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					 Ithaca Physical Therapy
      & Aquabilities

Shelly Graham, Charissa Morrisroe, Lindsay Harris
12/9/2010
Executive Summary_______________________________________________________________
          Ithaca Physical Therapy & Aquabilities is an aquatic and land based physical therapy office that
will be opening in Ithaca, New York that will be owned and managed by Joe Girardi, MBA, DPT, who is
from New York, NY. The mission of our practice will be to provide the highest quality orthopedic care to
the residents of Ithaca and the surrounding communities. We will strive to maintain a compassionate
and comfortable community and create a comprehensive and unique plan of care for each patient on
land or in the aquatic environment. We will show our dedication to the health and wellness of our
employees and the community at large by providing access to activities and equipment for promotion of
fitness and healthy lifestyles. We will strive to improve patient and client care through continuing
education and expand our reach by adding more services, expert clinicians, new technology, and
equipment as the need arises. We will maintain our ethical and moral obligations to the Ithaca
community and surrounding areas by providing the use of our resources for pro bono services.
          Ithaca Physical Therapy & Aquabilities will offer a comprehensive range of services to meet the
needs of our target population, which includes adults between the ages of 18-50 with orthopedic
pathologies. Our focus is in the areas of joint replacements, joint surgeries, joint pain, and general
athletic injuries. With the combination of aquatic therapy and land based treatment, we can address
clients with impairments in range of motion, joint mobility, balance, strength, and weight bearing status.
As our business grows, we will extend our target market to the pediatric, geriatric, and women’s health
population by expanding our pool services. The aquatic environment is an ideal place to treat many
associated impairments that face this spectrum of the population; and so creativity and innovative
therapy techniques will be used to address this secondary target population. The utilization and
implementation of aquatic physical therapy, land based physical therapy, individualized home exercise
programs, overall patient education, therapeutic exercise, modalities including electric stimulation for
pain control and ultrasound, manual therapy, massage therapy, and nutrition counseling will afford our
patients a variety of treatment care options to assist in their rehab and overall health improvement.
Our professional staff will be trained and specialized in these areas of treatment to maximize outcomes
and ensure quality for our patients.
          Aside from our physical therapy services we will offer wellness and prevention strength training
programs in the YMCA gym facilities. Our intended Step Down program, incorporated with the YMCA
facility, will also provide our patients with a nice transition from our physical therapy rehab to
continuing an individualized fitness regime. By utilizing our CSCS and aquatics directors, our facility will
offer training programs for athletes in sport specific athletic enhancement as well as prevention of
injuries. We will also offer corporate wellness packages to local businesses that include comprehensive
health and exercise programs and nutrition counseling. Free exercise classes will be offered at the
YMCA in the aerobics room as well as in the pool. This will allow consumers to supplement their fitness
programs with classes that focus on a strength training, core based, cardiovascular workout. In addition,
with battling child obesity in mind, we will encourage children in the community to come swim during
open pool hours, especially during the summer months. Our part time massage therapist is an
important asset to our team, as he/she will offer manual therapy treatments to our patient population
and contribute to our overall health and well being efforts. Our nutritionist will take referrals for

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general consultations as well as make visits to local schools and businesses to advocate for the
importance of a healthy diet and tips for incorporating one into everyday lifestyles. Ithaca Physical
Therapy & Aquabilities will also conduct fundraisers utilizing our services, and attempt to fulfill ethical
obligations by accepting as many referrals from the Ithaca Health Alliance as we are able to, on a
discounted or pro bono basis. A variety of other pro bono services will be presented, including
sponsoring of little league teams, massage-athons, and nutrition seminars.
         Aside from the physical therapy services offered to students on campus at Ithaca College and
Cornell University, our main local competition comes from Island Health and Fitness located in
downtown Ithaca. They offer many similar services as our facility, they are an established business, and
they are connected to Cayuga Medical allowing them convenience of care as well as referrals. Some
barriers posed to patients for accessing our services would be lack of time, money, and knowledge of
the services that we offer them, and insurance coverage. We are a new business, which can be a
downfall to us because we are not as established and experienced; and it may take a while to develop a
client base and generate word of mouth about what we offer. Despite our competition, Ithaca Physical
Therapy & Aquabilities has a unique opportunity that other businesses in town may not be able to offer
their patients. By contracting with the YMCA, we possess a large facility full of exercise equipment in
addition to a more intimate clinic setting for treatments and evaluations. Day care is available at a
discounted price, and gym memberships at the YMCA are offered to patients as well. Individualized
aquatic therapy treatment is an opportunity of ours that is not offered by Island Health and Fitness, who
perform mainly group exercise sessions. We also have a Swim Ex machine that can be used for
individual treatment, performance enhancement, and gait rehabilitation. Our variety and experience of
staff will foster the lifelong learning of our therapists and the growth of this business, which will
ultimately allow us to become more involved in the community, treat a large spectrum of the patient
population, and develop a notable reputation with our focus on overall health promotion and wellness.




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Vision Statement:_____________________________________________________________________
         The professional staff at Ithaca Physical Therapy & Aquabilities will strive to improve patient and
client care through continuing education and exceeding the excellent standard set by local competitors.
We will expand our reach by adding more services and expert clinicians as we become financially able.
We will strive to remain on the cutting edge by obtaining and competently utilizing new medical
technology and equipment as it becomes available. We will create a competitive working environment
by providing bonuses and continuing education funds to our employees as we gain notoriety and
success in the community. We will maintain our ethical and moral obligations to the Ithaca community
and surrounding areas by providing the use of our resources for pro bono services.

Mission Statement:____________________________________________________________________
        The mission of our practice is to provide the highest quality orthopedic care to the residents of
Ithaca and the surrounding communities. We strive to maintain a compassionate and comfortable
community and create a comprehensive and unique plan of care for each patient. We are providing a
multidisciplinary approach to obtain optimum function by working on land and in the water. We believe
that our services are optimized when we apply a team approach and incorporate patients, their
caregivers and other expert clinicians in our care. We run a cost effective business in order to maximize
value to our consumers. We are dedicated to the health and wellness of our employees and the
community at large by providing access to activities and equipment for promotion of fitness and
improving lifestyles.

Organizational Structure:_______________________________________________________________
          We at Ithaca PT & Aquabilities will employ a flat organizational structure in order to ensure a
direct flow of information because we are a small organization and all facets of our business need to be
in sync. Our three full time physical therapists will serve as managers because of their years of clinical
experience and will report to the owner. The PT managers will consult with the office manager who will
also be a manager responsible for the 2 part time receptionists. They all need to be in contact to run the
billing and business side of the establishment in order to let the other professionals focus on
patient/client care. The aquatic specialists, PTaide, part time PT’s, nutritionist, and massage therapist
will all report to the PT manager who is working concurrent hours because of the advanced clinical
experience of the PT managers. The aquatic specialists will work closely with the PT manager who sees
their patients on land. See Appendix A for an organizational chart.

Type of PT practice:_____________________________________________________________________
        We will be opening an orthopedic based Aquatic PT practice that also has land based physical
therapy to provide our patients with a variety of services for optimal care. The aquatic environment
allows patients to begin their rehabilitation earlier than on land alone and get back to optimum function
sooner. We have a contract with the neighboring Ithaca YMCA for the use of their facilities. As a part of



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our overall treatment package, we also offer the options of massage therapy and nutrition counseling
for a comprehensive approach.

Legal/Tax Status:______________________________________________________________________
         As a Professional Services Corporation, we will pay flat rate taxes of 35% with tax deductible
salaries, allowing us the ability to offer our employees tax free incomes. We will also ensure that our
employees have no personal liability for malpractice. We chose this type of legal operation for the
obvious tax and liability advantages it offers to us in comparison to others entities.

Operating Hours:______________________________________________________________________
                                         Monday -Friday
                                       Clinic: 7am to 7 pm
                                      Aquatics: 7am to 4pm
                                 Massage Therapy: 3pm-7pm
                              Nutritionist consultations: 3pm-7pm

        We planned these hours to allow flexibility of appointments for our patients and employees.
These hours allow patients who work full time to come in before or after work. We have provided our
nutrition counseling and massage therapy at the end of the day to allow full time workers to take
advantage of these services. Aquatics are built in throughout the day between two specialists, because
patients who tend to need this service are generally unable to return to work yet. We have
incorporated a designated meeting time for all employees who wish to attend. No patients will be
scheduled during this time to allow this. This is to foster good communication and unity amongst our
staff members, and allows every a chance to voice their opinions on business and clientele affairs.

