U.S. Physical Therapy, Inc., through with its subsidiaries, operates and/or manages outpatient physical therapy clinics that provide pre-and post-operative care for a variety of orthopedic-related disorders and sports-related injuries, treatment for neurological-related injuries and rehabilitation of injured workers.
The company also has a majority interest in businesses that are leading providers of industrial injury prevention services. Services provided in this business include onsite injury...
U.S. Physical Therapy, Inc., through with its subsidiaries, operates and/or manages outpatient physical therapy clinics that provide pre-and post-operative care for a variety of orthopedic-related disorders and sports-related injuries, treatment for neurological-related injuries and rehabilitation of injured workers.
The company also has a majority interest in businesses that are leading providers of industrial injury prevention services. Services provided in this business include onsite injury prevention and rehabilitation, performance optimization, post-offer employment testing, functional capacity evaluations, and ergonomic assessments. The majority of the IIP services are contracted with, and paid for, directly by employers, including a number of Fortune 500 companies. Other clients include large insurers and their contractors. These services are performed through Industrial Sports Medicine Professionals, primarily consisting of specialized certified athletic trainers.
The company’s strategy is to continue acquiring outpatient physical therapy practices, develop outpatient physical therapy clinics as satellites in existing partnerships, manage outpatient physical therapy clinics owned by third parties, and continue acquiring companies that provide or serve the company’s industrial injury prevention services sector.
Segments
The company operates its business through two reportable business segments: Physical Therapy Operations and Industrial Injury Prevention Services (‘IIP’).
Physical Therapy Operations segment
The company’s Physical Therapy Operations segment primarily operates through subsidiary clinic partnerships (‘Clinic Partnerships’), in which it generally serves as the general partner or managing member of the Clinic Partnerships. The company’s equity interests generally range from 65% to 75% (a range of 10%-99%) in the Clinic Partnerships. For the vast majority of the Clinic Partnerships, the managing healthcare practitioner is a physical therapist who owns the remaining limited partnership interest in the Clinic Partnership. Generally, the therapist partners have no interest in the net losses of Clinic Partnerships, except to the extent of their capital accounts. Since the company also develops satellite clinic facilities of existing clinics, most Clinic Partnerships consist of more than one clinic location. Some of the Clinic Partnerships serve as management services organizations, which manage and provide staffing and a variety of administrative services to physical therapy provider entities in which the company does not have an ownership interest. These Clinic Partnerships are similarly owned collectively by the company and one or more physical therapists who are involved in the management of the operations. To a lesser extent, the company operates some clinics through wholly-owned subsidiaries (hereinafter referred to as ‘Wholly-Owned Facilities’).
Clinics
The company operated and/or managed 729 clinics in 43 states on December 31, 2024. The company’s highest concentration of clinics is in the following states: Texas, Tennessee, Michigan, New York, Virginia, Oregon, Florida, Pennsylvania, Georgia, Maryland, Idaho, Missouri, Arizona, Alabama, Connecticut, South Carolina, and Wyoming. In addition to these clinics, the company also managed 39 hospital and/or physician-owned physical therapy practices as of December 31, 2024.
The company’s typical clinic occupies 1,000 to 7,000 square feet of leased space in an office building or shopping center. There are 20 clinics occupying space in the range of over 7,000 square feet to 16,500 square feet. The company attempts to lease ground-level space for its patients’ ease of access to clinics.
Each Clinic Partnership maintains an independent local identity, while at the same time enjoying the benefits of national purchasing, negotiated third-party payor contracts, centralized support services, and management practices. Under a management agreement, the company provides a variety of support services to each clinic, including supervision of site selection, construction, clinic design, and equipment selection, establishment of accounting systems and billing procedures, training of office support personnel, processing of accounts payable, non-clinical operational direction, auditing of regulatory compliance, payroll, benefits administration, accounting services, legal services, quality assurance, and marketing support.
