AI Tools, PT Skills: What Clinicians Need Now

0:00 You're listening to the PT Pinecast, where smart people in healthcare come to make noise. Here's your host, Jimmy McKay. Played the wrong intro. Correct intro. Take two. Broadcasting way too early from three separate Wi-Fi connections. It's PT Breakfast Club with Tony Meritato, Dave Kittle, and Jimmy McKay. That's a little better. Good morning, physical therapy. Double intro. Do we get double the sponsorship? You're going to love today's sponsors. I've decided to keep them all in one theme.

0:41 The sponsors have decided to come together, so we got one theme. Today, it's the only morning show where we talk about the business, the tech, the money, and the systems quietly rewriting your career while you're still explaining clamshells to someone named Bob. Today, why a billion-dollar tech company says PT first while actively replacing physical therapists. How Dave accidentally got discovered by artificial intelligence. We need to reverse engineer this because if you're not doing that, you're not going to get discovered by the artificial intelligence. And how that same technology is now listening to evals in real time from miles away. This is going to be a Dave-heavy episode. If you like rehab, business, and light existential dread before nine a.m., you are in the right place welcome to pt breakfast club which brings us to our very first sponsor theraband ai theraband ai the world's first resistance band powered by artificial intelligence did your theraband need ai probably not but we added it anyway tracks tension posture mood and your therapist's confidence and offers real-time coaching like more tension less tension honestly just ice it theraband ai because if it doesn't have ai in it is it even rehab anymore learn more why why is this smart dot health theraband ai does it need ai no should we put it in there absolutely we should I mean, if it doesn't snap, if the AI Thurban does not snap anymore and snap and break someone's orbital

2:13 socket, that's a win. I had one of those things happen, like Stroops, the dude from Stroops I was doing a live show with a while ago. It's like, well, that's not a thing. And then I had it happen, a resistance band that was just in my basement for a while, hadn't used it, was going to do some deadlifts, was warming up, snap, did hit me in the face. That's not an exaggeration. That's a thing that happens. The big story, we got to get into this one. We figure out what to talk about in what everybody does, families, group chats, right? And this one popped up. I think, who brought it up? You, Dave or Tony? I saw it too. Yeah. As you saw it, I was like, oh, yeah, I was going to share this one as well. Larry Benz, who I'm going to run into at Graham Sessions this week, dropped a scorcher.

2:53 Larry Benz giving zero Fs, breaking down Hinge Health's brand new state MSK care report. They're bold enough to be like, hey, everybody, we're Hinge Health. We have virtually no physical therapists, but we're going to do a State of the Union for you. Honestly, power marketing move. It's an old move. Old move. Let's see how it plays out for. State of the MSK report. On the surface, it is a beautiful argument that patients should see physical therapy first. Pause for dramatic effect. Well done. Clap, clap, clap. No notes, except for here comes some notes. The company publishing it is a two billion dollar tech firm whose entire business model is built on making sure patients don't see a physical therapist. Man, are we getting rugged or what?

3:35 They diagnose the system pretty well. then sell a solution that actually just provides a detour around everybody in the profession. They're like, wait, what happened here? I thought they were for us. This isn't a tech story. This is an incentive story. So here's the big idea. When the company replacing you becomes the loudest advocate for your profession, you should probably read the fine print. So Dave, why'd you bring this one up? Why was this? I mean, where do we start? Well, first of all, I respect Larry Benz significantly. He has a, I don't know when he started in private practice, but it was a long time that he was in private practice. And then he had with, I almost said Concentra, Confluent.

4:20 They, I don't know, he had, I think you had mentioned like maybe he stepped out of that in the last year or two and like retired or semi-retired. But in terms of private practice and PPS, he is like one of the, I don't know, one of the main authorities. Go ahead. I was going to say, he retired and set back out. He launched Confluent not as long as I thought ago. It says eleven and a half years, but he did a lot in eleven and a half years. Yeah, to take something and make it into I think they're close to maybe they're at least maybe I think five hundred locations, maybe closer to a thousand locations. I mean, now, of course, you're buying you're buying chains and groups. So it's a roll up strategy.

5:01 It's not like each one was a de novo. But to even do that in eleven years is just beyond impressive. Yeah. All right. So we're starting to the article. How would you explain to this to someone who hasn't read this? How would you explain what was going on in this article? Why was it important to bring up? Why is it our lead story? You don't have to give me specifics if you have them, great, but dig in. I've got some question starters or whatever, but I wanted to hear from you first since this was just sort of your suggestion. I, I agree with a lot of what he said around hinge health and sword health over the past couple of years.

5:43 I think I, I hate to say the word thought leader, but I think if there's anyone in our profession, that's a thought leader, it's Larry Benz. I remember back in twenty, twenty, twenty fourteen, twenty fifteen. You know, he was heavy into Twitter. His hashtag or his handle is at physical therapy on Twitter. He's always been leveraging social media, you know, And kudos to him. Like he's like obviously was like full on deep in his in his career and utilizing technology that was like newer and novel. And, you know, whether it was networking, I've just been a fan of his. I actually never met him. I would love to meet him at some point. I know, Jimmy, I think a year or so ago, you joked like you were going to invite yourself to his like Kentucky farm or his mansion, whatever his estate, whatever he's got down there.

6:31 And I was like begging to if you do it, if you do it, I want to come along with you. I don't know Larry well. We've interacted a few times. The vibe I get is he'd be like, yeah, okay, when? He wouldn't even say, okay. He'd just be like, yeah, what's good for you? Is it tomorrow? He writes a lot. He's been doing this more because the technology's gotten better, right? And he's an inch wide to mile deep kind of guy because he'll write a post, but then it'll lead to an article that just goes deep into a problem. And I think he's a thought leader, and I'm using air quotes, because... He's not he doesn't need the attention. He's doing it because he cares. He's like, here's what I see. He's like sort of like waving. This is what I see. Hey, everybody. In two years, you're going to be like, where did this come from?