Location:_____________________________________________________________________________
         We have chosen to be located adjacent to the YMCA in the empty lot between Wegmans and
Barnes & Noble. We chose this location because it is highly accessible to residents of Ithaca and its
surrounding towns via the main roads. It is also located on a bus route with ample parking available. It
also allows patients to plan their treatment time into their other errands, integrating it more easily into
their daily lives due to the proximity to the shops downtown.

Staff:________________________________________________________________________________
         Ithaca Physical Therapy and Aquabilities will be staffed by 5 physical therapists, two part-time
and three full time. There are two part time PTA’s, one full time PT Aid, and two part time receptionists.
We also have a full time office manager, two part time Aquatics specialists, a massage specialist, and
nutritionist consultant. We decided to include part time availability in order to allow flexibility with
scheduling for our employees. There are two aquatic specialists in order to reduce the time spent in the
pool by one person. The office manager will be in charge of all financial and billing in order to allow the
physical therapists to be more treatment focused. We have included a PT Aid and receptionists to make
the office run smoothly and give the PT’s less scheduling and maintenance duties. A nutritionist and


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massage therapist add unique assets to the team and serve to broaden our appeal to the community.
See Appendix B for a time chart.

Market Analysis:_______________________________________________________________________
         The strengths of Ithaca Physical Therapy & Aquabilities include a prime location between the
two colleges and on a bus route. This proximity to one of the main roads into and out of town makes
our practice accessible to residents north (Dryden, Cortland etc.) and south (Elmira, Horseheads). There
is also ample parking in this locale. By using the pre-established YMCA, we will be granted the use of the
entire facility for treatment (land + pool) affording us the freedom to purchase more equipment by
avoiding the financial burden of building a pool. We will also be affiliated with an already solvent entity
with loyal clientele built in and mutually benefit from a combined advertising strategy. Our patients can
also take advantage of extra services through the YMCA such as day care, gym memberships for
discounted prices, and exercise classes. Another strength of our facility is the offering of a unique
bundle of services to attract more patients/clients such as aquatics, massage, and nutrition
consultations and related services. Our staff of experienced professionals who are committed to team
work and communication through daily meetings will keep our business united in a common cause to
better the quality of life of each patient.
         A potential weakness of Ithaca Physical Therapy & Aquabilities is our intention to include new
grads in our part time staff that may lack clinical experience when we first start up. Being a new
business with limited financial resources to spend on continuing education or new equipment is also an
understandable weakness. Our inexperience may show through when it comes to establishing prices for
standard services. Starting a new business also comes along with the lack of reputation and word of
mouth to begin gaining a patient base. Although we will gain some benefits by being affiliated with the
YMCA, we are also at the mercy of their decision making. We are dependent on what they offer us and
if they close their doors for any reason we are out of our main facilities. Another perceived weakness of
our business is the inclement climate in upstate New York. Patients may be hesitant to get into the cold
water if they have to go about the rest of their day in the colder months.
          With our affiliation with the neighboring YMCA, we have the opportunity to continue to build
our relationship with them and work out more agreements to provide additional opportunities for our
clients and patients. It will also provide us the opportunities to work along with the YMCA in order to
better serve and help the community. We plan to offer a variety of pro bono services to the
community. These may include group water aerobics classes, free aerobics classes on land, as well as
health and nutrition seminars for those who don’t have the financial resources to pay for it. As other
ways of generating income for our business, we could have our nutritionist travel to local schools and
businesses to raise awareness of the importance of a healthy lifestyle. We also plan to establish
corporate wellness programs with local businesses. These efforts will contribute to prevention of health
issues. Having a massage therapist on staff also allows us the opportunity to use their services outside
of business hours for less therapy based treatments and promotion of relaxation and stress relief.
         As we continue to build our reputation and make money, we plan to hire more specialists to
offer services that are relevant to our patient and client population. Our first planned addition will be to

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acquire an athletic trainer, allowing us the opportunity to target the younger athletic population, and
reach out to local schools. When our financials allow it, we intend to purchase a SwimX for our own
building. This will offer us the opportunity to provide more one on one care with post surgical patients,
as well as athletes and physically fit individuals who are seeking challenging cross training options to
improve endurance and overall fitness. We are providing a competitive business by being associated
with the YMCA. It gives us the opportunity to advertise to a large portion of our target population. Our
business is also centrally located, allowing our patients and clients to be able to get to it easily from all
directions. It is far enough from its competition in the area but also in an area that a lot of people will
see since it is downtown.
          There are some external factors that can be viewed as threats to our business. The fact that this
business is new can be viewed as a threat for several reasons. Firstly, we have not yet been established
as care providers. Consumers are going to go to a facility that has been established and is reputable. It’s
difficult to attract people to your services if they are skeptical of your establishment and credibility.
Another threat to our nascent business is the uncertainty of the financial situation as it may be
challenging to judge how much to charge consumers for services in order to attract them to our
business while at the same time staying competitive with nearby facilities.
           Competition can be viewed as a major threat to this business as well. Island Health and Fitness
provides similar services and is not too far from our facility. They are already well established, and have
Cayuga Medical directly connected to them for referrals. If an individual gets a joint replacement done,
they are already right next to the Island Health and Fitness complex for their rehab. This takes away
from a portion of our target population. Another portion of our target population is eliminated from
right within Ithaca College and Cornell University. On site clinics are offered to students and faculty
members free of charge. Fitness center charges are already factored into the tuition costs of students,
so when it comes to working out and rehabbing there are services offered to them right on campus.
          Insurance companies are another threat to our business. In our Health Care System, dealing
with insurance companies is an unavoidable. They often times have more pull in our ability to treat
people than we would like. If someone doesn’t have proper insurance coverage for the services you aim
to provide, it could potentially prevent you from treating them. Insurance companies also determine
the amount of reimbursement that the facility gets for providing services. Therefore, we are somewhat
at their mercy, making them more of a threat to our business as a whole.
          The economy factors into the equation as well. It is far from its best these days, which is going
to affect how we need to run our business in order to stay afloat. Banks aren’t going to be as willing to
loan out money if the economy is poor, and we haven’t yet proven ourselves as a credible or financially
stable organization.
          The fact that aquatic physical therapy is a new and emerging form of treatment can also pose as
a threat to our business. It lacks evidence based support at this time, and is not as commonly known as
other physical therapy interventions. Patients may be skeptical about aquatics until they try it for
themselves.
          The climate of upstate NY can also be viewed as an external threat to our business. We have no
control over what Mother Nature blows our way; and there could be an ice or snow storm that prevents

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people from leaving their homes to come to their therapy sessions. Especially if someone is scheduled
for an aquatic therapy session, there’s a chance that they won’t want to get into a pool in the dead of
winter. If our facility was in Southern California for example, the weather would be less of a factor. See
Appendix C for SWOT Analysis.

Target Population:______________________________________________________________________
         Ithaca Physical Therapy & Aquabilities is best fit to treat adults around the ages of 18-50 with
orthopedic problems. Our focus is in the areas of joint replacements, joint surgeries, joint pain, and
athletic injuries. With the mix of aquatic therapy and on land treatment, we can address clients with
impairments in range of motion, joint mobility, balance, strength, and weight bearing status.
         There are 307,006,550 people residing in our nation with 127,466,929 people being within the
age range that our services apply to.1 Only 77% of the entire national population is covered by some
type of health insurance however, which limits their access to services such as ours.2 In Tompkins
County there are 56,555 people between the ages of 18-50.3
         In adults, the most common orthopedic problems are arthritis and injuries due to physical
activity. There are more than 46 million people in the US that have some form of arthritis, osteoarthritis
being the most common. Many of those who have osteoarthritis (about 435,000 per year) will have hip
or knee replacement surgery later in life. Some of the top injuries in adults include: muscle sprains and
strains, ligament tears, tendon tears (most of these are often seen in and around the knee and ankle
joints), dislocated joints, and fractures. Based on this data we have reason to believe that there is a
need for our practice in order to treat this population.4


Needs, Issues, Challenges Facing Our Target Population:_______________________________________
        Ithaca PT & Aquabilities can attend to the challenges that the patient population faces via the
combination of water and land based therapy. We can address the impairments present after surgeries
(decreased balance, strength, range of motion, and weight bearing status) by starting active therapy
sooner in the decreased weight-bearing environment of the pool. This allows us to start the recovery
process much faster than usual. Other common problems our population will face are athletic injuries
and overuse injuries, both of which can be benefited by aquatic therapy. With aquatic therapy we can
work on strength, range of motion, mobility, balance, and much more without as much stress being put
on the joints.
        The hectic lifestyles of our target population may limit their ability to make healthy diet and
exercise choices. Our optional nutrition and fitness services can address the health and wellness of our
patients in addition to their injury.



