"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.

Cody Lee and Jonathan Smith are clinic managers 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 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.

Subscribe to the Future Proof PT newsletter and receive exclusive resources that grow with every episode!

Subscribe to our YouTube Channel

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

Alex and Dana met on LinkedIn, started a podcast, and only met in person in October of 2025. They use their milestone 20th episode to issue an urgent call: 270,000 physical therapists must each become agents of change, starting today. They cover these topics and more:

-The economic reality is unsustainable. Therapists graduate with up to $200K debt (three-quarters of medical school) to earn a $120K salary ceiling. Compare that to nurse practitioners makin $150K with two years of training.

-The fee-for-service model traps therapy professionals. Many now leave between years 3-5, before their investment even pays off. But everything needed to transform exists right now.

-Physical therapists aren't physician extenders—they're doctoring professionals with their own licensed and supportive extenders (PTAs, health coaches, PT aides, etc.). The solution mirrors how surgeons often collaborate with physician associates: PTs should evaluate, plan care, and intervene when expertise is required, while delegating execution to skilled and/or trained team members.

-Time directly providing one-on-one patient care doesn't equal quality.

-High-quality clinicians redirect inappropriate referrals instead of accepting them like "manna from heaven."

-Setting realistic patient expectations based on prognosis and comorbidities IS the professional expertise that defines doctoring professionals. Yet the profession never fully claimed the direct access promise.

-Alex's recent experience with his father's hospitalization exposed for him healthcare's fractured reality: disciplines that don't communicate, 10+ daily errors, and systems where only patients with physician quarterbacks receive optimal care. Despite seamless technology enabling collaboration, hospitals remain unsafe places.

-Fee-for-service creates no incentive for safety or communication—but value-based models like TEAM (hitting 25% of hospitals in January) are shifting the landscape by making hospitals accountable for 30-day spending and outcomes. Therapists--this creates massive opportunity. For example, therapists can help ensure anyone who may be able to return directly home actually CAN go home, and can advocate for that on behalf of patients in collaborating with the multidisciplinary team.

-Complaints aren't actionable—they're just "the what." Action emerges when individuals realize they can move the needle in their own clinical settings, with their own patients, and with their own teams.

-Value-based care is the path to sustainable, higher PT and OT incomes in clinical roles.

-What Alex is excited about for the APTA PPS event this week!

And more!

Join them for Episode 20. Like it? Please give them a thumbs up and subscribe!

Subscribe to the Future Proof PT newsletter and receive exclusive resources that grow with every episode!

Subscribe to our YouTube Channel

Alex and I recently talked about the physical therapist income floor and ceiling. And in this episode, we talk with Dr. Marc Gruner, who offers a framework for a solution to that seemingly impenetrable ceiling.

Here's the punchline. The income ceiling in PT isn't about reimbursement rates. It's about your practice model.

Dr. Gruner created the RTM codes, which are the first new codes for PT in 20 years. Now we can absolutely make the strong argument that the PT billing codes don't adequately reimburse therapists for the value we create, and that the income ceiling should not be tens of thousands below providers who don't have doctoral degrees as the required minimum educational level.

But in this episode, Dr. Gruner explains why team-based care and value-based arrangements are the only path to sustainable income growth while providing access to care to our communities.

We talk about RTM in this episode, and about how RTM wasn't designed as simply another billing code. It's infrastructure for the glide path to value-based care for physical therapists.

So tune in to hear much more from Dr. Gruner, a true physician champion for the physical therapy profession. Learn how to stop top playing every position and start calling the plays.

RTM Strategic Deep Dive: Subscribe below for the full article on how remote therapeutic monitoring serves as a facilitator for value-based success, and why we make the argument that it is crucial for therapists to think of it that way. When you subscribe, you have access to the full archive of newsletter articles and to exclusive access to a supplemental set of resources that will hit your inbox after you subscribe (for free!).

Subscribe to the Future Proof PT newsletter and receive exclusive resources that grow with every episode!

Subscribe to our YouTube Channel

Drowning in student debt? Feeling undervalued as a PT? Here's why: You're trapped between an artificial floor and a glass ceiling. The floor? PT school costs more than an MBA at MIT—that's your barrier to entry. The ceiling? The AMA's physician-dominated board literally decides what you're worth. And between those two forces, you're stuck. Today we break down the economic trap keeping PTs fragmented, underpaid, and powerless—and what you can actually do about it. You're not alone, and the problem runs way deeper than you may think.

