EMRs, Membership Models, and the Real Problem with Reimbursement

0:02 Broadcasting way too early from three separate Wi-Fi connections. It's PT Breakfast Club with Tony Meritato, Dave Kittle, and Jimmy McKay. All right, good morning to you here on PT Breakfast Club. On today's show, a real ultrasound device gets a little screen time and a hit from an HBO Max TV show. Jimmy can't afford HBO Max, but Tony, Tony's like, yeah, it's on. Will Butterfly be the next Theragun? Beer ads don't show people drinking. Think about it. Could a similar rule make physical therapy marketing ten times better? I don't know. We're going to find out.

0:43 And the big one, if we ran Graham Sessions, What would we actually talk about? What would we put on the agenda? And also, for most of the audience, what the hell is Graham Sessions? Let's go. This is PK Breakfast Club. Good morning to you. Good morning to you both. Good morning. Good morning. Good morning. Good morning. I wanted to do this beer ad one first. Then we'll go to the virality. Tony, eagle eyes, spotting. We'll do that next. But I think constraints actually drive creativity. We've all had this. I mean, it's ironically the creative cliche. Think outside the box. I love when people work with me and they you're the creative one.

1:26 Jimmy, think outside the box. Just do whatever. And then I come back and I go, cool. I need you to give me the box. What problem are we solving for? What are the constraints? And then they're like, we didn't think about that. I go, great. We're thinking about it now. Let's dig in. So did you guys even know this? I thought it was a law. It's not a law. It's a guideline. Like the beer industry essentially self-polices. Back in the day, somebody in radio told me it was a law. I researched it. It's not a law. It's a policy. But if you think about it, in my lifetime, I've never seen someone in a beer ad drink a beer. Holding them? Yes. Cheersing them? Yes.

2:07 Frolicking on the beach with your friends who all have like abs, like eleven packs? Yes, that's allowed. But drinking the beer? Shotgunning them? Never seen it. You see that on SportsCenter or the Pat McAfee show. That you see shotgunning. Hey, congrats to the Hoosiers, by the way. I stayed up a little late last night to watch the Hoosiers. Go Canes. The Hoosiers? Come out of nowhere. It's a basketball school. So here's my question. Here's the box. If beer companies can still sell beer, I'm using their quotes, because what they don't sell is beer. What they really sell is good time. Hey guys, drink this. You'll be cool. Just like all your friends. But what if you couldn't, what if there were constraints?

2:48 What if there were things you couldn't do or show? Would that actually make you more creative? I think it would. This is what you play around with. This is where you have to create the box. So what constraints would you put on it? You can't introduce any of your education. Wouldn't that be amazing? Isn't there a gym company just using letters and just saying it's a thing? Does that help them or not? What if you couldn't show exercise? I mean, big things. I have a really quick example that every single person watching or listening knows. I love that. Because of the industry, the industry and the deliverable is the constraint. Geico.

3:29 Geico spends, I believe, either number one or number two, but I'm pretty sure number one, they spend either the first or second most ad dollars online and TV for Geico insurance. I said to my wife last night as we're watching the national championship game football, men's football championship game, and there was a Geico commercial. And I said, I turned and I said, isn't it crazy that they... had these Geico commercials and they have literally nothing to do with insurance. They don't even say the word insurance. The insurance is like, you know, Tony and everyone knows like it's a, it's like, it's like in the ether, it's not a physical thing.

4:10 There's no handshake, whatever. It's just like you buy it. And there's this like policy that like is an invisible shield or whatever. So Geico came up with the gecko and, And it's different than State Farm and Progressive and all these others that actually weave stories around insurance. Geico, the constraint of insurance, like where the consumer doesn't get a tangible thing, they don't know what it looks like, and they created this little mascot. That is the constraint. And so beer and alcohol commercials are kind of somewhere in the middle. And then you have physical therapy in our world where you could show and tell everything, and there are no constraints. That's the harder part.

4:50 When there's no constraints, you can do anything. And the problem now is you can do everything. So we've said this before. If you've listened to the show, American Airlines doesn't sell the cramped seat or the meal or the in-flight movie. They sell Maui, the beach, sell the destination. So I guess where are we going wrong? Because I feel like there's a lot of people... in our profession who are like, well, I don't know what to show them. So I'll talk about myself. I'll talk about my credentials. I'll talk about evidence based. I'll talk about the tools that I use. And I push back going, I have no idea what kind of impact wrench my mechanic has. I just want my car back as cheaply as possible, safe as possible.

5:32 Give me the best mix. So what should we be removing? Dave, pick something. If Geico doesn't have insurance. I was going to kick it over to Tony. I was going to say what they're doing is they're just not doing what Tony does. They're not documenting. They're not putting up. And even Jimmy puts up a lot of, I don't know what your post per day cadence is now in frequency, but people just are not doing enough recording of patients and situations in their office. It could be with the front desk person. Tony does mostly patient facing video. And, and a lot of times you don't even see the patient's face, their knee, it's their foot. It's the, you know, pointing at swelling, whatever. literally just model toady maritato total therapy solutions go on his facebook go on his instagram connect with him there uh anywhere else you know your facebook page whatever simply just look at i don't know click like most watched and just i would just model the top ten videos that you're he's already doing but people are afraid of like oh i don't want to get criticized i don't know if this is going to resonate what if it only gets three likes what you know what who cares but that's the thing is that i think that is the first hurdle before we're even talking about constraints of like creativity and like what to do.

6:48 Well, you highlighted one before Tony talks. Tony's aimed at patients. Josh Funk at Rehab to Perform is aimed at clinicians. So number one, define your audience. Tony knows who he's trying to talk to. People, not clinicians. Everybody but PTs. So what do you got? The only thing I could think of was I don't think we still do a good job understanding the buttons to push, understanding what the consumer wants, what they're afraid of, what they're interested in. And that's why I've been a supporter of the PT should not be the one creating the content. It should be somebody who doesn't understand PT. Somebody who has no idea what we do.