Representation of our Target Population in Ithaca:____________________________________________
        With the two colleges in Ithaca, there is a large population of athletes and young adults that
may face orthopedic problems requiring physical therapy. There is also Tompkins County Community
College and Cortland College nearby that may also bring in patients and clients. There are many
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intramural, club, and recreational athletes on these campuses that do not get access to the athletic
training services on campus. In Ithaca, there are also athletic groups such as Finger Lakes Runners Club,
Finger Lakes Cycling Club, Ithaca Triathlon Club, Cayuga Trail Club, and many others. People who
participate in these activities and clubs are susceptible to orthopedic injuries requiring physical therapy.
The age group that Ithaca PT & Aquabilities will serve is also well represented in Ithaca and in the
surrounding area (56,555 potential patients/clients).

Healthcare Opportunities for Our Target Population:__________________________________________
         The Ithaca community offers a wide variety of traditional and alternative healthcare options for
our target population. There are multiple Chiropractors, Occupational Therapists, Massage Therapists,
Nutritionists and Dieticians working in Ithaca. There are health and wellness clubs as well as gyms with
personal trainers available. Acupuncture, traditional Chinese medicine, craniosacral therapy, energy
healing, and herbal medicine practitioners are also available to our target population if they wish for
alternative healthcare options.5 Even if uninsured, our target population has access to the Ithaca Health
alliance which offers free health care to those in need and a resource library that has many alternative
medicine and holistic titles.6 There is also standard and emergency health care offered to our
population at Cayuga Medical Center. Both Colleges in Ithaca also offer health and wellness services to
the students and others affiliated with them.

Physical Therapy Opportunities for Our Target Population:_____________________________________
         There are many physical therapy offerings in Tompkins County, but none offer the unique blend
of services or location that we possess. The most well known opportunity for physical therapy in the
area is Island Health and Fitness, in affiliation with Cayuga Medical Center. There are numerous other
small privately owned physical therapy practices in the area as well as two physical therapy clinics, one
at each college in town who serve the college community, staff, and employees. There are also offices
such as the Center for Health located downtown that offers acupuncture and traditional Chinese
medicine but also has a Physical Therapist on staff.7

Related Services and Opportunities in the Ithaca Area that have been Shown to be Beneficial for Our
Target Population:__________________              _________________________________________
         The Ithaca Physical Therapy & Aquabilities along with the YMCA offer the Ithaca community and
its surrounding areas a variety of services. Our services are geared primarily toward our target
population consisting of males and females between the ages 18 and 50. We offer land based and
aquatic therapy, massage therapy, and nutrition counseling. The YMCA that we are associated with
contributes aerobics fitness classes, workout equipment, basketball and racquetball courts, and
personal training. This covers a wide variety of bases; but the town of Ithaca has many organizations
that offer related services that have been proven to be beneficial to this population as well. In Ithaca
alone, there are fifteen chiropractic organizations with five more in surrounding areas. There are
approximately ten businesses that offer massage therapy; a few of those businesses being Rasa Spa, Alta
spa, and Stress Out massage. Yoga and Pilates are very popular among these generations; and these

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classes are offered at the majority of fitness clubs. Mighty Yoga in downtown Ithaca specializes in this
particular form of exercise. Along those lines, exercise classes are also very popular, and are offered at
places like the Finger Lakes Fitness Center, Island Health and Fitness, and Ithaca College itself. Zumba is
a dance oriented exercise class that has gained popularity recently, and can be found at most facilities
that offer aerobics classes.
         Athletic and personal training can also be found at several sites in the Ithaca area. Curves for
Women limits appeal to females of all ages, but it includes personal training options. If this target
population is interested in alternative medicine, there are ten acupuncture clinics, as well as Tai Chi.
Aquatic physical therapy is not as readily accessible in this town. Island Health and Fitness offers water
aerobics and group therapy classes. Cornell University and Ithaca College offer aquatic physical therapy
through their on campus clinics, but the population these services are offered to are limited to students
and faculty within the schools. Our business will have an edge over these facilities by offering
individualized physical therapy services in the water and on land to the general public.
         Health and well being has been proven to be directly linked to physical fitness; and the Ithaca
area has many options for those who choose to be active. In addition to the gyms, exercise and dance
classes, and water aerobics as stated before, there are expansive hiking and biking trails throughout the
area. Taughonnack Falls and Buttermilk falls are popular scenic hiking trails close by. There are a variety
of organized walks and runs (such as 5K’s) put on by charity organizations at the local schools, and also
at downtown venues like Cass Park. The park itself offers lots of land for sports like soccer, pick-up
softball, roller-hockey, Frisbee, and paved paths for walkers, runners, basketball, tennis, bikers, and
rollerbladers.

Competition for Physical Therapy Services in Ithaca and Surrounding Areas:
         The healthcare market in Ithaca and the surrounding areas is very competitive and physical
therapy is no exception. Our main competition comes from Island Health and Fitness who enjoy the
benefit of being affiliated with the main healthcare and surgical option for residents of Tompkins
County: Cayuga Medical Center. Island Health also boasts a full gym, pool, warm water therapy pool,
corporate wellness, group fitness, personal training, spa, Pilates, café, and physical therapy services that
include aquatics.8 Although all these facilities are bundled in a convenient package, Island Health’s vast
but sterile atmosphere lacks part of the family and community feel that many Ithacan’s are accustomed
to. Our business fills this tight knit community role by being smaller and more personal. Our other main
competition for patients comes from the clinics at Cornell University and Ithaca College who also both
offer aquatics. Many students participate in intramural and club sports and sustain injuries in their
endeavors. They may be more likely to take advantage of the service located right at school instead of
our clinic. We hope to advertize directly to the student population and convince them that our facility
has what they need to get better faster.



Staffing:______________________________________________________________________________
        Ithaca Physical Therapy and Aquabilities will require five physical therapists. Our three full time

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senior physical therapists will have a minimum of 10 years of clinical experience with at least six in an
orthopedic setting. At least one senior PT will also be Certified Clinical Instructor and take responsibility
for any student working under their license. Another senior PT will be a Certified Strength and
Conditioning Specialist (CSCS) in order to offer preventative strength programs to members of our target
population. All senior physical therapists will serve in an informal mentoring role to our two part time
physical therapists who will be new graduates. The advanced skills and experience of the senior PT’s as
well as the Clinical Instructor certification will allow our business the opportunity to advance the skills of
our professional staff and expertly train the next generation of PT’s. All five PT’s will be responsible for
taking patient history, conducting appropriate tests and measures, and implementing a treatment plan.
They will also be responsible for re-evaluation and changing interventions as deemed necessary.
         Assisting the physical therapists with their case load, we are in need of two part time physical
therapist assistants with at least two years of clinical experience in order to help our business be on
track in our first quarter. As we gain more of a client base, these PTA’s may take up their own case load
as needed. We have included full and part time professional staff with flexible scheduling to allow for
enhanced learning opportunities between all of our staff members.
         Ithaca PT and Aquabilities will also hire two part time receptionists to manage our patient
phone calls and scheduling as well as a PT Aide to be a relay between the clinic, reception and office
manager. Our full time office manager will be responsible for all of our billing and marketing needs. Our
owner will be responsible for integrating the reports of the Senior Physical Therapists and the Office
Manager. The owner is also responsible for quality control measures, fiscal evaluations, performance
and productivity measures, as well as exploring the opportunity for expanding to new locations or
communities and is the ultimate decision maker for the business.
         The aquatics facet of our facility will require two part time specialists in aquatic therapy. These
specialists will be required to have Therapy & Rehab Institute’s Aquatic Therapeutic Exercise
Certification. We will also expect our specialists to be active members of the Aquatics Special Interest
Group (SIG) of the APTA as well as have experience in the aquatic setting for at least two years. They
are responsible for developing interventions in the aquatic environment and working with the PTs to
develop a comprehensive plan of care for patients.
         All of our staff members will be organized team players that possess an excellent work ethic
coming from a unified pride in a strong small business. We are also seeking a licensed massage
therapist to deal with pain and stress management for our population as well as the community at large.
We will also have a licensed nutritionist on staff that is familiar with our target population and their
needs such as weight management pre and post-surgery. Being affiliated with the YMCA gives us
another group of potential clients for our nutritionist and massage therapist which will add to our
income. The general population that utilizes the YMCA is more health conscious at large and may seek
these services to achieve a healthier well-being. See Appendix D for job descriptions.
                                            Our Start up staff includes:

       3 full time Senior Physical Therapists
       2 part time Junior Physical Therapists
       2 part time Physical Therapist Assistants
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       2 part time aquatics specialists
       1 full time nutritionist
       1 full time massage therapist
       1 Physical Therapy Aide
       2 part time receptionists
       1 full time Office Manager

Systems/Operations:__________________________________________________________________
         We have thoughtfully organized our job task structure in a way that allows for enough overlap
between staff members so that we still run smoothly in the event of an absence. We understand
however that if one of our professional staff members is absent then other employees will need to take
on extra duties and rescheduling of appointments may need to occur.
         In the event of the absence of a receptionist, the PT Aide and/or Office Manager will handle calls
during the hours he or she is working. The PT Aide will help with signing the patients in and scheduling
them for upcoming sessions. When neither the Office Manager nor PT Aide is present, the PTA and PTs
will be familiar with the required responsibilities in order to assist as needed with the receptionist’s
tasks. If the PT Aide is missing, then the PTA will do most of the cleaning, laundry and escorting of
patients between the gym and the pool and between therapists. The PT’s will also help with clean up by
picking up after their sessions to keep things tidy.
         If the nutritionist or massage therapist is absent for a day then on those days the services will
not be offered and the patients will be rescheduled for a different meeting time. If an aquatic therapist
is out then the patients who normally would see that therapist will be offered to schedule with the
other aquatic specialist during the day if there are openings or will just get land based therapy that day if
deemed appropriate.
         In the situation that a physical therapist is absent, the PTA working at that time will take on
treating the caseload. Initial evaluations will be transferred to the most available junior or senior PT, or
rescheduled in the schedule if overbooked. Although it may seem inconvenient to re-schedule patients,
we prioritize quality of care and aim to provide each patient with individualized attention.
         If a PTA is unable to work, we will offer our part time PT’s or the other part time PTA the option
to work a full day for over-time pay.
         As our business grows and becomes more successful, we will hire per-diem physical therapists,
physical therapy assistants, and aquatic therapists that will be available to be called to fill in when other
physical therapists are on vacation or taking sick time. In addition, our part time staff will have the
option to move to full time offered to them.

Physical TherapyServices:__________________________________________________________
        Ithaca Physical Therapy and Aquabilities will offer comprehensive, individualized treatment
plans for each patient/client. Due to the diverse nature of our target population, we will offer a range of
services. These services include aquatic physical therapy, land based physical therapy, individualized
home exercise programs, therapeutic exercise, modalities including electric stimulation for pain control
and ultrasound, manual therapy, massage therapy, and nutrition counseling.

Aquabilities                                                                                        Page 11
         Our Aquatic therapy programs will include deep water running as well as shallow water walking
in addition to other activities with equipment such as kickboards and water weights that further
increase the resistance of the water. Our land based programs will include a necessary combination or
ROM exercises, stretching, strengthening, core, and endurance activities based on patient history and
goals. Electric stimulation and both pulsed and continuous ultrasound will be used to manage pain
appropriately. Joint mobilizations will be performed at needed joints at varying angles and grades.
Transverse friction massage will be employed by our Physical Therapists who also have the option call in
our massage therapist for Swiss massage when needed. Nutrition counseling will balance out our
treatment plan when the need arises in order to reach and heal all facets of the underlying pathology of
our patients. Offering this range of diverse services will benefit our business, because we will appeal to a
maximum amount of potential clients and be able to truly hone a treatment plan that is unique to their
needs.
         When working with patients who are pre-operative, our CSCS certified senior PT will create a
comprehensive “pre-hab” strength program in order to maximize function post-surgery. It will also fall
to our staff to prepare our patients with what to expect from surgery and begin them in rehabilitation as
soon as possible in the water without undue stress on the joints of the lower extremity. We will begin
these patients in the pool as well as on a Swim-Ex when we add one to our clinic. In addition to
maintaining fitness with the pool exercises, patients will be learning water safety especially how to
adapt with their limited function as there are many water based activities in Ithaca that they may be
participating in.
         We strive to incorporate the most current research in our evidence based practice as well as use
the vast clinical knowledge of our employees and patient goals in order to maximize the function of our
orthopedic and post-surgical adult population. Utilizing the best current knowledge of the profession
will allow us to maximize positive outcomes, and grow our business through word of mouth.

Additional Services:
         Our affiliation with the YMCA allows us to offer additional services to our clients as well as the
community at large. Our senior physical therapists will be Certified Strength and Conditioning
Specialists (CSCS), which will allow our practice to offer wellness and prevention strength training
programs to clients in the community and YMCA members using the YMCA gym facilities. These
wellness and prevention programs will bring revenue into our business as well as attract new clients for
the YMCA. When our Swim-X is not being used for therapeutic services we will offer a training program
for athletes that is focused on sport specific athletic enhancement as well as prevention of injuries for a
competitive rate. As our business grows we will also offer pre- and post-season athletic team workouts
on land as well as cross-training in the water for a fee. We will offer corporate wellness packages to
local business that will involve exercise programs as well as nutrition counseling. We will have
merchandise available for sale including therabands, stretch out straps, and foam rolls, as well as tee
shirts and other paraphernalia with our logo. See appendix F for logo. These services and products will
get our name out in the community more and help us become a more recognized therapy provider,
which will increase our patient and client base.
         Aside from the mentioned revenue producing additional services, Ithaca Physical Therapy and
Aquabilities                                                                                       Page 12
Aquabilities will offer as many pro-bono services as possible and expand these services when finances
and staffing allows. Our pro bono work will involve setting up exercise classes at the YMCA on land and
in the pool that are free to the public. These classes will initially be offered one weeknight and one day
a weekend and expand if need arises. We will provide an assortment of classes that work on core, full
body toning, Pilates, yoga, and aerobics. In the pool, we will offer classes on core and balance, deep-
water running, water aerobics, and strength training in the water in order to address the many needs in
the surrounding community. Both the water and land classes will be provided in order to help
encourage a healthy living style, to help fight obesity, and to give former patients a way to continue to
exercise after therapy in an interactive and safe way. Providing these classes will advertise our name to
people who may now or in the future have orthopedic injuries. By having the classes, we will then
already have developed a good relationship with them so they may be more likely to come to our clinic
for our services.
         When our pool time is not being filled with aquatic physical therapy, we will encourage children
in the community to come for open swim especially during the summer months. Our nutritionist will
make visits to local schools, public forums, and businesses to advocate for the importance of a healthy
diet and serve a role in lessening the obesity related injuries we see in our clinic. We will run a bi-annual
massage fundraiser on a weekend in the fall and spring of each year with all of our professional staff.
The funds raised will go to the Ithaca Health Alliance, a free health care clinic serving the Ithaca
community. We will also strive to accept as many referrals from the Health alliance as we are able to on
a discounted or pro bono basis. All of these programs are directed to help the community improve their
lifestyle and wellbeing, which is very important in light of the growing obesity epidemic. Also it will
provide us with a positive and lasting relationship with the community, which will gain us more clients
and patients.

