Principles of Practice Development

1
Principles of Practice Development Marketing

• Rocky Mountain University Of Health Professions
• CC 562.3 T-DPT Class 10 (Oct 2006)
• Dr. Ed Ramsey, PT Business Consultant

2
A Little about Dr. Ramsey

• Almost 39, married 1 year this week
• Expecting our 1st child December 21
• Graduated from SC 1990 BS, 1991 MSPT
• RMUofHP 2004 DPT
• Worked in every PT setting between 1991-1996

3
Opening of Ramsey Rehab

• Opened Ramsey Rehab 1997 with 3 employees
  counting myself
• Turned down from 3 banks
• Finally approved for 68K business, 122K
  mortgage, 30K equipment lease
• 2,200 sq ft between 2 basement office condos
• Added 1st PTA in 2 months, PT in 6 months
• 100 visits/week in 3 months
• Story about Tufts, 100 visit mark

4
Continued Growth

• Opened satellite in 2000
• Leased 400 sq ft, 1,000 capital outlay
• Dr. Jones moves out
• Increased space to 1,200 sq ft
• Added more employees
• 2004Decided to build new 10,000 sq ft clinic
• 1.7 million

5
9 Years Later

• Took 49 employees/family on Cruise
• Employ 28 employees
• Need 4 more PTs, 3 PTAs
• Bill out 2.3 million Jan-June 2006
• Collect 1.1 million Jan-June 2006
• Profit per Visit of 6.2
• Schedule 710 patients/week

6
Consultant, Speaker Author

• National Speaker
• PPS 2003, 2004, 2005, 2006
• CSM 2004, 2005, 2006
• Pre-conference PPS CSM 2006
• Co-writing a book 2006, ? Published 2007
• National Consultant 2004-current

7
Why Do I Tell You This?

• Even today you can succeed in private practice if
  you develop and use a plan
• Vinod S clinic
• Tommy M clinic
• NH clinic (location matters)
• Opportunities

8
Class Information

• CREDIT HOURS One (1)
• INSTRUCTOR Ed Ramsey DPT
• Ed_at_RamseyRehab.com
• CLOCK HOURS Based on 50 minutes per hour, 9
  hours of class time is 450 minutes. The
  following schedule provides for 225 minutes in
  the morning and 225 minutes in the afternoon.
• 800am - 1000am Class
• 1000am - 1015am Break
• 1015am - 1200pm Class
• 1200pm - 130pm Lunch
• 130pm - 330pm Class
• 330pm - 345pm Break
• 345pm - 530pm Class

9
COURSE OBJECTIVES

• Upon successful completion of this course, the
  student will be able to
• 1. Describe the basic personal qualities
  necessary to be a successful business owner and
  how to strengthen weak areas through education
  and professional help.
• 2. Understand common clinic designs and the flow
  principle.
• 3. Complete an adequately detailed and tailored
  business and marketing plan.
• 4. Complete an accurate SWOT analysis.
• 5. Articulate the importance of pre-marketing,
  branding, a company mission statement and staying
  on message.
• 6. Describe marketing tips and ideas for the
  start-up and early years to include common
  mistakes and areas to target based on your own
  SWOT analysis.
• 7. Understand the necessity of credentialing
• 8. Identify the essential qualities of support
  staff
• PREREQUISITES None

10
TEACHING METHODS AND LEARNING ACTIVITIES

• Through extensive self-study, dynamic group
  discussion and focused practical projects, the
  experienced clinician/student will be given the
  framework to complete a detailed business and
  marketing plan that can be successfully utilized
  to open a private practice. 
• The focus will be on development of a business
  plan and creating a dynamic comprehensive
  marketing plan that will allow the experienced
  clinician to move from working for others to
  working for themselves.
• Students will be responsible for answering the
  questions in the pre-class assignment (as
  described in attachment A) and bringing two
  copies of it to class. Instructor will keep one
  copy.
• Grading for the pre-class assignment will be as
  described in attachment A.

11
METHODS OF EVALUATION

• METHODS OF EVALUATION
• Completion and submission of pre-class assignment
  at class 40
• Final project-grading of a business marketing
  plan
• Or final written exam 60
• GRADING SCALE
• Letter Grade Value Letter Grade Descriptor
• A 100 93 I Incomplete
• A- 92 90 IP In Progress
• B 89 87 W Withdrawal
• B 86 83 TC Transfer credit
• B- 82 80 NS Grade not submitted
• C 79 77 R Repeat Course
• C 76 73 AC Audit Course
• F 72 and below
• LATE ASSIGNMENTS Assessments submitted by
  students, which are postmarked one to thirteen
  days past the due date, in a course without an
  approved Incomplete status, may be subject to
  grade deductions ranging from 5-15. Faculty
  will determine the appropriate grade deduction.
• If assessments are not received postmarked within
  14 days after the due date, in a course without
  an approved Incomplete status, then the
  University will assume that the student has
  withdrawn from the course.

12
Attachment A Pre-Class Assignment Grading Sheet

• Please pull out attachment A from the syllabus.
• Please hand me your pre-class assignment

13
Mandatory Pre-Class Assignment

• Attachment A
• Mandatory Pre-class Assignment
• You must bring with you to class a minimum of 4
  of the following 5 items
• 1)   1 business plan (with marketing info)
  preferably from the medical field to use as
  samples.
• 2)   Demographics for your local area or the area
  you want to open a practice. Bring information on
  a minimum of 4 of the 8 listed below
• a.       Population (mention if varies by season,
  etc)
• b.      Socioeconomic breakdown
• c.       Disposable income
• d.      Work force data
• e.       Education
• f.        Medical Access
• g.       Competition
• h.       Reimbursement Rates
• 3)   A rough executive summary for your clinic or
  future clinic or new program
• 4)   A list of all potential competitors
• 5)   Rough draft of a SWOT analysis for your
  management team, your clinic, future clinic or
  new program

14
Pre-Class Optional Bonus

• Optional Bonus (20 points towards pre-class
  assignment grade)
• Provide 3-4 entire journal articles of Evidence
  Based Research or published case studies for a
  main selling point or techniques of your company.
  
