One-to-One

Sally Blakemore just wanted her life back.

After total ankle replacement surgery in October 2013, she saw some improvement with physical therapy but eventually hit a plateau. The pain and swelling came back, until even carrying a laundry basket across the house became a challenge. As a 43-year-old mother of three with a demanding full-time job, she needed to get her function back fast.

That’s when she went to see physical therapist Mike Frossard and experienced his unique one-on-one, private-pay therapy model — and everything changed.

An individual focus

Frossard opened 1:1 physical therapy & RUN in south Columbia (next to Shakespeare’s South) in fall 2014 with a goal of spending more time with individual clients to provide a more comprehensive, focused and personal experience.

The business has two components: 1:1 physical therapy for those recovering from injuries and RUN, an analysis and coaching service for endurance athletes such as marathon runners.

Instead of meeting with a therapist in a traditional setting, where the therapist works with two or more patients at once, Frossard’s clients get one-on-one attention in concentrated doses.

The idea is to increase the effectiveness of each session and get clients better faster, with longer-lasting results.

“I get Mike’s full attention the entire time,” Blackmore says, compared to her previous experience as one of three or four patients per therapist. “The time I spend with him is effective and efficient, and I see results more quickly.”

Once she started working with him in late 2014, Blakemore quickly began to see improvement in her pain levels, stamina and strength. She also feels that she understands her injury and recovery process better because of the individual attention.

“He holds me accountable, and I get feedback all the time” while doing exercises like leg lifts or stretches, she says. “Do you know how many reps I did the wrong way before this?”

Inspiration for the one-to-one business model came from Frossard’s 17-year physical therapy career, including 10 years in the workers’ compensation setting, where he focused on resolving pain and assisting clients with return to work. Although this was a rewarding career, he wanted to spend more time treating the whole body and resolving all of his clients’ injuries.

“When I started looking into opening a practice, the standard insurance-based model didn’t meet my goal of providing Columbia with a more comprehensive and intimate PT experience,” Frossard says. “It required too much overhead, and I’d have to see too many clients to make ends meet.”

To do the kind of one-on-one therapy he envisioned doing, he needed a different financial model and discovered the private-pay approach.

Today he’s averaging about four clients per day, three days a week. Many of his clients have chronic injuries that haven’t responded to treatment at other facilities, and like other physical therapists, most of his clients come in with joint or back injuries.

Client Steve Keithahn, a physician and triathlete with 10 years of experience, recently started seeing Frossard for a chronic hip injury that flared up about 15 months ago.

First he went back to the traditional physical therapy setting, which had helped in the past, but he says he couldn’t get completely better. He knew Frossard and decided to give his approach a try. It worked.

“You get better faster because what you’re doing is more effective,” he says. “His goal is to get you out on your own.”

How private pay works

As an example, a patient with an injury visits a doctor, who prescribes physical therapy three times a week for three weeks. The patient is free to choose any therapist he or she wants.

In a traditional insurance-based clinic, for each visit the patient will get about 25 minutes of one-on-one time with a licensed therapist and will likely have a $50 co-pay. That’s a total of 225 minutes of a therapist’s attention over nine sessions, for $450.

At 1:1, patients average two sessions per week for two weeks, then one session the final week. Although that is fewer sessions than prescribed, it actually includes substantially more personalized therapy: 75 minutes of one-on-one time with the therapist for a total of 375 minutes over five sessions.

Frossard charges a flat $133 per visit and guarantees at least 60 minutes of one-on-one time for that fee. In this example, the total would be $665 before insurance is involved. The pay model is based on clients paying the full amount directly to 1:1 and then seeking insurance reimbursement on the back end themselves. Frossard’s assistant, Laura Haycook, assists clients with self-claim difficulties.

The private-pay model is also known in the industry as cash-based or out-of-network.

“By taking insurance out of the equation, I empower my patients to be better consumers,” he says. “What I’ve done is create a window for me to spend as much time as I want with each patient.”

Clients can seek reimbursement from private insurance or from Health Savings Accounts or employer flex plans. Frossard says his clients have had an easy time getting HSA reimbursements and have had mixed success with private insurers.

Even without insurance reimbursements, Frossard says the model benefits every patient.

“What’s your time worth?” he asks. “Faster than average outcomes and a decreased number of visits mean less missed work and family time and less travel.”

Clients also benefit from seeing the same therapist at each visit and only paying for skilled treatments; Frossard says he makes it a point to focus on manual therapy and exercises that require guidance and feedback rather than simply having a client repeat exercises he or she does at home.

Explaining the private-pay model and its benefits to prospective clients has been one of the bigger challenges Frossard has faced. “It’s been tough getting people to see the value of going out-of-pocket to get quality care and making a self claim for reimbursement,” he says.

Blakemore submits insurance claims herself and says the results she’s seeing are well worth the extra paperwork.

“The value for me is in the results,” Blakemore says. “I’m getting to the finish line faster.”

Keithahn also submits his own insurance claims. Although he admits that minor hassle is a downside to the private-pay model, he says it’s a bigger hassle to keep going back to less-effective therapy programs.

“Getting better faster is an investment in itself,” he says. “Mike is worth it.”

