<h3>Duke's Dr. Chad Cook on the 5 things MSK therapists obsess over, and what we should be doing instead</h3> A VA physician once told a colleague of Dr. Chad Cook's that physical therapy isn't really the movement profession, it's the Swiss Army knife profession, because PTs do a little bit of everything. Whenever no one else knows what to do, the patient gets sent to PT to "get it sorted out." Chad isn't sure he disagrees. In this episode, Chad joins Alex and Dana to walk through five sacred cows in MSK physical therapy. These are the things clinicians treat as essential that, in his view, matter far less than the profession believes, and the skills we should be leaning into instead. Chad is a tenured professor at Duke University with appointments in Orthopaedics, Population Health Sciences, and the Duke Clinical Research Institute. He's been a PT for 36 years, a health services researcher for 27, and is one of the most cited voices in our field. What we cover: <ul><li>Why the "movement expert" identity has limited what PT can become, and the cost of letting ourselves be bucketed as specialists when so much of what we do is primary care</li><li>Where tissue-specific diagnosis still matters (red-flag screening) and where it really doesn't (the 56 SIJ tests, the rotator cuff special-test rabbit hole)</li><li>Why treatment specificity often doesn't drive outcomes, and what therapeutic ritual, contextual packaging, and alliance actually do</li><li>How the top 10% of clinicians handle session-by-session symptom fluctuation without losing the long-term trajectory</li><li>Why social media arguments about exercise intensity and volume miss the point, and what behavior change should look like instead</li></ul> Plus three threads that emerged outside the five-things framework: <ul><li>The case for training prognosis communication with the same rigor as diagnosis, and why patients are really looking for someone who can tell them what to expect</li><li>What top US psychologists told Chad about the power of physical touch: "You're lucky. You can put your hands on your patients. We don't have that." — and why it's a privilege PTs underuse</li><li>The phrase from one of Chad's fibromyalgia patients that frames what he thinks PT actually is: "negotiated behavior change"</li></ul> Dr. Cook shares some uncomfortable numbers that we need to face to address.-75% of PT referrals never initiate,-30% drop off after the first visit,-and MSK patient outcomes have actually gotten worse over the last two decades Plus, where Chad sees AI, digital-first care, and lifestyle medicine fitting in. Chapters 00:00 Introduction to Dr. Chad Cook02:56 The Identity Crisis in Physical Therapy05:47 The Role of Physical Therapists in Primary Care08:33 The Precision Paradox in Treatment10:51 The Emotional Aspect of Diagnosis13:29 The Transition to Self-Management15:41 The Impact of Digital Health Solutions18:20 The Future of Physical Therapy28:45 Navigating Uncertainty in Healthcare30:45 The Digital Transformation of Health Systems32:08 The Role of AI in Patient Care36:51 Understanding Patient Recovery Trajectories39:36 The Importance of Prognosis in Therapy46:04 Redefining Exercise and Patient Engagement50:48 The Power of Touch in Therapy55:22 Negotiating Behavioral Change in Healthcare59:09 The Future of Physical Therapy Find the full transcript <a href="https://www.notion.so/Transcript-for-Episode-31-with-Dr-Chad-Cook-AI-Generated-by-Riverside-36b2cee6a6d980078379dbfe3dcb5ba9?pvs=21" rel="noopener noreferrer" target="_blank">here.</a> Related: <a href="https://listen.hubhopper.com/episode/episode-30-one-bad-experience-with-pt-loses-patients-forever-with-dr-trevor-lentz-pt-phd-mph/33004593" rel="noopener noreferrer" target="_blank">Episode 30</a> with Dr. Trevor Lentz About our Guest: <a href="https://www.linkedin.com/in/chad-cook-22150510/" rel="noopener noreferrer" target="_blank">Dr. Chad Cook</a> is a tenured professor at Duke University with appointments in the Department of Orthopaedics, the Duke Clinical Research Institute, and the Department of Population Health Sciences. He is a physical therapist with more than 36 years of clinical experience, an active health services researcher, and a clinical board member for multiple healthcare organizations. Dr. Cook has been involved in securing over $16 million in external funding and has authored more than 450 peer reviewed manuscripts, 46 book chapters, and four textbooks. He has delivered over 100 keynote lectures across 40 countries. Chad’s recent article in Journal of Orthopaedic and Sports Physical Therapy: <a href="https://www.jospt.org/doi/abs/10.2519/jospt.2026.13992" rel="noopener noreferrer" target="_blank">Many Paths to Recovery: The Case for Treatment Pluralism.</a> About the show: Future Proof PT is a podcast for physical therapists who want to think beyond the clinic, about policy, payment, identity, and the future of the profession. Hosts: Alex Bendersky and Dana Strauss Want information on PT and OT reimbursement and opportunities in policy and advocacy? Read Dana's guest post series for <a href="https://otpotential.com/ceu-podcast-courses/how-ots-and-pts-get-paid" rel="noopener noreferrer" target="_blank">OT Potential</a> here: <a href="https://otpotential.com/ceu-podcast-courses/how-ots-and-pts-get-paid" rel="noopener noreferrer" target="_blank">"How OTs and PTs Get Paid."</a> Follow <a href="https://www.linkedin.com/in/danastraussdpt/" rel="noopener noreferrer" target="_blank">Dana Strauss</a> on Linked In.Follow <a href="https://www.linkedin.com/in/alexbenderskydpt/" rel="noopener noreferrer" target="_blank">Alex Bendersky</a> on Linked In.Subscribe to the <a href="https://www.linkedin.com/search/results/all/?keywords=future%20proof%20pt&origin=RICH_QUERY_SUGGESTION&heroEntityKey=urn%3Ali%3Aorganization%3A105894611&position=0" rel="noopener noreferrer" target="_blank">Future Proof PT</a> Linked In page. Subscribe to the <a href="https://www.youtube.com/@FutureProofPT" rel="noopener noreferrer" target="_blank">Future Proof PT</a> YouTube Channel.Subscribe to our <a href="https://future-proof-pt.beehiiv.com/subscribe" rel="noopener noreferrer" target="_blank">newsletter and email list</a>. Subscribe to our sister newsletter, <a href="https://www.timelessautonomy.com/subscribe" rel="noopener noreferrer" target="_blank">Timeless Autonomy,</a> Dana covers health policy insights and career growth tips for healthcare professionals and sends a weekly newsletter (nearly) every Sunday evening.