What You'll Learn:

• Why PTs earn less than other providers for the same skills - Discover how the American Medical Association controls your reimbursement rates
• The hidden economic barriers keeping PTs fragmented - Learn why our 400,000-strong profession has less influence than professionals with a smaller number of providers
• Why your PT school education failed you - The critical finance and regulatory knowledge gaps that leave new grads unprepared (and how to fix them yourself)
• The private practice opportunity - Understanding debt structures, consulting fees, and why smaller clinics actually have MORE freedom to innovate
• Your path out of fee-for-service dependence - Practical strategies for recouping your investment beyond insurance reimbursement
• Why certifications actually DO matter (despite what cynical colleagues say) - How specialization opens doors beyond your clinic job

Our guest today is Jon Lee, PT, DPT, MBA, the co-founder of Pickle, former pro sports PT, and someone who's navigated from clinical practice to Oxford MBA to vaccine development to healthcare tech

It's a conversation about the structural economic problems facing PTs—and actionable knowledge you won't get in school. You will enjoy how the three of us challenge each other throughout this hour-long conversation. We keep it real and it's ultimately optimistic.

This episode is great for new grads struggling with debt, mid-career PTs feeling stuck, clinic owners questioning their business model, and anyone wondering if they made a mistake choosing their healthcare profession.

Subscribe to the Future Proof PT newsletter and receive exclusive resources that grow with every episode!

Subscribe to our YouTube Channel

Dr. Drew Contreras, PT, DPT, SCS—Lieutenant Colonel (retired), former White House Medical Unit PT to Presidents Obama and Biden, and current APTA Vice President of Strategic Affairs—delivers a masterclass in professional evolution that will fundamentally shift how you view your career trajectory.

This is surgical precision strategy from someone who's operated at the highest levels of American healthcare.

Dr. Contreras dismantles the "comfort crisis" plaguing PT, where professionals complain about constraints while avoiding the uncomfortable work of actual transformation. His brings up a great point, too: venture capitalists are flooding PT because they see massive opportunity that many therapists are too comfortable to seize.

The Analogy-Based Insights You'll Gain:

• The Tree-Cutting Analogy: How value-based care mirrors service industries you already understand—and why PTs must stop being "branch pickers" and become strategic planners
• The Netflix Model of Healthcare: Why flexible, on-demand PT delivery (including treating astronauts in space) represents the future of patient engagement
• From Skilled Laborer to Expert Consultant: The mindset shift from counting clamshells to providing high-level clinical consultation that commands premium pricing
• The Spider-Man Principle: Why ordering imaging and labs comes with great responsibility—and how embracing this elevates PT to true doctoring status

Strategic Intelligence from the Inside:

Contreras reveals how political and healthcare leadership actually views PT's potential, sharing insights from Pentagon health clinics to White House medical operations. His perspective on "old guard versus new guard" leadership offers a roadmap for navigating professional transition without burning bridges.

The Uncomfortable Truth: Healthcare's shift is here and we already risk being late to the game. PTs equipped with "coloring-book anatomy knowledge" (it will make sense when you listen to the episode) successfully operated in primary care roles decades ago. Today's DPT graduates possess exponentially superior tools and knowledge, yet many lack the courage to step into their full scope of practice. And the "old guard" has to step up and embrace this too, even if it means adding to your knowledge base.

This episode will arm you with the strategic framework to thrive in healthcare's inevitable transformation.

For therapists ready to evolve beyond traditional treatment rooms into primary care leadership roles, this conversation provides the roadmap. For those comfortable with the status quo, it serves as a wake-up call to the professional reckoning already underway.

Read Dr. Contreras' bio here

Subscribe to the Future Proof PT newsletter and receive exclusive resources that grow with every episode!

Subscribe to our YouTube Channel

What distinguishes an explorer from a maintainer in the therapy profession? Why are outside disruptors capturing market share while traditional practices struggle? How can clinicians leverage cutting-edge research on mitochondrial DNA and movement disorders to revolutionize treatment approaches? We tackle these questions and more in a dialogue that bridges clinical excellence with business innovation.

Alex offers a provocative parable about buying lottery tickets that perfectly captures our profession's hesitation to proactively engage with healthcare transformation. "We're losing workforce," he warns, "but we're still failing to see that we need to go out and look into these risk-based contracts, at least explore, at least understand what they are and how to operationalize them."

We examine the stark contrast between traditional care models and patient-centered approaches that leverage technology. Is it better to "hold a patient's hand" through dozens of visits, or transition to guided self-management after fewer sessions? This question gets to the heart of therapy's value proposition in an evolving healthcare ecosystem.

The irony doesn't escape us: therapists expertly help patients recognize and build upon their strengths, yet we collectively struggle to do the same for our profession. The gap between the actual value therapists provide and our ability to communicate that value creates the perfect opportunity for disruption – either from outside forces or, ideally, from innovative thinkers within.

