Is it really UPTA vs APTA? What's Broken & What’s Next in PT?

WEBVTT

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You're listening to the P.T.

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Pinecast,

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where smart people in health care come to

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make noise.

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Here's your host, Jimmy McKay.

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You're listening to the P.T.

00:00:12.537 --> 00:00:13.257
Pinecast,

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where smart people in health care come to

00:00:15.400 --> 00:00:16.521
make noise.

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Here's your host, Jimmy McKay.

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Before we kick things off,

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big thanks to Empower EMR.

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smoother operations,

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That's empoweremr.com, empoweremr.com.

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Today's conversation is live, unedited,

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and intentional.

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My guest is a clinic owner,

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outspoken advocate,

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and someone aligned with UPTA,

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a new organization entering the advocacy

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space in our profession of physical

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therapy.

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You may have seen some passionate threads

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online, comments, words.

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This episode is about slowing down,

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asking direct questions,

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and getting real clarity.

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What exactly is UPT building?

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How's it different?

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What's the tactical plan,

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not just the critique?

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Today isn't about, like, right.

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It's about making room for questions that

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deserve real answers.

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Let's bring in our guest, Dr.

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Steve Rowland.

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Steve, welcome to the show.

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Hey, Jimmy.

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Good morning.

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Thank you.

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I appreciate you having me on.

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And you are in the sunny state of

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Florida.

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Do I have that right?

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The sunny state of Florida.

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You are smarter than me.

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I'm in upstate New York,

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so it's about freezing.

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Let's kick this off with looking back a

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little bit.

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When did you start feeling like something

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was missing from how PTs are represented

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professionally?

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Was there a moment?

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Was it just an era?

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When did you start to feel a shift

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that whatever it is now,

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it didn't feel like it used to be?

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Yeah.

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And I would say that was, you know,

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I hate using the word pre-COVID,

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but that would I would say pre-COVID,

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you know, because let's be honest,

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COVID really changed the trajectory of all

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health care.

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But, you know,

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even before then started seeing something,

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I think it was like back in the

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mid, you know,

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twenty fifteen timeframe when

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You know,

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that was when things were really changing

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and dynamics were changing.

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And, you know, I mean,

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go all the way back to two thousand

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eleven with, you know,

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changing different things and policy with

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Medicare.

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And, you know.

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That's basically it.

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You know,

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it's been coming on for over a decade.

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So what was it?

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I graduated in twenty sixteen.

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So what what was it?

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Was it culture?

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Was it rules?

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It's probably never going to be one thing.

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Right.

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It's got to be a mix.

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Yeah.

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You know, it's you talk to any,

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you know, and I'll focus.

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I've been in pretty much private practice.

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I've run a inpatient rehab.

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I was the CEO of a sixty nine

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bed inpatient rehab facility.

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I was the CEO of one hundred and

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eighty bed facility.

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acute hospital.

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So, you know, I've done PT.

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I've done the other side.

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I've done a lot of admin.

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I've treated a lot of patients through the

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years.

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And it really, it comes down to policy,

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you know,

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policy with these insurance carriers,

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the way that we're, you know,

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we're not allowed to dictate the care

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anymore.

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I feel like we've kind of lost connection

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with that.

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You know, a patient comes to our facility,

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we're being told, you know,

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you've got to get preauthorization.

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You've got to get the, I mean,

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we all know physical therapy.

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There's,

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there's no denying that physical therapy

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saves money.

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right why are we not getting the

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recognition that we deserve and and you

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know and i just want to make this

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perfectly clear i've been very vocal about

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the apta i support the apta not

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financially but again i i just want to

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give a shout out i know those guys

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they're in the grunt like we are every

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day they're fighting the good fight like

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we are uh do i feel like there's

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a

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whole yeah and that and that's you know

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nobody's perfect nobody's gonna hit it the

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nail right on the head but you know

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i think that's why the upta came to

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light was we felt the the private practice

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area you know we just felt like we

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weren't you know hey we're over here you

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know um things address this is my second

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time doing private practice so when i came

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back things were a lot different

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especially reimbursement policies

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reimbursement audits all-time hot

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We can talk about that.

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Yeah,

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I don't know a single PT right now

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in the last two years that is either

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not in an audit or has gone through

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a TPE audit.

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So what was it that made you decide

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that UPTA was the vehicle for that change

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instead of working with APTA?

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Because starting a new association is not

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easy.

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There's work involved.

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This is effort.

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There's a lot of effort.

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So what made you decide UPTA is going

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to be the vehicle for that change instead

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of APTA?

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I felt like they had a bigger hold

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on what was going on.

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Because UPTA is mostly made up of private

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practice members.

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We're the guys that are in the grunt

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right now.

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We're the guys.

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dealing with the daily issues.

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We're the ones going through the TPA

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audits.

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We're the ones training the Mac

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contractors, believe it or not.

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They call it TPE.

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For those of you out there who haven't

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been through a TPE,

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it's targeted probe and educate.

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Well,

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the last part of that is the educate.

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We're doing the educating.

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Unfortunately,

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the Macs still don't know what their own

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policy is.

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And that's sad.

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So, you know, that's why, you know,

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I started seeing Scott Gardner.

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He's our president.

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I started seeing some of his posts on

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social media.

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And, you know,

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I reached out to Scott because, you know,

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I went through an audit.

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And one of the things, you know,

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I believe it was an audio cast that

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Scott had put out for the UPTA.

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And on that audio cast,

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they had their company from out west who

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does compliance.

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I'm sorry,

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I can't remember the acronyms right now,

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but I think it was BCMS.

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And, you know, during that conversation,

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Scott talked about, you know,

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being through all these audits.

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And I was like, holy moly,

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here's a guy who's been, you know,

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just beat up by his Mac contractor.

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So I reached out to him, you know,

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I got him and I had a phone

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call.

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And when we talked,

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we just felt like we had a lot

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of the same.

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And I said, hey, if you ever need,

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you know,

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it wasn't him reaching out to me.

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It was me reaching out to him.

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I said, you know,

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I'm going through an audit right now.

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And he helped me with that.

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I'm fortunate to say I came out of

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that audit without any findings,

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but it's not fun,

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especially through Christmas.

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It's like,

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I want to enjoy Christmas with my family,

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and I've got these Medicare auditors

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asking me for all these charts.

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Yeah, that can be frustrating.

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So I see no disalignment there.

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I think people are pretty aligned.

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Many UPTA supporters, understandably,

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have frustrations with these processes and

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with APTA.

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Yes.

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Noticeably,

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a lot of energy online isn't spent talking

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about what UPTA is building.

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It's spent criticizing what APTA is doing

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or how it does it.

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My question to you as a member,

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don't you worry that that tone or constant

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comparison could actually underline the

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mission that you're on?

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Yeah, and I get it, though,

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because I'm one of them, so I understand.

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There's emotion, right?

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Yeah.

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And sometimes we say things online that...

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I've always told my staff,

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if you have a problem,

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don't send it an email,

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don't send it a text message,

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because it's very hard to understand the

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tone of that.

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Come to me in person.

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Let's talk it out.

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Let's hash it out.

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So am I going to say we're not

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guilty?

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Absolutely not.

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I'm not going to say that.

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There's times where yesterday morning,

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and I think that's what triggered this.

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I saw something that the APTA posted and

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I made a very reactionary post.

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As you know, I deleted it.

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But you, of course,

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have seen it before I deleted it because

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you responded to it.

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But, you know,

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there's times where emotion gets the

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better of you.

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And I think that's just the state of

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private practice right now.

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And I want to say this,

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I believe it's more than, you know,

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because, again,

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I've been

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in this position where I've not just been

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in private practice.

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I've been in other facilities and it's PT

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in general.

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And let's not discount occupational

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therapists and speech therapists as well.

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Absolutely.

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We're all in this together.

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And that's what I really want us to

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get out of this.

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So

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it can be seen and it can be

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portrayed as we're attacking the APTA,

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but I can honestly tell you behind the

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scenes now,

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there's communication between the UPTA and

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the APTA, and I think that's healthy.

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I think that's really good.

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And I think if we,

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and that's what we need.

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We need collaboration.

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Yeah, agreed.

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And I have to say, you know, honestly,

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you and I may not see eye to

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eye.

00:08:16.139 --> 00:08:16.699
There's been time,

00:08:16.720 --> 00:08:18.221
but I really appreciate you bringing me on

00:08:18.240 --> 00:08:18.360
this.

00:08:18.380 --> 00:08:19.680
And I really appreciate you being

00:08:19.721 --> 00:08:21.500
professional and having me on here.

00:08:21.920 --> 00:08:23.302
And I've listened to your podcast.

00:08:23.781 --> 00:08:24.781
I like your podcast.

00:08:24.822 --> 00:08:25.802
I think you're doing a great thing.

00:08:26.161 --> 00:08:26.442
Thanks.

00:08:26.541 --> 00:08:27.523
And I think we need to do this

00:08:27.562 --> 00:08:27.723
more.

00:08:27.742 --> 00:08:28.202
Cool.

00:08:29.362 --> 00:08:29.742
I, I mean, listen,

00:08:29.762 --> 00:08:30.302
this is what I do.

00:08:30.642 --> 00:08:31.062
I'll do it more.

00:08:31.202 --> 00:08:32.443
Don't threaten me with fun.

00:08:32.964 --> 00:08:33.244
Um,

00:08:33.283 --> 00:08:35.224
you've said burnout isn't a personal

00:08:35.264 --> 00:08:35.764
failure.

00:08:36.024 --> 00:08:37.764
It's a system design problem.

00:08:38.445 --> 00:08:41.524
Can you remember a time in your career

00:08:41.544 --> 00:08:42.605
when that became clear?

00:08:42.686 --> 00:08:43.625
Like when you were like, Hey,

00:08:44.636 --> 00:08:47.058
as a person doing practicing when that

00:08:47.119 --> 00:08:47.580
happened.

00:08:47.620 --> 00:08:48.640
So it's, you know,

00:08:48.660 --> 00:08:49.761
I think that's a really bold statement.

00:08:49.802 --> 00:08:50.883
Burnout isn't personal.

00:08:51.143 --> 00:08:54.184
This is a result of a system problem

00:08:54.205 --> 00:08:55.886
that we're unfortunately all in.

00:08:56.407 --> 00:08:57.707
So do you remember when that became like

00:08:57.729 --> 00:09:00.230
kind of clear and you sort of became

00:09:00.291 --> 00:09:01.471
front, had that emotion?

00:09:02.099 --> 00:09:03.620
Yeah, again, right, you know,

00:09:03.640 --> 00:09:06.482
going back to, you know, again,

00:09:06.504 --> 00:09:07.364
I'm going to go back to it.

00:09:07.484 --> 00:09:09.726
Audits are, we are a hanging fruit,

00:09:10.106 --> 00:09:10.467
you know.

00:09:11.028 --> 00:09:14.370
Mac auditors do not see us as a

00:09:15.072 --> 00:09:15.432
friend.

00:09:16.376 --> 00:09:17.498
They're going to say that and they're

00:09:17.518 --> 00:09:18.077
going to say, hey,

00:09:18.097 --> 00:09:19.357
these targeted probe and educate.

00:09:19.899 --> 00:09:20.958
We're here to help.

00:09:21.720 --> 00:09:22.519
Let's be honest.

00:09:22.799 --> 00:09:25.581
They're there to basically we're pickable

00:09:25.620 --> 00:09:26.022
right now.

00:09:26.701 --> 00:09:29.383
And they're picking on us because I can

00:09:29.423 --> 00:09:30.744
tell you from being through it now,

00:09:30.903 --> 00:09:32.524
I will say my back auditor here in

00:09:32.544 --> 00:09:32.904
Florida,

00:09:32.945 --> 00:09:34.446
we're first coast service options.

00:09:34.966 --> 00:09:36.145
She was highly professional.

00:09:36.166 --> 00:09:36.966
In fact, she called me.

00:09:36.986 --> 00:09:37.466
She goes, listen,

00:09:37.486 --> 00:09:38.888
I've been doing this for fifteen years.

00:09:39.864 --> 00:09:41.605
you're the first time and you know again

00:09:41.664 --> 00:09:42.544
i don't want to pat myself on the

00:09:42.565 --> 00:09:44.125
back but i found this to be quite

00:09:44.424 --> 00:09:46.885
intriguing she said you're the first

00:09:46.926 --> 00:09:48.687
person in fifteen years that i haven't get

00:09:48.746 --> 00:09:49.947
off had to get on the phone and

00:09:49.986 --> 00:09:51.307
say hey you forgot to send me the

00:09:51.346 --> 00:09:52.967
progress note for this date or hey you

00:09:52.988 --> 00:09:54.707
forgot to send me the the sign she

00:09:54.748 --> 00:09:56.308
said everything was organized everything

00:09:56.328 --> 00:09:58.549
was together and she said no findings

00:09:58.590 --> 00:10:00.309
congratulations you're free for a year

00:10:00.509 --> 00:10:01.951
okay great i'm free for a year so

00:10:01.990 --> 00:10:03.791
a year yeah i get to look forward

00:10:03.811 --> 00:10:05.591
to it again yay right the fact that

00:10:05.611 --> 00:10:07.552
you have to do it is still fresh

00:10:07.572 --> 00:10:09.072
emotionally taxing and taxing on your

00:10:09.113 --> 00:10:09.493
business

00:10:10.017 --> 00:10:10.197
Yeah.

00:10:10.457 --> 00:10:11.239
And I kept her number.

00:10:11.340 --> 00:10:11.519
You know,

00:10:11.539 --> 00:10:12.701
I appreciated that she gave me her

00:10:12.741 --> 00:10:14.666
personal number and she said, you know,

00:10:14.686 --> 00:10:16.369
if we can work together, let's do it.

00:10:16.649 --> 00:10:18.211
But what I can tell you from a

00:10:18.292 --> 00:10:19.494
PT standpoint is,

00:10:20.562 --> 00:10:22.625
private practice that's not the case in

00:10:22.725 --> 00:10:24.226
all of these you know there's other

00:10:24.267 --> 00:10:26.389
therapists i talk to right now where

00:10:26.408 --> 00:10:27.429
they're they're going through in fact i

00:10:27.450 --> 00:10:28.791
got a friend right down the road who's

00:10:28.831 --> 00:10:30.793
going through up in st augustine about two

00:10:30.812 --> 00:10:33.075
hours north of me here um he reached

00:10:33.154 --> 00:10:35.356
out to me uh late last night and

00:10:35.397 --> 00:10:36.937
he's he just went through an audit but

00:10:36.999 --> 00:10:38.700
he had to tell his you know unfortunately

00:10:39.421 --> 00:10:40.942
let's go back to january first twenty

00:10:40.961 --> 00:10:42.984
twenty five when everybody said hey let

00:10:43.024 --> 00:10:43.244
you know

00:10:43.985 --> 00:10:44.725
We got this win.

00:10:44.764 --> 00:10:45.586
And don't get me wrong.

00:10:45.946 --> 00:10:47.907
I know the intentions were good on this.

00:10:48.586 --> 00:10:51.327
If you get a referral from a physician

00:10:51.388 --> 00:10:53.808
or an NPP and it's got the date,

00:10:54.229 --> 00:10:56.269
it's got the signature that's legible and

00:10:56.309 --> 00:10:58.010
it says PT or OT or speech or

00:10:58.030 --> 00:11:00.351
whatever you want to do for that patient.

00:11:01.231 --> 00:11:02.552
And, you know,

00:11:02.753 --> 00:11:05.313
that's you now do the eval,

00:11:05.333 --> 00:11:06.214
you do your plan of care,

00:11:06.254 --> 00:11:07.554
you send that plan of care.

00:11:07.575 --> 00:11:08.815
Don't forget, that's the important part.

00:11:08.835 --> 00:11:10.515
You have to send that plan of care

00:11:11.076 --> 00:11:12.255
to that referring provider.

00:11:12.416 --> 00:11:13.256
They don't have to sign it.

00:11:13.990 --> 00:11:15.192
But you got to send it within thirty

00:11:15.211 --> 00:11:15.471
days.

00:11:16.131 --> 00:11:16.993
With that being said,

00:11:18.114 --> 00:11:19.254
a lot of the Macs still don't know

00:11:19.313 --> 00:11:20.455
that.

00:11:20.475 --> 00:11:21.676
Where's your sign point of care?

00:11:21.755 --> 00:11:25.077
That's that's a system problem.

00:11:25.177 --> 00:11:27.580
So these are the frustrations.

00:11:27.740 --> 00:11:30.761
I have a full time person sitting in

00:11:30.782 --> 00:11:31.442
this office.

00:11:32.001 --> 00:11:33.562
That's all they do is track down sign

00:11:33.602 --> 00:11:33.783
point.

00:11:33.802 --> 00:11:35.764
You pay that person and that's all they

00:11:35.804 --> 00:11:35.924
do.

00:11:36.600 --> 00:11:37.261
That's all they do.

00:11:37.461 --> 00:11:38.442
Well, not only that, I mean,

00:11:38.842 --> 00:11:40.163
we have a full compliance plan.

00:11:40.683 --> 00:11:42.625
You know, I've been down this road.

00:11:42.645 --> 00:11:43.365
So my,

00:11:44.106 --> 00:11:47.509
and a shout out to Rick Wanda.

00:11:47.528 --> 00:11:48.450
Wouldn't want to do his job.

00:11:48.850 --> 00:11:49.951
Really would not want to do his job.

00:11:50.410 --> 00:11:51.572
Rick and I have not always seen eye

00:11:51.692 --> 00:11:52.072
to eye.

00:11:52.993 --> 00:11:54.313
I'm still a gold member of Rick.

00:11:54.715 --> 00:11:56.255
I still listen to Rick's stuff.

00:11:58.422 --> 00:11:59.403
He has a job,

00:11:59.484 --> 00:12:00.865
he serves a very important,

00:12:00.904 --> 00:12:02.727
but why should we even be in that

00:12:03.269 --> 00:12:03.649
arena?

00:12:03.969 --> 00:12:06.432
Why should we be having to fight, fight,

00:12:06.493 --> 00:12:06.753
fight?

00:12:06.932 --> 00:12:07.995
And that's where I feel.

00:12:08.054 --> 00:12:11.519
I feel like we're climbing up a rock

00:12:11.559 --> 00:12:14.884
hill with no support and one slip and

00:12:14.923 --> 00:12:15.303
we're gonna go.

00:12:16.089 --> 00:12:16.708
Don't disagree.

