Leveraging Partnerships in Physical Therapy Practices

WEBVTT

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Good Tuesday morning to you.

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It is PT Breakfast Club Live.

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The three of us back together.

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It's been a while.

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He's Tony Maritato.

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He's Dave Kittle.

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I'm Jimmy McKay.

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We're all physical therapists in some way,

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shape, or form.

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A little bit different.

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I think that shows the

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breadth of the profession.

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So as we head into June here

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in the Northeast for Dave

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and myself and out in Ohio for Tony,

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good morning to you guys.

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Good morning, good morning.

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It is, again, I say this every episode,

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but beautiful weather,

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beautiful time of year.

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I am so happy to be here with you guys.

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It's great to have Jimmy back.

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I got a fresh haircut.

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Phillies are one of the best

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teams in baseball.

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Let's go!

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One of the best teams in baseball.

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Who is the best team in

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baseball there right now?

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I mean, they're 48.

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I just pulled up 48 and 24.

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Uh...

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Orioles, no,

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I think Dodgers maybe have the

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best record,

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but the Phillies are up there.

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They're top few teams, best record.

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So you don't adopt the New

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York team since you're

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living in New York now?

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Absolutely not, no.

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And we don't want him as a New Yorker.

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That's okay.

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He can keep his Phillies.

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The rivalry is real.

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Although it's a Mets-Phillies rivalry.

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I'm a Yankee fan.

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It's not really a Yankee-Phillies rivalry.

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Correct, yep.

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All right, Jimmy, open it up.

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Let's start with some news.

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This is something a little

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bit different that we're doing,

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but when PTs are in the

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news for good or bad,

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I think we need to pay attention to it.

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I'll throw a graphic on the screen.

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This story just came across.

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It was actually a couple months ago,

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but I didn't hear about it

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until just a couple days ago.

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Some people were sharing it

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in a Facebook group.

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But it looks like a fellow New Yorker,

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physical therapy entrepreneur,

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with a bit of a high...

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economic high style of

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living has been

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orchestrating a $300,000

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healthcare scam to help

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fund his extravagant lifestyle.

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A Queens-based physical

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therapist was found guilty

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on two counts of healthcare

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fraud by a grand jury back in January.

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And this, I remember it circulating,

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but I never dug into the specifics,

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but essentially he was the

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owner and operator of

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several PT clinics in

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actually in the greater Boston area.

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And between 14 and 18,

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he billed for non-existent

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sessions with patients that

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coincided with days when he

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was actually traveling around the world.

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So it was essentially just

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highly illegal healthcare fraud,

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and they're showing how

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it's not a victimless crime.

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And I think this story...

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highlights or makes the rest

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of the profession, which again,

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I think this is going to be a sliver of.

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Otherwise, it's not news.

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If this happened every day,

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it wouldn't really be news.

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And what I think it does is

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it makes honest physical therapists,

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which...

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from what I've seen,

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are most physical therapists,

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they overcorrect and they

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see something like this every six, eight,

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12 months or a couple of

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years and they overcorrect

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and they focus on, well,

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I can't bill for that

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because I don't want to be this person.

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Let's be very clear.

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This person knew what they were doing.

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This is gigantically extreme.

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But I think it does focus or

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shines a light on, hey,

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what are the things that

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you need to button up and

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make sure you're doing and

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documenting the right way?

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Again, this is an extreme example,

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but what I don't want

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people to do is overcorrect

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and not bill appropriately.

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So when a story like this comes up,

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what are your thoughts?

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I'm curious from Dave's perspective,

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because I know,

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and you kind of alluded to this,

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most therapists down bill, down code,

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under code.

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We're so terrified that

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we're going to do something wrong.

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And like you said,

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if you look at the total number, what,

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300,000 something

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therapists across the

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country and how few cases

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there actually are.

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Um,

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it's shocking that there aren't more

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headlines, you know, and, and again,

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frankly, 300,000,

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I would have imagined this

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would have been in the

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millions when you look at

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some of the details,

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but I think most of us are down coding,

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which is probably just as

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harmful as billing for

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services that weren't even

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delivered because we're

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devaluing the value of what is happening.

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Uh, but I lost track.

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What was the original question?

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Yeah, I mean,

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I was just sort of looking at like,

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I mean, you gave your thoughts.

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Like, Dave,

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when a story like this comes out,

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what comes to mind?

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Because you talk with a lot

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of practice owners that are

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not doing this.

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Let's be very,

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very clear that most people

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are not doing it.

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It's very egregious what

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this person is doing.

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Yeah, I mean,

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you're 100% right that this

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has resulted in the

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landscape of therapists under billing,

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under coding.

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I think Sturdy McKee has a quote.

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It's something like,

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No physical therapist,

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meaning the ones like you said,

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the ones our teammates,

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our our colleagues,

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the ones that are actually

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in accordance to normal

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standards and treating a

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reasonable amount of patients per day,

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a normal amount of patients per day.

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None of them are over

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billing or over coding.

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So like when we've looked at books,

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when we looked at EMRs and

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different practices that we've looked at,

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the productivity per

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therapist will usually be like three,

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like three units per visit.

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And so a lot of these outpatient clinics,

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I don't know what Tony's is like,

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but I'm assuming it's similar,

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but like a lot of the

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outpatient clinics in,

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at least where I've been in

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New York and New Jersey and Philly area,

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a lot of patients will be

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in the physical therapy

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office for like an hour.

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And maybe there may or may not be, I guess,

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medically necessary

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treatments being conducted at, you know,

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every minute that whole time.

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But therapists will under

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bill and it'll be like, you know, three,

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three units instead of a

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reasonably sufficient four units or,

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and many therapists don't

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even bill five units.

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I mean, some places,

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but like not all staff

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physical therapists.

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So you're right.

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These types of things,

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they come out in the news over time.

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But there's a disconnect.

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There's the egregious,

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completely illegal side,

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which is just overboard.

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And then it does affect the

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coding and the billing of a

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lot of physical therapists, for sure.

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Now, I wanted to share kind of related,

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but let me see if I can

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bring this up here.

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These are not physical therapists,

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but this is another example

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where these two podiatrists,

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they were delivering

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services for neuropathy.

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They were coding.

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And I believe my hunch is

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they probably felt that

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they were coding appropriately.

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But obviously,

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whoever the powers that be

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are decided they weren't.

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They got into a bunch of

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trouble because they were

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billing for services that

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were determined not to be

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within the codes that they were billing.

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Again, in this article,

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it says 7,000 claims.

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I don't understand how that

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resulted in only 181,000

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fees and penalties, but...

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there are so many examples

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out there and I've had this

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recent conversation I'd

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love to know what you guys

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think I really think small

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providers providers like me

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I don't have a legal

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department I don't have big

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budgets I don't have all of

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this other stuff I am being

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pushed out of the

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profession at least in the

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conventional term because

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I don't know.

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I think I'm billing correctly.

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I go through all the audits.

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I do all the stuff that I'm

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supposed to do.

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But I don't have the

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resources to keep up with

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larger organizations.

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And we see these stories,

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and it's a shame because

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people want to do a good job.

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I think there are genuine

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providers out there who

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want to help patients.

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But there's so many other

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hurdles that we have to overcome.

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What do you guys think about

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the small providers being

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pushed out because of the

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increasing regulation?

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Yeah, I mean, it's definitely a factor.

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When you put up the Synexis

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link in the group chat or wherever it was,

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I thought that that was

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typically cash pay.

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So I was actually surprised

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to hear that there were

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only insurances for that.

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I know I've seen a lot of

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chiropractors and a lot of

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and some chiros,

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I think machine for neuropathy.

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maybe another episode we can talk about,

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you know,

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it doesn't get results and

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actually helps people, but you know,

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I'm sure,

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I'm sure enough because I've

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seen reviews and things like that.

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But anyway, small, small, go ahead.

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What's interesting about

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that is I had also shared,

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like I was watching an Alex

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Hermosi clip recently and he was,

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was talking to a guy who

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does marketing for physicians.

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He didn't say what kind of

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physicians I was guessing

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chiropractors also who were

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in the neuropathy space.

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And he said his physicians

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were doing between two and

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$5 million a year in the

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neuropathy space.

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Now, you know, me, I it's all,

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I think it's all BS.

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I think it's all lies.

00:09:18.871 --> 00:09:19.812
I think that they're putting

00:09:19.852 --> 00:09:20.773
light on your skin and

00:09:20.812 --> 00:09:22.994
nothing's happening, but nonetheless,

00:09:23.453 --> 00:09:25.096
They're making two to five

00:09:25.157 --> 00:09:28.160
million dollars in a cash base.

00:09:28.380 --> 00:09:28.681
You know,

00:09:28.780 --> 00:09:30.663
we're going to cure neuropathy space.

00:09:30.744 --> 00:09:32.626
So, yeah, I thought it was cash as well.

00:09:34.019 --> 00:09:34.259
Got it.

00:09:34.278 --> 00:09:34.418
I mean,

00:09:34.599 --> 00:09:35.980
there's other colleagues out there

00:09:36.019 --> 00:09:37.340
using other devices where

00:09:37.559 --> 00:09:39.181
in a couple visits or something,

00:09:39.201 --> 00:09:40.201
the patient is reporting

00:09:40.240 --> 00:09:41.662
feeling more sensation,

00:09:41.701 --> 00:09:42.761
like even using the newbie,

00:09:42.782 --> 00:09:43.783
which I know we're going off track,

00:09:43.802 --> 00:09:44.342
but the newbie,

00:09:44.383 --> 00:09:45.442
like different devices kind

00:09:45.462 --> 00:09:47.283
of in the same world where

00:09:47.303 --> 00:09:49.585
there's patient subjective

00:09:49.664 --> 00:09:51.466
reports of feeling more sensation,

00:09:51.485 --> 00:09:53.186
more blood flow, things like that,

00:09:53.206 --> 00:09:53.485
whatever.

00:09:53.605 --> 00:09:54.746
So maybe that's a sidebar.

00:09:56.307 --> 00:09:59.048
The providers being pushed out, yes,

00:09:59.087 --> 00:09:59.889
I think that's also a

00:10:00.469 --> 00:10:02.350
component of all this with, like you said,

00:10:02.370 --> 00:10:02.570
Tony...

00:10:04.128 --> 00:10:04.948
full legal departments and

00:10:04.969 --> 00:10:06.168
compliance departments and all that.

00:10:07.570 --> 00:10:08.650
But at the end of the day,

00:10:08.671 --> 00:10:10.812
I think you could argue

00:10:11.331 --> 00:10:13.092
that these guys might be a

00:10:13.133 --> 00:10:13.734
little bit different.

