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Choose the Physical Therapy Clinic that Cares

Rhode Island clinic takes ADVANCE's Best PT Practice Award for 2009

Jonathan Bassett
Posted on: December 14, 2009
Vol. 20 - Issue 25 - Page 12

On the rugged Rhode Island coastline edging Narragansett Bay, in the colonial-era town of Warwick, you meet hard-nosed New Englanders with a strong independent streak-one that's been handed down through the old-world bloodlines of families who made their living working land and sea.

While the town has since adopted a more cosmopolitan feel, with strip malls jockeying for space amid lighthouses and clapboard cottages, personal liberty and a staunch work ethic continue to undergird the economy and way of life. It's here that you'll find Elite Physical Therapy, a seven-year-old practice founded by Michael Nula, MSPT, charged with safeguarding the musculoskeletal health of this unique and vibrant corner of the country.

"This is my passion and my fire," said Nula, who knew from an early age that Physical Therapy was his calling. A knee injury sustained in a high school basketball game landed him in the care of a skilled and caring PT, and Nula never wavered from his early vision to practice customer-driven Physical Therapy in his hometown.

After graduating from the University of Rhode Island with a degree in biology, and then a master's in Physical Therapy in 2000, Nula worked in the corporate PT world for just two years before striking out on his own with the first Elite location in 2002.

A fierce dedication to tried-and-true business principles allowed Elite to grow quickly in response to strong demand by consumers and referral sources. After expanding the Warwick office soon after opening, Nula opened his second location in Providence in 2005.

Through a challenging economic period, Elite boasted 39 percent growth in patient visits from 2007 to 2009, and 12 percent growth in patient referrals over the same period. On Dec. 3, Elite held a ribbon cutting ceremony for its third location, in the nearby town of Coventry.

"I consider myself very fortunate," said Nula. "I'm blessed to be able to do something I love, while providing a service to my community."

For its commitment to PT values and its response to the needs of today's therapy consumer, Elite Physical Therapy has been named ADVANCE's Best PT Practice of the Year for 2009. After tabulating entries from across the country, Elite emerged as the clear winner, with one member of the judging panel deeming them the top practice "by leaps and bounds."

How They Did It

Business consultants love to talk in sweeping terms about customer satisfaction, self-evaluations, assembling a forward-thinking management team, and delivering a welcoming customer experience. But it's often a challenge to visualize real-world applications of these systems.

For Elite, it begins with regular, no-holds-barred self-analysis. Quarterly and annually, Nula meets with his executive team for a top-to-bottom review of the entire practice and how it runs. Nothing is left off the agenda-reimbursement activity, account history, insurance denials, even the performance of each member of the Physical Therapy team.

Jason Harvey, MSPT, is Elite's vice president of operations. He first met Nula through a classmate at Northeastern University, just as Nula was opening his first office.

"When I met Michael, I said to myself, 'this guy's got a great vision of what PT should be,'" Harvey said. "He'd seen the workings of the corporate PT world, and wanted to create an environment that focused on the customer." So rather than take a safer job with an established rehab company, Harvey followed his instinct and rolled the dice. He now oversees the rehab directors of each Elite location, in addition to the day-to-day operations of the 14-clinician company, while continuing to treat patients daily.

Though Harvey was a neophyte to the management world, his skill set developed gradually as he took on added responsibilities at the growing company. "In this business, it all starts with the patient," Harvey said. "Take care of the patient experience first, and it naturally follows that you will take care of the 'players' responsible for it."

For Harvey, this means ensuring that each patient finishes their treatment plan, bringing them to what he calls their "success point." Do that consistently, Harvey said, and each patient becomes your unpaid spokesperson. If patients are falling off in a particular office or patient subset, he'll look into the reasons why.

"Business experts like to say that particles need to flow," said Harvey, adding that the practice maintains a strict 1:1 administrator-to-therapist ratio to allow Physical Therapists to focus on treatment. "If someone has too many people below them, they become bogged down. So you look at delegating responsibilities and changing your operations to keep things moving forward."

Steady, Sustainable Growth

Rehab practice experts across the board agree that customer-focused care is vital to a practice's growth. Regardless of where a patient falls on the needs spectrum, Elite meets them there, from no-interest payment plans for uninsured patients, to late-night appointment hours, to the practice-wide mandate that each patient is assigned their personal Physical Therapist for the duration of their rehab program.

"We have many little things in place to make the entire patient experience superior," said Kristyn Jodat, Elite's director of marketing and public relations. "We make every effort to learn a little special something about each patient, so we can help them be more comfortable."

It starts with taking a genuine interest in patients' overall health. At their first visit, each new patient is issued a pedometer and handout titled "5 Easy Steps to Setting up your Walking Program." Patients record their total number of steps at the end of the year, and prizes are issued to the winners.