• For example-below are research articles
  validating the use of exercise to improve the
  outcome of patients with knee OA. You could
  find more support-build a protocol around this
  and market it to the local community and referral
  sources. To successfully complete this bonus
  provide high quality research articles or
  published studies that you could use in the same
  method and write 2 paragraphs as to why you
  choose them and how you would use them in
  developing and marketing your clinic. (You can
  not use the articles I referenced below to
  receive this bonus).
• Deyle GD, Allison SC, Matekel RL, Ryder MG, Stang
  JM, Gohdes DD, Hutton JP, Henderson NE, Garber
  MB.
• Physical therapy treatment effectiveness for
  osteoarthritis of the knee a randomized
  comparison of supervised clinical exercise and
  manual therapy procedures versus a home exercise
  program.Phys Ther. 2005 Dec85(12)1301-17.
  PMID 16305269 PubMed - indexed for MEDLINE
• McCarthy CJ, Mills PM, Pullen R, Roberts C,
  Silman A, Oldham JA.
• Supplementing a home exercise programme with a
  class-based exercise programme is more effective
  than home exercise alone in the treatment of knee
  osteoarthritis.Rheumatology (Oxford). 2004
  Jul43(7)880-6. Epub 2004 Apr 27. PMID
  15113993 PubMed - indexed for MEDLINE

15
Questions to Ask-Refer to handout

• Yourself
• Do I want to do this?
• Am I committed?
• What am I willing to risk?
• Can I put my life/relationships/family on hold to
  do this?
• Your Family
• Spouse
• To do this you need to be 100 in synch with the
  family
• Missing family functions, birthdays, vacations
• Long nights, weekends, not enough money
• Kids
• Missing family events
• Missing sporting and school events
• Being tired or not around as much
• Extended Family
• Support to help in your absence
• Potential financial support for your family or
  business

16
Questions to Ask cont.

• Experts
• Legal
• Corporate status
• Ownership structures and Federal/State laws
• Leases and Contracts
• Accounting
• Method (cash vs. accrual)
• Out-source or not
• Projections
• Financial
• Business Plan creation, development, modification
• Projections (patient volume, PL, debt to equity
  ratio)
• Cash-flow
• Bank Relationship
• Mortgage Brokers

17
Questions to Ask cont.

• Best friend/personal confident/spiritual advisor
• What do they think of your idea
• Why
• Are they supportive or not
• Why or Why not
• Are their comments valid
• If yes-Thank them for taking the time to listen
  and analyze, then answer them and put the answers
  in the business plan
• If not-was your explanation clear, concise,
  accurate?

18
Additional Questions to Ask

• Other Successful PT clinic owners (Retired and
  Current-same state and other states)
• Other Business Owners
• All Feedback is worth listening to-but may not be
  worth acting upon. If someone is willing to
  listen-give them your spiel. Its good practice
  for you and repetition will help you focus and
  develop your plan.

19
Refer to Handout

• Questions to Ask
• Please spend 5 minutes and complete

20
Personal Skill Inventory

• What are you good at?
• What are you horrible at?
• What would you need to hire HELP for?
• Personality
• High strung, low key
• Energy Level
• Big Picture or Small Picture Person

21
Skill Inventory cont.

• Previously could you sleep at night
• Are you the type of person that can deal with
  on-going long term problems
• Can you live with a bad decision
• Can you forgive yourself of your mistakes if you
  learned from them
• Can you learn from your mistakes/or others
• Can you take constructive criticism
• Are you a leader? Team player? Both?
• Can you make the hard decision/tough call

22
Best Teacher

• Experience is the Best teacher
• Do you have experience in the exact business you
  plan to open?
• If not-can you get some before opening?

23
Business Experience

• Business Experience
• Managing a business in any field
• In PT
• Supervisory experience
• Customer Service experience
• Creating and working within a budget
• Hiring/Firing/Interviewing/H.R.
• Reading PL, making projections, looking for
  trends and making management decisions based on
  them
• Has your business judgment proved trustworthy
• Have you learned from your mistakes

24
Family/Friend Skill Inventory

• What are their talents
• Legal
• Financial
• IT
• Maintenance
• Keep this list for an emergency
• Experience has taught many of us never to hire
  family or friends
• It may cause friction by not hiring them but
  nothing compared to what happens to the
  relationship if it doesnt work out you fire
  them. (Example)

25
Refer to Handout

• Skill Inventory
• Please spend 5 minutes and complete

26
Establish Relationships

• Established Relationships with the Pros
• Legal
• Financial (Personal and Professional)
• IT
• Maintenance
• Construction
• Printing

27
Personal Resources

• Financial
• Do you need your salary to survive?
• How many months total expenses do you have in the
  bank?
• How is your credit score, line and credit
  worthiness?
• What is your current debt to equity ratio?
• Have you ever used a budget successfully?

28
Personal Resources Cont.

• Time
• What time commitments do you currently have other
  than this adventure?
• Child care
• Elder care
• Volunteer
• Associations/groups/religion/charities

29
You decided Yes-Now What?

• After completing the skill inventories, looking
  at you and your support system-What is next?
• Identify the Holes and their fixes with a

30
Develop a Business Plan

• A great business plan will force you to ask
  yourself and your support staff (paid
  professionals, family and friends) to answer many
  difficult questions that are important to your
  businesses future.
• They can be 20 pages or over 400 pages
• My last 3 took between 150-400 hrs to write
• It is a road map for your corporate success and
  will allow other professionals to see your
  potential in a multidimensional sense

31
Business Plan

• What is a business plan and why do I need to
  write one?
• Cant I just wing it?
• What if its in my head-good enough?
• All good business people have a business plan-you
  should too.