Duke's Dr. Chad Cook on the 5 things MSK therapists obsess over, and what we should be doing insteadA VA physician once told a colleague of Dr. Chad Cook's that physical therapy isn't really the movement profession, it's the Swiss Army knife profession, because PTs do a little bit of everything. Whenever no one else knows what to do, the patient gets sent to PT to "get it sorted out."Chad isn't sure he disagrees. In this episode, Chad joins Alex and Dana to walk through five sacred cows in MSK physical therapy. These are the things clinicians treat as essential that, in his view, matter far less than the profession believes, and the skills we should be leaning into instead. Chad is a tenured professor at Duke University with appointments in Orthopaedics, Population Health Sciences, and the Duke Clinical Research Institute. He's been a PT for 36 years, a health services researcher for 27, and is one of the most cited voices in our field.What we cover:Why the "movement expert" identity has limited what PT can become, and the cost of letting ourselves be bucketed as specialists when so much of what we do is primary careWhere tissue-specific diagnosis still matters (red-flag screening) and where it really doesn't (the 56 SIJ tests, the rotator cuff special-test rabbit hole)Why treatment specificity often doesn't drive outcomes, and what therapeutic ritual, contextual packaging, and alliance actually doHow the top 10% of clinicians handle session-by-session symptom fluctuation without losing the long-term trajectoryWhy social media arguments about exercise intensity and volume miss the point, and what behavior change should look like insteadPlus three threads that emerged outside the five-things framework:The case for training prognosis communication with the same rigor as diagnosis, and why patients are really looking for someone who can tell them what to expectWhat top US psychologists told Chad about the power of physical touch: "You're lucky. You can put your hands on your patients. We don't have that." — and why it's a privilege PTs underuseThe phrase from one of Chad's fibromyalgia patients that frames what he thinks PT actually is: "negotiated behavior change"Dr. Cook shares some uncomfortable numbers that we need to face to address.-75% of PT referrals never initiate,-30% drop off after the first visit,-and MSK patient outcomes have actually gotten worse over the last two decadesPlus, where Chad sees AI, digital-first care, and lifestyle medicine fitting in.Chapters00:00 Introduction to Dr. Chad Cook02:56 The Identity Crisis in Physical Therapy05:47 The Role of Physical Therapists in Primary Care08:33 The Precision Paradox in Treatment10:51 The Emotional Aspect of Diagnosis13:29 The Transition to Self-Management15:41 The Impact of Digital Health Solutions18:20 The Future of Physical Therapy28:45 Navigating Uncertainty in Healthcare30:45 The Digital Transformation of Health Systems32:08 The Role of AI in Patient Care36:51 Understanding Patient Recovery Trajectories39:36 The Importance of Prognosis in Therapy46:04 Redefining Exercise and Patient Engagement50:48 The Power of Touch in Therapy55:22 Negotiating Behavioral Change in Healthcare59:09 The Future of Physical TherapyFind the full transcript here.Related: Episode 30 with Dr. Trevor LentzAbout our Guest:Dr. Chad Cook is a tenured professor at Duke University with appointments in the Department of Orthopaedics, the Duke Clinical Research Institute, and the Department of Population Health Sciences. He is a physical therapist with more than 36 years of clinical experience, an active health services researcher, and a clinical board member for multiple healthcare organizations. Dr. Cook has been involved in securing over $16 million in external funding and has authored more than 450 peer reviewed manuscripts, 46 book chapters, and four textbooks. He has delivered over 100 keynote lectures across 40 countries.Chad’s recent article in Journal of Orthopaedic and Sports Physical Therapy: Many Paths to Recovery: The Case for Treatment Pluralism.About the show: Future Proof PT is a podcast for physical therapists who want to think beyond the clinic, about policy, payment, identity, and the future of the profession.Hosts: Alex Bendersky and Dana StraussWant information on PT and OT reimbursement and opportunities in policy and advocacy? Read Dana's guest post series for OT Potential here: "How OTs and PTs Get Paid."Follow Dana Strauss on Linked In.Follow Alex Bendersky on Linked In.Subscribe to the Future Proof PT Linked In page.Subscribe to the Future Proof PT YouTube Channel.Subscribe to our newsletter and email list.Subscribe to our sister newsletter, Timeless Autonomy, Dana covers health policy insights and career growth tips for healthcare professionals and sends a weekly newsletter (nearly) every Sunday evening.