00:10:13.854 --> 00:10:15.153
You don't have to pull it back up,

00:10:15.173 --> 00:10:16.615
but there was some equity

00:10:16.674 --> 00:10:17.635
holding something,

00:10:18.355 --> 00:10:19.777
meaning they may be owned

00:10:19.797 --> 00:10:20.857
by private equity or they

00:10:20.878 --> 00:10:21.837
might be owned by some

00:10:21.898 --> 00:10:22.918
investor or there's some

00:10:22.979 --> 00:10:23.899
financial sponsor or

00:10:23.940 --> 00:10:25.159
something of these interests,

00:10:25.701 --> 00:10:27.761
which could paint a little

00:10:27.782 --> 00:10:29.042
bit more of a target on their back.

00:10:29.062 --> 00:10:29.962
I don't know what you think about that.

00:10:31.513 --> 00:10:32.594
Yeah, I agree.

00:10:32.653 --> 00:10:34.075
I mean, deeper pockets, right?

00:10:34.154 --> 00:10:34.335
Like,

00:10:34.434 --> 00:10:35.856
why are you going to go after

00:10:35.897 --> 00:10:37.577
somebody who has no money to pay you,

00:10:37.717 --> 00:10:39.019
even if you find them guilty?

00:10:39.038 --> 00:10:41.761
I think deeper pockets,

00:10:41.802 --> 00:10:42.883
you can cut deeper.

00:10:42.982 --> 00:10:43.822
I think you create an

00:10:43.903 --> 00:10:45.565
example of that individual

00:10:45.644 --> 00:10:46.586
or that practice.

00:10:47.966 --> 00:10:48.366
I don't know.

00:10:48.767 --> 00:10:50.148
Who has it like the whole

00:10:50.607 --> 00:10:52.308
Count Dracula story where

00:10:52.408 --> 00:10:53.929
Vlad the Impaler would hang

00:10:53.990 --> 00:10:55.471
heads on a stake to like

00:10:55.551 --> 00:10:56.812
show how fierce he was?

00:10:56.831 --> 00:10:59.192
I think there's truth to

00:10:59.212 --> 00:11:00.573
that even to this day.

00:11:00.594 --> 00:11:02.735
I think when regulators and

00:11:02.796 --> 00:11:04.155
compliance want to come in,

00:11:04.417 --> 00:11:05.076
they want to make an

00:11:05.136 --> 00:11:06.498
example of you if they

00:11:06.518 --> 00:11:07.739
think you're doing something wrong.

00:11:08.499 --> 00:11:09.840
And sadly, you know,

00:11:09.879 --> 00:11:11.380
we only hear one side of the story.

00:11:11.600 --> 00:11:12.942
I'm not defending the people

00:11:12.982 --> 00:11:14.123
that do things that are wrong.

00:11:14.182 --> 00:11:15.464
We know that that happens,

00:11:15.924 --> 00:11:16.804
but I also want to bring

00:11:16.865 --> 00:11:18.427
reality in that we only

00:11:18.506 --> 00:11:19.927
hear one side of the story.

00:11:20.327 --> 00:11:20.528
Right.

00:11:20.567 --> 00:11:22.330
You also go after the ones you can win.

00:11:22.350 --> 00:11:23.630
I mean, there was a,

00:11:24.051 --> 00:11:25.351
there was a big uproar in

00:11:25.392 --> 00:11:26.993
the field that I was in

00:11:27.092 --> 00:11:27.953
previous to physical

00:11:27.994 --> 00:11:28.673
therapy and that was

00:11:28.754 --> 00:11:30.034
broadcasting and radio.

00:11:30.535 --> 00:11:33.138
And there was a big, big, uh,

00:11:33.977 --> 00:11:35.159
uh to use your vlad the

00:11:35.220 --> 00:11:37.062
impaler uh line like sort

00:11:37.081 --> 00:11:38.582
of witch hunt um for pay

00:11:38.643 --> 00:11:40.004
for play now keep in mind

00:11:40.044 --> 00:11:41.145
this was a record company

00:11:41.166 --> 00:11:41.966
saying we will give you

00:11:42.006 --> 00:11:44.349
cash or gifts for you to

00:11:44.389 --> 00:11:46.471
play the song because we

00:11:46.530 --> 00:11:47.952
know that this song will

00:11:47.993 --> 00:11:49.494
generate sales ticket sales

00:11:49.653 --> 00:11:51.416
record revenue the problem

00:11:51.456 --> 00:11:52.317
there is you're like well

00:11:52.517 --> 00:11:53.698
where's the problem in that

00:11:53.879 --> 00:11:54.879
it's a private radio

00:11:54.899 --> 00:11:55.561
station and a private

00:11:55.600 --> 00:11:56.701
record company making a deal

00:11:57.361 --> 00:11:57.962
there's rules and

00:11:57.982 --> 00:11:58.865
regulations around that

00:11:58.904 --> 00:12:00.125
because it's the FCC,

00:12:00.206 --> 00:12:01.548
it's the public airwaves.

00:12:01.629 --> 00:12:03.370
So like you can't do that on our,

00:12:03.530 --> 00:12:04.251
that's where the,

00:12:04.673 --> 00:12:06.235
the regulators came in and

00:12:06.274 --> 00:12:07.317
the regulators came in

00:12:07.376 --> 00:12:08.518
because it was an election year.

00:12:09.826 --> 00:12:10.246
And they said,

00:12:10.326 --> 00:12:12.408
we need I need my name in the headlines.

00:12:12.708 --> 00:12:14.090
So I'm going to go after a layup.

00:12:14.710 --> 00:12:14.910
Right.

00:12:15.291 --> 00:12:17.192
So so why are why are

00:12:17.272 --> 00:12:20.794
regulators going after practices?

00:12:20.894 --> 00:12:22.475
Because the regulations have changed.

00:12:22.676 --> 00:12:24.957
Like go even go like zoom out one more,

00:12:25.538 --> 00:12:26.719
which also brings us to the

00:12:26.759 --> 00:12:27.860
next thing we shared in our

00:12:28.019 --> 00:12:30.181
in our group chat, which was I think,

00:12:30.481 --> 00:12:31.842
Tony, you had shared this one, right?

00:12:32.741 --> 00:12:33.142
Dave did.

00:12:33.682 --> 00:12:35.004
No, I grabbed that from LinkedIn.

00:12:35.024 --> 00:12:35.163
Yeah.

00:12:35.604 --> 00:12:36.884
So this is a post that you

00:12:36.946 --> 00:12:39.047
saw seen from an orthopedic surgeon,

00:12:39.126 --> 00:12:40.828
Dr. Daniel Paul.

00:12:41.509 --> 00:12:43.931
And it's really like a rant

00:12:43.971 --> 00:12:45.873
that's not necessarily unique.

00:12:45.913 --> 00:12:47.594
We've seen this before, right?

00:12:47.654 --> 00:12:48.355
Or we've heard this.

00:12:48.774 --> 00:12:50.277
Or maybe you've said this before.

00:12:50.636 --> 00:12:51.538
And I'll summarize.

00:12:52.538 --> 00:12:53.318
It sounds like he's an

00:12:53.359 --> 00:12:54.519
orthopedic surgeon who's a

00:12:54.580 --> 00:12:56.542
private practitioner or knows some.

00:12:56.662 --> 00:12:57.302
And he's saying it's

00:12:57.462 --> 00:12:58.322
unsustainable for

00:12:58.423 --> 00:12:59.924
insurance-based physicians to

00:13:01.653 --> 00:13:03.094
to stay in business because

00:13:03.173 --> 00:13:04.754
large hospital systems are

00:13:04.815 --> 00:13:05.835
more than happy to buy it,

00:13:05.934 --> 00:13:08.456
buy them up because they have the weight,

00:13:09.157 --> 00:13:10.677
they have the money that can come in.

00:13:10.778 --> 00:13:12.118
Even if you're operating at a loss,

00:13:12.138 --> 00:13:12.938
they say, listen, well,

00:13:12.958 --> 00:13:13.999
we're a hospital system.

00:13:14.318 --> 00:13:15.360
So we might have the things

00:13:15.379 --> 00:13:16.080
that you're lacking,

00:13:16.541 --> 00:13:18.481
not only a stream of patients,

00:13:18.601 --> 00:13:20.142
which by the way, it's illegal to do that,

00:13:20.201 --> 00:13:20.722
but of course,

00:13:21.423 --> 00:13:23.583
it's easy to sort of corral patients there,

00:13:24.024 --> 00:13:25.884
but also we get paid differently.

00:13:26.524 --> 00:13:28.605
We get paid differently than you.

00:13:29.125 --> 00:13:30.385
Plus we have what Tony was

00:13:30.426 --> 00:13:31.485
mentioning a second ago is

00:13:31.525 --> 00:13:32.726
we have a legal department.

00:13:33.586 --> 00:13:34.628
So if we get shot,

00:13:35.028 --> 00:13:36.168
if we get hit with a thing,

00:13:36.707 --> 00:13:38.688
this is a BB gun.

00:13:38.729 --> 00:13:40.489
If you're a private practitioner,

00:13:40.929 --> 00:13:41.889
that thing's a torpedo

00:13:41.909 --> 00:13:42.889
gonna sink your whole ship.

00:13:43.169 --> 00:13:45.451
So Dr. Paul goes on and sort of outlines,

00:13:45.490 --> 00:13:46.451
I thought really well in

00:13:46.491 --> 00:13:47.591
three to four paragraphs,

00:13:48.783 --> 00:13:51.104
The problem he outlines in this one,

00:13:51.124 --> 00:13:52.004
the bottom paragraph,

00:13:52.284 --> 00:13:53.326
patients find out that the

00:13:53.365 --> 00:13:54.485
routine x-rays that used to

00:13:54.525 --> 00:13:57.788
cost 150 bucks now cost 850.

00:13:57.788 --> 00:13:58.889
And that comes from things

00:13:58.948 --> 00:14:00.529
like administrative bloat.

00:14:01.331 --> 00:14:01.591
Right.

00:14:01.691 --> 00:14:02.730
They now need to pay for the

00:14:02.770 --> 00:14:03.491
legal department,

00:14:03.511 --> 00:14:04.371
the marketing department

00:14:04.412 --> 00:14:06.153
and the new parking complex.

00:14:07.433 --> 00:14:09.596
But they can do that.

00:14:09.635 --> 00:14:10.556
They charge that money

00:14:10.596 --> 00:14:11.716
because they get paid differently.

00:14:11.777 --> 00:14:12.716
They can do that.

