From 6 to 23 Visits: How Jeremy Sutton Grew His PT Practice with a Local Podcast

0:01 And we are live. Dave Kittle, Tony Meritato. Dave, the hair is on point. I love it. The baseball locks are flowing. You know, there is. Oh, yes. We've got a doubleheader this weekend for our eighth graders. I'm like, seriously, a doubleheader? Okay. I had a couple doubleheaders already, and I get so sore. I need to work more on recovery. And my wife jokes that my my thirty year old body does not respond to doubleheaders as well as they used to. How many innings do you guys play? If it's a doubleheader, it's fourteen. So it's seven and seven.

0:42 Okay, that's what our kids are doing, seven and seven. But I'm also hitting and stealing bases, sliding headfirst in the second and home played and sliding on the turf, getting ripped up. So yeah, playing hard. They're trying to pick me off at first. I'm diving back in on my belly. Well, this this double header will be ugly because our kids have pitch counts. They can't pitch more than so many pitches per inning per game. And, you know, we only have like three pitchers on the team. So it reminded me, was it the Dodgers who put that guy in who was clearly not a pitcher? This was all over social media recently. Yeah, the Dodgers' Quique Hernandez because he wore the coaching of first base, like the protective helmet foam thing on the front.

1:31 So yeah, that was a little bit of a viral thing. He plays infield and outfield, but yeah, he pitched and he always messes around. All right. So let's jump into today's topics. We got two topics at least to start with. I want to discuss because I want to get your take on Joseph Lowe from PT Supply. He put out an AI analysis of ATI's financial status. Basically, we'll look at it, but he's saying, you know, when is ATI going to go bankrupt? And then Lauren Meffin is a SLP down in Florida, Gainesville. She put out a long form sales copy post that I thought, awesome, great.

2:13 I love seeing therapists doing this, but I want to get some perspective on, because I know you have a long history in copywriting. I'm curious to see if you see the same things that I see that would be recommendations to improve it. So I'm going to share Joseph's post from LinkedIn. Now, Joseph has been on the podcast. He knows us. We know him. Let me pull this out and bring it on. Okay. forgive my messages along the side, but so let's see. Joseph basically says, I uploaded the ATI-XK into ChatGPT and asked it to what it thought of them going bankrupt.

3:00 So let's hit a couple. So financial red flags from said still deeply unprofitable net losses, fifty four million, slightly improved from sixty six million net losses in two thousand twenty three. I'm going to hit a couple of the top ones and then I'll come back to you, Dave, for some feedback. Negative operating cash flow. Two thousand twenty four operating cash flow was negative. Nineteen million dollars is the second consecutive year of negative cash flow. I will say we've gone through negative cash flow multiple years in a row, but we are not ATI. Limited liquidity, cash on hand, thirty nine million, not enough to sustain them long.

3:44 If losses persist, current liabilities are one hundred and forty one million high and rising debt. So they're borrowing more money long term and L-two. I don't know what L-two debt is. Five hundred and fifty million. Any any feedback so far before I keep going? Yeah, those are all pretty big factors in terms of just their size and the amount of risk that they're carrying, like the amount of financial risk. So yeah, I mean, if you have a negative operational cash flow loss, I mean, they're covering up the current debt payments with the cash that's coming in from all their current patients and all those insurance claims and everything.

4:31 But certainly sounds like skating on thin ice. So, okay. Heavily diluted capital structure, raised twenty five million in a series a declining SG&A dropped by dropped to nine hundred ninety or ninety nine million. What's SG&A? The administrative expenses. So the formal is selling comma general comma and administrative expenses. So just admin costs. Oh, okay. Positive or neutral indicators. Revenue growth, net revenue growth grew from six hundred ninety nine million to seven hundred and fifty three million.

5:13 So up seven percent. Cost control, SG&A and impairment costs are down. Cash flow financing from two thousand twenty four up thirty five million. They're still raising money. So let me ask you as an investor. Go ahead. I was going to say that the SG&A, it includes things like rent utilities, the salaries of the employees, the admin employees that are not producing the revenue. So it is kind of a big part of any practice or company. So it's anyone in the billing staff. It's obviously the rent and the utilities. So the overhead, it's the rent of all these locations. And they probably lease most of them out. I don't think they, you know, they're in a practice business.

5:54 They're not, I doubt they own much of the real estate of these practices. So that's the SG&A component. Maybe Jerry Durham's listening and he heard you say employees that are not generating revenue. His ears are burning. Yeah, well, technically they're not. I mean, they do, but they do indirectly. They're not treating a patient, filing a claim, get paid for that time, that service. I get it. I get it. I know you do. Yeah. Burn rate net cash used in operations and investing roughly thirty three million in twenty twenty four at that pace.

6:36 Thirty nine million in cash lasts just over twelve months. So, you know, they just they don't have the sustainability in the deposits. When might bankruptcy happen? It's hard to say. They run out of cash in Q one Q two two thousand twenty six. So, I mean, the big thing is, you know, how are they still raising money? And I'm asking you, I generally don't know. How are they still raising money when they're in such a kind of dire predicament? I don't know, other than bankers who...