7:13 And Larry be like, look at my post from two years ago. That that exact thing happened. So here's some like, can you claim PT first when PTs weren't even the room writing the report? Like, is that the thing that pisses what pisses us off the most? Or do we are we just giving them their own flowers going? Hey, well done. We're getting smoked here. Let's ask, I want you to ask Tony. So Tony, is Hinge Health valid and are they okay to write this when they operate the way that they do? Yeah. Yeah. I read the article a couple of times. There was a couple of quotes in there that, you know, totally made sense. Yeah. I don't see the problem. Like they're basically saying, look, we created this solution, this platform, this amazing technology.

8:00 Yes, we agree. Patients should be seeing a physical therapist first. We have everything else covered. And I think collectively, the three of us generally agree, like the therapist's most valuable position, at least right now, is the evaluation, establishing the plan, identifying comorbidities, complexities, factors that are going to influence care. It is not in the delivery of the care. the delivery of the care, the AI analysis and watching people do stuff and improving compliance and all that can be outsourced to a platform like hinge or sword. Our role is more just kind of oversight, maybe initial evaluation.

8:43 The fact that they don't have a thousand therapists on staff doesn't bother me at all. I think this is a great, like, opportunity olive branch to say, hey, we're not leaving the profession behind. We want you guys to come along with us. We want the actual therapist to work alongside us. Let us do our part, which is what the technology is designed for. You guys do your part. And when you think of the consumer, their consumer, it's the employer, to my understanding. People who are working, they're not that complex. We're not talking about people who had amputees and strokes and brain injuries and pediatrics. We're talking about the same people that walk into my clinic that are going to work after PT, that are coming to PT after work.

9:30 They're fully functional. They just need a little guidance, which is what the AI platform can do. And I would step in either before, during, after at some point, but I don't need to be the main one delivering the service. Here's a question for you. Who benefits the most here? Patients? Employers? Shareholders? Who's going to benefit the most? What, so what, now what? This is sort of in the so what territory. So who benefits the most here? Potentially insurance companies because they're finding a way that they're offering a cheaper... alternative to billable units.

10:11 Insurance companies like it. That's why they agree to it. That's why they send out promotional Hinge Health, Sword Health emails on their behalf. That is probably the most savvy move of Hinge Health and Sword Health is that they've gone either directly to employers or they've gone to the insurance companies and Insurance companies, they want to hold money. They want to pay out less. They want to continue to make more billions. It is a genius business model. The founders of Hinge understood that. And they don't care about my style of delivery. They don't even care about Tony's style of delivery. They're like, we have a potential alternative solution. and it's a screen and maybe there's a little health coach maybe there's a little physical therapist on the front end but really it's just someone that has back pain or whatever and following exercises on a screen yeah as a side note i know we hammered this before but there was the company that tony brought in about the the coaching what was that like the coaching tiers for accountability it was mentioned on the sam par and uh my my fitness pal or my my something My body tutor.

11:20 So when you were describing, Tony, about AI can do the accountability and this and that, no, it cannot. That's why that company, because behavior change requires more than a push notification, an email, a text message to go log into an app. I am firmly a believer that for accountability... Like this. Like, I know we're still, guys, we're still live. This is not AI apps. Like, there's accountability. Like, I know I got to finish my, get dressed in my hair and brush my teeth and my breakfast. I got to make sure I'm here live because you guys are going to just go live at eight thirty a.m. anyway. Right. So there's accountability. Now, if this was just like, oh, I could just it's just like Hinge Health notification, whatever.

12:04 And I could just do it whenever I'll push it off. So I disagree that hinge and sword and all that, Tony, can be replacing all of the accountability, which is one of the big components of behavior change and pain relief and recovery and wellness and health and all that. Question that's on screen right now. Are PTs quietly losing the front door to care? I mean, instead of having to go to individuals, they're going to... So, I mean, so the question that was asked, are PTs quietly losing the front door? Will we eventually be only left with the back door?

12:45 So, this is, you know, a great, like... visual display of, okay, we still have a free market to some level. It's going to be decided, right? If the consumer wants what they are producing, the consumer is going to choose it and we will decay. The profession will die out. If the consumer doesn't want it, my biggest fear is then regulation steps in and somebody in government somewhere says, no, we got to listen to Dave. We got to listen to the therapist. We can't allow this to happen. And it stifles innovation. It takes away the opportunity for a company like Hinge to either live or die on their own merits.

13:28 And it just, you know, that's what really concerns me here. Yeah. Moving forward. Moving forward. I said this before. The consumer in general across the entire country over the next five or ten years does not want will not want Hinge Health or Sword Health. These companies will go away. I'm telling you, they do not. The insurance companies want this. They want this product and service. Sure. The any other stakeholders want this product or service to minimize paying for billable units or physical therapy or whatever. Yeah. The consumer, the actual employee, we talked about this before, an employee at, I don't know, Cargill or Walmart, and they get Hinge Health and Sword Health for free, and they get fired or they leave Walmart or Cargill, they move to another job.

14:11 Now that job does not give Hinge Health and Sword Health for free. That person will not pay ten dollars a month for Hinge Health or Sword Health. The consumer does not want this. drew uh right here drew cruz uh thank you for joining in live he's saying wouldn't we rather have those people on the remote side and more complex in person yeah sure that's fine that's fine the the people on the remote side there needs to be some human accountability on the other end in my opinion to do remote programming and all that when i paid mike laviolette the physical therapist to do remote programming i knew that if i was if i was not clicking my exercises and submitting my workouts, and he was asking me questions in between workouts or every other day or every other week, I knew that there was some human accountability.

14:58 That made me change my behavior. My goal was to work out and break a sweat every single day. But I knew the crux of it was like, I have this urge to satisfy this other human. There's some oversight. They're watching me. And when it's digital, there is no influence or there's significantly less influence. So yes, Drew. You can have those people remotely. Why not do that yourself? I know Tony's talked about remote programming or remote therapeutic monitoring. You could have it as a self-paced service, but as a standalone service, Hinge Health, Sword Health, no one, no consumer is going to pay five, ten, fifteen dollars a month for it out of pocket if they don't get it through their employer.

