Mike Horsfield: CEO of Rock Valley Physical Therapy

In this episode of Taking Back Healthcare, Mike Horsfield, CEO of Rock Valley Physical Therapy, shares how he’s grown a patient-first PT organization while navigating the operational challenges of today’s healthcare environment.He talks about leadership, scaling clinics, and using smart systems and technology to give clinicians more time to truly connect with and listen to their patients.

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Transcript:

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Rock Valley Origins

When I hear work-life balance, I think work should be the balance of life, not life the balance of work. Especially when you have a meaningful pursuit in life, like taking care of people.

I think going to that job should be the reprieve, should be the thing that fills your cup.

For me, that is really what I'm looking at, is how do we do something even cooler with the sense of community such that we can be that for all of our coworkers and continue to grow that community.

Thank you, Mike, for sitting down with us today and chatting with us a little bit about what y'all are working on at Rock Valley PT.

You're welcome. It's an honor to be here.

Awesome. So why don't we start off, why don't you tell us a little bit about your background, you know, a little bit of an interesting background. You are a provider first and then got into this role as CEO.

So tell us a little bit about that journey.

Yeah, so again, I'm a farm boy from Iowa, grew up in a little small farm, had the usual path to PT that most people have got injured, got exposed to it, and then chose to go here.

My first place of working and place I still get to work is Rock Valley. So I joined there in 93. Rock Valley started in 84.

It's a therapist owned practice. We had a couple of we had an office and a contract with a hospital at that time. And so have got the chance to work alongside my best friends for the last 32 years.

And the organization now has grown where we have 64 offices in four states, still therapist owned. Now we have 38 partners. So we're a legacy practice that loves this profession and tries to do the best we can to.

That's awesome.

Using my farm background, I would say I'm a steward of the land and I feel an obligation to leave the land better than I found it.

And that's kind of what Rock Valley has set out to try to do.

That's awesome. That's funny. I often joke with people that a Thales commute is like the only place that I've ever worked.

And it sounds like Rock Valley.

Yeah, it is. I've had lots of jobs. I now get to serve as the CEO of our organization.

But yeah, when you find a great place, why not just stay there?

And it's all about the people too. So you're working with some of the best people ever.

100%.

Yeah. You know, this model about a physician-owned group, I'm so curious to hear your take on that. You know, there's a lot of controversy around this model in general.

People say, I mean, I guess it's you're no longer allowed to start physician-owned practices. Is that right?

In physical therapy, I mean.

Oh, and I guess in just in medicine in general, but is that not the case?

No, no, absolutely not. And again, in a physical therapy-owned practice, you know, our whole market is very fragmented.

Yeah.

And so most of the most of the practices are, you know, that are in private practice are very small practices. One, two, three offices that are therapist-owned. It's harder and harder to do that.

And that's kind of one of the things we're setting out with our new company, Slate, is to make that easier for therapists to get into ownership. But yeah, it's still, it's still certainly a career path.

So, you know, you have an interesting perspective because you were a provider first, and then you got into this, you know, practice management, and obviously at a relatively high level as well.

You know, as a provider, what were some of the problems that you experienced that you then when you moved to management that you wanted to then solve later on?

Yeah, I think that is the reason I wanted to move to management, right?

3:27

Leadership Philosophy

Like people, you know, what draws you to leadership and it is to try to help more people.

I think as a therapist, you can help so many people on a daily basis, and then leadership, you can help people who help people, and then as you move up, you keep kind of expanding that circle of influence and your ability to help.

And I think, you know, the question I ask myself every day is, how do I make it easier to take better care of more people? Like, I think that's the right question to ask. And the easier part, the better and the more.

There's a shortage, right? We want to make it easier.

And so those are the problems that I set out every day to try to figure out is, how do we allow our therapists to take better care of our community and make it easier for them so they can go home at night, spend time with their families, do those

things. So that's really at the crux of why I enjoy doing what I do.

Did you have that problem? Were you, you know, were you being feeling like you were overworked or like didn't have enough time to spend with your family?

Well, I think my family might say that. Yeah, I think I loved what I loved what I did. And so it never felt like work to me.

Yeah.

And so when I and this is my perspective, and I appreciate others might see it differently is, I don't think we have, I'm not sure if we got an overwork problem or we got a purpose problem.

And so I always felt like a sense of purpose. And I, you know, one of the things during COVID that our team tasked me with was to say, Mike, we want you to do a work life balance talk.

And that led me down a rabbit hole to studying the science of happiness. So Arthur Brooks out of Harvard has a lot of this. And I think when I looked at that, I'm like, I think it's purpose.