32
Business Marketing Plan

• It will also include a detailed Marketing Plan
  with an in depth market analysis
• SWOT (strength, weakness, opportunity, threats)
• HOW DO I DO IT?
• You can pay a professional to write it
• Accountant, Consultant
• You can use free resources to assist you
• SBA, Local business college, library book, PPS
• You can write it yourself, or any combo

33
Help is Available

• See Impact (April and May 2005)
• Refer to web site
• www.ppsapta.org
• www.SBA.gov
• www.RamseyRehab.com (sample)
• www.score.org
• www.cweboston.org
• Library, bookstore, community college

34
Business Plan Help cont

• Best plans are written by someone with PT and
  Business Plan writing experience
• Same holds true for Marketing Plans
• If you have someone else write it
• Interview them, check other plans they have
  written
• Have they been accurate, well received, funded
• How do their prices compare to other
  professionals
• How much input do you have
• Make sure you know everything in it, the hows
  and whys
• Make sure you are comfortable with all sections,
  projections, etc It represents YOU! You are
  Liable for errors, omissions, false statements,
  etc

35
Review samples provided by the class

• Any commonalities between all of these plans?

36
Business Plan Outline

• Name of Company
• Executive Summary
• Vision Statement Section
• Objectives
• Mission
• Keys to Success
• Start-up Summary
• Company Ownership
• Company Location and Facilities
• Services
• Competitive Comparison
• Sales Information (Sell)
• Sourcing (Info)
• Future Products (Services, Expansion)
• Market Analysis Summary (What, Who, Where)
• Market Segmentation (Services Provided)
• Industry Analysis (Who else is doing it? Their
  success)
• Distribution Patterns
• Competition and Buying Patterns

37
Business Plan Outline cont.

• Strategy and Implementation Summary (Computer
  Back-up)
• Marketing Strategy (Payer Mix)
• Sales Strategy (Information Management)
• Sales Forecast
• Milestones
• Management Summary
• Organizational Structure
• Management Team
• Management Team Gaps
• Personnel Plan
• Other Management Considerations
• Financial Plan
• Important Assumptions
• Key Financial Indicators
• Breakeven Analysis
• Projected Profit and Loss
• Projected Cash Flow
• Projected Balance Sheet
• Business Ratios

38
Refer to Handout

• WALK-IN WELLNESS CENTERS, INC.
• Name of Company
• Executive Summary
• Brief 1-2 page summary
• Recognize the funder interest
• (SWOT) Situation Weapons Objectives Tactics
• Do you know who your customers are?
• Do you know the economic and physical demands
  required to
• service the customers?
• Do I know what to offer to relieve those
  demands? (point of service, location, personnel,
  equipment)
• Pinpoint request and ROI expectations
• How do we mutually benefit from the risks
• Recognize challenges
• Review and link elements
• Demonstrate confidence in you and the plan
• SWORT
• Strengths
• Weaknesses- in other providers not mine
• Opportunities

39
From Tom Little

• Smart Objectives
• Specific
• Measurable
• Achievable, Applicable
• Realistic
• Timely
• This section is very important- gives the funder
  the reason to fund your plan.
• Make sure it includes all the elements above.

40
Your Exec Summary

• Pull out the one you completed for the pre-class
  assignment
• Or if you didnt do it for pre-class-lets start
  one now

41
2.0 Vision Statement Section

• 2.0 Vision Statement Section
• 2.2 Objectives
• 2.3 Mission
• 2.4 Keys to Success
• To provide the public with a multiple of Health
  Screening Tests and immediate results with
  in-depth information concerning their actual
  results. This valuable health related
  information will be used to address health
  concerns, injurious behaviors and nutritional
  problems with the intent to modify behavior or
  attitudes that lead to these problems. It is
  then the employees job to instruct the testee in
  ways that Walk-In Wellness Centers, Inc.s (WIWC)
  services can assist them in living a healthier
  lifestyle.
• To achieve these goals will require a
  knowledgeable, friendly well educated staff with
  an out-going, extroverted personality and a
  wiliness to engage the public while selling
  products. They must have the ability to see the
  big picture concerning each testees health and
  factor that into their personalized educational
  discussions and the product WIWC offers.
• WIWC will be successful because of the long
  established support structure and time tested
  methodology that has been a value added assets to
  over 350 communities that it already services.
  The employees hired locally are some of the most
  highly trained in the field and have a proven
  tract record in the health promotions and
  Physical Therapy field.

42
3.1 Start-up Summary

• 3.1 Start-up Summary
• All Materials (Equipment, Sales Literature,
  Marketing Literature, Training Manuals, Training,
  Free Standing Inserts, etc) for opening and
  continued operation are being purchased through
  US Wellness. (www.USWellness.com) US Wellness is
  the leader in Public Health testing (onsite and
  through store-front locations) for the last 5
  years. They have 10 corporate owned and operated
  locations expanding to 40 by 2004 and 350
  locations throughout the United States and 2
  Internationally. USWellness is currently adding
  2-4 new sites per month.
• 3.2 Company Ownership
• The company (WIWC) is a Sub Chapter S Corporation
  owned by Edward Ramsey MSPT, president and owner
  of Ramsey Rehab, Inc. (www.RamseyRehab.com)
  Ramsey Rehab is an out-patient Physical Therapy
  clinic specializing in Orthopaedics and Sports
  Medicine. Ramsey Rehab is THE recognized
  leader in Sports Rehabilitation having provided
  services to the Northern Worcester County Region
  for over 6 years. Ramsey Rehabs strong
  management team and proven track record as well
  as all company resources will support WIWC in all
  forms of HR and operations through consultation,
  including capitol outlay and establishing a line
  of credit.
• Charity is a large part of the owners and
  management teams philosophy. It is our intent
  to donate a portion of the profits to St.
  Josephs Catholic Church, Charlton, MA. For the
  establishment of a Catholic school and free
  medical clinic as is currently being done with
  donations from the owner, Ed Ramsey. Support is
  also to be provided to 12 community organizations
  through Ramsey Rehab and Ed Ramsey, personally.