15:38 Full stop. Don't disagree. Someone was having this conversation yesterday and I appreciate where they were coming from. But they were like, hey, wouldn't you pay? They were sort of taking Tony's model of a hundred dollars a month access to his clinic for gym. But they were like, wouldn't you want for a hundred dollars a month, twenty five dollars a week, a daily check in with your PT and up an email update, a blob. And what they were talking about, what I was watching in real time was feature, feature, feature, feature, feature. And my response was, what's their problem? Like, what is the benefit? Now I get an extra text message every day. I got to be honest with you guys. I need less text messages. I need better text messages.

16:19 The people I want texting me are important. I bought a Christmas present a month and a half ago, and now I'm getting three text messages a week. I get it, right? Get the cell phone number. Get the email address. Ping, ping, ping, ping, ping. If they're not going to buy, make them unsubscribe. That's not a long-term, not for us. That's wrong. It's the wrong strategy. It's the right strategy if you're trying to sell me a duffel bag. My man, I just bought a duffel bag last month. My duffel bag problem is solid for a while. I'm good on the duffel bags. I know you also sell golf. This is Agio. Golf bags and this and this. I know you. I see you. I'm going to now unsubscribe. So understand what problem you're actually solving. I don't know that Hinge Health has that yet.

17:03 So I would say, again, reading through the article, trying to process and understand, I will make recommendations to an orthopedic surgeon when I have a patient in the clinic who may benefit from an orthopedic surgeon's assessment. I don't employ an orthopedic surgeon. I don't get any benefit from an orthopedic surgeon. I see this as no different. They don't need to go into the business of live physical therapists in order to solve the problem of delivering physical therapy. And so it's just, you know, I think it's great that they're acknowledging, hey, yeah, it'd be amazing to have a physical therapist in the loop to get a physical therapist evaluation.

17:48 But we're not going to pay for it, i.e. hinge. We are not going to pay for it because that's not the business we're in. It's too ambiguous. What am I getting right? Like we have different problems to solve. We have what the hell do we what what are we? I was someone someone had a post the other day about the movement system. And I was like, that was coming out. like, ten, twelve, thirteen years ago when I was sort of in PT school and I was like, I don't know what any of this crap was. I half know what any of this stuff is now. But I was like, I definitely don't know what the movement system is. And then I was looking into it and then, of course, I'm like, I got AI now. So I've got some posts coming out next week that sort of poke the bear like, hey, this was actually a good idea. We screwed it up. We screwed up the marketing of it.

18:30 We went to flowcharts and white papers and roundtable. We went to PDFs instead of JPEGs. We should have made movies about this. We should have done live streams instead of, let me explain to you what the movement is. If you can't explain it in twelve seconds, you don't have a thing. You don't have a good idea. That's actually not true. But if you can't explain it in twelve seconds, no one else is going to think you have a good idea. You might have a good idea, but if you can't explain it, it doesn't matter. Hinge is really good at explaining stuff to a different audience. Am I wrong? To employers, they go, hey, do you want to do a thing? It's cost savings. So here's my question. Is this what they're doing, healthcare innovation, Or HR innovation?

19:14 I know that I have an opinion, obviously. It's like financial engineering. I mean, it's not. It's not. Correct. Except we're getting rugged here, right? Yeah, but if you're going to waste from an employer perspective, if you're going to waste money, let's waste less money. If I'm going to pay for one of my people to go see Dave, and I know my person isn't going to do what's prescribed, they're not going to do the home exercises, they're not going to follow Dave's instruction. Why am I going to waste two hundred and fifty, five hundred dollars when I can waste twenty dollars? Like, we're going to put the effort out there.

19:57 But I mean, it's the same thing for me in the clinic. Like, I'm not going to pay for an expensive home exercise delivery system because I don't expect my patients to do the home exercises. If somebody will do it, I will spend the money, but they're not coming to me for that. I don't want to switch topics, but I'm dying to hear about Dave and the guy listening. Let's jump. I have a transition. We have to pay the bills, guys, but let's hear from Ben. Ben usually brings good ideas. Hinge is applauded for pushing the acceptance of digital PT. Hinge is applauded for addressing MSK cost of care. Hinge or something like Hinge is necessary in the true scheme of population health for MSK.

20:37 It's an inexpensive to deploy layer that reserves in-person PT skilled care for those who truly need it. A good front door. You want to be in the front door business. You don't want to be in the back door business. i'm just using analogies guys uh but it is part of the solution not the solution it's never the solution right this is never the thing it's always part of the thing it depends um all right let's switch a little bit of topics but we got to pay the bills we got a good one this segment is sponsored by goniometer gpt the first range of motion tool powered by artificial intelligence simply pointed at the joint And it confidently reports approximately ninety something degrees.

21:20 Probably. And three contradictory measurements per visit. Goniometer GPT because accuracy is overrated, but AI is trendy. Order now at trust the algorithm dot I go Goniometer GPT. All right. So, Dave, a patient found you. You dropped this in the group chat like super cash. Like, hey, Grok got me a payment. And I was like, the tight end from the Patriots. You're like, no, not Grok. Grok. I spelled it incorrectly. I don't think you spelled it incorrectly. I think you just read it incorrectly because I have ADD or whatever. Dyslexia. We may be entering a world where patients don't search for clinics anymore. Think about that.

22:01 We never wanted to search for the answer. We wanted the answer. I mean, I got when I was growing up like, hey, I was taught, ask questions, ask questions, figure things out. Hey, what's this? Go look it up. I wanted the answer. You told me to go look. OK, got it. I could have done that. So we may be entering a world now where patients don't search for clinics. They ask for a solution to a problem. And I hope you're the answer. So let's reverse engineer this. How did you know that it came from? How did what what found you like? Tell the story. Yeah, I want to cover this briefly because I definitely want to get into the us recording patient encounters through an AI app recording audio. That's a little teaser.