I think we, as humans, love to do hard things that make a meaningful difference in someone's life. I think it's when you take the meaningful part of that, that it starts to feel too hard.

And so I have, that's my view of this, is that we might have a purpose issue. And so again, for what you guys are doing, I'll tell us is, how do we bring the purpose back? How do we bring more face to face?

How do we just walk? Like I always said, if you put me in the gym at our office and just let me take care of people all day long and then let me go home at the end, boy, that'd be a good day.

But there's so much other stuff that has gotten in the way of that, that kind of drains the battery through the day. So that's what I'm excited about is, how do we bring the purpose back to our great profession?

I think that is really profound. I don't think people talk about that enough, that the overworked nature versus the purpose nature.

Because the fact of the matter is, all of these providers are people that have gone through very rigorous schooling, studying, testing.

They have 26.2 stickers on their cars.

Right.

They are not afraid of hard things.

Yeah.

Right? So I think it's when we try to keep making something easier. Like in what way?

Like easier, but the taking care of people for a living is hard.

Yeah.

But that's what makes it wonderful.

Yeah.

It is that paradox, right? Like hard things in life are the things we talk about. I climbed that mountain.

Yeah.

I ran that race.

I did this. I got that degree. I went to that hard school.

I got into that school hard to get. Like we love that as humans. And so to embrace the hard and to say that when I feel that, that matters because that means I'm doing something meaningful.

It's not something to run away from. And I think we can make it a lot easier than this. Right?

Like it's both of those things.

Yeah. Yeah. That makes sense.

How do you try to bring that purpose back for a lot of providers that just feel like they are punching a time clock or just feeling so squeezed? How do you like bring that excitement, that purpose, that humanity back to that experience?

I think it's just staying focused on what we do. Like again, it's simply, we take care of people for a living. I told you I was going to cry during this time.

I'm going to do it because it's what we get to do for a living.

Yeah.

Right? Like it is, I can't imagine there's anything more meaningful, at least.

Yeah.

That's my belief of helping another human through a hard time.

Yeah.

And that's what we get to do every day.

Yeah.

So to continue to remind them to build systems and processes and mission around that, to make sure incentives are aligned with that, to make sure we attract, to retain the right kind of people that believe in the same things.

There's lots of other ways to believe this. You can make some money in this profession. You can have that.

You can build it, sell it. Like there's people that do that. And to be honest, there was a time where some of my good friends, I had some resentment like, like this is our profession.

And then I realized like, okay, that's best for them. But what's best for us is to create an organization that remains provider owned, that stays focused on each patient interaction. And try to stay out of their way.

Like really do not overcomplicate that. And hopefully our reward systems and everything we build are aligned with that. And that's a continuous challenge.

We don't have it perfect. We never will. But I think we try to make it a little better each day.

So we were talking a little bit about this before, but do you think care is best delivered through private practices?

I think ownership.

8:57

Empowering Therapists

I'm going to use that word, right? Like ownership could mean, like I have a sense of ownership or agency or autonomy over this thing. I think care where the provider owns that relationship with the patient is best.

I think when that provider has some ownership in the practice and can have some influence over how that practice is done and not be told how to do it, I think that leads to better care.

So again, it is a complicated structure, but like we just launched a new organization called Slate, which is other small practices that could you help us with some of the revenue cycle management, the prior, like all this stuff that's hard.

And so what we're really focused on now is trying to reduce the barrier to entry so that we have more therapists. I think competition is good.

We're helping our, you know, even our competitors have gotten together with our competitors and starting to build a therapy network to collaborate. And I like to call it co-opitition. So we know where we can cooperate and still compete.

I think that is a healthy environment where, again, the consumer or the patient benefits from all of us having to be better every day. So I think that is the best environment for the people we're serving. And that's why we're here.

And so we should stay focused on that.

Got it. Got it. So you talked about some of the harder stuff that these practices have to figure out.

I always think it's an interesting dichotomy because all the providers went to school to be providers and to be really excellent at delivering the highest quality care possible.

And then you end up, a lot of them are entrepreneurial, a lot of like you, end up running practices. And you have to put together all these different pieces. And there is no business in a box for healthcare.

It isn't just pop up and say, oh, this is what you need to do to get started. This is one place, one stop shop for everything.

And so you really have to painstakingly look through all these different vendors for different things and the minutia of it can get quite overwhelming.

How, you know, talk to me about what some of those hard things that you guys at Slate work on creating some uniformity with the groups that you work with.