00:14:12.857 --> 00:14:14.057
The rules are not the same

00:14:14.118 --> 00:14:15.198
for you and me and the

00:14:15.239 --> 00:14:16.159
hospital down the street.

00:14:16.220 --> 00:14:18.221
And that is by definition ain't fair.

00:14:19.940 --> 00:14:20.879
Dave?

00:14:21.039 --> 00:14:22.760
It's not fair.

00:14:22.860 --> 00:14:23.961
Tony and I recently talked

00:14:24.000 --> 00:14:25.782
about the same type of

00:14:25.802 --> 00:14:26.761
thing for physical therapy

00:14:26.961 --> 00:14:29.363
and how an outpatient

00:14:29.423 --> 00:14:30.724
hospital physical therapy

00:14:30.744 --> 00:14:33.284
practice can make $300 per

00:14:33.504 --> 00:14:35.785
Medicare Part B visit by a

00:14:35.826 --> 00:14:36.586
physical therapist using

00:14:36.625 --> 00:14:38.326
the same CPT codes,

00:14:38.365 --> 00:14:40.687
same ICD-10 diagnosis codes.

00:14:41.027 --> 00:14:42.967
And if there's Tony billing

00:14:43.008 --> 00:14:44.107
like that versus his

00:14:44.148 --> 00:14:45.048
hospital across the street,

00:14:45.688 --> 00:14:46.690
Tony's going to make $100 or

00:14:46.690 --> 00:14:48.350
$109 or whatever dollars on

00:14:48.429 --> 00:14:50.390
average per Medicare Part B

00:14:50.912 --> 00:14:51.991
visit of four units.

00:14:52.072 --> 00:14:53.633
And then the hospital across the street,

00:14:54.072 --> 00:14:55.293
same licensed physical therapist.

00:14:55.474 --> 00:14:56.134
I mean, not the same.

00:14:56.673 --> 00:14:57.394
Another licensed physical

00:14:57.434 --> 00:14:58.434
therapist in the same state.

00:14:58.695 --> 00:15:00.255
Builds the same four CBT codes,

00:15:00.275 --> 00:15:00.995
same ICD-10 codes.

00:15:01.397 --> 00:15:03.157
The hospital makes $300 per

00:15:03.177 --> 00:15:04.597
visit for Medicare Part B.

00:15:04.778 --> 00:15:06.139
Literally the same thing,

00:15:06.599 --> 00:15:07.700
the same service.

00:15:07.779 --> 00:15:10.041
And we talked about facility fee.

00:15:10.221 --> 00:15:11.581
And I think Tony might have mentioned...

00:15:13.182 --> 00:15:14.503
uh, setting code or something.

00:15:14.682 --> 00:15:15.803
It's kind of in the same ballpark,

00:15:15.823 --> 00:15:16.104
but yeah.

00:15:16.783 --> 00:15:21.767
Um, and it just, it's not fair, but,

00:15:21.826 --> 00:15:22.506
but it is what it is.

00:15:22.527 --> 00:15:22.826
I don't know.

00:15:22.846 --> 00:15:23.027
Like,

00:15:23.368 --> 00:15:24.168
I don't know if we were going to talk

00:15:24.207 --> 00:15:26.369
about solutions around it, but like we,

00:15:26.448 --> 00:15:27.210
we kind of talked a little

00:15:27.230 --> 00:15:27.950
bit about it then.

00:15:27.970 --> 00:15:29.471
Um, but it,

00:15:29.770 --> 00:15:32.011
I shared it with you guys because I, um,

00:15:32.631 --> 00:15:33.592
it's the same thing that's

00:15:33.613 --> 00:15:34.673
happening in physical therapy.

00:15:34.693 --> 00:15:36.014
So physicians have been feeling it.

00:15:36.033 --> 00:15:37.335
That's why all the health

00:15:37.375 --> 00:15:38.335
systems everywhere have

00:15:38.355 --> 00:15:40.517
been acquiring the primary care doctors.

00:15:40.557 --> 00:15:41.096
They want to keep

00:15:41.657 --> 00:15:42.938
The primary care doctors in

00:15:42.979 --> 00:15:43.698
their network in the

00:15:43.739 --> 00:15:45.581
hospital system to not

00:15:45.660 --> 00:15:47.602
refer to even external

00:15:48.264 --> 00:15:49.745
physician specialists that

00:15:49.764 --> 00:15:50.806
they've referred to and

00:15:50.865 --> 00:15:51.947
have been friends with for decades.

00:15:52.327 --> 00:15:53.168
They want those referrals to

00:15:53.207 --> 00:15:54.730
stay within the NYU system

00:15:54.830 --> 00:15:56.711
or the HSS system or whatever.

00:15:56.731 --> 00:15:58.913
I mean, they're all everywhere.

00:15:59.453 --> 00:16:00.095
It is what it is.

00:16:00.154 --> 00:16:01.615
Geisinger, wherever it is.

00:16:02.616 --> 00:16:04.139
So, Tony,

00:16:04.178 --> 00:16:05.059
do you have anything else to fill

00:16:05.100 --> 00:16:05.320
in there?

00:16:05.945 --> 00:16:06.284
I do.

00:16:06.304 --> 00:16:07.125
I want to share some

00:16:07.166 --> 00:16:08.147
experience about that.

00:16:08.167 --> 00:16:09.128
But before I do,

00:16:09.827 --> 00:16:11.769
any feedback on that idea

00:16:11.870 --> 00:16:14.211
that you shared last week, I think it was,

00:16:14.331 --> 00:16:16.393
or any comments coming in about that?

00:16:17.094 --> 00:16:17.313
Yeah.

00:16:17.413 --> 00:16:18.274
Well, I mentioned to you,

00:16:18.355 --> 00:16:19.335
I think last week or maybe

00:16:19.355 --> 00:16:20.556
the week before that I had

00:16:20.596 --> 00:16:23.499
like most inbound messages

00:16:23.899 --> 00:16:24.860
from practice owners about,

00:16:25.019 --> 00:16:28.201
I spoke to one practice owner in Boston,

00:16:28.322 --> 00:16:30.024
pretty sizable practice.

00:16:30.083 --> 00:16:30.783
And he's like, Hey,

00:16:30.823 --> 00:16:32.264
we're looking to do this, this, this,

00:16:32.284 --> 00:16:33.346
we're trying to do some other things.

00:16:33.385 --> 00:16:33.966
We're talking to other

00:16:34.006 --> 00:16:35.368
practice owners to try to band together.

00:16:35.868 --> 00:16:36.148
He said,

00:16:36.168 --> 00:16:37.450
whatever you guys might be doing

00:16:37.470 --> 00:16:38.831
with that, because, so Jimmy,

00:16:38.850 --> 00:16:39.672
I don't know if you listened to it,

00:16:39.692 --> 00:16:41.354
but like Tony and I, I joked, I said,

00:16:41.754 --> 00:16:44.017
we should start a hospital, you know,

00:16:44.658 --> 00:16:46.178
physical therapy hospital or, you know,

00:16:46.198 --> 00:16:47.400
kid old marital hospital,

00:16:47.421 --> 00:16:48.201
whatever we joked.

00:16:48.341 --> 00:16:50.323
And I said, we want to get this contract.

00:16:50.344 --> 00:16:51.764
We want to get this, you know, in New York,

00:16:51.826 --> 00:16:54.028
it's called article 28 or in other States,

00:16:54.347 --> 00:16:55.308
it's probably something similar.

00:16:56.029 --> 00:16:57.171
And I said, let's just, you know,

00:16:57.250 --> 00:16:58.491
break even on a hospital,

00:16:58.672 --> 00:17:00.153
whatever the legal, you know,

00:17:00.293 --> 00:17:02.033
minimal standards are for whatever state,

00:17:02.094 --> 00:17:03.975
maybe somewhere with a

00:17:04.355 --> 00:17:05.476
lower cost of living or real estate.

00:17:05.496 --> 00:17:06.296
We get a hospital,

00:17:06.757 --> 00:17:08.096
but we just do it so that

00:17:08.136 --> 00:17:09.597
we can get this hospital contract.

00:17:09.617 --> 00:17:11.159
So it's just a license.

00:17:11.239 --> 00:17:12.180
It's a hospital on paper.

00:17:13.169 --> 00:17:14.250
Well, I mean,

00:17:14.289 --> 00:17:15.570
maybe you would actually have

00:17:15.611 --> 00:17:17.051
to have almost like an urgent care,

00:17:17.132 --> 00:17:18.472
like low budget hospital or

00:17:18.512 --> 00:17:19.232
something kind of thing.

00:17:19.794 --> 00:17:22.375
But the point would then be we we then say,

00:17:22.756 --> 00:17:22.955
hey,

00:17:22.996 --> 00:17:25.057
we got this Medicare Part B. And by

00:17:25.096 --> 00:17:25.357
the way,

00:17:25.577 --> 00:17:26.898
every other in-network insurance

00:17:27.239 --> 00:17:28.118
gets paid higher through

00:17:28.138 --> 00:17:29.240
the hospital contract

00:17:29.259 --> 00:17:30.681
compared to the private

00:17:30.701 --> 00:17:32.782
practice physical therapy contracts.

00:17:33.343 --> 00:17:33.522
Right.

00:17:33.903 --> 00:17:35.324
So like every insurance

00:17:35.983 --> 00:17:37.164
reimbursement visit of

00:17:37.285 --> 00:17:38.105
three or four or whatever

00:17:38.184 --> 00:17:39.265
units gets paid more.

00:17:40.105 --> 00:17:40.445
So anyway,

00:17:40.486 --> 00:17:42.267
I had a lot of inbound from that.

00:17:42.346 --> 00:17:43.606
I had Tony and I were

00:17:43.646 --> 00:17:44.727
fielding comments and

00:17:44.767 --> 00:17:45.827
questions about it publicly,

00:17:45.847 --> 00:17:47.969
but then also owners reaching out and.

00:17:48.868 --> 00:17:50.329
Some owners couldn't believe it.

00:17:50.470 --> 00:17:52.290
I even had an owner recently say,

00:17:52.631 --> 00:17:55.732
so he had sold to Select

00:17:55.792 --> 00:17:57.034
Medical several years ago.

00:17:57.314 --> 00:17:58.253
And he didn't even know.

00:17:58.454 --> 00:18:00.935
And I'm like, I don't know which hospital,

00:18:00.955 --> 00:18:01.576
but Select Medical

00:18:01.916 --> 00:18:02.576
definitely has an

00:18:02.596 --> 00:18:04.278
affiliation with a hospital system.

00:18:04.778 --> 00:18:06.618
And so they didn't even, obviously,

00:18:06.638 --> 00:18:07.240
they're not going to tell you.

