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

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!

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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!).

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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.

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