22:42 In terms of this, new patient called in. Our secretary always gets contact information, a little bit of patient demographic information about what's going on. Are they looking for an office visit? Because yes, guys, we have an office. Or are they looking for a house call? So if it's a house call, what's your address? That type of stuff. And they always have to ask. Otherwise, I would be very mad. They have to ask, how did you hear about us? Did you hear about us? I mentioned here on the show before that we've had maybe two or three people find this through ChatGPT when they're prompted, hey, how did you hear about us? Because historically, it's been like, other than word of mouth or a physician or a nurse agency or whatever, it's usually Google.

23:23 And so we had those two or three previous ChatGPT leads. And now yesterday... or the day before, whenever it was, we had our first lead patient or prospective patient come through Grok. And I actually had never used it. I had to pull it up and I was, oh, this is the thing that's like through Twitter or whatever, but it looks just like ChatGPT or Gemini or whatever. Yeah, they look, they look very similar. And so that I, I even, I, I spoke with the, the prospective patient. Cause like, I got to hear this, but then I went into my normal approach. So I didn't, I should, I, I can maybe ask, but I didn't ask like, what was, what did they look for? What did they prompt? But they were looking for a home visit. They were looking for a home visit and I can't remember the guy's date of birth, but he was like, he's like in his thirties or forties.

24:08 So I like, obviously like, you know, typically a younger person in general would be more likely to use these tools. Not always, but in general right now. So yeah. So that's interesting, but that's it really. Yeah. So you might be right. You might say something like someone older, someone... We're going to be ageist here for a second. I apologize, Kathy Cholick and everybody from APT, Jerry Axios. You might say, well, someone who's sixty years old isn't going to use... Sixty plus isn't going to use AI. But now when you Google something, the first result is now there. They're not waiting for you to go look for that. They're jamming it where you are already looking, which... If you're going for user adoption, that's the way to go, right?

24:49 Google's quietly saying, hey, this is a threat, but we have one, so we're going to put it as the first search result. Yeah, I would love to hear what were they looking for? How did this start? Even before, the emotional, like, God damn, I've got to take care of this. And then you have all these options. What did you do? And then on the flip side... How did Grok know that you were the answer? Is it SEO? What are we calling AI suggestion optimization? I know somebody already probably has a term, but it's SEO for AI. I don't know what it is. Yeah, prompt optimization. I don't know. I'm sure there's going to be a word that comes up soon.

25:29 What you do... to be the answer. Somebody asked me two years ago or in a comment was like, how do we get AI to make sure that when someone asks a question like this, we are the answer. And I was like, you need to be the answer is what I'm looking at. But, but how do they know the answer for that guy? Like, I want to know how it's called. Yeah, that, that I don't have the answer, but I'm assuming like, so, okay. So even right now, like if you, I think you did this before, if you pulled up like, uh, it's called AEO. Oh, so artificial intelligence. artificial engine optimization. So like SEO search engine optimization. So artificial engine optimization, AEO.

26:11 So I think if you just typed in like in-home physical therapy Manhattan, then it'll give you like the top three or five. Ben Gaiman said Dave quietly whispers into his Roomba every day for how great AI and robots are. And then AI and robots, of course, answer engine optimization. Oh, answer, answer. Okay. Do you guys know Pete Holmes? He's a comedian. I don't know. He's funny, and you've seen him, and he does this bit, and I don't know. I don't know if I can tell a bit because he has to say the word dildo like sixty-eight times. He stops in the middle of a comedy routine. Nate, Nate, Nate, edit that out, please, before we put him on the show. He won't say it sixty times, but he's saying it.

26:53 He stops in the middle of a comedy routine. He's saying it. He's like, I want to buy a bleep. I want to buy a bleep bleep. I want to buy a big bleep bleep bleep bleep bleep. And everybody in the audience is like, what? He does it for like a minute. And then he goes, good luck with all those targeted ads over the next week. And I was like, oh my God, he hacked everybody's algorithm in theory. But like, that's the question, which is like, how, what's the input? We want to be the output. We need to understand the middle. And then how, of course, to hack the system with what Will has now educated us as AEO, answer engine optimization. I like how it's answer engine and not AI. Because like, if you are the answer, I do want you to be found. I don't want you to be the best cast secret in your town.

27:35 I'm sure it comes back to pulling from whatever your current digital footprint is, right? So like online reviews, Google reviews, Yelp reviews, maybe SEO pages on your website. I don't know. Or like link, you know, backlinks. I can't imagine it being that much different than SEO. That was my question now to Tony. Everything's just a circle, guys. Are we back to make sure there's words on your page? And probably now, everything's smarter just by... We used to put words... on white background in white text at the bottom of our web pages. So we'd get found. It was like a way to like hack the system. And then when AI was reading job resumes, we were doing that and everything's a cold war, right?

28:19 I have missiles. I have fifty missiles. I have space lasers, right? Everything's just like a little bit to whatever. What's the right way? Because what you want to do is you want to do it the right way so you don't get dinged because you might always get shadow banned or whatever. So my question, I guess, to Will or Tony or whoever's listening right now... What are they talking about? So Jimmy, yeah, the right way, just like we do in the clinic, what's the right way in the clinic to treat a shoulder?

29:01 Eat better, sleep better, exercise more, manage your lifestyle. What's the right way for Dave to show up in Grok or ChatGPT? Create a presence, share information, deliver unique perspectives, answer questions that other people aren't answering or answer common questions in unique ways. That's it. There's nothing to it. There is no hack. There is no special formula. The people who do... try to find that it's temporary. Like Google has been fighting SEO for decades. I mean, you just need to provide value and let the machines do their job.