00:18:07.259 --> 00:18:08.380
They're not going to tell you, hey,

00:18:08.579 --> 00:18:09.881
we're going to buy you at

00:18:09.961 --> 00:18:11.301
whatever competitive price.

00:18:11.521 --> 00:18:12.682
dollar amount we can agree to.

00:18:13.104 --> 00:18:15.346
And like the next day or the next quarter,

00:18:15.405 --> 00:18:16.406
whenever we switch billing

00:18:16.467 --> 00:18:17.808
from your billing, our billing,

00:18:18.469 --> 00:18:19.349
all of our reimbursements

00:18:19.390 --> 00:18:20.432
per visit will really

00:18:20.511 --> 00:18:21.972
increase like tens of

00:18:22.032 --> 00:18:23.775
dollars or maybe hundreds

00:18:23.795 --> 00:18:25.076
of dollars per visit.

00:18:25.916 --> 00:18:26.017
Um,

00:18:27.434 --> 00:18:27.674
You know,

00:18:27.714 --> 00:18:29.375
we're kind of just barking up a

00:18:29.415 --> 00:18:31.696
tree here because the solutions are,

00:18:31.797 --> 00:18:32.576
you know, band together,

00:18:32.596 --> 00:18:35.057
strengthen numbers or I don't know,

00:18:35.097 --> 00:18:35.857
go cash based.

00:18:35.917 --> 00:18:36.238
I mean,

00:18:36.298 --> 00:18:37.519
there's not that many solutions

00:18:37.578 --> 00:18:38.479
around this because the

00:18:38.618 --> 00:18:40.119
ones that know this,

00:18:40.339 --> 00:18:41.720
the private equity backed sponsors,

00:18:41.819 --> 00:18:42.820
the bigger groups,

00:18:42.861 --> 00:18:43.641
the bigger chains that

00:18:43.661 --> 00:18:46.501
affiliate themselves with a partnership,

00:18:46.561 --> 00:18:47.722
some hospitals and health system,

00:18:47.742 --> 00:18:47.962
whatever.

00:18:48.722 --> 00:18:49.663
They're the ones that are

00:18:50.044 --> 00:18:51.244
going to be able to pay their therapist,

00:18:51.384 --> 00:18:51.605
you know,

00:18:51.924 --> 00:18:55.567
100K or 120K per year salary as W-2s.

00:18:56.428 --> 00:18:57.107
And those therapists will

00:18:57.127 --> 00:18:57.928
never leave and they don't

00:18:57.948 --> 00:18:59.189
want to go work for private practice.

00:18:59.209 --> 00:19:00.849
And the reimbursement and

00:19:00.950 --> 00:19:04.311
all this and the ACOs and

00:19:04.332 --> 00:19:05.032
the hospital models,

00:19:05.393 --> 00:19:06.973
this is part of the whole thing,

00:19:07.013 --> 00:19:08.855
the labor, the recruiting, the hiring.

00:19:08.894 --> 00:19:10.256
I mean, there's multiple factors here.

00:19:11.155 --> 00:19:12.037
So if I were going to break

00:19:12.057 --> 00:19:13.076
this down for someone who

00:19:13.778 --> 00:19:15.219
was just joining for the first time,

00:19:16.234 --> 00:19:17.615
If I do something and

00:19:17.675 --> 00:19:18.496
someone in a hospital

00:19:18.536 --> 00:19:19.715
system does the exact same

00:19:19.756 --> 00:19:21.076
thing to the exact same patient,

00:19:21.616 --> 00:19:23.518
they are getting more money

00:19:23.738 --> 00:19:26.759
per minute in terms of reimbursement.

00:19:27.578 --> 00:19:28.740
And when you extrapolate

00:19:28.779 --> 00:19:30.540
that over more therapists,

00:19:30.740 --> 00:19:32.540
over more patients, over more years,

00:19:33.362 --> 00:19:34.182
this is like trying to

00:19:34.221 --> 00:19:35.643
compete with someone at a

00:19:35.702 --> 00:19:37.462
marathon while they're riding a bicycle.

00:19:38.144 --> 00:19:39.064
Yep, exactly.

00:19:40.164 --> 00:19:41.808
Like I'm an optimistic guy,

00:19:41.848 --> 00:19:44.053
but we can do all the value

00:19:44.113 --> 00:19:46.278
proposition and marketing hacks we want.

00:19:46.337 --> 00:19:48.082
Like, how do we compete with this?

00:19:48.803 --> 00:19:49.765
I'm usually an optimistic guy.

00:19:51.172 --> 00:19:52.511
Well, and that's the question.

00:19:52.612 --> 00:19:53.672
How do we compete?

00:19:53.731 --> 00:19:56.012
So you come up with solutions to compete.

00:19:56.093 --> 00:19:57.972
Dave's looking at, okay, well,

00:19:58.113 --> 00:19:59.593
if I can't beat them, let's join them.

00:19:59.653 --> 00:20:00.854
I'm going to go that direction.

00:20:00.894 --> 00:20:02.534
Let me do a little investigation.

00:20:02.554 --> 00:20:04.034
Let's see what I can do.

00:20:05.775 --> 00:20:06.775
Dave and I talked about it.

00:20:06.795 --> 00:20:06.994
I said,

00:20:07.015 --> 00:20:08.115
there's got to be so many

00:20:08.335 --> 00:20:10.454
borderline defunct, bankrupt,

00:20:10.535 --> 00:20:11.596
ready to go out of business

00:20:11.635 --> 00:20:13.816
hospitals that you could go in,

00:20:13.875 --> 00:20:15.016
you can buy them up,

00:20:15.076 --> 00:20:16.777
you can get all of their contracts.

00:20:16.817 --> 00:20:18.817
They've done all the hard, heavy lifting.

00:20:19.477 --> 00:20:21.723
Now you just step in and you

00:20:21.763 --> 00:20:24.250
focus on the things that you do best.

00:20:24.972 --> 00:20:26.036
I think that's one option.

00:20:27.089 --> 00:20:29.551
Talking about internal referrals,

00:20:29.771 --> 00:20:30.992
I had mentioned on the show

00:20:31.614 --> 00:20:33.654
probably now seven years ago,

00:20:33.715 --> 00:20:34.916
maybe eight years ago,

00:20:34.936 --> 00:20:37.898
I was treating an office

00:20:37.939 --> 00:20:40.060
manager for a local primary care group.

00:20:40.500 --> 00:20:41.721
And the office manager told

00:20:41.761 --> 00:20:42.883
me for the first time in

00:20:42.942 --> 00:20:44.904
her 20 years working for

00:20:44.944 --> 00:20:46.906
this group of primary care docs,

00:20:47.567 --> 00:20:49.388
she had heard upper level

00:20:49.429 --> 00:20:51.109
management from the hospital say,

00:20:51.130 --> 00:20:52.912
we want to keep all of our

00:20:52.932 --> 00:20:53.852
referrals in-house.

00:20:53.991 --> 00:20:55.273
We do not want to send...

00:20:55.894 --> 00:20:57.996
outpatient therapy to any

00:20:58.135 --> 00:20:59.597
outpatient providers other

00:20:59.617 --> 00:21:00.919
than our own internal

00:21:00.959 --> 00:21:01.759
outpatient providers.

00:21:01.799 --> 00:21:02.840
And she said she had never

00:21:02.881 --> 00:21:03.541
heard that before.

00:21:04.242 --> 00:21:06.164
So this has been going on for years.

00:21:06.785 --> 00:21:09.028
I know in my area, every single,

00:21:09.188 --> 00:21:10.308
and I'm not exaggerating,

00:21:10.469 --> 00:21:12.810
every single local group of

00:21:12.932 --> 00:21:14.712
physicians or surgeons that

00:21:14.732 --> 00:21:15.733
were privately owned and

00:21:15.794 --> 00:21:17.655
operated got absorbed by the hospital.

00:21:17.695 --> 00:21:18.616
They all got bought out.

00:21:19.357 --> 00:21:21.298
But like anything, one door closes,

00:21:21.460 --> 00:21:22.500
another one opens.

00:21:22.701 --> 00:21:23.840
When that happened,

00:21:24.281 --> 00:21:25.823
what I started to see was

00:21:26.063 --> 00:21:28.084
those surgeons were referring out

00:21:29.021 --> 00:21:31.702
patients almost in spite of

00:21:32.124 --> 00:21:33.163
to stick it back,

00:21:33.304 --> 00:21:35.265
stick it to the man to show

00:21:35.305 --> 00:21:36.526
the hospital that they're

00:21:36.566 --> 00:21:37.787
not under their thumb.

00:21:38.346 --> 00:21:39.728
And so we were getting more

00:21:39.788 --> 00:21:41.028
referrals than ever because

00:21:41.169 --> 00:21:42.950
these surgeons were, you know,

00:21:43.109 --> 00:21:45.050
doing this to spite the hospital,

00:21:45.111 --> 00:21:46.270
to spite the manager.

00:21:46.672 --> 00:21:48.673
And they know they can't get fired.

00:21:49.032 --> 00:21:50.733
They're so desperate for surgeons.

00:21:51.173 --> 00:21:52.115
They're not going to fire

00:21:52.174 --> 00:21:52.914
them because they send

00:21:52.994 --> 00:21:54.476
outpatient therapy services

00:21:54.536 --> 00:21:55.836
to a private practice.

00:21:56.616 --> 00:21:56.737
Um,

00:21:56.936 --> 00:21:59.219
so I think that if you look at the

00:21:59.298 --> 00:22:00.019
landscape,

00:22:00.380 --> 00:22:01.961
just like we would do with the patient,

00:22:02.382 --> 00:22:04.063
okay, Mr. Patient, what's the problem?

00:22:04.403 --> 00:22:04.624
Well,

00:22:04.743 --> 00:22:06.625
all of my referrals are staying in house.

00:22:07.266 --> 00:22:07.546
Okay.

00:22:07.846 --> 00:22:09.208
How can we address this

00:22:09.268 --> 00:22:10.229
problem and how can we

00:22:10.269 --> 00:22:12.190
create a plan to solve it?

00:22:12.631 --> 00:22:13.672
That's where you step in.

00:22:13.711 --> 00:22:14.551
You start marketing

00:22:14.612 --> 00:22:17.335
specifically to insurance payers.

00:22:17.394 --> 00:22:18.556
If you're in network, like

00:22:19.135 --> 00:22:21.356
We have a local payer that

00:22:22.436 --> 00:22:23.676
something health benefits.

00:22:24.176 --> 00:22:24.998
It's obscure.

00:22:25.018 --> 00:22:25.817
It's not Blue Cross.