Space:_______________________________________________________________________________
         Ithaca Physical Therapy & Aquatibilities is constructed within a 1700 ft2 rectangular building
designed for outpatient care. We benefit immensely from our contract with the neighboring YMCA
because we have complete access to their facilities for patient care. The pool, fitness and gym area,
indoor track, laundry room, day care, and other amenities are available for our use. There are sliding
doors at the southernmost part of our patient clinic that lead into a glassed in temperature controlled
walkway that leads directly to the YMCA fitness area and pool for aquatic sessions. This easy access
weather resistant option will be very convenient for our patients and staff, and optimizes laundry
transport to and from the clinic as well. The sliding doors that we have placed at the main entrance and
the entrance leading into the YMCA provide patients and staff with a hands free access option. There is
a very slight ramp leading into the main entrance to provide smooth access for those who may be
operating in a wheel chair. After entering through the sliding doors, the patient is immediately in the
waiting room where they can check in with the receptionist at the front desk. There is plenty of
comfortable seating available for the wait time before seeing a therapist. In the waiting room there is a
unisex bathroom located near the entrance, a water fountain, a coat rack, a shelf with magazines and
brochures, a cabinet with merchandise for sale, a television mounted to the wall, as well as a message
board. The walls will be painted with a welcoming yellow color with pictures on the wall that
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complement the color palate. We will also include a section with individual pictures of all of our
therapists and their certifications. This aims to provide our patients with peace of mind that they are
receiving treatment from credible therapists.
         The front office that is occupied primarily by the receptionist consists of ample space for a desk
with a computer, fax/printer/copier machine, and telephone, as well as several filing cabinets to
maintain organization. There is no door closing in this space for access convenience of people coming in
or out.
         There are two locker rooms designated for respective genders that are located right off the
waiting room area. These contain an isolated area with lockers and a bench area for changing. There is
a closed in changing room for privacy, as well as two bathrooms and a shower. We included these into
our building schematic for someone who may want to shower or change before or after treatment.
There are also locker rooms in the YMCA near the pool that are available to patients who are
undergoing aquatic treatment. This availability is desired so that individuals do not have to walk all the
way across the clinic through the walkway to the YMCA, and then navigate to the pool in their swimsuits
or wrapped in a towel. We also do not want them to have to trail back through the clinic dripping wet
after their session.
         We have included ample space for an employee lounge in the northwest corner of the building.
This includes ample room for a large conference table for meetings and lunch, a bookcase for reference
textbooks, water cooler, fridge, microwave, cubbies for the employees, as well as two desks with
laptops for private documentation usage. There is an employee message board and calendar in this
space to keep all staff informed and updated. Having a closed off area for our employees away from the
treatment clinic is very beneficial for privacy purposes.
                  The actual treatment area of the clinic is very spacious to allow for treatment of several
patients at once without feeling claustrophobic. There is space allotted for eight high-low treatment
tables lined up against the west wall. Each table has enough room for a chair and a short stool to be
between them. There are curtains that can potentially close and separate each treatment area. There
are ample outlets oriented at the base of each table as well. In the middle of the room, there is space
for a large docking station and cabinets. This station has room for five laptops, a printer, and a
telephone which allows for employees to document and print out exercise programs for their patients.
The cabinets provide space for supplies like towels, therabands, blood pressure cuffs, etc. There is also
a sink and additional cabinets available on the far side of that room. Right next to the sink is an
entrance to the storage room, where the hydrocollator and equipment can be found. There is an
automatic door opening option for this as well in the event of an employee needing access whilst
carrying multiple supplies. A stereo system will be set up in the clinic that will provide light background
music that plays in the treatment area, as well as in the locker rooms. It will be set to a radio station like
light rock 97.3 that plays a variety of music appealing to a larger age range.
         The southwest section of the clinic is made up of cardio exercise equipment. We have access to
the YMCA’s equipment, but we have included the basic machines within our clinic for the convenience
of our patients who wish to use them for a quick warm up for example. An arm ergometer is in this area
as well because it cannot be found in the YMCA. There are windows in this corner of the gym to look

Aquabilities                                                                                         Page 14
outside into the fields of Ithaca while utilizing the equipment. There is also a dumbbell and weighted
strap stand with a variety of weights. We are including a mounted mat table that can be brought down
to the floor when desired. There are stability and bosu balls in this corner as well. Ample space
between the docking station and this equipment area has been allotted for patient use (ex. lunges, gait
analysis).
          The southeast corner is made up primarily of offices. Three small rooms are designated as
examination rooms. This space consists of a table with the option of a closed door for privacy. We
chose to have three exam rooms because at the peak of our day we have three PT’s on and should not
need more space than this for private initial evaluations. The massage therapist and nutritionist have
their offices in this area as well. The massage therapist has an office with enough room for a table, their
own desk, a storage cabinet, as well as ample space to navigate around the treatment table. The
nutritionist has a bit more space for a pair of armchairs for consultations. There is also room for a desk
and a storage cabinet. The office manager’s room is oriented next door to the nutritionist. Their room
is set up with a large desk and a pair of filing cabinets. Offering each of our specialty staff their own
office space will contribute to their success and ability to carry out their responsibilities in their own
designated space.
          Our two aquatics specialists will share a large space on the east end of the building. There are
two desks and chairs as well as filing cabinets for patient records. Within the room is ample space for a
Swim-Ex when we have the financial means to purchase one. The interior design of this office will be
decorated with images related to the aquatic environment.
          Parking at our facility will be located due east of our clinic. It is very large with more than
enough parking. Employees have a parking area allotted to them on the north side of the building. Our
facility is one level making it accessible to our target population who may be entering the clinic on
crutches or wheelchairs or with general difficulty when navigating stairs. The ramp at the front entrance
also makes us easily accessible to this population.
          Our extra space outside of our building has been utilized for our walkway connecting the clinic
to the YMCA. This area will also be embellished with foliage and structures to make it more
aesthetically pleasing.
          The interior décor of our building has been designed to portray a friendly, androgynous, and
welcoming environment. Color samples for the walls, flooring, and furniture can be found in
Appendix E. We chose a mustard tone of yellow as a neutral yet dimensional color base for our walls.
This color will be accented by anatomical paintings hung on the wall, samples of which can also be found
in the appendix. Anatomical models will also be included on mounted shelves over the treatment tables
for patient education or observations. The deep maroon and eggplant colors used for the floor and/or
countertops complement the yellow, at the same time dimming down the brightness of the walls. The
privacy curtain samples that we have chosen add to our cheerful color palate of the treatment area and
avoid the hospital room feeling with their pattern and color. The mirrors on the south wall provide an
opportunity for patients to view their form while carrying out their therapeutic exercises. The lights that
we have chosen to purchase will be mounted on the walls throughout the clinic and are adjustable for
intensity of light to accommodate different population needs. For example the lighting in the massage

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therapist’s office can be dimmed for treatment and relaxation purposes but have the ability to be
brighter for when the therapist is documenting and requires better lighting.
         The other offices and employee lounge may be decorated with a more neutral color palate.
Samples of these are also included in the appendix. They provide a professional tone, while remaining
interesting to the eye. The nutritionist and massage therapists office are more earth toned in nature for
a welcoming and relaxing environment. The aquatics specialists will have a brighter colored room with
more fun and creative décor for when the Swim-Ex is put into place and patients are entering that room
as a treatment environment. The conference room will be painted in a neutral color, but can be
decorated however the employees choose to do so. See appendix G for floor plan.

