US Physical Therapy at Midwest Ideas Conference: Strategic Growth Amid Challenges

On Tuesday, 26 August 2025, US Physical Therapy (NYSE:USPH) presented at the 16th Annual Midwest Ideas Conference, highlighting its strategic growth initiatives amid Medicare reimbursement challenges. Led by CEO Chris Redding, the company showcased robust growth through strategic acquisitions and a thriving industrial injury prevention business, while also addressing reimbursement headwinds and market fragmentation.

Key Takeaways

• US Physical Therapy is expanding through strategic acquisitions and a partner model.
• The industrial injury prevention segment is a major growth driver, exceeding $100 million in revenue.
• The company expects a positive shift in Medicare reimbursement next year.
• Technology investments aim to improve efficiency and margins.
• A share repurchase plan reflects confidence in long-term value.

Financial Results

• EBITDA Guidance: Updated to between $93 million and $97 million.
• Revenue Growth: Experienced 18% growth in the most recent quarter.
• Visits Per Clinic Per Day: Reached a record of 32.7 visits per clinic per day in Q2.
• Margin: Quarterly margins were around 21%.
• Industrial Injury Prevention Revenue: Exceeded $100 million.
• Dividend: Pays approximately $0.45 per quarter, just under 2%.

Operational Updates

• Partnership Model: Operates with a partner model, typically owning about 70% of each facility.
• Facility Count: Operates in just under 800 facilities nationwide.
• Technology Investments: Implementing AI-assisted documentation and partial virtualization of the front desk.
• New Clinic Investment: Costs between $170,000 to $200,000 to get a new facility profitable by year-end.

Future Outlook

• Medicare Reimbursement: Anticipates an increase next year after facing cuts for five years.
• Injury Prevention Business: Plans to deploy more capital due to its high margin and growth potential.
• Expansion Strategy: Continues seeking partnerships in markets aligned with values and growth objectives.

Q&A Highlights

• Illinois Market: Avoids due to high competition from CVS, Walgreens, and others.
• Reimbursement Uplift: Typically experiences a few percent uplift post-acquisition.
• Cybersecurity: Investing in cybersecurity to protect against potential threats.

In conclusion, US Physical Therapy’s strategic initiatives and growth potential were thoroughly discussed. For a deeper dive, refer to the full transcript below.

Full transcript - 16th Annual Midwest Ideas Conference:

Joe Noyans, Adviser, Three Part Advisers: Okay. We’re gonna go ahead and get started with the next presentation. First off, my name is Joe Noyans. I’m a three part advisers. I wanted to thank everyone for joining us here today in person and on the webcast.

Up next is one of our Investor Relations clients, U. S. Physical Therapy, which is traded on the New York Stock Exchange under the symbol USPH. Presenting on behalf of the company is the CEO, Chris Redding. And I’ll let him take over from there.

Chris Redding, CEO & Chairman, U. S. Physical Therapy: Thanks, Joe. And thank you to three part. You guys always put on a great conference. We appreciate your work. How many people, just to give me a point of reference, right now are familiar with our company on any kind of a granular basis?

So about half or maybe a little bit more of the room. I’m gonna try to go through this reasonably quickly and then leave time for questions, and we can go back and and spend some time on some of these key areas. By our name, we’re a national outpatient orthopedic physical therapy company primarily. We have a couple different things that we do. One of our secret sauces is that we do this a little bit differently than a lot of the other big companies in the industry.

We have a partner model where typically in in anything that we’ve built from scratch or bought, We’re generally about a 70% owner in that particular business and brand. And so in we’re in just under 800 facilities around the country. Each of those within the form is within a partnership. That partnership has a local brand that is something other than US physical therapy. Nashville, Tennessee, we have 80 locations around that market.

Middle Tennessee, that’s star physical therapy. On Long Island, in New York, we have 50 locations. That’s Metro physical therapy and aquatics. So when we buy into somebody’s business, we’re buying into that brand. The owners keep, meaningful interest in the business.

