Future-Proof PT

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 providers

Chapters:

00:00 Introduction to Kylie Williams

01:36 The Importance of Culture in Physical Therapy

05:05 Defining and Building a Positive Work Culture

09:29 Targeting the Right Audience for Recruitment

18:15 First Principles for Engaging New Clinicians

23:07 The Impact of Social Media on Attention Spans

23:40 Balancing Attention and Depth in Learning

25:20 Navigating the Attention Economy

26:10 Attracting Talent in a Digital Age

27:04 Creating Value in Social Media Content

28:27 The Challenge of Teaching Value in Social Media

30:18 Connecting Social Media to Business Success

32:12 Investing in Marketing Education for Therapists

34:03 Finding Balance in Clinical and Promotional Roles

37:15 The Role of Influencers in Modern Careers

39:07 Empowering Clinicians to Pursue Side Projects

40:47 The Importance of Agency in Clinical Roles

42:36 Shifting Paradigms in Therapy Business Models

44:40 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 OT Potential here: "How OTs and PTs Get Paid."

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(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.

• 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.

We 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.

We 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.

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 Life

Episode Quality Improvement Plan (EQIP)

ACCESS Model

ACCESS Technical FAQs

• Evidence-based practice vs. pseudoscience: where's the line?
• Why manual therapy should be reframed as an experimental intervention in many cases
• The 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 pseudoscience
• The economics of PT: balancing integrity with income
• Why strength training and exercise therapy are still key ingredients in PT treatment plans
• Teaching intellectual humility and critical thinking in healthcare education
• Practical strategies for clinicians who want to practice honestly without going broke

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.

https://www.painscience.com/subscribe [free newsletter]

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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.

• 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 Channel

We 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.

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 creation
• Why "it doesn't work" is invalid if you never tested it
• The sheep analogy: surviving vs. thriving in healthcare
• Richard Feynman's lesson on honest self-evaluation and scientific integrity
• A-B testing your way into value-based care leadership
• Why small experiments and lottery tickets matter in healthcare transformation
• How 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

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 conditions
• The "Healthcare Factory" metaphor for fee-for-service physical therapy
• Using patient-reported outcome measures (PROMs) as a clinical GPS tool for shared decision-making, not just compliance
• The 2020 telehealth pivot that separated clinical experts from customer service providers in digital health
• The difference between tech companies and true clinical integration in digital MSK care platforms
• The shift from "hands to brains" - why clinical reasoning and movement expertise is more valuable than manual techniques
• Understanding who bears financial risk in healthcare and why PTs should align with and target employers directly
• How to pitch directly to employers instead of chasing insurance panels
• 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

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 - proterahealth.com

Henry Ford Health - henryford.com

Dr. Eric Makhni on LinkedIn

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Here's the YouTube version of Episode 22

"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.

• Start without a playbook. There's no perfect formula, so learn from others, be curious, and experiment with applying concepts
• 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
• 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
• 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
• 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
• Growth enables opportunity. Increased volume allows you to hire team members you want to work with and create more positions
• Change is curvilinear. Success won't be immediate or linear. Persistence leads to exponential growth over time.

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Subscribe to Timeless Autonomy for health policy news and insights distilled for industry professionals. Written by Dana Strauss, PT, DPT