Yeah, so Slate, the kind of three different buckets we look at. So one is just kind of looking at, can we use our scale to purchase good technology, have some influence on what that technology does from the provider's perspective, right?

So on the road maps and things, we can say, no, like, I know this looks really cool, but this is the thing that really matters to us every day. This is the hard thing that if you guys solved it, it would make life so much better.

So to bring a group together both from a purchasing power standpoint, but probably more importantly from an influence and a partnership perspective, because although what we do is hard, it's not that complicated.

And for some reason, we have overcomplicated this.

And so you get a lot of different solutions that don't integrate, that I'm logging into five different systems, I'm trying to remember where everything is, we're putting the same information in four or five times. So it's that.

And then the other part is getting paid, revenue cycle management. It shouldn't be that hard for people to get the benefits they deserve through insurance, but insurance makes it hard. So we got to solve that.

And then the last part is just building a sense of community. Again, when we talk about it being hard, it's okay, but it's nice to have a support group that knows that, hey, it's in it together and we help each other.

So I think that sense of community, the way to get technology to help us and move it so that everyone can have that vision of, I just go in, I take care of people, and I go home, right? Like that's a really cool thing. And then I get paid for it.

And the money ends up in my bank account. Yeah, I mean, if we can solve those things, then I think we're going to have more providers, not just therapists. But I think you'll see a revival of private practice that's gone through consolidation.

You know, all the things that have happened in health care, which I'm not sure is great for consumers.

In what ways do you think consolidation is not great for consumers?

I think it's one is I don't I think competition makes people better. Again, going back to my farmer, you know, to me, the best fence is a greener pasture, we say on the farm, right?

And so I see health care companies, once they get control, they start limiting patients' access via the way they set up their ACOs or their insurance plans. So they guide the care.

When patients can't go any other place, what's the incentive to be better? And what do you do?

Yeah, yeah, yeah.

Right? And it also drives up cost. So lack of competition drives up cost.

So I think in both access, quality and care and cost, like, you know, I remember getting my MBA, they were saying, well, healthcare is the only thing where competition raises costs because everybody needs the latest and greatest, you know, MRI, and

that raises the price. Like, I mean, I could be wrong. I'm not an economist, but I see it where when you get a vertically integrated system where there's no choice, I'm not sure it's always great for care.

And there's some really good systems out there that do it well. But I've also seen the opposite of that occur.

Yeah, I would entirely wholeheartedly agree with you on that. Do you still practice today?

I don't see a lot. I still get an occasional text from a patient that I want me to go and see. I saw somebody a couple of weeks ago where I'll go in and see a patient or two.

But up to COVID, up to when COVID was happening, I saw our entire executive team saw patients three half days a week. And then we ran the company the other way. Obviously, when COVID came, the company needed a little more attention.

We wanted to keep all of our coworkers on. We didn't let anybody go during that time. So we decreased our patient care time.

I never quite got back to it fully. And I'm not sure, given how great our young therapists are, that anyone wants to be treating them anymore. I got a little bit out of practice, but I still love that drug.

I love the fix of going in and somebody texted me and said, Hey, Mike, can you help me? I mean, there's no better drug than somebody reached out to say.

So you missed it a little?

I did. I missed the connection of the drug, right? Like that I help somebody, I see that that's a really cool human experience and interaction.

You know, now I tell myself, well, I help people, help people, help people. But that drug doesn't feel as good. I'm for people removed from the really the cool part of healthcare.

So Rock Valley now serves over 64 different locations.

Is that right?

15:30

Practice Growth Strategies

That's pretty amazing. How have you grown like that? Is it just mainly through acquisition or do you organically grow and just like add doctors to the group?

How do you think about that?

Yeah, there's really three ways. So we look at it like, one of my favorite things is the reward of great work is more work.

So the initial snowball of Rock Valley was a therapist would come on, get too busy and we'd hire another therapist, and then that therapist would do a great job and be too busy and we hire the next.

We still grow through that, through that, we call it our practice within our practice. Like they come in, they develop, do a great job. Then we do a few de novo startups each year.

A lot of those, like one really cool one is a young, a therapist of ours, Jonathan, wanted to move to a certain area. So we'll say, hey, we'll support you. We look at the market, we do that assessment.

If it makes sense, we do it. And now he's doing great there. And then the third way is organizations will join Rock Valley through mergers or acquisitions.

And so given our involvement in many different organizations within our profession, we've gotten to know people.

And so when they're looking for a succession plan or just looking at doing something different, they'll reach out and if culture and the opportunity makes sense. So that's probably the bigger chunk of our growth recently.