In the running

Alongside the physical therapy side of the business is RUN, Frossard’s consulting service where he coaches runners and other endurance athletes.

This portion of the business evolved from his experience and desire to treat difficult running injuries, combined with his own love of running.

RUN’s target market is motivated athletes looking to boost their performance or train for an upcoming event, and Frossard approaches them from not only an analytical point of view but also a personal one. A longtime accomplished runner and triathlete himself, Frossard has competed in multiple Ironman-distance and shorter triathlons, marathons, half marathons and road races across the Midwest.

“Every small business needs a niche market, and I chose the endurance athlete,” he says. “It’s beneficial for these clients to have a clinician who understands their lifestyle, goals and training routines.”

Runners working with Frossard receive a 90-minute gait/run analysis that includes a whole-body strength, flexibility and stability assessment, as well as a two-camera video analysis of running mechanics. The video is then slowed to 60 frames per second to analyze biomechanics and symmetry.

This assessment can be used on healthy athletes wanting to improve efficiency and runners returning from injury, such as Keithahn.

“For triathletes, it’s so much repetition for so long that even subtle weaknesses and strengths can manifest in pretty significant injury,” he says. After his gait analysis and other work, “Mike had to tweak a few things for me, but boy it made a huge difference.”

Keithahn was able to improve not only his hip pain but also his speed and endurance.

Frossard’s partnership with professional endurance coach and physiologist Joe Company has created a strong support option for the robust community of runners and triathletes in mid-Missouri.

“Mike does running screening, addresses weaknesses and issues before they happen, builds rehab programs and offers the AlterG treadmill,” he says, “and I can organize the training program for each person.”

Like Frossard, Company is an accomplished endurance athlete with the benefit of both personal experience and academic knowledge of how the body performs in endurance athletics.

They offer marathon training and other support services, along with personal trainer Mark Wilson. Company trains athletes by reviewing data from power meters and electronic fitness data trackers; Wilson focuses on strength training and nutrition; and Frossard provides therapy for diagnosis and gait analysis.

The trio started a 12-week running training group in January for serious runners gearing up for a half marathon in St. Louis in April. Capped at 10 participants to ensure interaction and attention, the group attends classroom sessions where they learn about building training plans, nutrition, recovery strategies, tapering and more.

They also get hour-long individual gait analysis sessions and time on the AlterG treadmill.

Participants run on their own time and report back on mileage and progress. This isn’t like one of the popular Couch to 5K or Couch to 10K programs that help non-runners on-ramp to a completed race, Frossard says; this is designed for experienced competitive runners looking to improve performance.

“It’s not a program where I go run with them; it’s focused on education, for them to take the knowledge and go out and implement it,” he says. “We keep them motivated and accountable and address issues as they come up.”

Frossard’s goal is to build an all-encompassing run and endurance sport clinic that can help runners with everything from acute injury to advanced training and coaching.

Company says that through his partnership with Frossard and other like-minded mid-Missouri businesses, he’s grown to appreciate how local business people can have an impact on the community.

“Often local gets overlooked by cost because it might cost a little more to support a local businessperson,” he says. “But I love to support people I know — like the Coffee Zone and Bangkok Gardens — rather than a chain.”

The local “ecosystem” of endurance athletics, Company says, is strong and thriving and built on cooperation, from sports doctors to orthopedic surgeons, physical therapists, trainers, coaches, bike shops and more.

Defying gravity

One of the coolest training tools around is the AlterG, an antigravity treadmill with technology originally developed by NASA to help astronauts maintain fitness during prolonged space flight.

This is no run-of-the-mill treadmill; it’s a complex $37,000 training tool used by professional sports teams and college athletic programs. The antigravity technology allows the user to run or walk while bearing as little as 20 percent of his or her body weight.

“The unweighting technology allows athletes to train longer, run faster and build more strength than with traditional programs or machines, with minimal impact or joint stress,” Frossard says.

1:1 has one of the few in Missouri and the only one in Columbia that clients can pay to use. Frossard charges $25 for a 30-minute session or $35 for 60 minutes. A punch card and a 10 percent discount are available for clients wanting 10 or more sessions.

The AlterG is a core component of both sides of Frossard’s business — therapy and running consultation — and has attracted a number of clients who approached him curious about the machine.

“I wanted to see what it felt like to be on 40 percent of my body weight,” Blakemore says, “and I felt like an astronaut, bounding and buoyed.”

To aid in her ankle therapy, Blakemore spends time on the AlterG rotating through inclined and flat walking at varying percentages of body weight. It’s allowed her to get cardio workouts and continue walking without hindering progress on her ankle.

As a therapy tool, the AlterG is approved by the FDA for rehabilitation, aerobic conditioning, gait training and conditioning. It can also be used by healthy athletes training for marathons or other endurance events. If a runner is working toward a marathon by running 50 miles per week, for example, doing 10 of those miles on the AlterG can reduce wear and tear on joints while keeping up the training program.

“You get more miles with the same amount of stress,” he says.

Experienced runners can also use the machine for overtraining, which involves running intervals at 90 percent of body weight, and to work on posture and other biomechanics.