00:22:25.877 --> 00:22:26.557
It's not Humana.

00:22:26.577 --> 00:22:27.458
It's not any of them.

00:22:27.958 --> 00:22:29.259
I market specifically to

00:22:29.298 --> 00:22:30.979
individuals who have that insurance.

00:22:31.338 --> 00:22:32.700
And I market specifically to

00:22:32.759 --> 00:22:34.279
individuals who have that insurance,

00:22:34.319 --> 00:22:37.320
who have had a major injury or surgery,

00:22:37.361 --> 00:22:38.520
because I know that

00:22:38.560 --> 00:22:40.122
insurance reimburses higher

00:22:40.182 --> 00:22:40.902
than Medicare.

00:22:41.521 --> 00:22:42.923
Those individuals don't have

00:22:42.942 --> 00:22:44.204
a lot of options in the

00:22:44.285 --> 00:22:46.366
area because it's a small, obscure plan.

00:22:46.967 --> 00:22:48.308
And if they've already had surgery,

00:22:48.348 --> 00:22:49.690
their out-of-pocket deductible,

00:22:49.750 --> 00:22:51.432
their out-of-pocket max has been met.

00:22:51.811 --> 00:22:54.354
So they can come to me, out-of-pocket cost,

00:22:54.795 --> 00:22:56.276
totally covered by insurance.

00:22:56.797 --> 00:22:58.178
But I'm marketing very

00:22:58.258 --> 00:22:59.920
specific to that demographic.

00:23:03.383 --> 00:23:04.124
You guys are up.

00:23:04.688 --> 00:23:08.329
You got to compete on experience.

00:23:09.111 --> 00:23:10.172
Tony gave an anecdote

00:23:10.211 --> 00:23:11.332
recently about his front

00:23:11.352 --> 00:23:12.292
desk person helping a

00:23:12.813 --> 00:23:14.334
patient that kind of walked in,

00:23:14.354 --> 00:23:15.694
stumbled in, was not able to drive.

00:23:15.714 --> 00:23:17.195
It was a whole awesome story

00:23:17.236 --> 00:23:18.116
with this front desk person

00:23:18.156 --> 00:23:20.157
in terms of care and

00:23:20.198 --> 00:23:22.058
compassion and overall

00:23:22.098 --> 00:23:23.039
patient experience and

00:23:23.079 --> 00:23:25.361
someone that needed some

00:23:25.381 --> 00:23:25.922
help at the time.

00:23:27.634 --> 00:23:31.914
It's not easy, but I think moving forward,

00:23:32.134 --> 00:23:33.134
I kind of mentioned some

00:23:33.236 --> 00:23:34.776
cash physical therapy recently.

00:23:35.276 --> 00:23:37.717
I think it's early to cash

00:23:37.737 --> 00:23:38.317
physical therapy,

00:23:38.356 --> 00:23:39.237
and it's not for everyone,

00:23:39.676 --> 00:23:43.137
but to charge someone a

00:23:43.178 --> 00:23:45.199
dollar amount for whatever services,

00:23:46.199 --> 00:23:47.759
and as long as you do it

00:23:47.778 --> 00:23:49.480
right by that patient, that client,

00:23:50.305 --> 00:23:51.244
There's no clawbacks.

00:23:51.404 --> 00:23:53.405
There's no extra, you know, there's no,

00:23:53.506 --> 00:23:55.026
and then there's no future denials.

00:23:55.046 --> 00:23:57.165
There's no authorization issues with,

00:23:57.246 --> 00:23:57.445
you know,

00:23:57.746 --> 00:23:59.086
all this insurance issues and all that.

00:23:59.467 --> 00:24:01.606
It's not the best solution,

00:24:01.686 --> 00:24:02.987
but I think it's one of the

00:24:03.027 --> 00:24:03.647
best solutions.

00:24:03.688 --> 00:24:05.147
But any practice out there,

00:24:05.167 --> 00:24:05.948
they can compete on

00:24:06.008 --> 00:24:06.867
experience and all that.

00:24:06.907 --> 00:24:09.548
But if they have a patient

00:24:09.568 --> 00:24:11.269
experience that wows their

00:24:11.288 --> 00:24:12.028
patients or clients,

00:24:12.108 --> 00:24:12.949
I think that's the biggest

00:24:12.989 --> 00:24:14.509
way right now to compete.

00:24:15.069 --> 00:24:16.190
The challenge is with...

00:24:17.236 --> 00:24:18.957
recruiting and maintaining

00:24:19.017 --> 00:24:19.837
great staff members,

00:24:19.857 --> 00:24:20.958
whether it's on the clinical side,

00:24:20.978 --> 00:24:22.118
the admin front desk side,

00:24:23.599 --> 00:24:24.641
you have to have profit.

00:24:24.661 --> 00:24:26.061
You have to have cash to

00:24:26.162 --> 00:24:28.643
actually pay and retain those folks,

00:24:29.103 --> 00:24:30.044
which kind of makes it

00:24:30.084 --> 00:24:31.625
challenging if you are a

00:24:31.684 --> 00:24:33.506
person in network with your

00:24:33.665 --> 00:24:34.686
margins eroding,

00:24:35.907 --> 00:24:36.968
cost of living is increasing.

00:24:37.028 --> 00:24:38.048
Everyone is asking for more

00:24:38.088 --> 00:24:39.289
money and raises and all that.

00:24:40.089 --> 00:24:41.151
And then you're making less

00:24:41.451 --> 00:24:42.550
on the insurance side.

00:24:43.251 --> 00:24:44.971
So that's why it's like, I mean,

00:24:45.633 --> 00:24:46.593
it's kind of a bandaid.

00:24:46.633 --> 00:24:48.394
It's not a panacea cure-all,

00:24:48.433 --> 00:24:50.595
but having more and more

00:24:50.654 --> 00:24:51.576
out-of-pocket cash-based

00:24:51.615 --> 00:24:53.876
services can allow you to

00:24:53.916 --> 00:24:55.998
compete on experience and

00:24:56.097 --> 00:24:58.338
value and response to

00:24:59.219 --> 00:25:01.119
scheduling and doing things faster,

00:25:01.220 --> 00:25:01.460
better,

00:25:01.539 --> 00:25:02.681
or different than the competition.

00:25:03.597 --> 00:25:03.778
Yeah.

00:25:04.137 --> 00:25:06.339
This leads us to our next conversation.

00:25:07.000 --> 00:25:07.820
I think it was really nice

00:25:07.861 --> 00:25:09.162
that these three things popped up.

00:25:09.721 --> 00:25:11.083
And just for clarity for the audience,

00:25:11.143 --> 00:25:12.044
we sort of go back in a

00:25:12.084 --> 00:25:13.525
group chat and we're paying

00:25:13.545 --> 00:25:14.746
attention to things that we

00:25:14.786 --> 00:25:15.786
want to talk about and we

00:25:15.806 --> 00:25:16.666
think that you'd benefit

00:25:16.686 --> 00:25:17.366
from listening to.

00:25:17.688 --> 00:25:19.909
And I think this next quote

00:25:20.009 --> 00:25:21.509
or this next post from Greg Todd,

00:25:21.529 --> 00:25:22.451
who's been on the show before,

00:25:22.471 --> 00:25:23.230
was a smart guy.

00:25:24.311 --> 00:25:25.271
And he was pointing out a

00:25:25.332 --> 00:25:28.534
lesson from Dollar Tree.

00:25:28.733 --> 00:25:30.134
Now, there's Dollar Tree.

00:25:30.173 --> 00:25:31.233
There's Dollar General.

00:25:31.414 --> 00:25:32.375
And Dollar General was

00:25:32.474 --> 00:25:34.115
always sort of generally a dollar.

00:25:34.155 --> 00:25:34.935
That's how I remember it.

00:25:34.955 --> 00:25:36.036
Is everything in here a dollar?

00:25:36.256 --> 00:25:36.895
It's Dollar General.

00:25:36.915 --> 00:25:37.497
It's generally a dollar.

00:25:37.817 --> 00:25:38.936
But Dollar Tree was

00:25:39.017 --> 00:25:40.817
notoriously the dollar.

00:25:40.837 --> 00:25:42.238
And then there was also the dollar store,

00:25:42.278 --> 00:25:42.818
which I don't even know if

00:25:42.838 --> 00:25:43.659
that still exists anymore.

00:25:44.058 --> 00:25:45.501
But the idea was their value

00:25:45.541 --> 00:25:47.023
proposition was everything in the store,

00:25:47.305 --> 00:25:48.626
lots of things solve your problem,

00:25:49.048 --> 00:25:49.709
but our price,

00:25:49.969 --> 00:25:51.351
we're going to compete like Costco,

00:25:51.432 --> 00:25:52.272
but for other items and

00:25:52.292 --> 00:25:53.154
everything was a dollar.

00:25:53.595 --> 00:25:54.876
So Tony, when I shared this,

00:25:54.917 --> 00:25:55.538
what were your thoughts?

00:25:56.584 --> 00:25:56.824
Yeah.

00:25:57.044 --> 00:25:57.644
I mean, we,

00:25:57.723 --> 00:25:59.865
we need to figure out how we

00:25:59.944 --> 00:26:02.445
get basic revenue up,

00:26:02.686 --> 00:26:04.307
how we increase cart value.

00:26:04.366 --> 00:26:05.048
Like there's a lot of

00:26:05.087 --> 00:26:06.147
different ways to say it.

00:26:06.988 --> 00:26:09.088
Um, I think we see it across the board.

00:26:09.288 --> 00:26:12.089
And so same thing if

00:26:12.330 --> 00:26:13.711
insurance reimbursement is,

00:26:14.050 --> 00:26:14.932
I talked to somebody

00:26:14.991 --> 00:26:16.451
yesterday and they were like,

00:26:16.471 --> 00:26:16.892
wait a minute,

00:26:16.912 --> 00:26:17.492
what do you mean you're

00:26:17.512 --> 00:26:18.873
making less per visit?

00:26:18.932 --> 00:26:20.173
How is that even possible?

00:26:20.733 --> 00:26:21.013
I'm like,

00:26:21.054 --> 00:26:22.755
because third-party reimbursement

00:26:22.775 --> 00:26:24.455
has been going down two, 3% a year cost.

00:26:25.336 --> 00:26:27.538
cost of services is going up

00:26:27.858 --> 00:26:29.000
multiple percent a year.

00:26:29.019 --> 00:26:31.903
This gives us an opportunity

00:26:31.962 --> 00:26:33.765
because not everybody's going to adapt.