I mean, the growth of the individual practice is still our number one. But as far as location goes, people joining us has kind of been our biggest growth lately. And that's taken us into now Nebraska and South Dakota, Illinois, Iowa.

So now the kind of the reach has gotten a little broader for us.

And what's the big reason that other practices choose to be acquired by you guys?

I think it's the stuff we just talked about, right? It's just hard. It's hard to run a practice if you don't have scale.

A lot of these practice owners are seeing patients 40, 50 hours a week. Then, you know, they're often doing their revenue cycle management at night in the weekends. They're doing payroll on the weekends.

It just gets to be a lot for them. And they say, you know, I enjoy it. I love to do it.

I just like to have a little bit of support to do it. So those are the people we love to work with because they're great providers. They're delivering great care in their communities.

And then our admin team can just take some of that burden away and let them go. So when we have one of them call us and say, Hey, I'm taking my first vacation with my wife and two that I've had in four years.

Because, you know, again, that's the drug, right?

When I talk about the drug with the patient, that's now how I see that is we're helping that person start getting that life back that they always intended and envisioned when they went out on their own to start a private practice.

And, you know, we're just at the top of 2026 now. Happy New Year. And what are your big goals for Rock Valley this year?

My big goal is for the rest of the time I got left, because I'm old, you can see.

18:12

Community and Innovation

And so I don't have a lot of time left. But I think it's doubling down on the sense of community, of what we can be for our co-workers. When I hear work-life balance, I think work should be the balance of life, not life the balance of work.

You know, especially when you're in a meaningful, when you have a meaningful pursuit in life, like taking care of people, I think going to that job should be the reprieve, should be the thing that fills your cup.

Right?

And so for me, that is really what I'm looking at is, how do we do something even cooler with the sense of community such that we can be that for all of our co-workers and continue to grow that community?

That's really awesome. I think that really will resonate with people. I mean, you're in the practice of helping people and healing people.

And there's nothing that is more human than community, I think.

It's how we're designed, right? It's what fills us up when we feel at most peace and joy is when we're working with another group of like-minded humans to do something meaningful that's hard and supporting each other.

And I just don't understand why where we go to make a living can't be that community, why we have to believe like, I can only do so much of that.

Yeah.

And then I got to go back here and fill my cup. I think I just I don't know the answer to that. But I'm really curious to keep exploring how we can be better at that.

I think you're right.

You know, we spend most of our waking hours at work. Yeah. You might as well love your work and find it intensely purposeful.

Yeah.

Why not?

Yeah.

Why not?

Yeah. I agree with that.

You think about it in such an interesting way, because and correct me if I'm wrong, but you're almost thinking, how can I add technology to my practice to allow my providers to have more of a human experience with their patients?

Well, isn't that what technology was supposed to do for us?

Right.

I mean, I thought that was the vision of technology, was to give us more time with humans, to simplify our lives, to make it more efficient, to allow us to have more time for joy and human connection. And I don't think we've gotten it right yet.

And so that is one of the ways. And then again, how do we create? There's lots of other systems from the human resources standpoint and the benefit packages and what we offer.

There's lots of other ways to do that. But yeah, for the sake of our conversation today, yes, it's like I want to give more time back for two humans to be helping each other. That's really what I want.

Right.

And so what are some of those tools, technologies that you've come across that you think have the potential or that you're already seeing are transforming the lives of your providers and patients?

I think that the ambient listening kind of concept just, you know, I was just joking with our team. They always make fun of me because I'm not a tech guy. And for many years, I'm going, I just want to put a GoPro on my head.

Yeah.

That's my documentation system.

I don't understand why we have to do something else. Like we do meaningful stuff. It should be documented.

And when I just came on of the kind of the air conversation and the ambient listening, I kind of looked over at our CFO and he goes, yeah, Mike's been talking about this for years.

The whole idea of your phone's in your pocket and you get done at the end of the day, you check it, you say, yeah, that's what I did today. And you just walk out the door, right? Like that is, to me, that is...

And then all the revenue cycle management's done. It's all, everything is built, coded correctly, and everything comes back, not denied. And you got all the backroom stuff.

But from a therapist perspective, it's really, I just interact with the patient. Something else takes care of my, all the stuff. That I have to do, and I get to walk out the door and go see my family at night.

Like that is where it needs to get. And I think now, I'm seeing like, I think we can get there. And I don't think it's long.

Yeah, yeah.

Well, speaking of that, where do you think PT as a profession will go in the next, you know, three to five years?

22:32

Physical Therapyʼs Future

What changes do you think will take place that you're just beginning to see the early seeds of? Or what trends that you think will really pick up in the next three to five years for the profession of PT?