7:17 will somehow try to push this through their underwriting committee and their you know the risk tolerance and the bankers who maybe care more about this is this is real stuff by the way what I'm about to say yeah bank bankers who get bonus every december they get bonus based off of how much money they get out the door how much money they lend And so if a banker or bankers are more focused on their own personal bonuses, maybe they're about to jump jobs or whatever, this is one potential way on how this happens. Bankers who care more about their bonus and lending out this money to a fairly risky company, although the company ATI will say, well, we have all these locations, all these therapists, whatever, like, yeah, we have some volatility, but you know, we're huge, so you can't kill us.

8:04 or it's going to be hard to kill us so these bankers are like all right we'll lend out the money we'll put you through the credit committee whatever and then the bankers get bonus because they can somewhat influence some of this lending to occur uh or or whatever investors and That's one potential way. Of course, there's other folks that are watching that might have other ideas. And I'm sure the thing is that there's gonna be many different ways on how this could occur. The risk tolerance and the credit committees are gonna look at, all right, what's your cash and what's your cash coming in? And can you pay these minimal debt service payments moving forward? Like if they get more debt, they already have debt.

8:45 If they get more debt, like, hey, with your current cashflow, the way it is, if it stays the same, can you cover those debt service payments of new debt that you are asking for? You're asking for more money and more debt. And if they're cashflow can cover that debt service, that's how more debt could be approved. Right. So if we put Dave Kittle, I'm on the website right now. We take Sharon Vitti out of CEO position. We put Dave Kittle. Are you sharing the screen? No, I'm not sharing it. This is just I'm talking. I put Dave Kittle in its place. A little bit of context, a little bit of history. It says ATI was created in nineteen ninety six.

9:27 So we're looking at thirty years, almost thirty years. They've got eight hundred and seventy eight locations from when they publish some information on their website. So Dave comes in as the new interim CEO. What are some of the first things that you see on the horizon? And there's just for fun. But, you know, what are we looking at? Please. uh okay so I mean globally at this size of a company you need you need you need more money coming in and less money that you're spending right now your rents you already signed those rents those leases right so you sign that so that that is what it is you're not really gonna although you could negotiate lease by lease and say hey can we get some you know rent reduction whatever because otherwise you might have to have a really tough conversation with all of your landlords and with your teams.

10:25 So if I were the CEO, I would probably have a tough conversation with all the stakeholders, everyone that's part of the business. I'd go to the landlords. I would say, hey, We might be out of business and you might not be able to collect the next five to ten years of rent, however, or three years or whatever the years are remaining on the rent. If we totally go out of business or if we go into bankruptcy, you're not going to have anything. So maybe can we... re can we re-establish or tear up this lease and make a new lease you own real estate I don't tony so you could you have more insight on that I would go to the landlords I would try to do that as much as possible get some reduction I would get maybe can we can we can we just skip some payments I don't know like can we because if I push if I push payments out in the future like if we still have to pay them anyway like eventually that bills come and do right so hey can we get It's probably not gonna happen, but hey, can we get twelve months?

11:18 Can we get twelve months where you just, you know, within writing, can we just not pay rent for the next twelve months? I think these are the dire things that actually need to happen. Then you gotta go to all your therapists and you say, hey, We're in a really tough situation. It's not your fault. It's our fault. We put ourselves into this, the corporate team, the C-suite, whatever. We put ourselves into this. But here's what needs to happen. We need to go to a fifty-fifty, fifty percent salary, fifty percent productivity. So whatever your salary is now, let's just say for easy numbers, if you're at eighty K, know your your salary your next paycheck is going to be you know half of it is going to be guaranteed on your pay stub and then the other half is going to be based off of legal and compliant billing and coding of your visits plus the cash based services which hopefully they have some of the things the the compression boots the uh remote uh remote therapeutic monitoring or remote um remote workout programming that is totally self-pay or any other self-pay things like soft tissue work, massage, cupping, whatever.

12:28 So you got to go to your therapist and try to get buy-in, which is going to be basically impossible because I don't, how many therapists do they have? Tens of thousands of therapists. I don't know. I mean, if they have eight hundred and something locations, you have to assume, you know, they've got. Yeah. Multiple. Yeah. They have thousand therapists. So you're going to you're going to lose some therapists because some of them are, you know, probably. I don't know. Maybe a third. I don't know. Like maybe twenty five to thirty percent are going to take the resume and they're going to go look for home health jobs, sniff jobs, whatever. so then you then you maybe save some money there unfortunately and then the rest of the therapists have to agree to some fifty fifty compensation or if you want to get you want to get super aggressive and really like if you are about to take on water like the titanic tomorrow you could just say hey No more salaries.

13:19 You are strictly on a paid per unit basis, just like Fox Rehab. We're going to pay you per unit, whatever the dollar amount is. Last I heard, Fox Rehab was around sixteen, seventeen, eighteen dollars a unit. I think that's what I've heard. So that's another way to decrease the fixed cost of salaries, only pay people based off of their production. And maybe, I doubt it, but maybe you could save this Titanic from sinking. All right, Justin, special guest. Look at this guy. Jeremy Sutton. Jeremy, how's it going? It's going great. How are y'all?

14:00 Outstanding. I want to finish that conversation about ATI when Jeremy is finished, because I want to come back to that and share some alternative suggestions. Jeremy is here because before we started the show today, Dave and I were talking about marketing, marketing strategies. And one of the things that Jeremy is doing is he's doing these interviews. Just, you know, people are asking what's working for mobile therapy right now. Now you're doing kind of a hybrid model, Jeremy. You've got mobile, but you also are working with a concierge physician. Talk to us about anything that you see right now today that's working for you in building your brand, building your business and getting new patient referrals.