And then we add gas to the engine and a lot of back office resources to help them grow and scale the business. So we’ll talk a little bit about that. We’ll spend time on that. We’re growing. In spite of the last few years, we’ve had some headwind that was a result of really a med pack and CMS error in terms of how they were apportioning the physician fee schedule.

We can spend a little time on that later. We’ve had some Medicare headwinds that are finishing up this year. In spite of that, we’re growing still at a significant rate, and and and we’ll spend some time. This is our footprint around the country. Until recently, we weren’t also in New York.

We found the right partner in New York and we’re investing significant resources in that market. We’re we’re we’re homed in Texas. We our our corporate office is in Houston. Where we wanna be is in markets where, people wanna work and live. It’s easy to recruit, our our staff to be there, and where there’s enough people who live there.

And the reimbursement is good enough in that particular Reimbursement tends to go by state, in that particular state, to to give us a reasonable margin. So we’ve grown from scratch. The company’s been around thirty I think we’re thirty three years now. I’ve been with the company the past twenty two. In in my leadership role, I’m both chairman and CEO.

Chairman more recently, CEO the majority of the time. I have a great team of people and we’re doing a lot of good things. The rehab market’s still highly fragmented. It’s estimated by Bain to be about $40,000,000,000 market. Nobody’s got more than 10% market share.

Select Medical, it’s really their third product line, but they’re the largest PT provider. We’re one of the largest. We might be maybe the best known because we’re the one large public, really sole PT provider in the market. People know me really well. I’ve been in the business for forty years.

We have a good reputation. Demographics are in our favor as long as we can keep reimbursement moving in the right direction. I’m gonna jump through this. Know, the opportunity for physical therapy, and we have a couple studies, one big one was CMS right now in Maryland, where when physical therapy’s used as kind of the primary care gatekeeper for musculoskeletal problems, case cost goes down fifteen percent. If you extrapolated that over all 50 states, this is one state, one state’s data, it would be $100,000,000,000 in savings for the system.

That’s just for Medicare, not for all of musculoskeletal. So when we’re involved early, we can get a case resolved, a musculoskeletal case, much quicker than if they go to either home care or inpatient rehabilitation. Or they get opioids and bed rest and a combination of diagnostics that they probably don’t need in order to get well. So there’s a big impact. Again, it’s a highly fragmented market.

These are the top three ATI’s located here in Chicago. They were a public company for a very very brief time. No longer a public company. Kind of had a bit of a debacle, which we won’t spend time on. Self inflicted, unfortunately.

But it’s a healthy market. It’s a growing market. It’s a consolidating market. And we’re a provider that has really the best balance sheet in the industry. We have very little leverage.

We have great cash flow. We’ve got a great banking relationship and facility to continue to grow. And, there’s a lot of opportunity out there. So what we try to do is we try to find healthy, strong, of reasonable size partnerships in markets that we like. And then we buy controlling interest.

Although our partner continues to run day to day and manage the business locally, we’re certainly actively involved. And we add all the back office resources and infrastructure to help accelerate the growth, add more programs and services, and make it more profitable over time. We’re able to augment our growth through strategic tuck in acquisitions. These are little practices where our reimbursement, our contracted rates that we get paid from commercial payers, which make up the bulk of our reimbursement, are at a much higher rate than the mom and pop guys can get on their own. And so it becomes an accelerator for both profit and growth for these partners who stay with us until they retire one day.

And so we don’t get involved if somebody wants to sell their business and kind of go to the beach. We don’t wanna be a 100% owner. We want a partner in the business who cares as much about it as we do and who’s attached in these local markets. Our partners stay with us again until a point of retirement, at which point they’re incented along the way to grow the business with us. Because of our capital structure, we disperse available funds in these partnerships on the same cadence every month.