I think we're at a really junction point. And what I mean by that is, healthcare has, when healthcare went to, not many people have a primary care doctor anymore, right?

Like your primary care doctor used to follow you when you were sick to the hospital, and the hospitalist came along and that went away. Now to call, get into your primary care doctor can take days, so you go to convenient care.

So people are accessing healthcare in a very transactional manner. And most people don't have their person in healthcare.

I think physical therapy is uniquely positioned because we get to spend 40 minutes, our therapists at least get to spend 40 minutes with every patient. We get to know them, we get to know what their needs are.

We are in a position to own, to be people's healthcare person, to be the primary care provider for healthcare, to help them navigate our promise at Rock Valley is we'll get you better, we'll find somebody that will.

Right.

Right? So it's not that we can take care of all your needs, but we just like to be your trusted person.

That you call, so I think and the thing as a profession that I'm not sure we're ready to embrace, if I'm really start to poke sometimes at our profession is, do we want the responsibility that comes with that privilege?

Because that's not clocking in and clocking out. Right? That is really caring.

And again, technology can help us with some of that, right? It can make it easier. It can work workflows such that I don't have to be managing eight systems to keep track of all the people that count on me.

But when I told you like, I get a text from a patient I saw eight years ago that says, Mike, I'm having this issue. Can you help me? Like, that's the most important.

That's the biggest compliment I can get. Right? And I think our profession, if we want the responsibility that comes with that, I think we could step into that space.

I think there's a lot of interesting synergies between your professional philosophy and your personal philosophies and how we work here at Athelus Kamiya.

There's a lot of synergies between how we both think. Definitely aligned on the piece of having your work be a place that fills your cup and you find the incredible purpose in.

And also, if I personally think about the physicians that I would like to trust with my care or my family's care, it's going to be the doctor that cares, actually cares.

And sometimes that means that they're not the people that clock in and out, right? On the dot. Because a lot of the times care doesn't work that way.

We know what care feels like and you know when you're speaking with the doctor, that really believes that they are going to do whatever it takes to help you.

And when you're speaking to a doctor who's like, I'm so under water today and I got like three hours of notes to take after this, and you know, have a good day.

Yeah.

You know, and I don't blame either of the doctors, but I think that you want to go to the doctor that cares. Yes. No matter the case, right?

That's one of those decisions.

And I think together what we have an interest is I'm with you. Like there's a reason that that person is not present with you because they're thinking how am I going to get home and how am I going to get to my kids event and why?

Like they are real people that have real needs as well. And so I think what we share is the idea that can technology do both of those things? Allow them to be present.

Allow them to do that and get to their kids game at the same time. I think that is then when this health care crisis of shortage and burnout will change.

Again, I go back to it brings the purpose, the reason they went to school, as you mentioned, back to the table and says, this is not what I went to school for. I can't, I mean, I've heard so many of my friends that went to medical school say that.

I know.

This isn't why I went to school and that makes you sad.

The interesting thing is that same doctor that's so burnt out and that can't really spend time with you and that doctor that really cares. It can be the same doctor.

It's just a doctor that is enabled by amazing tooling technology and resources in a doctor that is flying blind a little bit and going solo at it. Could be the same doctor.

I've been that same doctor on this. Not a doctor, but I've been that same therapist in the same day, right? Based on what's happening.

So yeah, it 100% is. It's not a judgment on the individual. It is just an acknowledgement of the reality of what is right now.

Yeah.

No, I think that's so exciting because given the physician shortage we have, the nursing shortage, provider shortage that we have today, and the fact that these providers are so burdened, I think it's an incredibly exciting prospect that we can take

the existing pool of providers, make them so much more productive, so much happier if they really find meaning in their work again, like you said, and are able to connect with patients and heal more people and feel that back and have that fill their

cup. That's such an exciting proposition on a philosophical level, but also on an actual GDP level because these are our doctors that are already in chairs today. It's a productivity boost and a happiness boost, and in some ways can even mean a

And the providers.

It all flows, right? The economics all flow. So again, the question I always say, I ask myself, how do we make it easier to take better care of more people?

I don't look at that as like we got to drive productivity. It's not that. It's the easier is the part that drives the better and that drives the more.

Yeah.

And so, yeah, technology is absolutely got to be a key component of that.

Yeah.

Well, wonderful. Thank you for sitting down with us today. I really enjoyed this and I'm honored to have you sit with us today.

You know, you run such a big group. So thanks for taking the time out. And I'm really looking forward to hopefully partnering with you soon.

Yeah.

Well, thanks for the invite.

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