00:26:33.785 --> 00:26:34.586
There's going to be plenty

00:26:34.625 --> 00:26:36.248
of practice owners that are

00:26:36.288 --> 00:26:37.789
just going to do the status quo.

00:26:38.390 --> 00:26:40.152
This is where if we can't

00:26:40.211 --> 00:26:42.115
raise prices on third party payers,

00:26:42.174 --> 00:26:43.036
which Dave is

00:26:43.556 --> 00:26:44.957
You interviewed a gentleman

00:26:44.997 --> 00:26:47.196
that had successfully done that.

00:26:47.297 --> 00:26:48.337
It's on your channel.

00:26:48.698 --> 00:26:50.138
Go check out the Dave Kittle show.

00:26:50.638 --> 00:26:52.799
But the idea is where else

00:26:52.839 --> 00:26:54.599
can we make up this margin?

00:26:54.960 --> 00:26:56.201
Is it gonna be self-paced

00:26:56.221 --> 00:26:57.280
services that aren't

00:26:57.300 --> 00:26:58.281
covered by insurance?

00:26:58.342 --> 00:26:59.701
Is it gonna be product sales?

00:26:59.761 --> 00:27:01.083
Is it gonna be endorsements?

00:27:01.863 --> 00:27:03.503
People, there are practices out there,

00:27:03.523 --> 00:27:05.286
and I think about this every single day,

00:27:05.705 --> 00:27:07.507
that have tens of thousands

00:27:07.707 --> 00:27:09.328
of individuals in their database,

00:27:09.749 --> 00:27:10.489
and they're not doing

00:27:10.769 --> 00:27:12.330
anything with that information.

00:27:12.550 --> 00:27:14.132
It is a pot of gold,

00:27:14.573 --> 00:27:16.074
and they're not accessing

00:27:16.153 --> 00:27:18.454
it for anything that would, in fact,

00:27:18.515 --> 00:27:20.656
help those people and help

00:27:20.717 --> 00:27:21.377
the bottom line.

00:27:22.778 --> 00:27:24.640
Why do you think they're not accessing it?

00:27:24.660 --> 00:27:26.320
So to be clear, I want to set the stage.

00:27:26.862 --> 00:27:27.942
Before we go on here,

00:27:27.982 --> 00:27:29.163
reshare that thing with Greg,

00:27:29.202 --> 00:27:30.044
because I wanted to go through this.

00:27:30.064 --> 00:27:30.544
I just took it off.

00:27:30.564 --> 00:27:31.105
Can you share it?

00:27:31.692 --> 00:27:31.913
Yeah,

00:27:32.212 --> 00:27:34.054
so I think the idea here was Greg

00:27:34.074 --> 00:27:35.494
Todd shared a screenshot

00:27:35.535 --> 00:27:37.556
from Dollar Tree and said

00:27:37.615 --> 00:27:39.057
Dollar Tree is now becoming,

00:27:39.076 --> 00:27:41.759
and this is back in January, $1.25 tree,

00:27:41.818 --> 00:27:42.538
which doesn't really have

00:27:42.558 --> 00:27:43.279
the same ring to it.

00:27:43.319 --> 00:27:45.280
But the idea is that I do

00:27:45.340 --> 00:27:46.441
love their marketing, right?

00:27:46.480 --> 00:27:48.021
And they said for 35 years,

00:27:48.442 --> 00:27:49.403
our buyers have trekked

00:27:49.442 --> 00:27:50.364
around the world seeking

00:27:50.423 --> 00:27:52.904
out fantastic products for extreme value.

00:27:53.484 --> 00:27:55.226
We remain committed to our

00:27:55.266 --> 00:27:56.666
mission at bringing you the

00:27:56.846 --> 00:27:58.587
best value every day no matter the price.

00:27:58.989 --> 00:28:01.069
They focus on the benefits.

00:28:02.320 --> 00:28:03.082
not the features.

00:28:03.922 --> 00:28:05.323
And I've done the diatribe before.

00:28:05.343 --> 00:28:06.984
I've done the Jeep

00:28:07.605 --> 00:28:08.566
explanation of features

00:28:08.586 --> 00:28:10.007
versus benefits for you guys before,

00:28:10.047 --> 00:28:10.247
right?

00:28:10.307 --> 00:28:11.407
So the audience has heard that.

00:28:11.708 --> 00:28:14.150
They focus on more seasonal, more crafts,

00:28:14.210 --> 00:28:15.990
more party supplies, more food essentials,

00:28:16.070 --> 00:28:17.412
more thrills, more fun.

00:28:18.133 --> 00:28:19.794
By the way, we're raising prices to $1.25.

00:28:19.794 --> 00:28:22.796
And I have no doubt, like to be honest,

00:28:22.836 --> 00:28:23.896
looking at this years ago,

00:28:23.936 --> 00:28:25.198
I would have said, these guys are greedy.

00:28:26.398 --> 00:28:27.539
Now that I'm looking at this, I'm saying,

00:28:27.579 --> 00:28:29.641
if you lived at $1 per item for 35 years,

00:28:32.644 --> 00:28:35.267
And now you're only changing to $1.25,

00:28:35.267 --> 00:28:36.167
which is actually a large

00:28:36.327 --> 00:28:37.630
leap percentage-wise.

00:28:38.130 --> 00:28:39.971
But I don't doubt that they

00:28:40.011 --> 00:28:42.074
have to remain in business.

00:28:42.173 --> 00:28:43.295
And that's what Greg Todd's

00:28:43.914 --> 00:28:44.596
post was about.

00:28:44.615 --> 00:28:44.816
He said,

00:28:45.116 --> 00:28:46.698
can we take a lesson from Dollar Tree?

00:28:46.978 --> 00:28:47.838
They understand the first

00:28:47.878 --> 00:28:50.361
rule of business is to

00:28:50.441 --> 00:28:51.903
remain in business.

00:28:52.103 --> 00:28:53.503
You help zero people if you

00:28:53.544 --> 00:28:54.765
go out of business.

00:28:54.925 --> 00:28:57.107
Now we'll get back to what

00:28:57.127 --> 00:28:58.229
Tony was just talking about.

00:28:59.070 --> 00:29:00.152
you have 10 000 people in

00:29:00.172 --> 00:29:01.113
your database your email

00:29:01.153 --> 00:29:02.634
list your phone numbers and

00:29:02.653 --> 00:29:03.974
you're not trying to seek

00:29:04.075 --> 00:29:06.656
out to help them you might

00:29:06.676 --> 00:29:07.737
be saying well I guess I'm

00:29:07.778 --> 00:29:08.657
just going to keep sinking

00:29:08.718 --> 00:29:09.858
on this ship because these

00:29:09.898 --> 00:29:10.819
insurance companies aren't

00:29:10.839 --> 00:29:11.519
going to pay me more

00:29:11.720 --> 00:29:13.741
they're not I got news for

00:29:13.761 --> 00:29:14.863
you by all means keep

00:29:14.903 --> 00:29:16.104
advocating do those things

00:29:16.423 --> 00:29:17.183
I'll be over here with the

00:29:17.223 --> 00:29:18.685
rest of us trying to build

00:29:18.726 --> 00:29:19.967
our own ship not bailing

00:29:20.027 --> 00:29:21.387
out the sinking one right

00:29:22.250 --> 00:29:25.074
So let me ask you a two-part question,

00:29:25.114 --> 00:29:27.178
Dave and Tony.

00:29:27.258 --> 00:29:28.660
Why are individual practice

00:29:28.740 --> 00:29:31.704
owners not capitalizing on

00:29:31.724 --> 00:29:32.546
this pot of gold?

00:29:32.806 --> 00:29:34.087
And then follow-up question,

00:29:34.348 --> 00:29:35.730
what do you think they should be doing?

00:29:36.553 --> 00:29:37.854
Dave, go.

00:29:37.953 --> 00:29:39.595
One reason, I mean, there's a lot there.

00:29:39.915 --> 00:29:40.135
Okay.

00:29:40.296 --> 00:29:40.776
They're not,

00:29:41.096 --> 00:29:42.096
their heads are in the sand in

00:29:42.136 --> 00:29:43.397
regards to the email addresses,

00:29:43.438 --> 00:29:44.659
the phone numbers, the, I mean,

00:29:44.759 --> 00:29:45.680
it doesn't take that much

00:29:45.779 --> 00:29:47.401
to send automated emails.

00:29:47.461 --> 00:29:48.521
You can, you know,

00:29:48.561 --> 00:29:49.823
pay Chad Koontz or someone

00:29:49.863 --> 00:29:50.844
else to set up automated

00:29:50.903 --> 00:29:51.865
emails for all those,

00:29:51.944 --> 00:29:53.165
for hundreds or thousands

00:29:53.185 --> 00:29:54.326
of contacts that have done

00:29:54.386 --> 00:29:54.886
business with you,

00:29:54.906 --> 00:29:55.948
have been previous patients.

00:29:56.327 --> 00:29:57.009
You could, you know,

00:29:57.048 --> 00:29:57.788
spend a couple hundred,

00:29:58.390 --> 00:29:59.190
a couple thousand bucks,

00:29:59.210 --> 00:30:00.191
whatever with mailers.

00:30:00.211 --> 00:30:02.373
You could send, you know, envelopes,

00:30:02.452 --> 00:30:03.753
letters, whatever to all those patients.

00:30:03.814 --> 00:30:04.694
It takes a little bit of money.

00:30:04.815 --> 00:30:05.694
You want to try to use that

00:30:05.714 --> 00:30:06.415
to reactivate them.

00:30:06.496 --> 00:30:07.096
The reason why they're not

00:30:07.115 --> 00:30:07.916
doing it is because they

00:30:07.936 --> 00:30:08.938
just don't know any better.

00:30:08.978 --> 00:30:09.678
Their head's in the sand.

00:30:09.698 --> 00:30:10.858
They're treating too many patients.

00:30:10.919 --> 00:30:13.661
They're in a job, not really a business.

00:30:14.060 --> 00:30:14.741
There's a lot there.

00:30:16.083 --> 00:30:18.325
I do agree with the Greg Todd thing.

00:30:18.444 --> 00:30:18.605
So,

00:30:19.897 --> 00:30:21.138
the dollar general arguably

00:30:21.239 --> 00:30:22.539
would be terrible branding

00:30:22.559 --> 00:30:24.362
because you kind of set yourself as like,

00:30:24.461 --> 00:30:25.742
this is the dollar and this, you know,

00:30:25.762 --> 00:30:26.784
we're always going to be having,

00:30:26.864 --> 00:30:27.443
we're always going to have

00:30:27.503 --> 00:30:28.484
items for a dollar and now

00:30:28.505 --> 00:30:29.665
they're increasing their prices.

