Oct. 14, 2024
Fallologists Unite: How PTs Can Prevent Falls and Save Lives
In this episode of PT Pintcast, Jimmy McKay talks with Nick Patel from APTQI (Alliance for Physical Therapy Quality and Innovation) about the critical role physical therapists play in preventing falls among older adults. Falls are the leading cause of injury, death, and healthcare costs for people over 65, but the SAFE Act could change that. Nick dives deep into the challenges faced by PTs, how the bill aims to address them, and what therapists can do to take action. Tune in to learn more about fall prevention, the importance of advocacy, and why PTs are essential to solving this growing healthcare crisis.
Key Takeaways:
- The alarming statistics on falls in older adults.
- The SAFE Act and how it supports PTs in fall prevention.
- How PTs can advocate for change and help reduce fall risks for their patients.
Listen in to discover how PTs can be at the forefront of fall prevention, improve patient outcomes, and protect the profession from future cuts. Learn how to take action and support the SAFE Act today.
WEBVTT
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And boom.
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Nick, welcome to the show, man.
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Good to have you back.
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It's great to be back.
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Thanks for having me.
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It's been a while, Jimmy.
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How you been, man?
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So I mentioned it in the intro,
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but give people a little bit of context.
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I sort of like told people
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like your title and stuff like that,
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which is sort of ambiguous, right?
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It's just a lot of these big words.
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But what do you get to do?
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Like what's sort of like the
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purpose and the things that
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you accomplish in your role?
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What I get to do is work
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with some of the best
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operators of outpatient
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physical therapy in our industry.
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And the best way to describe
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it is sort of corralling
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all the great ideas that
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these folks have.
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So our members represent the
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actual companies and the
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people who sit on our board
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are the executives for those companies.
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It could be the CEO.
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It could be the operators like the COO.
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It could be the compliance folks.
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We have a real kind of variety.
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And as you can imagine,
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whenever you get that many
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people into a room that all
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know therapy really well
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and all like live and breathe this stuff,
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someone's got to kind of
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corral them all together
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and try to find a direction
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for all these wonderful
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thought processes.
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So that's in a nutshell what I do.
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Yeah.
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So you got a bunch of people who,
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who sort of can see
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outpatient physical therapy
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from a high level when they
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get in the room together,
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they're all probably very,
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very familiar with each other's problems,
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right?
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Cause they probably have the
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same problem and then it's
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time to talk about it.
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So one of those,
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one of those things that we
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get to look at on another
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macro level is falls
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increasingly becoming a
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major issue for older Americans and
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because I know how to read
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some census data,
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we have more older Americans,
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which is actually a good thing.
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We still have a lot of people around.
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Give me a sense though,
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from a big picture of just
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how big this problem is and
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why is it getting worse?
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Well,
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how big it is is probably summed up
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best by this stat,
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which I think still surprises people.
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Falls are the number one cause of death,
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injury and fracture in
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people over sixty five in our country.
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And most of the time people
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will say heart attack or stroke or cancer,
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which are all horrible things.
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But the number one stat is
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the number one cause is falls.
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And that's the emotional and
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pain and the grief that it causes.
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Then there's the money side.
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And these numbers are also mind boggling.
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We spend fifty billion
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dollars a year annually in
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medical costs due to falls.
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And that's where we are in
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twenty twenty four.
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By twenty thirty,
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we'll spend one hundred
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billion dollars per year on
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medical care associated with fall.
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So that's why this
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particular issue needs to
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have some solutions thought up.
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Yeah.
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So so why is it getting worse?
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Is it because we have more
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older adults and they're
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going to continue to age?
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Is that one of the reasons?
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Are there more?
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You know, I have a pet theory about that.
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And it sounds it sounds tongue in cheek,
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but I mean it kind of seriously, which is,
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you know, if you have a heart problem.
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You know exactly who to go to.
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You're going to go to a cardiologist.
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And if you have, you know,
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cancer in your family,
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you're going to seek out an
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oncologist when you get that, you know,
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colonoscopy or MRI or whatever.
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If you ask most people over
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sixty five in our country
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who the phallologist is, they don't know.
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And that's part of our fault.
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We don't get the word out.
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But part of it is,
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for such a huge cause of
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all this pain and suffering and death,
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there isn't that automatic
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in your head as a consumer of,
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that's the healthcare
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professional I should go to.
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But as I said many times on the Hill,
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we are the phallologists.
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Therapists are the phallologists.
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If we just rebranded ourselves like that,
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maybe more people would
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seek out care for it and
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we'd bend that curve a little bit.
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yeah uh as a communications
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marketing guy I love
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fallologist being very very
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clear to the point this is
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what I do this is one of
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the one of the things that
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I get to do let's talk
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about some fallologists how
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can pts play a leading role
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in reducing these falls so
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we maybe could get that off
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the top of the list as the
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leading call of a cause of
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death and mortality and hey
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listen nobody likes to
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spend more because if we're
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spending a lot on this
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We can't spend on other things.
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So how can we play a better
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role upstream in reducing
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fall risks for older adults?
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And then why are we actually essential?
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I mean, you're talking to the choir here,
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of course.
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So by all means,
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preach and make us say amen.
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But why are we essential to
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solving this problem?
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Well, I think of it this way.
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I mean,
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a lot of the causes for falls are
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absolutely in our
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wheelhouse as PTs and OTs.
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Because, you know, as I say,
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OTs are people too, right?
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So we have a unique, you know,
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scope of practice that
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deals with things like balance.
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Think about like the home
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care setup and like the way
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someone's house,
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because the home is the
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most common area where people fall.
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But like how to make your
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home more safe for you.
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Again, that's totally in our wheelhouse.
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The actions that people are
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doing when they fall are
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usually transitional activities.
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Getting out of the bathtub,
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getting out of a car,
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getting on and off the toilet.
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Again,
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if we are not the best people to
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teach people how to do
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these things safely, who is?
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Right.
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Like it has to be that we
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own those spaces.
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And, and so from my point of view,
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we know that stuff.
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We do implement it.
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Unfortunately,
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we use most of those skills
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after people have already fallen.
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We are great with decreasing
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the fall risk for a patient
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that comes in tomorrow.
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Who's already broken her hip
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because they tell us they
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broke their hip.
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And we say, well,
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Great,
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we can help you with your broken hip,
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but we're also,
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you told me you did this
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because of the fall.
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Well,
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we can do all these great things for
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you to make sure you don't fall again.
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And I'll remember one time
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and specifically,
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I was probably really early
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on in my career,
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I was maybe six months in,
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and I told this wonderful
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lady about how I was gonna
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help her with her hip,
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but because she fell,
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I was gonna decrease her
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fall by doing all those things.
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Now I'm in my head thinking
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this woman's gonna love me
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and it's great.
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I'm already picking out what
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flavor of bread she's gonna
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bake me and stuff like that.
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And I'll never forget it.
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She looks at me and she goes, that's great,
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dear.
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Sure would have been good to
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know that ahead of time.
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And it's just the simplest statement,
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but it always struck with me,
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and I heard that twenty years ago.
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But if what we do with
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people after they fall is
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effective to decrease future falls,
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why can't we move ourselves
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upstream a little bit and
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get at them before they had
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that massive injury and the
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pain and the cost and all
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that kind of stuff that happens?
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So that's sort of where I
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believe we need to kind of
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focus on a little bit.
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All right.
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So so let's talk about this safe act,
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right, that you're you're advocating for,
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like help me understand like big picture.
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What is it and how would it
00:06:45.569 --> 00:06:47.492
do the thing or should have
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done for that woman?
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Twenty years ago,
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how would it help us do the thing,
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which is prevent falls
00:06:51.959 --> 00:06:53.000
among older Americans?
00:06:53.680 --> 00:06:55.482
So what it would do is it's
00:06:55.502 --> 00:06:56.341
a very simple bill.
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First of all,
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it's I love bills are less
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than four or five pages
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because that means they're
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not super complicated.
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And this one is and it's very simple.
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We have already a benefit
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for Medicare called the
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annual wellness visit and
00:07:07.526 --> 00:07:09.187
the medical and Medicare benefit,
00:07:09.607 --> 00:07:10.826
which means like once a year.
00:07:10.887 --> 00:07:12.747
So once every twelve months.
00:07:13.408 --> 00:07:14.810
Any Medicare beneficiary can
00:07:14.850 --> 00:07:15.831
go into their physician.
00:07:15.951 --> 00:07:17.211
Usually it's an internist or
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a family practice doc and
00:07:18.913 --> 00:07:20.516
they get a free visit.
00:07:20.555 --> 00:07:22.338
So it's not nothing out of pocket to them.
00:07:22.677 --> 00:07:23.478
And they get screened for
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all these issues.
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You know, you get your blood work done.
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No cost to you.
00:07:27.723 --> 00:07:28.485
You get, you know,
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a cognition screening done.
00:07:31.168 --> 00:07:32.108
No cost to you, blah, blah, blah.
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All this stuff.
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Right.
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And then if something comes
00:07:35.130 --> 00:07:37.432
out of that visit, if your physician says,
00:07:37.932 --> 00:07:38.132
you know,
00:07:38.192 --> 00:07:39.452
tell me about your family history.
00:07:39.612 --> 00:07:40.653
And they say, you know what,
00:07:40.774 --> 00:07:42.634
my dad's diabetic, my mom's diabetic,
00:07:42.675 --> 00:07:43.295
you know, blah, blah.
00:07:43.755 --> 00:07:44.495
That physician may say,
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let's go get your A and C checked out.
00:07:45.997 --> 00:07:47.418
But don't worry, no cost to you.
00:07:47.437 --> 00:07:48.557
But someone else will do that.
00:07:49.139 --> 00:07:50.738
Maybe you have a family history of cancer.
00:07:50.759 --> 00:07:52.579
You should go get a mammogram once a year.
00:07:52.841 --> 00:07:53.761
It'll be no cost to you.
00:07:53.781 --> 00:07:54.201
Get it done.
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Colonoscopy once a year.
00:07:55.922 --> 00:07:56.622
No cost to you.
00:07:56.663 --> 00:07:57.103
Get it done.
00:07:58.932 --> 00:07:59.771
In this annual wellness
00:07:59.992 --> 00:08:00.833
position usually does
00:08:00.872 --> 00:08:01.853
something like a time get
00:08:01.894 --> 00:08:04.536
up and go or a some kind of
00:08:04.576 --> 00:08:06.298
fall screen or as asked you like,
00:08:06.319 --> 00:08:07.259
have you fallen in the last year?
00:08:07.278 --> 00:08:08.581
And they'll check a box and
00:08:08.600 --> 00:08:09.240
they'll say that, hey,
00:08:09.261 --> 00:08:10.482
you're a higher risk of falls.
00:08:10.942 --> 00:08:12.223
And then the conversation stops.
00:08:12.904 --> 00:08:14.766
Unlike with diabetes and cancers,
00:08:15.007 --> 00:08:16.007
the conversation just stops.
00:08:16.447 --> 00:08:19.488
But what this bill does in essence says,
00:08:20.009 --> 00:08:21.209
if during this visit,
00:08:21.548 --> 00:08:23.009
your physician determines
00:08:23.048 --> 00:08:24.410
you fell once in the last year,
00:08:24.790 --> 00:08:26.129
that patient automatically
00:08:26.149 --> 00:08:28.711
becomes eligible to go to
00:08:28.810 --> 00:08:32.091
any PT or OT and have a
00:08:32.130 --> 00:08:33.311
fall risk assessment done.
00:08:33.591 --> 00:08:35.032
Not just a time, get up and go,
00:08:35.052 --> 00:08:36.792
but let me test your strength.
00:08:36.831 --> 00:08:37.672
Let me test your balance.
00:08:37.692 --> 00:08:38.712
Let me check your inner ear.
00:08:39.033 --> 00:08:40.753
Talk to me about your home environment.
00:08:41.113 --> 00:08:41.874
um this could be done in
00:08:41.913 --> 00:08:43.274
their home or in our clinic
00:08:43.815 --> 00:08:45.235
and that will be free to
00:08:45.255 --> 00:08:46.537
that visit will be free to
00:08:46.557 --> 00:08:47.898
the patient just like the
00:08:48.019 --> 00:08:50.080
other um items that we try
00:08:50.120 --> 00:08:52.581
to do to stop a cancer or a
00:08:52.621 --> 00:08:54.644
diabetes diabetes diagnosis
00:08:55.144 --> 00:08:56.205
it'll be no cost them to
00:08:56.264 --> 00:08:57.686
incentivize the patient to
00:08:57.725 --> 00:09:00.828
go so and it puts us before
00:09:01.028 --> 00:09:03.190
they had that massive injury so um
00:09:04.071 --> 00:09:06.572
now if uh if if you have
00:09:06.611 --> 00:09:08.211
them and they come in and
00:09:08.312 --> 00:09:10.111
the visit's done you give
00:09:10.131 --> 00:09:11.253
them a great home program
00:09:11.273 --> 00:09:12.552
you give them you know uh
00:09:12.613 --> 00:09:13.552
instructions on how to make
00:09:13.572 --> 00:09:15.514
their home safer that you
00:09:15.533 --> 00:09:16.673
know that makes that
00:09:16.714 --> 00:09:17.494
patient better off because
00:09:17.573 --> 00:09:19.073
not just being told hey
00:09:19.094 --> 00:09:20.114
you're you're a fall risk
00:09:20.375 --> 00:09:21.534
but now they have something
00:09:21.794 --> 00:09:22.855
and the person is giving it
00:09:22.875 --> 00:09:24.095
to them is the health care
00:09:24.115 --> 00:09:25.196
provider that does this
00:09:25.235 --> 00:09:26.456
like every single day
00:09:27.115 --> 00:09:29.038
The fallologist putting the
00:09:29.097 --> 00:09:30.318
person at risk for falls in
00:09:30.339 --> 00:09:31.379
front of a fallologist.
