Another Opinion

Looking Ahead: Balancing Growth & "Remaining Small"

Q: How have recent consolidations and acquisitions changed the landscape of complex rehab providers over the last few years? What has caused it, and how has it changed the way consumers work with providers, or how providers work with payors, referral sources and others?

A: I expect and plan for the consolidation trends to continue as a result of two primary influences: growth initiatives fueled by the new investor capital being infused into our industry and by the need to significantly lower costs and improve efficiency in the face of payor and reimbursement challenges.

Providers are reacting to the downward pricing pressure on reimbursement and the additional onslaught of documentation hurdles, processing hurdles, and pre- and post-payment audit burdens. The insanity adage — “to keep doing the same thing over and over, expecting a different end result” — appropriately describes provider sentiment. Many independent providers do not want to experience the insanity any longer and are prepared to make bold changes to ensure their ability to service consumers for many years to come. An option for providers to relieve these challenges is to join a larger organization. The breadth and depth of a national complex rehab company can deploy resources to help navigate through some of these payor and regulatory challenges, which are simply not available to small local providers.

Growth alone does not address the key issues; smart expansion is a key strategic goal of our organization. As Starbucks preaches, “Stay small while you grow.” It very important to strike the right balance between growth and the ability to provide individual service by remaining small — the large-scale organization needs to appropriately use the resources and economies of scale available to it to continue to deliver what matters most to our consumer, payor and referring customers: “To deliver accurately fit product, timely.”

Q: Looking back 10 years, what have been key influences on ATG Rehab? How have you and your team been affected by policy, funding changes, new technology, new consumer demands?

A: The desire to be the best at what we do, and shaping our organization to most efficiently react to the requirements from the growing complexities of dealing with third-party payors is the overriding infl uence on our organization. ATG Rehab has invested significant dollars in our operating system and infrastructure to be sure that we can address the changing payor requirements and to continue to improve our timeliness. Economies of scale are one of the best weapons to offset external policy changes. To prepare for the next 10 years, we will continue to leverage our deep understanding of the complex rehab technology (CRT) process and our detailed understanding of our costs. We will work every day to build on the foundation of our customer-centric organization.

Q: How do you work to stay ahead of the curve on all of the above? How do you plan today so that you’re not playing catch-up, but rather determining your own plans and destiny?

A: Our team is focused on being proactive vs. reactive. Many times, this is not easy…so how do we do this? We focus on the Three P’s: plan, people and process.

Plan: Each year, our senior team engages in a detailed, collaborative process to create our annual tactical, strategic and financial plan. Quarterly, each of our management team members assesses, sets and resets our individual top five priorities…and we use technology to communicate our plans and progress with each other in real time.

People: We have worked for years recruiting and training the best management, ATP and support team in the industry. Our regional model fosters entrepreneurial spirit, accountability, close-to-thecustomer local touch and results. We have instilled a strong culture of internal communication to keep our 700+ associate team members informed and prepared.

Process: While we are an organization that was built by acquisition, in 2006 our management team made a conscious decision to stop acquisitions for a lengthy period of time to focus on our infrastructure. We want to ensure a consistent, increased use of technology and the creation/implementation of best practices. We have a detailed document totaling 150 to 200 pages for every position in our company — available to all team members via ATGWEB. The creation of dashboards and reports to be sure all of our team members had data available —almost at the speed of thought! — all revolved around building a platform that would be able to expand to become the leading CRT provider in the nation.

In addition to the three Ps, a key ingredient to a growing, stable and dynamic organization is to have a strong financial partner. We chose Audax Private Equity, a Boston-based investor of middle-market companies with a reputation for spurring growth and creating value.

The combination of committing ourselves to the industry, the 3P initiatives and our acquisition strategy will not only enable us to stay ahead of “catch-up,” but will allow us to advance to the next level.

This article originally appeared in the October 2011 issue of Mobility Management.

About the Author

Paul Bergantino is the CEO and president of ATG Rehab, headquartered in Rocky Hill, Conn.

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