7:28 Somebody looking from the outside in. I feel like I could do a better job marketing a restaurant that I'm not employee of a cook for involved with because I can see it from the consumer side. You know, now I've had twenty five years of experience. I've heard enough stories. I'm just barely starting to scratch the surface of understanding, like, what is the consumer really want to see? What is the consumer really want to hear? What are they looking for? And that's what I try to bring out in any of my consumer facing Social media. To Josh Funk, I feel like, fifteen years ago, twenty years ago, I was really good at talking to therapists.

8:11 Because I was in that world. I understood what the therapist, reading this job post, looking at this, wanted to hear. I understood, you know, what they were looking for. Now I'm so far dissociated from that therapist, I can't communicate well to that therapist anymore. But maybe because I'm a fifty-year-old man dealing with my own orthopedic issues, I can communicate to the fifty-year-old man with his orthopedic issues sitting on the other side of the camera. Tony highlights a few things there. One, you're selling transformation. And I know people are like, that's so vague and not concrete. But you're also, like a lot of your content for one of your YouTube channels is just selling transformation.

8:56 This looks like me. I remember one of the videos I saw recently was like, hey, these are the stitches after a knee replacement. And then people chime in with things like, and correct me if I'm wrong. Yeah, mine looked like that. Mine didn't look like that. Mine looked like this. Am I in trouble? I see me everywhere. If I see me everywhere, at least I know I'm in the right spot or what I'm looking for, what I know a lot of, what I don't know. Go around that. What Tony highlights is something I stole from someone called the curse of knowledge. If the PT is creating the content, a hundred percent, and they're like, I don't really know how to create content. I'm just going to record me doing me things. That's cool. But you have the curse of knowledge.

9:36 You know too much. Now you look and sound like a PT and that's not what you want, right? You want to... Let me ask the best question is the fifteenth question the PT might get to. Ask that one first or say that thing first. Sell the emotion or share the emotion of the clinic. If we had the same ad agency on hand in Tony's clinic for seven days with no prep and on hand in New York City with Dave, seven days, no prep, they would tell vastly different stories they would look sound feel vastly different because a camera could go i don't understand this and that's their sort of superpower i don't understand explain it to me explain it to me again explain it to me again i call it the yeah and i and i posted the video on friday tony says that i dress up too much i dress up too nicely for physical therapy really what were you wearing was it a nice polo shirt so we made a bunch of videos my new therapist and I and one was it was me with a pea coat on with a scarf on riding a recumbent not a recumbent an upright bike oh I saw that one and I literally my new therapist he's the man he like gets it right away he knew say his name no last name Wolfinger tell me that's not a concierge PT's name exactly exactly Anyway, so in terms of differences between Tony's clinic and my clinic, I said to him,

11:08 I go, like, the clinic, it was Friday afternoon. No one's there. It's quiet. And I go, hey, we're going to do some videos. You cool with that? Yeah, yeah. And I go, all right, this first one, I'm going to jump on the recumbent bike with my P-coat on with a scarf on. And you're going to say, Dave, what are you doing? And I'm going to say, you told me to warm up. and that was it and he like totally got it perfect shot whatever uh seven second video we're getting we're trying to get these digital assets out there i'm trying to be better like tony i'm trying to model his consistent behavior uh but tony said i dressed up too much i mean it brings up a good point but i was just giving you comments just to get get it going i appreciate it i appreciate it nonetheless awesome i thought it was a great video It actually got me thinking, like, I wasn't sure what you were trying to say, but like, I knew what you said.

11:57 I wasn't sure the meaning you were trying to convey, but that just got me stuck on that video longer because I was like, I don't get it. He's warming up. What does he mean? Yeah. It was like a pattern interrupt, wasn't it? A little bit. It should be. Yeah. That doesn't make any sense. I want to see what this is. I'll stick around for four more seconds. Um, this brings up something I didn't think we were going to go into, but like, um, I know we wear clothing as a physical therapist and we've adopted. Well, you could work scrubs or you can wear a pillow or you can wear a button down or you can wear your branded. So let me ask you this question. Do you know why the, you guys know the Orkin man?

12:39 Yeah. Dave, do you know the Orcan manual in the city? I don't even know if you guys know. Yeah, that's the pest control. Do you know why the Orcan man wears a helmet? Like his uniform is a helmet. It's like a white construction helmet with a red. They want to imply that they go under your deck because that's a common place for pets and rodents and animals. Yeah. Well, I was explaining that. And also like the thing we're doing, it's, it's not, it's not basic. Like you need, you gotta wear safety equipment. Doesn't he also have like a white suit, like on the logo or the commercial? It's like a white jumpsuit. I think. I'll tell you what you talk about. Tony talks about medical theater all the time.

13:20 If someone with pest control shows up with a white suit and a helmet on, versus someone else who shows up in an old Carhartt, looks like they were a mechanic for twenty five years. Which one can charge more money? For the Orkin thing? Yeah, that. But if you're fixing my diesel truck, I want the guys... No, no, no. Just plain Jane pest control. Which one can charge more? That's why it's theater. I'm going to pay more for that. But what Orkin... This was explained in college. What they're trying to say without saying it is, listen... We're the experts, and this isn't something you just do. You don't just go to the store and buy a can and shake it and spray it.

14:01 Dude, look at this helmet. You think I just wear a helmet around? That's why the guy's wearing a helmet while he's knocking on your door. This is serious business. But you're never going to not see it. So then someone might say, well, we should walk around with stethoscopes. And I'm like, maybe. I don't know. So this is where Dave's uniform would be different. I would say, Dave, what would your helmet be? I have an idea. I'll kick you my idea. If I were Dave, I would go the other way, and I would go with leather medical bag like the doctors used to have. I'm being serious, though, because that says house calls. That says concierge. Do you have concierge?