Future-Proof PT

Episode 31: Physical Therapy is the Swiss Army Knife Profession

<h3>And the active ingredients in PT often aren't even physical</h3> "We have the capacity to provide a level of care that nobody else in the healthcare system does. But we're being hamstrung by the payment models." — Dr. Trevor Lentz Dr. Trevor Lentz of Duke University on why patients write off physical therapy after one failed attempt, what the profession is actually selling, and the payment models keeping PT from delivering its real value. In this episode, Alex Bendersky and Dana Strauss sit down with Dr. Trevor Lentz, physical therapist, researcher, and faculty at Duke University, to unpack the structural and identity challenges facing the profession. The conversation moves across patient defection, language and labeling, payment reform, phenotyping, and what it would take to build longitudinal care models that finally pay therapists for outcomes rather than volume. What you'll hear: <ul><li>Why a single bad round of PT loses patients for life, and why the same isn't true for dentistry or primary care.</li><li>The challenge of fostering critical thinking and comfort with uncertainty in clinical education.</li><li>Trevor's research on removing copays, what it actually did to costs, and what payers misunderstand about long-term value.</li><li>The case that PT's active ingredients aren't physical, and why the language we use, from "assistant" to "exercise" to "blown disc," is quietly damaging the profession.</li><li>How <a href="https://www.dukehealth.org/treatments/orthopaedics/joint-health-program" rel="noopener noreferrer" target="_blank">Duke's Joint Health Program</a> built a longitudinal care model before the payment model existed.</li><li>Phenotyping, tiered care, and what it means for therapists to be the quarterback of a patient's care journey.</li><li>The <a href="https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2847237" rel="noopener noreferrer" target="_blank">AIM-Back trial </a>and the Pain Navigator program, recently published in JAMA Network Open, and what it teaches about scaling non-pharmacologic care.</li></ul> <h4>Find the complete transcript and outline <a href="https://www.notion.so/dsuzanne/Episode-30-Future-Proof-PT-Outline-and-Full-Transcript-3542cee6a6d980f99214e2c4b2638dc2?source=copy_link" rel="noopener noreferrer" target="_blank">here.</a></h4> Chapters: 00:00 Introduction00:23 Trevor's background and path to research03:00 Day-to-day at Duke03:54 Inductive vs. deductive reasoning in clinical practice05:39 The No-Copay Revolution study09:30 Horizontal vs. vertical value and the time-horizon problem12:44 Rethinking incentives and longitudinal care17:28 Why one bad PT experience ends the relationship forever20:53 The identity crisis and language problem26:57 Phenotyping and tiered, personalized care39:32 The Pain Navigator program and AIMBAC trial46:23 Navigators in the commercial space48:14 Closing: the whole-person argument About the guest: <a href="https://ortho.duke.edu/personnel/trevor-lentz-pt-phd-mph" rel="noopener noreferrer" target="_blank" style="color: rgb(34, 34, 34);">Trevor Lentz, PT, PhD, MPH</a> is an Associate Professor in Orthopaedic Surgery at Duke University and a licensed physical therapist. His work focuses on improving outcomes in musculoskeletal care by integrating behavioral and psychological factors, patient-reported outcomes, and real-world data into clinical decision-making. He leads and collaborates on pragmatic and hybrid effectiveness-implementation studies aimed at translating evidence into routine surgical and non-surgical musculoskeletal care. About the show: Future Proof PT is a podcast for physical therapists who want to think beyond the clinic, about policy, payment, identity, and the future of the profession. Hosts: Alex Bendersky and Dana Strauss Want information on PT and OT reimbursement and opportunities in policy and advocacy? Read Dana's guest post series for <a href="https://otpotential.com/ceu-podcast-courses/how-ots-and-pts-get-paid" rel="noopener noreferrer" target="_blank">OT Potential</a> here: <a href="https://otpotential.com/ceu-podcast-courses/how-ots-and-pts-get-paid" rel="noopener noreferrer" target="_blank">"How OTs and PTs Get Paid."</a> Follow<a href="https://www.linkedin.com/in/danastraussdpt/" rel="noopener noreferrer" target="_blank"> Dana Strauss </a>on Linked In.Follow <a href="https://www.linkedin.com/in/alexbenderskydpt/" rel="noopener noreferrer" target="_blank">Alex Bendersky</a> on Linked In. Subscribe to the <a href="https://www.linkedin.com/search/results/all/?keywords=future%20proof%20pt&origin=RICH_QUERY_SUGGESTION&heroEntityKey=urn%3Ali%3Aorganization%3A105894611&position=0" rel="noopener noreferrer" target="_blank">Future Proof PT</a> Linked In page.Subscribe to the <a href="https://www.youtube.com/@FutureProofPT" rel="noopener noreferrer" target="_blank">Future Proof PT</a> YouTube Channel.Subscribe to our <a href="https://future-proof-pt.beehiiv.com/subscribe" rel="noopener noreferrer" target="_blank">newsletter and email list</a>. Subscribe to our sister newsletter, <a href="https://studio.hubhopper.com/podcasts/459285/episodes/32994044/www.timelessautonomy.com/subscribe" rel="noopener noreferrer" target="_blank">Timeless Autonomy,</a> Dana covers health policy insights and career growth tips for healthcare professionals and sends a weekly newsletter (nearly) every Sunday evening.