Regardless of the reason they sought Physical Therapy, all patients complete a "Success Story" on their final day that summarizes their experience and results achieved. Discharged patients also receive a "graduation gift" of a T-shirt, coffee mug or water bottle.

Discharge postcards mailed to the patient's home thank them for their patronage and ask a 5-question survey about the quality of care they received. Quarterly newsletters keep former clients up-to-date on practice news, new programs, health tips and research updates. Former patients are also eligible for Elite's Aftercare Program, an independent fitness program directed and overseen by Elite PTs.

"This office is so pleasant," said Lynn Delucia, a retired Warwick school guidance counselor who returned to Elite for severe arm pain and stiffness, after undergoing care two years earlier for a separate condition. "Everyone is always smiling. It makes you feel better, and you smile too. Even the flowers at the front make a statement-beautiful, cheerful, and welcome."

Back to the Basics

Creating a seamless customer experience is easier said then done. Nula realizes that a thoughtful and dedicated care team comes first. To achieve it, Elite focuses on these tenets of solid rehab practice.

Staff development. "We're in a constant, rhythmic state of recruiting," Jodat said. "We don't just wait until we need help to look for good people." Nula, who served as a high school science teacher, and completes his doctoral degree this month at Temple University in Philadelphia, emphasizes staff education. Elite hosts about 3 courses per year through North American Seminars and Integrated Manual Therapy Solutions, open to all area Physical Therapists.

Twice per year they offer free in-house clinic workshops to community Physical Therapists, along with monthly in-house education to Elite Physical Therapists covering treatment advances, literature reviews, case studies, and even study sessions for the APTA's orthopedic clinical specialist (OCS) exam. Elite spends roughly $2400 per employee per year on continuing education.

Periodic performance reviews, monthly bonuses for hitting productivity targets, quarterly excellence awards, a holiday party recognizing length-of-service milestones, and an Employee of the Year award are other ways Elite guarantees an engaged and committed therapy staff.

The paperless office. Elite has embraced e-health in all its forms. With the help of a software development company, Nula pioneered a customized electronic patient documentation system formatted for a PDA, and is working to merge this platform with his practice management system that will give patients, Physical Therapists and insurance companies a one-stop information source. Working with a PDA affords Physical Therapists a simpler documentation system so they can better focus on patient care, said Nula.

Community involvement. Running a tight ship behind clinic doors is only half the battle-if you don't shout from the rooftops, clients won't know you're there. Elite has mastered the art of community presence, whether it's their visually appealing and frequently updated website (www.elitephysicaltherapy.com), promoting niche programs such as aquatic therapy, pediatrics and womens health, or entering former patients into a monthly gas card raffle for each friend or family member they refer back to the practice.

As for local organizations, you name it, and Elite is involved-Warwick Little League, Arthritis Foundation, multiple toy and canned food drives, the Ronald McDonald House and the Juvenile Diabetes Foundation are only the start of the list. Nula and Jodat both hold positions with the Central Rhode Island Chamber of Commerce to get the word out.

Dedication and Community Service

Elite would like to dedicate their award to their colleague Amanda Guerin Brini, MSPT, an Elite Physical Therapist who lost her short battle with leukemia on Feb. 25, 2009, at 27 years old. Brini showed untiring dedication to the PT profession during her brief career, Jodat said, and was one of only 11 students from around the country selected to receive the Mary McMillan Scholarship Award from APTA. She graduated from the University of Hartford in 2006.

"Amanda was the only person I ever hired on the spot," Nula said. "She made an immediate impression on me and I knew right away I wanted her on my team. Her spirit is behind us all the time."

For Nula, it all comes back to assembling the right players. Despite his practice's fast rise to the top, he's reluctant to take personal credit for his accomplishments, preferring to steer the conversation toward his executive team, his hand-picked Physical Therapy staff, his wife Lisa and their three children, and the community that supports him.

And rather than shy away from a challenge, Nula feels the health needs of today's consumers are more than sufficient to sustain a wide range of rehab practices.

"Competition fuels the fire," Nula says. "I don't look at [other practices] as my competitors. It drives us to do better. We're all here to serve the patient-and the practices that don't do that well, won't last."

Jonathan Bassett is managing editor at ADVANCE and can be reached at jbassett@advanceweb.com

The Elite 5-step Plan for Success

While Elite Physical Therapy has become a go-to destination for patients in their community, success didn't come overnight. Michael Nula and the Elite management team learned five key business principles along the way.