14:42 I carry not the traditional old school brown one, but I have a black leather briefcase. It's like a briefcase, but it has a sling as well. I've been doing black leather briefcases for seven, eight years. And I would just have like your name on it, like embroidered or something. I got the initials. That's fine. But like that tells part of the story. I don't. That's what we're trying to. So I think that's the problem is like the uniform for our profession would be so wide. I don't know where we would start. All right. We lost Tony. Tony was like, I'm out. He was. I think he had some spotty coverage anyway. Right. Yeah. He was. He was fuzzy on my end.

15:23 This is a good time to talk about our newest sponsor, Dave. Newest sponsor today. Never even heard of these guys, but if you think about it, like Geico, you know the problem and they solve it. Today's episode of PT Breakfast Club is brought to you by the HIPAA gag ball, the only compliance tool that guarantees silence. You don't have an image? I got to see this. I got up late this morning. Janice can't overshare about Mr. Henderson's sciatica if she's got a branded foam ball. HIPAA gag ball. It's stylish and legally ambiguous. HIPAA gag ball because when it comes to patient privacy, less is more. Actually, ChatGPT was like, I can't create that image because it had something to do with a gag.

16:07 I was like, you know this is satire. You created the ad. It still would not create it. Let's go to the next topic and maybe we'll get Tony back. I won't do the butterfly story because that was his. I will skip to... Oh, I wrote an article yesterday. I don't write a lot. But then I made a short-form video, which is something I do a lot. Did you type it or did you chat GVT? I talked for about an hour. To get a really good article, like one prompt, you will get... Ben Affleck was talking about this the other day. You'll get... Ben Affleck actually was terribly deep about AI the other day. I think it was on a Joe Rogan show.

16:48 And he was like, you will get the mean... you will get the very middle of the prompt. He's like, that's not what people pay for or want or pay attention to. So I'll usually go around for about an hour if I'm writing an article. Short form video, twenty minutes. But the idea was hard work doesn't convert. So some... Rob... This guy Rob is a PT for four years. He's been in all sorts of whatever sections of the profession. He's worked in professional sports. He's worked in a large agency or a large organization. And he was like... He had a series of posts. And I was like, do people not want to work hard?

17:29 It just feels like a weird mismatch. Someone goes through all this education, jumps through all these hoops, and then they're like, I don't want to work hard. Or... Yeah, some don't and some do. My counterpoint, well, then that's a bell curve. If you've got a hundred people, it'll fall on the bell curve because we know large enough numbers. My question is, is it laziness or is it a conversion factor? Like if I gave ten units of work thirty years ago, I would get X. And now if I give ten units of work, I get less than X. So I'm being de-incentivized. So I don't think it's are new grads lazy or I think it might be – I don't think it's even new grads. I think people are just saying people don't want to work anymore.

18:11 Or are people just better at doing math going the juice ain't worth the squeeze, so I'll work. But this extra stuff, it actually doesn't convert. You're asking smart people to do a stupid thing. So I said that and a bunch of people agree with me and then a bunch of people disagree with me. The funny part is the people that disagreed with me were like... All they were doing was using outliers. Like, well, Elon Musk wasn't handed anything. And I was like, I didn't say anything about being handed anything. What I said was, you're saying no one wants to work hard and I'm saying... They do want to work hard, but the juice ain't worth the squeeze, so why would they? Well, people who go outside the box and create their own companies, I'm like, exception or rule? Which one are we talking about?

18:51 People were talking, the premise was, these clinicians don't want to go the extra mile. And my counter was, why? Are people just lazy? Do I have shorter attention spans? Are they just disincentivized to work? I don't think that's true. I think the conversion factor is different because the funny part is, and this will be the last thing before I let you guys talk. In the same argument, they say, we get it. Reimbursements down and salaries are tough and schools more expensive. I was like, that sounds like a shitty beginning. It sounds as if the conversion factor is wrong. You're asking me to run the same mile, but mine's uphill. And you're wondering why I don't run harder. So that's all I was saying. I wasn't saying that there aren't lazy people.

19:32 There are. I think there are people who do want to work hard. But when they do, the conversion factor is different in twenty twenty six than it was in nineteen eighty six. That was my point. Yeah, and I hate the word hard. Hard is just such a subjective term. It's not measurable. What I perceive as hard is not what Dave perceives as hard. So we're using this weird metric to try and judge these differences. But I will say, you know, we are definitely in a situation where I think about things very differently than maybe a new grad clinician is thinking about them.

20:12 What I would value as a twenty five year veteran in the profession is not what a new grad might value. And so we're going to have different judgment on what's what's beneficial, not even hard. What's good, what's not good. Agreed. That's all I was saying. And it resonated in video. And the funny part is a lot of people making comments on Instagram were like, I've been a PT for twenty five years. And I was like, oh, here we go again. These kids are lazy. And they were like, no, it sucks now. It's different. He's right. The convert. I'm working just as hard as I did twenty five years ago. I'm getting less or I'm working harder and not getting the same. So it's not effort. So I was saying it's not the input, it's the output.

20:53 And if I keep doing something over and over again and getting a shitty result, and then I stop doing that thing as much, I'm yelled at for it. Like, that's weird. So anyway, that was my article. I did reach out to the guy who wrote the three-part series. Seems like a very smart guy. I told him, I was like, listen, I actually, ironically, and I said this in comments, I'm like, I agree with most of what you're saying. I don't think you're listening to what I'm saying. Because he was like, people need to work hard, buckle it up. And I'm like, my man, I worked for three years for free. My first job paid me fifteen thousand dollars a year. I did it because I wanted awesome. But eventually, after I worked at that radio station for three years and got promoted three times in the first seven months, but no raise, I did the math and I was like, oh, this sucks.

21:39 I don't want to work here. He literally was like, hey, boss, I promoted three times in seven months. I'm actually losing money because I moved from nights to days at the radio station. So I couldn't work a part-time job that I was a substitute teacher during the day. I was like, I'm losing a day getting promoted for you. And the GM's response was, do you want me to move you back to nights? And I was like, oh, you're a dick. Got it. Never mind. I don't want to work here anymore. So then I left. So that was my point. Real quick, my problem with this combo is my understanding, at least, is a lot of people want to get paid in relation to the effort they put in, not in the output they generate.