29:41 Yep. Do it the right way. I got my first cohort of my How to Launch a Podcast YouTube channel course. It's going well. And I've come back to the same principle because I know I'm talking to healthcare people. A lot of people in the class are PTs. Most are PTs. And I'm saying, guys, listen, I want you to keep this in mind. So talk to the audience in a term or a phrase or a word or a concept they already know. And now bring it to the new thing that they don't know. Frequency, intensity, time, type, volume, progression. Those are exercise principles. Their communication principles. Answer the boring question. Answer it in text. Answer it in video. Answer it on LinkedIn. Answer it on your website. Do it ten different frequency, intensity, time, type, volume, progression.

30:22 Do that. Drew's like, that is me. I'm in this cohort. Yes. But how many times, Drew, like validate this for me, have I said the same thing seventeen different ways, even in the course? Again, people didn't join my course because they could have Googled or AI'd how to launch a podcast. They didn't need that. They needed clarity and guidance. They needed me to hold their hand and hold them accountable. The accountability. Shocking. It works if you have a human there. Wow. These are parallels. Talk about that post that you had the other day. I think I turned it into a video. AI is better at selling your plan of care.

31:03 AI doesn't freeze on the phone. Before we do that, because this is related, let's get to Dave's listening in because this is so important. Wait, wait, wait. Before we do that, we have another sponsor. Quick, quick, quick. You didn't think that there needed to be AI in your ice packs, but Ice Pack AI is a first-class therapy solution with embedded machine learning. Ice Pack AI analyzes swelling, pain, therapist's mood, and lunar cycles and decides whether you deserve cold today. Sometimes it applies ice. Sometimes it sends a notification that says, have you tried just not being injured? Visit freezewithconfidence.ai. So what app are you using?

31:44 And what it would tell us this story. Okay, so long story short, we have taken the decision to start recording our physical therapist interactions and visits. Now we have the office, but historically we've only been doing home visits. When my therapists do a home visit, I literally have no idea what goes on. So they'll say like, yeah, here. And I'll be like, how did it go? And they'll be like this, this and that. And then like some patients stay around for weeks or months or years and some patients drop off after one or two or three visits. And it's like, there's gotta be something, right? so real quick if you're listening to this uh i'm in new york there's only like ten or eleven states where it's a two-party consent where you actually have to by law tell tell tell the person uh that hey i'm recording this if you're okay with that whatever um new york has a one-way consent believe it or not which is great so great for us we are still going to put it in the new client paperwork we've already done so it's like two sentences We can actually use some of this.

32:43 It gives us insights so that therapists can actually, if they wanted to, copy and paste it. It's not exactly like a scribe, but you can kind of use it for documentation purposes as well to be a little bit more efficient. I framed it that way, but then also for increasing the sales presentation, the pitch, the first visit, presenting the plan of care, hitting the milestones of a script that I've provided for them, pre and post, like, you know, greeting. Hey, what are your expectations today? Hey, here's the agenda today. Here's what we're going to do. Do you have any questions? Let's do this. Let's do this. We're going to then do this. We're going to do a pre and post test. We're going to do a little bit of treatment or whatever modalities or intervention or whatever.

33:23 Then I'm going to talk about the I'm going to show you this graphic that we have. It's called Mount Dumour. One, two, three steps going back up the mountain as a metaphor and a visualization tool. three, three legs of the stool. Here's why we're different. It's a whole Alex Ramosy, three legs of the stool pitch metaphor explaining like, here's the plan of care, laying out the plan of care. So it's a lot, it's a lot for my therapist to do. I can now listen in. I can go back the AI and I'm not going to say which one, cause we're using one and we're probably going to switch over to another one. And one of these companies eventually are going to sponsor the show. So I don't want to give them any pre juju before the juju is signed. This isn't an AI scribe, right? What is this? What would you call this?

34:04 Well, so we'll take a step back. I'm a Philadelphia Eagles fan. The Eagles play. They're knocked out of the playoffs right now, but they play a game on Sunday. Then the Philadelphia Eagles do game tape review. They review game tape on Monday and Tuesday. They're like, hey, what went well? What went poorly or bad? Where can we optimize? Where can we improve? And that's exactly what this does. And it grades... The insights are insane. It grades the therapist on each step of the sales script that whether they get a one out of five, they get a four out of five. It grades each step. It gives insights. It tells how much they talked, their talk ratio versus the patient's talk ratio. I can ask a questions like, Hey, when you, when they were speaking to Mr.

34:46 Smith, Did the therapist hit on any emotional triggers? Did Mr. Smith get flustered or shocked with the pricing and the cost? Did they explain, did they give any objections? Did the therapist, uh, did the therapist mention the word, uh, package or whatever the words are. It can grade the therapist on what words to avoid, and I can put a bunch of words to avoid in the system, like discharge or whatever words you want to avoid. If I don't want them to say... price. I could have him say like investment or, you know, do you, or do you have funds or funding or like different words that I would want the therapist to use and not use.

35:33 It's insane. The amount of insights. And I was mentioning this because last night I'm home in Brooklyn. My therapist is in the office at five, doing an about, and I'm listening to the about in real time and it's documenting it. It's giving, I can have the whole transcript if I wanted to. It's there. I have the audio. I can go listen to the audio. I can click through and listen to different audio clips. I can ask the AI, Any of the questions like, hey, how is this going? What's the likelihood that this is going to convert and they're going to continue to stay with us? What's the sentiment like? Does the patient seem nervous or comfortable? Or are they asking a lot of questions? Are they being quiet and cold? Like all that. It's insane.

36:13 You can also probably go in and say, this is what great looks like. Give me a score how this person did really quickly from zero to one hundred. I've worked with an app like this. It was like a sales app that did that with phone calls. And then also great for me was... Uh, what was my next step with that? What am I supposed to do? Cause Jimmy, by the time I hang up, I have no idea who I just talked to. Here's a great suggestion from Ben though. We know how learning takes place. Could it shock your physical therapy, like a collar or a, like a whoop ring? Hey, this is how much it costs.