So us and our partner gets a distribution of available cash in the partnership. It’s different than every other acquirer in the business which is otherwise heavily levered. No partner distributions downstream to limited or minority partners other than maybe for some of them for taxes. We distribute all available cash in these partnerships. So our partners’ cash flow grows over time.

They have the guarantee of a back end buyout at some point in in the distant future updated to the profitability at that point in time, at the same multiple that we bought it at maybe ten or fifteen years ago. And so when you look at our blended average of what we’ve acquired these partnerships at, from an actual EBITDA perspective. Not forward adjusted, you know, made up EBITDA numbers, but actual TTM EBITDA. Our our average buyback multiple is about seven and a quarter times. And so they’re highly accretive.

They do well. The partners are incented with us to grow the business, to treat people well, and to look for opportunity, which we also help them do. It’s easier to think about what we don’t do than run through this list of everything we do do, which you can look at on the screen. We don’t treat patients personally. Although by background, I’m a physical therapist.

I grew up in the business. I had a long career at a high level in sports medicine. I’m able to talk to somebody about exactly how an ACL reconstruction happens and the rehabilitation afterwards. And so there’s credibility there if needed. People know that.

I don’t have to pull it out very often, but I understand the business. We’re not taking care of patients daily. We’re we’re not local, so we’re not overseeing staff. Although we have all the stats that come out of that. And we’re not creating the local relationships with the referral source.

Those things stay with our partners and our staff locally. We do everything else. All the regulatory stuff, all the benefits, all the legal work, all the bill pay, all the development work, development work being acquiring and folding in other companies and diligence around that. We obviously, as a public company, do all the accounting and all the Starbucks work and, you know, all of it, all of it. And really, it’s a great fit with our partners because our partners are clinicians always.

They’re good at what they do. They have to do 12 things that they’re not good at, that they’d rather not have to do, that they’re happy to give to us, that free them up to do more of what they enjoy. And for most of them, it’s creating new relationships and growing the business, which which we help to facilitate as well. And so it eliminates, you know, friction in terms of their growth. It eliminates the headaches.

We do it with people with significant expertise in those areas. So typically we’re able to do it more effectively, more efficiently. We have all the optics we need to get all the information we need. And then we have alignment of incentives. And that’s why it works.

So I talked about the fact that it’s a fragmented market. You know, there are thirty, forty thousand outpatient physical therapy facilities around the country. Most are privately held, most are small. For the most part, we’re not interested in the smallest of those just because they’re too much work and not enough meat on the bone. So they have to get to a decent size, million ish in EBITDA or greater.

A big practice with multiple clinics might be 2 or $3,000,000 in EBITDA. Really big practice like the one that we bought in New York with Metro, which is kind of rare air, is 8 to $10,000,000 in EBITDA. But most are small. What we look for is we look for a partner who cares about what they do. They obviously have to care about the care that they’re providing.

They’re taking and wanna take good care of their staff. They’re not just looking to make a buck. Although they understand that in order to be healthy, the business has to be run effectively and efficiently. And more than anything, they wanna grow. And they need resources to do that.

So we have values alignment. We have strong integrity. We have the desire to grow, and the willingness to take input from a partner who’s done this for a long time. That’s a good recipe for success for us. Those are the kind of people that we look for.

This is just an example of clinics that we’ve done, partnerships or clinic ads in the last year. As you can see, we’re growing around the country, a variety of different geographies. One of my primary roles, at least as as I’ve defined it in our company, is in development. So I get out, I meet people. I’m forty years in this business, which is a long time.

People know our company, they know me, and they know how we compare to a lot of the private equity groups that are out there in in the world, which are, in today’s world, seven to 10 times levered. Unfortunately, since, you know, the the post COVID area. A lot of people transacted in 2021 when money was still free or looked at it that way. And then ’22, interest rates began to run, and people were over levered and upside down. And and, you know, it’s a hard position to get out of.