43
4.1 Company Location

• 4.1 Company Location and Facilities
• Ramsey Rehab has two locations
• Main Office Satellite
• 33 Electric Avenue Suite B-10 100 Erdman Way
• Fitchburg, MA 01420-7954 Leominster, MA
  01450-1841
• Walk-In Wellness Centers, Inc. (WIWC)
• Main Office Satellite
• 33 Electric Avenue Suite B-10 111 King Phillip
  Road
• Fitchburg, MA 01420-7954 Worcester, MA 01450
• Primary service area for WIWC and one of it best
  assets will be its mobility. WIWC will have the
  ability to service a different location each day.
  (Health clubs, health stores, alternative
  medicine locations, YMCA or YWCAs, Pharmacies,
  Physician offices, Wal-Mart/K-Mart or Grocery
  stores like USWellness models). Management will
  contract with specific target locations to
  rent/lease space 1 day per week. Marketing
  literature will support each service location.
  As volume grows at that location it will be
  determined by management whether to add
  additional days at that location and eventually a
  permanent storefront there.
• Expansion into Health Fairs, Local and State
  Fairs, Agricultural or Art Fairs, Corporate or
  Business Conventions and Corporate on-site
  services.

44
5.1 Services

• 5.1 Services
• High quality standardized, objective, reliable,
  reproducible and public friendly health tests and
  health related counseling available immediately
  and at a fair value. Tests will include Bone
  density (assess actual risk of breaking a bone),
  Body Fat Analysis (Measures your percentage of
  muscle mass to fat mass and compares it to the
  healthy normal), Arterial Stiffness (reliable
  indicator for risk of heart attack), Skin
  Hydration and damage (Illustrates the damage
  already done to your skin by sun exposure and
  chance of cancerous cells), Peripheral Vision
  Testing (measures and quantifies your peripheral
  visual field and detect potential visual
  problems), VO2 Max (tests your ability to breathe
  and potential for lung disease), Metabolic Rate
  (Measures the efficiency of your body, a good
  measure of a persons overall health). Equipment
  can be view at www.USHealth.com/Business/services_
  equip.asp
• Many additional testing equipment and tests are
  available to expand into depending on local needs
  and regulations (Cholesterol, allergy, Hormone,
  drug, and over 80 additional blood derivered
  tests).
• Two other areas of expansion include utilizing
  the test results and biomarkers for weight
  management classes and selling of
  biopharmaceuticals/supplements. These two areas
  will become significant for surpassing the 30
  profit mark. The success of these offerings will
  be dependent on the skills of WIWC employees in
  up-selling.
• USWellness has been strong in their support of
  these areas through weekly womans newsletter and
  monthly wellness newsletter, monthly conference
  calls on topical continuing education issues and
  high quality glossy inserts and 4 color pamphlets
  for lay public education.

45
6.1 Competitive Comparison

• 6.1 Competitive Comparison
• Currently there is no Independent competition in
  the Northern MA, Central MA or Southern CT.
  There are 4 Urgent Care centers (within 30 miles)
  that provide a few of these tests but typically
  require physician authorization, insurance
  approval, long waiting period and clinic
  appointments. Occasionally justification to any
  of these check points could delay or prevent the
  testing to occur. A co-payment is usually also
  paid. Local hospitals also offer some of these
  tests but the above restrictions still apply.
• No similar weighty management program combined
  with objective testing, nutritional education and
  scientifically supported targeted
  biopharmaceuticals/supplements.
• None of these services are currently provided at
  local fairs, state fairs or conventions at
  present.
• 6.2 Sales Information (Sell)
• 6.3 Sourcing (Info)
• 6.4 Future Products (Services, Expansion)
• Expansion into additional areas for permanent
  storefronts and addition of other tests can
  include drug testing, allergy testing, hormone
  testing, vaccination program for flu, pneumonia,
  etc.
• USWellness provides over 110 tests for a myriad
  of health issues and has the documentation for
  instruction of employee/tester and testee
  handouts. All tests and literature as well as
  the health monitoring programs are designed by
  renowned experts in the health field and the
  company is overseen by a medical oversight board.

46
7.1-2 Market Analysis

• 7.1 Market Analysis Summary (What, Who, Where)
• 7.2 Market Segmentation (Services Provided)
• 8.1 Industry Analysis (Who else is doing it?
  Their success)
• Currently there is no Independent competition.
  There are 4 Urgent Care centers (within 30 miles)
  that provide a few of these tests but typically
  require physician authorization, insurance
  approval, long waiting period and clinic
  appointments. Occasionally justification to any
  of these check points could delay or prevent the
  testing to occur. A co-payment is usually also
  paid. Local hospitals also offer some of these
  tests but the above restrictions still apply.
  Equipment we utilize is state-of-art with
  literature to back up its claim of reliability
  and accuracy within 4 of the Gold Standard,
  very acceptable for mobile equipment. This
  literature will be marketed and available for
  public review and education.
• No similar weight management program combined
  with objective testing, nutritional education and
  scientifically supported targeted
  biopharmaceuticals/supplements.
• None of these services are currently provided at
  local fairs, state fairs or conventions at
  present.
• As mentioned earlier (www.USWellness.com) US
  Wellness is the leader in Public Health testing
  (onsite and through store-front locations) for
  the last 5 years. They have 10 corporate owned
  and operated locations expanding to 40 by 2004
  and 350 locations throughout the United States
  and 2 Internationally.
• Financial numbers available for review as well as
  volume reports show this field and technique to
  be a highly successful turn-key operation.

47
9.1 9.5

• 9.1 Distribution Patterns
• 9.2 Competition and Buying Patterns
• Savvy consumers will continue to look towards
  their insurance to provide these ancillary
  testing but if insurance trends of managed care
  continue- these tests will not be covered in the
  future or a larger sharing of the cost will be
  passed on to the consumer. We will offer the
  same high quality, reliable services for less
  because the over head and paperwork will be much
  less. Convience will also be a major selling
  point. In addition, as the public becomes more
  health conscious and looking for healthy
  alternative- the solutions we provide will be
  ideal to answer their questions and fill their
  needs.
• Implementation now will allow us complete market
  dominance and the ability to educate the public
  for improved branding and market loyalty.
• 9.3 Strategy and Implementation Summary (Computer
  Back-up)
• 9.4 Marketing Strategy (Payer Mix)
• 9.5 Sales Strategy (Information Management)
• All computer systems will have a daily removable
  back-up as well as a copy to a second hard-drive.
  
