we advocate requires questioning established practices, reimagining care delivery, and having the courage to venture into unfamiliar territory.As Alex puts it: "I'm optimistic because I think the better days are ahead, because that's my nature, but I'm also realistic that it may take a catastrophe for those models to be absorbed. We just want to be on a good hill when the catastrophe hits."Are you ready to climb that hill? To join us as explorers charting new territories in healthcare transformation? To balance rigorous clinical standards with business innovation?Listen now to discover how adopting an explorer's mindset could transform your practice and ensure our profession remains central to healthcare's future. Because the future of therapy will be written by those willing to explore it – and we believe you have an important chapter to contribute.TakeawaysThe explorer's mindset encourages seeking new horizons in therapy.Therapists must adapt to changing healthcare delivery models.Curiosity and innovation are essential for professional growth.Understanding value-based care is crucial for therapists.Therapists need to articulate their value to stakeholders.Research consumption strategies can enhance clinical reasoning.Collaboration with other healthcare providers is vital.Growth can be achieved through efficiency and subtraction.Therapists should prepare for risk-based contracts.The future of therapy depends on adaptability and exploration.#TherapyLeadership #HealthcareInnovation #PhysicalTherapy #ValueBasedCare #PracticeManagementLink to the transcript here.Subscribe to the Future Proof PT newsletter and receive exclusive resources that grow with every episode!Subscribe to our YouTube ChannelCheck out our friend and colleague's *course on AI for PTs (and so many others!) by Cody Lee, PT, DPT*affiliate link

Episode 16: The PT Explorer's Mindset | Bridging Research, Disruption, and Innovation

Episode Summary: In the latest episode of Future Proof PT, hosts Dana Strauss and Alex Bendersky, along with special guest Jerry Durham, tackle the critical crossroads facing physical therapy as a profession. They challenge listeners to question whether they're functioning as true healthcare professionals or merely "operators" in a broken system.The trio discusses how healthcare is rapidly transforming around us, including recent proposed policy changes in the 2026 Physician Fee Schedule Proposed Rule that could significantly impact physical therapists. While time-based providers like primary care physicians are seeing increases of 5-9%, independent PTs face a -1% adjustment. The trio make the case that this should be a wake-up call for the profession. Key topics covered include:<ul><li>The value of hands-on patient relationships in an AI-driven healthcare landscape</li><li>Why team-based care is essential for survival in evolving payment models</li><li>The importance of understanding the broader healthcare ecosystem beyond PT</li><li>Strategies for demonstrating value to referring physicians and payers</li><li>Embracing the shift to outpatient and in-home care</li></ul> This conversation serves as both a warning and a call to action for physical therapists to "look up" from their treatment tables, redefine their professional identity, and secure their place in the healthcare of tomorrow.Whether you're a clinic owner, practicing PT, or student, or in a non-clinical role, this episode delivers uncomfortable truths alongside actionable insights that could transform your approach to practice. You won’t want to miss it. Link to the episode transcript <a href="https://futureproofpt.notion.site/Future-Proof-PT-Episode-15-Transcript-24b2cee6a6d98051a3fbdd9197b5b85b" rel="noopener noreferrer" target="_blank">here.</a> <a href="https://future-proof-pt.beehiiv.com/subscribe" rel="noopener noreferrer" target="_blank">Subscribe</a> to the Future Proof PT newsletter and receive exclusive resources that grow with every episode!<a href="https://www.youtube.com/@FutureProofPT" rel="noopener noreferrer" target="_blank">Subscribe to our YouTube Channel</a> Check out our friend and colleague's *<a href="https://www.aiforpts.com/a/l2oym" rel="noopener noreferrer" target="_blank">course on AI for PTs </a>(and so many others!) by Cody Lee, PT, DPT *affiliate link

Episode Summary:In the latest episode of Future Proof PT, hosts Dana Strauss and Alex Bendersky, along with special guest Jerry Durham, tackle the critical crossroads facing physical therapy as a profession. They challenge listeners to question whether they're functioning as true healthcare professionals or merely "operators" in a broken system.The trio discusses how healthcare is rapidly transforming around us, including recent proposed policy changes in the 2026 Physician Fee Schedule Proposed Rule that could significantly impact physical therapists. While time-based providers like primary care physicians are seeing increases of 5-9%, independent PTs face a -1% adjustment. The trio make the case that this should be a wake-up call for the profession.Key topics covered include:The value of hands-on patient relationships in an AI-driven healthcare landscapeWhy team-based care is essential for survival in evolving payment modelsThe importance of understanding the broader healthcare ecosystem beyond PTStrategies for demonstrating value to referring physicians and payersEmbracing the shift to outpatient and in-home careThis conversation serves as both a warning and a call to action for physical therapists to "look up" from their treatment tables, redefine their professional identity, and secure their place in the healthcare of tomorrow.Whether you're a clinic owner, practicing PT, or student, or in a non-clinical role, this episode delivers uncomfortable truths alongside actionable insights that could transform your approach to practice. You won’t want to miss it.Link to the episode transcript here.Subscribe to the Future Proof PT newsletter and receive exclusive resources that grow with every episode!Subscribe to our YouTube ChannelCheck out our friend and colleague's *course on AI for PTs (and so many others!) by Cody Lee, PT, DPT*affiliate link