And the active ingredients in PT often aren't even physical"We have the capacity to provide a level of care that nobody else in the healthcare system does. But we're being hamstrung by the payment models." — Dr. Trevor LentzDr. Trevor Lentz of Duke University on why patients write off physical therapy after one failed attempt, what the profession is actually selling, and the payment models keeping PT from delivering its real value.In this episode, Alex Bendersky and Dana Strauss sit down with Dr. Trevor Lentz, physical therapist, researcher, and faculty at Duke University, to unpack the structural and identity challenges facing the profession.The conversation moves across patient defection, language and labeling, payment reform, phenotyping, and what it would take to build longitudinal care models that finally pay therapists for outcomes rather than volume.What you'll hear:Why a single bad round of PT loses patients for life, and why the same isn't true for dentistry or primary care.The challenge of fostering critical thinking and comfort with uncertainty in clinical education.Trevor's research on removing copays, what it actually did to costs, and what payers misunderstand about long-term value.The case that PT's active ingredients aren't physical, and why the language we use, from "assistant" to "exercise" to "blown disc," is quietly damaging the profession.How Duke's Joint Health Program built a longitudinal care model before the payment model existed.Phenotyping, tiered care, and what it means for therapists to be the quarterback of a patient's care journey.The AIM-Back trial and the Pain Navigator program, recently published in JAMA Network Open, and what it teaches about scaling non-pharmacologic care.Find the complete transcript and outline here.Chapters:00:00 Introduction00:23 Trevor's background and path to research03:00 Day-to-day at Duke03:54 Inductive vs. deductive reasoning in clinical practice05:39 The No-Copay Revolution study09:30 Horizontal vs. vertical value and the time-horizon problem12:44 Rethinking incentives and longitudinal care17:28 Why one bad PT experience ends the relationship forever20:53 The identity crisis and language problem26:57 Phenotyping and tiered, personalized care39:32 The Pain Navigator program and AIMBAC trial46:23 Navigators in the commercial space48:14 Closing: the whole-person argumentAbout the guest:Trevor Lentz, PT, PhD, MPH is an Associate Professor in Orthopaedic Surgery at Duke University and a licensed physical therapist. His work focuses on improving outcomes in musculoskeletal care by integrating behavioral and psychological factors, patient-reported outcomes, and real-world data into clinical decision-making. He leads and collaborates on pragmatic and hybrid effectiveness-implementation studies aimed at translating evidence into routine surgical and non-surgical musculoskeletal care.About the show: Future Proof PT is a podcast for physical therapists who want to think beyond the clinic, about policy, payment, identity, and the future of the profession.Hosts: Alex Bendersky and Dana StraussWant information on PT and OT reimbursement and opportunities in policy and advocacy? Read Dana's guest post series for OT Potential here: "How OTs and PTs Get Paid."Follow Dana Strauss on Linked In.Follow Alex Bendersky on Linked In.Subscribe to the Future Proof PT Linked In page.Subscribe to the Future Proof PT YouTube Channel.Subscribe to our newsletter and email list.Subscribe to our sister newsletter, Timeless Autonomy, Dana covers health policy insights and career growth tips for healthcare professionals and sends a weekly newsletter (nearly) every Sunday evening.