• As mentioned the Management of WIWC is
  experienced in the Health Field, Health Care
  management and in marketing. To further our
  success each employee will go through training by
  USWellness on the proper use of the equipment,
  program implementation and customer service.
• Initial training will be provided by USWellness
  at their corporate office in Gaithersburg, MD
  with follow-up through monthly phone conference
  calls, monthly newsletter and phone follow-ups as
  needed to the medical directors.

48
9.5 cont

• Contracts will be signed with the sites prior to
  equipment purchase. Marketing material will be
  presented to local newspapers, health facilities
  and medical offices in addition to the actual
  provider sites. This pre-roll out marketing will
  provide for a fast start. Additional income will
  be derived from providing services at fairs as
  mentioned in earlier sections and lastly through
  providing testing for Pharmaceutical Companys.
  Pharmaceutical companys through their local drug
  representatives request health screenings/tests
  at local physician offices. Those requests are
  paid by their respective companys and requested
  through USWellness. USWellness through contract
  will pass these screening/testing opportunities
  to their local facilities. We will be the only
  site in Central-Northern MA and Metro-Boston.
  The only other site in MA is in Springfield.
  (Shoppers Drug Assist Compounding Pharmacy)
  Last year the money generated through
  Pharmaceutical contracts in MA was 42,000.00.
  It is expected to triple this year and we expect
  to get a large portion of that revenue due to our
  location and mobility.
• (Pharmaceutical revenue USWellness Yr 2000 600K,
  Yr 2001 2.2mil, Yr 2002 3.5mil projected to
  reach 4.5 mil, Yr 2003 Projected 6.5mil)

49
9.6 Sales Forecast

• 9.6 Sales Forecast
• See attached spreadsheet in your handout  

50
10.1 Milestones

• 10.1 Milestones
• Opening Day
• Breaking even
• Paying off start-up Debt
• Hiring third employee
• Establishing permanent storefront
• Purchasing additional equipment
• Each site sales surpassing 300,000.00
• Sales of Biopharmaceuticals equal 25 site sales
• Recognized as the Leader in Public Health Testing

51
11.1 Management Summary

• 11.1 Management Summary
• 11.2 Organizational Structure
• 11.3 Management Team
• Management
• Ed Ramsey MSPT. Owner of Ramsey Rehab, Ramsey
  Reality Trust and a Board of Director of St.
  Josephs Catholic Radio Station and North Central
  MA Red Cross. Ed has over 24 years of management
  experience from retail to Health Care. From
  oversight of one location to 6 locations in
  several states. Ed has been on several National
  and state boards, participates in community
  activities and religious organizations. Ed
  advises friends on financial matters and
  investing and has lectured locally and at State
  conferences of topics from Physical Therapy,
  health care, starting a new business, tithing,
  and disaster services to name a few.
• Manager
• Joseph Magdis, BS (Management with concentration
  in Marketing) AS PTA, CSCS, ACE. Joe has over 16
  years experience in the Health Field and has had
  8 years of management experience.
• Ed Ramsey will oversee company operations. Joe
  will attend to all daily decisions of the
  company. Additional employees will be hired as
  needed.

52
Management/Personnel

• 11.4 Management Team Gaps
• Minimal experience in contract negotiation for
  facility leases in union and non-unionized
  companies. This deficit will be reduced by
  awareness of this, establishment of short-term
  contracts in unfavorable conditions and use of
  USWellness information on typical rates and
  contracts for its other 350 facilities. A
  partnership will also be cultivated with local
  business owners to elicit advice in this area to
  prevent egregious errors.
• 11.5 Personnel Plan
• Hiring only highly qualified personnel with
  health care/promotions/marketing experience.
  Then an extensive training program initiated at
  USWellness then continued onsite by management
  staff.
• Training will be on-going through monthly phone
  conference calls by USWellness medical
  directors, newsletters, on-line courses and
  direct phone calls or e-mails to the medical
  directors as needed.
• 11.6 Other Management Considerations
• One strategy to maintaining respect will be by
  surrounding our company with experienced leaders
  in the health and business world to act as
  mentors and advisors. Also establishment of a
  local Medical Board of Directors to assist with
  local decisions.

53
12.1 Financial Plan

• Please refer to your handout

54
13.1 Important Assumptions

• 13.1 Important Assumptions
• Success with this program at the existing 100
  sites in the US can be reproduced in MA
• Contracts/lease agreements can be arranged at a
  reasonable rate for each site
• Openings available at the designated fairs and no
  other similar testing already present
• Costs to have a booth at the fairs are affordable
• Coverage and well trained staff are available
• Pharmaceutical open house revenue will continue
  to grow 2-3 times annually
• We will be able to service the Pharmaceutical
  open houses as requested

55
Equipment

• BILL TO/SHIP TO
• Walk- In Wellness Centers Inc.144 Hammond Hill Rd
  Charlton MA. 01507Phone [phone]
• QUANTITY
• DESCRIPTION
• 1 Bone Sonometer
• 1 Resting Metabolic Rate Analyzer
• 1 Body Composition Analyzer
• 1 Arterial Stiffness Analyzer
• 1 Skin Damage Analyzer
• 1 Spirometer Lung Function Analyzer
• 1 One Year Licensing Agreement
• Includes Lap Top Shipping
• TOTAL43,295.00