00:12:17.129 --> 00:12:19.010
So when all you have is a hammer,

00:12:19.030 --> 00:12:19.910
the world is full of nails.

00:12:20.291 --> 00:12:21.892
So Jimmy worked in radio for fifteen

00:12:22.253 --> 00:12:22.472
years.

00:12:22.513 --> 00:12:23.472
So I look at things.

00:12:23.893 --> 00:12:24.594
I look at words.

00:12:25.734 --> 00:12:27.696
I gave this lesson a mini lesson.

00:12:27.836 --> 00:12:28.855
Not like I'm giving you a lesson,

00:12:28.875 --> 00:12:29.917
but I'll just say what I taught.

00:12:31.017 --> 00:12:32.879
I think a lot of disagreements that happen

00:12:32.899 --> 00:12:35.899
in the comments section happen because of

00:12:35.960 --> 00:12:36.841
something very basic.

00:12:37.639 --> 00:12:39.282
And this is like almost kindergarten

00:12:39.322 --> 00:12:41.043
level, which makes it simple, not easy.

00:12:41.844 --> 00:12:44.586
When someone is expressing frustrations,

00:12:44.785 --> 00:12:45.606
that's an emotion.

00:12:46.346 --> 00:12:46.567
Yes.

00:12:46.748 --> 00:12:49.389
And when someone else is coming back with

00:12:49.490 --> 00:12:51.251
something tangible or logic,

00:12:52.592 --> 00:12:54.553
both of those things can be true and

00:12:54.573 --> 00:12:56.155
you are now talking past each other.

00:12:57.187 --> 00:12:59.869
I love there's a GIF out there that

00:12:59.889 --> 00:13:03.068
shows a chain link fence and two Dobermans

00:13:03.249 --> 00:13:05.330
on one side barking at another dog,

00:13:05.409 --> 00:13:06.610
a golden retriever on the other side.

00:13:06.649 --> 00:13:07.769
And all of a sudden the chain link,

00:13:08.030 --> 00:13:09.110
they're barking through the fence and all

00:13:09.130 --> 00:13:10.331
of a sudden the chain link fence slides

00:13:10.350 --> 00:13:10.711
out of the way.

00:13:10.750 --> 00:13:11.811
And then they both just sort of stare

00:13:11.831 --> 00:13:12.751
at each other.

00:13:12.851 --> 00:13:13.991
Yep.

00:13:14.011 --> 00:13:14.792
Neither is wrong,

00:13:14.851 --> 00:13:17.072
except people want to be seen, heard,

00:13:17.092 --> 00:13:17.533
and understood.

00:13:17.552 --> 00:13:17.633
Yep.

00:13:19.217 --> 00:13:22.578
So if I've been an APTA member for

00:13:22.599 --> 00:13:23.200
a long time,

00:13:23.740 --> 00:13:25.461
I hold them accountable every twelve

00:13:25.500 --> 00:13:27.061
months, as you should.

00:13:27.140 --> 00:13:27.902
I tell people all the time.

00:13:28.001 --> 00:13:30.403
I was at an APTA New Jersey student

00:13:30.423 --> 00:13:31.602
event this weekend and someone said,

00:13:32.083 --> 00:13:32.943
why should I be a member?

00:13:33.043 --> 00:13:34.144
And I said, you shouldn't.

00:13:34.644 --> 00:13:36.524
And then I paused and said,

00:13:37.046 --> 00:13:39.647
unless you understand what you are buying,

00:13:40.907 --> 00:13:43.028
membership is a how, not a what.

00:13:45.431 --> 00:13:47.451
Netflix isn't a membership organization.

00:13:47.532 --> 00:13:49.833
Membership is how you get access to the

00:13:49.874 --> 00:13:51.695
content.

00:13:51.735 --> 00:13:53.316
Netflix is in the boredom reduction

00:13:53.355 --> 00:13:53.816
business.

00:13:54.976 --> 00:13:56.136
You're in the feeling business.

00:13:56.677 --> 00:13:59.578
So if someone goes into and pays money

00:14:00.419 --> 00:14:01.360
to APTA and says,

00:14:01.460 --> 00:14:03.461
I need to make sure I get my,

00:14:03.780 --> 00:14:04.741
and I think I did the math,

00:14:05.241 --> 00:14:06.243
it's X number of dollars to be an

00:14:06.283 --> 00:14:07.964
APTA national member and then a state

00:14:08.004 --> 00:14:08.264
member.

00:14:08.283 --> 00:14:09.424
And then if you want an academy or

00:14:09.445 --> 00:14:09.745
whatever,

00:14:10.404 --> 00:14:11.285
let's say it's five hundred bucks.

00:14:12.066 --> 00:14:13.927
if you're waiting to draw the direct line

00:14:13.947 --> 00:14:15.687
between pay five hundred bucks put five

00:14:15.707 --> 00:14:17.048
hundred dollars in the coke machine and

00:14:17.107 --> 00:14:19.690
get six hundred dollars worth of value out

00:14:20.049 --> 00:14:22.510
i need to understand what you value i

00:14:22.551 --> 00:14:25.052
do it because i'm a joiner that's in

00:14:25.091 --> 00:14:27.413
my dna i like going to the events

00:14:27.893 --> 00:14:29.274
i got buddies who were like couldn't

00:14:29.594 --> 00:14:30.734
wouldn't catch me there on my worst on

00:14:30.754 --> 00:14:32.894
my last day get it neither of us

00:14:32.934 --> 00:14:34.956
are wrong but if i keep barking at

00:14:34.995 --> 00:14:37.437
him because you got to join because it's

00:14:37.457 --> 00:14:38.158
your duty

00:14:39.504 --> 00:14:40.485
That's Newton's law, man.

00:14:40.505 --> 00:14:44.109
You're pushing on the wrong pain point.

00:14:44.149 --> 00:14:45.370
I think I said it this morning.

00:14:45.530 --> 00:14:47.572
Someone asked me, Tony Meritato asked me,

00:14:48.273 --> 00:14:49.975
why do people go to CSM?

00:14:50.796 --> 00:14:51.856
And I said, great question.

00:14:52.496 --> 00:14:53.999
I said, I think I said a lot.

00:14:54.038 --> 00:14:55.120
It's more like a carnival.

00:14:56.782 --> 00:14:59.544
it's not just roller coasters or teacups.

00:14:59.985 --> 00:15:01.647
That's for the person who values...

00:15:01.726 --> 00:15:02.528
Carnivals are smart.

00:15:03.089 --> 00:15:04.690
They have teacups because they're like,

00:15:04.910 --> 00:15:06.211
well, if someone values teacups,

00:15:06.371 --> 00:15:06.993
we got those.

00:15:07.212 --> 00:15:08.575
If someone values fried foods,

00:15:08.754 --> 00:15:09.416
we got those.

00:15:09.635 --> 00:15:11.298
If someone values games, we got those.

00:15:12.784 --> 00:15:14.765
If you go into APTA because you're like,

00:15:14.905 --> 00:15:16.306
I'm going to get my five hundred,

00:15:16.326 --> 00:15:17.426
I'm going to pay five hundred bucks every

00:15:17.446 --> 00:15:17.586
year.

00:15:17.605 --> 00:15:18.687
I'm going to get this out.

00:15:18.807 --> 00:15:20.267
I need to understand what you think you're

00:15:20.326 --> 00:15:20.586
getting.

00:15:20.907 --> 00:15:21.988
This is a misalignment.

00:15:22.388 --> 00:15:23.908
I thought I was going to get immediate

00:15:23.927 --> 00:15:25.328
relief from my billing.

00:15:25.849 --> 00:15:27.389
Well, I don't know if APTA,

00:15:27.408 --> 00:15:28.090
I don't work for APTA.

00:15:28.370 --> 00:15:29.629
I don't know if APTA ever said that.

00:15:29.730 --> 00:15:31.770
I'm pretty sure they didn't because this

00:15:31.850 --> 00:15:32.811
system sucks.

00:15:33.171 --> 00:15:33.770
I'll say it.

00:15:34.071 --> 00:15:34.672
It sucks.

00:15:35.032 --> 00:15:35.932
But so does gravity.

00:15:36.511 --> 00:15:37.511
And I can't change it.

00:15:37.552 --> 00:15:37.812
Right.

00:15:38.312 --> 00:15:40.092
So let me ask you this.

00:15:40.173 --> 00:15:41.673
This is an unfair question.

00:15:41.693 --> 00:15:42.333
I'm using air quotes.

00:15:42.374 --> 00:15:42.474
It's

00:15:42.693 --> 00:15:43.453
Unfair question.

00:15:43.754 --> 00:15:45.014
But if you had a magic wand,

00:15:45.115 --> 00:15:47.735
what is the first system redesign that you

00:15:47.755 --> 00:15:50.356
would make to actually relieve burnout and

00:15:50.397 --> 00:15:51.897
frustration at a practical level?

00:15:52.236 --> 00:15:53.378
You got a clean whiteboard.

00:15:53.418 --> 00:15:54.957
What would you do?

00:15:55.558 --> 00:15:55.879
Yes.

00:15:55.979 --> 00:15:57.719
I mean, first and foremost, I think,

00:15:58.019 --> 00:15:58.980
you know, let's not.

00:16:01.530 --> 00:16:03.732
downplay who we are we are doctors of

00:16:03.773 --> 00:16:06.115
physical therapy right the thing that

00:16:06.274 --> 00:16:08.437
boggles my mind is why do we still

00:16:08.538 --> 00:16:11.279
need a referral why do we still need

00:16:11.760 --> 00:16:13.221
a signed plan of care that would that

00:16:13.241 --> 00:16:15.504
would be my my first thing is let's

00:16:15.544 --> 00:16:18.547
eliminate that because that's where a lot

00:16:18.587 --> 00:16:20.408
of us in private practice we spend a

00:16:20.570 --> 00:16:23.272
lot of our time tracking down planet cares

00:16:23.732 --> 00:16:24.533
doctors don't read them

00:16:25.672 --> 00:16:26.871
I haven't talked to a single doctor who

00:16:26.892 --> 00:16:28.773
said, Hey, I read your plan of care.

00:16:28.832 --> 00:16:29.332
I love it.

00:16:29.432 --> 00:16:32.173
You know, and you know, there's a,

00:16:32.193 --> 00:16:33.734
we have to track these plan of cares

00:16:33.754 --> 00:16:34.774
down to make sure that we get them

00:16:34.813 --> 00:16:35.835
signed within thirty days.

00:16:35.875 --> 00:16:36.154
Right.

00:16:36.534 --> 00:16:37.375
We walk into the office.

00:16:37.394 --> 00:16:38.735
We're like, Hey, it's day twenty nine.

00:16:39.336 --> 00:16:40.096
The little M.A.

00:16:40.135 --> 00:16:40.895
sitting at the desk.

00:16:41.596 --> 00:16:42.277
She scribbles it.

00:16:42.356 --> 00:16:43.136
Here you go.

00:16:43.157 --> 00:16:44.116
What would that remove?

00:16:45.636 --> 00:16:46.317
A lot of burden.

00:16:46.998 --> 00:16:47.618
A lot of burden.

00:16:48.357 --> 00:16:49.197
Don't need a referral.

00:16:49.258 --> 00:16:49.979
And I've talked to.

00:16:50.158 --> 00:16:51.278
So I have a direct line.

00:16:51.996 --> 00:16:53.018
to HHS right now.

00:16:53.077 --> 00:16:54.278
So I got to tell you a little

00:16:54.317 --> 00:16:54.818
funny story.

00:16:54.839 --> 00:16:57.039
So seven, eight years ago,

00:16:57.080 --> 00:16:58.260
let's call it seven, eight years ago,

00:16:58.980 --> 00:17:00.121
a good friend of mine,

00:17:00.341 --> 00:17:02.202
he's a car dealer in town.

00:17:02.263 --> 00:17:02.863
Great guy.

00:17:03.322 --> 00:17:04.423
He invited my wife and I to a

00:17:04.483 --> 00:17:05.124
polo match.

00:17:05.223 --> 00:17:07.546
Well, at that polo match, Dr. Oz.

00:17:08.648 --> 00:17:09.709
Big fan of Dr. Oz.

00:17:09.729 --> 00:17:11.769
So I walk up to Dr.

00:17:11.829 --> 00:17:13.029
Oz like I normally do.

00:17:13.069 --> 00:17:13.810
I'm not shy.

00:17:13.830 --> 00:17:15.050
I'm like, hey, can we talk?

00:17:16.211 --> 00:17:17.511
And he was very polite.

00:17:17.731 --> 00:17:18.551
He sat down with me.

00:17:18.592 --> 00:17:19.792
He talked to me.

00:17:20.532 --> 00:17:21.752
We talked about wellness.

00:17:21.772 --> 00:17:22.773
We talked about health care.

00:17:22.834 --> 00:17:24.673
We talked about all kinds of things.

00:17:24.913 --> 00:17:25.473
We hit it off.

00:17:26.335 --> 00:17:29.355
And we remembered that moment.

00:17:29.476 --> 00:17:31.516
And when he got appointed the head of

00:17:31.556 --> 00:17:33.717
CMS, what's the first thing I did?

00:17:33.777 --> 00:17:35.798
I reached out to him.

00:17:35.857 --> 00:17:36.278
He remembered.

00:17:37.381 --> 00:17:38.622
remember that conversation he's like oh

00:17:38.642 --> 00:17:40.363
man i remember that day so what does

00:17:40.383 --> 00:17:41.742
he do he puts me in charge with

00:17:41.823 --> 00:17:43.263
his he puts me in contact with his

00:17:43.304 --> 00:17:46.105
deputy director he's the guy that does

00:17:46.125 --> 00:17:47.707
policy this is the guy you got to

00:17:47.727 --> 00:17:50.147
talk to you have great ideas talk to

00:17:50.167 --> 00:17:52.128
this guy so we've been in communication

00:17:52.189 --> 00:17:53.690
like he gave me his email address he

00:17:53.710 --> 00:17:55.810
gave me his phone number he's like hey

00:17:55.851 --> 00:17:58.311
let's talk about these things so you know

00:17:58.352 --> 00:18:00.653
that that's one of those moments where you

00:18:00.673 --> 00:18:01.334
know okay

00:18:02.862 --> 00:18:04.423
Use those moments to your advantage,

00:18:04.544 --> 00:18:05.924
use the people that you've met through

00:18:05.964 --> 00:18:07.046
your years of contact,

00:18:07.287 --> 00:18:08.188
use that to your advantage.

00:18:08.708 --> 00:18:10.068
But these guys,

00:18:10.150 --> 00:18:11.191
when you're talking to them,

00:18:11.490 --> 00:18:15.535
they have no idea what we do, none.

00:18:15.634 --> 00:18:16.536
And it's not, and again,

00:18:16.615 --> 00:18:18.097
I'm not putting blame on anybody,

00:18:19.105 --> 00:18:21.767
What happens is these guys get replaced.

00:18:21.967 --> 00:18:22.247
Right.

00:18:22.827 --> 00:18:25.048
So let's say we're doing advocacy and

00:18:25.068 --> 00:18:26.410
we're beating the bush and we're talking

00:18:26.430 --> 00:18:27.490
to Congress people.

00:18:27.550 --> 00:18:27.851
And, you know,

00:18:27.891 --> 00:18:29.291
my best friend is Mike Caradopolis.

00:18:29.311 --> 00:18:30.113
Shout out to Mike.

00:18:30.633 --> 00:18:32.094
Mike is really attacking health care right

00:18:32.114 --> 00:18:32.555
now.

00:18:32.694 --> 00:18:33.756
He said, Steve, give me a year.

00:18:33.915 --> 00:18:34.175
You know,

00:18:34.536 --> 00:18:36.017
Mike used to be the president of the

00:18:36.057 --> 00:18:38.219
Florida Senate.

00:18:38.598 --> 00:18:39.359
Mike's a good guy.

00:18:39.500 --> 00:18:40.840
Mike knows Mike gets stuff done.

00:18:40.881 --> 00:18:42.122
Mike Mike's very hard to beat.

00:18:42.721 --> 00:18:45.684
bought right so he's really pushing the

00:18:45.744 --> 00:18:47.125
he's pushing the envelope now on health

00:18:47.145 --> 00:18:48.686
care for me and he's he's working behind

00:18:48.707 --> 00:18:49.827
the scenes and I talked to Mike at

00:18:49.847 --> 00:18:52.250
least once a week and and his wife

00:18:52.289 --> 00:18:53.991
now is now you know she walked into

00:18:54.031 --> 00:18:56.193
a position she was a internal medicine

00:18:56.213 --> 00:18:57.775
doctor so she's now the head she's

00:18:57.835 --> 00:19:00.116
actually our acting Surgeon General of the

00:19:00.136 --> 00:19:02.759
United States so okay had dinner with them

00:19:02.778 --> 00:19:04.260
the other night you know she walked into

00:19:04.280 --> 00:19:05.261
that position it's not going to be a

00:19:05.281 --> 00:19:06.363
full-time position but again

00:19:07.262 --> 00:19:08.525
She's got to be careful because she works

00:19:08.545 --> 00:19:09.226
for HHS.

00:19:09.246 --> 00:19:11.769
She's working directly at Kennedy Junior

00:19:11.808 --> 00:19:12.210
side,

00:19:12.710 --> 00:19:15.634
so she can't give me an unfair advantage.

00:19:15.673 --> 00:19:17.316
But these are things that I can do

00:19:17.375 --> 00:19:20.079
to meander the past.

00:19:20.119 --> 00:19:22.502
But what I've found over the last year

00:19:22.522 --> 00:19:23.744
since Mike's been in office,

00:19:25.731 --> 00:19:26.732
Nobody in Congress,

00:19:26.913 --> 00:19:29.375
nobody who's making these policy decisions

00:19:29.715 --> 00:19:31.857
really has a fair shake as to what

00:19:31.897 --> 00:19:32.137
we do.

00:19:32.178 --> 00:19:32.699
We're still,

00:19:33.278 --> 00:19:35.101
we're still looked at as an ancillary

00:19:35.141 --> 00:19:35.480
provider.

00:19:35.500 --> 00:19:36.422
We're still looked at, you know,

00:19:36.442 --> 00:19:37.462
and I hate to use this word,

00:19:37.482 --> 00:19:38.463
but I'm going to use it anyway.

00:19:38.523 --> 00:19:40.125
Two words, three words,

00:19:40.165 --> 00:19:41.866
glorified massage therapists.

00:19:41.886 --> 00:19:42.867
That's the way.