Equipment:___________________________________________________________________________
         As an orthopedic practice, it is important for us to have proper evaluation equipment. We felt
that it was important to have reflex hammers, goniometers, measuring tapes, and a dynamometer. All
of these would be used in an initial evaluation and during re-evaluations in order to help determine the
patient’s impairments and monitor progress. We purchased numerous quantities of these supplies so
that several therapists can be doing evaluations at the same time and there will be extras in the clinic. It
is also important to have multiple stethoscopes and blood pressure cuffs so many therapists can be
using them at once because with our population it is important to be monitoring blood pressure
throughout exercise. We will also monitor the blood pressure of athletes during graded exercise testing.
With many people in this society having heart problems, blood pressure should be monitored at rest
and during exercise if a serious heart condition is involved or indicated.
         Since many of our patients will have joint injuries that require decreased weight bearing status,
it is important to have assistive devices for them to use. We have an array of different types of devices
such as walkers, crutches, a wheel chair, slide boards, a quad cane, gait belts, and parallel bars. These
different devices will be used to help protect the patients’ injuries and to help progress patients to
increasing weight bearing status as their treatment allows. Most people will have personal devices from
the doctors so we do not need to have too many of each but it is safe to have at least one of each
available for use in the clinic.
         As an outpatient and aquatic clinic, we strive to provide comprehensive care to patients by
giving them complete land based programs along with a wide range of aquatic activities. For that reason
we plan to purchase a selection of exercise equipment made for the aquatic environment including:
flotation devices, noodles, underwater flotation dumbbells, short fins, long fins, aqua joggers,
kickboards, starboards, webbed finger gloves, and balls. This array of equipment will allow us to be able
to implement balance, cardiovascular, strengthening and stretching exercises in the pool. Doing these
exercises in the pool will take advantage of the natural resistance created by the water with the added
benefit of decreased impact forces while doing exercises.
         While we have access to the gym at the YMCA, we will also have some exercise equipment
available for use in our clinic. This allows the therapists to do exercises with their patients without
having to travel through the walkway to another building. We will purchase multiple stability balls, a
treadmill, a bike, an elliptical, a stepper, an arm ergonometer, a recumbent bike, a hand wall climber,
therabands, foam rollers, exercise putty, dumbbell weights, a trampoline, a bosu ball, a stability disk, an
Aquabilities                                                                                       Page 16
incline board, and a balance block. This selection of exercise, balance and stretching equipment will
allow the therapists to do most of their exercises with patients in the clinic and only have to move over
to the YMCA with higher level patients. We have purchased the computer program Exercise pro in order
to help develop exercise prescriptions for patients and to be able to print out home exercise programs
for them.
         Along with exercise prescription, our therapists will also be proficient in modalities and manual
therapy techniques. This is why it is important for our facility to be equipped with high-low tables to
allow our therapists to use proper body mechanics. To give patients comprehensive treatment we also
plan to purchase machines for modalities such as an ultrasound unit, a TENS unit with multiple sizes of
electrodes for different applications, and hot and cold packs. This will allow therapists to offer pain
management therapies and use multiple techniques to help better the patient’s recovery.
         We are purchasing anatomical charts and anatomical models for the purpose of patient
education. Since it is best to be able to show them what is going on in their body, models and charts can
give them the view they need to understand. A patient’s understanding of their injury will help them
come to terms with how and why they need to do their therapy and exercises.
         There are a few very expensive pieces of equipment we plan to add to our clinic, one being a
Swim-Ex that will give us the option to do some aquatic therapy in our clinic. This would allow the
therapists to work one on one with patients in a more intimate and less distracting aquatic setting.
Swim-Ex’s are also designed to be a pool especially for therapy so they has many features that are not
found in the YMCA pool. Movement analysis technology is also a pricey piece of equipment that would
be beneficial to our patients. With this equipment the therapists will be able to get a more objective
observation of the biomechanics of their patients. It will allow them to analyze movements in order to
help them develop treatment plans. Movement analysis will also be helpful in aiding athletes in
maximizing performance by analyzing patterns during a sport specific skill and teaching them how they
can improve their task while preventing injury. A balance system such as BIODEX would also be helpful
in gaining more objective insight into the patients. This machine would be helpful to help evaluate
patients’ balance, which is often decreased after joint injuries and surgeries. It can also be a training
tool to use to help develop better balance in patients. We are planning on adding all of these tools
respectively as we become financially solvent. See appendix H for full equipment list.

First year budget:_______________________________________________________________________

Average charge:
        By using the Medicare fee calculator, we calculated an average charge for an aquatics patient in
our facility. Each aquatics session will be 45 minutes in length equaling 3 units at $35.52 for a total
average charge of $106.56. Our on land sessions will also be 45 minutes with one unit each of
therapeutic exercise ($28.44), manual therapy ($26.64), and neuromuscular re-education ($29.51)
totaling $84.59. We then averaged the aquatics and land based totals to achieve our average charge of
$95.58 per patient.

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Patient Care Based Income:
        Once we arrived at an average charge, we determined that our full and part time physical
therapist staffers are the equivalent of 5 full time PT’s. With our PTA’s assisting with the Physical
Therapist’s patients, we determined that PT’s would see patients for 30 minutes and the PTA would
contribute the remaining 15 to complete a 45 minute treatment time. Each PT was then determined to
have a maximum of patients of 13 per day (6.5 hours/30 min), bringing the total patients per day to be
65 with all PT’s at a 100% fill rate (13 patients per day x 5 PT’s). We then multiplied our 65 patient per
day maximum by quarterly fill rates of 60%, 65%, 70%, and 85% coming up with 39, 42, 46, and 55
patients per day respectively per quarter. Each number of patients per quarter was then multiplied by
our average charge of $95.58 achieving a daily income and multiplying it by 65 days per quarter, taking
into consideration holidays in their respective quarters. Our quarterly earnings were calculated to be
$242,295.30, $260,933.40, $285,784.20, and $341,698.50 respectively. Our grand total of net patient
care based income amounted to $1,130,711.40 as seen in the “services” line of our revenue portion of
our budget.

Income from equipment:
        We have physical therapy equipment to be sold for a profit. 8 rolls of therabands will be sold
with each roll consisting of 75 ft. When sold in 2 foot increments, 37 patients will use up one roll at $5
each. This will yield a profit of $1,036 in revenue. 50 foam rollers will be sold. Each foam roller costs us
$10 and will be sold for $15 leaving a $5 net profit. Therefore, we would have a $250 profit. 100 ace
bandages will be sold for $5. We will purchase them for $2 each, leaving a $3 net profit each and $300
total. 20 hand putties will be sold for $8 each. We will buy them for $6.60, yielding a profit of $1.40
each, and $28 total. 100 ice packs will be sold for $18 each. They will cost us $14 each, yielding a $4
profit per pack and $400 total net profit. When our equipment is all sold, we will make a profit of
$2,000 as seen in the “Equipment” line in the revenue portion of our budget. Our patient care
“services” portion is added to our “equipment” line yielding a “Total operating revenue”.

Income from services:
        Our non-patient care based income was calculated by assessing prices for the extra services that
we offer. Our first year budget allows us the opportunity to include a Swim Ex pool that will be oriented
in the extra space that was allotted in the aquatic director’s office. In purchasing this piece of
equipment, we will be able to treat patients one on one with the benefit of an underwater treadmill, jet

Aquabilities                                                                                         Page 18
systems, and a massage wand to loosen up muscles. This piece of equipment has the potential to take
our aquatic treatment to another level. Sports performance and gait retraining will be enhanced and
will draw more patients to our clinic for these services. Our aquatics directors will be offering packages
of $250 for 10 one hour long sessions for athletes at an estimated 25 patients per year, adding $6250 to
our revenue. Our corporate wellness packages will include presentations on nutrition, ergonomics, and
body mechanics at a rate of $200/hr. for 6 businesses adding an additional $2400 to our income. The
wellness and prevention strength training program offered by our CSCS certified PT during their time not
occupied by our fill rate will be in one hour long sessions with 10 sessions per package for $200 an
average of 50 patients per year will use this service for $1,000 to our revenue. These additional services
will add an estimated $9,650 in total.

Income from Sales:
        Logoed tee shirts, water bottles, large towels, yoga pants, and gym bags for sale will bring in
additional revenue to our business as well as disperse our logo to the community. T-shirts will be
purchased at T-shirt Express in Ithaca for $5.75 each, and sold for $8. If all 100 T-shirts are sold, we will
make a profit of $225. Water bottles will be purchased for $9.50 each, and sold for $10 to patients. If
all 75 of purchased water bottles are sold, we will make a profit of $18.75. We will be selling towels to
patients who are in the aquatic environment. Towels will be sold for $8 each. They are purchased for
$3.50 each, and if all 25 are sold, our total net profit will be $112.50. Yoga pants which will appeal to
our patients who participate in the exercise classes at the YMCA will be sold for $15 each. A net profit of
$7.25 will be made, and if all 25 are sold, we will gain $180. 50 drawstring gym bags will be purchased
for $4.50 each, and will be sold for $8. $170 profit will be made on sold gym bags. Our total net profit
from all of sold merchandise will be $706.25. Our income from sales and services added together add
10,356.25 seen in our budget as “non operating revenue.” Our operating and non operating revenue
added together give us a “Total Revenue” of $1,305,567.65. Not only will selling merchandise with our
business’ logo on it generate revenue for our company, but it will also assist in our marketing plan to
advertise our services to the public.