14:46 Yeah, I'm sorry, Tony, that you cut out. My earbuds weren't working, but I think you said talk to us about how you're getting these referrals, right? Absolutely. Okay, perfect. Yeah, so I've done podcasts. I think I've interviewed over three or four hundred people at this point in the last eight years. So that's really my bread and butter as far as meeting people in schools. and you know you had talked about multiple times going and talking to doctors and so really really my kind of my mo was just hey I'm going to interview you for forty five minutes and we're going to talk about whatever but I know with these orthopedic surgeons they may not have forty five minutes so I started reaching out to the ones I kind of knew and said hey do you have fifteen minutes to answer four or five questions and they were like yeah absolutely and so that's what I've done and um gone to them and I've done it with three or four orthopedic surgeons.

15:40 And I think I've done four concierge doctors. But the third concierge doctor I did was Dr. Natalia, Dr. Natalia Laura Geese and her sister, Dr. Victoria. And we just hit it off. I took my wife with me. It was on a Saturday. It was weird. I think I've told you this, Tony. I'm like, you're not going with me to meet another professional. What's going on? And she's like, we don't have kids. So anyway, we went. um they loved monica thank god which everybody does and uh and yeah we just hit it off there like I told him I did tai chi and uh which was the truth but not really because I hadn't done it in a long time um and so I I ended up leading tai chi for five minutes at a yoga uh seminar they were doing and then they asked me to come on and then it turned into we you know see some patients with us will you come in our office will you be here two or three days a week so it really just from that one interview um man they have given me so many patients in the last year and I just looked yesterday and I had I have seventeen leads that I've gotten since april the first and I've closed thirteen of them so it's like amazing it's just it's just been huge I mean I was I was going from you know not I was seeing six to eight people a week or six to eight visits a week and then last week I had eighteen or two weeks ago at eighteen last week I had twenty one this week I have twenty three so it's just been amazing wow So shout out to Tony, because this is Tony Meritato's.

17:06 He's been doing this for three, four, five something years. This is his idea. And I just want to give him a shout out because he's so humble. But this is Tony, you did this with orthopedic surgeons in Ohio. And Jeremy, the reason why you're on today is not only just because you're a friend of the show and you're one of our colleagues, one of our tight colleagues, but also because you take these ideas and then you actually implement them. Yeah. And you actually go out and do it. And not everything works, but this is obviously working. Yeah. Jeremy is the best example of somebody who executes and he's not afraid to try stuff and he just goes out and does it. Dave, this goes back to PT Tech Talks. Rob Vining and Dave Kittle, the originals, the OGs.

17:46 We talked about doing physician interviews back in like. Wow. Two thousand seven or something. It's crazy. But Jeremy, back to you. So give us the actual like you. You kind of glossed over. You reached out to physicians, orthopedic. How did you reach out? Did you call? Did you send a letter? Like, what exactly did you do? yeah so most of them I sent a facebook message to you uh oh directly yeah directly away from the gatekeepers yeah I don't I just bypassed the gate you can't the gatekeepers and I don't don't coincide very I don't know um so the the doctor dr natalia I had no no connection with him whatsoever so I just you know did a google search concierge because they it's either concierge or direct primary care here And there used to be just two.

18:38 Now there's thirty, which is great for me. So you're in you're you're in Louisiana. There's two hundred and fifty thousand people around this area here. But but small. Wow. Yeah. So there's, there's literally from where I'm sitting at a park, a half mile from my kid's school, my concierge doctor is like a hundred yards this way. And there's two more in the same complex that he's in. Um, and it's, it's insane. Um, but so yeah, with her, I just reached out, sent their business page, a Facebook message. And I learned this from Will Boyd, who's the master at everything. And it was so basically I always give them an out. I say, hey, my name is Jeremy Sutton.

19:18 I have this local podcast where I interview the best doctors, business owners here in town. I would love to highlight you on my podcast. We're going to take five to thirty minutes, however I say it. And then I'm just going to ask you questions. I am perfectly fine sending you the questions before time. So you know what I'm going to ask you so there's no surprises. It's not live. I will edit it if you have any issues. And by the way, I know you're super busy trying to change the world or trying to do total hips or whatever it is they're doing. So if you don't have time, no problem. God bless you. Have a great day. And that's basically the message I send every single person. Because they have an out. You're not trying to be overbearing. Actually, this is the first year that I've had people say no.

20:02 In the past, I don't think I asked anybody that said no. Well, maybe one or two, but it's been more people either just ignore me or say no, but who cares? I've got forty-something episodes. It's working. Dave, the screenshot yesterday, somebody found one of the concierge doctors here locally through a short I posted on YouTube. And so Dave said, I hope you screenshotted that. I sent it to him and his wife, Dave, because I knew he wouldn't respond. And she was like, dude, you're awesome. We love you. So yeah, that's what I've been doing. And it's been working. And so what is the distribution like for you? You do this. Well, let's do the mechanics of it. Are you doing it in person? Because I can't believe you do that.

