PTO 84 | Peak Productivity Program


Are you in a place now where you're struggling to grow and increase your clinic’s cash flow? Host, Nathan Shields, helps you in this new series that breaks down one of his main programs called 180 Days to Peak Productivity. Having been exclusively providing this in his business consulting and coaching to independent PT business owners around the country, Nathan now opens up this seven-step process for you! He shares a general framework that will get peak production and efficiency out of your clinic, leading to greater patient results, revenues, and profits. In this episode, Nathan kicks off the series with the first step of the Peak Productivity Program. Following these steps is what you'll need to make the most out of what you've established and set yourself up for growth in the long term. Pay attention to what Nathan is going to share, and hopefully, you'll find yourself with more profits and freedom!


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Increased Cash Flow In 30 Days: Step One Of The Peak Productivity Program

If you've read my blogs, you know that I've been providing business consulting and coaching to independent PT business owners around the country since about mid-2019. In a series of episodes going forward, I'd like to share with you a general framework or an example of what I'm providing my coaching clients through the work that I'm doing and at least one of my main programs. It's not the be-all and end-all of what I provide and I don't believe it's the answer for everybody. It's simply a good framework for most of my clients that I began working with.

What's the program? It's a seven-step process that I call 180 Days to Peak Productivity. The seven steps include particular statistics or key performance indicators, KPIs, that need to be tracked and improved, programs that are shared and need to be implemented in your company and exercises meant to set and maintain peak productivity standards going forward in your business. Each of the upcoming episodes dedicated to these seven steps, I'll delve into one step at a time that gets my clients and will get you closer to peak clinical production.

The seven steps are not in random order. I purposefully set them up as I did in a sequence that is based on a couple of things. Number one, what is the easiest thing to implement that gets the quickest return. Step one is a free download on my website. It's all about immediately increasing your revenue in 30 days. Subsequent steps take a little bit more work and they involve more moving parts, namely more members of your organization, yet continue to generate greater returns not as quickly as step one.

Making the effort to track and improve this one KPI will result in added revenues for your business (without a single new patient!) Click To Tweet

No matter how well you do in the implementation of my 180 Days to Peak Productivity Program, it will fall flat with your team and it will be hard for you to sustain the gains you make if you don't develop an underlying purpose and establish company values. The importance of both purposes, the why of your clinic and values, how you operate is the subject of a different conversation. I've interviewed Sturdy McKee about purpose. I've interviewed Stephen Rapposelli about values. I interviewed my business partner Will Humphreys about creating a culture within your company. I've interviewed them in the past and I would refer you back to those episodes if you haven't established your purpose and values yet and encourage you to do so. Getting those straight sets you up for sustained long-term growth and success.

I spend plenty of time initially with my clients who have yet to establish those things because I know their value. They are necessary to establish if you want to have freedom and growth in your company. Let's get into the seven steps of my 180 Days to Peak Productivity Program. I'm excited to share these steps with you. If at any time you'd like some help on how to implement these steps or coaching on other aspects of your business, things you're having difficulty with and whatnot, reach out to me individually. I'm excited to share what I've learned with you.


Step one to your path to peak productivity out of your PT clinic is to increase your revenues in 30 days. It's the first step in achieving peak productivity and it gets you the quickest result from your investment of time and energy and gives you one thing to focus on of the many plethoras of things you could do. In fact, if I told you you could increase your revenues by 10% by doing just one thing, would you do it? Of course. If you get nothing else from the other six steps that I'll share, at least focus on this first step and forever. It's a free download on my website,, so you don't have to take notes. Go to the website and you can download it for free.

The one major result from this step is increased revenues and more importantly, increased bottom-line profit because I would assume that your expenses should stay the same even though you take this first step. You don't have to see more patients. You don't have to do any more marketing. Simply be more efficient with the patients that you're currently seeing. The other result as you go through this and the full seven-step process is that they will give you the financial bandwidth to invest more money and/or time back into you. If you have greater revenues, you'll be able to hire the next team member to take the burden off of you, which will allow you to work on your business more, which will generate more patients and opportunities for growth.

With greater revenues at your current volume, you could hire a part-time virtual assistant to do minor admin work or marketing tasks. You could hire another part-time or full-time physical therapist to allow you to work on your business and give you some admin time. Also, provide you the funds you need to invest in a coach or consultant to guide you to become a better business owner and meet your goals. All of this is to say that increasing revenues open more opportunities and freedom. Freedom to work on the business, to spend time with your family or spend time on your hobbies.

The first step in the Seven-Step process to Peak Productivity and Freedom is a simple one. It will not only generate more revenue but also begin transforming your clinic, whether you're a new or established owner. You have to continue to manage and monitor this first action step and that is to track the average skill units, billing per visit, per provider and by the clinic. I call it Skilled Units per Visit or SUV. Consider the following checking questions. Once you have your patients in the door, are you maximizing your services provided? How would you know and how would you monitor that? Are you and your provider team accounting for all of the skilled services that you provide? Are you unknowingly providing your services at a discount or for free to the benefit of the insurance companies and to the detriment of your clinic?

