Interview with Mike Horsfield, PT, MBA - February 2015

The following is not original material. This interview is reproduced with permission from Cinema, a former Twitter personality & blogger who left the social media world years ago. The reproduction is intended to preserve & share Cinema's insightful interviews.

Mike Horsfield, PT, OCS, MBA, ATC of Bettendorf, IA serves as CEO of Rock Valley Physical Therapy. He has a unique and passionate perspective on the profession of Physical Therapy; in fact, he was invited to give a talk at the latest Graham Sessions. He is also one of few PTs to hold an MBA.

As usual, I learned quite a bit from the interview, and I’m sure you’ll get a lot out of it as well. Enjoy!

First, tell us about the first hour of your day. What is your daily morning routine beginning as soon as you wake up?

M-W-Fri I see patients in the morning.  I get up at 5:15, shower, have Greek Yogurt with peanut butter and granola for breakfast and then am off to the clinic where I am seeing patients by 6am.  T-Th are my administrative days.  I get up at 6:15, shower, start with the same breakfast and then I straighten my daughter’s hair (I am crazy good with a flat iron) and drive her to school those days.  Really enjoy those few minutes of one on one time with her.    

Give us the backstory of you find your way into the wonderful world of Physical Therapy?  

My story is typical of many PT’s.  I was became familiar with what Physical Therapists do after undergoing knee surgery from a football injury in high school.  In college I waivered between education, coaching and physical therapy.  After volunteering for a local PT practice I realize that effective therapists are also great teachers and coaches so I ultimately went down that path.  

Why did you decide to get an MBA? And, how has that impacted your business decision-making?

I realized after getting in way over my head in my first management opportunity that I had to do something to speed up the learning curve.   It was very clear to me that one high school business class in my 20 years of formal education was not quite enough.  Rock Valley was beginning to grow at that time as well so the management team saw the need to expand the organization’s business acumen so they supported my decision to take night classes to get my MBA.

The MBA has been instrumental in helping me get outside our clinical world and see our practice as a business.  When you are learning alongside people from John Deere, Caterpillar and United Airlines they help you look at your processes and business in a whole new light.  I realized that the fundamentals of business apply to all of us.  Organizations that build tractors are faced with many of the same challenges and opportunities we face everyday.

Learning and decision making is about knowing enough to ask the next best question.  Just like PT school provides us with the scientific foundation to begin our clinical learning and decision making process the MBA provided me with a similar business foundation  This has allowed me to continue to learn through the years by asking the next best question.

Tell us about the beginnings of Rock Valley Physical Therapy. Also, what was your role with the company, and how has that changed over the years?

The Rock Valley story is a great example of how collaboration is many times a better option that competition.  In 1984 Mark Levsen and Steve Layer both opened private practices a couple of blocks away from each other.  After being in business a few short months Mark invited Steve to lunch and they realized they shared the same patient care and business philosophy and decided to join their practices together rather than competing with each other for the next 30 years.  This spirit of collaboration continues to be a strong part of our company’s culture.  We make it a point to get to know our competitors. In doing so we often discover that we share the same goals and this leads us to find ways to help each other by partnering or joint venturing.  Building these relationships has been instrumental in helping us grow from 6 to 25 clinics in the past 7 years.  This philosophy and has been the motivation behind  Midwest Therapy Network. This union of 16 private practices with nearly 60 clinics is dedicated to improving the practice environment for physical therapist owned practices in our States.

As I listen to the challenges of Private Practice owners across the country I often wonder how much better off we would be as a group if everyone was willing to walk across the street and truly get to know their competition.  I believe they would realize as Mark and Steve did that they have more in common than they may think.  United we are so much stronger than we are as single entities.  For us it has been a whole lot more fun figuring out how we are going to grow the pie for all rather than beating each other up for the one piece left.

I joined Rock Valley after graduating from the University of Iowa in 1993.  In 1997 I was given the opportunity to oversee a management service agreement with local hospital and nursing home.  In 2001 I became a partner in Rock Valley and in 2005 assumed the role of COO for our Iowa clinics.  Steve Layer transitioned from CEO back to full time patient care in 2010 and that is when I assumed the role of CEO.  Thanks to many great mentors along the way the entire journey has been and continues to be a wonderful learning experience..

Give us an example of some of the hardest challenges that Rock Valley PT had to overcome in it’s 30 years? And, how were they solved?

Five years ago we saw where health care was going and had to make a decision whether we wanted to grow or consolidate.  We understood if we wanted to grow in an environment where there would be vertical integration and risk sharing we had to be willing to consider alternative business relationships with providers and health systems.  That led to some great debate at our Board level.  A year later we eventually reached consensus on our “non-negotiable” principles that we still adhere to when we partner today.  We are fortunate to have a high trust environment where our owners can get into heated debates and then open and beer and move on.  We are proud of the fact that we have eleven business partners and have never had to take a vote on an issue.  We have always been able to reach consensus through thoughtful  discussion.

Share some of the most important entrepreneurial lessons you’ve learned over the many years of doing business.

Surround yourself with great people and then jump and grow wings on the way down.  One thing I am sure of is 100% of opportunities never explored fail.  Great people do great things.  Organizational systems need to be designed to encourage great people to fly as fast and far as they want but also build in the parachute to ease the landing if they fail.  Failure needs to be embraced in an organization as a great learning opportunity.  Do something!  Act!  It is too easy to be paralyzed by analysis.  If something feels right and the potential downside is not fatal then go for it and learn from the experience.  I have also learned to never underestimate the value of a relationship.  Relationships are long term investments and should be treated as such.