36:53 This is the investment. Drew, Drew Cruz is saying, I don't know what this is called, but shut up and take my money. Right. And so what, so you're listening in real time though. That's nuts. In real time, I was listening to it. I could, I actually, I prompted, I was sending a, I sent one message. I don't want to be overbearing because my new therapist is only like a week and a half, two weeks in. I sent him a message. I sent him a message in real time. Now, I don't know if you saw, but there was a push notification that hit his phone that if he briefly took his phone out or flipped his phone over, he would be able to click into it. And in the question I could message him and say, I don't like, like we're not going to, but like, let's say we, I wanted to give like a, a manual price reduction or whatever, something on the fly, like, Oh, offer this or do this or whatever.

37:44 But I'm, but I'm listening in real time. Yes. Ben, Ben Galen. Yes. I will message you or send me a message. So I don't forget, but I'll let you know what companies we're using. How many days until you can just have all your therapists wearing the Ray-Ban metaglasses and you can be watching the eval in real time while it's transcribing? I mean, honestly, we're barely not. That technology is also insane right now, the metaglasses. It's not even a stretch, right? We're like, oh, yeah, probably by the weekend, if we're being honest here. That's already been in development for twelve months. Rachel's saying this is a good one. Let's get some good statistics, not just for one interaction, but can you look at a therapist over a month, a quarter, a year? Rachel's asking like one of those stats that flies around a lot.

38:26 Does it track how often or how quickly the PT interrupts a patient? That you need to be reminded about, right? And because we're big dumb animals, we're humans. These are good KPIs to measure. You can also, I'll check. I mean, it, it absolutely will give a, a talk ratio between the therapist and the client. Yes. Ben's asking, am I making a case for an AI robot PT? Not against it. No, no, I'm against it. We are, we are someone who's going to spend three hundred fifty dollars per visit or three or four thousand dollars for package or whatever. Like, It's still with a human. I mean, if it changes, then yes, I'll go AI robots and I will come on here and I will exclaim that.

39:12 But no, as of right now, it's to help our therapist cover all of the things that I want them to cover in the first visit. So I'm still hiring and paying human physical therapists. Getting a message from the studio. We've just... okay, the live stream has just been bought by this app. We've just been purchased. So apparently we are now owned. They bought us during the conversation. In the last six minutes, we've actually been bought by Peekaboo AI, which is actually the app that Dave's used, the competitor of the app that Dave's used, Peekaboo AI, looking right into your client interactions and your patient interactions. These things that you're talking about, they're like, oh yeah, like we're so used to giant leaps.

39:56 It feels like it's a hockey stick, right? It's not a linear improvement. It's almost straight up. So when I throw out some ridiculous thing that we could do, they're just like, yeah, just give it to six developers. And in a week, that'll be in the basic plan. It's not even the advanced plan. This is wild. I'm excited to... Go ahead. So right after this, I have a go live with one of these companies. I have been using it for like two weeks, maybe three weeks. I've been using it. But like I negotiated like a free trial going into a paid three month pilot. They gave me like the first month kind of for free. But then I mean, it gets really expensive. So I wanted to ask Tony, Tony, how how many dollars, how much?

40:41 per month, per, they call it license or user, but you can say therapist. So, you know, the cost of, you know, web PT or, you know, and prompts is a little bit more expensive now, but in general, uh, what, what cost do you think this is? And I'll, I'll give you a range afterwards, but what is the cost per physical therapist do you think for this type of value insight. Maybe it's more valuable to me. Maybe it's less valuable to you, but I'm curious, like to get your thoughts on like the pricing, like the investment for this. All right, so every time my wife asks me to make a guess like that, she wants me to go low so she can be like, no, it's way more.

41:22 No, I don't care. I literally don't. I'm just curious what you think it is. Realistically, knowing what just a standard scribe is going to charge, I would have to think it's probably like twelve hundred a month per clinician is what I would be thinking. No, this is going to go to something that on a sales side, it doesn't matter that Dave is using it or other therapists would be using it to sell a low value product or service. The fact is, this would be something that could get a realtor to sell a three million dollar house. This would be something that could get, you know, somebody to buy a twenty million dollar yacht like that. It should be in that twelve hundred dollar a month range is what I would guess.

42:05 So I've done three demos. I have another demo with another company tomorrow, even though, so I'm not the nicest consumer, right? Cause I'm going live today with one of them going live, but then tomorrow I'm still shopping around because I want to, I want to see what else is out there. Cause there's something else I didn't mention in terms of another like feature benefit. It's kind of around two hundred and fifty dollars to three hundred dollars per month per therapist, right? Okay. Which is actually, it's way lower than what Tony was saying because you were saying, would you say, twelve hundred or fifteen hundred per therapist? I didn't say it, but my guess would have been twenty to thirty dollars a month. And the reason I said that is. I mean, and here's the reason.

42:47 And I didn't look it up first. I don't know what app Dave is using. I'm looking at a similar app. And this is why I quickly look. I was like, my guess was twenty to thirty dollars a month. And then I looked up what this one is doing. Let me take off. Well, I don't care. I've got their name on the screen. I've used a similar tool, which is doing something similar. Maybe I'd pay a little more because it was HIPAA compliant or something. But I don't know that I'd pay twelve hundred out. No way. Because how many plans of care would you need to do? This is going to be a race to the bottom quickly, right? Like, yeah, this is going to get cheap, in my opinion, super fast. And that's the thing, because it is newer on the market. And I've heard Hermosi talk about this. I've heard him reference it when he's talking about training his sales team.

43:31 But it still doesn't have the market penetration. It's going to be super expensive, or at least I would assume it to be. And then as more competitors come out, as it becomes commoditized, the price and the value goes down. Guess what? Just like physical therapy, like physical therapy today to treat a shoulder problem is not as valuable as it was. Fifty years ago, because it has been become commoditized. I did a video on Jevons Paradox, which is something I had no idea what the hell it was, but Jared Hall did a post on it, and it explains that. It's when something becomes more efficient, we don't use less of it, we actually use more of it. And then the paradox came about when coal became more efficient, England in the My big question for Dave is how did your therapist respond to it?