Episode 15: Beyond the Treatment Session | Physical Therapists who Dare to Look Up

Dana and Alex explore the Therapy Value Quotient, an objective framework for measuring clinical impact that goes beyond subjective reasoning. Learn a practical algorithm that factors in functional improvement, patient complexity, care intensity, and cost—plus why establishing clear therapy prognoses is essential for professional survival. Key topics covered in this episode: objective clinical measures, therapy prognosis, value-based care, capitation, long-term patient relationships, and preparing for AI-driven healthcare analytics.Essential listening for therapists ready to prove their value in measurable ways while maintaining meaningful patient connections. <a href="https://www.youtube.com/@FutureProofPT" rel="noopener noreferrer" target="_blank">Subscribe to our YouTube Channel</a> <a href="https://future-proof-pt.beehiiv.com/subscribe" rel="noopener noreferrer" target="_blank">Sign up for our newsletter and receive exclusive resources that grow with every episode!</a> Check out our friend and colleague's <a href="https://www.aiforpts.com/a/l2oym" rel="noopener noreferrer" target="_blank">course on AI for PTs </a>(and so many others!) by Cody Lee, PT, DPT Sponsored by Saatva Mattresses:<a href="https://saatva.partnerlinks.io/m0got0v5u0eu" rel="noopener noreferrer" target="_blank"> use this link for 15% off Saatva mattresses </a>or tell anyone at a Saatva show room that Dana Strauss, PT, DPT sent you. This offer is stackable with any other active offer Saatva offers at the time! Future Proof PT helps physical therapists navigate the changing healthcare landscape and build sustainable, value-driven practices.

Dana and Alex explore the Therapy Value Quotient, an objective framework for measuring clinical impact that goes beyond subjective reasoning. Learn a practical algorithm that factors in functional improvement, patient complexity, care intensity, and cost—plus why establishing clear therapy prognoses is essential for professional survival.Key topics covered in this episode: objective clinical measures, therapy prognosis, value-based care, capitation, long-term patient relationships, and preparing for AI-driven healthcare analytics.Essential listening for therapists ready to prove their value in measurable ways while maintaining meaningful patient connections.Subscribe to our YouTube ChannelSign up for our newsletter and receive exclusive resources that grow with every episode!Check out our friend and colleague's course on AI for PTs (and so many others!) by Cody Lee, PT, DPTSponsored by Saatva Mattresses: use this link for 15% off Saatva mattresses or tell anyone at a Saatva show room that Dana Strauss, PT, DPT sent you. This offer is stackable with any other active offer Saatva offers at the time!Future Proof PT helps physical therapists navigate the changing healthcare landscape and build sustainable, value-driven practices.

Episode 14: How Precise is your Prognosis?

Physical Therapists, listen up! "Make America Healthy Again," or MAHA, is a chance to improve the professional identify of PTs regardless of politics! It's a chance to embrace and highlight the profession and its doctoral status and to position its reputation as long-term partners in patients'/the population's MSK health as opposed to merely providers of episodic care. PTs can and should be the "quarterbacks" of MSK care. That will mean eliminating some of our vocabulary and leaning into other expressions. MAHA isn't just a chance for the profession's perception. It's an opportunity to attract well-deserved reimbursement improvements. Here's what you'll learn when you tune in: <ul><li>How government healthcare initiatives create opportunities for physical therapists to advance the profession, and why you should embrace the positive of new positioning, regardless of political affiliations or biases</li><li>Why PTs should position themselves as "quarterbacks" of musculoskeletal care</li><li>The importance of using doctoral titles, professional language, and of obtaining your tDPT if you graduated PT school prior to the DPT (like Dana!)</li><li>Why you should remove "discharge" from your clinical vocabulary</li><li>Potential challenges for the profession: reimbursement, resource limitations, and outcomes tracking</li></ul> We make the case for PTs to step up as lifetime partners in MSK health and ditch the notion of being solely providers of episodic care. And we encourage you to embrace the top of scope positioning of PTs and argue it's a "must-do" to secure a future we are all proud of. Enjoy the conversation and the practical insights on how to position yourself, your practice, and your profession for future success in a changing healthcare landscape. <a href="https://www.youtube.com/@FutureProofPT" rel="noopener noreferrer" target="_blank">Subscribe to our YouTube Channel</a> <a href="https://future-proof-pt.beehiiv.com/subscribe" rel="noopener noreferrer" target="_blank">Sign up for our newsletter and receive exclusive resources that grow with every episode!</a> Check out our friend and colleague's <a href="https://www.aiforpts.com/a/l2oym " rel="noopener noreferrer" target="_blank">course on AI for PTs </a>(and so many others!) by Cody Lee, PT, DPT Sponsored by Saatva Mattresses:<a href="https://saatva.partnerlinks.io/m0got0v5u0eu" rel="noopener noreferrer" target="_blank"> use this link for 15% off Saatva mattresses </a>or tell anyone at a Saatva show room that Dana Strauss, PT, DPT sent you. This offer is stackable with any other active offer Saatva offers at the time!

