If you browse all the different private practice forums out there (or receive all the emails I do from practice owners), it is clear there is a great deal of uncertainty and fear about how the Affordable Care Act, ACOs and other changing components of the healthcare system will affect private physical therapy practices.

In many areas of healthcare (often more so than in the PT realm) we are seeing progressively more corporate conglomeration of private practices and the "pushing out" of small private practices. Physicians are finding it much harder to keep their practices profitable, and hospitals/corporations are buying up them up left and right.

What does all this mean for physical therapy private practice owners?

"My referring physicians are being forced to keep their physical therapy referrals 'in house.'"

The above statement is a complaint I've heard a number of times in the past few years. With the aforementioned hospital/corporate purchasing of medical practices, those physicians become employees of a system that usually has a "physical therapy department," and the doctors are being told that they must keep all therapy referrals within their hospital/corporate system.

Is this legal? I doubt it, but it's happening anyway and in greater amounts every year. So what can you do to protect your current or future PT practice against this damaging trend?

Stop relying completely on physicians for all your referrals.

This situation, and the fear surrounding it, loses a great deal of intensity if your practice does not rely solely on physicians for new patient referrals. In no way am I saying that cooperation and collaboration with physicians is not important. I'm looking specifically at the topic of patient/income generation (not patient care and/or the healthcare team).

Some of you may think, "But I'm not in a direct access state, so I'm forced to rely on physicians for referrals." I practice in Texas where we do not currently have true direct access, so all my patients must acquire a referral before I can start treatment.

However, less than 10 percent of my patients are directly referred to me by physicians. Most of my new patients come from word of mouth (other patients), complementary health/wellness/fitness practitioners (e.g., personal trainers, acupuncturists, massage therapists, etc.), and online sources (Google, YouTube, etc.).

Given the above, the majority of my prospective patients call without having a physician referral and then have to go through the frustrating process of getting one, but that's another topic altogether.

In short, I guide them through the options they have for acquiring a referral and do my best to make sure they follow through so we can start treatment. It's an annoying hurdle, but not an outright roadblock. I know many practices like mine in states like Texas that keep their schedules full of referrals from nonphysician sources.

So how do you decrease your dependence on physician referrals? The answer to that question has filled entire books, but in short, you must market directly to the public as well as related fitness, wellness and nonphysician healthcare practitioners.