00:30:30.247 --> 00:30:31.748
I know like he posts things

00:30:31.807 --> 00:30:32.888
on purpose like that to be

00:30:32.949 --> 00:30:34.829
provocative and there's some things,

00:30:34.890 --> 00:30:35.611
and I love Greg,

00:30:35.790 --> 00:30:36.491
there's some things that I

00:30:36.672 --> 00:30:37.972
really agree with him on

00:30:38.032 --> 00:30:38.673
and there's some things

00:30:38.712 --> 00:30:40.214
where I would push back or disagree on.

00:30:40.234 --> 00:30:41.075
Maybe we could talk about

00:30:41.095 --> 00:30:41.695
that another time.

00:30:42.455 --> 00:30:42.537
Um,

00:30:43.176 --> 00:30:44.799
But he's right with physical

00:30:44.839 --> 00:30:45.480
therapists that are

00:30:45.500 --> 00:30:47.163
insurance-based can't do this, right?

00:30:47.183 --> 00:30:48.066
Because you're not gonna,

00:30:48.226 --> 00:30:49.047
unless you have strength in

00:30:49.067 --> 00:30:50.829
numbers and it takes time

00:30:50.849 --> 00:30:51.811
and effort to do, you know,

00:30:51.912 --> 00:30:53.375
increasing your reimbursement,

00:30:53.394 --> 00:30:54.416
like renegotiating your

00:30:54.457 --> 00:30:55.178
rates with insurance,

00:30:56.214 --> 00:30:57.556
it's not happening, right?

00:30:57.615 --> 00:30:59.596
And so the practices are

00:30:59.636 --> 00:31:01.038
kind of in a similar

00:31:01.077 --> 00:31:02.798
situation of Dollar General

00:31:02.878 --> 00:31:04.099
or Dollar Tree or whatever.

00:31:04.760 --> 00:31:06.082
They pigeonhole themselves

00:31:06.241 --> 00:31:07.942
almost to a fault now over

00:31:08.002 --> 00:31:11.045
time with the branding around a dollar.

00:31:11.164 --> 00:31:12.165
It's almost like saying like

00:31:12.165 --> 00:31:14.186
$50 physical therapy practice.

00:31:14.227 --> 00:31:15.188
Like that's the name of the practice, $50.

00:31:15.188 --> 00:31:16.248
It's good at some point,

00:31:16.769 --> 00:31:17.890
it's good in the 80s or 90s or the 2000s.

00:31:17.910 --> 00:31:18.369
But now in 2024,

00:31:18.369 --> 00:31:18.930
if you're $50 physical therapy,

00:31:26.895 --> 00:31:27.516
I mean, yeah,

00:31:27.556 --> 00:31:29.077
your margins are getting squeezed.

00:31:29.097 --> 00:31:29.738
You're getting tight.

00:31:30.999 --> 00:31:32.641
And so the reason why he

00:31:32.661 --> 00:31:33.801
posts it is because his

00:31:33.842 --> 00:31:36.263
thing is like solutions based offers and,

00:31:36.964 --> 00:31:37.244
you know,

00:31:37.384 --> 00:31:39.207
pitching like a two to five

00:31:39.247 --> 00:31:40.488
thousand or whatever dollar

00:31:41.409 --> 00:31:43.790
solution based offer for your low back,

00:31:43.830 --> 00:31:45.472
your plantar fasciitis, whatever it is.

00:31:45.833 --> 00:31:46.794
Now, let me stop you right there.

00:31:48.776 --> 00:31:50.396
Physical therapists cringe at that.

00:31:51.508 --> 00:31:53.509
And yet, if you walk down the street,

00:31:53.749 --> 00:31:56.890
you see people offering, hey,

00:31:56.910 --> 00:31:59.590
this is a reach into your

00:31:59.631 --> 00:32:02.491
wallet one time and solve

00:32:02.511 --> 00:32:04.092
the problem with one transaction.

00:32:04.372 --> 00:32:06.492
And I think this is culture change.

00:32:07.053 --> 00:32:08.054
What I was getting at is why

00:32:08.074 --> 00:32:08.834
do you think PTs...

00:32:10.015 --> 00:32:11.496
Why are they not accessing

00:32:11.516 --> 00:32:14.718
their database to bring more value?

00:32:14.738 --> 00:32:16.218
I think it's fear.

00:32:16.499 --> 00:32:17.179
They don't know how.

00:32:17.519 --> 00:32:18.199
And number two,

00:32:18.259 --> 00:32:19.000
they don't think that

00:32:19.019 --> 00:32:19.859
they're supposed to do it

00:32:20.080 --> 00:32:20.780
because the people they

00:32:20.820 --> 00:32:21.861
learned from didn't do it.

00:32:22.481 --> 00:32:24.542
People like Greg Todd, well,

00:32:24.603 --> 00:32:26.364
he's just trying to scam people.

00:32:27.849 --> 00:32:28.130
No.

00:32:28.750 --> 00:32:29.813
What he's trying to do is

00:32:30.594 --> 00:32:32.836
help people at scale, dot, dot, dot,

00:32:33.217 --> 00:32:35.721
and also remain in business.

00:32:35.740 --> 00:32:37.423
I mean, I like how Greg Todd said that.

00:32:37.442 --> 00:32:37.722
He's like,

00:32:38.163 --> 00:32:39.184
the first rule of business is

00:32:39.244 --> 00:32:40.066
remain in business.

00:32:40.125 --> 00:32:41.127
If you're not afloat,

00:32:41.167 --> 00:32:42.128
you can't help anybody.

00:32:42.730 --> 00:32:42.789
Now,

00:32:42.910 --> 00:32:44.530
Now, I do want to hear from Tony.

00:32:45.030 --> 00:32:45.651
Arguably,

00:32:47.011 --> 00:32:48.952
Greg Todd owns a couple clinics in Tampa,

00:32:48.972 --> 00:32:49.554
Florida, real quick.

00:32:49.574 --> 00:32:50.253
And I love Greg.

00:32:50.673 --> 00:32:52.035
I would do anything for him.

00:32:52.154 --> 00:32:52.894
And I don't want to really

00:32:52.934 --> 00:32:54.076
speak too badly about him.

00:32:54.395 --> 00:32:54.855
I love him.

00:32:55.317 --> 00:32:56.817
But he's got two practices

00:32:57.057 --> 00:32:58.317
or three in the Tampa area

00:32:58.577 --> 00:33:00.419
that are in network that do

00:33:00.459 --> 00:33:02.059
not do what he's saying.

00:33:02.579 --> 00:33:04.101
Let me just leave it like that.

00:33:04.260 --> 00:33:05.602
And I want to hear what Tony says.

00:33:06.601 --> 00:33:07.082
You know what?

00:33:07.521 --> 00:33:10.125
I have two clinic locations here.

00:33:10.144 --> 00:33:11.226
I don't do any of the stuff

00:33:11.247 --> 00:33:13.608
that I tell you guys to do.

00:33:13.628 --> 00:33:14.810
Similar to Greg,

00:33:15.391 --> 00:33:17.433
we started in a different era.

00:33:17.733 --> 00:33:19.777
We built a different model.

00:33:20.037 --> 00:33:21.898
Back in my day.

00:33:22.859 --> 00:33:23.201
What's that?

00:33:23.976 --> 00:33:24.895
I said, back in my day.

00:33:24.915 --> 00:33:24.996
Yeah.

00:33:26.817 --> 00:33:28.676
Uphill both ways in the snow.

00:33:29.637 --> 00:33:30.478
No, but seriously,

00:33:30.778 --> 00:33:32.939
that is a completely different business.

00:33:34.078 --> 00:33:35.160
And like you said,

00:33:35.859 --> 00:33:36.980
when I'm looking at the

00:33:37.099 --> 00:33:38.681
content that I put out,

00:33:38.740 --> 00:33:41.501
that Greg puts out, that others put out,

00:33:41.521 --> 00:33:44.041
we were talking to the current model,

00:33:44.061 --> 00:33:45.163
the current situation.

00:33:45.643 --> 00:33:46.442
I think it's interesting.

00:33:46.482 --> 00:33:48.683
I was looking up some numbers here.

00:33:48.743 --> 00:33:50.723
So Dollar General is a...

00:33:52.765 --> 00:33:54.046
What are these numbers here?

00:33:54.365 --> 00:33:56.686
Market caps are about $23,

00:33:56.686 --> 00:33:58.287
$27 billion between Dollar

00:33:58.307 --> 00:33:59.367
Tree and Dollar General.

00:33:59.407 --> 00:34:01.008
So they're big companies.

00:34:01.067 --> 00:34:02.229
These aren't small companies.

00:34:02.669 --> 00:34:03.868
Dollar General is doing

00:34:03.929 --> 00:34:06.450
profit margin of almost 4%.

00:34:06.450 --> 00:34:08.530
Dollar Tree is a negative 3%

00:34:08.530 --> 00:34:09.331
profit margin.

00:34:09.972 --> 00:34:11.871
But if you look at that compared to Costco,

00:34:11.891 --> 00:34:13.213
and I'm going somewhere with this.

00:34:14.141 --> 00:34:15.382
Costco is huge.

00:34:16.161 --> 00:34:16.822
I love Costco.

00:34:16.842 --> 00:34:18.684
I go to Costco probably three days a week.

00:34:19.143 --> 00:34:22.847
They're at almost $400 billion market cap,

00:34:23.206 --> 00:34:25.148
but they're only doing a

00:34:25.148 --> 00:34:27.190
2.8% profit margin.

00:34:27.250 --> 00:34:28.931
So none of these are really

00:34:28.990 --> 00:34:31.032
like high profit, but they're at scale.

00:34:31.713 --> 00:34:33.215
The interesting lessons that

00:34:33.255 --> 00:34:34.034
I think you could learn

00:34:34.074 --> 00:34:35.396
when you think of a Costco

00:34:35.677 --> 00:34:38.699
versus a Dollar General or Dollar Tree.

00:34:39.380 --> 00:34:40.822
I've walked into Dollar

00:34:40.882 --> 00:34:42.543
General when I'm in a rush

00:34:42.583 --> 00:34:43.764
and I need to grab something.

00:34:44.264 --> 00:34:46.027
Generally speaking, the place is a mess.

00:34:46.387 --> 00:34:48.068
There's junk all over the place.

00:34:48.188 --> 00:34:49.730
The shelves are disorganized.

00:34:49.809 --> 00:34:52.572
Everything looks broken, old, worn out.

00:34:52.592 --> 00:34:54.315
It is not a pleasurable

00:34:54.375 --> 00:34:55.376
shopping experience.