20:44 I don't have the confidence to do that. But for the listeners, are you doing it in person? Are you doing through Zoom? Is it audio only video? What is it? Oh, it's whatever. Most of them have been in person. However, I can get a conversation with these guys. You know, most of them have been in person. And so I have a little microphone that I hate. I ordered a new one because this one's horrible. But I go the first orthopedic surgeon. I sat on a stool and he sat on a chair in one of his exam rooms. I take my tripod that's in the back of the truck right now with my iPhone and I record it on the iPhone and then I record the sound on my laptop because I lost a podcast episode one time and I still think it's the greatest episode I ever recorded.

21:28 But but and I never got that guy back. So I do offer an in-person. And then also if they can't make that happen, we'll do zoom. So whatever is best for them, because like I'm on their time. Right. I'm just, I'm trying, I am, I am trying to get something from them, but I am serving them as well by talking about them and posting it to everywhere. Um, but yeah, I mean, just whatever they need me to do, I'm perfectly okay doing it. I've had two people offer me, um, podcast studios here in town and, um, I haven't taken them up on it because I have I have trouble with like committing to the same thing every day, which is why I want to have my own business. I want to be able to do what I want when I want it.

22:09 And so I have gotten rid of all the things where I have to be here Monday at twelve. Um, and so the podcast studio is kind of the same thing. And it's, um, honestly, I've been so busy the last few weeks. I haven't been able to do an episode. And so I gotta, I gotta get somebody, I have one, but the doctor won't let me release it for a couple more weeks. Cause he's got something going on, but it's cool. It's cool. And so the people that are watching that are like, yeah, but I don't have any subscribers. I don't have any watchers or listeners. Yeah. What, what's your, where did you start? What are you doing right now in terms of like, what's your audience? Oh my gosh. So another, another marketing type of business person I met here in town asked me, what was my goal for my podcast?

22:52 And I was like, meet doctors. I mean, I don't, who cares? And so she's like trying to get me to do all this other stuff to grow the audience. So I would say that, so I had the servant PT podcast. I had two other podcasts. This is the lowest downloaded podcast I've ever had, which bothers me to a certain extent, but also, not really but I started I started a youtube channel over probably like in february of last year I think I had forty subscribers until we did the march madness um I've looked I've gained fifty subscribers in the last month so I'm starting to get some momentum there uh I think I'm up to one hundred and thirty three. You know, I'm starting to grow TikTok, Facebook, Instagram, LinkedIn, all this stuff.

23:32 And so I'm just shoving stuff out, you know, two to three videos a day. Very short, you know, thirty seconds to four minutes. And I just know it's going to get momentum eventually. And yeah, I mean, I'm just trying to really talk to local people. Yeah. jimmy mckay jumping in from possibly thirty thousand feet saying it's the ultimate olive branch he also said size doesn't matter that's what she said Jeremy, are you posting these on YouTube under a healthy SBC? It looks like. Yes. And I haven't, I haven't posted a podcast video in a few weeks.

24:13 Um, I've still, I've still been posting them on iTunes, but, uh, to be honest, my Mac book is a thousand years old and it takes forever to upload it at my house. Um, but I need to get the rest of those, but yes, it's all on healthy SBC. Um, Any of these physicians who didn't reply the first time, have you sent a second or third outreach either different ways? Like, so if you went through Facebook Messenger, have you tried different approaches? LinkedIn, you know, I don't know, through their gatekeepers, have you tried other approaches to try to send them a second or third reach out? And if so, do you say the same thing or you say something different? Um, sometimes I say, no, I usually say something different.

24:55 So I'll say, Hey, um, you know, I know you're busy. Like if I see that they've seen it, Like I had one physician, a concierge physician say, yeah, I'd love to be on your podcast and then kind of ghosted me. And so I've reached back out and he's just ignored it every time. And so I've got a different approach. I'm probably going to send him a bobblehead of himself and say, hey, I'd love to talk to you about how I can help your patients or what. I don't know what I'm going to do. That's my idea. And I had that bobblehead ordered and I didn't order it one day. I don't know. But anyway, to answer your question, so. The two of the most recent orthopedic surgeons are in the same group. And so basically, I got the other one's information from one.

25:37 And so sometimes I'll say, hey, do you recommend anybody else for me to interview? There you go. I always do that. But yeah, I'll reach out. Three-way text message. Hey, Dr. A. Yes. You were on my show. You said you loved it and blah, blah, blah. And then, you know, you know, Dr. B, you said that he would be good on video. Can you send can you send us a three way text message or three way email to loop in Dr. B? Now it's coming from Dr. A. It's not even coming from you. Yeah. The second one in the group. So I knew the first one that I interviewed. So he grew up with a good friend of mine really close to where I where I am. And so that was kind of my end with him. But I have seen all of their patients, you know, because I've been here for sixteen years. So I've seen all their patients.

26:19 But these doctors that I started interviewing have only been practicing for five years or less, which is good because now all the doctors that I've been seeing patients for years are starting to get ready to retire. So I want to build relationships with the new guys. And so that's really who I'm targeting. And the second one said. man, I'd love for you to just interview the whole staff at once. And I was like, yes, when can we set that up? Like tomorrow? Cause I can be right. I can, we can do it now. So, yeah. Hey, so real quick, I just went on Amazon. You can buy a custom bobble head that matches the person. It's seventy nine dollars. Dave and I have talked about not bad, not bad, not bad. That I mean, seventy dollars to get something like that.