The company provides services at its clinics on an outpatient basis and generally charges for treatment on a per-procedure basis. Medicare patients are charged based on prescribed time increments and Medicare billing standards. The company continually assesses the potential for developing new services and expanding the methods of providing existing services in the most efficient manner while providing high-quality patient care.
Therapists at the company’s clinics initially perform a comprehensive evaluation of each patient, which is then followed by a treatment plan specific to the injury as prescribed by the patient’s physician. The treatment plan may include a number of procedures, including therapeutic exercise, manual therapy techniques, ultrasound, electrical stimulation, hot packs, iontophoresis, education on management of daily life skills, and home exercise programs. A clinic’s business primarily comes from referrals by local physicians.
Patient Care Providers and Staffing
The company continues to seek to attract the employment of physical therapists who have established relationships with physicians and other referral sources by offering these therapists a competitive salary and incentives based on the profitability of the clinic that they manage. For multi-site clinic practices in which a controlling interest is acquired by the company, the prior owners typically continue as employees to manage the clinic operations, retaining a non-controlling ownership interest in the clinics and receiving a competitive salary for managing the clinic operations. In addition, the company has developed satellite clinic facilities as part of existing Clinic Partnerships and Wholly-Owned Facilities, with the result that a substantial number of Clinic Partnerships and Wholly-Owned Facilities operate more than one clinic location.
Typically, each therapist partner or director, including those employed by Clinic Partnerships in which the company acquired a majority interest, enters into a multi-year employment agreement for a term of up to five years with their Clinic Partnership. Each agreement typically provides for a covenant not to compete during the period of their employment and for up to two years thereafter. Under each employment agreement, the therapist partner receives a base salary and may receive a bonus based on the net revenues or profits generated by their Clinic Partnership or specific clinic. In the case of Clinic Partnerships, the therapist partner receives earnings distributions based upon their ownership interest. Upon termination of employment, the company typically has the right to purchase the therapist’s partnership interest in Clinic Partnerships. For those Clinic Partnerships the company created in connection with an acquisition, the partner also has the right to cause the company to purchase their interest upon termination of their employment, generally after a set holding period.
Sources of Revenue
Payor sources for physical therapy operations are primarily managed care programs, commercial health insurance, Medicare/Medicaid, and workers’ compensation insurance. Commercial health insurance, Medicare, and managed care programs generally provide coverage to patients utilizing the company’s clinics after payment by the patients of normal deductibles and co-insurance payments. Workers’ compensation laws generally require employers to provide, directly or indirectly through insurance, costs of medical rehabilitation for their employees from work-related injuries and disabilities, and in some jurisdictions, mandatory vocational rehabilitation, usually without any deductibles, co-payments, or cost sharing. Treatments for patients who are parties to personal injury cases are generally paid from the proceeds of settlements with insurance companies or from favorable judgments. If an unfavorable judgment is received, collection efforts are generally not pursued against the patient, and the patient’s account is written off against established reserves. Bad debt reserves relating to all receivable types are regularly reviewed and adjusted as appropriate.
The company’s physical therapy business depends to a significant extent on its relationships with commercial health insurers, health maintenance organizations, preferred provider organizations, and workers’ compensation insurers. In some geographical areas, the company’s clinics must be approved as providers by key health maintenance organizations and preferred provider plans to obtain payments. Failure to obtain or maintain these approvals would adversely affect financial results.
Medicare
During the year ended December 31, 2024, approximately 40.6% of the company’s visits and 36.0% of its net patient revenue was from patients with Medicare or Medicaid program coverage. To receive Medicare reimbursement, a facility (Medicare Certified Rehabilitation Agency) or the individual therapist (Physical/Occupational Therapist in Private Practice) must meet applicable participation conditions set by the Department of Health and Human Services (‘HHS’) relating to the type of facility, equipment, recordkeeping, personnel, and standards of medical care, and must also comply with all state and local laws. HHS, through Centers for Medicare & Medicaid Services (‘CMS’) and designated agencies, periodically inspects or surveys clinics/providers for approval and/or compliance. Failure of the company’s subsidiaries to obtain or maintain certifications as Medicare providers or failure to enroll as a group of physical/occupational therapists in a private practice could adversely affect financial results.