44:30 And then at scale, what do you think the majority of physical therapists in the market today working right now, what do you think they would think of it? I pitched each therapist. I got there before I even started it. I got there by, I know I, at the end of it, I did kind of say like, It's going to be mandatory, but I did say, hey, this can help with documentation. This can help with better conversions. This can help you get more results for patients, in my opinion. This can ease your ability to present the plan of care in the first visit and get more buy-in.

45:13 My therapists are... Ten ninety nine independent contractors there. Eat what you kill. But then also now some with base salary and upside. So either way, if you cover if you do this, like if you if you just cover the steps that we're talking about, we're going to practice it like. It's okay. I know it's different. I know this is something that you're not used to from DPT school or your other jobs or whatever, but you also will earn more. And I hit on all the things that they said that is important to them. So they want to have whatever, less paperwork, treat less patients, make more money. This literally is the conduit to do so. I think what was the response though?

45:54 Like, what were they like? Every, every single therapist said, cool. All right. I'm like, I'm in. That's fine. And even, even my new guy, Andrew. So he, he was like, you know, Oh, the first time he recorded, he said like, Oh, like the first, I don't know. Like as soon as he hit record and he starts his eval, he said like, Oh, it was like a little, he was thinking like a little maybe nervous or whatever. But then like, as you're evaluating the patient, like you forget about it. You just do your, you're just going to do your normal thing. Yeah. I was going to say that clinicians in general want confidence and competence. They want to know, am I good? Am I above good? Good. And then I want to be confident in that. So I think the people who would be afraid of this are people who are like, I know I'm terrible and I don't want anybody to see this.

46:37 They... Exactly. And would I, would I want to keep them on my team? No. Right. So it could help as an earlier off ramp instead of having a therapist stay on an extra four to six months. And then there, then there's like way more issues. This could help us exit therapists faster that are not the right fit. Yeah. John Frazier, good to see you, John, was a military PT, or maybe he still is. I thought he said he retired. He says he's addressing technology to include AI in the upcoming ANKLE CPG revision. I know very little about CPGs, but on purpose, they don't redo them often, right? It's like a huge deep dive. The fact that they're already, like, I'm imagining reviewing the ANKLE CPG was on the docket, they're already like, oh, we need this in there.

47:20 That's fast. For research to respond sort of this fast, I mean, I know it's not the... but it's fast for research. So good on you, John, because I know how slow the wheels of academia move for good reason sometimes, but this is good reason to move a little faster. Ben says, someone like Dave who values value and values consistency and values the product will value this a lot. value value value value brought to you by values uh someone who is packing a clinic with twenty to seven dollar a visit patients five times at a time they will not no they will never slow down they don't even have because yes exactly because the clinic is so high volume you don't have time to review all these calls but even even the insight like the quick breakdown exactly Drew saying, I'd be down to record my patient interaction so he knows if he can be better at communicating.

48:03 Or, hey, you could pair Drew wanting to be better at communicating and John saying, we're going to put it in the CPG. It's like, am I communicating well? Am I listening? Am I responding? Am I doing something clinically well? Could I have done? I don't know if I've met a therapist who's like, could I have done something better? Who doesn't say that? Most of them are like, what could I have done better there? Now you can see it. And the one thing I didn't mention about this entire thing is that this has already been used for years in home services, construction, HVAC, pools, roofers, literally everything. So the salesperson, the sales rep in person goes to someone's home, goes to Tony Emeritato's home, and they do a free estimate.

48:47 They go through the assessment, whatever. They... what what what are you looking for what type of scope of project whatever it is right layout hey what's your what's your budget whatever they're going through a script this is already used by so many industries and there is also used in um in dental so one of the companies that i have demoed with they have a bunch of dental practices because the dentist not not the traditional cleanings where it's like again high volume but the dental the dental practices that are selling you know fifteen thousand to fifty thousand dollar dentures or full you know sets of teeth those are also big dollar amount packages whether it's paid up front or packages or financing or whatever but there's already a lot of dental practices using this and i've talked to all these companies so far believe it or not i'm the first physical therapist to reach out So you don't have to say which one it is, but what is this called?

49:40 What would you call this? It's an AI sales solution. Yeah, CPTs wouldn't be searching for that. So a suggestion for them, call it something different if you want to. You would need to call it a clinical confidence. I don't know. I won't name it for you. AI would be better to do that. But don't call it that. Don't call it sales. Don't do that. If you want PTs to ignore something, write the word sales on top. They will never read past. And I love you. And I love the fact why you do that. So call it something different, which is like confidence and confidence. The clinical confidence and competence app, insights, CPG, live CPG creator, something like just word salad the crap out of it.

50:20 But say seven words that I like. Not sales. Don't say sales if you want PTs to read it. This is why... Well, there are certain therapists that are okay with the word sales. And those are the ones that will find themselves in out-of-network or cash practices. They want to get coached. They're okay with sales. They will say to me, I'll, I'll, I'll, I'll start the conversation with them in the beginning. If they're looking at it, you know, they're reaching out and they're looking to, you know, join us and I'll say, you know, sale. I know some therapists that sales is a dirty word, bad word, whatever. And how do you feel about it? How do you describe, you know, we're going to be, we're going to be doing sales role play today. I'm meeting up with my new therapist today from, you know, it's all thirty to four or whatever.

51:05 A lot of what we're going to cover today are his other avowals from this week that we recorded. And we're going to go through it. We're going to use the sales tool, but we're also going to go through objections and, you know, objections and rebuttals. Like, hey, this sounds too expensive. I need to think about it. I wanted to use my Medicare, my insurance, whatever. And we're going to literally do sales role play. But that therapist has already opted in to this. And I agree with you, Jimmy. It's not for every therapist. That's good, though. It's not for everything. Good. Be the early adopter here. We've got nine minutes left. We'll do parting shots in a second. Later on today, I'm going to Graham Sessions. I had AI write a movie trailer script in a world where reimbursement is shrinking, documentation is endless, and the profession is under more pressure than ever.