27:01 That's incredible. Yeah. I love that idea before we let you go real quick. So I've seen you posting and I know you told me off air some shockwave stuff that you're doing. Tell tell us a little bit about how that's going, what you're doing with that. Yeah. So we just started that this week. I just posted a just so you're the gracious host. Y'all had shared his Facebook ads with me. So I'm going to start right now. Will Boyd, the man, my brother, who I text all the time and tell him how much I love him and how awesome he is. But he shared the Facebook ads he's running out in Phoenix. And so I'm going to start. I've run Facebook ads before here.

27:41 We didn't get a good response out of them. That was actually took me to a house and I texted a picture of my wife. I was like, hey, I'm going in this house. That's where I am. But we're going to start doing that pretty heavily next week. Either I'm going to run the ads or the doctor. So I'm partnering with another concierge doctor here in town who originally bought it to treat ED. And he's just not having a very good response to marketing that. And he's like, it's been sitting in my office for six months. Nobody's touched it. Wow. So I went Wednesday. I had somebody who's a client of mine say he was coming, but he was stuck at work. And so I ended up treating their front office staff. He was having some knee issues.

28:23 And I did twelve hundred shocks to her to the one to the medial one to posterior knee. And she was like, I feel better because that was that was the only time I've ever used one. So I said, hey, come in here. Let's just see how this works. But I'm excited about that. I think that's going to turn into something big because, you know, the people that I see at the other concierge at Dr. Natalia's office, they're doing all the med spa things there. And it's just it's a thing that's tangible that I can show people and say, hey, this is really cool. It click, click, click, click, click. And, you know, you're feeling it. And so I think it's going to be awesome. And I'm honestly probably that's the only marketing I'm going to do as far as running ads just to that for a couple of months and see how it goes. But I think that could be something where I partner with him for maybe four to six months and then end up getting a machine myself because you know, we're going to, we're doing a fifty fifty split and I'm super excited that he's letting me use his machine.

29:15 But at the end of the day, if we're marketing it and it's working, then I'm like, well, why would I take fifty? And he knows that too. So it's not a big deal. But yeah, I'm excited about it. All right, buddy. Well, hey, I know you're busy. I know you're in the car. Go enjoy the rest of your day. Thanks so much for joining us. Thank you. I finally made it on a morning show. I'm big now. See you guys later. Dr. Jeremy Sutton. Dr. Jeremy Sutton. Thank you so much. All right. What a great human that guy is. Love the accent. Absolutely. Going back to ATI real quick, I think the biggest thing, and you hit it in a couple of what you said, was, hey, we need cash right now.

29:58 We need cash today. I can go out and borrow cash, but it's going to cost me a crap ton of percentage because we look so bad on the balance sheet. What can I do with I took a concept from Seth Godin. He had shared this years ago. He said, you know, basically, we're not in health care. We are in finance. We are financing. We're taking patients. We're delivering a service to the patient. We are covering the cost of that service in a third party payer model, not your model. We're financing the patient's recovery, we're paying the therapist, and then we're waiting another fifteen to thirty days before the insurance company pays us.

30:45 So we are ultimately a finance company. That's a failing model when you're running out of cash. I can't be a bank if I don't have money to lend. So how do I switch that to, okay, now I need money now. This is where you get into, I'm selling packages. I'm selling services. I'm creating a digital footprint, which they're doing some of that stuff. I love the idea of looking at what Weight Watchers did. You know, Weight Watchers was a failing business model. Their stock price went from one hundred dollars a share down to a dollar a share. They made a pivot to say, hey, we can't sustain. Let's go out. Let's get a bunch of physicians in.

31:25 Let's go GLP one or whatever GLP blockers. And let's go where the money is. And now they have people that are coming in that are driving payments first in hundreds of dollars instead of the ten or fifteen dollar a month memberships that they used to sell. Their stock is at seventy seven cents a share right now. Holy moly. So even that might not have helped. I don't know. It will too little too late, you know, so like you're late to the party, but there are, again, going back to other models that I think the physical therapy business can look at and, and kind of take lessons from, um, But yeah, I think the key to ATI is turnaround if it ever happens.

32:13 And maybe it's a cultural thing. That's not going to happen. But it's, hey, we need to stop financing everybody else's service and we need to get payments up front. How do we do that? How do we bring money in the door today and then give the services down the road? And that's a big thing with Alex Hermosi and a lot of the guys on social media and what they're preaching. They're like, look, you need high profit to sustain. You need profit now to make this work. So that would be probably where I go. And I would just look at we've got thousands, tens of thousands of visits going on weekly.

32:53 What do these people need right now? They need supplements. They need shockwave. They need pain relief. They need things that they are willing to pay for beyond just what insurance is going to reimburse for. That's where I would put all of my efforts into. But it's a big cultural shift. I don't think therapists want to do it. I think you get a lot of resistance. Therapists aren't going to be the salespeople. So this is where you bring in a sales force that is dedicated to selling the things that patients want because the therapists are not going to be the ones to do it. And if you brought a Salesforce in, you got to pay them, although they would probably be fine with a hundred percent commission, but then you're still paying them whatever the commission is.

33:34 Then you got to pay the therapist to actually do the service, fulfill the service. And so the admin staff that are indirectly, but not producing revenue. ATI, as of right now, today, May first, twenty twenty five, ATI stock price at eighty four cents a share. Over the past five years, it's down ninety nine point eighty three percent. Holy moly. I mean, we've seen how many countless businesses have we seen go that way? You know, they just they they shrink until they eventually disappear. All right. And anything else about that before we go off on to a different post that Lauren Meffin had shared?