22:20 And I think that's where we have a disconnect. I don't care if you work hard. I would rather you work easy and produce more output that I can pay you more for. Agreed. I also agree. Show me the path. But we're going in and also in the argument was like, well, reimbursements going down. I'm like, right. We all agreed that agreed. I don't want you to say, well, I showed up and I did average and I got more. That math doesn't math either. But when people say these kids today, like anything after these kids today. I don't know if it's ever been good. It's not good. So read that. It's on LinkedIn. I would love people's thoughts. Let's go back.

23:00 Now that Tony's back, this is your topic and I don't want to take it. I had this up next. A real clinical tool that Dave has experience with. And I feel like you were all about this for a while there. I mean, externally. You still use this. I mean, I still am. I'm not going to say the name of the product forever. I haven't pursued any Tony's... Brand deals or whatever. So like, but yeah, I mean, I mentioned I did some episodes on it and I, I still think regardless of the device, I do think that diagnostic ultrasound is really great for orthopedic anything. So home visits, concierge for brick and mortar outpatient in network, Medicare out of network, whatever.

23:41 It doesn't matter. I think it's, still significantly underutilized by physical therapists. So yeah, Tony mentioned he saw it on ER or Grey's Anatomy or The Pit or what's the show nowadays? What's the newest soap opera with hospitals? P-I-T-T Pitt. It's an emergency department in Pittsburgh. It's a decent show. My wife and I have to laugh every episode. We didn't get our woke bingo card, but if you did, we would hit bingo every episode. They're checking all of the boxes. But so it was was I think it was episode twelve, season one or something like that.

24:27 We're sitting there, we're watching and all of a sudden they pull out this butterfly ultrasound. Now, I don't do diagnostic ultrasound, but I know the product. I was like, holy shit, this is this is, you know, paid placement. This is what I've been talking about. This is what we need to get get more of in our profession. I shared that post yesterday, tagged you guys. A couple people came back. They said it wasn't a paid promotion. So somebody had put out a media release, press release. When the episode aired, I guess a representative from the show reached out to the company, said, hey, we want one of these devices. There's got to be some compensation somewhere behind this. Of course.

25:07 But no, it wasn't technically a paid placement. What I'm saying is, so now Dave uses different devices. this would be something where if i had that device in my clinic i would immediately be putting out uh content connecting that episode to me in the clinic to what i'm actually doing uh whether it be you know a green screen with that in the background and me talking about it to me actually using it with clients showing how it works i would be leveraging the recognition of pit which this episode came out, I think, in twenty twenty four. So it's not a current episode.

25:48 It just hit my radar. But I just think it's brilliant. And it was just you guys remember Wayne's World. Jimmy has shared photos of Wayne's World like it was exactly that. They said the name, they said the brand, they turn the box around, they show the logo and it came back in the episode two or three times. It was hilarious. It's so it's absolutely a paid placement. Why would they say it wasn't? The press release said they did not pay for it. They just asked for a free product and then used the product in the show. I used to do this back in the day, obviously on a different scale. This to them is nothing.

26:29 This is like, I mean, this could be the wife of a writer. Her brother is a PT and she goes, hey, I need a thing. Can you give me a thing? I mean, I used to get free crap all the time. And this is back when you had to run a radio station to touch five thousand or fifty five thousand or five hundred thousand people. And I would just go to the media page and anything that I wanted. I'm like, hey, I run a radio station. Here's my bio. Look at me. Here's the link to my Web site. I'm at Northeast Pennsylvania. Here's our demo. I want two of your things. I'll give one away and I keep one. And they were like, done. I used to get weird things like three-man slingshots. Anything a twenty-eight-year-old would want, I would just be like, I want that. And then I would talk about it for five minutes or all day.

27:10 And then I'd use it and I'd come back again. I don't know. It seems weird that they wouldn't just be like, yeah. If it was. So this denial... I wanted to use this as an opportunity to talk about the fact that I sent... boxes of radio station logo stickers hats t-shirts promotional things to uh the office because the office was shot in scranton pennsylvania and i was running a radio station in scranton pennsylvania while the show was a hit and we got my sticker on there twice and i would send boxes yeah i got them somewhere oh it was in the background it wasn't like they were like this is a cool radio station we love listening to this radio station that It literally was the sticker was on like a locker in a high school scene, but you take what you can get.

27:56 And we milked the hell out of that thing. Of course. Like we, we even mocked how it was like tiny in the background. We were like, Hey, we're giving out free magnifying glasses. So you can actually see the radio station sticker. It's in there. I swear magnifying glass, but it wasn't. I don't, I don't know. I mean, if they say it isn't, I don't know why they wouldn't just disclose it. Like there's no reason to lie. I haven't seen the clip, but the way you guys are describing it, it certainly sounds like it would be. Well, it sounds like I just read this press release from April, twenty twenty five. It sounds as if the reason they use the butterfly. I haven't seen the show. A regular ultrasound. I guess they were they were in like it was a mass casualty event and they were like, there's no room.

28:38 Get this out of here. Give me that portable bang, bang, bang. And like, I don't but I don't know if they were like, you know, and Noah Wiley was like in butterfly save the day. Like if he did that, you got a John Wayne moment. You run with that. It was pretty close to that. I think I sent you guys the YouTube clip of it. It was obnoxiously promotional. Really? That's what I'm saying. See, I didn't even see it yet, but it sounds like it. Yeah, it seems weird. And the funny part is a lot of the therapists, and I don't know Dave's opinion, that I shared that screenshot to, they were like, yeah, it's okay. It's not the best of the best.

29:18 It's a good entry-level device. So it's not even like they went and got this great, amazing thing. I think it was just that was the branding they saw that this was the first, you know, portable ultrasound they saw. It's got the best branding. It's got the biggest recognition. This is what we're going to go with, which, again, goes back to the power of having not the best product, but the best messaging around the product. Yeah. All right. So it remains to be seen. Maybe we'll see more things. Maybe that's how you keep the show on the air. I mean, think about it. People would be up in arms if they were like, now you can just pay for placement. I'm like, you do realize that happened. Like it was supposed to be M&Ms in E.T., but they didn't want to pay.