00:09:31.399 --> 00:09:32.140
Right.
00:09:32.181 --> 00:09:34.123
So if therapists are nodding
00:09:34.143 --> 00:09:35.745
along right again, I said, you know,
00:09:35.784 --> 00:09:37.046
Nick's over here preaching to the choir,
00:09:37.066 --> 00:09:38.547
but he's just screaming at a man.
00:09:38.587 --> 00:09:39.948
But how can they get
00:09:40.009 --> 00:09:41.870
involved themselves and
00:09:42.370 --> 00:09:43.292
along with their patients
00:09:43.392 --> 00:09:44.293
in supporting it?
00:09:44.373 --> 00:09:45.674
Because I like simple.
00:09:45.835 --> 00:09:46.534
I like clear.
00:09:46.696 --> 00:09:47.416
I like value.
00:09:48.216 --> 00:09:50.219
but these things don't just happen, right?
00:09:50.239 --> 00:09:50.359
Well,
00:09:50.379 --> 00:09:51.460
you might put up a great idea if
00:09:51.480 --> 00:09:52.421
there's no support behind,
00:09:52.441 --> 00:09:53.160
it doesn't do it.
00:09:53.201 --> 00:09:54.982
So talk to me from like a
00:09:55.062 --> 00:09:55.964
tactical perspective,
00:09:56.004 --> 00:09:56.823
like what do people
00:09:56.923 --> 00:09:58.525
actually need to do to make
00:09:58.566 --> 00:10:00.847
sure this thing doesn't fall off?
00:10:01.898 --> 00:10:02.619
No pun intended, right?
00:10:04.400 --> 00:10:05.701
So a couple of things.
00:10:05.881 --> 00:10:08.085
And the simplest things are
00:10:08.105 --> 00:10:09.725
the ones that most of PTs
00:10:10.006 --> 00:10:11.087
are used to doing because
00:10:11.107 --> 00:10:12.369
we've asked people to do it many times.
00:10:12.809 --> 00:10:14.731
And you can send in letters
00:10:14.751 --> 00:10:15.552
to your member of Congress.
00:10:15.591 --> 00:10:16.533
It is a bill right now.
00:10:16.793 --> 00:10:18.195
The bill number is H.R.
00:10:18.274 --> 00:10:19.416
seventy six eighteen.
00:10:20.216 --> 00:10:21.197
It's a bipartisan bill.
00:10:22.278 --> 00:10:24.578
And if you go to aptqi.com
00:10:24.658 --> 00:10:26.120
under the Take Action tab,
00:10:26.440 --> 00:10:27.500
you'll see letters in there
00:10:27.520 --> 00:10:28.441
that one's written from the
00:10:28.461 --> 00:10:29.422
point of view of a therapist,
00:10:29.522 --> 00:10:30.062
one's written from the
00:10:30.081 --> 00:10:31.001
point of view of a patient.
00:10:31.043 --> 00:10:31.883
So, you know,
00:10:31.923 --> 00:10:33.244
you got patients that feel
00:10:33.283 --> 00:10:34.923
strongly about this, you know,
00:10:35.504 --> 00:10:36.125
give them the link,
00:10:36.164 --> 00:10:36.985
have them fill it out.
00:10:37.145 --> 00:10:37.385
You know,
00:10:37.446 --> 00:10:38.566
other therapists in your clinics
00:10:38.586 --> 00:10:39.046
can do it.
00:10:39.346 --> 00:10:40.346
That's the easiest thing.
00:10:40.667 --> 00:10:41.628
No sweat off your back.
00:10:42.207 --> 00:10:43.048
Put your address in.
00:10:43.109 --> 00:10:43.548
Honest to God,
00:10:43.568 --> 00:10:44.509
it takes maybe thirty
00:10:44.548 --> 00:10:45.990
seconds tops for you to do
00:10:46.049 --> 00:10:47.591
it or a patient to do it.
00:10:48.211 --> 00:10:49.032
But then there's some next
00:10:49.072 --> 00:10:49.952
level things that you can
00:10:49.993 --> 00:10:51.913
do that I think maybe we
00:10:51.974 --> 00:10:52.914
don't do as good a job.
00:10:53.095 --> 00:10:54.236
We're great at sending in letters,
00:10:54.297 --> 00:10:55.236
but I think therapists can
00:10:55.277 --> 00:10:56.859
do a little bit better job about this.
00:10:57.840 --> 00:10:59.000
You kind of alluded to this earlier,
00:10:59.081 --> 00:11:00.022
and I talked about this is
00:11:00.081 --> 00:11:01.062
we have this communications
00:11:01.102 --> 00:11:02.083
problem that we're not
00:11:02.104 --> 00:11:03.144
associated with falls.
00:11:03.184 --> 00:11:03.284
Right.
00:11:04.004 --> 00:11:06.827
And both from a consumer point of view,
00:11:07.187 --> 00:11:08.548
but also from a legislator
00:11:08.589 --> 00:11:10.051
and decision maker point of view.
00:11:10.410 --> 00:11:11.032
And so one of the things
00:11:11.052 --> 00:11:12.653
that we've done at APTQI is
00:11:12.692 --> 00:11:14.014
we've probably hosted almost
00:11:14.835 --> 00:11:16.277
Got about twenty so far
00:11:16.677 --> 00:11:18.318
members and staffers of
00:11:18.379 --> 00:11:20.240
Congress to come into our clinics.
00:11:20.280 --> 00:11:21.001
And guess what we do?
00:11:21.221 --> 00:11:22.423
We do a fall risk assessment on them.
00:11:22.722 --> 00:11:24.164
We like, hey, let me show you what we do.
00:11:24.585 --> 00:11:25.186
And we've had a lot of
00:11:25.206 --> 00:11:26.868
people leaving the clinic saying,
00:11:27.048 --> 00:11:28.028
I did not know that this is
00:11:28.048 --> 00:11:29.350
what you guys do all the time.
00:11:29.650 --> 00:11:30.892
Put them on a balance master.
00:11:30.932 --> 00:11:31.793
Tell them to stand on one
00:11:31.832 --> 00:11:32.833
leg with their eyes closed.
00:11:33.254 --> 00:11:33.414
You know,
00:11:33.434 --> 00:11:36.437
show them how the setup of a
00:11:36.618 --> 00:11:37.379
house can work.
00:11:37.658 --> 00:11:38.759
dramatically increase or
00:11:38.798 --> 00:11:39.659
decrease their risk of
00:11:39.679 --> 00:11:41.399
falls by the angle of their
00:11:41.620 --> 00:11:43.780
recliner or the height of the toilet seat,
00:11:43.801 --> 00:11:45.061
or some really simple
00:11:45.100 --> 00:11:46.662
things like put some bars here or,
00:11:47.062 --> 00:11:47.822
you know, stuff like that,
00:11:47.861 --> 00:11:49.523
that you sent second nature to you,
00:11:49.562 --> 00:11:50.682
but they need to know it.
00:11:50.722 --> 00:11:53.744
And I think that places in their minds, Oh,
00:11:53.783 --> 00:11:55.284
this is what PTs can actually do it.
00:11:55.304 --> 00:11:56.804
This is what OTs can actually do.
00:11:57.144 --> 00:11:58.105
And you gotta have that
00:11:58.125 --> 00:11:59.405
because letters are one thing,
00:11:59.885 --> 00:12:02.067
but you know, saying that my,
00:12:02.626 --> 00:12:03.687
my healthcare staffer,
00:12:03.846 --> 00:12:06.388
I personally went to that clinic and,
00:12:06.528 --> 00:12:08.690
And they showed me what they do.
00:12:09.029 --> 00:12:09.850
And they actually showed me
00:12:09.870 --> 00:12:10.711
that I have some fall
00:12:10.750 --> 00:12:12.412
deficits that I didn't even know I had.
00:12:12.711 --> 00:12:15.173
And, you know, let's face it, you know,
00:12:15.193 --> 00:12:15.693
when you're talking about
00:12:15.714 --> 00:12:17.075
that over-sixty-five demographic,
00:12:17.095 --> 00:12:17.735
that includes a lot of
00:12:17.755 --> 00:12:18.436
members of Congress.
00:12:18.456 --> 00:12:19.456
They probably are very
00:12:19.476 --> 00:12:20.898
curious about what that would look like.
00:12:20.937 --> 00:12:22.458
So get them in your clinic.
00:12:22.538 --> 00:12:23.239
And that is,
00:12:23.799 --> 00:12:25.201
I'm not saying it's super easy,
00:12:26.100 --> 00:12:27.081
but it's super fruitful.
00:12:27.322 --> 00:12:29.663
And if you get, you know, if you invite,
00:12:30.364 --> 00:12:30.563
you know,
00:12:30.644 --> 00:12:32.465
every clinic's got two senators
00:12:32.485 --> 00:12:33.025
in the Congress,
00:12:33.485 --> 00:12:34.726
a member of Congress of the
00:12:34.767 --> 00:12:36.268
House in their district.
00:12:36.827 --> 00:12:38.649
We're lucky at APTQI.
00:12:38.669 --> 00:12:39.812
We have a lot of multi-state
00:12:39.871 --> 00:12:41.033
large members.
00:12:41.432 --> 00:12:42.695
So we've gotten about twenty
00:12:42.715 --> 00:12:45.597
to come in just from the summer till now.
00:12:46.138 --> 00:12:47.158
And we have more lined up
00:12:47.200 --> 00:12:48.140
before the end of the year.
00:12:48.221 --> 00:12:51.423
So don't underestimate just
00:12:51.524 --> 00:12:52.585
showing someone what
00:12:52.644 --> 00:12:53.605
therapy does and how
00:12:53.666 --> 00:12:54.927
powerful that can be by
00:12:54.967 --> 00:12:55.869
putting them in your clinic.
00:12:56.168 --> 00:12:57.729
Yeah, and that show where, listen,
00:12:57.788 --> 00:12:58.729
everybody's favorite day in
00:12:58.769 --> 00:13:00.110
third grade was show and tell.
00:13:00.970 --> 00:13:02.029
You wanted to do more of the
00:13:02.049 --> 00:13:04.890
showing because that got more attention,
00:13:05.010 --> 00:13:06.971
that told a better story.
00:13:07.370 --> 00:13:08.110
So by all means,
00:13:08.150 --> 00:13:09.331
I feel like show and tell
00:13:09.471 --> 00:13:12.351
in your example is the show is very much,
00:13:12.672 --> 00:13:12.772
hey,
00:13:12.792 --> 00:13:13.831
wouldn't it be great if you could do
00:13:13.851 --> 00:13:15.312
a fall assessment on your senator,
00:13:15.432 --> 00:13:16.312
like your state senator?
00:13:16.332 --> 00:13:17.232
Like, wouldn't that be amazing?
00:13:17.753 --> 00:13:21.972
The tell is not, you know, not important,
00:13:22.013 --> 00:13:23.673
but those are the letters, right?
00:13:24.053 --> 00:13:24.354
Because...
00:13:25.153 --> 00:13:26.254
Understanding your audience
00:13:26.294 --> 00:13:27.174
is really important.
00:13:27.456 --> 00:13:29.017
And people in elected positions,
00:13:29.476 --> 00:13:30.538
their job is to make sure
00:13:30.557 --> 00:13:31.337
that the people in their
00:13:31.378 --> 00:13:32.938
districts or their states are heard.
00:13:33.539 --> 00:13:34.941
And understanding how many
00:13:34.980 --> 00:13:35.921
of those people this can
00:13:35.961 --> 00:13:37.802
affect when you show them
00:13:38.243 --> 00:13:39.244
and just a couple of stats
00:13:39.264 --> 00:13:39.984
that you had mentioned in
00:13:40.024 --> 00:13:41.164
terms of cost or number of
00:13:41.184 --> 00:13:42.265
people affected.
00:13:42.725 --> 00:13:44.907
Now, that's easy to remember.
