Finding the Balance Between Business & Patient Care

For those of you who have been following my recent blog content and tweets, you know that I’ve refocused much of my efforts in promoting of business solutions and marketing strategies in the rehab business. However, in all this promotion of business, the center of attention must always revolve around the core of our calling – our patients.

In a previous post, I’ve referenced the movie “A Beautiful Mind” covering the story of John Nash, a noted mathematician and economist, famed for developing the Nash Equilibrium solution. The Nash Equilibrium functionally states that for all things being equal, when a group of individuals are faced with choices that affect each other; it is best for the all parties to make the choice that is both best for themselves AND the group at large. For more on this, please refer to my post on Collaboration vs. Competition. I’ve discovered that this is a key principle in finding the balance between business and patient care.

I suppose the question then is raised: Can one truly attain the best of both worlds?

Alright… I know… I’m a total sci-fi dork!

Let me answer that question by sharing the following:

As I’ve transitioned into the skilled setting from acute care & wellness, I’m dealing less with operational flow, less biomechanics, less pain science… and WAY more with the tinkering of labor hours and optimizing RUG levels (Resource Utilization Groups). In any case, most SNF’s operate with the assumptive model that all newly admitted patients can handle the most possible minutes of rehab therapy in a week. This is considered an “Ultra High” level (720 minutes of mixed therapy delivered per week) until the patient (or in some communities, the “resident”) is unable to keep up with such a level of intensity. Usually at this time, the RUG level is lowered to a Very High or a High level of intensity. (The RUG levels are usually only a business consideration for the care of patients with Medicare A or HMO-PPO insurance)

In any case, this model may seem to have competitive and conflicting point of interest. In many models of healthcare delivery, the less a firm delivers, the more the firm will profit. OR, it may be the case that the more a firm delivers, the more they can bill for and thus profit. It should be fairly apparent that both extremes of this continuum could either lead to under-utilization (or withholding of services) or rampant over-utilization of resources. Regardless of the case, it is sorely evident one element, the KEY element, is missing in this business consideration: THE PATIENT!

But, how does this all relate back to Dr. Nash’s game theory solution? Easy! Just as before, if all parties do what is best for the party as a whole AND each individual contributor, the entire group will reap the best outcomes for the situation. In the case of economy driven patient care, what is best done for the patient will obviously give the patient the best outcome for health and well-being. At the same time, a health system cannot afford to over-deliver services (the utilization of resources would simply collapse the infrastructure for most health systems, hospitals, and clinics). Therefore, the providers must be highly efficient with the time, resources, capital, direct-patient-care minutes/hours delivered – AND – rely highly upon agile processes. This is particularly important for operational systems to which each business unit must be intimately familiar with, not simply the development of new operations. The corollary to all of this is really that the days of the waterfall command structure is DEAD.

If only one person in the business unit serves as the linchpin for all business operations, … then….

So how does this reflect upon evidenced based practice? How about the evidence based business (I believe the new hashtag is #EBBP) for which Physical Therapist, Twitter Guru, Jerry Durham champions? How about the Experienced Based Business (#ExpBB) that I, personally, keep touting as a industry NEED should we hope to survive, thrive, and expand during the changes times & shifting face of the healthcare landscape? (see Mickey Mouse Moment blog series)

Personally, I find that the best thing we can do is to market to consumers. I’ve always held the view that healthcare is THE MOST PECULIAR economic model by which the payer can simply deny payment. Imagine this model in ANY OTHER industry!

Sadly, because we exist in this current market landscape of healthcare, we are positioned best to leverage demand side economics. We must market our expertise, the service we provide, the fact that we are available for access, AND MOST IMPORTANTLY, our very personage. Why? Because it is the empathetic and compassionate care given by a physical therapist that the consumers want. They love it. They crave it. They desire it with boiling envy!

If we deliver our services with such an attitude and emotional content, this will place patients back in the place they belong; the center of care. This will also position the physical therapy profession to be known in the marketplace as one which holds the customer experience as the utmost in the process of service delivery. Of course, we must employ evidenced base practice to properly educate, treat, train, and therefore demonstrate desired outcomes. However, I must remind the clinical mind that the customers are emotional. Satisfaction is emotional. The outcome is objective; the experience is subjective. Both are needed to promote best practice.

And while this post leaves only the tip of the iceberg unveiled, I do plan on sharing more content as I continue my learning about these subjects in my studies.

I want to thank Physiopedia for the opportunity to share opinions, discuss issues, and bolster collaborative efforts to improve global health. And, thus, I leave you until next time.

Humbly, Yours in service,

-Ben Fung

Sensorimotor Impairment in Neck Pain

Join Chris Worsfold in this short online course to learn about the evaluation and rehabilitation of sensorimotor impairment in patients with neck pain.


Jerry Durham
Jerry Durham
June 17, 2013 at 2:49 am


Excellent insight.
Step 1….Get people to read this post!

I will just say the last 4-5 paragraphs of your post are the key to OUR success. If all will read those, ask questions and go forth and DO IT! We will be alot further along

Thanks for the insight

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