00:19:43.249 --> 00:19:43.288
Oh,

00:19:43.328 --> 00:19:44.650
you guys are the people that rub people,

00:19:44.670 --> 00:19:45.069
right?

00:19:45.550 --> 00:19:46.571
So how do we change that?

00:19:47.906 --> 00:19:48.366
Numbers.

00:19:49.167 --> 00:19:49.587
Numbers.

00:19:50.107 --> 00:19:51.327
We all have to start.

00:19:51.347 --> 00:19:52.048
Numbers of what?

00:19:52.449 --> 00:19:52.828
People.

00:19:53.128 --> 00:19:53.328
Us.

00:19:53.489 --> 00:19:54.589
Therapists.

00:19:54.609 --> 00:19:56.770
We need to wake up.

00:19:56.810 --> 00:19:58.451
We need a what and a how.

00:19:58.872 --> 00:19:59.192
Yes.

00:19:59.392 --> 00:20:01.252
So writing your congresspeople.

00:20:01.692 --> 00:20:02.893
In those explanations,

00:20:02.952 --> 00:20:05.134
we need to include this is what we

00:20:05.193 --> 00:20:05.974
do.

00:20:06.035 --> 00:20:07.055
We're movement specials.

00:20:07.174 --> 00:20:08.375
We're not massage therapists.

00:20:08.395 --> 00:20:10.936
We're not this.

00:20:11.297 --> 00:20:11.576
And again,

00:20:11.616 --> 00:20:12.676
let's go back to your question that you

00:20:12.737 --> 00:20:12.917
asked me.

00:20:12.938 --> 00:20:13.897
If there's one thing I could do.

00:20:14.198 --> 00:20:15.719
So the Planet Cares, that's a simple fix,

00:20:15.759 --> 00:20:15.979
right?

00:20:15.999 --> 00:20:16.419
Got it.

00:20:18.323 --> 00:20:19.703
my and i can't talk too much about

00:20:19.743 --> 00:20:21.144
this because i'm in the early stages of

00:20:21.226 --> 00:20:23.487
developing this right now i've got ndas

00:20:23.528 --> 00:20:24.769
and all that stuff but we need to

00:20:24.788 --> 00:20:27.371
prove outcomes and not just prove outcomes

00:20:27.510 --> 00:20:29.211
because i can tell you our patients get

00:20:29.231 --> 00:20:31.193
better and we say but how can we

00:20:32.555 --> 00:20:34.297
extrapolate that to a dollar amount

00:20:34.376 --> 00:20:37.179
downstream cost savings oh photo right i

00:20:37.199 --> 00:20:39.740
mean there are ways to do that correct

00:20:39.941 --> 00:20:41.682
but it has to go one step further

00:20:41.702 --> 00:20:44.285
okay to what photo is great you know

00:20:44.305 --> 00:20:45.905
we can say patient went from this to

00:20:45.945 --> 00:20:46.207
this

00:20:47.288 --> 00:20:49.170
let's look at data let's look at real

00:20:49.210 --> 00:20:51.991
data if that patient was discharged and i

00:20:52.011 --> 00:20:53.133
don't i don't even like doing the word

00:20:53.173 --> 00:20:54.354
dish or i don't think patients should be

00:20:54.394 --> 00:20:55.976
discharged from physical therapy i think

00:20:56.476 --> 00:20:57.896
you go to your dentist every six months

00:20:57.916 --> 00:20:58.897
for cleaning you should go to your

00:20:58.938 --> 00:21:00.859
physical therapist for a checkup right

00:21:01.559 --> 00:21:02.821
let's check your balance let's look

00:21:02.862 --> 00:21:04.883
especially patients over sixty five high

00:21:04.923 --> 00:21:06.644
fall risk you know they've got diabetes

00:21:06.664 --> 00:21:08.606
they've got all the risk factors so hold

00:21:08.626 --> 00:21:09.827
on a second before we go too far

00:21:09.867 --> 00:21:11.229
down i want to make sure i understand

00:21:11.288 --> 00:21:13.310
if so i don't get lost sure we

00:21:13.351 --> 00:21:13.510
need

00:21:15.156 --> 00:21:17.058
Physical therapists in the wild,

00:21:17.179 --> 00:21:18.339
if they're associated with the group or

00:21:18.359 --> 00:21:18.480
not,

00:21:18.500 --> 00:21:19.721
we need a lot of people to do

00:21:19.881 --> 00:21:21.362
a specific thing.

00:21:21.461 --> 00:21:22.722
Yes.

00:21:22.762 --> 00:21:23.903
Doesn't APTA do that?

00:21:24.365 --> 00:21:25.444
They have apps.

00:21:25.506 --> 00:21:26.846
They do something called a flash action

00:21:26.866 --> 00:21:27.086
strategy.

00:21:27.106 --> 00:21:27.846
They've been doing this.

00:21:28.587 --> 00:21:29.368
I can only speak to you.

00:21:29.429 --> 00:21:31.150
I've been in a PT for ten years.

00:21:31.891 --> 00:21:32.852
They've been doing that.

00:21:33.251 --> 00:21:36.294
But there's only one organization doing

00:21:36.354 --> 00:21:36.815
it.

00:21:36.894 --> 00:21:38.256
And I can't speak to it.

00:21:38.296 --> 00:21:39.696
So is it the number of organizations or

00:21:39.717 --> 00:21:40.397
the number of people?

00:21:40.718 --> 00:21:41.878
Because the second you said people.

00:21:42.378 --> 00:21:43.279
It's grassroots.

00:21:43.539 --> 00:21:45.300
That's that's the only thing we get done.

00:21:45.320 --> 00:21:47.001
And here's what I'm going to tell you

00:21:47.041 --> 00:21:47.423
about the APTA.

00:21:47.442 --> 00:21:48.903
So they may be fighting behind the scenes

00:21:48.923 --> 00:21:49.144
for us.

00:21:49.163 --> 00:21:49.923
They may be doing this.

00:21:49.943 --> 00:21:50.265
They may be.

00:21:50.305 --> 00:21:51.285
I don't know if they're fighting behind

00:21:51.305 --> 00:21:51.705
the scenes.

00:21:51.746 --> 00:21:52.506
They're they're pretty.

00:21:53.307 --> 00:21:53.586
Yeah.

00:21:53.846 --> 00:21:54.428
Well, you know what I mean?

00:21:54.468 --> 00:21:54.948
You know what I mean?

00:21:55.008 --> 00:21:56.828
We don't see everything they do when

00:21:56.888 --> 00:21:57.869
they're in D.C.

00:21:57.930 --> 00:21:58.210
Right.

00:21:58.289 --> 00:21:59.671
We don't see the conversations.

00:21:59.711 --> 00:22:01.932
We don't see what's being discussed at the

00:22:01.952 --> 00:22:03.034
table, et cetera, et cetera.

00:22:04.515 --> 00:22:06.155
We as we cannot.

00:22:06.296 --> 00:22:07.457
So I'll tell you.

00:22:07.477 --> 00:22:09.198
So in two thousand and four.

00:22:09.317 --> 00:22:09.478
Right.

00:22:09.498 --> 00:22:10.638
Let's go back to two thousand and four.

00:22:12.190 --> 00:22:14.912
I just opened my private practices.

00:22:14.932 --> 00:22:17.093
So I had three private practices,

00:22:17.354 --> 00:22:18.433
opened them in two thousand wide,

00:22:18.453 --> 00:22:19.355
three private practices.

00:22:19.934 --> 00:22:22.196
We got hit back to back to back.

00:22:22.237 --> 00:22:24.278
In six weeks we had three hurricanes.

00:22:24.317 --> 00:22:24.679
All right.

00:22:25.546 --> 00:22:27.067
just devastated this whole area.

00:22:27.186 --> 00:22:28.207
I live on the Space Coast.

00:22:28.247 --> 00:22:31.268
We're right near Elon Musk and Jeff Bezos

00:22:31.288 --> 00:22:32.347
and all the rocket launch.

00:22:32.367 --> 00:22:33.509
There's a rocket launch that pretty much

00:22:33.528 --> 00:22:34.308
goes up every day now.

00:22:34.328 --> 00:22:35.229
We're so immune to it.

00:22:35.249 --> 00:22:36.809
We're like, oh, look, another rocket.

00:22:37.410 --> 00:22:41.010
But three hurricanes back to back to back.

00:22:41.471 --> 00:22:43.912
I remember watching the National Guard

00:22:43.951 --> 00:22:47.374
coming in here in trucks and truckloads,

00:22:47.653 --> 00:22:51.055
and people were walking around in a fog

00:22:51.315 --> 00:22:52.715
waiting for the government to show up to

00:22:52.756 --> 00:22:53.076
help them.

00:22:54.537 --> 00:22:56.118
They tell, you know, you live in Florida,

00:22:56.159 --> 00:22:58.300
they tell you prepare, prepare, prepare,

00:22:58.361 --> 00:22:58.661
right?

00:22:59.161 --> 00:23:01.503
Get water, get batteries, get a generator,

00:23:01.544 --> 00:23:02.203
do this, do this.

00:23:02.625 --> 00:23:03.525
I was prepared, right?

00:23:03.545 --> 00:23:04.266
So I'm not walking around,

00:23:04.326 --> 00:23:04.846
I'm walking around,

00:23:04.906 --> 00:23:06.407
I'm driving around saying, you know,

00:23:06.448 --> 00:23:06.989
my therapist,

00:23:07.009 --> 00:23:08.529
we were out of work for almost three

00:23:08.569 --> 00:23:08.910
weeks.

00:23:09.431 --> 00:23:10.352
I told my therapist, hey,

00:23:10.392 --> 00:23:10.811
if you want to,

00:23:11.752 --> 00:23:12.973
if you want to work and get paid

00:23:13.013 --> 00:23:15.435
come in here i had the water guy

00:23:15.516 --> 00:23:17.317
zephyr hills i had him drop off big

00:23:17.336 --> 00:23:19.199
shout out to them they came and dropped

00:23:19.278 --> 00:23:21.340
off i don't know a hundred two hundred

00:23:21.520 --> 00:23:23.582
big five gallon jugs of water and i

00:23:23.622 --> 00:23:25.564
had my staff going around to our patients

00:23:25.604 --> 00:23:27.045
and delivering and all that stuff but the

00:23:27.065 --> 00:23:29.586
point of being is the amount of people

00:23:29.606 --> 00:23:31.228
that were walking around in a fog bank

00:23:31.248 --> 00:23:31.749
and that's where

00:23:32.886 --> 00:23:33.928
We used to be an apathy.

00:23:33.988 --> 00:23:35.130
I would say physical therapists,

00:23:35.230 --> 00:23:36.912
we were in a state of apathy five

00:23:36.951 --> 00:23:38.493
years ago, right?

00:23:38.513 --> 00:23:40.556
I see anger and you see it in

00:23:40.576 --> 00:23:41.537
the posts, right?

00:23:41.557 --> 00:23:42.278
We're getting angry.

00:23:42.939 --> 00:23:44.661
That's a step up and that's where we

00:23:44.701 --> 00:23:45.041
need to be.

00:23:45.410 --> 00:23:46.691
I disagree, not to split hairs.

00:23:46.770 --> 00:23:47.530
Apathy is worse.

00:23:47.851 --> 00:23:49.751
If I'm actually angry,

00:23:49.811 --> 00:23:51.833
it shows I want to still engage.

00:23:52.012 --> 00:23:53.153
Apathy is worse.

00:23:53.594 --> 00:23:55.375
To me, that's what I'm saying.

00:23:55.394 --> 00:23:56.315
We were in apathy.

00:23:56.355 --> 00:23:56.974
We're in anger now.

00:23:56.994 --> 00:23:58.175
That's better.

00:23:58.796 --> 00:23:59.737
Oh, sorry, sorry, sorry.

00:23:59.856 --> 00:24:00.277
I agree with that.

00:24:00.336 --> 00:24:00.777
Yeah, my bad.

00:24:01.196 --> 00:24:02.218
Yeah, we need to get angry.

00:24:02.337 --> 00:24:03.919
We need to get angry.

00:24:03.979 --> 00:24:06.579
So you're showing me, and this is good,

00:24:06.599 --> 00:24:08.580
you're telling me and showing me a story

00:24:08.661 --> 00:24:10.741
of what happens when we don't do a

00:24:10.781 --> 00:24:12.542
thing and the result of.

00:24:12.603 --> 00:24:13.042
Yes, exactly.

00:24:14.056 --> 00:24:15.196
So what do we need to do?

00:24:15.317 --> 00:24:18.138
Because so far it's get PTs to have

00:24:18.159 --> 00:24:18.660
a voice.

00:24:19.700 --> 00:24:22.521
So it's frequency, intensity, time, type,

00:24:22.582 --> 00:24:23.502
volume, and progression.

00:24:24.044 --> 00:24:25.203
These are exercise principles,

00:24:25.244 --> 00:24:26.365
but those are also communications

00:24:26.384 --> 00:24:26.806
principles.

00:24:27.165 --> 00:24:28.547
So frequency, how often you do it,

00:24:28.626 --> 00:24:29.067
intensity,

00:24:29.106 --> 00:24:30.107
the passion with which you do it,

00:24:30.407 --> 00:24:31.729
intensity, time, type, volume,

00:24:31.749 --> 00:24:32.309
and progression.

00:24:33.471 --> 00:24:34.652
APTA has been doing this.

00:24:34.832 --> 00:24:36.792
Why hasn't it worked from your point of

00:24:36.853 --> 00:24:37.032
view?

00:24:37.473 --> 00:24:38.414
If that's what we need to do.

00:24:38.835 --> 00:24:40.355
Yeah, without being inside the APTA,

00:24:40.435 --> 00:24:41.136
I can't tell you.

00:24:41.257 --> 00:24:42.597
But all I can say is,

00:24:43.791 --> 00:24:46.694
from my chair looking in,

00:24:46.855 --> 00:24:49.298
I don't see that anything has made that

00:24:49.317 --> 00:24:49.618
change.

00:24:49.638 --> 00:24:50.880
And the only thing I can put on

00:24:50.920 --> 00:24:51.381
that is

00:24:52.537 --> 00:24:52.797
you know,

00:24:52.997 --> 00:24:54.939
people in those spots change every two

00:24:54.979 --> 00:24:56.220
years, every four years,

00:24:56.259 --> 00:24:57.760
every time a new administration, so.

00:24:58.162 --> 00:24:59.782
You're saying on the receiving end of.

00:25:00.442 --> 00:25:02.144
Yeah, so it's a constant,

00:25:03.105 --> 00:25:05.567
it's a constantly evolving process.

00:25:05.586 --> 00:25:06.887
The only constant is change.

00:25:07.348 --> 00:25:07.628
Correct.

00:25:07.648 --> 00:25:08.430
In terms of those people.

00:25:08.490 --> 00:25:10.050
You get new people, you get new people.

00:25:10.070 --> 00:25:12.012
So here's what I can tell you though,

00:25:12.113 --> 00:25:13.173
as patients go,

00:25:13.913 --> 00:25:15.315
Patients are waking up because what's the

00:25:15.335 --> 00:25:16.175
first thing a patient does?

00:25:16.215 --> 00:25:17.978
They call their doctor and they say, hey,

00:25:18.038 --> 00:25:19.519
skip the MRI, skip the x-ray,

00:25:19.539 --> 00:25:20.641
just send me to my therapist.

00:25:20.740 --> 00:25:21.000
Right.

00:25:21.320 --> 00:25:24.544
We've done a great job of waking up

00:25:24.605 --> 00:25:25.164
patients.

00:25:25.305 --> 00:25:28.367
Now we need to wake up the policymakers.

00:25:28.607 --> 00:25:28.888
Right.

00:25:29.789 --> 00:25:31.230
And how will you do that?

00:25:32.744 --> 00:25:34.885
by communicating with the policymakers,

00:25:34.905 --> 00:25:36.806
by getting the inside scoop.

00:25:36.846 --> 00:25:37.806
These people are, you know,

00:25:37.905 --> 00:25:40.826
it wasn't hard to find the deputy director

00:25:40.866 --> 00:25:41.386
of CMS.

00:25:41.406 --> 00:25:43.647
I'm not saying that we need to bombard

00:25:43.688 --> 00:25:43.827
him.

00:25:44.087 --> 00:25:44.887
So my question is,

00:25:45.228 --> 00:25:47.828
so now you identify your audience.

00:25:48.348 --> 00:25:48.548
Yes.

00:25:48.568 --> 00:25:49.548
We go back to what I did, right?

00:25:49.628 --> 00:25:51.130
I know who I'm talking to.

00:25:51.250 --> 00:25:51.589
Yep.

00:25:51.789 --> 00:25:54.031
I have to deeply understand what bothers

00:25:54.071 --> 00:25:55.413
them, what their hopes and dreams are,

00:25:55.653 --> 00:25:56.974
and what their frustrations are in terms

00:25:57.015 --> 00:25:58.056
of the policymaker.

00:25:58.576 --> 00:25:59.156
Typically,

00:25:59.637 --> 00:26:01.038
and I don't have a lot of advocacy

00:26:01.098 --> 00:26:01.599
experience.

00:26:01.619 --> 00:26:02.520
I do have a lot of communication

00:26:02.560 --> 00:26:04.162
experience.

00:26:04.321 --> 00:26:05.784
I have to understand what makes you tick.

00:26:06.825 --> 00:26:07.905
And then I have to understand what I

00:26:07.925 --> 00:26:08.666
bring to the table.

00:26:09.675 --> 00:26:12.719
And where your goals and frustrations

00:26:12.898 --> 00:26:14.440
cross, if you look at a Venn diagram,

00:26:14.539 --> 00:26:15.760
and what I can bring to the table,

00:26:16.142 --> 00:26:16.922
that is our why.

00:26:16.961 --> 00:26:18.423
That's where Simon Sinek starts.

00:26:18.442 --> 00:26:20.384
He says, now that I have a why,

00:26:20.605 --> 00:26:21.246
when I walk in,

00:26:21.885 --> 00:26:24.127
now you hear your frustrations and goals

00:26:24.147 --> 00:26:25.088
coming out of my mouth.

00:26:25.368 --> 00:26:26.410
That's when the other person starts

00:26:26.529 --> 00:26:28.152
nodding.

00:26:28.192 --> 00:26:29.133
So I guess I'm just like,

00:26:30.032 --> 00:26:32.275
would you do it more frequently,

00:26:32.394 --> 00:26:34.017
more intensely, more often?

00:26:35.287 --> 00:26:35.626
Yes.

00:26:36.728 --> 00:26:38.769
All of the above.