00:13:45.167 --> 00:13:46.408
Later on, when this thing comes up,
00:13:46.427 --> 00:13:47.188
they're going to go, hey,
00:13:47.208 --> 00:13:47.769
I remember that.
00:13:47.828 --> 00:13:48.809
That was pretty impactful.
00:13:48.850 --> 00:13:50.030
This is kind of a big deal.
00:13:50.591 --> 00:13:52.591
This sounds simple, but as you mentioned,
00:13:52.611 --> 00:13:53.413
it's not easy,
00:13:53.832 --> 00:13:54.874
but it feels like it's worth it.
00:13:55.553 --> 00:13:55.793
Yeah.
00:13:55.855 --> 00:13:56.495
And then you've kind of
00:13:56.534 --> 00:13:57.575
placed your profession,
00:13:57.615 --> 00:13:58.936
not just you yourself individually,
00:13:58.975 --> 00:13:59.716
but now you've placed your
00:13:59.736 --> 00:14:00.996
profession in that person's
00:14:01.037 --> 00:14:03.239
head as I know what these guys do now.
00:14:03.778 --> 00:14:06.520
Because for good or bad therapy,
00:14:06.541 --> 00:14:08.000
we practice in so many settings.
00:14:08.562 --> 00:14:10.082
We do so many different things.
00:14:10.722 --> 00:14:11.984
If you ask ten people what a
00:14:12.024 --> 00:14:12.884
physical therapist does,
00:14:12.903 --> 00:14:14.164
you might get seven different answers.
00:14:14.585 --> 00:14:15.505
And probably none of them
00:14:15.525 --> 00:14:18.067
are going to be like a falls expert.
00:14:18.086 --> 00:14:19.587
You'll get works with my kid
00:14:19.947 --> 00:14:20.649
in their school.
00:14:20.668 --> 00:14:22.490
You'll get I saw them in the hospital.
00:14:22.789 --> 00:14:24.630
You'll get and they work in sniffs.
00:14:24.730 --> 00:14:27.011
You'll get I hurt my foot
00:14:27.072 --> 00:14:27.831
and they help me there.
00:14:28.232 --> 00:14:30.094
But they'll have all these things.
00:14:30.173 --> 00:14:31.575
And that's because they
00:14:31.634 --> 00:14:32.595
personally experienced it
00:14:32.615 --> 00:14:33.515
because they were shown it.
00:14:33.875 --> 00:14:35.397
But they haven't been shown this yet.
00:14:35.437 --> 00:14:37.658
So your show and tell analogy is spot on.
00:14:38.029 --> 00:14:38.190
Yeah.
00:14:38.250 --> 00:14:38.529
Yeah.
00:14:38.649 --> 00:14:39.591
And none of those seven
00:14:40.191 --> 00:14:42.452
definitions of PT are wrong.
00:14:43.013 --> 00:14:44.173
No, but we've got to make sure.
00:14:44.394 --> 00:14:45.033
I don't know, man.
00:14:45.254 --> 00:14:45.475
I mean,
00:14:45.495 --> 00:14:46.755
maybe I walk around at CSN with
00:14:46.796 --> 00:14:48.056
fallologist merch and just
00:14:48.076 --> 00:14:48.756
start selling that.
00:14:48.777 --> 00:14:49.856
But it feels like that's a
00:14:49.917 --> 00:14:52.119
really good way to say we do that.
00:14:52.178 --> 00:14:53.299
This is something that we do.
00:14:54.000 --> 00:14:55.000
I only tried you like a five
00:14:55.020 --> 00:14:56.562
percent royalty, man.
00:14:56.621 --> 00:14:57.062
I'll hawk it.
00:14:57.081 --> 00:14:57.361
Let's go.
00:14:59.964 --> 00:15:01.683
So what's the deadline on this?
00:15:02.784 --> 00:15:04.184
If we just say, hey, do it, whatever,
00:15:04.365 --> 00:15:05.125
you and I both know no
00:15:05.145 --> 00:15:05.826
one's going to do it.
00:15:05.946 --> 00:15:08.206
But we need to put a
00:15:08.307 --> 00:15:10.567
measurable and specific goal on this.
00:15:11.087 --> 00:15:12.729
By when do PTs need to act
00:15:12.788 --> 00:15:13.809
to make sure this is heard?
00:15:14.149 --> 00:15:16.350
For maximum effectiveness,
00:15:16.451 --> 00:15:17.191
as you may have heard,
00:15:17.211 --> 00:15:18.672
we got an election coming
00:15:18.711 --> 00:15:20.032
up in less than two months,
00:15:20.371 --> 00:15:21.312
which means that this
00:15:21.352 --> 00:15:22.774
congressional session ends
00:15:24.114 --> 00:15:25.835
early January of twenty twenty five.
00:15:26.475 --> 00:15:27.655
And so any
00:15:28.615 --> 00:15:30.157
any legislation anything
00:15:30.236 --> 00:15:31.037
last minute they're going
00:15:31.057 --> 00:15:31.917
to pass is probably going
00:15:31.937 --> 00:15:34.177
to be all put together
00:15:34.538 --> 00:15:35.879
probably around november
00:15:36.119 --> 00:15:37.320
right and then they'll have
00:15:37.340 --> 00:15:38.399
their mad rush before the
00:15:38.440 --> 00:15:39.740
holidays to uh to get it
00:15:39.801 --> 00:15:41.621
done so for peak
00:15:41.662 --> 00:15:42.721
effectiveness we need to
00:15:42.741 --> 00:15:43.642
have our voice heard as
00:15:43.701 --> 00:15:44.682
much as possible between
00:15:44.743 --> 00:15:45.903
now and the end of october
00:15:46.062 --> 00:15:46.964
that's really like that
00:15:47.004 --> 00:15:49.105
window um that if we don't
00:15:49.125 --> 00:15:50.424
get it doesn't mean it's uh
00:15:50.644 --> 00:15:51.546
end of the world it just
00:15:51.586 --> 00:15:52.385
means we have to start all
00:15:52.426 --> 00:15:53.125
over again this will be a
00:15:53.166 --> 00:15:54.126
brand new congress starting
00:15:54.147 --> 00:15:55.167
january twenty twenty five
00:15:55.187 --> 00:15:56.008
we got to reintroduce the
00:15:56.048 --> 00:15:57.067
bill and start from scratch
00:15:57.798 --> 00:15:59.081
Perfect.
00:15:59.442 --> 00:16:01.725
APTQI.com.
00:16:01.765 --> 00:16:02.407
Did I get that?
00:16:02.427 --> 00:16:02.748
I did, right?
00:16:02.768 --> 00:16:03.448
That is perfect.
00:16:03.548 --> 00:16:03.909
I got it.
00:16:03.929 --> 00:16:04.110
All right.
00:16:04.171 --> 00:16:04.792
That's where you can find
00:16:04.831 --> 00:16:05.472
more information.
00:16:05.793 --> 00:16:05.933
Nick,
00:16:05.953 --> 00:16:07.355
is there anything I didn't ask about
00:16:07.375 --> 00:16:08.658
that you want to make sure PT's new?
00:16:10.043 --> 00:16:11.304
The other thing that I just
00:16:11.325 --> 00:16:12.466
wanted to highlight again
00:16:12.625 --> 00:16:13.846
is while I'm preaching to the choir,
00:16:13.866 --> 00:16:14.807
take a second.
00:16:15.008 --> 00:16:16.129
There's a second provision
00:16:16.168 --> 00:16:17.049
of the SAFE Act that I
00:16:17.070 --> 00:16:18.490
think is really important
00:16:18.510 --> 00:16:20.113
for us to understand.
00:16:20.452 --> 00:16:21.714
And the reason we put that
00:16:21.754 --> 00:16:24.556
in there was to help
00:16:24.576 --> 00:16:26.017
solidify and protect us
00:16:26.057 --> 00:16:26.717
against these cuts,
00:16:26.738 --> 00:16:27.798
which I know we are all
00:16:27.918 --> 00:16:29.279
dealing with and facing.
00:16:29.700 --> 00:16:32.842
So quick lesson on
00:16:32.962 --> 00:16:34.625
governmental accounting methods.
00:16:35.666 --> 00:16:37.307
when we get cut as therapists,
00:16:37.988 --> 00:16:39.089
the government on paper
00:16:39.109 --> 00:16:39.889
will save money because
00:16:39.909 --> 00:16:40.711
they're paying us less.
00:16:41.350 --> 00:16:43.173
Now you and I and the choir
00:16:43.192 --> 00:16:44.774
understand that we are low
00:16:44.794 --> 00:16:45.634
cost providers.
00:16:45.754 --> 00:16:46.535
And when you take out the
00:16:46.556 --> 00:16:47.456
low cost provider,
00:16:47.616 --> 00:16:49.078
or if you decrease their
00:16:49.099 --> 00:16:50.099
ability to do their job,
00:16:50.720 --> 00:16:51.640
the entire healthcare
00:16:51.660 --> 00:16:52.642
continuum probably spends
00:16:52.682 --> 00:16:54.202
more money downstream and
00:16:54.243 --> 00:16:55.104
that's not good for us.
00:16:55.163 --> 00:16:56.825
But the problem is accounting wise,
00:16:56.845 --> 00:16:57.566
it's really hard to
00:16:57.605 --> 00:16:58.947
dynamically score what a
00:16:59.006 --> 00:17:00.048
physical therapist does.
00:17:00.408 --> 00:17:01.809
And so when you cut therapy
00:17:02.049 --> 00:17:03.671
that saves money, when you increase costs,
00:17:03.931 --> 00:17:04.372
uh, uh,
00:17:04.511 --> 00:17:05.952
reimbursement therapy that costs
00:17:05.972 --> 00:17:07.013
the government money and
00:17:07.034 --> 00:17:07.615
that's a cost her.
00:17:08.434 --> 00:17:09.977
So one thing that we did
00:17:10.636 --> 00:17:12.659
with this bill is we said, you know,
00:17:12.739 --> 00:17:13.579
if we, um,
00:17:14.227 --> 00:17:15.147
we get this bill passed the
00:17:15.188 --> 00:17:16.528
second provision which is
00:17:16.568 --> 00:17:18.611
along the paragraph says if
00:17:18.652 --> 00:17:19.633
this goes into effect this
00:17:19.673 --> 00:17:20.673
new benefit for seniors
00:17:20.713 --> 00:17:21.994
goes into effect the
00:17:22.015 --> 00:17:23.696
government needs to track
00:17:23.896 --> 00:17:25.278
the people who fell after
00:17:25.719 --> 00:17:26.659
words and compare like the
00:17:26.700 --> 00:17:27.660
folks who had this screen
00:17:27.681 --> 00:17:29.021
by ptrot and the folks who
00:17:29.041 --> 00:17:31.144
didn't and what happened to
00:17:31.163 --> 00:17:32.125
the nature of falls into
00:17:32.144 --> 00:17:33.125
the incidence of falls and
00:17:33.165 --> 00:17:34.106
things like that and are we
00:17:34.126 --> 00:17:35.067
spending more for people
00:17:35.307 --> 00:17:36.169
who don't get you know a
00:17:36.189 --> 00:17:37.650
fall risk assessment and those that do
00:17:38.828 --> 00:17:40.130
As you will probably understand,
00:17:40.450 --> 00:17:41.369
the people in the group
00:17:41.410 --> 00:17:42.550
that had that fall
00:17:42.570 --> 00:17:43.830
resistance will probably fall less.
00:17:44.192 --> 00:17:46.232
And we've done some backwards analysis,
00:17:46.553 --> 00:17:47.913
pretty heavy math on that.
00:17:47.932 --> 00:17:48.913
And we know that that's true.
00:17:49.314 --> 00:17:50.694
If people who've had therapy
00:17:50.815 --> 00:17:52.915
after a minor fall have a
00:17:53.175 --> 00:17:54.056
fifty percent less
00:17:54.115 --> 00:17:55.317
likelihood of falling again
00:17:55.836 --> 00:17:57.377
in the next six months to
00:17:57.397 --> 00:17:58.377
the level that requires an
00:17:58.478 --> 00:17:59.979
ER or a hospital visit.
00:17:59.999 --> 00:18:01.200
So we know that that happens.
00:18:01.920 --> 00:18:03.421
So if Congress gets a report
00:18:03.682 --> 00:18:04.521
saying that here's what
00:18:04.561 --> 00:18:06.083
therapy does and here's
00:18:06.123 --> 00:18:09.486
what therapy saved in terms
00:18:09.526 --> 00:18:10.707
of downstream expenditure,
00:18:11.387 --> 00:18:12.689
those savings that
00:18:12.729 --> 00:18:13.930
therapists do don't have to
00:18:14.109 --> 00:18:15.611
be dynamic anymore.
00:18:15.631 --> 00:18:16.692
It's not pie in the sky.
00:18:17.132 --> 00:18:18.973
It's the experience of what
00:18:19.013 --> 00:18:20.055
happened when you did this.