We’ve not done that. We’ve been selective. We’ve deployed plenty of capital, but we’ve done it in a in a disciplined way with good returns. And these are just some examples around the country. Different brands, different geographies, different additions.

Half of those will be organic, and the other half roughly will be acquired. So this is pretty easy to understand. You know, we leave the business from a care perspective intact, but we professionalize a lot of the back office things that need to be done. For instance, if you’re a small provider trying to negotiate with Aetna or United Healthcare or Blue Cross Blue Shield, it’s literally impossible. You you take what you’re given or you’re out of network.

And most people don’t do well out of network in our world because patients don’t wanna patients who have coverage for physical therapy don’t wanna pay, you know, a 40% of charges co pay when they can pay $20 And so the payer network part, the back office professionalism makes a big difference. We’re about a third federal, which is different than a lot of other health care companies. I wish it was less. It’s a decent payer, but the last few years we’ve had some headwinds. Medicare made and MedPAC made big error in 2021 when they reapportioned the physician fee schedule in an attempt to pay primary care doctors more.

And their intent was to take from orthopedic surgery, interventional pain medicine, or pain management, and physical medicine and rehabilitation doctors, since they were the highest earning physicians in the physician fee schedule. What MedPAC didn’t know when they advised CMS to reapportion the schedule directionally to primary care was that we were embedded, our codes that we built for, because we built certain codes in the fee schedule, are sprinkled throughout those three large, largely surgeon subsets of the fee schedule. MedPAC should have known we were there, didn’t know we were there. So that competence or incompetence resulted in us with an 11 and a half percent highest reduction in my forty year career ever that I’ve seen for anybody for largely the lowest earning part of the physician fee schedule, which is the physical therapists who come out of school with a doctorate degree and make under $90 a year by and large. They apologized, but they didn’t fix it.

And so over the last five years, that 11 and a half percent has been sliced and diced and spread over that period. And this is the last year that we’ll have it. Next year we have an increase. In my forty years, if we separate these past five and and say that’s kind of a one off aberration, There’ve been three or four other years in the prior thirty five years of my career where we’ve had any meaningful downward movement. Typically, it’s been small upward adjustments over time.

And we’re part of the fee schedule that saves money for the system just because of how efficient and effective we are. So we’ve been fighting our way through that. That’s ending this year. The aggregation of those cuts for us has been $50,000,000 worth of EBITDA. And in this year alone, it’s $25,000,000 worth of EBITDA.

And despite that, we’ve grown double digits and we’ve kept a pristine balance sheet. And so while it’s been difficult, we’ve we’ve done, I think, reasonably well. It has it has cast a bit of a wet blanket over our stock price. Obviously, we added another $25,000,000 in EBITDA, excuse me, to our EBITDA guidance this year’s, just been updated. It’s between 93 and $97,000,000.

So 25,000,000 is a pretty good chunk. Right? And and despite that, you know, we’ve grown in high double digits, 18% here this last quarter. Know, we report a lot of different things. Our visits per clinic per day continue to grow.

The most recent second quarter, last year I think three of the quarters were three all time records for each of those three quarters. Our first and second quarter this year were all time records. We’re up to 32.7 visits per clinic per day in the second quarter, which is very seasonally strong for us. Demand is strong right now. We’re we’re we’re getting our labor, which has been a tight labor market.

We made some investments that’s moving directionally in the right in the right way. And we’re rolling out programs and some One’s an AI assisted documentation service, which is helping us be a little bit more efficient. The other is a partial virtualization of the front desk, which is just at the beginning rolling out, but we expect to have about a third of our facilities covered with that by year end. And that is helping us be a little bit more efficient and and continue to get margins back directionally where they need to be. Talked about this.

Margins are down a little bit from where they were at the high end 2021 coming out of a you know, coming out lean in COVID. Our most recent quarterly margins were were for the second quarter, we’re back around 21%. We’ll we’ll we’ll get margins back up a bit. I don’t know that we’ll be back up in, you know, the 23 to 25%, but we’ll still have a healthy margin. One of the one of the parts of the business that I wanna spend a little time on, In 02/2017, we started what we refer to as our industrial injury prevention business.