34:20 Yeah, let's jump to that. Shoot, I just had it up here. Let me grab it real quick. So I have been sharing, just for context before I share my screen, I've been sharing a bunch of long form sales copy. I'm going this direction a little more heavily. Jeremy Sutton's doing some of this as well. So the idea is building a narrative, building a story. Okay, I'm going to share this. You guys already saw this screenshot, I think, last time we were on. Let me get it over here. This is just talking about spouses that fall, non-emergency fall recovery, things like that.

35:03 I had said publicly, my goal is not to sell that, but if somebody is going to buy it, I will deliver it. But my goal is just to get it out there. I looked at the numbers yesterday, and that post, just a static photo generated image by AI and long form, over six thousand views, all organic, nothing paid yet. Lauren shared a post that she had created. So Lauren is an amazing SLP. She's down in Gainesville. I won't read the whole thing, but let me hit a little bit of it. So it says, quote, are you or a loved one experiencing choking, coughing, difficulty swallowing at home?

35:45 First, right off the bat, what do you think of that opening line, Dave? Yeah. Yeah, it's not the best. It's more of a descriptor instead of a question. I mean, does it end in a question mark? It does, a question mark. So it says, are you or a loved one experiencing choking, coughing, or difficulty swallowing at home? I mean, well, one thing is like, you're, you're asking like, are the parents experiencing the swallowing issues or is it, you're asking the forty, fifty year old that their, their mother or father has the coughing issue or is this a pediatric thing?

36:26 Is this for your children? So it's like, it's asking multiple, it's asking the reader like multiple different people in their family. Like instead of just like, does your son or daughter cough? Does your son or daughter have coughing or swallowing issues? Like this post, like, is it for the pediatric child or is it for the parents of the decision maker who's forty, fifty, sixty years old? So right there, like it's asking for you to consider multiple people in your family. So that's a little unclear. Yeah, I agree. I would say it's not specific enough. I would look at it more direct to have you noticed your mom or dad choking when they sip morning coffee?

37:10 Have you noticed, what does it say, coughing difficulties? Have you noticed your mom gagging when she takes a bite of a sandwich? Or your mom who had a stroke, is she now coughing more, choking more when she's trying to drink coffee? I don't want to say thin liquids, but that's what's coming to my mind because thin liquids is professional jargon. You know, it's something that they would actually be drinking. So I make it water, water, tea. Yeah, yeah. I make it person person specific, you know, as much more granular. So it says, quote, are you or your or a loved one experiencing choking, coughing, difficulty swallowing at home?

37:51 Our comprehensive in-home swallowing evaluation brings expert care directly to you. No travel, no wait time, no waiting rooms, just personalized support in your own environment. just think it's too vague still. You know, it's, it's too general. It's, it's clearly an ad. It's clearly like, give me the story. And this is what I try to do when I'm, when I'm coaxing chat GBT to generate the sales copy, I give it specific things. So I never had a family member who had a stroke, but I did have a family member, my mom who had fallen and who had a brain bleed, who, you know, had repeated falls.

38:34 And I know what I was thinking when I was going through that. I know that my mom would never do fall prevention, even if she had just fallen. She had just tripped over something. She would say, oh, it's no big deal. It was just an accident. Like, these are the things that I would want to bring into the narrative. So for somebody, I think you're talking and I'm completely ignorant to this. So forgive me. OK, so what is important here? Well, it's going to be a mom. It's going to be a mom who had a stroke. It's going to be a mom who's choking when she drinks her morning coffee with toast. Why? You know, why would she want to do this?

39:17 Because she's embarrassed. She stopped going out with her her gal pals. She's not doing the things that she used to do. And she also, you know, has never seen anybody. She's never talked to anybody about something like this. These are the things that I would bring in. What what are you thinking in related to relation to this? I agree. I do love the bringing in a story. I think that might be the biggest component where you're saying, you know, either, you know, Mary, we had a client, we had a family member, you know, I know what this is like. We had, you know, someone in our family or whatever, like you said. Now, if you don't, then maybe you say, okay, we had a past patient or something that agreed to do this or whatever.

40:01 But bringing in a story, like we recently had a client and they were coughing on their you know their tea and they try to make the tea warmer they try to make the tea cooler they try to you know thicken it with extra honey no matter what they did their mother or father or themselves continued to cough every time they had their favorite drink and they you know got upset and they thought that you know they could no longer enjoy life if they couldn't have their morning tea or coffee or whatever it is and They tried this, they tried this, they tried calling their physician, their primary care, they this, that, and nothing seemed to work. They tried whatever, allergy medication, whatever the other alternatives are, I don't know.

40:45 They tried this, this, this, and they thought that there was nothing to do, there was nothing, they tried everything, and that there was no hope. Until they found until they took me up on this offer or whatever of the sleep or the swelling study. And what we found was this simple little thing, whatever it is, maybe it's not simple. Maybe it's complex. We found this. thing this issue to be the the biggest culprit or we have this treatment or this offering or solution that is you know often overlooked and uh you know historically proven with research but not utilized enough because it's overlooked and it was just this one little thing and it's not your fault you know you you didn't know but here's the here's the solution that helped mary And you continue on with the story or end the story from there.

