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

Please subscribe to the Future Proof PT podcast and share it with a friend!

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.

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, PT, DPT