Episode 30: One Bad Experience with PT Loses Patients Forever with Dr. Trevor Lentz, PT, PhD, MPH

<h2>Why content follows culture, and practical actions clinic owners can implement within the next 3 months.</h2> Find the full episode transcript <a href="https://futureproofpt.notion.site/Episode-29-Transcript-with-Kylie-Williams-3462cee6a6d98070b6c6d286228ec861" rel="noopener noreferrer" target="_blank">here.</a> Posting more isn’t a growth strategy. Kylie Williams joins us to break down why “marketing to patients” on social media is getting harder, and why the clinics that win are the ones building culture that therapists actually want to be part of. We talk retention, autonomy, flexibility, benefits that matter, and a simple “side quest” approach to content that does not derail clinical excellence. Kylie is a healthcare professional with 8+ years of experience in physical therapy as a PTA. Now in a non-clinical role, she focuses on industry market analysis and storytelling to help private practices grow, adapt, and stay strong in a change healthcare landscape. Key Topics: -Social media's impact on private practice growth-Creating a strong clinic culture to reduce turnover-Innovative marketing strategies for healthcare providers Chapters: 00:00 Introduction to Kylie Williams01:36 The Importance of Culture in Physical Therapy05:05 Defining and Building a Positive Work Culture09:29 Targeting the Right Audience for Recruitment18:15 First Principles for Engaging New Clinicians23:07 The Impact of Social Media on Attention Spans23:40 Balancing Attention and Depth in Learning25:20 Navigating the Attention Economy26:10 Attracting Talent in a Digital Age27:04 Creating Value in Social Media Content28:27 The Challenge of Teaching Value in Social Media30:18 Connecting Social Media to Business Success32:12 Investing in Marketing Education for Therapists34:03 Finding Balance in Clinical and Promotional Roles37:15 The Role of Influencers in Modern Careers39:07 Empowering Clinicians to Pursue Side Projects40:47 The Importance of Agency in Clinical Roles42:36 Shifting Paradigms in Therapy Business Models44:40 Embracing Creativity and Optimism in Therapy Want information on PT and OT reimbursement and opportunities in policy and advocacy?Read Dana's guest post series for <a href="https://otpotential.com/ceu-podcast-courses/how-ots-and-pts-get-paid" rel="noopener noreferrer" target="_blank">OT Potential</a> here: <a href="https://otpotential.com/ceu-podcast-courses/how-ots-and-pts-get-paid" rel="noopener noreferrer" target="_blank">"How OTs and PTs Get Paid."</a> Follow<a href="https://www.linkedin.com/in/danastraussdpt/" rel="noopener noreferrer" target="_blank"> Dana Strauss </a>on Linked In.Follow <a href="https://www.linkedin.com/in/alexbenderskydpt/" rel="noopener noreferrer" target="_blank">Alex Bendersky</a> on Linked In. Subscribe to the <a href="https://www.linkedin.com/search/results/all/?keywords=future%20proof%20pt&origin=RICH_QUERY_SUGGESTION&heroEntityKey=urn%3Ali%3Aorganization%3A105894611&position=0" rel="noopener noreferrer" target="_blank">Future Proof PT</a> Linked In page.Subscribe to the <a href="https://www.youtube.com/@FutureProofPT" rel="noopener noreferrer" target="_blank">Future Proof PT</a> YouTube Channel.Subscribe to our <a href="https://future-proof-pt.beehiiv.com/subscribe" rel="noopener noreferrer" target="_blank">newsletter and email list</a> for exclusive content. Subscribe to our sister newsletter, <a href="https://studio.hubhopper.com/podcasts/459285/episodes/32994044/www.timelessautonomy.com/subscribe" rel="noopener noreferrer" target="_blank">Timeless Autonomy,</a> Dana covers health policy insights and career growth tips for healthcare professionals and sends a weekly newsletter every Sunday evening.