41:38 But I think the story is a huge part of engaging. Yeah, I as we're talking through this, I was just thinking I can remember it. a, a older individual in my family, I want to say an aunt or an uncle like talking or coughing and food coming out of their mouth and them being so embarrassed at Thanksgiving dinner, you know? And so now that they're, they're doing that, they're pulling away, they're retracting their, uh, whatever to themselves. And they're missing out on these family engagements. Like, I think that's something that most of us can relate to. I also remember, and these are real stories. I remember a woman, she was not a family member.

42:21 I think she was a physical therapy patient. Drinking, coughing, her dentures were coming out, you know, and so like all of these incredibly embarrassing stories, but real stories that actually happen. Those are the things that I think would resonate a little bit more strongly. And they're so specific, but they're very common. So then the post goes into, okay, what's included? I think there are elements here that we're missing, like the urgency, all the other aspects that are gonna make me like, they've clearly been dealing with this for a while. Well, why are they gonna go get it addressed now?

43:02 But then when we get into what's included, I just think it's too much professional jargon. Comprehensive swallow evaluation at home, licensed speech therapist, I don't think anyone cares. Mobile swallow study, like she has some equipment and here, optional mobile instrument imaging. I want to see that stuff. This is the cool stuff. This is the stuff that nobody else does. This is the innovation and the technology. I would emphasize the visual aspect of this more. Optional video and imaging. I wouldn't make it optional. I would just say, look, this is what we do. A thousand dollars, fifteen hundred dollars, whatever the cost of it is.

43:45 But we will bring this out to your house. This is, again, what impresses the person. This is what makes them realize, you know, why didn't I get this before? Oh, maybe my doctor or whoever didn't have this equipment, but you do. Customized swallow exercise program, diet recommendations, recommended products. It's fine. I just don't know that that adds much value. Maybe because we don't have the emotional trigger yet to say it. Total investment. She didn't use the word price or cost. She said investment.

44:26 I love that. Yep. Includes one hundred and twenty minute in-home session. I would immediately get rid of the time. Do not stick me with a time. If I can deliver seven hundred and fifty dollars of value in ten minutes, let me get out in ten minutes. You know, I was sitting there yesterday thinking about this again. I'm doing I had two evaluations yesterday morning. I'm like, what in the world are therapists doing that take more than twenty minutes? I am struggling to find things to do to spend more time with this person. And, you know, whatever. Okay. Includes a hundred and twenty minute session, written summary, individualized care plans.

45:11 I would just I would turn this into no time frame. And I would say this includes the confidence and the security of knowing that the next time you're sitting around the family table. grandma or grandpa is not going to choke and spit food across the table. You know, it's going to bring the joy of family back together. Like that's what I want this to deliver. Not a written summary, not an individualized care plan, not any of that stuff. I want confidence and security and family connection. Those are the things that I want it to deliver. What do you think? Yeah, a hundred percent. I knew you were going to say take the time out of there.

45:54 The only time people ask me about our home visit duration, it's typically when it's the forty, fifty, sixty year old son or daughter who's arranging it for their mother or father, but they're like already converted. verbally on the phone and they're they're thinking about like like you know week over week in the future like how often are we basically going to be there and for them the time they perceive it to be important because they're asking like how much for what we're paying I guess like how much are you actually going to be there to help them to take them through movements or exercise or you know whatever transfers or whatever But I agree with you a hundred percent on that. Take the time out of that because people just want the solution. They want their, they want themselves or their mother father to not cough and choke when they're having their favorite drink or their, you know, their breakfast or whatever.

46:42 Uh, so just stay focused on what they care about. And if it takes Yeah. Any other thoughts just in regards to like what Jeremy shared with us and what he's doing, what Lauren is doing here, what you see on social media generally? Well, back to back to what Jeremy is doing with with reaching out to physicians to get them. What is it? A fifteen minute interview on his show? Yeah. I'm so glad that he's sending second or third, like follow up messages to folks that are not answering. But like we kind of covered, like asking those other physicians for an introduction is like the easiest thing ever.

47:28 Like that's the easiest way to break through. And sometimes we get caught, like even myself, like I think I could get caught up with like, sending a second or third message to the person that's not answering and you still should do that and that is part of rejection that is part of just like you know marketing and just like repetitions and you should be asking those folks a different approach but asking them again even if they don't answer and that's okay like He gave them an out. He said, hey, if you're busy, don't even worry about it. It's all good, whatever. But approaching it dynamically, hitting them up on LinkedIn, because if they have their own LinkedIn... He said he does Facebook messaging.

48:11 So that's a little more personal, I think. So the ones that are not answering... look them up on LinkedIn, send them an email or connect with them on LinkedIn and then send them a DM there. And so Jeremy shared with me that screenshot of a patient in the wild that commented on his YouTube video and said, oh, this doctor we heard about and we just scheduled a visit with him, Dr. So-and-so, thank you so much. And he sent me the screenshot. And then I said, dude, I hope you sent that screenshot to that physician. He's like, absolutely, already did. Awesome. Take that screenshot, and for the next physician that has not answered your previous outbound messages, you take that screenshot and you say, hey, Dr. Tony, are you accepting more new patients?