30:02 So now E.T. and Elia did Reese's Pieces and they were like, that was our single best spend ever. Because it became a thing. If you're anti-product placement, I would like to introduce you to Wheel of Fortune and The Price is Right. Those are commercials with commercials between. The whole show is a commercial with commercials between. In fact, I would love for the Wheel of Fortune. Dave, are you old enough to remember when Wheel of Fortune, if you were the winner, you would just win money? Then they'd wheel out this giant set that rotated slowly.

30:43 And it was like a living room, a garage, a bedroom. And there was just stuff. There's just like stuff everywhere, like a motor. And then you'd have money and you'd be like, I want the bed. And then Sajak would quickly be like, the bed from Ashley Furniture valued at thirteen hundred dollars. And then you'd be like, I want the motorbike. The motorbike brought to you by Bobbity Bob motorbike. And you'd spend your money down until you're like, all right, I'm good. That was brilliant, in my opinion. Oh, supermarket sweep. It's a commercial with commercials in between. So if anybody's up in arms about a thing showing up on a show, I'm kind of like, have you met everything else? Right. All right. I have no problem with it. It is weird if it's true. They don't. They lied about it. That is a weird thing.

31:24 But Lyle, you want. All right. So I'm going to Graham Sessions this week. And did either of you know about what Graham Sessions was? Tony didn't. Only from you. Okay, here's how I'll describe it. Graham Sessions is an event that's been going around, I think it's twenty years or twenty-one. It's been a long time. And essentially, it was like, let's do this small meeting. So it's scalable. So everybody can be in one room. And let's just talk about the biggest issues in our profession. And this is years ago. They were like, let's create a safe space. So you can talk because of course, you're going to leave and talk about stuff. But you can't say who saw anything.

32:06 You can talk about the idea. but you can't attribute it to anybody so you feel free like let's say you got a big fancy job and you got a lot to lose and you're like i don't be saying that um but you want the ideas in the room that's what graham session is i went ten years ago i went in and and then i haven't been back i'm going on thursday so if without you guys knowing the agenda or what happens there it's pretty much twitter or linkedin that's what happens in the room but they're the people right Let's not... Listen, we're not going to talk about Graham Sessions because it hasn't happened yet. I'll be streaming there live and doing interviews. But if you were to set the agenda, what would you guys put on the agenda?

32:51 I want to thank Katie Sutton for having this idea. She was like, you're going to Graham Sessions. You can talk about that on Breakfast Club? She's a host of podcasts. And now she's thinking like a podcaster. She goes, well, yeah, talk about that. But what would you guys do? And I was like, oh... That's a really good idea. So what are the topics that matter most to clinicians? Because remember, the people in the room are mostly, it's only a hundred and fifty people invite only. I call it the cool kids lunch table. Some people took offense to that and I go, but it is though. You had to be invited. Mean girls, you can't sit with me. What topics matter most to clinicians? What would you put on the agenda? What would you ban from the event? I would have like the video game, the taboo game, the buzzer. Every time someone used a bugged word or jargon, I'm like, eh, jargon word or the lunk alarm.

33:35 Every time you dropped a weight, I would use that. So what would you put on the agenda? What matters most that you hope gets talked about? Dave? Who do you want? All right, I'll go first. So, I mean, let's just cut right to it. My topic would not want to be fully discussed. And the reason is because everyone in the room is entrenched in the traditional payment system. in-network insurance model. The biggest limitation, the biggest hang-up, the arguably, I don't want to sound over the top here, but arguably the biggest shift of the future of the profession.

34:17 And we talk about, let's say even twenty years in the future. I mean, even longer, yes, but payment reimbursement, health insurance reimbursement will never be increasing And everyone else has increases of cost of living with every aspect of their life. When they buy a Starbucks coffee, whatever they get car insurance through Geico, whatever, whatever it is, everything is increasing. Their income is capped. The practice owner's income is capped. The biggest thing to ever talk about in any of these formats, is self-pay, private pay. And I don't care if you live somewhere rural where apparently everyone is making twelve dollars an hour and doesn't have discretionary income. People pay for what they value.

34:58 People buy all over the country in every and I've had family in Decatur, Alabama. and Huntsville, Alabama, and all over the South. And I have family in Florida and Nebraska, all over the place where it's not a metropolitan city like New York, where we can just charge anything. So I understand that. But the biggest topic is payment reimbursement or payment models. That is full stop, the most important thing, because with that, if there is a change in that, which there's not going to be, because everyone that's in the room that is the original ten guys, fifteen guys, twenty guys of Graham Sessions. They all have multiple practices that are all in network.

35:40 So my topic would be the topic that they would want to fully ban. They'll let us talk about it and riff on it, but that is not what they would want to highlight. That's my opinion. Tony, what do you got? I would open with AI. have to. I would probably talk about AI in the middle and I'd probably wrap up with AI just to make sure we didn't miss out on AI. How's AI going to help with the future of a physical therapy business? Please tell me. How's it going to pay the bills? Oh, denials. I'm glad you asked. AI will help us develop new business models. AI will help us figure out how to deliver better quality services with fewer future therapists because we're not going to have therapists becoming our students going into therapy.

36:33 AI is going to help us operate with fewer staff, fewer non-professionals. AI will really help us manage all of the problems we have. I mean, that's the tool in and of itself. Okay, so let me just push back a little bit. You got a supernova AI, Gemini, ChatGPT, GetMarried, they have an AI kid, and physical therapy practice can use it, and... there's still capped reimbursement and people are still gonna be calling in and saying, I wanna use my Medicare and my in-network insurance. And then what, Tony? The physical therapy practices, whether it's the owner, the front desk person, staff therapist, who's on the phone or on the email or whatever, when prospective patients are reaching out, You're going to use ChatGPT to say, okay, give me a proper script on how to overcome the rebuttals, whatever.