00:18:20.595 --> 00:18:22.115
So that can actually
00:18:22.376 --> 00:18:23.557
insulate us because every
00:18:23.577 --> 00:18:24.999
time they try to cut us in the future,
00:18:25.019 --> 00:18:26.339
we can point to it like, hey,
00:18:26.380 --> 00:18:27.300
if there's less therapists.
00:18:28.222 --> 00:18:28.742
you know you're going to
00:18:28.762 --> 00:18:30.943
spend more here because it's your data,
00:18:31.003 --> 00:18:31.464
not mine.
00:18:31.545 --> 00:18:32.964
It's not sponsored by APT.
00:18:33.665 --> 00:18:35.507
So that's what they need.
00:18:35.686 --> 00:18:37.248
It's their own data that shows it.
00:18:37.667 --> 00:18:39.388
It's kind of like Congress
00:18:39.409 --> 00:18:40.449
is always skeptical about
00:18:41.230 --> 00:18:42.549
the studies that show milk
00:18:42.589 --> 00:18:43.490
is really good for you and
00:18:43.530 --> 00:18:45.051
it's sponsored by the dairy farmers.
00:18:46.471 --> 00:18:47.633
So this is like we can keep
00:18:47.673 --> 00:18:48.292
telling them that,
00:18:48.333 --> 00:18:49.634
but it has to be in their own data.
00:18:50.114 --> 00:18:52.096
so um if you can make a dent
00:18:52.155 --> 00:18:53.438
in a potentially hundred
00:18:53.478 --> 00:18:54.519
billion dollar a year
00:18:54.578 --> 00:18:55.681
problem they're probably
00:18:55.701 --> 00:18:56.781
going to think twice about
00:18:56.902 --> 00:18:57.702
cutting you next time
00:18:57.722 --> 00:18:59.944
around and so that makes it
00:18:59.964 --> 00:19:00.926
just a little I mean it's
00:19:01.126 --> 00:19:02.268
nothing else changes about
00:19:02.508 --> 00:19:03.549
um you know the need for
00:19:03.589 --> 00:19:05.392
our patients but if you're
00:19:05.451 --> 00:19:06.212
sick of the cuts
00:19:06.692 --> 00:19:07.554
And if you're sick of people
00:19:07.574 --> 00:19:09.115
as being told that therapists, you know,
00:19:09.154 --> 00:19:10.016
have to take the brunt of
00:19:10.096 --> 00:19:11.597
all these cuts because we
00:19:11.617 --> 00:19:13.519
have to save money as a country and blah,
00:19:13.538 --> 00:19:13.759
blah, blah.
00:19:14.039 --> 00:19:14.980
This is our way to say,
00:19:15.381 --> 00:19:16.701
to show that not only can
00:19:16.721 --> 00:19:17.962
we help the patient outcome,
00:19:18.324 --> 00:19:19.424
but we can help the
00:19:19.525 --> 00:19:20.705
financial costs for the
00:19:20.726 --> 00:19:21.626
healthcare system as well
00:19:21.686 --> 00:19:22.968
and get credit for it for going out.
00:19:23.028 --> 00:19:23.387
Yeah.
00:19:23.509 --> 00:19:23.689
Yeah.
00:19:23.729 --> 00:19:24.269
Keep preaching.
00:19:24.388 --> 00:19:25.089
That's, and that's,
00:19:25.210 --> 00:19:27.192
that's what PTs like to hear, but yeah.
00:19:27.432 --> 00:19:28.152
we need to do something
00:19:28.172 --> 00:19:29.112
about it talking to each
00:19:29.172 --> 00:19:31.452
other is good but the the
00:19:31.492 --> 00:19:32.792
show of someone else needs
00:19:32.833 --> 00:19:34.294
to be uh needs to be shared
00:19:34.894 --> 00:19:35.794
uh nick last thing we do on
00:19:35.814 --> 00:19:36.634
the show is we call the
00:19:36.653 --> 00:19:38.214
parting shot what's a mic
00:19:38.234 --> 00:19:39.315
drop moment soapbox
00:19:39.355 --> 00:19:40.816
statement you know idea or
00:19:40.855 --> 00:19:41.836
concept you just want to
00:19:42.236 --> 00:19:45.017
leave as we wrap up oh man
00:19:45.057 --> 00:19:46.156
mic drop moment I would you
00:19:46.176 --> 00:19:49.738
know I I'd say this um there are uh
00:19:52.208 --> 00:19:53.147
Like I alluded to earlier,
00:19:53.848 --> 00:19:54.950
a hundred billion dollars,
00:19:55.109 --> 00:19:57.231
number one cause of death and injury.
00:19:57.551 --> 00:19:58.553
But the one that the one
00:19:58.573 --> 00:19:59.473
that always sticks with me
00:19:59.634 --> 00:20:01.875
is a person over sixty five
00:20:01.895 --> 00:20:02.257
in this country.
00:20:02.517 --> 00:20:03.518
They fall every second.
00:20:04.578 --> 00:20:04.638
Wow.
00:20:04.659 --> 00:20:05.539
We've been on this, you know,
00:20:05.559 --> 00:20:06.961
we've been on the podcast
00:20:06.980 --> 00:20:07.862
for about a half an hour.
00:20:07.981 --> 00:20:08.701
Think about how many people
00:20:08.721 --> 00:20:09.242
have already fallen.
00:20:09.962 --> 00:20:10.143
And,
00:20:10.702 --> 00:20:12.284
and so there's numbers that are big in
00:20:12.304 --> 00:20:13.684
terms of dollars and their
00:20:13.724 --> 00:20:14.865
percentages that are big,
00:20:15.365 --> 00:20:16.586
but every second,
00:20:16.726 --> 00:20:17.806
that's what it equates to.
00:20:18.766 --> 00:20:21.207
And we have to do something about it.
00:20:21.446 --> 00:20:22.367
And if it's not the
00:20:22.428 --> 00:20:23.708
phallologists of the world
00:20:23.768 --> 00:20:25.449
screaming about this, like who will,
00:20:25.528 --> 00:20:26.048
who would do it?
00:20:26.229 --> 00:20:26.769
Who's doing it?
00:20:27.910 --> 00:20:28.269
All right.
00:20:28.289 --> 00:20:28.390
Nick,
00:20:28.410 --> 00:20:29.549
thanks for putting this in perspective.
00:20:29.569 --> 00:20:30.431
Thanks for doing what you do.
00:20:30.451 --> 00:20:31.730
And hopefully we can get a couple people.
00:20:32.050 --> 00:20:32.791
We'll share the link in the
00:20:32.811 --> 00:20:33.912
show notes that people can
00:20:33.951 --> 00:20:35.132
actually take that step.
00:20:35.333 --> 00:20:36.633
Because even if we can get a
00:20:36.692 --> 00:20:37.874
hundred people to take that step,
00:20:37.894 --> 00:20:39.153
that's a hundred more that
00:20:39.173 --> 00:20:40.193
wouldn't have been there yesterday.
00:20:40.894 --> 00:20:42.674
Nick for APTQI, appreciate your time, man.
00:20:42.694 --> 00:20:43.536
Thanks, Jimmy.
00:20:43.576 --> 00:20:50.417
Have a good one.
00:20:50.438 --> 00:20:50.838
That's it.
00:20:50.858 --> 00:20:52.019
That's all I need.
00:00:01.858 --> 00:00:02.939
And boom.
00:00:03.940 --> 00:00:05.142
Nick, welcome to the show, man.
00:00:05.902 --> 00:00:06.623
Good to have you back.
00:00:07.003 --> 00:00:07.985
It's great to be back.
00:00:08.025 --> 00:00:08.705
Thanks for having me.
00:00:08.724 --> 00:00:09.285
It's been a while, Jimmy.
00:00:09.305 --> 00:00:09.846
How you been, man?
00:00:10.768 --> 00:00:12.269
So I mentioned it in the intro,
00:00:12.288 --> 00:00:13.830
but give people a little bit of context.
00:00:13.910 --> 00:00:15.131
I sort of like told people
00:00:15.172 --> 00:00:16.493
like your title and stuff like that,
00:00:16.513 --> 00:00:18.035
which is sort of ambiguous, right?
00:00:18.054 --> 00:00:19.297
It's just a lot of these big words.
00:00:19.757 --> 00:00:21.018
But what do you get to do?
00:00:21.057 --> 00:00:21.818
Like what's sort of like the
00:00:21.899 --> 00:00:23.041
purpose and the things that
00:00:23.080 --> 00:00:24.222
you accomplish in your role?
00:00:25.250 --> 00:00:28.032
What I get to do is work
00:00:28.051 --> 00:00:29.792
with some of the best
00:00:29.932 --> 00:00:31.314
operators of outpatient
00:00:31.333 --> 00:00:33.576
physical therapy in our industry.
00:00:34.115 --> 00:00:36.658
And the best way to describe
00:00:36.698 --> 00:00:38.659
it is sort of corralling
00:00:38.700 --> 00:00:40.320
all the great ideas that
00:00:40.920 --> 00:00:41.841
these folks have.
00:00:41.862 --> 00:00:45.043
So our members represent the
00:00:45.084 --> 00:00:46.284
actual companies and the
00:00:46.304 --> 00:00:47.426
people who sit on our board
00:00:47.445 --> 00:00:48.987
are the executives for those companies.
00:00:50.408 --> 00:00:51.628
It could be the CEO.
00:00:51.649 --> 00:00:53.670
It could be the operators like the COO.
00:00:53.811 --> 00:00:55.332
It could be the compliance folks.
00:00:56.091 --> 00:00:57.533
We have a real kind of variety.
00:00:58.054 --> 00:00:59.154
And as you can imagine,
00:00:59.194 --> 00:01:00.776
whenever you get that many
00:01:00.816 --> 00:01:02.436
people into a room that all
00:01:02.896 --> 00:01:04.278
know therapy really well
00:01:04.317 --> 00:01:05.739
and all like live and breathe this stuff,
00:01:06.039 --> 00:01:07.439
someone's got to kind of
00:01:07.459 --> 00:01:08.540
corral them all together
00:01:09.081 --> 00:01:10.262
and try to find a direction
00:01:10.302 --> 00:01:12.263
for all these wonderful
00:01:12.664 --> 00:01:13.625
thought processes.
00:01:13.665 --> 00:01:15.445
So that's in a nutshell what I do.
00:01:15.665 --> 00:01:15.926
Yeah.
00:01:15.945 --> 00:01:17.406
So you got a bunch of people who,
00:01:17.546 --> 00:01:18.906
who sort of can see
00:01:18.986 --> 00:01:20.147
outpatient physical therapy
00:01:20.188 --> 00:01:21.447
from a high level when they
00:01:21.489 --> 00:01:22.388
get in the room together,
00:01:22.789 --> 00:01:24.109
they're all probably very,
00:01:24.150 --> 00:01:26.210
very familiar with each other's problems,
00:01:26.331 --> 00:01:26.450
right?
00:01:26.531 --> 00:01:27.230
Cause they probably have the
00:01:27.251 --> 00:01:28.490
same problem and then it's
00:01:28.512 --> 00:01:29.371
time to talk about it.
00:01:29.751 --> 00:01:30.611
So one of those,
00:01:30.953 --> 00:01:31.813
one of those things that we
00:01:31.852 --> 00:01:32.832
get to look at on another
00:01:32.972 --> 00:01:35.153
macro level is falls
00:01:35.474 --> 00:01:36.594
increasingly becoming a
00:01:36.655 --> 00:01:38.855
major issue for older Americans and
00:01:39.534 --> 00:01:40.415
because I know how to read
00:01:40.474 --> 00:01:41.335
some census data,
00:01:41.617 --> 00:01:43.159
we have more older Americans,
00:01:43.198 --> 00:01:44.359
which is actually a good thing.
00:01:44.400 --> 00:01:45.942
We still have a lot of people around.
00:01:47.024 --> 00:01:47.844
Give me a sense though,
00:01:47.864 --> 00:01:49.087
from a big picture of just
00:01:49.126 --> 00:01:51.629
how big this problem is and
00:01:51.750 --> 00:01:52.731
why is it getting worse?
00:01:53.766 --> 00:01:53.945
Well,
00:01:54.746 --> 00:01:56.266
how big it is is probably summed up
00:01:56.487 --> 00:01:57.688
best by this stat,
00:01:57.707 --> 00:01:59.769
which I think still surprises people.
00:02:00.569 --> 00:02:03.131
Falls are the number one cause of death,
00:02:03.210 --> 00:02:04.352
injury and fracture in
00:02:04.371 --> 00:02:05.992
people over sixty five in our country.
00:02:06.433 --> 00:02:07.433
And most of the time people
00:02:07.453 --> 00:02:09.715
will say heart attack or stroke or cancer,
00:02:09.754 --> 00:02:11.436
which are all horrible things.
00:02:12.036 --> 00:02:14.457
But the number one stat is
00:02:14.617 --> 00:02:16.139
the number one cause is falls.