56
Current Operations

• Current Operations September to current
• September 1, 2002 Company opened
• September 1, 2002 Signed contract with
  USWellness to cover 10-12
• Independent Pharmacies between MA and CT
• (September and November, potential for 18
  months/alternating months) Potential 68,000
  contract if fully realized.
• September 1, 2002 Ed Ramsey Purchased equipment
  (turned down bank lease) Terms were not
  favorable to allow future unrestricted expansion
• September 11, 2002 Provided first of 11 Bone
  Density scans (480/ 6 hr day)
• September 18, 2002 Proposal and presentation
  for 1st permanent site (Global Fitness)
• September 27, 2002 Global Fitness accepts
  proposal without modifications (Attached)
• October 3, 2002 Completed September Bone
  Density Contract
• October 8, 2002 Open House for 1st permanent
  Wellness site (Global Fitness)
• October 11-12, 2002 Covered Tufts Womens Fun Run
• October 15, 2002 First day at permanent site.
  (Next week start 3 day/wk coverage)
• October 15, 2002 Global requests second permanent
  site at Stowe location (on hold
• until current site has proven
  profitable.
• October 23, 2002 Coverage for Exec. Womens
  Network
• November 1, 2002 Start first of 11 Body Fat
  coverage sites (480/ 6 hr/day)
• December 2002 Grand Opening- to be scheduled.
  (Elected officials, media, public)

57
Global Fitness Proposal

• Global Proposal
• Walk-In Wellness Centers, Inc.
• Proposal to Global Fitness
• 9/18/02
• Submitted by
• Ed Ramsey MSPT, Pres
• Joe Magdis PTA, BS, CSCS
• Manager and Site Coordinator
• 508-438-0487 Business
• 508-864-4033 Cell Phone

58
Global cont

• Company History
• Ramsey Rehab
• Walk-In Wellness Centers, Inc.
• Walk-In Wellness Centers, Inc. (WIWC) is owned by
  Edward Ramsey MSPT, president and owner of Ramsey
  Rehab, Inc. (www.RamseyRehab.com) Ramsey Rehab is
  an out-patient Physical Therapy clinic
  specializing in Orthopaedics and Sports Medicine.
  Ramsey Rehab is THE recognized leader in
  Sports Rehabilitation having provided services to
  the Northern Worcester County Region for over 6
  years. Ramsey Rehabs strong management team and
  proven track record as well as all company
  resources will support WIWC in all forms.
• WIWC is a new company opened in 2002 to perform
  health testing initially through mobile sites and
  eventually from permanent sites that cross-refer
  and support each other. Joe Magdis PTA, BS, CSCS
  is the manager of WIWC and will be responsible
  for providing all services to Global Fitness. He
  will be your primary contact and can be reached
  at 508-864-4033 Cell, 508-438-0487 Business.
• Wellness Concept
• To provide the public with a multitude of Health
  Screening Tests and immediate results with
  in-depth information concerning their actual
  results. This valuable health related
  information will be used to address health
  concerns, injurious behaviors and nutritional
  problems with the intent to modify behavior or
  attitudes that lead to these problems. It is
  then the employees job to instruct the tested in
  ways that WIWCs services can assist them in
  living a healthier lifestyle.
• To achieve these goals will require a
  knowledgeable, friendly well educated staff with
  an out-going, extroverted personality and a
  wiliness to engage the public while selling
  products. They must have the ability to see the
  big picture concerning each testeds health and
  factor that into their personalized educational
  discussions and the product WIWC offers. Joe is
  the embodiment of these talents and will work
  with your staff as needed to assist them in your
  own product up-sales.
• WIWC will be successful because of the long
  established support structure and time tested
  methodology that has been a value added assets to
  over 350 communities that it already services.
  The employees hired locally are some of the most
  highly trained in the field and have a proven
  tract record in the health promotions and
  Physical Therapy field.
• (www.USWellness.com) US Wellness is the leader
  in Public Health testing (onsite and through
  store-front locations) for the last 5 years.
  They have 14 corporate owned and operated
  locations expanding to 40 by 2004 and 350
  locations throughout the United States and 2
  internationally. USWellness is currently adding
  2-4 new sites per month.
• WIWC purchased all equipment and received staff
  education and training through them.

59
Marketing Plan Outline

• Start your Marketing Plan
• Table of Contents
• 1.0 Executive Summary............ 3
  
• 2.0 Market Audit.. 5
• 2.1 Market Research 5
• 2.1.1 Customer Survey.......... 5
• 2.1.2 Data Base Mining. 6
• 2.1.3 Competition Analysis... 8
• 2.1.4 Demographic Analysis. 8
• 2.2 Market Needs 9
• 2.3 Environmental Data.. 9
• 2.3.1 Strategic Plan/Goal........... 9
• 2.3.2 Service Area. 9
• 2.3.3 WIWC Facility Location/Hours/Access...
  10
• 2.3.4 Medical Staff/Provider Structure.. 1
  0
• 2.3.5 Referral Sources/Volume. 11
• 2.3.6 Historical Activity Levels. 11
• 2.3.7 Payer Mix. 11
• 2.3.8 Pricing Arrangements... 12

60
Marketing Plan Outline cont

• 2.5 Market Trends... 15
• 2.6 Market Growth.. 15
• 2.7 SWOT Analysis. 15
• 2.7.1 Strengths... 15
• 2.7.2 Weaknesses.. 16
• 2.7.3 Opportunities 17
• 2.7.4 Threats.. 18
• 2.8 Competitive Analysis 18
• 2.9 Keys to Success. 19
• 2.10 Critical Issues 20
• Marketing Position. 20
• 4.0A Marketing Strategies... 21
• 4.1A Marketing Mission Statement 21
• 5.0A Marketing Objectives and Action
  Plans. 21
• 4.0B Marketing Strategies... 32
• 5.0B Marketing Objectives and Action
  Plans. 32
• 4.0C Marketing Strategies.. 37
• 5.0C Marketing Objectives and Action
  Plans 37
• 4.0D Marketing Strategies.. 43

61
Refer to Handout

• Sample Marketing Outline and sections from a
  marketing plan I created.

62
From Tom Little

• Smart Objectives
• Specific
• Measurable
• Achievable, Applicable
• Realistic
• Timely
• This section is very important- gives the funder
  the reason to fund your plan.
• Make sure it includes all the elements above.