Why content follows culture, and practical actions clinic owners can implement within the next 3 months.Find the full episode transcript here.Posting more isn’t a growth strategy. Kylie Williams joins us to break down why “marketing to patients” on social media is getting harder, and why the clinics that win are the ones building culture that therapists actually want to be part of. We talk retention, autonomy, flexibility, benefits that matter, and a simple “side quest” approach to content that does not derail clinical excellence.Kylie is a healthcare professional with 8+ years of experience in physical therapy as a PTA. Now in a non-clinical role, she focuses on industry market analysis and storytelling to help private practices grow, adapt, and stay strong in a change healthcare landscape.Key Topics:-Social media's impact on private practice growth-Creating a strong clinic culture to reduce turnover-Innovative marketing strategies for healthcare providersChapters:00:00 Introduction to Kylie Williams01:36 The Importance of Culture in Physical Therapy05:05 Defining and Building a Positive Work Culture09:29 Targeting the Right Audience for Recruitment18:15 First Principles for Engaging New Clinicians23:07 The Impact of Social Media on Attention Spans23:40 Balancing Attention and Depth in Learning25:20 Navigating the Attention Economy26:10 Attracting Talent in a Digital Age27:04 Creating Value in Social Media Content28:27 The Challenge of Teaching Value in Social Media30:18 Connecting Social Media to Business Success32:12 Investing in Marketing Education for Therapists34:03 Finding Balance in Clinical and Promotional Roles37:15 The Role of Influencers in Modern Careers39:07 Empowering Clinicians to Pursue Side Projects40:47 The Importance of Agency in Clinical Roles42:36 Shifting Paradigms in Therapy Business Models44:40 Embracing Creativity and Optimism in TherapyWant information on PT and OT reimbursement and opportunities in policy and advocacy?Read Dana's guest post series for OT Potential here: "How OTs and PTs Get Paid."Follow Dana Strauss on Linked In.Follow Alex Bendersky on Linked In.Subscribe to the Future Proof PT Linked In page.Subscribe to the Future Proof PT YouTube Channel.Subscribe to our newsletter and email list for exclusive content.Subscribe to our sister newsletter, Timeless Autonomy, Dana covers health policy insights and career growth tips for healthcare professionals and sends a weekly newsletter every Sunday evening.