Imagine if you could pick up the phone and call your younger self right after graduating physio school, then what advice would you give him?

Listen better, be more patient and enjoy every step along the journey!

Tell us about HAVlife. And, how did you end up on their Board of Directors?

The mission of HAVlife is to prevent lost potential in kids by providing them the opportunity to participate in sports, music or the arts.  It was started by a friend of mine who lost his son Hunter Aaron Vondran (HAV) to a tragic accident at age 13.  HAVlife works through the schools and other non-profits to ensure children 10-15 years of age have access to the resources they need to be involved in these activities.  Since its inception 7 years ago HAVlife has given over $600,000 back to the kids in our community.

Rock Valley has been supporters of HAVlife since their beginning.  We are proud that the proceeds from a charity basketball game organized by our philanthropic committee was the first corporate donation to HAVlife.  We also organize a yearly special needs All-Star Football Camp with former Iowa Hawkeye football legends for HAVlife.  This camp is not only a highlight for the campers but is also a highlight of the year for the former Hawks and our employees who volunteer to help with the event.

After being engaged supporters of HAVlife for five years I was honored when their founder Mike Vondran asked me to serve on their Board.  It a pleasure to work alongside this 100% volunteer Board who is trying to impact the future of our community one child at a time.

I hear you gave a talk at Graham Sessions 2015 (#GrahamSessions2015). What motivated you to take the stage?

I was humbled and honored when Steve Anderson asked me to give a “What I believe” talk (and you can’t say no to Steve can you?).  The motivation for my talk came from the passion I have for our great profession and the values instilled in me growing up on a farm.  Like the land we farm I believe we have not inherited this profession from our predecessors but rather are borrowing it from our grandchildren. We need to take great care of it and leave it in better condition than we found it.  Reiterating my point earlier I believe collaboration among small practices in a “farm co-op” model is a way in which we can continue to keep PT ownership thriving in this time of industry consolidation.  I believe we need more owners not renters in our profession.

I absolutely love the way you worded that – “we need to take care of the “land” and leave it in better condition that we found it”. What were your biggest take-aways from Graham Sessions 2015?

I left Graham Sessions exhausted (mentally and physically) and inspired.  Our profession is in great hands. The talent, passion, and capabilities of the people assembled in Savannah was impressive.

Favorite books & authors? Reading recommendations? (personally & professionally)

Some of my favorite authors are Malcolm Gladwell, Daniel Pink and Jim Collins.  I am currently reading The Power of Habit by Charles Duhigg which is very good.  I love to read to learn but have never enjoyed reading “for fun”.  Always thought it was a waste of time.  Much prefer to wait until the book is made into a movie and then go see it.  More efficient and the popcorn is better.

How do you manage to maximize your life – professional & personal – given how busy you are?

I am blessed to be surrounded with people I love and respect in all aspects of my life.  I have the pleasure of working alongside my best friends and going home to a loving family every night.  I have learned that life is more about who accompanies you on the ride than what happens along the way or where you end up in the end. Perspective and gratitude = happiness.

Staying in the world of Physical Therapy, what important truth do very few people agree with you on?

One area where my thought differs from the PT establishment is that I believe we need to find ways to get closer to referring sources, hospitals, health systems and payers.  We have had such an inferiority complex as a profession that our fight for independence has taken our focus away from the bigger goal of interdependence.  Getting closer to these entities will enable us to show the true value we bring not only to the customer but to other providers.  This was never more clear to me than when I worked on the inpatient floor.  Inpatient therapists are in the best position to elevate our profession.  They have the opportunity to interact daily with decision makers and elevate our profession IF they choose.  It was so satisfying changing the image of the Physical Therapist  at the hospital we contracted with from “the people who walked patients” to the “professionals who coordinated the discharge planning”.  This only comes from accepting responsibility and treating all parties as a customer.  I am excited to hear what comes from the PPS task force looking into acceptable business models.  We need to find models that allow us to ethically partner with other providers and payers.

Another contrarian opinion I shared at Graham Sessions in Memphis is that maybe we get paid enough for the services we provide.  It seems that no matter what conference you go to the predominate “woe is me” conversation surrounds inadequate payment.  I would just ask each of us to step back for a minute and look where venture capitalists are investing their money.  These people know very little about our profession other than the economics and they are choosing to invest in physical therapy companies rather than put their money in tech, oil, etc.  Why?  Because we have a great thing going and a huge opportunity in front of us.  I understand that payment is regional and there are definitely some parts of the country that deserve to be paid more for their services.  However, the amazing reality is there are practices getting $65 visit that turn a 20% profit and other practices with $100 per visit income that are barely making it go.  We need to spend more energy and time focused on operational excellence and memorable customer experiences and less time complaining about payment.  A wise man once told me that no matter how much you make it is just enough.  So true.  

Given the choice of anyone in the world, with who would you want to catch dinner with?

I am a product of the 80’s and a big Steelers fan so I would love to be invited over to the Rooney’s for dinner.  I figure their house is nicer than mine and maybe they would invite Bradshaw, Franco and Rocky over as well.  The Steelers embody everything I would want for our organization-success, class, integrity and admiration from its team members and competitors.  It would be great to learn how the Rooney family has been able to maintain this balance over the years in the highly competitive world of professional sports.

Mike, what a fantastic read! Thank you for sharing your thoughts and passions. Look forward to more from you in the coming years.

Follow Mike on Twitter: @Mike_Horsfield 

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