Is Your Practice Ready for Direct Contracts?

Physical therapy practices are under intense pressure. Reimbursement is flat, costs are climbing, and adding volume no longer guarantees growth. For many leaders, direct-to-employer (D2E) contracting feels like the next logical step—a way to build stability, improve margins, and strengthen community relationships.

But there’s a difference between knowing D2E is the future and being ready to pursue it.

In this post, we outline what readiness actually looks like—and what separates clinics that thrive in employer partnerships from those that struggle to get started.

From Surviving to Scaling

Reimbursement-based growth has hit a ceiling. Most practices are already running lean, seeing more patients per day while making less per visit. The old formula—more locations, more volume, more productivity—no longer works when every additional visit adds administrative complexity, and you're already struggling to keep a full staff.

Direct employer partnerships offer a new path: fairer reimbursement, faster payment, and lower friction. But they require a different kind of preparation—not just marketing or networking, but operational consistency and clinical accountability.

The good news? You don’t need to be a multi-location giant to be ready. You just need to have the fundamentals in place.

The Five Signs You’re Ready for Direct Contracts

1. Your Front Office Runs Smoothly

If your intake and scheduling workflows are predictable and repeatable, you’re halfway there. Employers value reliability. They want to know their employees can access care quickly, get scheduled without confusion, and stay on track throughout treatment.

Standardizing those front-end processes ensures your practice can handle new patient streams without chaos. If this still feels like a work in progress, we've got a quick list of great places to start.

2. You Can Measure What Matters

Employers expect data—not anecdotes. If you can report on outcomes, satisfaction, and engagement (NPS, discharge rates, return-to-work timelines), you’re positioned to show value.

This doesn’t have to be complex. Even basic outcomes tracking and surveys can help you start the conversation with data in hand.

3. Your Patient Experience Feels Modern

Online scheduling, email or text reminders, telehealth options—these aren’t extras anymore, they’re expectations. Employers want care that feels accessible and convenient for their employees.

Hybrid models that blend in-person visits with digital check-ins are especially appealing because they improve adherence and reduce time off work.

4. Your Operations Are Built for Flexibility

Direct contracts often require new billing workflows (but good news, they're simpler!), unique pricing structures, or outcomes reporting. If your systems and staff can adapt quickly, you’ll stand out.

Practices that can adjust—without breaking existing operations—are the ones employers trust to pilot new programs.

5. You Think Like a Partner, Not a Vendor

D2E contracting isn’t about selling visits; it’s about solving problems. Employers are looking for collaborators who can reduce MSK costs, speed up recovery, and improve employee satisfaction and well-being.

Clinics that bring ideas, not just services, become long-term partners in benefit design.

Common Barriers (and How to Fix Them)

Not every practice checks every box yet—and that’s okay. Here are a few common roadblocks and how to overcome them:

• No outcomes data? Start simple. Collect NPS to gain a benchmark on the patient experience. Build from there.
• Disorganized intake? Define a consistent workflow before layering in automation.
• Hesitant about selling? Reframe the mindset: you’re not pitching; you’re partnering to solve an employer’s cost problem. We built a handy guide to walk you through this process, too.
• Limited time or tech? Tools like Second Door’s Digital Front Door and Lead Management systems can help structure the patient journey so your team stays focused on care.

The Readiness Journey

Direct contracting isn’t a switch you flip — it’s a progression. The clinics that succeed start by tightening operations, improving data visibility, and clarifying their value story. From there, they pilot one or two small employer relationships, learn from the process, and grow confidently.

Second Door supports that progression by giving PT practices the infrastructure to capture leads, manage relationships, and report on outcomes with clarity.

The Takeaway

Direct contracts represent one of the biggest growth opportunities in the history of outpatient physical therapy—specifically for clinics that are prepared to deliver consistent results.

If your front office is organized, your outcomes are measurable, and your mindset is collaborative, you’re ready to take the next step.

👉 Want to know if your practice is ready for direct contracts? Schedule a conversation with Second Door and let’s map out the next step together.