Now my background was sports medicine. And so when you take care of a team, I worked with the Redskins, I worked took care of the athletes, I lived in Richmond, Virginia, University of Richmond. We took care of a of a semi pro hockey team, lots of high schools, rugby clubs, lots of groups. You’re certainly there when somebody tears an ACL and you you get them fixed up and and you eventually get them back. But you’re there to keep all the little aches and pains from turning into, you know, a big impactful thing that keeps you from playing the game that you wanna play.

We do the same thing embedded in large industries. And so we’re in all 50 states with this injury prevention business that we started from scratch in ’17. It’s now over well over a $100,000,000 in revenue. It’s over $20,000,000 in EBITDA. It’s it grew last quarter and it’s been growing somewhere between 2030%.

Last quarter was right at 30%. The organic part of that is closer to 20%. We’ve done some select acquisitions, although there aren’t as many companies to acquire. And we’re embedded in the workforce. For instance, we’re in I don’t know exactly how many over 500 Costco warehouses around the country.

Costco has pledged to us that we’ll be everywhere they go because of the impact that we’ve been able to make for them. We’re in every major auto manufacturer pretty much in the country with the exception of General Motors. We might be fractionally in an employer. For instance, Costco, the average person who covers Costco for us has three warehouses that they cover at any given time. So we’re there a certain number of hours each week.

Or we’re in Nissan Motors in their million, however many square foot plant in rural Tennessee, we have 50 FTEs. And we do everything from prevention to full service medical testing, drug testing, pre employment testing. You name it, we do it. Saves the company typically a three to one return on what they pay us versus their hard cost return, and there’s a lot of soft cost benefits as well. This business growing like crazy has a great organic element.

The acquisitions that we’ve done over time have increased. The types of industries that we’re in. We call those industry verticals. They’ve also helped to increase the width and breadth of our service offering, which has grown significantly since we started this in 02/2017. We’ve we wanna deploy significantly more capital directionally to this part of our business just because it has such good margin profile and such good embedded organic growth.

And the capital we need to invest to service an employer is literally the hourly wage of the person that goes there and a laptop. Now that doesn’t include the back office infrastructure and support, but it’s not capital intensive at all. It doesn’t require a facility. It doesn’t require lease and rent and electricity. It just requires a well trained person and the IT infrastructure to support it, basically.

And so the the return on that investment is very, very high. So we like this business a lot. When we report margins, PT, and injury prevention, Based on how our injury prevention partnerships are structured, we have two main partnerships, one in Denver, one in Indiana. They’re fully encapsulated. So our fully loaded margin in injury prevention is about the same as our pre corporate margin, our facility based margin in PT.

Our gross margin in injury prevention is about twice what it is in physical therapy. It’s really good. We’re a reasonably small publicly traded healthcare company. We pay a dividend. We paid a dividend since 2012, I think.

About I think 45¢ a quarter, I think is where we are. Just roughly just under 2%. We deploy capital to de novos, which cost as as much as as little as a $170,000 to $200,000 to get a facility up profitable by the end of year one, and then consistently profitable over its life. So the ROI on that is really strong. We deploy capital to acquisitions.

And then of course, we have a small amount of debt that that that we, you know, use for our existing cash flow. We recently, based on where we are trading or where we have been trading recently, our board, we authorized the share repurchase plan, which I would tell you preferentially is not where we would normally see our best return. But based upon where the stock has traded more recently as a result of some of these Medicare headwinds and where we’ve been, again, we’ve still been highly highly profitable and growing, just not the extent that we’re used to. But we have a share repurchase plan in place as well to deploy capital if and when we choose to do that. So I’m gonna stop there, Joe, and just leave five or six minutes open up for questions.