37:25 So yes, that could maybe help in real-time or training team members. But again, there's sales books. All that's already available. All that is already available. So, in the future, you have Supernova, amazing AI that can help do anything, maybe even have phone calls that is an AI agent that is sounding better than me, that it can do pauses and tonality and overcome objections and all that. People still have to see value and part with their money to decide to pay a physical therapy practice out of pocket for a plan of care, remote programming, an evaluation, and then home exercises from Tony Meritato or whoever.

38:06 So I don't see... Yes, there's so many changes that could occur through AI, but I don't see how AI will change the relationship between a human who wants to pay another physical therapy human out of pocket their hard-earned money to do business with them. I think you just said it. I think you've got AI agents right now that can answer phone calls, that can communicate in a way across languages. Doesn't even have to be English. They can communicate in different languages that can understand and start to learn the psychology of the person on the other line on the phone better than me. Okay. who could communicate the value better than me, who could sell my value so that, yes, I become the fleshy bag that delivers the service, but the AI is the one that actually includes the plan of care.

38:57 Okay, fine. Let's say I agree to all of that. The human comes into the physical therapy office. The physical therapist meets the prospective patient for the first visit. Now we're back to face-to-face old school. Now you have no AI experience. layer it's human to human how are you the practice going to deliver something that is worth a hundred or two hundred dollars or whatever dollar amount per visit then sell a package that's three thousand dollars or however many thousand dollars you want to charge for twelve visits sixteen visits whatever without any ai layer no app no computer no screen no nothing That is that's where there's a limitation on AI because this will continue.

39:41 I don't care what you guys say about technology. In the twenty years from now, they're still going to be people paying out of pocket or even wanting to use their insurance for physicians, physical therapists, chiropractic, massage, acupuncture, massage, every every every other every service under the sun for health and wellness where it's human to human. We agree. And I'll get Jimmy in on this. You and I agree on that. It's still the human delivering the human. I heard a term called de-skilling. And what these guys were saying basically is that the AI can de-skill things down to its raw component. So if we break this apart, the sales process, which most of us are terrible at, the AI can handle better.

40:25 We are just there for the engagement, for the interaction, for the delivery that the AI can't do yet. But the idea is the AI can do the sales, can process the payment, can verify the insurance, can create the script and deliver it in a way that is appealing to the consumer. So the AI sold everything that needs to be sold, even collected the money and put it in your bank account. The thing the AI can't do is what you're saying, which is me actually being there with you, making you feel better. That's the stuff we're good at. We are not good at all the other things. And then on a bigger population scale, the AI can come up with better treatment protocols in mass so that people who don't want to pay two hundred dollars, who want to pay ten bucks, can pay ten bucks and they can still get a solution customized to them across millions of cases because I can't figure out a million cases, a million plans of care, but the AI can.

41:23 And so it takes away all of the low value stuff. It takes away all of the easy stuff. It makes amazing care available at scale. And it sells the one-on-one stuff better than I could ever sell it so that I just have to deliver it and focus on the patient care experience. Jimmy, what are you thinking? I think it will do the things that Dave's talking about poorly and last, where all the humanness needs to come in. Operationally is where I think it will be... Like, practice owners are already running around like their hair is on fire. We've been in the Facebook groups. What are you using for this? So I would say like, go from the outside in. AI call center, even if it's just for triage, I'm not saying Dave doesn't still sell the plan of care, but someone answers the phone before they get to Dave knowing like, no or yay.

42:11 So instead of Dave answering a hundred phone calls, he's answering forty in a week, but he's closing at a higher rate because sixty of those were non-convertibles anyway. Prior authorization revenue cycle management. We've seen that. Everybody's claiming they do it really well. From what I'm hearing, no one's perfect yet, but someone's going to get there. And then it's great job security if you do AI for revenue cycle management or prior auth because the insurance companies are going to get better. And then it's just Russia and the US. It's just an arms race. Um, in clinical care, number one, we've already seen it, right? Like AI scribes. So like that's here, that will get better.

42:51 But also can you dig through where's the, can you, can you go and find me in our EMR? five people that hey let's just reach out even if it just brings dave us like a list here's five people who haven't been on schedule for five months give them a ringy dingy see how they're doing so i think that's tasks it's task rabbit you know like that's what i would oh rtm as well could it make it easy can it process size this so the humans do more of the stuff that dave's talking about high value, low repeatability for now, and just get those tasks out of the way. And the smart ones will do it, in my opinion, because what's our resistance?

43:35 Is this going to cost too much? And is it going to break even? The smart ones will do it for a percentage of what they bring in. That's like, oh, I'll do revenue cycle management for a percentage. This way, if the percentage goes up or RTM, I will do it for a percentage. right? So that just remove all the barriers. Oh, I don't know if it's going to pay for itself. Don't worry about it. If we suck, it's nothing and we charge you nothing. But if it's pops off, then we pop off together. So I don't, I hopefully, and I don't think the human stuff won't, it can't be not well anyway. Is there already, Jimmy, is there already an agenda or list of topics for Graham Sessions that you were... Yes. I don't know if I'm supposed to talk about it or not. Again, this is a super secret thing. I don't see...

44:15 Do you think you'd get in trouble if you were to answer yes or no, my topic is on the list? Yes. Do you think you'd get in trouble if you said... All right, good. It better be. It better. Good. No, they're not on the list. Oh, they're not. Yeah, exactly. Exactly. That's my point I said from the jump. Neither of the things which is insane, which is insane. What else are you talking about? What are we talking about? Medical EMR and writing notes and Allegra. OK, OK. The third topic, Dave gave a topic. I gave a topic. The third topic that's got to be on the list, got to be at the top of the list. like recruitment and attraction and bringing new professionals into the physical therapy profession.

44:58 And that's easier if you have higher pay or you're out of pocket because I can pay my therapist six figures right now at a base salary and performance pay because I can charge mostly out of pocket or be out of pocket and get creative with that because I'm focused to offer what I deem to be I think significant value, although the consumers will be the full judge and jury on if we actually convey and deliver value. But That's why I can, and other practices are going to charge, other practices are going to pay their therapist, you know, seventy five grand or something out of out of school because they're limited by reimbursement. So I mean, yes, we could talk about recruitment and hiring.