External disruptors aren't succeeding because they provide better clinical care. They're succeeding because they've packaged therapy expertise in ways that solve specific problems for stakeholders, speaking the language of value, efficiency, and outcomes that resonates with payers and health systems.

This conversation isn't meant to be comfortable – it's meant to be catalyzing. The explorer's mindset we advocate requires questioning established practices, reimagining care delivery, and having the courage to venture into unfamiliar territory.

As Alex puts it: "I'm optimistic because I think the better days are ahead, because that's my nature, but I'm also realistic that it may take a catastrophe for those models to be absorbed. We just want to be on a good hill when the catastrophe hits."

Are you ready to climb that hill? To join us as explorers charting new territories in healthcare transformation? To balance rigorous clinical standards with business innovation?

Listen now to discover how adopting an explorer's mindset could transform your practice and ensure our profession remains central to healthcare's future. Because the future of therapy will be written by those willing to explore it – and we believe you have an important chapter to contribute.

• The explorer's mindset encourages seeking new horizons in therapy.
• Therapists must adapt to changing healthcare delivery models.
• Curiosity and innovation are essential for professional growth.
• Understanding value-based care is crucial for therapists.
• Therapists need to articulate their value to stakeholders.
• Research consumption strategies can enhance clinical reasoning.
• Collaboration with other healthcare providers is vital.
• Growth can be achieved through efficiency and subtraction.
• Therapists should prepare for risk-based contracts.
• The future of therapy depends on adaptability and exploration.

#TherapyLeadership #HealthcareInnovation #PhysicalTherapy #ValueBasedCare #PracticeManagement

Link to the transcript here.

Subscribe to the Future Proof PT newsletter and receive exclusive resources that grow with every episode!

Subscribe to our YouTube Channel

Check out our friend and colleague's *course on AI for PTs (and so many others!) by Cody Lee, PT, DPT

*affiliate link

Episode Summary:

In the latest episode of Future Proof PT, hosts Dana Strauss and Alex Bendersky, along with special guest Jerry Durham, tackle the critical crossroads facing physical therapy as a profession. They challenge listeners to question whether they're functioning as true healthcare professionals or merely "operators" in a broken system.

The trio discusses how healthcare is rapidly transforming around us, including recent proposed policy changes in the 2026 Physician Fee Schedule Proposed Rule that could significantly impact physical therapists. While time-based providers like primary care physicians are seeing increases of 5-9%, independent PTs face a -1% adjustment. The trio make the case that this should be a wake-up call for the profession.

Key topics covered include:

• The value of hands-on patient relationships in an AI-driven healthcare landscape
• Why team-based care is essential for survival in evolving payment models
• The importance of understanding the broader healthcare ecosystem beyond PT
• Strategies for demonstrating value to referring physicians and payers
• Embracing the shift to outpatient and in-home care

This conversation serves as both a warning and a call to action for physical therapists to "look up" from their treatment tables, redefine their professional identity, and secure their place in the healthcare of tomorrow.

Whether you're a clinic owner, practicing PT, or student, or in a non-clinical role, this episode delivers uncomfortable truths alongside actionable insights that could transform your approach to practice. You won’t want to miss it.

Link to the episode transcript here.

Subscribe to the Future Proof PT newsletter and receive exclusive resources that grow with every episode!

Subscribe to our YouTube Channel

Check out our friend and colleague's *course on AI for PTs (and so many others!) by Cody Lee, PT, DPT

*affiliate link

Dana and Alex explore the Therapy Value Quotient, an objective framework for measuring clinical impact that goes beyond subjective reasoning. Learn a practical algorithm that factors in functional improvement, patient complexity, care intensity, and cost—plus why establishing clear therapy prognoses is essential for professional survival.

Key topics covered in this episode: objective clinical measures, therapy prognosis, value-based care, capitation, long-term patient relationships, and preparing for AI-driven healthcare analytics.

Essential listening for therapists ready to prove their value in measurable ways while maintaining meaningful patient connections.

Subscribe to our YouTube Channel

Sign up for our newsletter and receive exclusive resources that grow with every episode!

Check out our friend and colleague's course on AI for PTs (and so many others!) by Cody Lee, PT, DPT

Sponsored by Saatva Mattresses: use this link for 15% off Saatva mattresses or tell anyone at a Saatva show room that Dana Strauss, PT, DPT sent you. This offer is stackable with any other active offer Saatva offers at the time!

Future Proof PT helps physical therapists navigate the changing healthcare landscape and build sustainable, value-driven practices.