Episode 29: Build a PT and OT Clinic Where Therapists Want to Work

<h3>How RVUs (Not the Conversion Factor) Quietly Squeeze PT and OT and the Practical Blueprint to Shift From "Minutes" to ACO-Ready Value</h3> <a href="https://futureproofpt.notion.site/Future-Proof-PT-Episode-28-Transcript-3312cee6a6d98065896fd565ff9aa62f?source=copy_link" rel="noopener noreferrer" target="_blank">(read the full transcript here)</a> In this episode, Alex and Dana discuss the CMMI ACCESS Model and what it could unlock for MSK care inside ACOs. They debate digital enablement reality and explain how aligned incentives can reshape referral pathways. They make a direct case the that the physical therapy profession's future depends on understanding payment mechanics. A core theme of this episode is that if PT stays positioned as specialty care based on "treatment minutes" as the primary service, it will keep losing in a system shifting relative value units (RVUs) toward primary care and behavioral health. If PT repositions around evaluation-driven expertise and ACO partnership, the profession can move from survival to influence. <h4>Here's what else you'll learn:</h4> <ul><li>Why the ACCESS Model payments are intentionally low, and why that is not the point.</li><li>How ACOs think about total cost of care and why MSK spend is hard for primary care to manage.</li><li>What “aligned incentives” can look like in a PCP + ACO + ACCESS org + PT partnership.</li><li>Why engagement is often 3–5% for digital MSK programs, and what that means in context.</li><li>A practical “go do this tomorrow” play for clinics: identify local ACO participants and pursue Preferred Provider relationships.</li><li>The RVU basics most therapists never learned, and why it changes your advocacy strategy.</li><li>Why PTs should prioritize evaluation, differential diagnosis, and plan-setting, with PTAs executing more follow-up care.</li><li>How waitlists and access challenges become non-starters if PT wants to play in ACO-aligned care.</li><li>A potential new productivity mindset: RVU-based expectations instead of “visits per week.”</li></ul> Want more information on PT and OT reimbursement and opportunities in policy and advocacy?Read Dana's guest post series for <a href="https://otpotential.com/ceu-podcast-courses/how-ots-and-pts-get-paid" rel="noopener noreferrer" target="_blank">OT Potential</a> here: <a href="https://otpotential.com/ceu-podcast-courses/how-ots-and-pts-get-paid" rel="noopener noreferrer" target="_blank">"How OTs and PTs Get Paid."</a> Follow<a href="https://www.linkedin.com/in/danastraussdpt/" rel="noopener noreferrer" target="_blank"> Dana Strauss </a>on Linked In.Follow <a href="https://www.linkedin.com/in/alexbenderskydpt/" rel="noopener noreferrer" target="_blank">Alex Bendersky</a> on Linked In. Subscribe to the <a href="https://www.linkedin.com/search/results/all/?keywords=future%20proof%20pt&origin=RICH_QUERY_SUGGESTION&heroEntityKey=urn%3Ali%3Aorganization%3A105894611&position=0" rel="noopener noreferrer" target="_blank">Future Proof PT</a> Linked In page.Subscribe to the <a href="https://www.youtube.com/@FutureProofPT" rel="noopener noreferrer" target="_blank">Future Proof PT</a> YouTube Channel.Subscribe to our <a href="https://future-proof-pt.beehiiv.com/subscribe" rel="noopener noreferrer" target="_blank">newsletter and email list</a> for exclusive content. Subscribe to our sister newsletter, <a href="https://studio.hubhopper.com/podcasts/459285/episodes/32994044/www.timelessautonomy.com/subscribe" rel="noopener noreferrer" target="_blank">Timeless Autonomy,</a> Dana covers health policy insights and career growth tips for healthcare professionals and sends a weekly newsletter every Sunday evening.

How RVUs (Not the Conversion Factor) Quietly Squeeze PT and OT and the Practical Blueprint to Shift From "Minutes" to ACO-Ready Value(read the full transcript here)In this episode, Alex and Dana discuss the CMMI ACCESS Model and what it could unlock for MSK care inside ACOs. They debate digital enablement reality and explain how aligned incentives can reshape referral pathways. They make a direct case the that the physical therapy profession's future depends on understanding payment mechanics.A core theme of this episode is that if PT stays positioned as specialty care based on "treatment minutes" as the primary service, it will keep losing in a system shifting relative value units (RVUs) toward primary care and behavioral health. If PT repositions around evaluation-driven expertise and ACO partnership, the profession can move from survival to influence.Here's what else you'll learn:Why the ACCESS Model payments are intentionally low, and why that is not the point.How ACOs think about total cost of care and why MSK spend is hard for primary care to manage.What “aligned incentives” can look like in a PCP + ACO + ACCESS org + PT partnership.Why engagement is often 3–5% for digital MSK programs, and what that means in context.A practical “go do this tomorrow” play for clinics: identify local ACO participants and pursue Preferred Provider relationships.The RVU basics most therapists never learned, and why it changes your advocacy strategy.Why PTs should prioritize evaluation, differential diagnosis, and plan-setting, with PTAs executing more follow-up care.How waitlists and access challenges become non-starters if PT wants to play in ACO-aligned care.A potential new productivity mindset: RVU-based expectations instead of “visits per week.”Want more information on PT and OT reimbursement and opportunities in policy and advocacy?Read Dana's guest post series for OT Potential here: "How OTs and PTs Get Paid."Follow Dana Strauss on Linked In.Follow Alex Bendersky on Linked In.Subscribe to the Future Proof PT Linked In page.Subscribe to the Future Proof PT YouTube Channel.Subscribe to our newsletter and email list for exclusive content.Subscribe to our sister newsletter, Timeless Autonomy, Dana covers health policy insights and career growth tips for healthcare professionals and sends a weekly newsletter every Sunday evening.