00:02:16.739 --> 00:02:20.080
And that's the emotional and
00:02:20.140 --> 00:02:23.283
pain and the grief that it causes.
00:02:23.623 --> 00:02:24.663
Then there's the money side.
00:02:24.704 --> 00:02:27.145
And these numbers are also mind boggling.
00:02:27.506 --> 00:02:29.206
We spend fifty billion
00:02:29.247 --> 00:02:30.467
dollars a year annually in
00:02:30.508 --> 00:02:32.469
medical costs due to falls.
00:02:33.030 --> 00:02:34.191
And that's where we are in
00:02:34.211 --> 00:02:35.110
twenty twenty four.
00:02:35.592 --> 00:02:36.391
By twenty thirty,
00:02:36.412 --> 00:02:37.453
we'll spend one hundred
00:02:37.513 --> 00:02:39.875
billion dollars per year on
00:02:39.955 --> 00:02:41.276
medical care associated with fall.
00:02:41.336 --> 00:02:42.977
So that's why this
00:02:43.317 --> 00:02:44.837
particular issue needs to
00:02:44.877 --> 00:02:46.338
have some solutions thought up.
00:02:47.000 --> 00:02:47.520
Yeah.
00:02:47.539 --> 00:02:49.502
So so why is it getting worse?
00:02:49.562 --> 00:02:50.862
Is it because we have more
00:02:50.883 --> 00:02:51.604
older adults and they're
00:02:51.623 --> 00:02:52.585
going to continue to age?
00:02:52.625 --> 00:02:53.926
Is that one of the reasons?
00:02:53.947 --> 00:02:54.447
Are there more?
00:02:55.187 --> 00:02:56.748
You know, I have a pet theory about that.
00:02:56.769 --> 00:02:58.651
And it sounds it sounds tongue in cheek,
00:02:58.670 --> 00:03:00.673
but I mean it kind of seriously, which is,
00:03:01.274 --> 00:03:02.915
you know, if you have a heart problem.
00:03:03.415 --> 00:03:04.578
You know exactly who to go to.
00:03:04.717 --> 00:03:06.319
You're going to go to a cardiologist.
00:03:06.741 --> 00:03:08.002
And if you have, you know,
00:03:08.141 --> 00:03:09.343
cancer in your family,
00:03:09.824 --> 00:03:10.705
you're going to seek out an
00:03:10.825 --> 00:03:12.527
oncologist when you get that, you know,
00:03:12.788 --> 00:03:14.471
colonoscopy or MRI or whatever.
00:03:15.431 --> 00:03:16.774
If you ask most people over
00:03:16.834 --> 00:03:18.135
sixty five in our country
00:03:18.575 --> 00:03:20.758
who the phallologist is, they don't know.
00:03:21.520 --> 00:03:23.561
And that's part of our fault.
00:03:25.161 --> 00:03:26.140
We don't get the word out.
00:03:26.401 --> 00:03:27.342
But part of it is,
00:03:28.181 --> 00:03:30.723
for such a huge cause of
00:03:30.763 --> 00:03:34.443
all this pain and suffering and death,
00:03:34.804 --> 00:03:35.943
there isn't that automatic
00:03:36.004 --> 00:03:37.784
in your head as a consumer of,
00:03:38.064 --> 00:03:38.865
that's the healthcare
00:03:38.884 --> 00:03:40.086
professional I should go to.
00:03:40.445 --> 00:03:42.907
But as I said many times on the Hill,
00:03:43.127 --> 00:03:44.127
we are the phallologists.
00:03:44.146 --> 00:03:45.407
Therapists are the phallologists.
00:03:45.426 --> 00:03:46.948
If we just rebranded ourselves like that,
00:03:47.168 --> 00:03:48.288
maybe more people would
00:03:48.307 --> 00:03:49.188
seek out care for it and
00:03:49.209 --> 00:03:50.348
we'd bend that curve a little bit.
00:03:50.709 --> 00:03:52.949
yeah uh as a communications
00:03:53.009 --> 00:03:54.030
marketing guy I love
00:03:54.050 --> 00:03:55.790
fallologist being very very
00:03:55.811 --> 00:03:56.811
clear to the point this is
00:03:56.850 --> 00:03:57.890
what I do this is one of
00:03:57.911 --> 00:03:58.671
the one of the things that
00:03:58.731 --> 00:04:00.012
I get to do let's talk
00:04:00.032 --> 00:04:01.372
about some fallologists how
00:04:01.413 --> 00:04:03.853
can pts play a leading role
00:04:03.932 --> 00:04:05.954
in reducing these falls so
00:04:05.993 --> 00:04:07.615
we maybe could get that off
00:04:07.655 --> 00:04:08.514
the top of the list as the
00:04:08.574 --> 00:04:09.634
leading call of a cause of
00:04:09.675 --> 00:04:11.415
death and mortality and hey
00:04:11.455 --> 00:04:12.195
listen nobody likes to
00:04:12.235 --> 00:04:13.376
spend more because if we're
00:04:13.395 --> 00:04:14.417
spending a lot on this
00:04:15.396 --> 00:04:16.718
We can't spend on other things.
00:04:16.737 --> 00:04:18.379
So how can we play a better
00:04:18.420 --> 00:04:20.500
role upstream in reducing
00:04:20.560 --> 00:04:21.841
fall risks for older adults?
00:04:21.882 --> 00:04:24.244
And then why are we actually essential?
00:04:24.264 --> 00:04:25.404
I mean, you're talking to the choir here,
00:04:25.444 --> 00:04:25.764
of course.
00:04:25.785 --> 00:04:27.086
So by all means,
00:04:27.166 --> 00:04:28.187
preach and make us say amen.
00:04:28.548 --> 00:04:30.509
But why are we essential to
00:04:30.569 --> 00:04:31.290
solving this problem?
00:04:31.589 --> 00:04:32.810
Well, I think of it this way.
00:04:32.971 --> 00:04:33.250
I mean,
00:04:34.711 --> 00:04:36.894
a lot of the causes for falls are
00:04:37.053 --> 00:04:37.874
absolutely in our
00:04:37.915 --> 00:04:39.516
wheelhouse as PTs and OTs.
00:04:39.536 --> 00:04:40.636
Because, you know, as I say,
00:04:40.716 --> 00:04:41.956
OTs are people too, right?
00:04:41.997 --> 00:04:46.920
So we have a unique, you know,
00:04:47.221 --> 00:04:48.122
scope of practice that
00:04:48.161 --> 00:04:49.442
deals with things like balance.
00:04:50.283 --> 00:04:52.365
Think about like the home
00:04:52.384 --> 00:04:53.745
care setup and like the way
00:04:54.807 --> 00:04:55.447
someone's house,
00:04:55.507 --> 00:04:56.389
because the home is the
00:04:56.428 --> 00:04:57.870
most common area where people fall.
00:04:58.269 --> 00:04:59.151
But like how to make your
00:04:59.170 --> 00:05:00.132
home more safe for you.
00:05:00.432 --> 00:05:01.992
Again, that's totally in our wheelhouse.
00:05:03.254 --> 00:05:04.314
The actions that people are
00:05:04.334 --> 00:05:05.216
doing when they fall are
00:05:05.255 --> 00:05:06.396
usually transitional activities.
00:05:07.098 --> 00:05:08.319
Getting out of the bathtub,
00:05:08.499 --> 00:05:10.040
getting out of a car,
00:05:10.079 --> 00:05:11.240
getting on and off the toilet.
00:05:11.321 --> 00:05:11.541
Again,
00:05:11.802 --> 00:05:14.163
if we are not the best people to
00:05:14.184 --> 00:05:15.345
teach people how to do
00:05:15.384 --> 00:05:16.586
these things safely, who is?
00:05:16.605 --> 00:05:16.706
Right.
00:05:16.846 --> 00:05:18.086
Like it has to be that we
00:05:18.267 --> 00:05:19.288
own those spaces.
00:05:19.749 --> 00:05:21.451
And, and so from my point of view,
00:05:21.951 --> 00:05:22.872
we know that stuff.
00:05:22.932 --> 00:05:23.793
We do implement it.
00:05:23.874 --> 00:05:24.535
Unfortunately,
00:05:24.995 --> 00:05:26.177
we use most of those skills
00:05:26.297 --> 00:05:27.458
after people have already fallen.
00:05:27.959 --> 00:05:29.379
We are great with decreasing
00:05:29.399 --> 00:05:30.942
the fall risk for a patient
00:05:30.961 --> 00:05:32.062
that comes in tomorrow.
00:05:32.262 --> 00:05:33.384
Who's already broken her hip
00:05:33.524 --> 00:05:34.505
because they tell us they
00:05:34.545 --> 00:05:35.146
broke their hip.
00:05:35.166 --> 00:05:35.987
And we say, well,
00:05:36.307 --> 00:05:36.668
Great,
00:05:38.329 --> 00:05:39.848
we can help you with your broken hip,
00:05:39.889 --> 00:05:40.389
but we're also,
00:05:40.408 --> 00:05:41.009
you told me you did this
00:05:41.029 --> 00:05:41.769
because of the fall.
00:05:42.089 --> 00:05:42.230
Well,
00:05:42.269 --> 00:05:43.730
we can do all these great things for
00:05:43.750 --> 00:05:45.050
you to make sure you don't fall again.
00:05:45.310 --> 00:05:46.411
And I'll remember one time
00:05:46.451 --> 00:05:47.091
and specifically,
00:05:47.211 --> 00:05:48.072
I was probably really early
00:05:48.091 --> 00:05:48.432
on in my career,
00:05:48.451 --> 00:05:49.492
I was maybe six months in,
00:05:49.711 --> 00:05:50.653
and I told this wonderful
00:05:50.692 --> 00:05:52.192
lady about how I was gonna
00:05:52.213 --> 00:05:53.274
help her with her hip,
00:05:53.334 --> 00:05:54.874
but because she fell,
00:05:54.954 --> 00:05:55.754
I was gonna decrease her
00:05:55.774 --> 00:05:57.175
fall by doing all those things.
00:05:57.194 --> 00:05:58.134
Now I'm in my head thinking
00:05:58.154 --> 00:05:59.014
this woman's gonna love me
00:05:59.035 --> 00:05:59.636
and it's great.
00:05:59.935 --> 00:06:00.795
I'm already picking out what
00:06:00.855 --> 00:06:01.795
flavor of bread she's gonna
00:06:01.836 --> 00:06:02.916
bake me and stuff like that.
00:06:03.877 --> 00:06:05.321
And I'll never forget it.
00:06:05.341 --> 00:06:07.648
She looks at me and she goes, that's great,
00:06:07.687 --> 00:06:07.927
dear.
00:06:08.430 --> 00:06:09.351
Sure would have been good to
00:06:09.391 --> 00:06:10.173
know that ahead of time.
00:06:11.629 --> 00:06:14.372
And it's just the simplest statement,
00:06:14.432 --> 00:06:15.612
but it always struck with me,
00:06:15.632 --> 00:06:17.173
and I heard that twenty years ago.
00:06:17.694 --> 00:06:19.154
But if what we do with
00:06:19.194 --> 00:06:21.016
people after they fall is
00:06:21.055 --> 00:06:23.156
effective to decrease future falls,
00:06:23.898 --> 00:06:24.999
why can't we move ourselves
00:06:25.119 --> 00:06:27.220
upstream a little bit and
00:06:27.259 --> 00:06:28.461
get at them before they had
00:06:28.480 --> 00:06:30.482
that massive injury and the
00:06:30.521 --> 00:06:32.062
pain and the cost and all
00:06:32.083 --> 00:06:33.004
that kind of stuff that happens?
00:06:33.024 --> 00:06:34.504
So that's sort of where I
00:06:34.545 --> 00:06:36.185
believe we need to kind of
00:06:36.225 --> 00:06:36.886
focus on a little bit.
00:06:37.158 --> 00:06:37.579
All right.
00:06:37.620 --> 00:06:40.242
So so let's talk about this safe act,
00:06:40.644 --> 00:06:42.125
right, that you're you're advocating for,
00:06:42.165 --> 00:06:43.608
like help me understand like big picture.
00:06:43.687 --> 00:06:45.449
What is it and how would it
00:06:45.569 --> 00:06:47.492
do the thing or should have
00:06:47.512 --> 00:06:48.153
done for that woman?
00:06:48.194 --> 00:06:48.935
Twenty years ago,
00:06:49.314 --> 00:06:50.416
how would it help us do the thing,
00:06:50.456 --> 00:06:51.598
which is prevent falls
00:06:51.959 --> 00:06:53.000
among older Americans?
00:06:53.680 --> 00:06:55.482
So what it would do is it's
00:06:55.502 --> 00:06:56.341
a very simple bill.
00:06:56.362 --> 00:06:56.682
First of all,
00:06:56.762 --> 00:06:58.083
it's I love bills are less
00:06:58.103 --> 00:06:58.983
than four or five pages
00:06:59.023 --> 00:06:59.802
because that means they're
00:06:59.822 --> 00:07:00.744
not super complicated.