00:26:38.789 --> 00:26:40.571
Start with your local representatives.

00:26:40.912 --> 00:26:42.272
So it just sounds like you're saying I

00:26:42.292 --> 00:26:43.875
would just do it more and I would

00:26:43.914 --> 00:26:44.474
do it better.

00:26:44.654 --> 00:26:46.156
I don't understand how.

00:26:47.438 --> 00:26:48.238
Yeah.

00:26:48.358 --> 00:26:51.401
Emails, phone calls, getting involved.

00:26:51.500 --> 00:26:51.981
Hold on a second.

00:26:52.001 --> 00:26:53.323
So I'm a communications consultant.

00:26:53.583 --> 00:26:53.863
Email.

00:26:54.124 --> 00:26:54.403
Good.

00:26:54.463 --> 00:26:55.204
That's specific.

00:26:56.198 --> 00:26:57.538
what would you put in the email that

00:26:57.578 --> 00:26:58.818
is different than what APTA?

00:26:59.079 --> 00:26:59.519
Like I,

00:26:59.559 --> 00:27:01.201
like when a CI used to look over

00:27:01.221 --> 00:27:01.840
my shoulder and be like,

00:27:01.881 --> 00:27:03.001
why are you doing that exercise?

00:27:03.041 --> 00:27:03.582
I'm like, I don't know.

00:27:03.602 --> 00:27:04.241
It's on the protocol.

00:27:04.343 --> 00:27:05.123
Not a good answer.

00:27:05.482 --> 00:27:06.963
So if I just said email, I'm like,

00:27:07.084 --> 00:27:07.564
not enough.

00:27:07.584 --> 00:27:08.244
I'm trying to see your,

00:27:08.545 --> 00:27:09.545
what I'm trying to do is have you

00:27:09.565 --> 00:27:10.165
show me your work,

00:27:10.226 --> 00:27:11.306
like show me your thought process.

00:27:11.546 --> 00:27:12.446
So email is great.

00:27:12.567 --> 00:27:13.448
APTA does that,

00:27:14.188 --> 00:27:15.788
but how would you do it differently?

00:27:16.068 --> 00:27:18.109
More often, all capital letters?

00:27:18.130 --> 00:27:19.631
No, not at all.

00:27:20.070 --> 00:27:20.351
Yeah.

00:27:20.371 --> 00:27:21.071
So good point.

00:27:21.112 --> 00:27:22.092
The first thing I would do is start

00:27:22.192 --> 00:27:22.893
asking them questions.

00:27:22.913 --> 00:27:23.012
So

00:27:25.292 --> 00:27:26.134
One of the things that I've done,

00:27:26.193 --> 00:27:27.294
very successful action.

00:27:27.493 --> 00:27:28.734
Let's talk about insurance companies.

00:27:28.755 --> 00:27:29.875
Let's talk about Blue Cross Blue Shield.

00:27:29.895 --> 00:27:31.196
I had a really hard time getting in

00:27:31.257 --> 00:27:32.518
network with Blue Cross Blue Shield.

00:27:32.557 --> 00:27:33.478
So what's the first thing I did?

00:27:33.538 --> 00:27:34.199
I picked up the phone.

00:27:34.239 --> 00:27:35.239
I said, hey,

00:27:35.259 --> 00:27:36.240
you're down the road for me.

00:27:36.839 --> 00:27:38.260
Can I come up there and talk to

00:27:38.340 --> 00:27:38.401
you?

00:27:38.461 --> 00:27:39.741
Who do you call at Blue Cross Blue

00:27:39.761 --> 00:27:40.623
Shield to do that?

00:27:40.663 --> 00:27:41.202
Like, what is that?

00:27:41.222 --> 00:27:41.442
I mean,

00:27:41.482 --> 00:27:43.163
you just you have it's a system.

00:27:43.365 --> 00:27:44.545
You got to go through the numbers.

00:27:45.766 --> 00:27:47.548
yep and you can find out who your

00:27:47.587 --> 00:27:49.810
local rep is every insurance company has a

00:27:49.891 --> 00:27:52.913
local rep that's assigned to your area

00:27:52.993 --> 00:27:54.375
right so you get a hold of that

00:27:54.415 --> 00:27:56.878
person you drive to them you meet with

00:27:56.919 --> 00:27:59.321
them you here's what physical therapy does

00:27:59.362 --> 00:28:00.722
hey can i give you a demonstration can

00:28:00.742 --> 00:28:02.505
i look can i do an ergonomic assessment

00:28:02.525 --> 00:28:02.826
for your desk

00:28:03.425 --> 00:28:04.186
I'm here to help.

00:28:04.606 --> 00:28:05.086
Oh, my God.

00:28:05.347 --> 00:28:06.949
I never knew you guys did this.

00:28:07.328 --> 00:28:08.089
I told Mike that.

00:28:08.150 --> 00:28:08.589
I said, dude,

00:28:09.029 --> 00:28:09.990
I'm going to get on a plane.

00:28:10.010 --> 00:28:11.592
I'm going to come visit you and Stephanie.

00:28:11.952 --> 00:28:13.253
You're going to take me into these

00:28:13.314 --> 00:28:15.394
congressional offices, right?

00:28:15.414 --> 00:28:17.155
These guys that sit on ways and means,

00:28:17.576 --> 00:28:18.897
these guys that sit on energy and

00:28:18.938 --> 00:28:19.438
commerce.

00:28:19.919 --> 00:28:21.440
I'm going to do an ergonomic assessment

00:28:21.460 --> 00:28:21.700
for them.

00:28:21.799 --> 00:28:22.921
I'm going to sit down and talk to

00:28:22.941 --> 00:28:23.020
them.

00:28:23.040 --> 00:28:24.122
I just need fifteen minutes.

00:28:24.721 --> 00:28:26.022
Let me tell them what physical therapy

00:28:26.042 --> 00:28:27.344
does, because a lot of them don't think,

00:28:27.364 --> 00:28:28.565
you know, and Mike didn't even know.

00:28:28.605 --> 00:28:29.085
He didn't know.

00:28:29.465 --> 00:28:29.885
He's like, damn,

00:28:29.905 --> 00:28:31.086
I didn't know you guys did all that.

00:28:31.186 --> 00:28:32.307
Yeah, that's what we do.

00:28:32.748 --> 00:28:33.568
So to summarize,

00:28:33.669 --> 00:28:35.671
your job is more face time with the

00:28:35.691 --> 00:28:36.632
people who make decisions.

00:28:36.932 --> 00:28:37.512
We really do.

00:28:37.633 --> 00:28:38.713
We really got to get, you know,

00:28:39.213 --> 00:28:40.655
we have to get more involved.

00:28:40.675 --> 00:28:42.717
We've done it a very good angle with

00:28:42.778 --> 00:28:43.357
patients.

00:28:44.098 --> 00:28:45.440
Let's now do it with the people who

00:28:45.500 --> 00:28:46.260
are writing policy.

00:28:46.280 --> 00:28:48.262
So that's your how is face to face

00:28:48.343 --> 00:28:49.443
and like, I like it.

00:28:49.544 --> 00:28:50.384
Show, don't tell.

00:28:50.565 --> 00:28:52.026
Ergonomic assessment is not a tell,

00:28:52.086 --> 00:28:52.567
it's a show.

00:28:53.067 --> 00:28:53.426
Love that.

00:28:54.705 --> 00:28:57.348
So you are increasing frequency and

00:28:57.469 --> 00:28:58.308
increasing the how.

00:28:58.328 --> 00:28:58.410
Yep.

00:28:59.269 --> 00:28:59.971
The question is,

00:29:00.131 --> 00:29:02.933
how often is APTA doing this right now

00:29:03.273 --> 00:29:05.194
and are they doing that?

00:29:05.236 --> 00:29:06.896
So that's my point.

00:29:06.997 --> 00:29:08.038
That's one of my points,

00:29:08.077 --> 00:29:10.779
which was we have people from outside the

00:29:10.839 --> 00:29:13.442
APTA complaining about what the APTA is

00:29:13.462 --> 00:29:16.424
doing and they don't know what they're

00:29:16.484 --> 00:29:16.826
doing.

00:29:16.846 --> 00:29:16.905
Yep.

00:29:18.759 --> 00:29:19.480
Yeah, I mean,

00:29:19.500 --> 00:29:20.480
I'll give you that fair share.

00:29:20.500 --> 00:29:21.740
I'm not going to disagree with you there.

00:29:21.780 --> 00:29:23.020
But, you know, you call a complaint.

00:29:23.101 --> 00:29:23.980
I call it, you know,

00:29:24.000 --> 00:29:25.621
we really just want change of policy that

00:29:25.740 --> 00:29:26.701
when it comes down to it.

00:29:27.362 --> 00:29:28.461
I think everybody does.

00:29:28.501 --> 00:29:28.701
Right.

00:29:28.721 --> 00:29:30.561
Both sides agree.

00:29:30.602 --> 00:29:31.282
That's what we agree on.

00:29:31.303 --> 00:29:31.883
That's coming out.

00:29:31.903 --> 00:29:32.002
Yeah.

00:29:33.823 --> 00:29:35.222
And to be honest with you,

00:29:35.663 --> 00:29:37.304
I keep reaching out to these guys.

00:29:37.844 --> 00:29:42.384
You know, I put my contact at HHS.

00:29:42.424 --> 00:29:42.585
Yeah.

00:29:43.105 --> 00:29:43.964
And I did apply.

00:29:44.025 --> 00:29:44.805
So right now,

00:29:45.305 --> 00:29:46.185
for those of you out there,

00:29:46.286 --> 00:29:48.365
I believe the APTA put somebody forward.

00:29:49.701 --> 00:29:51.182
UPTA put me forward.

00:29:51.202 --> 00:29:55.086
They have not yet selected the HACC

00:29:55.105 --> 00:29:55.467
Committee,

00:29:55.606 --> 00:29:56.768
the Healthcare Advisory Committee.

00:29:56.788 --> 00:30:00.050
So Dr. Oz- HHS has not picked someone,

00:30:00.230 --> 00:30:00.530
you mean?

00:30:00.671 --> 00:30:01.571
Correct.

00:30:01.592 --> 00:30:02.251
It's been delayed.

00:30:02.291 --> 00:30:03.933
It was supposed to be end of November,

00:30:04.114 --> 00:30:05.234
end of October, end of November.

00:30:07.135 --> 00:30:08.257
We want a seat at that table.

00:30:08.857 --> 00:30:10.759
So the APTA put a person forward.

00:30:11.320 --> 00:30:12.642
UPTA put me forward.

00:30:12.821 --> 00:30:14.503
You know, my communication with them is,

00:30:14.624 --> 00:30:15.724
hey, Steve, that position,

00:30:15.785 --> 00:30:17.708
that board has not yet been filled.

00:30:17.928 --> 00:30:18.788
We're getting to it.

00:30:19.308 --> 00:30:20.911
So, again, that's you know,

00:30:20.931 --> 00:30:21.791
you talk about action.

00:30:22.031 --> 00:30:23.534
These are the actions we need a seat

00:30:23.574 --> 00:30:24.074
at the table.

00:30:24.634 --> 00:30:25.875
Right.

00:30:25.935 --> 00:30:27.758
IHI Institute for Health.

00:30:28.479 --> 00:30:30.859
innovation does anybody know who the ihi

00:30:31.020 --> 00:30:32.981
is it's a big organization in boston

00:30:33.362 --> 00:30:35.323
they're the ones that write policy when

00:30:35.383 --> 00:30:37.884
medicare wants to change policy they call

00:30:37.923 --> 00:30:40.266
the ihi there's not a physical therapist

00:30:40.306 --> 00:30:43.847
on the ihi board why let's get a

00:30:43.988 --> 00:30:46.189
physical therapist on the ihi board if

00:30:46.269 --> 00:30:49.310
medicare is talking if cms and hhs is

00:30:49.371 --> 00:30:50.471
talking to ihi

00:30:51.624 --> 00:30:54.267
We need to go to IHI, right?

00:30:54.287 --> 00:30:55.788
You don't want to invest in Tesla.

00:30:56.107 --> 00:30:57.789
You want to invest in the battery company

00:30:57.849 --> 00:30:59.811
that's making the batteries for Tesla,

00:30:59.832 --> 00:31:00.071
right?

00:31:00.373 --> 00:31:01.614
So let's circle that.

00:31:01.653 --> 00:31:03.776
Hold on a second.

00:31:03.855 --> 00:31:05.577
I don't disagree with you.

00:31:05.698 --> 00:31:06.618
Is this something you think

00:31:07.486 --> 00:31:08.166
You're going to do,

00:31:08.626 --> 00:31:09.548
UPTA is going to do,

00:31:09.667 --> 00:31:10.828
APTA should be doing,

00:31:11.088 --> 00:31:12.330
or we should be doing.

00:31:12.510 --> 00:31:13.971
I hate we because I don't know who

00:31:13.991 --> 00:31:14.593
that's talking to.

00:31:15.432 --> 00:31:15.993
Let's be honest.

00:31:16.094 --> 00:31:17.675
I'm not waiting for...

00:31:17.736 --> 00:31:19.017
I'm on the board of UPTA,

00:31:19.596 --> 00:31:21.818
but I'm not waiting for the UPTA to...

00:31:23.208 --> 00:31:24.249
come to my rescue.

00:31:24.288 --> 00:31:24.429
Now,

00:31:24.489 --> 00:31:26.009
I'm going to be part of that rescue

00:31:26.029 --> 00:31:26.391
plan,

00:31:26.510 --> 00:31:29.272
and the UPTA is really taking some very

00:31:29.292 --> 00:31:30.473
strong action right now.

00:31:31.734 --> 00:31:32.655
I'm also not going to wait on the

00:31:32.715 --> 00:31:34.257
APTA to solve my problems.

00:31:34.557 --> 00:31:36.419
Because our problems are our problems.

00:31:36.459 --> 00:31:39.221
This is where we most wholeheartedly

00:31:39.421 --> 00:31:39.621
agree.

00:31:39.641 --> 00:31:41.603
Yep.

00:31:41.643 --> 00:31:43.124
I look at membership like I pay

00:31:43.163 --> 00:31:43.684
membership.

00:31:44.204 --> 00:31:45.946
Yeah.

00:31:45.967 --> 00:31:47.508
I close that tab, take a deep breath,

00:31:47.827 --> 00:31:50.349
and then I immediately continue to work on

00:31:50.410 --> 00:31:51.250
solving my own problems.

00:31:52.105 --> 00:31:53.567
This is what I'm talking about with logic

00:31:53.606 --> 00:31:54.228
and emotion,

00:31:54.288 --> 00:31:56.169
what I think I'm buying and what actually

00:31:56.229 --> 00:31:57.069
APTA is selling.

00:31:57.390 --> 00:31:58.631
If they're not aligned,

00:31:59.490 --> 00:32:01.092
I can see why people are frustrated.

00:32:01.432 --> 00:32:02.553
I understand that.

00:32:03.253 --> 00:32:05.476
So it sounds like you and I understand

00:32:05.496 --> 00:32:07.576
what the value or lack of value of

00:32:07.636 --> 00:32:10.159
membership is and we're okay with having

00:32:10.199 --> 00:32:11.859
it or not because it's a binary decision.

00:32:12.339 --> 00:32:14.882
But it sounds like you join something and

00:32:14.942 --> 00:32:17.443
then immediately start working on solving

00:32:17.463 --> 00:32:18.964
your own problems too, right?

00:32:19.244 --> 00:32:22.046
Where I am confused is when people aren't

00:32:22.086 --> 00:32:22.826
a part of something,

00:32:23.105 --> 00:32:25.007
which is one thousand percent OK.

00:32:26.106 --> 00:32:28.528
And they complain about the lack of

00:32:28.788 --> 00:32:30.368
results from that thing,

00:32:30.669 --> 00:32:32.409
from that gym they don't belong to.

00:32:32.930 --> 00:32:34.529
And they stand outside and yell,

00:32:34.950 --> 00:32:36.070
I don't have abs.

00:32:36.211 --> 00:32:37.131
It's your fault.

00:32:37.351 --> 00:32:38.951
Which yelling, I don't have abs.

00:32:38.971 --> 00:32:40.412
It's your fault is OK.

00:32:41.291 --> 00:32:41.491
Right.

00:32:41.731 --> 00:32:43.212
But I'm allowed to hold up a mirror

00:32:43.252 --> 00:32:45.614
and say, this feels dumb.

00:32:45.634 --> 00:32:46.614
Right.

00:32:47.478 --> 00:32:48.117
And I agree with you.

00:32:48.218 --> 00:32:48.817
And you know what?

00:32:48.837 --> 00:32:49.318
And that was my,

00:32:50.019 --> 00:32:50.979
I probably didn't convey that,

00:32:51.019 --> 00:32:54.400
but my two thousand and four analogy with

00:32:54.420 --> 00:32:55.460
the hurricanes, that was it.

00:32:55.480 --> 00:32:55.681
You know,

00:32:55.721 --> 00:32:58.300
people are standing around going, hello,

00:32:58.320 --> 00:33:00.602
like, hello, you should have.

00:33:01.021 --> 00:33:02.583
Hey, you should have prepped.

00:33:02.643 --> 00:33:03.383
You should have been ready.

00:33:03.403 --> 00:33:05.903
You should have known we were coming.

00:33:06.163 --> 00:33:07.943
Where's the Publix is up there,

00:33:07.963 --> 00:33:09.464
but Publix is the big grocery store down

00:33:09.505 --> 00:33:09.704
here.

00:33:10.224 --> 00:33:11.105
Publix isn't open.

00:33:11.144 --> 00:33:11.325
You know,

00:33:11.345 --> 00:33:12.586
they got back open when they had when

00:33:12.605 --> 00:33:13.185
they could, but.

00:33:14.181 --> 00:33:14.500
You know,

00:33:14.540 --> 00:33:16.282
don't wait for somebody to come and help

00:33:16.323 --> 00:33:18.605
you take action now.

00:33:18.785 --> 00:33:20.905
And that's what I'm saying is as a

00:33:20.945 --> 00:33:21.747
physical therapist,

00:33:22.067 --> 00:33:23.428
I don't care if you're in a skilled

00:33:23.468 --> 00:33:24.209
nursing facility.

00:33:24.509 --> 00:33:26.010
I don't care if you collect a paycheck

00:33:26.030 --> 00:33:28.051
because everybody should be asking right

00:33:28.092 --> 00:33:28.412
now.