63
Whats the Next Step

• Type of Clinic and Design

64
Deciding the type of Clinic

• What are your interests?
• What did your market study tell you about the
  area you are considering?
• Competition
• Any, how many, proximity
• Same patient population
• Similar patient populations or treatments
• Do your strengths work well in this area, pt
  population
• Patient population-demographics (age, education,
  income, disposable income, community support)

65
Clinic Type cont.

• Reimbursement for your services
• Cash vs. Insurance or mix
• Will the mix work with the projections you ran
• Is it higher or lower than projected
• Are all insurance plans in the area taking new
  providers
• Enrollment delays?
• Do they pay for PTAs? No one pays for aides!
• Can you survive if you DO NOT get into some of
  the plans
• Do you need to join a PT network?

66
Consider all optionsThink outside of the box!

• Can you buy someone else out
• Can you open a clinic within a clinic
• Can you add services to other local clinics
  without being their competitor
• Can you run your clinic without a bldg-a virtual
  office

67
Financing your Dream

• Upon completion and refinement of the business
  plan-DECIDE how to finance
• Business bank loan
• Personally fund through
• 2nd mortgage
• Home equity loan
• Cash in your retirement plan
• Borrow money from friends/family
• Take on a partner

68
My Opinion

• Personally-I would take a business loan from the
  bank and/or use your available cash (and did)
  before I would ever consider any of the other
  options. Especially borrowing on my home or
  removing my retirement or borrowing from a
  friend. The risk is too HIGH that you could lose
  everything.
• A Mortgage broker may be an alternative, if the
  banks are not directly willing but interested.
• Same thing about borrowing from Family/friends.
  It changes your relationships permanently.
• Taking on a Partner is possible but is a much
  longer discussion with many, many variables.

69
Working 2 Jobs or more

• I recommend that you work on your dream, develop
  your business plan, sales pitch, marketing plan,
  scouting a location all while still working at
  least 1 job.
• Never cheat your current employer-but in your off
  hours, weekends get this out of the way while
  banking as much as possible.
• Some employers will assist you others may see if
  you want to open up another location for them,
  others may be hostile. Be honest in any
  direction you choose to go.
• Plan to work per diem initially even when you
  open your own place to allow some cash flow to
  pay bills.
• Banks historically will not finance close to what
  is needed and will not bankroll your payroll.
• Consider opening part-time while continuing to
  work for someone else (your previous job, or per
  diem, self-contracting, etc).

70
Picking a Location

• As in all real estate deals- CONSIDER
• Location, location, location
• Drive-by traffic count (weekday, weekend, hourly,
  holiday)
• Accessibility (car, bus, taxi, metro, shuttle, on
  foot)
• Future area of growth or decline and effects
• Proximity to current/future referral sources, ?
  Too close?
• More than adequate parking-or else
• Drive-by visibility, day or night, safety of area
• Run the numbers- do they fit the budget?
• Does it fit into the business and marketing plan?

71
Buying/Building versus Leasing

• Things to consider
• Which option are you comfortable with
• What do you think the area will be like in the
  next 10, 20, 30 years
• What are your plans for retirement
• Will the cash flow support a mortgage
• Pros and Cons of each

72
Clinic design/flow

• Typical or Unique
• Rectangle- RX rooms, offices on outside
• Gym space in the center
• Design only one path for pts in/out flow
• Single vs. Multiple use space
• Think patient and staff flow
• Plan for future expansion
• Patients
• Programs
• Physical Plant

73
Insurance-Fire, Liability,

• Too Much is almost as Bad as TOO little!
• Make sure you have a good representative
• Make sure you get the correct type

74
Insurance cont.

• Make sure your venture is insurable
• Business location, patient population, etc
• Example-Wellness Center, Rock climbing wall
• Speak to your agent prior to funding
• State and National APTA, PPS can help

75
Incentive Policies

• Depends on your Corporate Philosophy
• I find it beneficial but it took some convincing
  for me to buy into it.
• Determine which stat most reflects what that
  persons jobs is or what you want to focus on
  (most use arrival, productivity)
• Be objective and consistent in enforcement
• Retroactively apply prior to roll-out to test
  impact
• Adjust every 6 months
• Dont GIVE away the Farm, or under-incentivize
• Incentives must be motivating to work
• Excellent presentation at last years PPS conf

76
StatsSome of the many to check

• Some should be monitored
• Daily
• arrival, co-pays collected vs. owed
• Weekly
• arrival, productivity
• Monthly
• arrival, productivity, total billed,
  collected, w/o, aging
• new referrals, charges/visit, collected/visit,
  cost/visit, insc mix
• Annually
• volume, trends, pl, insc mix, after tax profit,
  taxes vs. projections
• Look for trends, anticipate and adjust slowly-do
  not make quick and frequent changes-its
  unhealthy for everyone.

77
Marketing

• Every interaction (physical, verbal, non-verbal,
  by phone, letter) is a Marketing Opportunity
  seize it!!!!!
• Develop a logo, a tag line and branding
• All marketing literature, company literature and
  staff conversations must stay on the company
  message
• Have a 30 sec, 1 min and 3 min spiel
• Complete a SWOT, marketing plan
• Know your abilities (Corporate/Personal) and
  capitalize on strengths, downplay weaknesses
• Cultivate relationships, monitor quality
• Effectively deal with all problems now/cool head
  only

78
More on Marketing

• Attend as many community events as possible.
• Encourage your staff to attend as well
• This is part of my staff merit raise system
• Give staff company coats, etc to raise your
  company visibility and branding
• Try donating sports screens, and your services
  instead of the 10-20 ad in books and events-do
  that too if possible
• Potentially assign staff to each area team or
  community program to act as a reference. They
  dont necessarily have to attend all functions
  but its a point person

79
Contact Information

• Private Practice Section, APTA
• 1-800-517-1167
• 1055 North Fairfax St, Suite 100
• Alexandria, VA 22314
• www.ppsapta.org
• Or contact your state chapter

80
www.ppsapta.org
81
www.ppsapta.org
82
PPS 20 step Plan-Opening Up a Private Practice
83
PPS Member Mentor Program
84
www.SBA.gov
85
www.score.org
86
Center for Women and Enterprise
87
Contact Information

• Ed Ramsey DPT
• Owner
• Ramsey Rehab Inc (www.RamseyRehab.com)
• Walk-In Wellness Centers (www.WalkInWellness.com)
• 978-353-0030
• Ed_at_RamseyRehab.com
• Additional articles and reference materials at
  www.RamseyRehab.com

88
www.RamseyRehab.com
89
Previous Web casts

• Consider purchasing previous web casts for your
  reference library
• HIPAA
• Billing
• Employment policies
• Contacting/Joining your state PPS
• Becoming active on a National/State level
• Attending State and National PPS
  meetings/conferences
• Join PT-PAC (Political Action Committee)

90
(No Transcript)
91
Your Future!
92
(No Transcript)
93
Final Assignment

• Option 1 Written Exam
• Option 2 Complete a comprehensive Business and
  Marketing Plan using the format and examples from
  class.
• Grading and Requirements
• Refer to syllabus
• Make sure you have handed in your pre-class
  assignment or you will get a zero.