00:07:00.843 --> 00:07:02.363
And this one is and it's very simple.
00:07:02.824 --> 00:07:04.665
We have already a benefit
00:07:04.745 --> 00:07:06.064
for Medicare called the
00:07:06.144 --> 00:07:07.485
annual wellness visit and
00:07:07.526 --> 00:07:09.187
the medical and Medicare benefit,
00:07:09.607 --> 00:07:10.826
which means like once a year.
00:07:10.887 --> 00:07:12.747
So once every twelve months.
00:07:13.408 --> 00:07:14.810
Any Medicare beneficiary can
00:07:14.850 --> 00:07:15.831
go into their physician.
00:07:15.951 --> 00:07:17.211
Usually it's an internist or
00:07:17.291 --> 00:07:18.894
a family practice doc and
00:07:18.913 --> 00:07:20.516
they get a free visit.
00:07:20.555 --> 00:07:22.338
So it's not nothing out of pocket to them.
00:07:22.677 --> 00:07:23.478
And they get screened for
00:07:23.499 --> 00:07:24.139
all these issues.
00:07:25.000 --> 00:07:26.663
You know, you get your blood work done.
00:07:26.762 --> 00:07:27.684
No cost to you.
00:07:27.723 --> 00:07:28.485
You get, you know,
00:07:29.225 --> 00:07:31.108
a cognition screening done.
00:07:31.168 --> 00:07:32.108
No cost to you, blah, blah, blah.
00:07:32.168 --> 00:07:32.629
All this stuff.
00:07:32.668 --> 00:07:32.869
Right.
00:07:34.069 --> 00:07:35.011
And then if something comes
00:07:35.130 --> 00:07:37.432
out of that visit, if your physician says,
00:07:37.932 --> 00:07:38.132
you know,
00:07:38.192 --> 00:07:39.452
tell me about your family history.
00:07:39.612 --> 00:07:40.653
And they say, you know what,
00:07:40.774 --> 00:07:42.634
my dad's diabetic, my mom's diabetic,
00:07:42.675 --> 00:07:43.295
you know, blah, blah.
00:07:43.755 --> 00:07:44.495
That physician may say,
00:07:44.576 --> 00:07:45.976
let's go get your A and C checked out.
00:07:45.997 --> 00:07:47.418
But don't worry, no cost to you.
00:07:47.437 --> 00:07:48.557
But someone else will do that.
00:07:49.139 --> 00:07:50.738
Maybe you have a family history of cancer.
00:07:50.759 --> 00:07:52.579
You should go get a mammogram once a year.
00:07:52.841 --> 00:07:53.761
It'll be no cost to you.
00:07:53.781 --> 00:07:54.201
Get it done.
00:07:54.240 --> 00:07:55.502
Colonoscopy once a year.
00:07:55.922 --> 00:07:56.622
No cost to you.
00:07:56.663 --> 00:07:57.103
Get it done.
00:07:58.932 --> 00:07:59.771
In this annual wellness
00:07:59.992 --> 00:08:00.833
position usually does
00:08:00.872 --> 00:08:01.853
something like a time get
00:08:01.894 --> 00:08:04.536
up and go or a some kind of
00:08:04.576 --> 00:08:06.298
fall screen or as asked you like,
00:08:06.319 --> 00:08:07.259
have you fallen in the last year?
00:08:07.278 --> 00:08:08.581
And they'll check a box and
00:08:08.600 --> 00:08:09.240
they'll say that, hey,
00:08:09.261 --> 00:08:10.482
you're a higher risk of falls.
00:08:10.942 --> 00:08:12.223
And then the conversation stops.
00:08:12.904 --> 00:08:14.766
Unlike with diabetes and cancers,
00:08:15.007 --> 00:08:16.007
the conversation just stops.
00:08:16.447 --> 00:08:19.488
But what this bill does in essence says,
00:08:20.009 --> 00:08:21.209
if during this visit,
00:08:21.548 --> 00:08:23.009
your physician determines
00:08:23.048 --> 00:08:24.410
you fell once in the last year,
00:08:24.790 --> 00:08:26.129
that patient automatically
00:08:26.149 --> 00:08:28.711
becomes eligible to go to
00:08:28.810 --> 00:08:32.091
any PT or OT and have a
00:08:32.130 --> 00:08:33.311
fall risk assessment done.
00:08:33.591 --> 00:08:35.032
Not just a time, get up and go,
00:08:35.052 --> 00:08:36.792
but let me test your strength.
00:08:36.831 --> 00:08:37.672
Let me test your balance.
00:08:37.692 --> 00:08:38.712
Let me check your inner ear.
00:08:39.033 --> 00:08:40.753
Talk to me about your home environment.
00:08:41.113 --> 00:08:41.874
um this could be done in
00:08:41.913 --> 00:08:43.274
their home or in our clinic
00:08:43.815 --> 00:08:45.235
and that will be free to
00:08:45.255 --> 00:08:46.537
that visit will be free to
00:08:46.557 --> 00:08:47.898
the patient just like the
00:08:48.019 --> 00:08:50.080
other um items that we try
00:08:50.120 --> 00:08:52.581
to do to stop a cancer or a
00:08:52.621 --> 00:08:54.644
diabetes diabetes diagnosis
00:08:55.144 --> 00:08:56.205
it'll be no cost them to
00:08:56.264 --> 00:08:57.686
incentivize the patient to
00:08:57.725 --> 00:09:00.828
go so and it puts us before
00:09:01.028 --> 00:09:03.190
they had that massive injury so um
00:09:04.071 --> 00:09:06.572
now if uh if if you have
00:09:06.611 --> 00:09:08.211
them and they come in and
00:09:08.312 --> 00:09:10.111
the visit's done you give
00:09:10.131 --> 00:09:11.253
them a great home program
00:09:11.273 --> 00:09:12.552
you give them you know uh
00:09:12.613 --> 00:09:13.552
instructions on how to make
00:09:13.572 --> 00:09:15.514
their home safer that you
00:09:15.533 --> 00:09:16.673
know that makes that
00:09:16.714 --> 00:09:17.494
patient better off because
00:09:17.573 --> 00:09:19.073
not just being told hey
00:09:19.094 --> 00:09:20.114
you're you're a fall risk
00:09:20.375 --> 00:09:21.534
but now they have something
00:09:21.794 --> 00:09:22.855
and the person is giving it
00:09:22.875 --> 00:09:24.095
to them is the health care
00:09:24.115 --> 00:09:25.196
provider that does this
00:09:25.235 --> 00:09:26.456
like every single day
00:09:27.115 --> 00:09:29.038
The fallologist putting the
00:09:29.097 --> 00:09:30.318
person at risk for falls in
00:09:30.339 --> 00:09:31.379
front of a fallologist.
00:09:31.399 --> 00:09:32.140
Right.
00:09:32.181 --> 00:09:34.123
So if therapists are nodding
00:09:34.143 --> 00:09:35.745
along right again, I said, you know,
00:09:35.784 --> 00:09:37.046
Nick's over here preaching to the choir,
00:09:37.066 --> 00:09:38.547
but he's just screaming at a man.
00:09:38.587 --> 00:09:39.948
But how can they get
00:09:40.009 --> 00:09:41.870
involved themselves and
00:09:42.370 --> 00:09:43.292
along with their patients
00:09:43.392 --> 00:09:44.293
in supporting it?
00:09:44.373 --> 00:09:45.674
Because I like simple.
00:09:45.835 --> 00:09:46.534
I like clear.
00:09:46.696 --> 00:09:47.416
I like value.
00:09:48.216 --> 00:09:50.219
but these things don't just happen, right?
00:09:50.239 --> 00:09:50.359
Well,
00:09:50.379 --> 00:09:51.460
you might put up a great idea if
00:09:51.480 --> 00:09:52.421
there's no support behind,
00:09:52.441 --> 00:09:53.160
it doesn't do it.
00:09:53.201 --> 00:09:54.982
So talk to me from like a
00:09:55.062 --> 00:09:55.964
tactical perspective,
00:09:56.004 --> 00:09:56.823
like what do people
00:09:56.923 --> 00:09:58.525
actually need to do to make
00:09:58.566 --> 00:10:00.847
sure this thing doesn't fall off?
00:10:01.898 --> 00:10:02.619
No pun intended, right?
00:10:04.400 --> 00:10:05.701
So a couple of things.
00:10:05.881 --> 00:10:08.085
And the simplest things are
00:10:08.105 --> 00:10:09.725
the ones that most of PTs
00:10:10.006 --> 00:10:11.087
are used to doing because
00:10:11.107 --> 00:10:12.369
we've asked people to do it many times.
00:10:12.809 --> 00:10:14.731
And you can send in letters
00:10:14.751 --> 00:10:15.552
to your member of Congress.
00:10:15.591 --> 00:10:16.533
It is a bill right now.
00:10:16.793 --> 00:10:18.195
The bill number is H.R.
00:10:18.274 --> 00:10:19.416
seventy six eighteen.
00:10:20.216 --> 00:10:21.197
It's a bipartisan bill.
00:10:22.278 --> 00:10:24.578
And if you go to aptqi.com
00:10:24.658 --> 00:10:26.120
under the Take Action tab,
00:10:26.440 --> 00:10:27.500
you'll see letters in there
00:10:27.520 --> 00:10:28.441
that one's written from the
00:10:28.461 --> 00:10:29.422
point of view of a therapist,
00:10:29.522 --> 00:10:30.062
one's written from the
00:10:30.081 --> 00:10:31.001
point of view of a patient.
00:10:31.043 --> 00:10:31.883
So, you know,
00:10:31.923 --> 00:10:33.244
you got patients that feel
00:10:33.283 --> 00:10:34.923
strongly about this, you know,
00:10:35.504 --> 00:10:36.125
give them the link,
00:10:36.164 --> 00:10:36.985
have them fill it out.
00:10:37.145 --> 00:10:37.385
You know,
00:10:37.446 --> 00:10:38.566
other therapists in your clinics
00:10:38.586 --> 00:10:39.046
can do it.
00:10:39.346 --> 00:10:40.346
That's the easiest thing.
00:10:40.667 --> 00:10:41.628
No sweat off your back.
00:10:42.207 --> 00:10:43.048
Put your address in.
00:10:43.109 --> 00:10:43.548
Honest to God,
00:10:43.568 --> 00:10:44.509
it takes maybe thirty
00:10:44.548 --> 00:10:45.990
seconds tops for you to do
00:10:46.049 --> 00:10:47.591
it or a patient to do it.
00:10:48.211 --> 00:10:49.032
But then there's some next
00:10:49.072 --> 00:10:49.952
level things that you can
00:10:49.993 --> 00:10:51.913
do that I think maybe we
00:10:51.974 --> 00:10:52.914
don't do as good a job.
00:10:53.095 --> 00:10:54.236
We're great at sending in letters,
00:10:54.297 --> 00:10:55.236
but I think therapists can
00:10:55.277 --> 00:10:56.859
do a little bit better job about this.
00:10:57.840 --> 00:10:59.000
You kind of alluded to this earlier,
00:10:59.081 --> 00:11:00.022
and I talked about this is
00:11:00.081 --> 00:11:01.062
we have this communications
00:11:01.102 --> 00:11:02.083
problem that we're not
00:11:02.104 --> 00:11:03.144
associated with falls.
00:11:03.184 --> 00:11:03.284
Right.
00:11:04.004 --> 00:11:06.827
And both from a consumer point of view,
00:11:07.187 --> 00:11:08.548
but also from a legislator
00:11:08.589 --> 00:11:10.051
and decision maker point of view.
00:11:10.410 --> 00:11:11.032
And so one of the things
00:11:11.052 --> 00:11:12.653
that we've done at APTQI is
00:11:12.692 --> 00:11:14.014
we've probably hosted almost
00:11:14.835 --> 00:11:16.277
Got about twenty so far
00:11:16.677 --> 00:11:18.318
members and staffers of
00:11:18.379 --> 00:11:20.240
Congress to come into our clinics.
00:11:20.280 --> 00:11:21.001
And guess what we do?
00:11:21.221 --> 00:11:22.423
We do a fall risk assessment on them.
00:11:22.722 --> 00:11:24.164
We like, hey, let me show you what we do.
00:11:24.585 --> 00:11:25.186
And we've had a lot of
00:11:25.206 --> 00:11:26.868
people leaving the clinic saying,
00:11:27.048 --> 00:11:28.028
I did not know that this is
00:11:28.048 --> 00:11:29.350
what you guys do all the time.
00:11:29.650 --> 00:11:30.892
Put them on a balance master.
00:11:30.932 --> 00:11:31.793
Tell them to stand on one
00:11:31.832 --> 00:11:32.833
leg with their eyes closed.
00:11:33.254 --> 00:11:33.414
You know,
00:11:33.434 --> 00:11:36.437
show them how the setup of a
00:11:36.618 --> 00:11:37.379
house can work.