45:40 It's really easy. Don't go on Indeed. Don't run LinkedIn ads. Simply go and send a direct message to all the therapists in the entire area. Oh, that just takes time and effort there. I just saw the whole recruiting hiring step. Dave, here's my model. You should talk at PPS. Here's how to slide into the DMs. And I want the image. I get nothing out of it. I like this. I close my laptop. I go on my day. I'm done. I'm not going to go fly to the Graham Sessions or PPS. At PPS or Graham Sessions, you pay me a couple grand, maybe I'll come. But I'm not going to come and pay for a flight and a hotel and go off like this. What do I get out of it?

46:20 That's a good question. But I have a great image for your talk at PPS called sliding in the DMS would be you sliding into second base like Willie Mays Hayes in major league. That just looks, that works good. That looks, that would sell. Yeah. We do. I just hit another one. By the way, I just want to reiterate, none of those topics are on the itinerary for Graham Sessions, which is later this week. It's insane. It's insane. Can you share the list after Graham Sessions? Do you want to discuss it after Graham Sessions? Or you can't talk about it? Oh, I can talk. We can talk about the rule of Graham Sessions is it's not like Fight Club.

47:01 You're not supposed to talk about Fight Club. Graham Sessions is you can talk about... the fights, but you can't talk about who fought Because the idea is if you're someone big fancy and then someone big fancy said this, that could get you in trouble. Nothing crazy is said. Nothing that hasn't been said on LinkedIn or Twitter, forty gajillion times. We do want to pay the bills to make sure we can bring you information like this. This episode is brought to you by Practice Mojo Crystals, the only wellness solution infused with actual CPT code vibrations. Hold one in your hand and chant nine seven one one oh nine seven one one oh nine seven one one oh three times and realign your reimbursement energy who needs ai when you have mojo crystals comes in three billing tiers standard premium and denied prejudice practice mojo crystals from when your emr is down copays late and mercury is definitely in retrograde find them online at practice mojo crystals.org Next topic.

48:04 Which one didn't we do? We did that one. We did this one. Oh, we're ripping through these. Oh, Throwback Tuesday. Throwback Tuesday. On Facebook, something came up. We've been doing a live stream for a long time. We found a post from two years ago. And I was like, I will listen to this and then we will talk about it. So I listened to it for like twenty minutes this morning. And we were talking about Tony's Unlimited. Two years ago this week, we were talking about Tony's Unlimited one hundred dollar a month access model. Was it ahead of its time due for a revival? Or Tony, are you still doing that two years from now? We just talked about it last week.

48:45 I know, but this is... It's still going strong. We're still doing it. It's been going on for twenty five years. But yes, still there. Yes. All right. So so follow up questions. That was just the lead in question, Dave. Follow questions. What changed, if anything, in two years of you doing this? What did it teach you? Did it affect important things like no shows, flow, reactivations? Did it have a positive ROI outside the I know you really weren't doing it for the just for the hundred dollars a month per person. You were like, what? It's going to create culture, right? It's a gym thing. but with a cheers vibe. So what did it do? What'd you learn in two years of doing a hundred bucks a month on the limited gym access?

49:26 Yeah. A hundred fold down, down a bad side of it is you have to have the right therapist who can manage it, who's comfortable with it, who enjoys it. The upside is you use it to capture cancellations, capture no-shows. You can fill those spots with people you have in the clinic on the hundred dollar a month plan. They bring in friends and family, neighbors. They increase our revenue. It's totally a net positive. It just has to be managed like anything. You have to have the right person managing it. And you sell the value of five days a week. Nobody wants to come five days a week.

50:07 In twenty five years of doing it, one or two people might come five days a week, but most of them are happy to do two days a week. They're happy to get out in thirty minutes. They don't they don't occupy resources that we're using for other things. So five days a week and it's like just throughout normal business hours, Tony? Yeah, they're still scheduled. We still have appointments for them just so we don't overload certain times and we could block out certain times if we wanted. But yeah, generally the value to the consumer is unlimited access. The reality to the consumer is you're probably still going to come twice a week for thirty minute sessions.

50:52 So I don't think I've really, we've talked about this a bunch that you have this membership. I don't recall. Maybe you mentioned it. I just, I didn't recall that even the gym slot where they're exercising and they do whatever they want on in their, in your space that they schedule a time for that. So there is, that's actually beautiful, right? Yeah. Right. They're scheduling a time to work out. I didn't know that. Yeah. So I didn't know that either. That is something that I think we've overlooked. I think, uh, cause I also have nudged you to raise the price. We talked about this. This was a published episode two years ago and it was a hundred dollars a month. Then it's still a hundred dollars. Now I, you know, it's probably, it probably could be bumped up to one twenty five, maybe one fifty a month and no one bat an eye.

51:38 Well, you think more Jimmy two hundred? No, I was going to say, but then add the value, which is like, now we have towels that are eucalyptus scented, just like Equinox, you know what I mean? And just run around with like a eucalyptus flavored Lysol every once in a while, hit the towels with it. You got to up the value, right? But someone was talking on LinkedIn and they said, you need a two hundred thousand dollar investment. And I was like, you'd need less than five grand in Facebook marketplace. Like, I do not think if you do a two hundred thousand dollar equipment investment, I don't know when you see your money back, but it's not soon. So, I mean, really, really quick, cause we covered it a bunch, but in terms of scheduling a slot to go, to go work out at a physical therapy office as a gym membership is so overlooked.

52:22 I can't believe we never talked about it deeply, but it's a, it forces someone to come now. Of course they love you, Tony. They love the cheers environment. Everyone knows each other's names and the, you know, the older gentleman with the joke book and all that. So there's a little bit of that community stuff, plus the built-in accountability of scheduling an appointment. to go work out. Planet Fitness doesn't do that. Gold's Gym, any other place, yes, and if it's group fitness, like Orange Theory or F-Forty-Five or whatever, like, you're not book, you're selecting a class time, but if you show up or not, like, They don't care. So you have folks that are going there more often, most likely because of the subtle booking of a time.

