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LOUISVILLE/LAGRANGE/HILLVIEW The pages of MD-UPDATE often relate the challenges physician practices face in the wake of the Affordable Care Act (ACA), but physician offices are not the only businesses affected by the law. Complementary services, such as physical therapy practices, have also seen significant consequences from the legislation.

According to Patrick Myers, PT, DPT, OCS, MS, COMT, founder and owner of Apex Physical Therapy, the biggest issues his practices face are akin to those physicians encounter – decreased reimbursement and increased paperwork. Indirectly, the increasing trend of hospital-employed physicians has created an additional challenge for independent physical therapy practices, who rely on physician referrals for part of their patient base. Apex has countered the trend by adjusting its strategy to focus more on consumer-driven marketing.

10 Years and Growing

Myers opened Apex 10 years ago at its Middletown location to follow a desire to be an independent business practitioner. The practice specializes in outpatient orthopedic therapy for pediatric and adult patients. “Most of the things we see are musculoskeletal. We do see some very modest neurological deficits,” says Myers. However, they are not afraid to refer out neurological issues that area outside of their wheelhouse.

Today, Apex is one of the largest independent physical therapy practices in the area, and each of their therapists holds a doctorate in physical therapy. “I do think more people are recognizing physical therapy not only as an adjunct source of their health care, but I think they’re making the choice the first time,” says Myers. “We’re at 10 years in practice, and we’re busier company-wide than we’ve been ever.”

In April 2011, MD-UPDATE featured Myers and his use of the Australian-based Maitland Concept for manipulative physiotherapy. All of Apex’s therapists now use components of the Maitland or Mulligan concepts in their practice.

Brad Conder, PT, DPT, OCS, clinic director of Hillview and River Road, has used manual therapy techniques for eight of his 10 years of practice and is close to being Maitland certified. “As a company we try make sure all our therapists are trained in the best physical therapy training out there with the most evidence behind it,” says Conder.

One of the practice’s keys to success, according to Conder, is scheduling patients appropriately so there is enough time for a combination of manual therapy and exercise prescribed by therapist. “The combination of those two things usually yields the best outcomes backed up by evidence,” he says.


Co-owner and Clinic Director Nick Austin, PT, DPT, OCS, CSCS, joined Apex in 2006 when he partnered with Myers to open the company’s LaGrange clinic. The clinic doubled in size in its first few years and moved to a new building Apex designed. It houses both private and open treatment areas and is set up for TRX training, dry needling, and massage.

Dry needling is another technique almost all of Apex’s therapists are certified in. “Dry needling uses an acupuncture needle with a different approach. The approach of the needle is to stimulate a local twitch response in a trigger point,” says Austin. The twitch response resets the muscle and results in decreased pain and spasms. Typically one to three sessions are needed to see the expected effect, and the therapy can be used alone or in conjunction with other therapies.


Conder joined Apex six years ago and has been the clinic director at the Hillview location for three years. “I was attracted to Apex’s small private model,” says Conder. “Being a small private practice, we get to really control how we run our business.”

The Hillview clinic, is located in Bullitt County, and has a slightly different mix of patients than the other clinics, which includes a significant amount of work industry patients. They also see sports injuries, spine patients, and automotive patients. Open for four years, the Hillview clinic doubled its volume in its first year of business. Conder estimates 25 percent of Hillview’s patients in a month are return patients or family referrals because of the practice’s reputation and service.

River Road

Three months ago, Apex opened its newest location, a small satellite clinic located inside Heuser Health, a medically oriented fitness practice, on River Road. “We came across a great relationship with Dr. Louis Heuser at Heuser Health. Really the practices fit together perfectly like puzzle pieces,” says Myers.

The partnership has spawned a new business model for Apex that focuses on industrial medicine. “We are developing a new business model to where we can actually reach out to companies with more of a wellness and prevention model,” says Conder. The River Road Clinic gives Apex a presence on the north side of Louisville, as well as a base for expanding their industrial medicine concept.

Apex has partnered with DSI Work Solutions, who offers work injury prevention and management programs and training, to promote the new model. “We don’t focus on injury; we focus on prevention,” says Conder. The program offers “front-end” services, such as prevention programs, work station evaluation, and post-offer job screenings within OSHA guidelines, in addition to back-end treatments once an injury has occurred.

Conder says so far the model has been successful and is one they are looking to grow. Apex is in the process of opening another clinic with Heuser in east Louisville.

Culture of Customer Service

While Apex still receives a good number of physician referrals, they are seeing an increase in direct access patients and word-of-mouth referrals. Both Myers and Austin believe their strong culture of customer service is an important factor driving these results. “We train for customer service at all levels with our staff,” says Austin. “That’s one of the ways we meet the challenge of bigger and larger competitors in the community is to try to treat people as well as we can possible treat them.”

Their culture of customer service extends to physicians as well. Apex’s staff believes in a team approach to care and a two-way street for referrals: physicians refer to them and they refer out when patients need another service. Apex strives to have great working relationships with physicians because they see themselves as an extension of the physician’s health care team.

“We’d like to be the place you would send your mom to,” concludes Austin.