Marketing
The company focuses its marketing efforts primarily on physicians, including orthopedic surgeons, neurosurgeons, physiatrists, internal medicine physicians, podiatrists, occupational medicine physicians, and general practitioners. In marketing to the physician community, the company emphasizes its commitment to quality patient care and regular communication with physicians regarding patient progress. The company employs personnel to assist clinic directors in developing and implementing marketing plans for the physician community and to assist in establishing relationships with health maintenance organizations, preferred provider organizations, case managers, and insurance companies.
Industrial Injury Prevention Services segment
Services provided in the IIP segment include onsite injury prevention and rehabilitation, performance optimization, post-offer employment testing, functional capacity evaluations, and ergonomic assessments. The majority of these services are contracted with, and paid for, directly by employers, including a number of Fortune 500 companies. Other clients include large insurers and their contractors. The company performs these services through Industrial Sports Medicine Professionals, consisting of both physical therapists and ATCs.
In 2017, the company acquired a 55% interest in an initial IIP business. In 2018, the company acquired a 65% interest in another business in the IIP sector and then combined the two businesses. After the combination, the company owned a 59.45% interest in the combined business, Briotix Health, Limited Partnership (‘Briotix Health’). In 2019, the company acquired 100% of a third provider of industrial injury prevention services. The acquired company specializes in delivering injury prevention and care, post-offer employment testing, functional capacity evaluations, and return-to-work services. It performs these services across a network in 45 states, including onsite at eleven client locations. The business was then combined with Briotix Health, increasing the company’s ownership position in the partnership to approximately 76%. In 2021, the company acquired a company that specializes in return-to-work and ergonomic services, among other offerings, and contributed those assets to Briotix Health. On October 31, 2023, the company made an acquisition and purchased 100% of an additional IIP business and contributed its assets to Briotix Health. As part of the October 2023 acquisition, the company also acquired a 55% interest in an ergonomics software business. In April 2024, the company acquired 100% of an IIP business and contributed its assets to Briotix Health. Subsequent to the above-mentioned acquisitions and the purchases and sales of the redeemable non-controlling interests of the limited partners, the company’s ownership in Briotix Health is approximately 92%.
On November 30, 2021, the company acquired an approximate 70% interest in another leading provider of IIP services.
Regulation
The company rents clinic space for some of its clinics from referring physicians and has taken the steps that are necessary to ensure that all leases comply to the extent possible and applicable, with the space rental Safe Harbor to the Fraud and Abuse Law.
The company has taken steps regarding the structure of such arrangements as necessary to sufficiently distinguish them from these suspect ventures, and to comply with the requirements of the Fraud and Abuse Law.
Although the business of managing physician-owned and hospital-owned physical therapy facilities is regulated by the Fraud and Abuse Law, the manner in which the company contracts with such facilities often falls outside the complete scope of available Safe Harbors. The company’s arrangements comply with the Fraud and Abuse Law, even though federal courts provide limited guidance as to the application of the Fraud and Abuse Law to these arrangements.
Further, the Stark Law (Provisions of the Omnibus Budget Reconciliation Act of 1993 (42 U.S.C. § 1395nn)) has application to the company’s management contracts with individual physicians and physician groups, as well as any other financial relationship between the company and referring physicians, including medical advisor arrangements and any financial transaction resulting from a clinic acquisition. As with the Fraud and Abuse Law, the company considers the Stark Law in planning its clinics, establishing contractual and other arrangements with physicians, marketing and other activities, and the company’s operations are in compliance with the Stark Law.
History
U.S. Physical Therapy, Inc. was founded in 1990. The company was incorporated in 1992 under the laws of the state of Nevada.