Expenses:_____________________________________________________________________________

Salaries, benefits, and FICA:
        We will be offering three full time PT’s a salary of $65,000 per year. Our two part time PT’s will
make a yearly income of $25,000. Our part time PTA’s and our massage therapist will make $16,000 per
Aquabilities                                                                                         Page 19
year. The two part time Aquatics specialists will make $32,000. The nutritionist will make $23,000. The
PT Aide will make $22,000, and the two part time receptionists will make $12,500. The office manager
receives $50,000, and the owner allots the net revenue to himself as well as areas of the business that
need developing. All salaries add up to an expense of $477,500. In our job descriptions, we claim to
offer competitive salaries; and we ensured this by researching average salary ranges for each position
that we will be employing. In general, we stayed toward the middle range of the reported average
salaries, to avoid being on the lower end. If a position is part time, we started out with the average
salary and then divided by two. As a first year business, we believe that we are offering generous
salaries that have a very good potential to increase in the near future, considering our net revenue for
the first year budget. Offering “competitive” salaries will help our business be successful, because our
therapists and staff will be more motivated to perform their duties with quality assurance.
        All full time staff will be offered a benefits package of 20% of their income which will include
one week of paid vacation, and one week of sick and personal days per calendar year. Health, life and
dental insurance will be included, as well as a small portion contributed to continuing education fees
that will gradually increase with each consecutive year that the person remains working at Ithaca
Physical Therapy and Aquabilities. We have included the basic package for our full time staff that
includes major components of a standard package that will be increased in subsequent years as our
budget allows.
        Our part time staffers will receive a benefits package of 15% because they are working fewer
hours than our full time staff. This package will include one week of paid vacation and/or sick/personal
time and health and dental insurance. This package is reduced due to the fact that many of these
employees will have other part time jobs possibly with benefits; and they are working less within our
company therefore requiring less time off.
        Both packages are comprehensive and practical and leave room to expand as profits grow.
Possible extra benefits can include more vacation, sick and personal days, travel expenses, greater
continuing education funds, and tuition reimbursement for new graduates. Holiday bonuses and sign on
bonuses for new staff will also be instituted when profits allow. Bonuses for all of our staff come to
$84,975 as seen in the expenses section of our 2010-2011 budget.
        FICA taxes of $36,528.35 will be paid based on the salaries of our complete staff.

Supplies, equipment:
        Based on our comprehensive equipment list (Appendix H) our supplies ($10,509.96) and
Aquabilities                                                                                       Page 20
equipment ($65,176.98) total $75,686.94. We classified supplies as anything that will be bought not in
relation to patient care (office supplies, toilet paper, water cups, etc). Equipment has been classified as
direct patient care related items (therabands, treadmill, treatment tables, etc)

Communication:
        We have allotted $15,000 dollars for marketing purposes discussed later in this plan. We will
pay $2,000 per year on phone, wireless internet, and faxing services, based on Time Warner Cable’s
package for small businesses. This totals our first year communication expense to $17,000.

Rent:
        We have worked out a rent agreement signed with the YMCA that includes a rate of $100 per
hour for right to exclusive use of the pool, and $80 per hour for non exclusive use of their gym facilities.
When considering the 8 hours/day that the pool will be used, as well as 12 hours/day that we have
access to the gym workout facility, this charge of $180 per hour will equal a yearly charge of $350,000.
Although this is a large expense, we were able to save a great deal of money on our facility’s purchased
equipment by using what is available to us through the YMCA.

Net Revenue:
        Our total expenses: salary, benefits, FICA, supplies, equipment, communication, and rent total
up to $1,041,690. When our total expenses are subtracted from our total revenue, there is a net profit
of $263,877.65. A 25% tax is paid on this net profit, which equals $65,969.40. With this tax amount
deducted from our profit, we obtain a net revenue of $197,908 for Ithaca Physical Therapy &
Aquabilities in the 2010-2011 fiscal year.

Marketing Plan:________________________________________________________________________

Objective:
        With our various marketing strategies we plan to add high school students to our target
population and increase our patient load to a 90% fill rate in the next 3 years. We will also target the
upper end of our patient population in an effort to add geriatric specific services and ensure the 90% fill
rate is achieved in the 3 year span. We will market our special services, such as our swim-Ex program,
in order to set ourselves apart from the majority of orthopedic businesses in Ithaca. We will especially
stress the aquatics aspect of our business because it is one of our most unique services. We will use as
many channels of advertising as possible to reach a maximum amount of new patients. We will also
Aquabilities                                                                                        Page 21
capitalize on our collaboration with the YMCA and use its premises to advertize for our clinic as well as
our cross-over special services.

Advertising activities:
        We will run a series of radio ads on Z95.5 and 97.3, two very popular radio stations in the area.
We have decided on these two because they have a large fan base among our target audiences. One is
very popular with the younger generation we are expanding to suit and the other is more geared to
adults to incorporate the rest of our target population. Our ads will explain what services we offer,
where we are located, and how to contact us. These radio spots will encourage listeners to visit our
Facebook, Twitter, and web pages for more information. We will also purchase advertisements on
Facebook that will pop up when a health-related page of the site is visited. We will use these social
media platforms to embrace the technology of the age and spread the word of our business to as many
potential clients as possible.
        We will also create brochures and flyers to distribute to healthcare offices in the community as
well as the corkboards and front desk of YMCA and other local related services that have a client base
that could benefit from our services. These will be colorful and creative to catch the eye of a passerby.
On our flyers we will include the schedule of both revenue-producing and pro-bono classes and
descriptions of each. An example of our brochure can be found in Appendix J. The flyers we send to
other healthcare offices, as well as those available at the front desk of the YMCA will give information
about our offerings including additional services such as the day care and discounted gym memberships
through the YMCA. We will also create business and appointment cards with our logo. Each of our
professional staff will also have personalized business cards with our logo.
        To enhance our exposure amongst the community, we will purchase a billboard ad to have
placed on the main roads, route 13 and route 96 as you enter the town of Ithaca. Our facility’s name,
picture, and contact information will be placed on the billboard. In addition, since the T-CAT is the main
public transportation system in Ithaca, and has a bus stop right by our plaza, we plan to coordinate with
this service and place an advertisement for our business on individual bus lines and at bus stops.
        We also plan to offer merchandise that can be purchased, with our logo to spread our business’
name to the far reaches of the community. We will offer tee shirts, water bottles, large towels, yoga
pants, and gym bags with our facility’s logo on them. Financial information pertaining to these sales can
be found in the budgeting section of this business plan.
        We also plan to sponsor local sports teams, such as a little league team, to further spread our
Aquabilities                                                                                         Page 22
logo and word of our business. We will provide tee-shirts with our logo, and run fundraisers for our
sponsored team. We will also keep a donation box in our office to raise further funds for the
team/league. By sponsoring a team of young people, they will grow up knowing our name and think of
us first when they are in need of physical therapy services in the future.

Personal Selling Activities:
        Ithaca Physical Therapy and Aquabilities will also be offering a number of physical therapy home
treatment supplies for purchase. These will include therabands of various resistances sold for $5 for
every 2 feet, foam rollers sold for $15 dollar, ace bandages for $5, hand putty for $8, ice packs for $18,
as well as offering special orders to patients when necessary. We are assuming that all of the products
bought will be sold in the year, and we will therefore make approximately $2000. Specific financial
information concerning the selling of these products is included in the budget portion of this business
plan. We will be offering these products and can use our net profits to buy more equipment if patient
demands call for it.

Internal/external public relations activities:
        In an effort to spread word of mouth about our business and mutually benefit the community at
large we plan to capitalize on our partnership with the YMCA by offering wellness and prevention
strength training programs to clients in the community and YMCA members using the YMCA gym
facilities. We will also offer pre-and post season workouts for local athletic teams to broaden our appeal
to the high school and younger demographic. We will reach out to local businesses by offering
corporate wellness programs to benefit the workforce of our community.
        During the first quarter when our fill rate is only 60%, our therapists and specialists will dedicate
some time to marketing our company. One of the advertising activities that they will be responsible for
is organizing a seminar presentation to the local health centers, like Cayuga Medical Center. They will
talk with the professional staff about the services that we will be offering at Ithaca Physical Therapy &
Aquabilities, so that they will be aware of us and can then appropriately refer patients to our clinic.
Since we are starting out as a new business, we are not yet established in the community, and so need
the support of fellow health care professionals to increase our recognition and referral numbers.
        In order to reach an even larger range of possible consumers, Ithaca Physical Therapy and
Aquabilities will offer free water aerobics and land based exercise classes free of charge to YMCA
members, patients, and the public. During the first few quarters when our Aquatics specialists will not

Aquabilities                                                                                        Page 23
be treating patients for full 8 hour days, we will take advantage of this free time to conduct these
classes. To maximize our investment in renting a pool, we will open up free swim times to the public
when aquatic therapy is not requiring the space. Our onsite nutritionist will also travel to local schools
and businesses to present a case for the importance of a healthy diet and lifestyle, as well as advertising
the services that we offer. We will run a massage fundraiser, with all funds donated to the Ithaca Health
Alliance, a free health care clinic serving the Ithaca community. With these pro bono services we hope
to better the community we are a part of and reach out to as many individuals in need of our services as
we are able. We want the public to know that we promote overall health and wellness, and make
efforts to offer free services to those who need it. As finances allow, we will expand our services into
areas that seem lacking and further disseminate our company name and show how much we value
being a part of the diverse community of Ithaca.