00:11:37.658 --> 00:11:38.759
dramatically increase or
00:11:38.798 --> 00:11:39.659
decrease their risk of
00:11:39.679 --> 00:11:41.399
falls by the angle of their
00:11:41.620 --> 00:11:43.780
recliner or the height of the toilet seat,
00:11:43.801 --> 00:11:45.061
or some really simple
00:11:45.100 --> 00:11:46.662
things like put some bars here or,
00:11:47.062 --> 00:11:47.822
you know, stuff like that,
00:11:47.861 --> 00:11:49.523
that you sent second nature to you,
00:11:49.562 --> 00:11:50.682
but they need to know it.
00:11:50.722 --> 00:11:53.744
And I think that places in their minds, Oh,
00:11:53.783 --> 00:11:55.284
this is what PTs can actually do it.
00:11:55.304 --> 00:11:56.804
This is what OTs can actually do.
00:11:57.144 --> 00:11:58.105
And you gotta have that
00:11:58.125 --> 00:11:59.405
because letters are one thing,
00:11:59.885 --> 00:12:02.067
but you know, saying that my,
00:12:02.626 --> 00:12:03.687
my healthcare staffer,
00:12:03.846 --> 00:12:06.388
I personally went to that clinic and,
00:12:06.528 --> 00:12:08.690
And they showed me what they do.
00:12:09.029 --> 00:12:09.850
And they actually showed me
00:12:09.870 --> 00:12:10.711
that I have some fall
00:12:10.750 --> 00:12:12.412
deficits that I didn't even know I had.
00:12:12.711 --> 00:12:15.173
And, you know, let's face it, you know,
00:12:15.193 --> 00:12:15.693
when you're talking about
00:12:15.714 --> 00:12:17.075
that over-sixty-five demographic,
00:12:17.095 --> 00:12:17.735
that includes a lot of
00:12:17.755 --> 00:12:18.436
members of Congress.
00:12:18.456 --> 00:12:19.456
They probably are very
00:12:19.476 --> 00:12:20.898
curious about what that would look like.
00:12:20.937 --> 00:12:22.458
So get them in your clinic.
00:12:22.538 --> 00:12:23.239
And that is,
00:12:23.799 --> 00:12:25.201
I'm not saying it's super easy,
00:12:26.100 --> 00:12:27.081
but it's super fruitful.
00:12:27.322 --> 00:12:29.663
And if you get, you know, if you invite,
00:12:30.364 --> 00:12:30.563
you know,
00:12:30.644 --> 00:12:32.465
every clinic's got two senators
00:12:32.485 --> 00:12:33.025
in the Congress,
00:12:33.485 --> 00:12:34.726
a member of Congress of the
00:12:34.767 --> 00:12:36.268
House in their district.
00:12:36.827 --> 00:12:38.649
We're lucky at APTQI.
00:12:38.669 --> 00:12:39.812
We have a lot of multi-state
00:12:39.871 --> 00:12:41.033
large members.
00:12:41.432 --> 00:12:42.695
So we've gotten about twenty
00:12:42.715 --> 00:12:45.597
to come in just from the summer till now.
00:12:46.138 --> 00:12:47.158
And we have more lined up
00:12:47.200 --> 00:12:48.140
before the end of the year.
00:12:48.221 --> 00:12:51.423
So don't underestimate just
00:12:51.524 --> 00:12:52.585
showing someone what
00:12:52.644 --> 00:12:53.605
therapy does and how
00:12:53.666 --> 00:12:54.927
powerful that can be by
00:12:54.967 --> 00:12:55.869
putting them in your clinic.
00:12:56.168 --> 00:12:57.729
Yeah, and that show where, listen,
00:12:57.788 --> 00:12:58.729
everybody's favorite day in
00:12:58.769 --> 00:13:00.110
third grade was show and tell.
00:13:00.970 --> 00:13:02.029
You wanted to do more of the
00:13:02.049 --> 00:13:04.890
showing because that got more attention,
00:13:05.010 --> 00:13:06.971
that told a better story.
00:13:07.370 --> 00:13:08.110
So by all means,
00:13:08.150 --> 00:13:09.331
I feel like show and tell
00:13:09.471 --> 00:13:12.351
in your example is the show is very much,
00:13:12.672 --> 00:13:12.772
hey,
00:13:12.792 --> 00:13:13.831
wouldn't it be great if you could do
00:13:13.851 --> 00:13:15.312
a fall assessment on your senator,
00:13:15.432 --> 00:13:16.312
like your state senator?
00:13:16.332 --> 00:13:17.232
Like, wouldn't that be amazing?
00:13:17.753 --> 00:13:21.972
The tell is not, you know, not important,
00:13:22.013 --> 00:13:23.673
but those are the letters, right?
00:13:24.053 --> 00:13:24.354
Because...
00:13:25.153 --> 00:13:26.254
Understanding your audience
00:13:26.294 --> 00:13:27.174
is really important.
00:13:27.456 --> 00:13:29.017
And people in elected positions,
00:13:29.476 --> 00:13:30.538
their job is to make sure
00:13:30.557 --> 00:13:31.337
that the people in their
00:13:31.378 --> 00:13:32.938
districts or their states are heard.
00:13:33.539 --> 00:13:34.941
And understanding how many
00:13:34.980 --> 00:13:35.921
of those people this can
00:13:35.961 --> 00:13:37.802
affect when you show them
00:13:38.243 --> 00:13:39.244
and just a couple of stats
00:13:39.264 --> 00:13:39.984
that you had mentioned in
00:13:40.024 --> 00:13:41.164
terms of cost or number of
00:13:41.184 --> 00:13:42.265
people affected.
00:13:42.725 --> 00:13:44.907
Now, that's easy to remember.
00:13:45.167 --> 00:13:46.408
Later on, when this thing comes up,
00:13:46.427 --> 00:13:47.188
they're going to go, hey,
00:13:47.208 --> 00:13:47.769
I remember that.
00:13:47.828 --> 00:13:48.809
That was pretty impactful.
00:13:48.850 --> 00:13:50.030
This is kind of a big deal.
00:13:50.591 --> 00:13:52.591
This sounds simple, but as you mentioned,
00:13:52.611 --> 00:13:53.413
it's not easy,
00:13:53.832 --> 00:13:54.874
but it feels like it's worth it.
00:13:55.553 --> 00:13:55.793
Yeah.
00:13:55.855 --> 00:13:56.495
And then you've kind of
00:13:56.534 --> 00:13:57.575
placed your profession,
00:13:57.615 --> 00:13:58.936
not just you yourself individually,
00:13:58.975 --> 00:13:59.716
but now you've placed your
00:13:59.736 --> 00:14:00.996
profession in that person's
00:14:01.037 --> 00:14:03.239
head as I know what these guys do now.
00:14:03.778 --> 00:14:06.520
Because for good or bad therapy,
00:14:06.541 --> 00:14:08.000
we practice in so many settings.
00:14:08.562 --> 00:14:10.082
We do so many different things.
00:14:10.722 --> 00:14:11.984
If you ask ten people what a
00:14:12.024 --> 00:14:12.884
physical therapist does,
00:14:12.903 --> 00:14:14.164
you might get seven different answers.
00:14:14.585 --> 00:14:15.505
And probably none of them
00:14:15.525 --> 00:14:18.067
are going to be like a falls expert.
00:14:18.086 --> 00:14:19.587
You'll get works with my kid
00:14:19.947 --> 00:14:20.649
in their school.
00:14:20.668 --> 00:14:22.490
You'll get I saw them in the hospital.
00:14:22.789 --> 00:14:24.630
You'll get and they work in sniffs.
00:14:24.730 --> 00:14:27.011
You'll get I hurt my foot
00:14:27.072 --> 00:14:27.831
and they help me there.
00:14:28.232 --> 00:14:30.094
But they'll have all these things.
00:14:30.173 --> 00:14:31.575
And that's because they
00:14:31.634 --> 00:14:32.595
personally experienced it
00:14:32.615 --> 00:14:33.515
because they were shown it.
00:14:33.875 --> 00:14:35.397
But they haven't been shown this yet.
00:14:35.437 --> 00:14:37.658
So your show and tell analogy is spot on.
00:14:38.029 --> 00:14:38.190
Yeah.
00:14:38.250 --> 00:14:38.529
Yeah.
00:14:38.649 --> 00:14:39.591
And none of those seven
00:14:40.191 --> 00:14:42.452
definitions of PT are wrong.
00:14:43.013 --> 00:14:44.173
No, but we've got to make sure.
00:14:44.394 --> 00:14:45.033
I don't know, man.
00:14:45.254 --> 00:14:45.475
I mean,
00:14:45.495 --> 00:14:46.755
maybe I walk around at CSN with
00:14:46.796 --> 00:14:48.056
fallologist merch and just
00:14:48.076 --> 00:14:48.756
start selling that.
00:14:48.777 --> 00:14:49.856
But it feels like that's a
00:14:49.917 --> 00:14:52.119
really good way to say we do that.
00:14:52.178 --> 00:14:53.299
This is something that we do.
00:14:54.000 --> 00:14:55.000
I only tried you like a five
00:14:55.020 --> 00:14:56.562
percent royalty, man.
00:14:56.621 --> 00:14:57.062
I'll hawk it.
00:14:57.081 --> 00:14:57.361
Let's go.
00:14:59.964 --> 00:15:01.683
So what's the deadline on this?
00:15:02.784 --> 00:15:04.184
If we just say, hey, do it, whatever,
00:15:04.365 --> 00:15:05.125
you and I both know no
00:15:05.145 --> 00:15:05.826
one's going to do it.
00:15:05.946 --> 00:15:08.206
But we need to put a
00:15:08.307 --> 00:15:10.567
measurable and specific goal on this.
00:15:11.087 --> 00:15:12.729
By when do PTs need to act
00:15:12.788 --> 00:15:13.809
to make sure this is heard?
00:15:14.149 --> 00:15:16.350
For maximum effectiveness,
00:15:16.451 --> 00:15:17.191
as you may have heard,
00:15:17.211 --> 00:15:18.672
we got an election coming
00:15:18.711 --> 00:15:20.032
up in less than two months,
00:15:20.371 --> 00:15:21.312
which means that this
00:15:21.352 --> 00:15:22.774
congressional session ends
00:15:24.114 --> 00:15:25.835
early January of twenty twenty five.
00:15:26.475 --> 00:15:27.655
And so any
00:15:28.615 --> 00:15:30.157
any legislation anything
00:15:30.236 --> 00:15:31.037
last minute they're going
00:15:31.057 --> 00:15:31.917
to pass is probably going
00:15:31.937 --> 00:15:34.177
to be all put together
00:15:34.538 --> 00:15:35.879
probably around november
00:15:36.119 --> 00:15:37.320
right and then they'll have
00:15:37.340 --> 00:15:38.399
their mad rush before the
00:15:38.440 --> 00:15:39.740
holidays to uh to get it
00:15:39.801 --> 00:15:41.621
done so for peak
00:15:41.662 --> 00:15:42.721
effectiveness we need to
00:15:42.741 --> 00:15:43.642
have our voice heard as
00:15:43.701 --> 00:15:44.682
much as possible between
00:15:44.743 --> 00:15:45.903
now and the end of october
00:15:46.062 --> 00:15:46.964
that's really like that
00:15:47.004 --> 00:15:49.105
window um that if we don't
00:15:49.125 --> 00:15:50.424
get it doesn't mean it's uh
00:15:50.644 --> 00:15:51.546
end of the world it just
00:15:51.586 --> 00:15:52.385
means we have to start all
00:15:52.426 --> 00:15:53.125
over again this will be a
00:15:53.166 --> 00:15:54.126
brand new congress starting
00:15:54.147 --> 00:15:55.167
january twenty twenty five
00:15:55.187 --> 00:15:56.008
we got to reintroduce the
00:15:56.048 --> 00:15:57.067
bill and start from scratch
00:15:57.798 --> 00:15:59.081
Perfect.
00:15:59.442 --> 00:16:01.725
APTQI.com.
00:16:01.765 --> 00:16:02.407
Did I get that?
00:16:02.427 --> 00:16:02.748
I did, right?
00:16:02.768 --> 00:16:03.448
That is perfect.
00:16:03.548 --> 00:16:03.909
I got it.
00:16:03.929 --> 00:16:04.110
All right.
00:16:04.171 --> 00:16:04.792
That's where you can find
00:16:04.831 --> 00:16:05.472
more information.
00:16:05.793 --> 00:16:05.933
Nick,
00:16:05.953 --> 00:16:07.355
is there anything I didn't ask about
00:16:07.375 --> 00:16:08.658
that you want to make sure PT's new?
00:16:10.043 --> 00:16:11.304
The other thing that I just
00:16:11.325 --> 00:16:12.466
wanted to highlight again
00:16:12.625 --> 00:16:13.846
is while I'm preaching to the choir,
00:16:13.866 --> 00:16:14.807
take a second.