94
METHODS OF EVALUATION

• METHODS OF EVALUATION
• Completion and submission of pre-class assignment
  at class 40
• Final project-grading of a business marketing
  plan
• Or final written exam 60
• GRADING SCALE
• Letter Grade Value Letter Grade Descriptor
• A 100 93 I Incomplete
• A- 92 90 IP In Progress
• B 89 87 W Withdrawal
• B 86 83 TC Transfer credit
• B- 82 80 NS Grade not submitted
• C 79 77 R Repeat Course
• C 76 73 AC Audit Course
• F 72 and below
• LATE ASSIGNMENTS Assessments submitted by
  students, which are postmarked one to thirteen
  days past the due date, in a course without an
  approved Incomplete status, may be subject to
  grade deductions ranging from 5-15. Faculty
  will determine the appropriate grade deduction.
• If assessments are not received postmarked within
  14 days after the due date, in a course without
  an approved Incomplete status, then the
  University will assume that the student has
  withdrawn from the course.

95
Attachment B

• Please take out attachment B from the syllabus
• Written Final Exam grading sheet OR
• Business Marketing grading sheet
• Please remember the following
• Each Spelling Error -1 Point
• Each Grammatical Error -1 Point
• Late submissions will lose points per RMU grading
  policy
• Comments Additional points will be awarded for
  novel marketing ideas that are plausible and for
  evidence based practices/techniques as
  demonstrated in class and on the pre-class
  assignment bonus.
• Document Guidelines
• MS Word format (.doc)
• double spaced-use example referred in class as a
  guideline
• 1 Margins
• length should be between 10 and 25 pages maximum.
  Be brief and concise-papers that do not clearly
  cover the topic within the page allotment will
  have 2 points deducted for each additional page.

96
Additional References

• I have some previous presentations on my
  website-free (www.RamseyRehab.com) but can also
  recommend the following resources
• PPS-How To Open a Private Practice Manual (for
  sale on the PPS website)
• PPS "How To" 1.5 day classes, next one is in the
  North West but after that it's scheduled for
  Philadelphia in April 2006 (at the moment). It
  covers what is in the book as well as additional
  information.
• The PPS website has a list of mentors.
• There are paid consultants with PT
  experience-like me. APTA and PPS has a list also.
  
• There are excellent classes at PPS National
  Conference as well as CSM each year
• Your state may have a local PPS chapter that
  could help you, also.

97
Additional optional reading. Not required but if
YOU want more information this is a good place to
start looking.

• http//www.ramseyrehab.com/business_consulting.htm
  l Ed Ramseys consulting page with many good
  articles and samples from previous National
  presentations on starting a private practice.
• Barrera R. Over Promise and Over Deliver. The
  secret of unshakable customer loyalty. New York,
  NY. Penguin 10014 2005 ISBN 1-59184-061-9.
• Nosse L J, Friberg D G, and Kovacek P R.
  Managerial and supervisory principles for
  physical therapists. Philadelphia Lippincott
  Williams Wilkins 1999. ISBN 0-7817-4264-1.
• McCormack G L, Jaffe E G, Goodman-Lavey M. The
  Occupational Therapy Manager. Bethesda American
  Occupational Therapy Association 2003. ISBN
  1569001782.
• Schaefer, K. Marketing techniques for physical
  therapists. Gaithersburg MD Aspen
  Publications 1991. ISBN 0834202085.
• Glinn J E and Crankhorn A. Marketing techniques
  for physical therapists Independent study
  course 14.3.2. La Crosse WI Orthopedic
  Section, American Physical Therapy Association
  2004. Can be ordered from the Ortho Section
  website at https//www.orthopt.org/143.php.
• Richmond T, Powers D. Business Fundamentals for
  the Rehabilitation Professional. Slack Inc. 2004.
  ISBN 13-978-1-55642-593-6.
• Articles and Web sites
• Roth MS, Amoroso WP. Linking core competencies
  to customer needs strategic marketing of health
  care services. J Healthcare Marketing. 1993
  49-54.
• Weiss R. Dont forget about the office staff.
  Marketing Health Services. 2003 10-11.
• Jacobs K. Innovation to action marketing
  occupational therapy. Am J Occup Ther 1998 Sep
  52(8)618-20 http//www.ncbi.nlm.nih.gov/entrez/q
  uery.fcgi?cmdRetrievedbPubMedlist_uids9739393
  doptAbstract
• http//www.knowthis.com/tutorials/marketing/market
  ingplan1.htm
• http//sbinfocanada.about.com/cs/businessplans/a/b
  izplanmarkplan
• Palacio M. 25 secrets of profitability of private
  practice. Online Advance for Occupational Therapy
  Practitioners serial online. 2000. Available
  at http//www.advanceforot.com/common/editorial/e
  ditorial.aspx?SECCCCC14. Accessed October 9,
  2000.

98
Legal

• This information is the property of Dr. Ed
  Ramsey and should not be copied or otherwise used
  without the express written permission of the
  authors.

99
Contact Information

• Ed Ramsey DPT
• Ramsey Rehab Inc.
• 978-466-6677 Phone
• 978-466-1133 Fax
• Ed_at_RamseyRehab.com
• www.RamseyRehab.com

100
Questions?????

• I will be happy to take your questions now.