Areas of Future Growth:_________________________________________________________________
        As Ithaca Physical Therapy & Aquabilities gains experience and more financial resources, there
will be several opportunities for expansion and growth within the business. As the need arises, and we
begin discharging patients from our care, we will institute a step-down program in conjunction with the
YMCA that will bring in new clients for them and also allow patients to ask us questions about their
continuing healing. This will allow us to aid patients with the transition to post rehabilitation exercise
plans with our continuing help. A deeper patient-therapist relationship can be built over time, and we
will become the clinician of choice for many patients who need to return for service. With our major
focus on optimal patient care, some of the first items we will be able to expand upon when finances and
space allow for it, will be our equipment. We are looking to purchase video equipment and technology
for gait analysis, which will allow us to performing biomechanical assessments of patient’s gait and
lower extremities in relation to their pain, and then in turn offer orthotics as a treatment option. We
are planning to purchase a Wii and television for motion and balance assessments as well. In our
practice, we will see patients status post joint replacements and orthopedic surgeries. Balance training
and assessments will be vital to their rehab and recovery; and the Wii provides a fun interactive method
of doing so. Our business will also invest in a spinal traction table that can provide traction to both the
cervical and lumbar spine. A portion of our target population has a lot of reported neck and back pain.
This table will provide our therapists with another treatment option for these patients. In addition to
acquiring new equipment, we will prioritize the upkeep and updating of our clinic’s existing equipment
to ensure quality to our patients. Documentation software, as well as updated versions of exercise pro
Aquabilities                                                                                        Page 24
for the computers will be vital to remaining current with our practice and treatments. Additional filing
cabinets will also be necessary, as we are required to hold on to patient records for 6 years.
        In the aquatic environment, we plan to expand our target population and services by
contracting with local pediatric clinics, a women’s health organization, and assisted living facilities. We
can also add more water aerobics classes that focus on a cardiovascular workout, balance and strength
training all within the pool. This will benefit our business by marketing our services to a larger spectrum
of the population; which in turn will help get our name out in the community about the additional
classes and services that are available to them through our practice. In order to offer advanced
treatment to our patients, we will continue to expand upon our current equipment list designed for the
aquatic environment.
        Once our special staff establishes themselves, we will work toward increasing the amount of
involvement we have within the community, addressing corporate wellness by providing presentations
on health and nutrition, providing ergonomical assessments of employees in the workplace, lectures on
proper body mechanics, etc. We will provide more massage-athons and exercise classes, such as yoga
and pilates, as well as aerobic strength training classes at the YMCA facility. The current fitness craze
that has swept our society also prompts us to utilize our nutritionist and CSCS therapist to put on a
weight-watchers type program open to members of the YMCA, our patients, and eventually the public.
This will allow us to address proper nutrition and well being, the value of an individualized exercise
program, and overall weight management practices.
        We plan to continually boost the quantity of pro bono services that we will provide, as well as
amplify the amount of financial support we afford to the Ithaca Health Alliance. Not only will this allow
us to fulfill our ethical and professional duties by providing additional pro bono services, but it will also
assist our business in becoming more locally recognized for the services that we offer.
        When we are financially able, we plan to enlarge our staff by hiring a personal trainer that will
work primarily within the YMCA facility; and will draw clientele from both our clinic and the YMCA gym.
We also plan to hire another full time office manager to distribute the responsibilities of the position,
like our marketing responsibilities. We also intend to employ a homecare therapist that will be affiliated
with us, and can be responsible for making home visits to our patient population. Homecare is a crucial
step between acute care and outpatient, especially when dealing with orthopedic surgeries and joint
replacements; and so by recruiting these patients before they are in the outpatient phase of their rehab,
they will be more likely to come to our practice for the outpatient phase as well. As our clinic gains

Aquabilities                                                                                          Page 25
popularity and our patient pool grows, we plan to offer our part time therapists and specialists the
opportunity to become full time employees. We may also then choose to hire additional therapists
and/or staff to support our growth. This will allow us to treat more patients, without having to
transition to a 15 minute treatment schedule, and thus increase our revenue. As our business grows
and becomes established in the community, we will also begin accepting students to complete clinical
affiliations at our clinic. Our senior PT’s will serve as CI’s as they are certified. Adding clinical affiliations
will spread our business name to local and national colleges and Universities as a thriving business. We
also plan to welcome local high school students who are considering a career in physical therapy to
shadow an experienced PT in our clinic for 2 weeks with the option for them to volunteer more time if
interested.
        As more therapists are hired and patient needs are analyzed, our business will consider opening
our facility for longer hours. If we could extend our hours until 8pm at night, have the support staff
needed, and still fill the schedule with patients, we will view this as revenue boosting future plan.
Within our practice, we will offer staffing advancements as well that will provide a shift of job
responsibilities and altered pay. By doing this, we will gradually be transitioning to a tall organizational
structure; but we chose to do so in order to give our therapists opportunities to move up a hierarchal
ladder with hopes that the therapists will be more invested in our clinic long term. This will make our
business more successful because the incentive to offer the best patient care possible will ensure that
each physical therapist comes to work each day with an attitude of excellence.
        We plan to make it an additional responsibility of the office manager to organize valid in-
services to be conducted at our clinic, as well as being registered in New York State to provide
continuing education opportunities to therapists from all over the area. We will also get involved with
the APTA organizations, and offer to host related regional events at our clinic. This will help increase the
recognition of our business on a statewide level, rather than just locally. We will make it a priority of
ours to gain more specializations among our staff as well; which will benefit the treatment that we are
able to provide to our patients.
        For our staff, we will offer a superior benefits package which will include additional bonuses
around the holidays, continuing education coverage, as well as APTA membership expenses.
        As a way to generate more revenue, we will obtain more products to sell to the patient
population, based on their demand and desired items throughout our first few years.
        With these future plans, this business will grow and we will start to plan for overall expansion of

Aquabilities                                                                                             Page 26
our clinic to allot for ample treatment space, as well as additional offices that may be necessary to
accommodate supplementary staff. As we gain more equipment within the clinic, as well as treatment
tables for increased patient care, we will need more room to work with. As we design a new space, we
want to keep in mind our carbon footprint; and so therefore, the building plans will be made with
energy efficiency as a priority.




Aquabilities                                                                                       Page 27
                                             References

1. US Census Bureau. http://www.census.gov/popest/national/asrh/NC-EST2009-sa.html. Updated July
       8, 2010. Accessed October 31, 2010

2. The Kaiser Family Foundation. State Health Facts.
        http://www.statehealthfacts.org/profileind.jsp?cmprgn=1&cat=3&rgn=34&ind=130&sub=39.
        Accessed October 31, 2010.

3. Tompkins County Chamber of Commerce. Community Profile.
      http://www.tompkinschamber.org/COMMUNITY-PROFILE/Facts--Stats/Demographics. Updated
      2010. Acessed October 31, 2010.

4. National Institute of Arthritis and Musculoskeletal and Skin Diseases.
        http://www.niams.nih.gov/Health_Info/Sports_Injuries/sports_injuries_ff.asp. Updated June
        2009. Accessed October 31, 2010.

5. Tompkins County Chamber of Commerce. Business Directory.
      http://www.tompkinschamber.org/BUSINESS/Business-Directory. Updated 2010. Accessed on
      October 30, 2010.

6. Ithaca Health Alliance. Educational Programs. http://www.ithacahealth.org/index.html. Updated
        2010. Accessed on October 30, 2010.

7. Center for Health. Practitioners. http://www.ithacacenterforhealth.com/index.php/practioners.
       Updated 2010. Accessed on October 30, 2010.

8. Island Health and Fitness. Overview of IHF, CMC Physical Therapy.
       http://www.islandhealthfitness.com/index.php. Updated 2010. Accessed on October 30, 2010.

9. APTA. Medicare fee Calculator. http://apta.org. Updated 2010. Accessed December 3, 2010.

10. T-Shirt Express. http://t-shirtexpressions.logomall.com/default.aspx. Accessed December 3, 2010.

11. Quick Salary Look Up. http://www.salary.com/salary/index.asp. Updated 2010. Accessed December
        3, 2010.

12. Time Warner Cable. Business Class. http://www.twcbc.com. Updated 2010. Accessed December 3,
        2010.

13. Marketing site?




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