Joe Noyans, Adviser, Three Part Advisers: What’s kept you out of Illinois, ATI?

Chris Redding, CEO & Chairman, U. S. Physical Therapy: We go where there’s the best opportunity. So in Illinois, in this market, in Chicago, every third corner you probably have a CVS, a Walgreens, an ATI, and an Athletico across the street from one another. And they’re easier places to go to. Both of those companies are capital structures. I know both, I know the founders of both of those companies, their friends, I know them really well.

ATI and Athletico Story are two different private equity disasters for different reasons. They’re just easier places to go. Same reason we’re not in California. Sometimes life’s too short. When you when you make an acquisition, what’s the typical uplift on commercial reimbursement?

Yeah. It varies by sophistication and by their market penetration and presence, but it’s usually a few percent. It varies by contract. I’ll give you an example. In Metro, the New York opportunity, which we were out of New York for a long time, and we picked our partner very, very carefully there.

That’s a complicated market, an expensive market as well. We did the deal, I think we closed, I think November was our first month. We were at a $101 a visit. We’re up to a $107 a visit. We do between six and seven hundred thousand visits a year.

So those dollars add up pretty quickly. So there’s one way to think of it if you’re buying a a company,

Joe Noyans, Adviser, Three Part Advisers: you know, a million

Chris Redding, CEO & Chairman, U. S. Physical Therapy: of EBITDA, like, day one after the acquisition, they’re gonna be $1.01 or 1,500,000.0. Yeah. There gonna be a there’s gonna be a lift. Now, right out of the gate, there are usually things that we have to do to invest in the business too. For instance, in today’s world, cybersecurity is a big deal, particularly for a health care company.

You know, you get hacked and you get shut down by the hackers, and then the government penalizes you for being hacked. And so you get it from both sides. And so we usually have to make investments in cybersecurity and other things. Those are capital investments that don’t directly run through the P and L, but the EBITDA lift is usually pretty direct. There always has been.

Some of it’s red state, blue state. Some of it’s state solvency. Some of it’s labor, some of it’s the work comp system and the rules around that. Work comp’s one of our higher payers. Some of it is payer dominance or payer competitiveness.

There’s a whole host of factors, but they don’t tend to correlate to what Medicare pays. They tend to be disconnected. It’s always been that way. Can’t tell you why it’s not that way for ambulatory surgery, because you get paid on a grouper rate there, which is a rate tied to Medicare, and it’s not that way for PT. But it’s never been that way for PT.

So we concentrate where, for instance, we just did deals in Wyoming and Alaska where the net rate is gonna be somewhere north of a $180 a visit. It’s easier to have margin and, you know, to add profitability as long as there’s enough population there to do it. That’s the key. Other questions? Yes, sir?

Yeah. So these are these are trained health care professionals who are either therapists or athletic trainers. So they know the musculoskeletal system. The long and the short of it is we don’t care whether somebody has an issue that happened by playing weekend softball, working in the yard, or it’s a work related issue. We have an aging, workforce in this country.

Companies aren’t able to ask somebody if they’ve had surgery or they have a physical injury that might prevent them from doing a job. So we have a testing program in place that’s called post offer testing, excuse me, which is deployed to determine whether somebody can do the physical job demands. But when they’re there, normally during the week, they’re a trusted provider. They’re circulating. They know who where the high risk, high load jobs are.

They get to know the people. Again, they don’t care the reason. We’re trying to intervene early before somebody decides they need to take off work and go to a doctor who may or may not give them the right diagnosis, or who might send them for a throwaway MRI just because they own a machine. And we’re able to do some early intervention work with them to keep that from becoming a recordable injury. That’s a lot of what we do.

We’re walking and talking. And if we’re in a auto manufacturer, our people have a hard hat on and and they’re in a particular area in charge of a certain part of the workforce, and they get to be a trusted trusted provider there just to help people stay healthy. Thank you. Thank you all.

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