51:52 One conference dares to ask the hardest questions in physical therapy. This week, from the APTA Centennial Center in Alexandria, Virginia, comes the Graham Sessions, the theme this year. Diamonds are made under pressure. Two days, one profession, one room. I'm going there. It's a bunch of people. My question, Dave, just like, I'm out. My question to you guys is going to be, I'm going to live stream and interview people from there. I want to ask three or four questions. I don't want to go crazy, but I want to ask the same three or four questions. What would you want to know? Tony is the last person who would want to go to Graham Sessions because you're like, I'd rather be out doing, not talking about it. Plus, Tony's like, are there people there?

52:33 I'm good. Let's not do that. But what would you want to know from those people in the room? It's a good smattering of our professions. CEOs, I hate this word, but I'm using quote, thought leaders. What are my three questions? You tell me. What are you thinking? My thing would be like, I like similarities and differences. So I would go like, what surprised you the most so far that you didn't see coming? What were you hoping to see but haven't seen on the docket? Like, I like, what did you not see or what did you want to see? What does success look like from the conversations in this room five years from now? Like... Those sorts of big picture. Because I can ask them generically in a good way.

53:16 And I can ask the same thirty people. My goal is twenty plus interviews for seven minutes. I don't want to bog... This isn't a let's get into your life story. This is like... tactical boom, boom, boom. And I'm going to try to live stream from there. I'm trying to live stream these things because why wouldn't I? So I've got a rolling cart. I'm bringing the whole studio. Everything you're looking at right now is coming with me because I want to be ridiculous. I want to be the guy there with stupid headphones on. But this is supposedly the room where it happens. But I want to get it out of the room, at least the ideas. The whole pitch with Graham Sessions is it's the safe space where you won't have to attribute Jimmy's crazy idea to Jimmy. So Jimmy's free to say it, even when Jimmy just says the crazy idea most of the time. But if you don't want to or you might be penalized for it, let's make sure the idea gets spread, but you don't have to worry about the repercussions.

54:01 But I want the ideas to get out of a damn room. So that's what I'm doing. I love it. I think those are great questions. I'm terrible with that kind of stuff on the spot. Um, but yeah, the, the, what surprised you, you know, what did you think we would be doing at this point? And then what does success look like five years from now? Um, because that gives us a forward indicator of not, not if they're right or wrong. I don't care about that. It's where are they mentally? What are they thinking is going to happen moving forward? That's what I'm so curious about. Ben has a good question. Did you assume there would be s'mores to go with the Graham Sessions, which I brought up before and I think it's a valid question.

54:44 Something you just made me think of. I did interviews at Graham Sessions a decade ago. They're somewhere on the internet. Maybe in my five-hour drive from New York to DC, I'll listen to them and some of the people I interviewed will still be in this room again. I'll be like, hey, remember that thing you were super passionate about? Did we solve that? Did we whatever what do we do with that what happened with that did we knock that out of the park or we just sweep that one under the rug like a like an old dog turd uh because many of those things are the hot topic for a hot minute and then we just sort of like i guess we're not going to solve that moving on uh so that is graham sessions i'll be there tony parting shot So interesting. Yesterday, I went to the dental hygienist. I go twice a year. This was the first time he had said, I see the same guy usually.

55:28 He was like, all right, time for x-rays. We're going to do the x-rays. Boom, boom, boom, boom, boom. He pulls them up. He's like, hey, I'm going to take a look at these first. Then I'm going to have AI look at them. And then the dentist is going to look at them. And I thought about that. And I was like, oh, how's that going for you? Is AI helpful for you? And he was like, it's OK. He's not a big tech guy anyway. But I was just thinking, I wonder if that was his way to kind of inform me, hey, we got AI. You know, he didn't ask if it's okay for AI to look at it. He just said, hey, I'm going to look, AI is going to look, and the dentist is going to look. And then, of course, if we ever get the time, maybe another episode, we talk about that whole, the dental hygienist sees me first.

56:13 The dentist comes in at the very end. The dental hygienist says, these are the images. Everything looks good. What do you see, doctor? I don't even know the dentist's name. That's great. Then the dentist pokes in my mouth. Twenty seconds, Max. He's done. He's out the door to me. Man, that's my model. Like, let me have the PTA do all the stuff. My PTAs are more than capable of doing everything that needs to be done. If they get into trouble, I am there to help take it to another level, do what I can do best. But there's no need for me to be the one in the room the entire time.

56:54 Yeah. That was my parting shot. Parting shot. Gosh, I did not have on my bingo card. I was hoping Dave was still going to be here. Words mentioned during this episode that I didn't see coming. Backdoor, penetration, the D word he wants me to delete out, and role play. Didn't see that coming on PT Breakfast Club. Maybe you don't have the kids in the car when you're listening. I would say... adopts these technologies we're talking about, you don't have to do them all, but if you don't do some of them, at least slowly at first, they will run you over. You will get smoked and you will say, I never saw it coming. I think Hemingway said slowly then suddenly. Someone else said a little bit less poetically uh have things fall apart uh slowly at first than all at once so if you're not at least touching that's what i hope you take away from listening to us is like i don't think you're going to be an expert none of us on this show are experts and all this stuff we're all just playing around with stuff and then some of this stuff will be a fad and it'll it'll go away but like play and be be informed be informed so you understand this stuff All right, maybe I'll see you guys live from Graham Sessions.

58:00 Tony, I'll report back on Tuesday. I'll try to tune in. Have a good weekend. I'll try to tune in. Drive safe. That's it. We're out. Boys, what the hell are you doing? Follow Tony Maritano on YouTube at Total Therapy Solution. Find Dave Kittle at conciergepainrelief.com and on YouTube at The Dave Kittle Show. And follow Jimmy McKay at PT Podcasts on YouTube, the socials, and wherever you binge podcasts you pretend are for CEU. And hey, just a reminder, none of this was for advice. This was for entertainment only. Our lawyers say that counts. Thanks to you.