00:33:28.532 --> 00:33:29.794
And I have this discussion with my

00:33:29.834 --> 00:33:30.753
therapist and I'm like, dude,

00:33:31.315 --> 00:33:32.576
I want to pay you more.

00:33:32.756 --> 00:33:33.656
I really do.

00:33:34.017 --> 00:33:35.738
You deserve so much more than you're

00:33:35.758 --> 00:33:36.138
making.

00:33:36.638 --> 00:33:38.560
But the policy right now does not allow

00:33:38.601 --> 00:33:38.861
that.

00:33:39.340 --> 00:33:40.781
Now we do have alternate, you know,

00:33:40.801 --> 00:33:41.163
Hey guys,

00:33:41.202 --> 00:33:42.923
if you want to start doing seminars or,

00:33:43.064 --> 00:33:43.243
you know,

00:33:43.263 --> 00:33:44.484
you want to work and do this and

00:33:44.806 --> 00:33:46.047
I'll split that with you.

00:33:46.287 --> 00:33:48.067
You know, it sounds like you're saying,

00:33:48.268 --> 00:33:50.210
I will show you my math and,

00:33:51.023 --> 00:33:52.025
Yes.

00:33:52.444 --> 00:33:53.385
I will open my book.

00:33:53.746 --> 00:33:55.207
But if you can help me increase the

00:33:55.287 --> 00:33:56.347
left side of my equation,

00:33:56.448 --> 00:33:58.028
I will help you increase the right side

00:33:58.048 --> 00:33:58.528
of your equation.

00:33:58.548 --> 00:33:59.910
If you can help me increase the input,

00:34:00.090 --> 00:34:01.412
I will give you some of that output.

00:34:02.112 --> 00:34:03.873
That is the rising tide that lifts all

00:34:03.893 --> 00:34:04.213
ships.

00:34:04.634 --> 00:34:04.834
Yeah.

00:34:04.854 --> 00:34:05.354
And honestly,

00:34:05.894 --> 00:34:07.056
we just had this meeting last year.

00:34:07.076 --> 00:34:08.295
We do a staff meeting every year for

00:34:08.315 --> 00:34:08.817
compliance.

00:34:08.836 --> 00:34:11.077
We go over documentation and we follow

00:34:11.139 --> 00:34:11.539
Rick's.

00:34:11.639 --> 00:34:15.681
You got to have seven principles of a

00:34:15.742 --> 00:34:16.501
compliance plan.

00:34:16.561 --> 00:34:17.643
And that's the other thing I say to

00:34:17.682 --> 00:34:18.543
physical therapists out there.

00:34:18.563 --> 00:34:19.605
And I want to say to them, listen,

00:34:20.264 --> 00:34:22.266
Don't give the auditors,

00:34:22.306 --> 00:34:23.547
don't give the MAC contractors,

00:34:23.626 --> 00:34:25.007
don't give them fire.

00:34:25.748 --> 00:34:26.009
You know,

00:34:26.048 --> 00:34:28.230
don't give them oxygen to fuel their fire.

00:34:28.771 --> 00:34:29.030
You know,

00:34:29.110 --> 00:34:30.972
make sure that you guys are staying on

00:34:31.012 --> 00:34:31.893
top of compliance.

00:34:32.032 --> 00:34:33.733
You know, have a compliance plan.

00:34:34.253 --> 00:34:35.034
Update your policy.

00:34:35.114 --> 00:34:36.755
I just posted this the other day on

00:34:36.835 --> 00:34:38.217
the physical therapy site.

00:34:38.257 --> 00:34:39.237
And I said, hey, guys,

00:34:39.257 --> 00:34:40.358
don't forget it's end of the year.

00:34:40.858 --> 00:34:42.659
Update your policies and procedures.

00:34:42.780 --> 00:34:44.081
Things have changed.

00:34:44.360 --> 00:34:45.242
So let me ask you this.

00:34:45.282 --> 00:34:45.922
We'll switch,

00:34:45.961 --> 00:34:47.103
but I'll sort of ask you the same

00:34:47.143 --> 00:34:47.523
question.

00:34:47.682 --> 00:34:49.505
You have described documentation as

00:34:49.565 --> 00:34:52.346
compliance theater, which is a great term.

00:34:52.507 --> 00:34:53.927
I mean, compliance theater.

00:34:54.628 --> 00:34:56.748
Even as a PT student, I was like,

00:34:57.429 --> 00:34:58.791
who am I writing this for?

00:35:00.192 --> 00:35:02.552
I use a different term, self-pleasuring.

00:35:02.592 --> 00:35:02.873
I was like,

00:35:02.893 --> 00:35:04.014
this feels like this is for me.

00:35:04.034 --> 00:35:05.355
It's not pleasurable for me and no one's

00:35:05.394 --> 00:35:05.755
reading it.

00:35:06.036 --> 00:35:07.135
It's pleasurable for me.

00:35:07.175 --> 00:35:08.336
So you've described documentation as

00:35:08.356 --> 00:35:09.038
compliance theater.

00:35:09.378 --> 00:35:11.398
Great phrase.

00:35:11.798 --> 00:35:13.581
If you could rebuild clinical notes from

00:35:13.641 --> 00:35:14.061
scratch,

00:35:14.882 --> 00:35:15.581
what's the thing,

00:35:15.621 --> 00:35:17.344
what's the first thing you would change or

00:35:17.384 --> 00:35:18.085
first or second thing?

00:35:18.125 --> 00:35:19.005
What would you change?

00:35:19.146 --> 00:35:21.628
If you could rebuild compliance,

00:35:21.668 --> 00:35:23.010
if you could remove compliance theater,

00:35:23.090 --> 00:35:24.371
what would you make it be?

00:35:24.931 --> 00:35:25.092
Yeah.

00:35:25.172 --> 00:35:26.492
And well, I, the,

00:35:26.512 --> 00:35:29.896
the problem was there where, you know,

00:35:29.916 --> 00:35:31.077
we had to search for words.

00:35:31.117 --> 00:35:31.478
So, um,

00:35:32.463 --> 00:35:33.563
I'm going to tell everybody out there,

00:35:33.603 --> 00:35:33.844
listen,

00:35:33.943 --> 00:35:35.103
I understand private practice is

00:35:35.143 --> 00:35:35.925
struggling right now,

00:35:35.985 --> 00:35:38.166
but if you're not using AI technology,

00:35:38.806 --> 00:35:40.567
you really need to stay, you know,

00:35:40.706 --> 00:35:41.628
AI is not going away.

00:35:41.688 --> 00:35:42.547
It's not going anywhere.

00:35:42.588 --> 00:35:43.568
And we use AI.

00:35:44.528 --> 00:35:45.509
You know, I use prompt.

00:35:45.588 --> 00:35:47.150
I'll just be transparent.

00:35:47.250 --> 00:35:48.530
You know, I, I, I've done,

00:35:50.099 --> 00:35:52.820
webinars for prompt discussing prompt,

00:35:53.021 --> 00:35:53.221
you know,

00:35:53.240 --> 00:35:54.641
there's other great programs out there.

00:35:54.661 --> 00:35:54.840
Don't,

00:35:55.061 --> 00:35:56.302
I don't think prompt is the only one

00:35:56.342 --> 00:35:56.621
out there.

00:35:56.661 --> 00:35:58.282
Sorry, prompt, but, um, you know,

00:35:58.302 --> 00:36:00.802
they do have an all inclusive tool where,

00:36:01.003 --> 00:36:01.822
you know, I,

00:36:02.083 --> 00:36:03.643
so I've gone in and here's the other

00:36:03.664 --> 00:36:05.344
thing too, is, um,

00:36:06.744 --> 00:36:09.304
I don't claim to be a compliance expert

00:36:09.324 --> 00:36:12.505
that that's Rick's smart enough to hire

00:36:12.565 --> 00:36:13.907
Rick and listen to him.

00:36:13.987 --> 00:36:14.286
Yes.

00:36:14.487 --> 00:36:14.646
Yeah.

00:36:14.706 --> 00:36:16.666
And I'll get, it's funny story.

00:36:16.706 --> 00:36:18.407
So you're probably not, uh,

00:36:19.309 --> 00:36:20.510
you haven't been in the profession long

00:36:20.530 --> 00:36:22.592
enough to know Steve Levin.

00:36:22.711 --> 00:36:25.693
Steve Levin was the Rick Gawanda before,

00:36:26.014 --> 00:36:27.135
you know, Rick was still around,

00:36:27.175 --> 00:36:28.916
but Steve was the, you know,

00:36:28.936 --> 00:36:29.838
and Steve reached out to me.

00:36:29.878 --> 00:36:31.579
Steve was from Florida and Steve reached

00:36:31.659 --> 00:36:33.581
out to me and actually I reached out

00:36:33.621 --> 00:36:34.141
to Steve.

00:36:34.161 --> 00:36:34.902
Let's backtrack.

00:36:34.922 --> 00:36:37.623
So I called Steve and first thing Steve

00:36:37.643 --> 00:36:38.784
said when he picked up the phone,

00:36:38.804 --> 00:36:39.005
you know,

00:36:39.045 --> 00:36:40.425
his secretary got him on the phone.

00:36:40.445 --> 00:36:40.646
He goes,

00:36:41.027 --> 00:36:42.507
what letter did you get from Medicare?

00:36:43.237 --> 00:36:43.858
They already know.

00:36:43.938 --> 00:36:45.101
They know why you're calling.

00:36:45.221 --> 00:36:45.360
Yeah.

00:36:45.380 --> 00:36:45.882
I'm like, huh?

00:36:46.463 --> 00:36:47.123
I didn't get a letter.

00:36:47.443 --> 00:36:47.643
I said,

00:36:47.684 --> 00:36:48.485
I want you to come up for a

00:36:48.525 --> 00:36:49.907
couple of days and go through my practice

00:36:49.927 --> 00:36:51.510
and tell me what I'm doing wrong.

00:36:51.826 --> 00:36:53.126
So you were preempting the letter.

00:36:53.166 --> 00:36:53.507
You were like,

00:36:54.146 --> 00:36:55.487
how do I not get the letter?

00:36:55.748 --> 00:36:57.208
I don't know what I'm doing.

00:36:57.369 --> 00:36:58.009
I mean,

00:36:58.028 --> 00:36:59.570
we're going back to two thousand and five

00:36:59.610 --> 00:36:59.809
now.

00:36:59.849 --> 00:37:00.911
But, you know,

00:37:00.951 --> 00:37:02.271
and he drove up and he's like, man,

00:37:02.311 --> 00:37:02.952
I got to salute you.

00:37:02.972 --> 00:37:04.231
You're the first person I've ever called

00:37:04.271 --> 00:37:04.952
me, you know,

00:37:05.132 --> 00:37:06.353
before you received the letter.

00:37:06.373 --> 00:37:07.454
But, you know, he spent two days.

00:37:07.494 --> 00:37:08.273
He told me, you know,

00:37:09.195 --> 00:37:10.594
you're doing ninety five percent right.

00:37:10.635 --> 00:37:11.795
But, you know, do this, do this,

00:37:12.516 --> 00:37:13.777
do this with those five percent.

00:37:13.856 --> 00:37:14.117
Right.

00:37:14.577 --> 00:37:15.958
And he helped me in and we stayed

00:37:15.998 --> 00:37:17.079
in contact, unfortunately.

00:37:17.739 --> 00:37:17.938
You know,

00:37:17.978 --> 00:37:19.500
he passed away tragically in a car

00:37:19.559 --> 00:37:20.500
accident in Costa Rica.

00:37:20.539 --> 00:37:21.541
But, you know,

00:37:21.581 --> 00:37:22.701
he was active with the APTA.

00:37:22.740 --> 00:37:24.081
If you talk to the APTA guys,

00:37:24.362 --> 00:37:25.581
they know who Steve was, you know,

00:37:25.601 --> 00:37:27.382
but now Rick is filling that spot.

00:37:27.523 --> 00:37:29.864
So I don't claim to know the compliance,

00:37:29.884 --> 00:37:31.164
but I know enough to make myself

00:37:31.204 --> 00:37:31.563
dangerous.

00:37:31.583 --> 00:37:34.204
But if a physical therapist reaches out to

00:37:34.244 --> 00:37:36.505
me and says, you know,

00:37:37.206 --> 00:37:37.786
how do I do this?

00:37:37.827 --> 00:37:38.286
How do we do this?

00:37:40.179 --> 00:37:42.581
I feel compelled to help that person

00:37:43.121 --> 00:37:44.882
because by helping them, it only helps me,

00:37:44.942 --> 00:37:46.202
right?

00:37:46.661 --> 00:37:48.143
I'm not doing the job for them,

00:37:48.422 --> 00:37:49.302
but I'm going to say, hey,

00:37:49.342 --> 00:37:51.824
if it's a compliance issue, call Rick,

00:37:51.983 --> 00:37:52.244
right?

00:37:52.925 --> 00:37:54.965
If it's something else, you know, hey,

00:37:55.065 --> 00:37:55.945
I can help you with that.

00:37:56.025 --> 00:37:57.666
You need, you know, hey, try this,

00:37:57.726 --> 00:37:58.407
like prompt.

00:37:58.487 --> 00:37:59.286
I told him the other day.

00:38:01.297 --> 00:38:03.677
In and of itself, it's a vanilla shell,

00:38:03.717 --> 00:38:03.958
right?

00:38:04.159 --> 00:38:04.998
But if you go in and put the

00:38:05.039 --> 00:38:06.000
compliance feature,

00:38:06.019 --> 00:38:09.240
so there's a toggle in prompt that says

00:38:09.380 --> 00:38:11.141
you wanna do custom documentation.

00:38:12.043 --> 00:38:13.182
Well, as soon as they told me that,

00:38:13.242 --> 00:38:14.943
I'm like, hell yeah, it's game on.

00:38:15.625 --> 00:38:17.344
So I created templates for my therapists.

00:38:17.465 --> 00:38:18.606
So when they're doing their evals,

00:38:18.626 --> 00:38:19.666
they're doing their progress notes,

00:38:19.686 --> 00:38:20.646
they're doing their daily notes,

00:38:20.666 --> 00:38:21.688
they're doing their discharges.

00:38:22.987 --> 00:38:23.728
It's got all the,

00:38:24.068 --> 00:38:26.233
it's got all the Medicare stuff built into

00:38:26.293 --> 00:38:28.978
it that the word salads that they're

00:38:29.039 --> 00:38:30.882
looking for built into it so that the

00:38:31.021 --> 00:38:33.347
AI technology then puts it into the notes.

00:38:33.632 --> 00:38:35.554
So that's saying – it sounds like you're

00:38:35.574 --> 00:38:36.153
saying, hey, listen,

00:38:36.373 --> 00:38:38.215
make sure you're using a chainsaw because

00:38:38.295 --> 00:38:39.336
we used to have an ax,

00:38:39.356 --> 00:38:40.177
but now that there's a chainsaw,

00:38:40.418 --> 00:38:41.278
you're not using it.

00:38:42.159 --> 00:38:43.179
That's on you, right?

00:38:44.001 --> 00:38:46.322
So that's how to go through this.

00:38:46.342 --> 00:38:48.224
That's what power tool to use to get

00:38:48.264 --> 00:38:49.264
the tree down now.

00:38:49.826 --> 00:38:52.807
But if you were able to completely rebuild

00:38:52.847 --> 00:38:55.650
clinical notes from scratch –

00:38:56.070 --> 00:38:56.851
What would you do?

00:38:56.891 --> 00:38:58.652
Japanese ideas are better.

00:38:59.653 --> 00:39:00.695
For some reason, Americans are like,

00:39:00.715 --> 00:39:01.476
what do we add to it?

00:39:01.496 --> 00:39:02.896
It's like, what do we take away?

00:39:03.036 --> 00:39:04.318
What does it mean to be there?

00:39:04.797 --> 00:39:07.641
So if you can even go further upstream

00:39:07.820 --> 00:39:10.903
to rebuild compliance theater,

00:39:11.244 --> 00:39:13.585
or I should say, change, remove,

00:39:13.626 --> 00:39:15.146
what would you do to compliance theater?

00:39:15.927 --> 00:39:17.208
What only needs to be there?

00:39:17.775 --> 00:39:17.815
OK,

00:39:17.835 --> 00:39:19.916
so we all agree that physical therapy

00:39:19.936 --> 00:39:20.697
saves money, right?

00:39:21.016 --> 00:39:22.137
There's no disagreement there.

00:39:22.637 --> 00:39:22.838
Now,

00:39:23.719 --> 00:39:25.980
we can get in the argument of private

00:39:26.019 --> 00:39:28.760
practice versus chain clinics versus

00:39:29.141 --> 00:39:29.940
hospital based.

00:39:30.061 --> 00:39:31.021
And again, I'm not

00:39:32.130 --> 00:39:33.391
I'm not going to get into that discussion

00:39:33.431 --> 00:39:33.632
right now,

00:39:33.652 --> 00:39:35.094
but let's just talk as a whole, right?

00:39:35.153 --> 00:39:37.697
So we know that we save insurance

00:39:37.757 --> 00:39:38.478
companies money.

00:39:39.018 --> 00:39:40.719
Insurance companies know that we save them

00:39:40.739 --> 00:39:41.501
money, hopefully.

00:39:41.681 --> 00:39:44.324
But if I could change documentation,

00:39:44.364 --> 00:39:46.085
when I first got into this business,

00:39:46.146 --> 00:39:48.389
documentation was so that if I called out

00:39:48.509 --> 00:39:48.789
sick,

00:39:49.994 --> 00:39:53.135
the therapist who came in after me knew

00:39:53.215 --> 00:39:54.637
exactly what I was doing with that

00:39:54.677 --> 00:39:56.157
patient, right?

00:39:56.257 --> 00:39:57.438
It wasn't that I had to use the

00:39:57.458 --> 00:39:59.219
word educate or I had to use the

00:39:59.239 --> 00:40:02.181
word verbal cues or all this.

00:40:02.601 --> 00:40:03.402
It's like, oh my God,

00:40:03.442 --> 00:40:04.041
what do I gotta do?

00:40:04.601 --> 00:40:05.963
It's very time consuming.

00:40:06.003 --> 00:40:06.123
Now,

00:40:06.282 --> 00:40:07.583
AI has helped with that because my

00:40:07.623 --> 00:40:08.003
therapist,

00:40:08.364 --> 00:40:09.284
when they walk out at the end of

00:40:09.304 --> 00:40:09.545
the day,

00:40:09.565 --> 00:40:10.766
their notes are done and I know those

00:40:10.806 --> 00:40:12.626
notes are compliance and I can run reports

00:40:12.666 --> 00:40:14.047
behind the scenes to see what they're

00:40:14.068 --> 00:40:14.987
billing, how they're billing.

