PRIVATE PRACTICE - AC25 - How Key Performance Indicators Link With Insurance Contract Negotiations To Drive Profits
Recorded On: 11/12/2025
.1 CEUs/ 1.0 Contact Hours
Course Level: Intermediate
From 2011-2023, physical therapy reimbursement declined 37.0%. In 2024, Medicare reimbursement decreased another 1.8%. Physical therapy has become a low-margin industry. Organizations that achieve and maintain solid profit margins will understand the Key Performance Indicators that drive their business. They will also understand how insurance contracting and rate increase negotiations impact their profit margins. Key Performance Indicators and insurance contracting are interrelated and profoundly impact your profitability. In this session, you will learn what Key Performance Indicators impact your profitability, along with industry benchmarks and ways to maximum those indicators. You will learn how to leverage those well-managed Key Performance Indicators in your insurance contract negotiations to gain fee schedule increases.
Attendees will also learn what language in a contract is favorable to the provider and language they need to avoid in a contract that is favorable to the payer. Often, physical therapists struggle to grasp this reality. These different mindsets can make the difference between signing a contract that is provider-friendly versus signing a contract that is payer-friendly. In this session, attendees will also learn how to present fee schedule increase requests in a way that resonates with insurance companies. Finally, attendees will learn the practice tips that the presenters used to negotiate fee schedule increases in their combined 60+ year careers.
Upon completion of this course, you will be able to:
- Discover practical strategies on how to use your Key Performance Indicators to secure insurance contract fee schedule increases
- Identify language to include and language to exclude in an insurance contract
- Learn proven techniques to understand how insurance companies think and view physical therapy providers in contract negotiations
- Understand what information is required to successfully negotiate and/or renegotiate an insurance contract
Rick Gawenda
PT
Gawenda Seminars and Consulting
RICK GAWENDA, PT, is a licensed physical therapist with over 30 years of experience and currently serves as the founder and President of Gawenda Seminars & Consulting, Inc. He graduated with a Bachelor of Science degree in Physical Therapy from Wayne State University in Detroit, Michigan, in 1991.
He has provided valuable education and consulting to hospitals, private practices, skilled nursing facilities, and rehabilitation agencies in the areas of CPT coding, ICD-10 coding, billing, documentation compliance, revenue enhancement, practice management, and denial management as they relate to outpatient therapy services. Mr. Gawenda has presented nationally since 2004 and has provided over 1000 on-site seminars and webinars.
In addition, Mr. Gawenda is retained by attorneys to serve as an expert in regard to legal or physical therapy state board issues regarding documentation, billing, supervision, and utilization of support personnel and compliance with insurance rules and regulations as well as physical therapy state board requirements.
Mr. Gawenda is a member of the American Physical Therapy Association (APTA) and Michigan Physical Therapy Association (MPTA). Mr. Gawenda is a Past President of the Section on Health Policy & Administration of the APTA. He is the current Chair of the APTA Private Practice Payment Policy
Mr. Gawenda is also the author of “The How-To Manual for Rehab Documentation: A Complete Guide to Increasing Reimbursement and Reducing Denials” and “Coding and Billing for Outpatient Rehab Made Easy: Proper Use of CPT Codes, ICD-9 Codes, and Modifiers”.
Kennedy I. Hawkins, MBA, JD, LLM
President
Kennedy Hawkins Consulting
Kennedy Hawkins, MBA, JD, LLM was the President & CEO of PT Northwest for 21 years until starting his own consulting firm in 2023. He helped PT Northwest become a widely respected physical rehabilitation group at the state and national levels. In 2016, 2017, 2018, 2021, & 2022, PT Northwest was named a Top Oregon Workplace by The Oregonian newspaper. Kennedy was instrumental in helping PT Northwest win the National Association of Rehabilitation Agencies 2016 Innovation Award. In 2023, Kennedy received Intermountain Healthcare’s ROMS Quality Improvement Award.
Along with his consulting work, Kennedy recently became the Director of the Executive Development Center at Willamette University’s Atkinson Graduate School of Management. Kennedy will oversee the development of the healthcare leadership program, as well the expansion of the MBA program’s current executive development offerings. Willamette University has become one of the leading MBA programs in the nation.
He has over 30 years of experience and has held numerous national physical rehabilitation industry leadership positions. Kennedy is regarded as a “thought leader” in the areas of healthcare and leadership.
Kennedy enjoys snowboarding with his family, hiking behind his in-laws' farm in the Highlands of Scotland, international travel, and mentoring teens and young adults.
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