00:16:15.008 --> 00:16:16.129
There's a second provision
00:16:16.168 --> 00:16:17.049
of the SAFE Act that I
00:16:17.070 --> 00:16:18.490
think is really important
00:16:18.510 --> 00:16:20.113
for us to understand.
00:16:20.452 --> 00:16:21.714
And the reason we put that
00:16:21.754 --> 00:16:24.556
in there was to help
00:16:24.576 --> 00:16:26.017
solidify and protect us
00:16:26.057 --> 00:16:26.717
against these cuts,
00:16:26.738 --> 00:16:27.798
which I know we are all
00:16:27.918 --> 00:16:29.279
dealing with and facing.
00:16:29.700 --> 00:16:32.842
So quick lesson on
00:16:32.962 --> 00:16:34.625
governmental accounting methods.
00:16:35.666 --> 00:16:37.307
when we get cut as therapists,
00:16:37.988 --> 00:16:39.089
the government on paper
00:16:39.109 --> 00:16:39.889
will save money because
00:16:39.909 --> 00:16:40.711
they're paying us less.
00:16:41.350 --> 00:16:43.173
Now you and I and the choir
00:16:43.192 --> 00:16:44.774
understand that we are low
00:16:44.794 --> 00:16:45.634
cost providers.
00:16:45.754 --> 00:16:46.535
And when you take out the
00:16:46.556 --> 00:16:47.456
low cost provider,
00:16:47.616 --> 00:16:49.078
or if you decrease their
00:16:49.099 --> 00:16:50.099
ability to do their job,
00:16:50.720 --> 00:16:51.640
the entire healthcare
00:16:51.660 --> 00:16:52.642
continuum probably spends
00:16:52.682 --> 00:16:54.202
more money downstream and
00:16:54.243 --> 00:16:55.104
that's not good for us.
00:16:55.163 --> 00:16:56.825
But the problem is accounting wise,
00:16:56.845 --> 00:16:57.566
it's really hard to
00:16:57.605 --> 00:16:58.947
dynamically score what a
00:16:59.006 --> 00:17:00.048
physical therapist does.
00:17:00.408 --> 00:17:01.809
And so when you cut therapy
00:17:02.049 --> 00:17:03.671
that saves money, when you increase costs,
00:17:03.931 --> 00:17:04.372
uh, uh,
00:17:04.511 --> 00:17:05.952
reimbursement therapy that costs
00:17:05.972 --> 00:17:07.013
the government money and
00:17:07.034 --> 00:17:07.615
that's a cost her.
00:17:08.434 --> 00:17:09.977
So one thing that we did
00:17:10.636 --> 00:17:12.659
with this bill is we said, you know,
00:17:12.739 --> 00:17:13.579
if we, um,
00:17:14.227 --> 00:17:15.147
we get this bill passed the
00:17:15.188 --> 00:17:16.528
second provision which is
00:17:16.568 --> 00:17:18.611
along the paragraph says if
00:17:18.652 --> 00:17:19.633
this goes into effect this
00:17:19.673 --> 00:17:20.673
new benefit for seniors
00:17:20.713 --> 00:17:21.994
goes into effect the
00:17:22.015 --> 00:17:23.696
government needs to track
00:17:23.896 --> 00:17:25.278
the people who fell after
00:17:25.719 --> 00:17:26.659
words and compare like the
00:17:26.700 --> 00:17:27.660
folks who had this screen
00:17:27.681 --> 00:17:29.021
by ptrot and the folks who
00:17:29.041 --> 00:17:31.144
didn't and what happened to
00:17:31.163 --> 00:17:32.125
the nature of falls into
00:17:32.144 --> 00:17:33.125
the incidence of falls and
00:17:33.165 --> 00:17:34.106
things like that and are we
00:17:34.126 --> 00:17:35.067
spending more for people
00:17:35.307 --> 00:17:36.169
who don't get you know a
00:17:36.189 --> 00:17:37.650
fall risk assessment and those that do
00:17:38.828 --> 00:17:40.130
As you will probably understand,
00:17:40.450 --> 00:17:41.369
the people in the group
00:17:41.410 --> 00:17:42.550
that had that fall
00:17:42.570 --> 00:17:43.830
resistance will probably fall less.
00:17:44.192 --> 00:17:46.232
And we've done some backwards analysis,
00:17:46.553 --> 00:17:47.913
pretty heavy math on that.
00:17:47.932 --> 00:17:48.913
And we know that that's true.
00:17:49.314 --> 00:17:50.694
If people who've had therapy
00:17:50.815 --> 00:17:52.915
after a minor fall have a
00:17:53.175 --> 00:17:54.056
fifty percent less
00:17:54.115 --> 00:17:55.317
likelihood of falling again
00:17:55.836 --> 00:17:57.377
in the next six months to
00:17:57.397 --> 00:17:58.377
the level that requires an
00:17:58.478 --> 00:17:59.979
ER or a hospital visit.
00:17:59.999 --> 00:18:01.200
So we know that that happens.
00:18:01.920 --> 00:18:03.421
So if Congress gets a report
00:18:03.682 --> 00:18:04.521
saying that here's what
00:18:04.561 --> 00:18:06.083
therapy does and here's
00:18:06.123 --> 00:18:09.486
what therapy saved in terms
00:18:09.526 --> 00:18:10.707
of downstream expenditure,
00:18:11.387 --> 00:18:12.689
those savings that
00:18:12.729 --> 00:18:13.930
therapists do don't have to
00:18:14.109 --> 00:18:15.611
be dynamic anymore.
00:18:15.631 --> 00:18:16.692
It's not pie in the sky.
00:18:17.132 --> 00:18:18.973
It's the experience of what
00:18:19.013 --> 00:18:20.055
happened when you did this.
00:18:20.595 --> 00:18:22.115
So that can actually
00:18:22.376 --> 00:18:23.557
insulate us because every
00:18:23.577 --> 00:18:24.999
time they try to cut us in the future,
00:18:25.019 --> 00:18:26.339
we can point to it like, hey,
00:18:26.380 --> 00:18:27.300
if there's less therapists.
00:18:28.222 --> 00:18:28.742
you know you're going to
00:18:28.762 --> 00:18:30.943
spend more here because it's your data,
00:18:31.003 --> 00:18:31.464
not mine.
00:18:31.545 --> 00:18:32.964
It's not sponsored by APT.
00:18:33.665 --> 00:18:35.507
So that's what they need.
00:18:35.686 --> 00:18:37.248
It's their own data that shows it.
00:18:37.667 --> 00:18:39.388
It's kind of like Congress
00:18:39.409 --> 00:18:40.449
is always skeptical about
00:18:41.230 --> 00:18:42.549
the studies that show milk
00:18:42.589 --> 00:18:43.490
is really good for you and
00:18:43.530 --> 00:18:45.051
it's sponsored by the dairy farmers.
00:18:46.471 --> 00:18:47.633
So this is like we can keep
00:18:47.673 --> 00:18:48.292
telling them that,
00:18:48.333 --> 00:18:49.634
but it has to be in their own data.
00:18:50.114 --> 00:18:52.096
so um if you can make a dent
00:18:52.155 --> 00:18:53.438
in a potentially hundred
00:18:53.478 --> 00:18:54.519
billion dollar a year
00:18:54.578 --> 00:18:55.681
problem they're probably
00:18:55.701 --> 00:18:56.781
going to think twice about
00:18:56.902 --> 00:18:57.702
cutting you next time
00:18:57.722 --> 00:18:59.944
around and so that makes it
00:18:59.964 --> 00:19:00.926
just a little I mean it's
00:19:01.126 --> 00:19:02.268
nothing else changes about
00:19:02.508 --> 00:19:03.549
um you know the need for
00:19:03.589 --> 00:19:05.392
our patients but if you're
00:19:05.451 --> 00:19:06.212
sick of the cuts
00:19:06.692 --> 00:19:07.554
And if you're sick of people
00:19:07.574 --> 00:19:09.115
as being told that therapists, you know,
00:19:09.154 --> 00:19:10.016
have to take the brunt of
00:19:10.096 --> 00:19:11.597
all these cuts because we
00:19:11.617 --> 00:19:13.519
have to save money as a country and blah,
00:19:13.538 --> 00:19:13.759
blah, blah.
00:19:14.039 --> 00:19:14.980
This is our way to say,
00:19:15.381 --> 00:19:16.701
to show that not only can
00:19:16.721 --> 00:19:17.962
we help the patient outcome,
00:19:18.324 --> 00:19:19.424
but we can help the
00:19:19.525 --> 00:19:20.705
financial costs for the
00:19:20.726 --> 00:19:21.626
healthcare system as well
00:19:21.686 --> 00:19:22.968
and get credit for it for going out.
00:19:23.028 --> 00:19:23.387
Yeah.
00:19:23.509 --> 00:19:23.689
Yeah.
00:19:23.729 --> 00:19:24.269
Keep preaching.
00:19:24.388 --> 00:19:25.089
That's, and that's,
00:19:25.210 --> 00:19:27.192
that's what PTs like to hear, but yeah.
00:19:27.432 --> 00:19:28.152
we need to do something
00:19:28.172 --> 00:19:29.112
about it talking to each
00:19:29.172 --> 00:19:31.452
other is good but the the
00:19:31.492 --> 00:19:32.792
show of someone else needs
00:19:32.833 --> 00:19:34.294
to be uh needs to be shared
00:19:34.894 --> 00:19:35.794
uh nick last thing we do on
00:19:35.814 --> 00:19:36.634
the show is we call the
00:19:36.653 --> 00:19:38.214
parting shot what's a mic
00:19:38.234 --> 00:19:39.315
drop moment soapbox
00:19:39.355 --> 00:19:40.816
statement you know idea or
00:19:40.855 --> 00:19:41.836
concept you just want to
00:19:42.236 --> 00:19:45.017
leave as we wrap up oh man
00:19:45.057 --> 00:19:46.156
mic drop moment I would you
00:19:46.176 --> 00:19:49.738
know I I'd say this um there are uh
00:19:52.208 --> 00:19:53.147
Like I alluded to earlier,
00:19:53.848 --> 00:19:54.950
a hundred billion dollars,
00:19:55.109 --> 00:19:57.231
number one cause of death and injury.
00:19:57.551 --> 00:19:58.553
But the one that the one
00:19:58.573 --> 00:19:59.473
that always sticks with me
00:19:59.634 --> 00:20:01.875
is a person over sixty five
00:20:01.895 --> 00:20:02.257
in this country.
00:20:02.517 --> 00:20:03.518
They fall every second.
00:20:04.578 --> 00:20:04.638
Wow.
00:20:04.659 --> 00:20:05.539
We've been on this, you know,
00:20:05.559 --> 00:20:06.961
we've been on the podcast
00:20:06.980 --> 00:20:07.862
for about a half an hour.
00:20:07.981 --> 00:20:08.701
Think about how many people
00:20:08.721 --> 00:20:09.242
have already fallen.
00:20:09.962 --> 00:20:10.143
And,
00:20:10.702 --> 00:20:12.284
and so there's numbers that are big in
00:20:12.304 --> 00:20:13.684
terms of dollars and their
00:20:13.724 --> 00:20:14.865
percentages that are big,
00:20:15.365 --> 00:20:16.586
but every second,
00:20:16.726 --> 00:20:17.806
that's what it equates to.
00:20:18.766 --> 00:20:21.207
And we have to do something about it.
00:20:21.446 --> 00:20:22.367
And if it's not the
00:20:22.428 --> 00:20:23.708
phallologists of the world
00:20:23.768 --> 00:20:25.449
screaming about this, like who will,
00:20:25.528 --> 00:20:26.048
who would do it?
00:20:26.229 --> 00:20:26.769
Who's doing it?
00:20:27.910 --> 00:20:28.269
All right.
00:20:28.289 --> 00:20:28.390
Nick,
00:20:28.410 --> 00:20:29.549
thanks for putting this in perspective.
00:20:29.569 --> 00:20:30.431
Thanks for doing what you do.
00:20:30.451 --> 00:20:31.730
And hopefully we can get a couple people.
00:20:32.050 --> 00:20:32.791
We'll share the link in the
00:20:32.811 --> 00:20:33.912
show notes that people can
00:20:33.951 --> 00:20:35.132
actually take that step.
00:20:35.333 --> 00:20:36.633
Because even if we can get a
00:20:36.692 --> 00:20:37.874
hundred people to take that step,
00:20:37.894 --> 00:20:39.153
that's a hundred more that
00:20:39.173 --> 00:20:40.193
wouldn't have been there yesterday.
00:20:40.894 --> 00:20:42.674
Nick for APTQI, appreciate your time, man.
00:20:42.694 --> 00:20:43.536
Thanks, Jimmy.
00:20:43.576 --> 00:20:50.417
Have a good one.
00:20:50.438 --> 00:20:50.838
That's it.
00:20:50.858 --> 00:20:52.019
That's all I need.