00:40:15.469 --> 00:40:16.208
Are they under billing?

00:40:16.248 --> 00:40:17.409
Are they over billing?

00:40:17.429 --> 00:40:18.911
And I can have those conversations with

00:40:18.951 --> 00:40:19.090
them.

00:40:20.771 --> 00:40:23.094
But really, documentation, you know,

00:40:23.114 --> 00:40:24.394
the tenth visit progress note,

00:40:24.414 --> 00:40:25.036
let's go there.

00:40:25.856 --> 00:40:26.155
Really?

00:40:26.757 --> 00:40:28.378
Do we need a tenth visit progress note?

00:40:28.498 --> 00:40:29.838
I mean, I get it.

00:40:29.858 --> 00:40:31.360
So it sounds like everything you've said

00:40:31.420 --> 00:40:34.063
so far, correct me, make it lighter,

00:40:34.784 --> 00:40:36.445
simpler, make it more, like,

00:40:36.864 --> 00:40:37.405
what are we doing?

00:40:37.445 --> 00:40:38.266
Why are we doing this?

00:40:38.387 --> 00:40:39.347
I was very confused when I was a

00:40:39.407 --> 00:40:39.628
student.

00:40:39.688 --> 00:40:41.009
I'm like, who am I writing this for?

00:40:41.168 --> 00:40:42.429
And they're like, for the EMR.

00:40:42.449 --> 00:40:43.451
And I was like, no, no,

00:40:43.490 --> 00:40:44.452
that's not a who, that's a what.

00:40:44.952 --> 00:40:45.813
What are we doing for?

00:40:46.193 --> 00:40:47.574
And then I was explained in not so

00:40:47.614 --> 00:40:48.094
many words.

00:40:48.815 --> 00:40:50.195
In case, right?

00:40:50.255 --> 00:40:50.416
I mean,

00:40:50.436 --> 00:40:51.396
this is literally what I was taught.

00:40:51.496 --> 00:40:52.757
Write as if you're going to read this

00:40:52.797 --> 00:40:53.297
in court.

00:40:53.398 --> 00:40:53.838
And I was like,

00:40:54.699 --> 00:40:55.639
what are we talking about?

00:40:55.659 --> 00:40:57.021
I'm going to write ten thousand notes in

00:40:57.041 --> 00:40:57.541
my career.

00:40:58.601 --> 00:40:59.983
Maybe two are read in court.

00:41:00.003 --> 00:41:01.483
I don't know what my batting average would

00:41:01.503 --> 00:41:01.704
be.

00:41:02.204 --> 00:41:03.865
That's what I'm doing all this.

00:41:03.885 --> 00:41:05.067
And that's where I think your phrase

00:41:05.106 --> 00:41:08.248
compliance theater hits the nail on the

00:41:08.289 --> 00:41:08.570
head.

00:41:09.349 --> 00:41:10.670
Oh, this is performance.

00:41:10.690 --> 00:41:11.431
So it sounds like.

00:41:12.644 --> 00:41:13.746
Faster is the outcome,

00:41:13.786 --> 00:41:16.447
but lighter and lighter is a good word.

00:41:16.467 --> 00:41:16.807
Simple.

00:41:16.847 --> 00:41:17.748
Like, what's the point?

00:41:17.847 --> 00:41:19.329
Understand what the point is for first.

00:41:19.369 --> 00:41:20.849
Who's the who is reading this?

00:41:21.170 --> 00:41:22.851
It sounds like it's for and you can

00:41:22.891 --> 00:41:24.532
make you can make one piece of content,

00:41:24.552 --> 00:41:24.972
right?

00:41:24.992 --> 00:41:25.413
I mean,

00:41:25.432 --> 00:41:27.275
whoever called EMR or notes content,

00:41:27.295 --> 00:41:27.655
but it is.

00:41:28.961 --> 00:41:30.362
It should be for the next therapist.

00:41:30.443 --> 00:41:31.985
It should be for the continuing medical

00:41:32.025 --> 00:41:33.166
record for the patient.

00:41:33.186 --> 00:41:35.047
So in case that follows them, the next,

00:41:35.088 --> 00:41:35.288
next,

00:41:35.367 --> 00:41:36.688
next therapist knows what's going on.

00:41:36.949 --> 00:41:37.909
And tertiarily,

00:41:37.989 --> 00:41:39.972
it should be to defend what... I mean,

00:41:40.012 --> 00:41:40.532
really what it is,

00:41:40.572 --> 00:41:41.813
it's defending what we're doing.

00:41:42.614 --> 00:41:43.614
Not explaining it, right?

00:41:43.775 --> 00:41:45.137
Because when someone says, write this...

00:41:46.266 --> 00:41:47.708
as if you'd be okay with it being

00:41:47.748 --> 00:41:48.268
read in court,

00:41:48.949 --> 00:41:50.710
I feel like I'm immediately the defendant.

00:41:50.771 --> 00:41:54.175
So it's change it from defense to not

00:41:54.275 --> 00:41:57.458
offense, but explanation.

00:41:57.599 --> 00:42:00.202
Like a useful rule instead of a necessary

00:42:00.242 --> 00:42:00.842
compliance theater.

00:42:00.862 --> 00:42:01.943
Right.

00:42:02.244 --> 00:42:02.985
We should have...

00:42:04.260 --> 00:42:05.862
the ability to put our hands more on

00:42:05.922 --> 00:42:07.804
patients and educate our patients rather

00:42:07.824 --> 00:42:09.045
than sitting there burying our face.

00:42:09.105 --> 00:42:10.945
Because I do consulting.

00:42:11.547 --> 00:42:12.327
I go around and I see,

00:42:12.527 --> 00:42:13.387
I don't do as much of it as

00:42:13.449 --> 00:42:15.010
I did previously,

00:42:15.050 --> 00:42:16.690
but I'll go into clinics and what's the

00:42:16.731 --> 00:42:17.192
therapist doing?

00:42:17.211 --> 00:42:18.532
They're buried in their computer.

00:42:20.184 --> 00:42:22.045
It's like, really?

00:42:22.925 --> 00:42:23.527
Unfortunately,

00:42:23.626 --> 00:42:25.188
it deters from what we're really trying to

00:42:25.208 --> 00:42:25.748
accomplish.

00:42:26.608 --> 00:42:27.150
Don't disagree.

00:42:27.349 --> 00:42:27.829
All right.

00:42:27.849 --> 00:42:28.331
That makes sense.

00:42:29.130 --> 00:42:30.793
You said fragmentation is hurting the

00:42:30.813 --> 00:42:31.253
profession.

00:42:31.532 --> 00:42:32.094
I don't disagree.

00:42:32.773 --> 00:42:35.175
But starting a new organization could be

00:42:35.235 --> 00:42:37.038
seen as adding to that.

00:42:37.617 --> 00:42:39.719
How do you reconcile that tension?

00:42:39.940 --> 00:42:40.960
I don't disagree with starting a new

00:42:41.001 --> 00:42:41.661
association.

00:42:41.840 --> 00:42:42.302
I'm just trying to...

00:42:43.496 --> 00:42:43.576
Yeah.

00:42:43.596 --> 00:42:44.998
And I think in the UPTA,

00:42:45.018 --> 00:42:45.757
we're not going away.

00:42:45.998 --> 00:42:47.820
You know, there's been things that, oh,

00:42:47.880 --> 00:42:49.001
you guys will be gone in a year.

00:42:49.041 --> 00:42:50.043
You'll be gone in two years.

00:42:50.103 --> 00:42:51.824
Now with the board of the UPTA,

00:42:51.884 --> 00:42:53.525
you know, it's a constantly moving target.

00:42:53.545 --> 00:42:54.706
There'll be people that drop off and

00:42:54.726 --> 00:42:56.409
people that drop, drop, drop in.

00:42:56.449 --> 00:42:58.451
But our intentions are good.

00:42:58.490 --> 00:42:58.871
And, you know,

00:42:58.891 --> 00:43:01.054
when you put a group of people together

00:43:01.074 --> 00:43:03.516
who have the same goals, the same,

00:43:03.775 --> 00:43:05.117
they want the same outcome and they're

00:43:05.157 --> 00:43:05.878
working together.

00:43:06.599 --> 00:43:07.980
you know, we're not going anywhere.

00:43:08.039 --> 00:43:09.521
So the UPT, yes, does it,

00:43:09.782 --> 00:43:10.302
but you know,

00:43:10.623 --> 00:43:12.724
it's like the guy down the street that's

00:43:12.744 --> 00:43:14.626
going to, I always tell my therapist,

00:43:14.666 --> 00:43:16.367
I'm not going to make you sign a,

00:43:16.588 --> 00:43:17.489
you know, people come in and go,

00:43:17.509 --> 00:43:18.329
do you have a non-compete?

00:43:18.550 --> 00:43:19.471
No.

00:43:19.490 --> 00:43:20.512
You want to open a clinic?

00:43:20.871 --> 00:43:21.952
I'll help you open the clinic.

00:43:22.253 --> 00:43:22.753
Right.

00:43:22.833 --> 00:43:23.054
Right.

00:43:24.224 --> 00:43:25.284
Because competition is healthy.

00:43:26.003 --> 00:43:27.364
And if you're going to do it right,

00:43:27.465 --> 00:43:28.565
I'm going to show you how to do

00:43:28.605 --> 00:43:29.065
it right.

00:43:29.704 --> 00:43:30.905
And then we'll work together because

00:43:30.925 --> 00:43:31.706
that's only going to help me in the

00:43:31.726 --> 00:43:32.045
long run.

00:43:32.365 --> 00:43:33.025
Initially,

00:43:33.706 --> 00:43:36.766
I may lose patients to that clinic down

00:43:36.806 --> 00:43:37.166
the road.

00:43:37.887 --> 00:43:39.806
But overall, and I've seen this happen,

00:43:39.947 --> 00:43:41.327
you know, when I first started this,

00:43:41.387 --> 00:43:42.768
you know, the building I'm sitting in,

00:43:42.827 --> 00:43:44.987
I started in two thousand and two.

00:43:45.668 --> 00:43:47.588
There's now four more PT clinics within

00:43:47.648 --> 00:43:48.469
three miles of me.

00:43:49.987 --> 00:43:51.750
I'm seeing more numbers today than I was

00:43:51.789 --> 00:43:52.289
back then.

00:43:52.570 --> 00:43:53.391
It's a good thing, right?

00:43:53.490 --> 00:43:57.072
People know physical therapy, right?

00:43:57.132 --> 00:43:58.353
If it wasn't needed,

00:43:59.155 --> 00:44:00.755
they wouldn't be able to open because they

00:44:00.775 --> 00:44:02.717
have to pay overhead and people.

00:44:02.876 --> 00:44:03.597
Yeah, right.

00:44:03.918 --> 00:44:05.079
So what are the goals...

00:44:05.918 --> 00:44:06.800
of UPTA.

00:44:07.159 --> 00:44:08.420
They seem similar to APTA,

00:44:08.440 --> 00:44:10.182
and even if they're the same, that's okay.

00:44:10.862 --> 00:44:12.304
How will they do them differently?

00:44:12.844 --> 00:44:14.365
So when UPTA was formed,

00:44:14.547 --> 00:44:15.728
that is what I asked,

00:44:15.867 --> 00:44:17.449
and I was told it's coming.

00:44:17.469 --> 00:44:17.528
Yes.

00:44:17.949 --> 00:44:18.809
And I don't...

00:44:18.829 --> 00:44:20.492
And it might be somewhere that I haven't

00:44:20.532 --> 00:44:21.952
seen, but as Katie asks,

00:44:22.673 --> 00:44:24.635
does UPTA have a public-facing information

00:44:24.655 --> 00:44:26.876
that all PTs and PTAs can access without

00:44:26.896 --> 00:44:28.358
being a member about...

00:44:29.297 --> 00:44:30.038
What will you do?

00:44:30.619 --> 00:44:31.458
These three questions.

00:44:31.800 --> 00:44:32.460
What will you do?

00:44:32.659 --> 00:44:33.880
How will it make my life better?

00:44:33.960 --> 00:44:34.420
In what ways?

00:44:34.501 --> 00:44:35.342
And then what do I need to do

00:44:35.362 --> 00:44:35.782
to get it?

00:44:35.862 --> 00:44:37.063
I'm getting membership or whatever.

00:44:37.302 --> 00:44:38.684
But how?

00:44:39.304 --> 00:44:41.766
Vision without a plan is a dream, right?

00:44:41.865 --> 00:44:43.806
So help me understand how we go from

00:44:43.907 --> 00:44:46.148
frustrated to alleviated.

00:44:46.188 --> 00:44:48.489
And this might be an unfair question to

00:44:48.570 --> 00:44:51.711
ask you because you aren't an association.

00:44:51.871 --> 00:44:52.811
This is a thing.

00:44:53.152 --> 00:44:54.373
But why do you belong?

00:44:54.432 --> 00:44:56.014
How do you see it as a road

00:44:56.054 --> 00:44:57.034
to what you want to get to?

00:44:57.608 --> 00:44:57.788
Yeah.

00:44:57.847 --> 00:45:01.471
So our biggest goal right now, you know,

00:45:01.490 --> 00:45:02.190
we have targets,

00:45:02.210 --> 00:45:04.052
but our main goal right now is policy.

00:45:04.333 --> 00:45:06.134
We want to we want to change policy.

00:45:06.273 --> 00:45:06.534
Right.

00:45:07.335 --> 00:45:09.757
So our first move that we did and

00:45:09.836 --> 00:45:11.438
kudos to Scott for doing this.

00:45:11.478 --> 00:45:11.958
But, you know,

00:45:12.018 --> 00:45:14.621
he found a law firm that deals in

00:45:14.641 --> 00:45:14.880
this.

00:45:14.940 --> 00:45:15.400
And, you know,

00:45:15.882 --> 00:45:18.382
we filed a we filed a federal lawsuit

00:45:18.422 --> 00:45:20.085
against CMS, you know, welcome.

00:45:20.545 --> 00:45:21.425
Hey, Scott.

00:45:22.894 --> 00:45:24.900
Kennedy Jr., welcome to your new position.

00:45:25.079 --> 00:45:27.246
Here's a lawsuit from...

00:45:27.385 --> 00:45:28.528
And I'm sure he's not reading them.

00:45:28.588 --> 00:45:30.413
It's some lawyer somewhere doing it or

00:45:30.432 --> 00:45:31.074
whatever, but...

00:45:32.128 --> 00:45:33.849
We don't have the ability to, you know,

00:45:33.869 --> 00:45:34.449
we can say,

00:45:34.568 --> 00:45:35.708
I don't want to take Medicare,

00:45:36.250 --> 00:45:38.090
but we can't technically opt out of

00:45:38.130 --> 00:45:38.530
Medicare.

00:45:38.590 --> 00:45:39.130
Right.

00:45:39.170 --> 00:45:42.112
So that that holds us accountable to still

00:45:42.132 --> 00:45:43.552
being an ancillary provider.

00:45:43.873 --> 00:45:44.112
Right.

00:45:44.773 --> 00:45:47.693
So when the lawyers reviewed the policy

00:45:47.733 --> 00:45:49.934
language, they said two things.

00:45:50.215 --> 00:45:52.295
It violates the Commerce Act.

00:45:52.755 --> 00:45:53.715
Right.

00:45:53.755 --> 00:45:54.476
Free trade,

00:45:54.597 --> 00:45:56.677
the ability to see patients without

00:45:57.117 --> 00:45:57.818
restrictions.

00:45:58.338 --> 00:45:59.177
And number two,

00:45:59.318 --> 00:46:00.679
it violates the Fifth Amendment.

00:46:02.269 --> 00:46:03.210
And they said,

00:46:03.251 --> 00:46:04.492
this is kind of a no-brainer.

00:46:04.532 --> 00:46:04.731
Now,

00:46:05.233 --> 00:46:06.514
typically when these things happen with

00:46:06.534 --> 00:46:06.974
CMS,

00:46:06.994 --> 00:46:07.855
we're going to go to the table and

00:46:07.875 --> 00:46:09.275
there's going to be some type of mediation

00:46:09.295 --> 00:46:10.155
and we'll meet in the middle.

00:46:10.197 --> 00:46:11.177
But hey,

00:46:11.757 --> 00:46:13.259
if a doctor can opt out of Medicare

00:46:13.278 --> 00:46:14.659
and not take Medicare and then still

00:46:14.699 --> 00:46:15.940
charge what that doctor wants to

00:46:16.101 --> 00:46:17.302
reasonably and necessary,

00:46:18.023 --> 00:46:19.503
absolutely we should be able to do that.

00:46:19.583 --> 00:46:21.025
So, you know, that was our first step.

00:46:21.045 --> 00:46:21.385
Okay.

00:46:22.085 --> 00:46:23.007
So let me ask you this.

00:46:23.067 --> 00:46:24.367
So you've done that.

00:46:24.527 --> 00:46:26.849
You've taken a very, very specific action.

00:46:27.389 --> 00:46:28.030
Yeah.

00:46:28.090 --> 00:46:28.771
Like no notes.

00:46:29.271 --> 00:46:31.434
My question is, in three years...

00:46:32.583 --> 00:46:35.706
If that lawsuit doesn't produce tangible

00:46:35.746 --> 00:46:37.148
results that your members can see,

00:46:37.788 --> 00:46:39.050
are you now in the same boat as

00:46:39.110 --> 00:46:40.952
APTA where you're standing there saying,

00:46:41.231 --> 00:46:43.454
we did stuff and the members are like,

00:46:43.594 --> 00:46:44.855
keep dropping one hundred and fifty bucks

00:46:44.875 --> 00:46:46.577
a year, but nothing happened.

00:46:46.657 --> 00:46:47.557
And then you have to say,

00:46:48.259 --> 00:46:49.320
don't hate the player, hate the game.

00:46:50.056 --> 00:46:50.898
No, that's the risk.

00:46:51.018 --> 00:46:52.400
You know, I'm a risk taker.

00:46:52.860 --> 00:46:53.242
My wife,

00:46:53.362 --> 00:46:54.382
we like to go to we like to

00:46:54.402 --> 00:46:54.884
go to Vegas.

00:46:54.923 --> 00:46:55.724
My wife's a gambler.

00:46:55.744 --> 00:46:55.985
Right.

