First Rehabilitation, an independent physical rehabilitation provider in Palm Beach County, has significantly improved its operations and financial performance after replacing paper-based processes and disconnected software systems with a unified outpatient rehabilitation platform.

Founded nearly 40 years ago by David Kashuba, First Rehabilitation now operates three locations and has treated more than 80,000 patients. Today, operations are led by COO Nick Kashuba, who helped guide the organization through a major technology upgrade after years of administrative inefficiency.

Before the change, the practice relied heavily on manual processes. Patient charts were assembled, printed and physically routed. Billing, scheduling and claims information were spread across three separate systems, making it difficult to see which claims had been paid, which balances were outstanding and where revenue was being delayed.

The organization also depended on an outside billing service that charged a 5.25% fee per claim, reducing net income on every reimbursement. Medicare billing was especially cumbersome, requiring physical patient charts to be sent weekly to the biller. Claims were frequently delayed, and staff lacked timely visibility into payment status.

Clinical documentation was another strain. Therapists were spending 30 to 40 minutes completing evaluation notes for each patient. With clinic volume regularly exceeding 90 patients a day, documentation often spilled into evenings and weekends, creating added pressure on clinicians.

To address those issues, First Rehabilitation evaluated Spry, an outpatient rehabilitation platform that combines scheduling, documentation, billing, eligibility checks and reporting in one system. The appeal was not simply digitization, but the ability to connect functions that had previously operated separately.

One of the biggest draws was Spry’s AI Scribe, which allows therapists to document visits in real time and generate structured clinical notes more efficiently. On the revenue-cycle side, the platform offered automated claims processing, integrated eligibility verification and a more direct connection between clinical documentation and billing.

The system also included eFax capabilities, eliminating the need to print and physically send charts to the Medicare biller. Electronic remittance advice processing was brought into the platform as well, allowing payments to move through the system without routing through the previous outside processor.

The platform is now used daily across First Rehabilitation’s organization and has become central to how the clinics operate. Scheduling, reminders, documentation, billing and payment tracking are handled through one system, giving staff faster access to information that once required checking multiple places.

The change has had a measurable impact. According to Kashuba, insurance reimbursements rose from $2,680 in November to $102,000 in March. Overall revenue increased by approximately 37%, while first-quarter profit rose 21% year over year. March profit alone was up 36%.

Several operational improvements contributed to the gains. Automated reminders and better patient communication helped reduce the cancellation rate from 17% to 7.5%, allowing more scheduled visits to be completed. Eliminating the outside billing fee immediately improved margins, while faster claims processing and electronic payment handling helped reduce delays in cash flow.

The platform also helped the practice expand capacity. Monthly appointment volume rose from 827 to 1,590, an increase of roughly 92%. Daily completed visits increased from about 90 to 92 patients to approximately 113.

For therapists, the most visible improvement has been the reduction in documentation time. Evaluation notes that once took 30 to 40 minutes now take about five minutes, freeing clinicians to spend more time with patients and reducing the need for after-hours paperwork.

The increased efficiency has also supported growth in staffing. With stronger revenue performance and better operational control, First Rehabilitation added another physical therapist, confident that its systems could support higher patient volume without recreating the documentation and billing bottlenecks it had worked to eliminate.