Episode 28: Skin in the Game: How PT Wins in the ACCESS Model

<h2>A reality-check on what works today, what is hype, and what must improve before digital-first MSK care earns trust</h2> We sit down today with <a href="https://www.linkedin.com/in/sergeiai/" rel="noopener noreferrer" target="_blank">Sergei Polevikov</a> (<a href="http://FixHealth.ai" rel="noopener noreferrer" target="_blank">FixHealth.ai</a>, <a href="http://Well.AI" rel="noopener noreferrer" target="_blank">Well.AI</a> / Chart2Chart) for a reality-check conversation on what AI in healthcare actually is, where it genuinely helps today, and where the hype can cause harm. Sergei breaks down AI’s evolution from early machine learning to modern transformer models, then moves from definitions into the real stakes: transparency, validation, and workflow fit. Then we discuss with him the risk of overpromising in musculoskeletal care. The conversation zooms in on a massive, under-discussed shift: Medicare’s growing interest in digitally enabled care models that can substitute for traditional services, and what that could mean for PTs, patients, and outcomes. Sergei explains why digital-first triage is likely the future, while also outlining the biggest watch-outs right now, including hallucinations, automation bias, incomplete data, and the lack of real-time interoperability that healthcare needs most. We also cover a PT and OT relevant rubric for separating hype from real clinical value: does the tool augment PT judgment and continuity of care, or is it being positioned (and reimbursed) to substitute for PT, especially in emerging Medicare digital-first models? Takeaways from the episode should help outline what to pressure-test before adoption or referral: safety guardrails and hallucination risk, transparency and validation in real-world MSK populations, EHR/workflow fit (not “more clicks”), and whether the vendor’s incentives align with outcomes vs. billing. Clinicians are concerned about AI "replacing clinicians tomorrow," but that's not reality and it distracts from the real issue. The biggest threat is poorly governed digital care pathways that can bypass PT and OT, fragment care, and dilute instead of improve accountability unless the evidence and oversight are truly there. Follow<a href="https://www.linkedin.com/in/danastraussdpt/" rel="noopener noreferrer" target="_blank"> Dana Strauss </a>on Linked In.Follow <a href="https://www.linkedin.com/in/alexbenderskydpt/" rel="noopener noreferrer" target="_blank">Alex Bendersky</a> on Linked In. Subscribe to the <a href="https://www.linkedin.com/search/results/all/?keywords=future%20proof%20pt&origin=RICH_QUERY_SUGGESTION&heroEntityKey=urn%3Ali%3Aorganization%3A105894611&position=0" rel="noopener noreferrer" target="_blank">Future Proof PT</a> Linked In page.Subscribe to the <a href="https://www.youtube.com/@FutureProofPT" rel="noopener noreferrer" target="_blank">Future Proof PT</a> YouTube Channel.Subscribe to our <a href="https://future-proof-pt.beehiiv.com/subscribe" rel="noopener noreferrer" target="_blank">newsletter and email list</a> for exclusive content.

A reality-check on what works today, what is hype, and what must improve before digital-first MSK care earns trustWe sit down today with Sergei Polevikov (FixHealth.ai, Well.AI / Chart2Chart) for a reality-check conversation on what AI in healthcare actually is, where it genuinely helps today, and where the hype can cause harm.Sergei breaks down AI’s evolution from early machine learning to modern transformer models, then moves from definitions into the real stakes: transparency, validation, and workflow fit. Then we discuss with him the risk of overpromising in musculoskeletal care.The conversation zooms in on a massive, under-discussed shift: Medicare’s growing interest in digitally enabled care models that can substitute for traditional services, and what that could mean for PTs, patients, and outcomes. Sergei explains why digital-first triage is likely the future, while also outlining the biggest watch-outs right now, including hallucinations, automation bias, incomplete data, and the lack of real-time interoperability that healthcare needs most.We also cover a PT and OT relevant rubric for separating hype from real clinical value: does the tool augment PT judgment and continuity of care, or is it being positioned (and reimbursed) to substitute for PT, especially in emerging Medicare digital-first models?Takeaways from the episode should help outline what to pressure-test before adoption or referral: safety guardrails and hallucination risk, transparency and validation in real-world MSK populations, EHR/workflow fit (not “more clicks”), and whether the vendor’s incentives align with outcomes vs. billing.Clinicians are concerned about AI "replacing clinicians tomorrow," but that's not reality and it distracts from the real issue. The biggest threat is poorly governed digital care pathways that can bypass PT and OT, fragment care, and dilute instead of improve accountability unless the evidence and oversight are truly there.Follow Dana Strauss on Linked In.Follow Alex Bendersky on Linked In.Subscribe to the Future Proof PT Linked In page.Subscribe to the Future Proof PT YouTube Channel.Subscribe to our newsletter and email list for exclusive content.

Episode 27: The $900 Billion Problem | Can AI Actually Fix Musculoskeletal Care?

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

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

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!