48:57 Here's an example. I interviewed Dr. Johnson, and this person saw the video and is basically going to see him partly because of my video, because of our interview. so the question you you reach out to them hey are you accepting more new patients if they're super busy they're not going to care but if they're concierge direct primary care they are always going to be accepting more new patients or clients or now they're calling them members so you got to speak their language do they care about getting more new members in their practice lead with that hey this is a digital evergreen asset that if we do we knock it out for five minutes ten minutes fifteen minutes we we knock out this interview it's going to live on the internet forever to help drive traffic to your practice we'll put the link of your website in the description of all the videos and this will be working for you and your team even when you guys are sleeping when you're on vacation whatever this this interview will be viewed thousands or whatever, hundreds of times or whatever by local folks that are looking for a concierge direct primary solution, like you got to like position it to what they care about.

50:02 And if they're accepting and they're looking for more new members for their concierge practice, leave with that. And then it's like, oh, you're not pitching your interview. You're pitching like free evergreen marketing deliverable for this position. What do you think? Yeah, no, I totally agree. And I love what you said about understanding what the motivation is on the physician side. I think too many of us, too many therapists, because we are looking for patients think, oh, the doc wants patients. There isn't a single person in my community with MD after their name who needs more new patients, not a single one. So when I approach them, if I approach them, I'm not saying get more new patients.

50:45 What I'm saying is, hey, we'll get you more of the patients you want. We'll get you more of the commercial, not Medicare, not Medicaid. I will bring you patients that are your highest reimbursing, lowest administrative burden, highest potential for a positive outcome. I'm not going to bring you somebody like an orthopedic surgeon. I'm not going to bring you somebody who's got a list of patients Comorbidities and complexity. I'm going to give you the healthy, active, you're going to have the best outcome and it's going to show. That's who I'm going to bring to your office. And they're going to be private insurance.

51:25 You're going to get paid the most possible money for the time you're investing. And that came from... Talking to surgeons, talking to physicians, them telling me I am so sick of primary care docs or other referral sources for them, sending them all the Medicaid referrals, you know. And so I quickly understood, oh, these guys don't need more. They need more of the right kind. And so what I do when I was reaching out and saying, hey, let's do a ten minute interview. I specifically tell them, let me know who you want. What is the best payer for you right now? Let me know what specific procedure you're doing that you want me to ask you about that you want me to promote.

52:09 If you're doing stem cell, if you're doing PRP, if you're doing high value cash based services, we'll talk about it all day long. Because that's what they need. Every new referral isn't worth the same to them, and I need to understand where the value is for them. And once they realize that I know that, now I'm their advocate, now I'm helping them, now the reciprocity kicks in, and now they want to start sending me people too. And that's really where the value comes in here. Even if you have no audience, when I first started doing this, I'd get twenty views, but it didn't matter because it's the reciprocity of them knowing, hey, this guy is looking out for me.

52:50 He understands what I need. He's not just looking to drain my resources on third party payers that I can't afford to see. Yeah. Amen. All right, let's do parting shots. I'll go first. So I am going to investigate the bobblehead idea. I think this is awesome. Who would you send it to? Who and why? Come on. Okay, so I've got a handful of orthopedic docs right now. I want them sending me more total knee replacements. I don't know why every total knee replacement isn't coming to my clinic in my city. I'm going to generate bobbleheads. I'm going to create social media content first, and then I'm going to send it to the surgeon along with a link to the social media video that I created so that they could see what I'm doing.

53:43 Would it make sense for you to mention in that that you have such a big totally replacement following on YouTube or you don't think they would care about that? No, no, they would definitely care. Yeah, I would mention it. I'd have a link, you know, to it so that when they get it, they can go see it. Absolutely. I am leveraging every asset that I have. So you would have a link out like with a QR code because you're going to send this with the bobblehead or you would do a digital message with a bobblehead that you're physically going to send. QR code would be great. I didn't think of that. No, I was just going to like mention the YouTube channel, mention the number of subscribers, mention a couple of the resources that I have.

54:24 I don't know. QR code works well, too. So maybe both of them. I like the idea of you sending the bobblehead to grab their attention. And then you mentioned your Facebook group, but the YouTube following for Total New Replacements. And then also including what you just mentioned a few minutes ago about sending more... total knee replacement candidates to you that are, you know, the healthiest candidates, the most motivated candidates with the least comorbidities and the best insurance. Although it sounds, as I'm saying it, it sounds like it could be a little sound to your snake oil, but like, if that's what they care about, then that's what you got to say.

55:05 Chat GPT will clean it up for me. There you go. There you go. What you got? Parting shot for me is I think I might have to start a whole channel, maybe have Nate or someone else do it to do the physician interviewing. I've already spoken to a bunch of physicians. I have a buddy that's a podiatrist nearby. Uh, he absolutely, he would do this in a second. He would start doing this. We could do, you know, uh, plantar fasciitis, bunionectomy, Achilles, that type, those types of content. And then just one by one asking for referrals from him, asking other physicians. Uh, but again, they're, they're busy. So, but ultimately, uh, Doing this approach, I think it's time.

55:47 I think it's time and it'll certainly help with referrals. So I'm strongly considering it. Watching Tony's success with it, watching Jeremy Sutton's success with it, I think it's time for me to certainly consider it seriously. All right. Awesome, guys. Go check out the Dave Kittle show on YouTube and iTunes and everywhere else. Go check out P.T. Pinecast. Learn Medicare billing every Tuesday, Thursday morning at eight thirty a.m. Eastern time. We'll be here. See you guys later. Thanks, Dave. Thank you.