  1. Always keep a positive attitude. Everything starts with you. If you want your staff to be positive, lead by example.
  2. Communicate. Handle any disagreements or upsets in the workplace immediately.
  3. Keep yourself well. Exercise, find time to spend with family and friends, and do things that make you happy outside the office. Try hard to keep balance in your life.
  4. Be very picky about who you hire, and hold them to high standards. Surround yourself with great people, and great things will happen.
  5. Have fun. Remember why you got into the profession in the first place-because you love it. Keep the fire alive by working with your patients and colleagues to make your practice a fun place to be.

About the Contest

ADVANCE would like to thank our esteemed judging panel, comprised of past winners of the Best PT Practice Contest:

  • Lance Knaub, PT, DPT, OCS, CSCS
  • BREAKTHRU Physical Therapy and ¬Fitness
  • Moorestown, NJ
  • Kevin J. McGovern, PT, DPT, CSCS
  • McGovern Physical Therapy Associates
  • Revere, MA
  • Ed Ramsey, PT, DPT
  • Ramsey Rehab
  • Leominster, MA

ADVANCE would also like to thank our sponsor for making this contest possible:

Visit www.nustep.com for a full line of award-winning recumbent cross trainers for safe, effective full-body exercise, including the new T5XR, with more than 40 new features and design improvements.


High Heels: Worth the Risk?

Thursday, August 19, 2010
HEALTH NEWS by Andrea E. McHugh

Researchers will present their findings in a study that suggests the prolonged walking in and wearing of high heels may lead to joint degeneration and knee osteoarthritis at the annual meeting of the American Society of Biomechanics at Brown University August 18th-21st.

Danielle Barkema, a master’s candidate at Iowa State University, didn’t get the idea from a scientific journal or studying orthopedics, but instead, from her sister. “My sister had experience in a department store atmosphere, and a lot of the older women she had worked with had been wearing high heels for years, and a lot of them had various joint problems through the years,” says Barkema.

She conducted the study under the guidance of kinesiology professor Phil Martin, by organizing and observing walking trials with 15 women, each walking in flat, two-inch, and 3.5-inch heels. Using sensors and accelerometers in the lab, Barkema measured the affect each heelstrike had on the knee joint. Their study found that heel height is a major factor in the potential for long term joint issues and is directly affected by factors including walking speed and stride lengths. “The higher the heel, the higher the risk,” for joint degeneration and knee osteoarthritis, concludes Barkema.

Mike Nula, CEO and Founder of Elite Physical Therapy in East Greenwich, says he has seen first hand, throughout his career, the affects of long-term wearing of high heels. “I can’t tell you how many people come through here with foot, knee and back problems due to poor footwear,” he says. “We make the analogy that the body is a lot like a house: if the foundation is not strong, nothing will be.”

Nula’s not calling for a boycott of stilettos; he knows better. “Women love their shoes–I should know. I’m married and have three daughters!” he jokes. But, he recommends, wear them sparingly. Depend on well-made, supportive shoes for everyday wear and reserve high heels for special occasions or short-term use. “We’re just saying limit your use, use in moderation,” he explains. He suggests starting at a store that has qualified staff, like Feet First (in Wakefield and East Greenwich) or Jamiel’s Shoe World (in Warren) who will properly measure your foot. By making the right decisions now, he says, you can avoid having to deal with pain and discomfort later in life.


School warns parents of possible risks of toning shoes

Credit: NBC 10 News
Toning shoes are sold by a number of brands.
By Audrey Washington
Published: September 14, 2010

Toning or rocker-bottom shoes are one of the hottest trends in athletic sneakers. And just like any craze, they are not without some controversy.

"Parents be cautious. Be aware of the fact that they don't give the best side-to-side support," said Tom Geismar, superintendent of the Exeter-West Greenwich School District.

That's the message going out to parents of students at Metcalf Elementary School after school officials reported student injuries associated with toning shoes.

The Exeter-West Greenwich School District said it is not banning the sneakers. But an administrator said they are advising parents not to send their children to school wearing the shoes, which are sold under brand names such as Skechers Shape-Ups and Reebok EasyTone.

School officials said they have two problems with the shoes: the thick sole and what they call an awkward design. They said it makes it too easy for children to fall and injure their ankles.

"We felt we needed to alert parents of the potential hazards that existed and let them consider whether they wanted to send their kids to school with these shoes on," Geismar said.

Dr. Michael Nula specializes in Physical Therapy and has his own opinion about toning shoes for children. He said he would not recommend them for children.

"By having that rocker technology, basically you're changing the center of gravity and you're challenging the sensory receptors that are in your foot that record balance and where your body is in space," Nula said.

Nula said when the body works harder to keep balance, it increases the chance of falling.

"What's going to be more appropriate for children is getting them in a more supportive shoe, just like a running shoe, just fitted well," Nula said.

Geismar said he will meet with his staff to see if toning shoes are an issue at other schools in the district.

Call today for an appointment at the Elite Physical Therapy clinic nearest you!