53:02 They show up more often. They like the environment. Plus, they probably feel a little bit better because they're like, I'm working on a moving. And so they're more likely to show up and continue with the membership or reactivate for physical therapy. Because they like the environment. And both of those things feed into each other. They like the culture, the environment. They like the jokes and all that. Plus, they're moving around. The next morning, they feel better. The next morning after that, they feel better. So it's like, oh, so I'm going to go for my second time of the week and go work out there again and just do that indefinitely unless something else pops up that's, you know, like emergent or aches or pains or whatever. So when we talk about it and when I'm telling a prospect, hey, this is available to you.

53:45 I specifically say that I say, look, you still have a scheduled time. You are still expected to be here. I'm not going to call you if you don't show up. I'm not going to penalize you. I'm not going to give you a no show cancellation fee, but I will expect you to be here. So like Dave said, they get the accountability. Now, why is that different from Planet Fitness where they don't want you to be there and Because I know that if that person's in my clinic and I get a no-show at the same time, I can reactivate that patient into an insurance-covered physical therapy visit. So there is value for me and that person physically being in my clinic. I want them to come. Not just for the personal satisfaction of knowing that that person would be sitting on a couch watching TV or coming into my clinic and getting stronger.

54:34 There's also the fact that, hey, this is going to potentially recover a cancellation no-show if they are physically in my clinic. Yeah. So the twist before we hit parting shots would be, Dave, is there any way you could steal this? Could you go to a gym and say, I've got five patients. We're going to do a weekly meetup as a reactivation. How much to rent the gym? Got it. For five patients, you're charging me this. I need to charge them to cover my cost, make margin, and do it. Is that something you could ever twist? Just because you don't have brick and mortar doesn't mean you do. Or could you use it as your brick and mortar? I knew you're gonna say it. And I was gonna say yes.

55:15 So we do. And so now I need to go in today. We're going to be in the office. So I'll ask Noah Hyman, if we could do that. And, you know, I'll have to pay or what I don't know if he'll increase the rate or whatever. But we'll see it. There's space, there's open space. And yeah, it totally could be something that would be doable. Here's what I would do. I would say, Eisenhower, I think, said, you don't go to war with what you need. You go to war with what you have. I'd go to your staff and go, who do I got? What's their excited flavor? How much would I need to pay them to do an hour or once a week? You reverse engineer orange theory. Great. This is what I got. If you could teach a class, what class would you teach if I paid you to do it?

55:57 And then... Go to your EMR and then hit people. We've got this offering at this location at this time. See if it plays out. And you're saying Noah is the person who you pay for the space? I would rent it with him. If it pops, it pops. I'll keep doing it. We all win. You do nothing. If it doesn't, well, I'm going to try it for a month and then I'm not. And no harm, no foul. Right. All right, let's do parting shots. parting shots oh wait we have a sponsor for parting shots i want to make sure we got this parting uh where'd it go there we go uh the linkedin clinician starter pack is now a thing it's a downloadable uh package uh finally everything you need to become a thought leader your dpt cohort scrolls pass at eleven pm you get a ring light you get one hashtag Motivation Monday template and a step-by-step guide to posting your cancellation policy like it's a TED Talk, the LinkedIn Clinician Starter Pack, because being overbooked is optional, but being overbranded is essential.

56:56 All right, parting shot. All right. I think I mentioned this on the last episode, but it's worth mentioning again. Elon Musk is notoriously bad at predicting timeframes, but he did say, quote, you don't need to save money anymore because we will reach that point of. um prosperity where nobody needs to save nobody needs to earn everybody will have money uh all thanks to your local ai now he's thinking it's going to be in three to five years i don't think that's going to happen but um i i will start that episode with dave so ridiculous it's a ridiculous statement He's talking about universal basic income.

57:38 Essentially, everybody just gets money. He's saying AI will bring the cost of everything down to the point where nothing will cost us anything. And we will have universal basic income because we won't need jobs to buy stuff because everything, yeah. I will believe it when he says it while he's standing on Mars, which he said he would be at Mars already. So I'm not saying it's wrong. I'm just saying timelines. All right, Dave, what do you got for your parting shot? I don't want to hammer too much on the Graham sessions. I not, and I have been invited in the past. So I want to just say that it's not that I'm being salty because I'm not at the, the cool kids table or whatever. I've been invited back in twenty, twenty sixteen, seventeen, eighteen, around that, around that time.

58:24 I, I, Right, right. So I mean, I love the initiative. I love the private nature of it. I think it's great. I just think the payment reimbursement consideration, that is the biggest component of the entire physical therapy industry in the US. And so for that not to be a topic for the most upcoming Graham sessions is... Insane because reimbursement is not increasing. But again, like I said, I believe still most of those owners have chains of in-network practices. And maybe that's why I have nothing else to include or provide other than that.

59:07 I just baffled. Yeah, well, I will be there asking those questions. I am going to attempt to live stream. I'm going to attempt to be standing outside. I'm not going to broadcast the talks. My goal is to broadcast essentially beyond the sidelines of the Super Bowl and say like, all right, if this is the conversation, share the ideas and the things that surprised you. What is it in the room that shocked you? What was in the room? Like those big questions with... the one hundred and forty nine other thought leaders. And I will. So I'm going to try to go live. I'm going to bring the equipment down there and see if we could do it. We should still live stream that morning because I don't think it starts until later that afternoon. It's my. Yeah. So I'll go. I'll figure out a way. Plus, I got a phone.

59:48 Tony, Dave, find them where they are. And thanks for listening. That's it. We're out. Boys, what the hell are you doing? Follow Tony Meritato 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 Podcast on YouTube, the socials, and wherever you binge podcasts you pretend are for CEUs. And hey, just a reminder, none of this was for advice. This was for entertainment only. Our lawyers say that counts. Thanks, Keith.