Physical Therapists, listen up! "Make America Healthy Again," or MAHA, is a chance to improve the professional identify of PTs regardless of politics! It's a chance to embrace and highlight the profession and its doctoral status and to position its reputation as long-term partners in patients'/the population's MSK health as opposed to merely providers of episodic care. PTs can and should be the "quarterbacks" of MSK care. That will mean eliminating some of our vocabulary and leaning into other expressions. MAHA isn't just a chance for the profession's perception. It's an opportunity to attract well-deserved reimbursement improvements. Here's what you'll learn when you tune in:How government healthcare initiatives create opportunities for physical therapists to advance the profession, and why you should embrace the positive of new positioning, regardless of political affiliations or biasesWhy PTs should position themselves as "quarterbacks" of musculoskeletal careThe importance of using doctoral titles, professional language, and of obtaining your tDPT if you graduated PT school prior to the DPT (like Dana!)Why you should remove "discharge" from your clinical vocabularyPotential challenges for the profession: reimbursement, resource limitations, and outcomes trackingWe make the case for PTs to step up as lifetime partners in MSK health and ditch the notion of being solely providers of episodic care. And we encourage you to embrace the top of scope positioning of PTs and argue it's a "must-do" to secure a future we are all proud of.Enjoy the conversation and the practical insights on how to position yourself, your practice, and your profession for future success in a changing healthcare landscape. Subscribe to our YouTube ChannelSign up for our newsletter and receive exclusive resources that grow with every episode!Check out our friend and colleague's course on AI for PTs (and so many others!) by Cody Lee, PT, DPTSponsored by Saatva Mattresses: use this link for 15% off Saatva mattresses or tell anyone at a Saatva show room that Dana Strauss, PT, DPT sent you. This offer is stackable with any other active offer Saatva offers at the time!

Episode 13: Is "Make American Healthy Again" the Next Big Opportunity for Physical Therapists?

Ready to revolutionize your PT career? Think of it like Wayne Gretzky's famous quote - skate to where the puck is going, not where it's been. In today's rapidly evolving healthcare landscape, having a game plan for your career as part of the PT profession (clinical, non-clinical, or both) isn't just nice-to-have, it's essential for survival. The signs of change are everywhere if you know where to look. Want the inside scoop? Follow the money and the power players. Watch what policymakers and their advisors are saying and doing, and keep your eyes on where big investors are placing their bets - that's key to reading the proverbial tea leaves. Let's talk about our profession's journey. Physical therapy has come a long way in fighting for autonomy - you know, breaking free from needing that doctor's prescription to treat patients. But while we were focused on that battle, we might have missed some existential challenges. Take the fee-for-service system, for instance. It's like a bad relationship - it's not just hurting us, it's impacting how other providers coordinate and collaborate with us. making sure patients get to us. Even worse? It's pushed us to focus on visit counts rather than what really matters: individualized treatment plans, proper dosing, and patient outcomes. This affects how everyone sees PT - from insurance companies to doctors to patients themselves. Many view therapy as this huge time commitment, rather than seeing its true value. Not great, right? In this episode, Alex and I are talking about this. We're tackling Remote Therapeutic Monitoring (RTM) and its connection to the recently update Innovation Center Strategy - stuff that could completely reshape your practice. This isn't just about boring billing codes - it's about positioning yourself at the cutting edge of healthcare. We are sharing helpful insights about healthcare tech, new payment models, and what it means for your future. Plus, you won't want to miss Alex's brilliant "train model" that perfectly shows how digital and in-person care can work together seamlessly. We're also sharing what the CMS Innovation Center leadership said in their blog and in recent public appearances about their vision for healthcare's future. Every week, we update our Resources Database, which is available to all newsletter subscribers. Not a subscriber yet? <a href="https://future-proof-pt.beehiiv.com/subscribe" rel="noopener noreferrer" target="_blank">Sign up here! </a>It's free and we send valuable resources right to your inbox every week. Chapters 00:00 The Future of Care Delivery Models06:00 The Importance of Quality Data in EMR Systems08:35 Navigating Regulatory Changes in Healthcare10:46 The Impact of Technology on Patient Care13:41 Conclusion and Future Directions18:37 Innovative Models in Medicare Services20:42 The Role of Data in Patient Care22:33 Future of Therapy: Embracing Change25:43 Case Studies: Remote Therapeutic Monitoring28:14 Valuing Preventive Care in Therapy32:08 Understanding Episode Groupers36:10 Collaboration Across Disciplines40:13 Advocacy and Access to Care

