By Sara Mulick, Chief Revenue Officer, ION PT Network
Ask a client how they bought their physical therapy program and you will usually hear about the importance of outcomes which often come down to price. Savings below fee schedule. Cost per visit. These are the numbers that get modeled in the RFP, debated over on the renewal call, and reported up to finance as evidence of program value.
However, these metrics provide an incomplete picture of true physical therapy costs.
The cost of physical therapy is set by two things: the cost per visit and how many visits occur. A client can negotiate an aggressive discount and still spend far more on a claim than a client who did not negotiate those same discounts but managed utilization well. We have institutionalized a purchasing process that optimizes just one, and often the smaller, variable in the equation.
The Other Half of the Cost Equation
A negotiated discount addresses only half the cost equation. The other half is utilization: the number of visits required for an episode of care. A competitive rate loses value when visit counts become excessive. By actively managing care around the worker’s progress and functional needs, a program can deliver greater overall value even at a higher per-visit rate.
In data we reviewed across a national program, nonsurgical cases averaged roughly 9 visits over 4 weeks; surgical cases averaged roughly 19 visits over 7 weeks. That gap is expected because a surgical case should not be managed to the same target as a straightforward nonsurgical one. The harder question is what happens among similar cases: why does one worker progress to discharge while another with a comparable injury runs significantly more visits? Is that extra care necessary, or is the original plan just continuing without enough visibility into the worker’s progress?
That is where active clinical management matters. It is not about cutting visits indiscriminately, but keeping each one tied to measurable progress toward function and recovery. Price determines what we pay per visit. Clinical management determines how many visits we ultimately pay for and whether those visits are delivering value.
That is the variance that moves the needle on program costs, and it is rarely what the program is selected on.
Speed to care has become table stakes
For most of the last decade, the industry’s answer to these challenges was speed. Get the injured worker into care faster and the downstream problems shrink. That was correct, and the industry acted on it. Time to schedule and time to first appointment became standard reporting, then standard expectations, then standard selection criteria.
The result is that these metrics have converged. Scheduling turnaround measured in hours rather than days is now unremarkable. Nearly every credible partner in this space reports strong numbers, and the differences between them are small enough to fall inside normal month-to-month noise.
When a metric stops distinguishing between anyone, it stops being useful for selection. A payer who chooses a program on turnaround time in 2026 is not choosing on performance. They are choosing on a bar that everyone clears, and pricing becomes the default measure of a program.
Speed still matters. It has simply moved from a differentiator to a hygiene factor, and the industry has been slow to update its scorecard accordingly.
The unmeasured middle
What almost no one is buying on is the stretch between the first visit and discharge.
That period is where the plan of care either adapts to how the patient is responding or continues the trajectory set by an authorization written with limited information. It is where a case either progresses toward function and closure or quietly settles into a maintenance pattern that nobody is watching closely enough to interrupt. It is where nearly all the cost variation lives, and it is the least visible part of the episode to the person accountable for the claim.
Better questions
This is a fixable problem, and the fix starts with what is asked at the business review.
Averages are the wrong frame. An average visit count tells a client nothing about the variation underneath it, and that variation is where the money is. The useful questions are distribution questions. What percentage of cases finished below the authorized visit count, and what happened in the ones that did not? Where does jurisdictional performance differ from the book average, and is there a clinical explanation or just an unmanaged one? What is the total cost of an episode by case type, not the cost of a unit? How many cases required a second authorization cycle, and how long did the worker wait during it? How frequently is clinical management applied to cases? How often was there proactive intervention that changed the course of physical therapy?
None of these are comfortable questions for a vendor partner to answer. These questions surface program variances that go far beyond a pricing comparison. That is precisely the argument for asking them.
The discount is the easiest number in this business to negotiate but not the most consequential one to win. Clients who are serious about physical therapy spend will get further by scrutinizing the middle of the episode than by squeezing another two points out of the rate.
About Sara Mulick
Sara Mulick is Chief Revenue Officer at ION PT Network, where she leads the company’s efforts to expand its reach with payers, employers, and third-party administrators nationwide. She has spent more than two decades in workers’ compensation sales and is known for developing high-performing teams and building growth strategies across complex healthcare services.
Before joining ION, Sara was Chief Sales Officer at The IMA Group, where she directed enterprise growth across evaluation and clinical services. Earlier in her career, she rose through a series of executive positions at One Call, eventually heading a national sales organization accountable for more than $1 billion in annual revenue. Throughout her career, she has focused on commercial growth, strategic partnerships, and innovation in the workers’ compensation industry.
About ION PT Network
ION PT Network is a national physical therapy management company built exclusively for workers’ compensation. Founded in 2017 by physical therapist Joseph Noel, ION manages PT care on behalf of payers, employers, and third-party administrators, coordinating treatment through independent providers with licensed clinical oversight at every stage of a case. More than half of ION’s staff are licensed therapists. Learn more at www.ionptnetwork.com.