00:46:56.106 --> 00:46:57.827
She'll sit at a blackjack table all night.

00:46:59.130 --> 00:47:00.112
Is that what you would say?

00:47:00.231 --> 00:47:01.213
Hey, like, yes.

00:47:01.233 --> 00:47:02.394
No, I know.

00:47:02.454 --> 00:47:03.295
I would not say that.

00:47:03.335 --> 00:47:04.978
But, you know, again,

00:47:05.018 --> 00:47:06.320
then what would you say?

00:47:07.021 --> 00:47:08.382
we're not going to take, yeah,

00:47:08.422 --> 00:47:09.342
we're not going to take no for an

00:47:09.382 --> 00:47:09.583
answer.

00:47:09.623 --> 00:47:10.804
We're going to get an answer on this.

00:47:10.824 --> 00:47:12.445
The attorney's pretty, you know, it's,

00:47:12.585 --> 00:47:13.824
it's going to go to mediation.

00:47:13.945 --> 00:47:15.045
Something's going to happen.

00:47:15.286 --> 00:47:17.427
It's not like, no,

00:47:17.608 --> 00:47:18.929
it's nothing in life is guaranteed.

00:47:18.989 --> 00:47:20.228
We may lose the case.

00:47:20.289 --> 00:47:21.889
We may lose the case horribly and we

00:47:21.929 --> 00:47:23.811
fall flat on our face and try this.

00:47:24.032 --> 00:47:24.652
I'm down with it.

00:47:24.891 --> 00:47:25.072
Yeah.

00:47:25.193 --> 00:47:27.313
And we have other avenues behind the

00:47:27.353 --> 00:47:28.715
scenes on where we're going to evoke

00:47:28.755 --> 00:47:29.114
change.

00:47:29.135 --> 00:47:30.516
You know, we just submitted a, um,

00:47:32.125 --> 00:47:33.666
The CMMI, right?

00:47:33.706 --> 00:47:36.106
So Center for Medicare and Medicaid

00:47:36.246 --> 00:47:36.827
Innovation.

00:47:37.746 --> 00:47:38.987
So to my knowledge,

00:47:39.208 --> 00:47:40.407
somebody can correct me on this.

00:47:40.748 --> 00:47:43.309
There's never been a innovation.

00:47:46.230 --> 00:47:46.789
Basically,

00:47:46.869 --> 00:47:48.371
I guess we could call it a test

00:47:48.411 --> 00:47:51.492
pilot where does physical therapy save

00:47:51.552 --> 00:47:52.231
money, right?

00:47:53.152 --> 00:47:55.072
So I'm laying there one night and I'm

00:47:55.092 --> 00:47:56.914
like, what I normally do.

00:47:58.163 --> 00:47:59.204
staring at the ceiling going,

00:47:59.224 --> 00:47:59.784
what can I do?

00:47:59.804 --> 00:48:00.585
You know, what can we work on?

00:48:00.625 --> 00:48:03.067
So I got up and I looked,

00:48:03.086 --> 00:48:05.188
and that's how I found the IHI, right?

00:48:05.208 --> 00:48:07.871
Because IHI works directly with CMMI.

00:48:08.632 --> 00:48:11.213
And I sat there most of the evening

00:48:11.253 --> 00:48:15.036
and typed up a CMMI where I want

00:48:15.056 --> 00:48:16.358
to do a pilot study with physical

00:48:16.378 --> 00:48:18.159
therapists, right?

00:48:18.179 --> 00:48:20.121
I want physical therapy, private practice,

00:48:20.922 --> 00:48:21.682
In the United States,

00:48:21.963 --> 00:48:23.003
take a pilot project.

00:48:23.043 --> 00:48:23.143
Now,

00:48:23.204 --> 00:48:23.925
I don't know if this is going to

00:48:23.945 --> 00:48:26.266
get approved, but again,

00:48:27.027 --> 00:48:28.168
if first you don't succeed,

00:48:28.387 --> 00:48:29.248
try and try again.

00:48:29.349 --> 00:48:30.349
I'm not going to let it fall on

00:48:30.389 --> 00:48:30.849
deaf ears.

00:48:31.530 --> 00:48:33.112
I can keep resubmitting and resubmitting

00:48:33.132 --> 00:48:33.692
and resubmitting.

00:48:33.733 --> 00:48:34.612
So I ran it by the board and

00:48:34.632 --> 00:48:36.034
the board said, yeah, this is great.

00:48:36.054 --> 00:48:36.614
Let's do it.

00:48:37.054 --> 00:48:38.416
So we submitted it on behalf of the

00:48:38.496 --> 00:48:40.378
UPTA because we felt UPTA would be,

00:48:40.478 --> 00:48:40.637
you know,

00:48:40.657 --> 00:48:42.699
and we submitted it to the powers that

00:48:42.739 --> 00:48:43.019
be.

00:48:43.500 --> 00:48:43.661
And

00:48:44.380 --> 00:48:46.862
ta-da it got submitted to cmmi now i

00:48:46.922 --> 00:48:48.882
hope that goes through and then we can

00:48:48.922 --> 00:48:50.202
start looking for private practices

00:48:50.222 --> 00:48:51.704
because it's going to be very specific and

00:48:51.724 --> 00:48:53.304
they're going to track data and we're

00:48:53.324 --> 00:48:55.545
going to see does private practice versus

00:48:56.224 --> 00:48:57.465
something else you know what are the

00:48:57.505 --> 00:48:59.367
hospitalizations what are the opioid use

00:48:59.407 --> 00:49:01.867
what are you know falls etc but these

00:49:01.927 --> 00:49:03.427
are all the things that we're doing we're

00:49:03.467 --> 00:49:05.048
navigating do i know if the apt is

00:49:05.088 --> 00:49:06.929
doing it or not no i don't i

00:49:06.949 --> 00:49:08.230
don't know what they're doing they may

00:49:08.250 --> 00:49:11.030
have i know that they did put um

00:49:11.751 --> 00:49:14.193
somebody forward for that HHS hack board,

00:49:14.393 --> 00:49:14.893
which is good.

00:49:15.114 --> 00:49:15.295
You know,

00:49:15.315 --> 00:49:16.255
these are all good things that we can

00:49:16.295 --> 00:49:18.617
do, but we have to keep chipping away.

00:49:18.878 --> 00:49:21.360
We cannot, we cannot be complacent.

00:49:21.760 --> 00:49:22.961
We cannot be complacent.

00:49:22.981 --> 00:49:23.623
All right.

00:49:23.663 --> 00:49:25.445
So let me ask a more fair question.

00:49:26.686 --> 00:49:28.186
A young PT comes to you and says,

00:49:28.246 --> 00:49:29.027
I'm disillusioned.

00:49:29.108 --> 00:49:29.748
What's the point?

00:49:32.666 --> 00:49:34.648
Why should they believe in UPTA and what

00:49:34.668 --> 00:49:36.768
would you tell them it offers that another

00:49:36.807 --> 00:49:37.728
organization doesn't?

00:49:37.789 --> 00:49:38.688
Essentially, what do you do?

00:49:38.728 --> 00:49:40.188
How does it make my life better?

00:49:40.590 --> 00:49:41.929
And then what do we need to do

00:49:41.949 --> 00:49:42.250
to get it?

00:49:42.329 --> 00:49:43.510
How would you explain their terms?

00:49:44.150 --> 00:49:44.550
Absolutely.

00:49:45.010 --> 00:49:46.590
I actually just had this happen.

00:49:47.030 --> 00:49:48.811
I take a lot of students, right?

00:49:48.831 --> 00:49:49.851
So I just had two students.

00:49:50.311 --> 00:49:52.213
My student just left in early December.

00:49:52.253 --> 00:49:53.773
She's going to be a great therapist,

00:49:53.813 --> 00:49:54.172
by the way,

00:49:54.193 --> 00:49:55.474
and hopefully she's watching this.

00:49:56.954 --> 00:49:58.755
But I just had this conversation and I

00:49:58.795 --> 00:49:59.474
told her, do both.

00:50:01.802 --> 00:50:03.483
Join the APTA, join the UPTA.

00:50:03.503 --> 00:50:04.764
Join both.

00:50:04.784 --> 00:50:06.545
There's no harm in that, right?

00:50:08.327 --> 00:50:10.088
But again... And then do what, though?

00:50:10.628 --> 00:50:11.208
Why?

00:50:11.248 --> 00:50:12.289
That's not a normal response.

00:50:12.329 --> 00:50:12.730
I like that.

00:50:12.829 --> 00:50:13.471
Why do both?

00:50:13.490 --> 00:50:14.490
What should she do next, though?

00:50:14.510 --> 00:50:15.192
She's got to do something.

00:50:15.231 --> 00:50:15.592
Taste.

00:50:15.672 --> 00:50:17.152
Yes, and be active.

00:50:17.612 --> 00:50:19.454
I tell people what organization you're in,

00:50:19.514 --> 00:50:20.414
and then ask,

00:50:20.715 --> 00:50:23.516
what are the free resources I can do?

00:50:23.856 --> 00:50:24.858
Join every free committee,

00:50:24.878 --> 00:50:26.378
get every email, and then just taste,

00:50:26.539 --> 00:50:28.280
and then slowly unsubscribe to the ones

00:50:28.300 --> 00:50:28.840
that you're liking.

00:50:29.760 --> 00:50:29.900
Yeah.

00:50:29.920 --> 00:50:30.481
So, you know,

00:50:30.521 --> 00:50:33.121
she was at my side for twelve weeks.

00:50:33.141 --> 00:50:36.443
So she I taught her through tangible

00:50:36.583 --> 00:50:36.943
action.

00:50:37.623 --> 00:50:38.043
Right.

00:50:38.083 --> 00:50:39.224
She was in on the meetings.

00:50:39.324 --> 00:50:40.503
I let her sit on some of the

00:50:41.003 --> 00:50:42.965
discussions that I had with my contact up

00:50:42.985 --> 00:50:43.824
at HHS.

00:50:43.864 --> 00:50:45.106
And she got to see and she's like,

00:50:45.206 --> 00:50:45.626
oh, my God,

00:50:45.646 --> 00:50:46.985
there's so much that goes on behind the

00:50:47.005 --> 00:50:47.306
scenes.

00:50:47.746 --> 00:50:49.186
But it was awakening for her because,

00:50:49.226 --> 00:50:50.746
you know, and nothing to the universities.

00:50:50.786 --> 00:50:52.708
I mean, I'm not against that,

00:50:52.748 --> 00:50:53.387
but she's like,

00:50:54.088 --> 00:50:55.809
you guys should teach a class on this.

00:50:56.856 --> 00:50:58.418
You guys should teach a class on,

00:50:58.577 --> 00:51:00.159
and how many students, I don't know,

00:51:00.440 --> 00:51:01.300
maybe you know this, Jimmy,

00:51:01.320 --> 00:51:02.922
how many PT students do we have in

00:51:02.942 --> 00:51:04.483
the country right now that are in school?

00:51:04.503 --> 00:51:05.503
I think there's ten grand,

00:51:05.583 --> 00:51:07.125
I think there's ten thousand graduating

00:51:07.144 --> 00:51:07.445
every year.

00:51:07.465 --> 00:51:08.186
Yeah,

00:51:08.206 --> 00:51:10.108
could you imagine if every one of those

00:51:10.148 --> 00:51:11.748
ten thousand were to, like,

00:51:11.789 --> 00:51:14.130
write a letter or get involved?

00:51:14.331 --> 00:51:15.771
And I know the APTA's working on doing

00:51:15.791 --> 00:51:16.952
that with the students and stuff like

00:51:16.972 --> 00:51:17.112
that.

00:51:17.132 --> 00:51:18.173
Right, right, right.

00:51:18.193 --> 00:51:19.195
So this is where I get to step

00:51:19.215 --> 00:51:20.195
back in and say,

00:51:20.536 --> 00:51:21.836
that is very simple to ask,

00:51:21.916 --> 00:51:23.237
that is very difficult to do.

00:51:23.257 --> 00:51:24.298
Yeah.

00:51:24.338 --> 00:51:25.940
You've posted something on social media.

00:51:26.880 --> 00:51:28.900
anybody has getting even people to click

00:51:28.960 --> 00:51:31.460
like even if they agree with it so

00:51:31.541 --> 00:51:33.702
you saw it you agreed with it but

00:51:33.722 --> 00:51:35.182
you didn't do anything about it why

00:51:35.842 --> 00:51:38.804
because attention and time are finite so

00:51:38.824 --> 00:51:41.344
it is i do not disagree but i

00:51:41.364 --> 00:51:44.146
will say it is simple it's just not

00:51:44.606 --> 00:51:46.146
even if you have a hundred thousand do

00:51:46.186 --> 00:51:47.706
the math on this i let's say we

00:51:47.726 --> 00:51:49.266
have a hundred thousand paying apta

00:51:49.286 --> 00:51:51.168
members go to their youtube channel

00:51:52.148 --> 00:51:53.409
they don't have a hundred thousand

00:51:53.469 --> 00:51:55.532
subscribers last time i checked they don't

00:51:55.552 --> 00:51:57.094
have a hundred thousand anything because

00:51:57.134 --> 00:51:59.916
getting people to do one extra thing is

00:52:00.016 --> 00:52:01.659
simple just do this just do this one

00:52:01.679 --> 00:52:03.300
thing because it's never one thing it's do

00:52:03.380 --> 00:52:05.302
this one thing now and then another thing

00:52:05.382 --> 00:52:07.123
another thing and eventually it's not that

00:52:07.164 --> 00:52:07.385
easy

00:52:07.934 --> 00:52:09.715
No, I get it.

00:52:09.735 --> 00:52:12.376
I've got thirteen physical therapists.

00:52:12.416 --> 00:52:13.777
Good luck trying to get them.

00:52:13.878 --> 00:52:14.858
Hey, guys,

00:52:15.157 --> 00:52:16.458
take time out of your day and hey,

00:52:16.498 --> 00:52:17.800
I need you to send this email.

00:52:17.840 --> 00:52:18.079
Right.

00:52:18.659 --> 00:52:20.081
So behind the scenes,

00:52:20.101 --> 00:52:21.201
that's what the UPT is doing.

00:52:21.221 --> 00:52:22.021
We create links.

00:52:22.041 --> 00:52:22.961
We make it easy.

00:52:23.061 --> 00:52:24.483
And, you know, an APTA does this, too.

00:52:25.543 --> 00:52:26.123
And by the way,

00:52:26.324 --> 00:52:28.204
when APTA sends out that link,

00:52:28.244 --> 00:52:31.045
I'm still filling out the APTA link as

00:52:31.085 --> 00:52:31.266
well.

00:52:31.306 --> 00:52:32.746
Yeah, because you said numbers.

00:52:32.887 --> 00:52:34.188
It kind of doesn't matter who they're,

00:52:34.307 --> 00:52:34.547
right.

00:52:34.648 --> 00:52:35.128
Yeah, agreed.

00:52:35.748 --> 00:52:36.309
Right, it's volume.

00:52:36.329 --> 00:52:37.389
That's what we need to do.

00:52:37.409 --> 00:52:38.030
We need volume.

00:52:38.050 --> 00:52:39.650
And we need, and again, yes,

00:52:40.030 --> 00:52:40.692
I agree with you.

00:52:40.811 --> 00:52:44.032
And I think both organizations serve a

00:52:44.114 --> 00:52:44.534
purpose.

00:52:46.643 --> 00:52:48.125
I just want to see more collaboration.

00:52:48.905 --> 00:52:50.327
That's my biggest thing is I just want

00:52:50.347 --> 00:52:51.847
to see us come together as a profession.

00:52:51.947 --> 00:52:52.588
I want to see, you know,

00:52:52.608 --> 00:52:54.530
because here's what the policymakers want,

00:52:54.750 --> 00:52:55.030
you know,

00:52:55.329 --> 00:52:56.371
and the insurance companies want.

00:52:56.411 --> 00:53:01.215
They want us to be disagreeing, right?

00:53:01.315 --> 00:53:02.496
Because it causes weakness.

00:53:02.536 --> 00:53:03.556
And when you have weakness,

00:53:04.056 --> 00:53:05.697
they pretty much win, right?

00:53:07.641 --> 00:53:08.601
These insurance carriers,

00:53:08.641 --> 00:53:09.443
it's not getting easier.

00:53:09.463 --> 00:53:09.663
You know,

00:53:09.782 --> 00:53:13.563
I opted out of UHC and Optum and

00:53:13.744 --> 00:53:15.143
I actually know physical therapists right

00:53:15.164 --> 00:53:16.045
now that are getting audit.

00:53:16.065 --> 00:53:17.025
This is disgusting.

00:53:17.065 --> 00:53:17.965
And this is, you know,

00:53:18.005 --> 00:53:20.445
another thing not to get into a legal

00:53:20.525 --> 00:53:22.126
argument, but I got a therapist right now.

00:53:22.166 --> 00:53:23.746
She's in Southern Georgia and the poor

00:53:23.766 --> 00:53:26.507
thing, they're going back seven years.

00:53:26.547 --> 00:53:28.347
So she's been out of network since day

00:53:28.568 --> 00:53:30.248
one with UnitedHealthcare Optum.

00:53:31.530 --> 00:53:32.951
they want retroactive payment.

00:53:33.010 --> 00:53:34.311
They haven't even seen the damn notes,

00:53:34.331 --> 00:53:35.572
but they're saying it wasn't medically

00:53:35.612 --> 00:53:37.074
necessary and we want all this money back.

00:53:37.094 --> 00:53:38.635
So she's like reaching out to me,

00:53:38.695 --> 00:53:40.536
what do I do?

00:53:40.556 --> 00:53:41.378
You gotta fight it.

00:53:41.538 --> 00:53:43.059
You gotta fight it because if they get

00:53:43.099 --> 00:53:45.501
what they want and I can tell her,

00:53:45.740 --> 00:53:47.382
hey, just stop taking UHC patients,

00:53:47.422 --> 00:53:50.445
but that's not a win.

00:53:50.764 --> 00:53:52.907
It's like that's on the patient,

00:53:52.927 --> 00:53:55.509
but that's where we need policy.

00:53:55.528 --> 00:53:56.849
That's where we need to fight back and

00:53:56.889 --> 00:53:57.971
say, and I told her, I said,

00:53:59.380 --> 00:53:59.559
you know,

00:53:59.579 --> 00:54:01.081
we need to band together and fight this.