Ready to revolutionize your PT career? Think of it like Wayne Gretzky's famous quote - skate to where the puck is going, not where it's been. In today's rapidly evolving healthcare landscape, having a game plan for your career as part of the PT profession (clinical, non-clinical, or both) isn't just nice-to-have, it's essential for survival.The signs of change are everywhere if you know where to look. Want the inside scoop? Follow the money and the power players. Watch what policymakers and their advisors are saying and doing, and keep your eyes on where big investors are placing their bets - that's key to reading the proverbial tea leaves.Let's talk about our profession's journey. Physical therapy has come a long way in fighting for autonomy - you know, breaking free from needing that doctor's prescription to treat patients. But while we were focused on that battle, we might have missed some existential challenges.Take the fee-for-service system, for instance. It's like a bad relationship - it's not just hurting us, it's impacting how other providers coordinate and collaborate with us. making sure patients get to us. Even worse? It's pushed us to focus on visit counts rather than what really matters: individualized treatment plans, proper dosing, and patient outcomes.This affects how everyone sees PT - from insurance companies to doctors to patients themselves. Many view therapy as this huge time commitment, rather than seeing its true value. Not great, right?In this episode, Alex and I are talking about this. We're tackling Remote Therapeutic Monitoring (RTM) and its connection to the recently update Innovation Center Strategy - stuff that could completely reshape your practice. This isn't just about boring billing codes - it's about positioning yourself at the cutting edge of healthcare.We are sharing helpful insights about healthcare tech, new payment models, and what it means for your future. Plus, you won't want to miss Alex's brilliant "train model" that perfectly shows how digital and in-person care can work together seamlessly.We're also sharing what the CMS Innovation Center leadership said in their blog and in recent public appearances about their vision for healthcare's future. Every week, we update our Resources Database, which is available to all newsletter subscribers. Not a subscriber yet? Sign up here! It's free and we send valuable resources right to your inbox every week.Chapters00:00 The Future of Care Delivery Models06:00 The Importance of Quality Data in EMR Systems08:35 Navigating Regulatory Changes in Healthcare10:46 The Impact of Technology on Patient Care13:41 Conclusion and Future Directions18:37 Innovative Models in Medicare Services20:42 The Role of Data in Patient Care22:33 Future of Therapy: Embracing Change25:43 Case Studies: Remote Therapeutic Monitoring28:14 Valuing Preventive Care in Therapy32:08 Understanding Episode Groupers36:10 Collaboration Across Disciplines40:13 Advocacy and Access to Care

Episode 12: Digital Meet Physical: The Next Era of Physical Therapy

Want to stay ahead of the curve in physical therapy? Future Proof PT brings you straight-talking, no-nonsense conversations about what really matters in healthcare today. From dissecting policy risks and opportunities to exploring innovative practice and payment models to practical ways to accelerate your career growth, we're your go-to source for understanding the forces reshaping our profession and the healthcare industry at large. Through candid dialogue and real-world perspectives, we're building a community of forward-thinking professionals working both in and out of direct patient care. They aren't just adapting to change – they're shaping it. Whether you're looking to understand market dynamics or seeking professional growth, each episode delivers actionable insights that will transform how you view the future of healthcare. Come join the conversation!

Want to stay ahead of the curve in physical therapy? Future Proof PT brings you straight-talking, no-nonsense conversations about what really matters in healthcare today. From dissecting policy risks and opportunities to exploring innovative practice and payment models to practical ways to accelerate your career growth, we're your go-to source for understanding the forces reshaping our profession and the healthcare industry at large.Through candid dialogue and real-world perspectives, we're building a community of forward-thinking professionals working both in and out of direct patient care. They aren't just adapting to change – they're shaping it.Whether you're looking to understand market dynamics or seeking professional growth, each episode delivers actionable insights that will transform how you view the future of healthcare. Come join the conversation!

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Future-Proof PT

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