PTO 84 | Peak Productivity Program
Peak Productivity Program: Increasing revenues open more opportunities and freedom.


The answer to these questions is to manage, track and improve your SUV, your average scaled units build per visit. There are four steps to this and the first one is to figure out what your average skilled units per visit build is. You have to eliminate the CPT codes for heat, ice, electrical stimulation and ultrasound if you do those things and focus only on those servers that are reimbursed for skilled services, evals, re-evals, manual therapy, etc. Some EMRs are adept and allow you to generate the report by CPT code and many don't. It will probably be a manual effort for some of you that you eventually will turn over to someone else to do for you, but whether it's you or someone else down the road, it's definitely worth the investment of your time. For flat ratepayers or payers in which you only build one unit per visit with one CPT code, you may have to manually adjust your numbers.

3.0 automatically instead of one if you see a patient for an average of 45 minutes or 4.0 if you see patients for an average of 60 minutes, even though you're only billing one code and so on. You'll have to manually adjust the numbers. Step two is to determine what number is the right SUV for your clinic. Many clinics see patients for an hour. That would put you in the 4.0 skilled units per visit range. If they want to do modalities after the hour and the treatment extends an hour and fifteen minutes because you put ice and stim on at the end of the therapy session, it’s great. That gives you even more possible revenue. The skilled units should equate to the time spent in the clinic. A minimum of 4.0 if it's a 60-minute visit.

If your skilled units per visit average are between 3.4 and 3.6, you should be at 4.0, then obviously you're immediately losing out on 10% to 15% of potential revenue. We saw our patients on an average of about 60 minutes or more and that's expected our providers to properly document and bill for a minimum of 4.0 scale units per visit average each week. Be sure that you are properly, ethically providing and documenting for your skilled services. Most important, don't succumb to devaluing your services. Now, you are tracking the SUV. You have decided what it should be and what is right for your clinic. Step three is to set the standard. That's not only sharing what it should be but also starting to hold the provider team accountable. You know where it should be and you know where it's at.

Looking at the numbers, is there a gap? There typically is and it's usually around the 10% to 15% range. Therapists are known for what I call a compassionate billing out of the fear of overbilling. Overbilling isn't an issue if there's equal stress on proper documentation to support skilled services provided, but it's equally unfair and unethical to underbill for your PT services. It cheats the company and the owner from revenues. It cheats the profession by devaluing your services. All for the benefit of insurance companies who ultimately pay less for physical therapy and thus show evidence for why they should continue to decrease reimbursement rates to physical therapists.

Don't hammer the entire team if just one person is an outlier. Handle the situation individually. Click To Tweet

Clinics who track this statistic initially may have an average skilled unit per visit of 3.4, 3.6 or 3.7 range for patients that are present for 60 minutes on average. Improving this that alone 10% to around 4.0 is an automatic increase in revenues. It should be noted that this deck should improve during weeks with high cancellation rates. More skilled services and additional therapy could be added to patient care for their benefit should the patient before or after them not show up or cancel. If there is a gap, now is the time to set the expectation with your providers. Start tracking the stat and push production to meet the expectation. This requires getting the team buy-in either via one-on-one meetings or during a regular team meeting in which you can explain the value of maximizing skilled services for each visit.

I would refer you to an episode in which I interviewed Arlan Alburo. He discussed the thirteen-step process for getting team buy-in. Look back to that episode and use those thirteen steps to your benefit to get team buy-in with a successful implementation of this program. Ideally, this new program and expectation will then be put in writing as part of the physical therapist and physical therapy assistants' job description and then provide providers in the future a standard going forward. We're tracking the statistic, we know it should be. We've put it in writing and we're announcing the minimum expectation of our providers going forward. That forces to track that routinely. This is one of your cardinal weekly KPIs going forward. It should be in line with total visits, new patients, arrival rate, those main KPIs as well as others that you might be tracking.

Track it for each location and track it for each provider. Many times, what we found in our clinics is that a majority of the providers were billing well above 4.0 as appropriately and documented appropriately. Usually, there was 1 or 2 that would fall into the 3.6 to 3.8 range and bring the entire team down. You don't want to hammer the entire team if just one person is an outlier. It's an opportunity to go one-on-one with that person and handle that individually. The important thing is to set it, monitor it, and track it routinely going forward.

Assuming your billing and collections process is smooth and steady, this process alone, once implemented will increase your revenues in 30 days. What would you do with a 10% increase in your revenues? What would you invest that profit in going forward, your family and your reinvestment in the business and yourself? This is the beginning of your transformation as an owner. This first step will help you gain greater freedom and more profits. Remember, if you want help with this or other aspects of your business going forward, I'm providing consulting and coaching services for PT owners to help get you where you want to be. Reach out to me at Check out the website and the first steps for the free download on the website.

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