00:54:01.262 --> 00:54:01.463
You know,

00:54:01.483 --> 00:54:03.224
there's basically what Optum is trying to

00:54:03.244 --> 00:54:03.626
do is,

00:54:04.507 --> 00:54:05.909
and I know this is coming for me

00:54:05.949 --> 00:54:06.268
too.

00:54:06.509 --> 00:54:08.411
I opted out of Optum UHC because I

00:54:08.431 --> 00:54:09.393
didn't want to accept the,

00:54:09.612 --> 00:54:11.295
the measly amount of money that they want

00:54:11.315 --> 00:54:13.277
to pay me for a visit because it's

00:54:13.297 --> 00:54:14.960
not worth my time, energy, or effort.

00:54:15.061 --> 00:54:16.882
But I know now that,

00:54:17.318 --> 00:54:18.699
Those patients are still coming to me

00:54:18.739 --> 00:54:20.340
because they want a good quality service.

00:54:20.760 --> 00:54:23.561
And UHC Optum is now paying me twice

00:54:23.802 --> 00:54:24.822
what they would have paid me if they

00:54:24.842 --> 00:54:26.023
would have just come to the table and

00:54:26.063 --> 00:54:26.963
sat down and talked to me.

00:54:27.963 --> 00:54:28.885
At some point,

00:54:29.184 --> 00:54:31.286
they're going to audit me and they're

00:54:31.306 --> 00:54:32.786
going to want retroactive payment because

00:54:32.827 --> 00:54:36.068
that's their way to scare you away so

00:54:36.108 --> 00:54:37.728
that you just drop them because they don't

00:54:37.748 --> 00:54:39.630
want to pay that, right?

00:54:39.650 --> 00:54:40.550
Let's be honest.

00:54:41.632 --> 00:54:43.112
The insurance company's job is to keep the

00:54:43.132 --> 00:54:44.012
money in their bank account.

00:54:44.346 --> 00:54:45.047
That is right.

00:54:45.206 --> 00:54:46.467
Understanding the physics of the

00:54:46.507 --> 00:54:47.648
environment you're in is terribly

00:54:47.668 --> 00:54:48.110
important.

00:54:48.909 --> 00:54:51.813
And understanding what their goals are and

00:54:51.833 --> 00:54:53.514
what your goals and where they are aligned

00:54:53.534 --> 00:54:54.556
and where they are not aligned.

00:54:54.956 --> 00:54:56.117
We got about six minutes left.

00:54:56.157 --> 00:54:57.217
I want to be respectful of time.

00:54:57.599 --> 00:54:58.179
Last question,

00:54:58.199 --> 00:54:59.260
then we'll do the parting shot.

00:54:59.800 --> 00:55:00.742
So last question is,

00:55:00.942 --> 00:55:03.284
what does success look like in five years?

00:55:04.144 --> 00:55:06.547
for you not just with upta but like

00:55:06.686 --> 00:55:09.829
what what would success look like in five

00:55:09.869 --> 00:55:11.791
years something like realistically right

00:55:11.831 --> 00:55:13.592
like this is no magic wand but like

00:55:14.132 --> 00:55:16.054
what when what would you sit down in

00:55:16.094 --> 00:55:18.356
five years and say yes we have succeed

00:55:18.396 --> 00:55:20.458
we have achieved success and i'm

00:55:20.559 --> 00:55:21.760
purposefully leaving that open-ended

00:55:22.474 --> 00:55:24.576
Yeah, I mean, honestly, I'm not stopping.

00:55:24.635 --> 00:55:26.297
I've got another clinic I'm opening next

00:55:26.358 --> 00:55:27.498
month, you know, February.

00:55:27.538 --> 00:55:28.458
Hopefully, you know,

00:55:28.498 --> 00:55:30.059
if the contractors can get the build out

00:55:30.099 --> 00:55:30.760
done, we're opening.

00:55:30.780 --> 00:55:31.561
So I'm not stopping.

00:55:31.581 --> 00:55:33.862
I'm not letting reimbursement.

00:55:33.922 --> 00:55:34.862
I'm not letting policy.

00:55:34.882 --> 00:55:35.983
I'm not letting audits.

00:55:36.003 --> 00:55:37.204
I'm not letting that get in my way.

00:55:37.244 --> 00:55:38.445
I'm still doing what I'm doing and

00:55:38.485 --> 00:55:39.545
providing good service.

00:55:39.606 --> 00:55:39.887
And, you know,

00:55:39.907 --> 00:55:40.927
we just have to keep fighting a good

00:55:40.947 --> 00:55:41.228
fight.

00:55:41.268 --> 00:55:42.047
And, you know,

00:55:42.088 --> 00:55:43.909
my success for me is to not give

00:55:43.989 --> 00:55:44.190
in.

00:55:44.409 --> 00:55:45.990
You know, I left the profession.

00:55:47.150 --> 00:55:48.490
For a reason, I felt burned out.

00:55:48.751 --> 00:55:49.791
I was just like toast.

00:55:49.871 --> 00:55:50.891
I wanted to go do something else.

00:55:50.911 --> 00:55:51.891
I went and worked for a stem cell

00:55:51.911 --> 00:55:52.211
company.

00:55:52.251 --> 00:55:53.992
Then I ran an orthopedic company and then

00:55:54.032 --> 00:55:55.333
I went to work for a hospital system.

00:55:55.393 --> 00:55:57.775
And honestly, my true passion was like,

00:55:57.934 --> 00:55:58.954
there's still work to be done.

00:55:59.516 --> 00:56:01.255
So crazy me in twenty twenty two.

00:56:01.436 --> 00:56:01.697
Hey,

00:56:01.737 --> 00:56:03.777
let's scale three clinics in eight months.

00:56:04.018 --> 00:56:04.838
You're out of line.

00:56:04.978 --> 00:56:05.597
Right.

00:56:05.617 --> 00:56:05.998
Got it done.

00:56:06.619 --> 00:56:08.179
But but again, you know,

00:56:08.199 --> 00:56:09.079
success for me is.

00:56:10.083 --> 00:56:11.563
Taking care of the people.

00:56:11.885 --> 00:56:13.365
We have a family here, right?

00:56:13.786 --> 00:56:15.128
I've got therapists that worked for me

00:56:15.188 --> 00:56:16.708
twenty years ago that as soon as I

00:56:16.768 --> 00:56:18.911
popped my doors back up, they were like,

00:56:18.990 --> 00:56:20.351
I want to come work for you.

00:56:20.371 --> 00:56:21.273
To me, that's success.

00:56:21.773 --> 00:56:23.574
I want to build an environment where

00:56:23.635 --> 00:56:25.536
physical therapists can come in and this

00:56:25.617 --> 00:56:27.259
they can treat autonomously.

00:56:27.679 --> 00:56:29.860
They can treat the way they were taught

00:56:30.442 --> 00:56:31.802
and we can continue.

00:56:31.922 --> 00:56:32.123
I mean,

00:56:33.083 --> 00:56:35.664
Nothing like the daughter who brings in

00:56:35.704 --> 00:56:37.485
her mom, who's ninety four years old,

00:56:37.525 --> 00:56:39.885
who's got her first case of vertigo.

00:56:39.945 --> 00:56:41.465
And she's like, the world is ending.

00:56:41.525 --> 00:56:43.525
And she walks out on visit number two

00:56:43.585 --> 00:56:45.286
and she comes in on visit three and

00:56:45.306 --> 00:56:46.925
she kisses you on the cheek and says,

00:56:47.646 --> 00:56:48.567
you saved me.

00:56:48.867 --> 00:56:49.766
I'm so much better.

00:56:49.806 --> 00:56:50.306
Thank you.

00:56:50.447 --> 00:56:50.606
You know,

00:56:50.626 --> 00:56:52.007
that that's why we do what we do.

00:56:52.047 --> 00:56:52.867
So to me,

00:56:52.927 --> 00:56:54.447
success is putting my hands on more

00:56:54.487 --> 00:56:54.927
patients,

00:56:55.307 --> 00:56:56.728
spending more time with the patients,

00:56:57.387 --> 00:56:58.588
less time documenting.

00:56:58.628 --> 00:56:59.909
You know, these are all changes.

00:56:59.949 --> 00:57:00.568
But, you know, really.

00:57:01.409 --> 00:57:02.449
As a group,

00:57:02.771 --> 00:57:04.251
that's where we need to come together.

00:57:04.291 --> 00:57:05.934
We need to come together and say enough

00:57:06.054 --> 00:57:06.614
is enough.

00:57:06.934 --> 00:57:08.416
I'm not taking it anymore.

00:57:08.876 --> 00:57:10.458
And I see lots of posts on these

00:57:10.478 --> 00:57:11.981
different pages about we need to start a

00:57:12.081 --> 00:57:12.320
union.

00:57:12.340 --> 00:57:13.161
We need to start a union.

00:57:13.181 --> 00:57:14.344
So that's something else I'm working on.

00:57:14.364 --> 00:57:15.344
It's not a union.

00:57:15.405 --> 00:57:16.985
It's an independent practice association.

00:57:17.005 --> 00:57:18.208
And there's a few of them out there

00:57:18.228 --> 00:57:18.728
right now, but.

00:57:19.588 --> 00:57:22.250
we're in the process right now of building

00:57:22.269 --> 00:57:23.590
that independent practice association,

00:57:23.630 --> 00:57:25.092
but we have lawyers involved,

00:57:25.152 --> 00:57:26.152
which takes time, energy,

00:57:26.192 --> 00:57:27.992
and effort because we want to make sure,

00:57:28.012 --> 00:57:29.733
because we know as soon as we start

00:57:29.753 --> 00:57:30.414
that IPA,

00:57:30.954 --> 00:57:33.356
and it's been done in general physicians,

00:57:33.396 --> 00:57:34.456
it's been done with OBGYN,

00:57:34.496 --> 00:57:36.257
my good friend who's an OBGYN down the

00:57:36.297 --> 00:57:36.516
road,

00:57:36.556 --> 00:57:37.657
he said best thing he ever did was

00:57:37.677 --> 00:57:41.059
he joined that practice association.

00:57:41.079 --> 00:57:42.239
The main thing you got to be careful

00:57:42.340 --> 00:57:43.681
of with collective bargaining,

00:57:44.101 --> 00:57:45.702
you can't just go for higher

00:57:45.742 --> 00:57:46.282
reimbursement.

00:57:46.302 --> 00:57:47.161
You got to do other things.

00:57:47.181 --> 00:57:48.123
You got to do compliance.

00:57:48.143 --> 00:57:48.523
That's where

00:57:49.163 --> 00:57:51.003
We bring in other people who,

00:57:51.063 --> 00:57:51.963
and we create a newsletter,

00:57:51.983 --> 00:57:52.643
whatever we do,

00:57:52.684 --> 00:57:55.405
but it's in the infancy stage now,

00:57:55.445 --> 00:57:57.204
but we're gonna run that through as a

00:57:57.364 --> 00:58:00.746
separate division of the UPTA so that we

00:58:00.766 --> 00:58:02.266
can give something tangible to the

00:58:02.306 --> 00:58:03.867
physical therapist and say, hey,

00:58:03.907 --> 00:58:06.628
belong to this IPA and we're gonna go

00:58:06.648 --> 00:58:08.208
to bat for you on reimbursement.

00:58:08.447 --> 00:58:09.548
But it's a big,

00:58:09.648 --> 00:58:10.568
as most people can tell you,

00:58:10.588 --> 00:58:12.650
that's a huge uphill battle to take on.

00:58:12.690 --> 00:58:13.789
So we wanna make sure that we have

00:58:13.889 --> 00:58:15.289
all the infrastructure in place first,

00:58:15.309 --> 00:58:17.030
that we have the attorney in place

00:58:17.751 --> 00:58:18.751
That is, you know,

00:58:18.771 --> 00:58:20.331
going to make sure because, you know,

00:58:20.351 --> 00:58:21.452
when you start going when you start

00:58:21.492 --> 00:58:22.793
hitting the insurance companies where it

00:58:22.932 --> 00:58:24.092
counts in their pocketbook,

00:58:24.492 --> 00:58:25.233
they're going to fight back.

00:58:25.893 --> 00:58:26.853
So we know that.

00:58:26.893 --> 00:58:28.934
But that's kind of it in a nutshell

00:58:29.014 --> 00:58:30.735
is, you know, I'm not going to stop.

00:58:30.835 --> 00:58:31.976
I'm going to I'm going to keep working

00:58:32.016 --> 00:58:32.615
tirelessly.

00:58:33.577 --> 00:58:33.956
All right.

00:58:33.976 --> 00:58:36.938
This is the parting shot.

00:58:37.478 --> 00:58:39.338
One last mic drop moment.

00:58:39.559 --> 00:58:40.778
No pressure.

00:58:40.798 --> 00:58:42.920
Just your legacy on the line.

00:58:44.684 --> 00:58:46.204
All right, Parting Shop, powered by U.S.

00:58:46.244 --> 00:58:46.945
Physical Therapy,

00:58:47.045 --> 00:58:50.307
a nationwide network of clinics focused on

00:58:50.347 --> 00:58:51.188
developing clinicians,

00:58:51.248 --> 00:58:51.969
not burning them out.

00:58:52.530 --> 00:58:53.650
Leadership tracks, mentorship,

00:58:53.690 --> 00:58:54.150
career growth,

00:58:54.170 --> 00:58:55.552
and the stability to build your future in

00:58:55.572 --> 00:58:55.952
PT.

00:58:55.972 --> 00:58:57.193
If you want a place that supports how

00:58:57.333 --> 00:59:00.295
you want to practice, visit usph.com.

00:59:00.315 --> 00:59:02.358
That is usph.com.

00:59:02.458 --> 00:59:02.697
Also,

00:59:02.757 --> 00:59:04.820
I do want to thank our nonprofit of

00:59:04.860 --> 00:59:06.260
the episode, Team Gleason,

00:59:06.280 --> 00:59:08.163
a nonprofit founded by former NFL player

00:59:08.182 --> 00:59:10.563
Steve Gleason after his ALS diagnosis.

00:59:11.425 --> 00:59:12.806
their mission to help people living with

00:59:12.885 --> 00:59:14.346
als stay independent connected and

00:59:14.365 --> 00:59:16.266
purposeful for as long as possible that

00:59:16.286 --> 00:59:17.806
means providing advanced communication

00:59:17.827 --> 00:59:19.708
devices mobility gear personalized tech

00:59:19.728 --> 00:59:21.869
and even life experiences designed to give

00:59:21.909 --> 00:59:23.688
people living with als more control over

00:59:23.728 --> 00:59:26.090
their lives until there's a cure there's

00:59:26.130 --> 00:59:28.030
team gleason no white flags learn more at

00:59:28.090 --> 00:59:31.211
team gleason.org all right uh parting shot

00:59:31.231 --> 00:59:32.672
your last trap uh chance for a mic

00:59:32.693 --> 00:59:34.753
drop moment soapbox statement whatever you

00:59:34.793 --> 00:59:36.673
want uh give it away

00:59:37.938 --> 00:59:40.244
Yeah, it's all about collaboration.

00:59:40.344 --> 00:59:41.809
It's all about, like I talked about,

00:59:41.849 --> 00:59:43.074
we need to join together.

00:59:43.173 --> 00:59:44.097
You're right.

00:59:46.771 --> 00:59:49.092
When we take jabs at something on social

00:59:49.112 --> 00:59:51.295
media, it's basically out of frustration.

00:59:51.335 --> 00:59:53.235
And it's really what we want to do

00:59:53.275 --> 00:59:54.295
is we want to evoke change.

00:59:54.335 --> 00:59:55.456
We want to wake people up.

00:59:55.577 --> 00:59:57.717
You know, it's not that we, again,

00:59:57.757 --> 00:59:59.159
the APTA serves its purpose.

00:59:59.179 --> 01:00:00.619
The UPTA serves its purpose.

01:00:00.659 --> 01:00:02.001
We're all on the same path together.

01:00:02.021 --> 01:00:03.282
But that's the main thing.

01:00:03.322 --> 01:00:05.143
You know, dentists, doctors,

01:00:05.603 --> 01:00:07.143
I see I'm friends with all these people

01:00:07.164 --> 01:00:07.724
in the community.

01:00:07.744 --> 01:00:08.605
They collaborate.

01:00:08.885 --> 01:00:08.965
Yeah.

01:00:09.717 --> 01:00:10.617
The PTs down the road,

01:00:10.637 --> 01:00:11.579
they don't want to collaborate.

01:00:11.619 --> 01:00:13.380
Why do we not do that?

01:00:14.179 --> 01:00:15.740
There's plenty of business to go around.

01:00:15.800 --> 01:00:16.802
We really need to start.

01:00:16.981 --> 01:00:18.362
Every setting needs to come together.

01:00:18.402 --> 01:00:19.322
We all need to come together.

01:00:19.862 --> 01:00:22.063
We really need to just start waking up

01:00:22.143 --> 01:00:24.746
and saying, we're done.

01:00:25.465 --> 01:00:26.626
Real change is going to happen.

01:00:26.847 --> 01:00:27.746
As the Beatles once said,

01:00:27.847 --> 01:00:29.427
come together right now.

01:00:29.608 --> 01:00:31.608
As former APTA president Sharon Dunn said,

01:00:31.789 --> 01:00:33.789
we are better together.

01:00:34.449 --> 01:00:35.251
Steve, appreciate the time.

01:00:35.291 --> 01:00:36.472
Thanks for the hour.

01:00:36.512 --> 01:00:37.152
I loved it.

01:00:37.673 --> 01:00:38.173
Thanks, Jimmy.

01:00:38.193 --> 01:00:38.574
Appreciate it.

01:00:38.594 --> 01:00:39.155
Let's do it again.

01:00:39.815 --> 01:00:40.994
All right.

01:00:41.014 --> 01:00:42.115
That's it for this one.

01:00:42.576 --> 01:00:44.036
We're just getting warmed up.

01:00:44.516 --> 01:00:45.396
Smash, follow,

01:00:45.456 --> 01:00:47.277
send it to a friend or crank up

01:00:47.318 --> 01:00:48.297
the next episode.

01:00:48.818 --> 01:00:49.798
Want to go deeper?

01:00:50.219 --> 01:00:54.081
It is at PG podcast.com or find us

01:00:54.141 --> 01:00:56.822
on YouTube and socials at PG podcast.

01:00:57.242 --> 01:00:59.523
And legally, none of this was advice.

01:00:59.603 --> 01:01:01.364
It's for entertainment purposes only.

01:01:03.005 --> 01:01:04.864
See Keith, we read the script.

01:01:05.146 --> 01:01:05.806
Happy now.