00:34:55.896 --> 00:34:59.317
Yet the 23 billion dollar market cap,

00:35:00.577 --> 00:35:02.318
when you look at, you know,

00:35:02.518 --> 00:35:04.159
the target consumer between

00:35:04.219 --> 00:35:05.858
Costco versus Dollar General,

00:35:05.898 --> 00:35:06.878
they're very different.

00:35:07.259 --> 00:35:09.019
But both of them are selling value.

00:35:09.099 --> 00:35:10.820
Both of them are selling discounts.

00:35:11.701 --> 00:35:13.201
They just do it in very

00:35:13.300 --> 00:35:15.302
different ways of operating.

00:35:16.237 --> 00:35:17.798
So to your point,

00:35:18.579 --> 00:35:20.340
when we look at our business model,

00:35:20.440 --> 00:35:21.119
what we do,

00:35:21.139 --> 00:35:23.121
I think there's a lot of ways

00:35:23.201 --> 00:35:24.362
to make this happen.

00:35:24.942 --> 00:35:26.382
And what Jimmy was saying,

00:35:26.443 --> 00:35:28.463
why aren't we accessing our databases?

00:35:28.523 --> 00:35:29.523
Why aren't we going through

00:35:29.563 --> 00:35:30.563
and finding alternative

00:35:30.603 --> 00:35:31.465
streams of revenue?

00:35:32.210 --> 00:35:34.152
Part of it, people feel dirty.

00:35:34.351 --> 00:35:35.432
People feel guilty.

00:35:35.512 --> 00:35:36.514
People feel like they can't

00:35:36.554 --> 00:35:37.655
make too much profit or

00:35:37.715 --> 00:35:39.717
they're being egregious and

00:35:39.757 --> 00:35:40.737
they're taking advantage.

00:35:41.518 --> 00:35:43.219
Listen to the passion and

00:35:43.300 --> 00:35:45.101
the joy in Dave's voice

00:35:45.362 --> 00:35:46.603
when he talks about business.

00:35:46.844 --> 00:35:47.364
Even for me,

00:35:48.105 --> 00:35:49.826
listen to what gets us excited.

00:35:49.865 --> 00:35:51.688
Now, Dave is still a therapist.

00:35:51.708 --> 00:35:53.028
He's still treating patients.

00:35:53.088 --> 00:35:53.929
It's not like he doesn't

00:35:53.969 --> 00:35:54.911
enjoy patient care.

00:35:54.971 --> 00:35:55.552
He does.

00:35:56.112 --> 00:35:57.072
But there's a level of

00:35:57.152 --> 00:35:58.413
passion that comes through

00:35:58.452 --> 00:35:59.432
in the way he talks about

00:35:59.472 --> 00:36:00.853
business and business ideas

00:36:00.914 --> 00:36:03.014
and innovation that, you know,

00:36:03.255 --> 00:36:06.356
other clinicians feel about patient care.

00:36:06.956 --> 00:36:07.856
And it's the same for me.

00:36:07.916 --> 00:36:09.036
Like, I enjoy patients.

00:36:09.077 --> 00:36:11.438
I've got five evals on my schedule today.

00:36:11.538 --> 00:36:12.878
I'm going to go do those evals.

00:36:12.898 --> 00:36:13.858
I'm going to do the best

00:36:13.878 --> 00:36:15.039
that I possibly can do.

00:36:15.559 --> 00:36:17.239
But I don't get as excited

00:36:17.320 --> 00:36:18.800
about that 20 years later.

00:36:19.280 --> 00:36:20.501
As I do and I think about

00:36:20.601 --> 00:36:21.583
how I can innovate my

00:36:21.643 --> 00:36:22.603
business and how I can

00:36:22.664 --> 00:36:23.644
elevate the profession,

00:36:23.764 --> 00:36:25.166
how I can do all these other things.

00:36:25.766 --> 00:36:28.969
So we each have to find our passion.

00:36:29.170 --> 00:36:30.152
We hear that all the time.

00:36:31.157 --> 00:36:32.338
Leverage that passion.

00:36:32.858 --> 00:36:33.858
Outsource the things that

00:36:33.898 --> 00:36:35.400
maybe we're not as passionate about.

00:36:35.579 --> 00:36:36.760
I will outsource patient

00:36:36.780 --> 00:36:38.240
care every chance I get

00:36:38.561 --> 00:36:39.322
because there are other

00:36:39.402 --> 00:36:41.182
clinicians that are far more passionate,

00:36:41.523 --> 00:36:42.664
far more innovative,

00:36:43.043 --> 00:36:44.764
really love what they do.

00:36:46.565 --> 00:36:47.686
And I'm going to focus my

00:36:47.766 --> 00:36:49.306
energy on what I do best

00:36:49.327 --> 00:36:49.887
and what I'm most

00:36:49.927 --> 00:36:51.168
passionate about right now,

00:36:51.248 --> 00:36:52.507
which is building my

00:36:52.547 --> 00:36:53.528
business and innovating.

00:36:53.648 --> 00:36:53.909
Jimmy?

00:36:54.068 --> 00:36:54.208
Yeah.

00:36:54.429 --> 00:36:54.588
I mean,

00:36:54.608 --> 00:36:55.809
that's sort of like goes a lot like

00:36:55.949 --> 00:36:57.112
it's like funny how we're

00:36:57.132 --> 00:36:58.052
sitting on this spectrum

00:36:58.092 --> 00:36:59.012
right now from left to

00:36:59.052 --> 00:36:59.873
right and right to left.

00:36:59.893 --> 00:37:01.815
You've got Dave and Tony and then myself.

00:37:02.532 --> 00:37:04.813
is I don't do any patient care right now.

00:37:04.853 --> 00:37:05.894
I've always sort of done

00:37:05.954 --> 00:37:06.835
things on the periphery

00:37:06.894 --> 00:37:07.576
after the first two,

00:37:07.615 --> 00:37:08.637
three years of my career.

00:37:09.697 --> 00:37:10.478
I moved into,

00:37:10.637 --> 00:37:12.599
I want to stay in the profession,

00:37:12.639 --> 00:37:14.900
but I wanted to do it different ways.

00:37:15.121 --> 00:37:15.902
And that's what I want.

00:37:16.121 --> 00:37:17.884
That's sort of what I preach

00:37:17.903 --> 00:37:18.925
whenever I talk to people,

00:37:18.965 --> 00:37:20.465
especially students when I go places,

00:37:20.505 --> 00:37:21.927
which is you can do a lot

00:37:21.947 --> 00:37:23.128
of different things a lot

00:37:23.148 --> 00:37:23.907
of different ways.

00:37:24.208 --> 00:37:25.248
And I think the reason

00:37:25.268 --> 00:37:26.469
people aren't doing some of

00:37:26.489 --> 00:37:27.550
the things we're suggesting,

00:37:27.911 --> 00:37:28.931
I'm guilty of as well.

00:37:29.413 --> 00:37:30.793
The answer, in my opinion, is fear.

00:37:31.454 --> 00:37:32.974
I don't think I'm allowed to

00:37:33.014 --> 00:37:35.056
do it because we're real followers.

00:37:35.077 --> 00:37:36.338
We want to be generally good people,

00:37:36.518 --> 00:37:37.318
which is funny that we

00:37:37.338 --> 00:37:39.860
started with the news of the guy who was,

00:37:39.961 --> 00:37:41.583
you know, buying $300,000.

00:37:41.583 --> 00:37:43.445
I don't know if I should.

00:37:43.905 --> 00:37:45.106
And even if I say, okay,

00:37:45.166 --> 00:37:46.067
I can see what you're saying.

00:37:46.086 --> 00:37:47.268
I should access my database

00:37:47.307 --> 00:37:48.989
and show people some value.

00:37:49.309 --> 00:37:49.929
Now I don't know how.

00:37:50.811 --> 00:37:52.132
So it's I don't know if I

00:37:52.333 --> 00:37:54.815
should and then I don't know how.

00:37:55.556 --> 00:37:56.896
And unless you walk someone,

00:37:57.157 --> 00:37:58.097
unless you take, you know,

00:37:58.157 --> 00:37:58.918
how to teach a kid how to

00:37:58.938 --> 00:37:59.820
jump off a diving board,

00:38:00.139 --> 00:38:00.940
you got to walk them to the

00:38:00.960 --> 00:38:01.842
end of a diving board,

00:38:01.902 --> 00:38:03.864
hold their hand and say, you can do this.

00:38:04.264 --> 00:38:05.846
Remember, it's close your eyes and jump.

00:38:06.226 --> 00:38:07.086
And you have to repeat that

00:38:07.146 --> 00:38:07.947
over and over and over again.

00:38:07.987 --> 00:38:08.768
But ultimately,

00:38:09.949 --> 00:38:10.931
unless you throw the kid in.

00:38:11.570 --> 00:38:12.891
They have to decide to jump

00:38:13.070 --> 00:38:13.871
and do these things.

00:38:14.351 --> 00:38:14.990
And that doesn't mean you

00:38:15.010 --> 00:38:15.632
have to do it alone.

00:38:15.652 --> 00:38:16.351
I want to be very clear of

00:38:16.371 --> 00:38:17.652
the last thing is you can

00:38:17.711 --> 00:38:18.853
hire people who are good at

00:38:18.893 --> 00:38:20.574
these things to stand there,

00:38:20.793 --> 00:38:23.375
hold your hand or jump for you.

00:38:23.775 --> 00:38:24.394
That's allowed.

00:38:24.695 --> 00:38:26.016
You can use that as a cheat code.

00:38:26.115 --> 00:38:28.137
Other people as a cheat code

00:38:28.177 --> 00:38:29.137
are 100 percent allowed.

00:38:30.273 --> 00:38:30.452
Now,

00:38:30.634 --> 00:38:31.735
in terms of what we're trying to do

00:38:31.775 --> 00:38:32.775
real quick with

00:38:33.157 --> 00:38:34.257
partnerships and acquisitions,

00:38:34.778 --> 00:38:35.780
one of the things in our

00:38:35.800 --> 00:38:37.922
playbook is to go in,

00:38:38.023 --> 00:38:39.706
use their database like the next day,

00:38:39.726 --> 00:38:41.027
the next week, the next month, whatever,

00:38:41.148 --> 00:38:42.248
and reactivate previous

00:38:42.289 --> 00:38:44.572
patients via email, text message.

00:38:45.293 --> 00:38:46.293
and maybe paper letters.

00:38:46.875 --> 00:38:48.255
So I'm okay with Tony

00:38:48.275 --> 00:38:49.757
mentioning it because they

00:38:49.998 --> 00:38:50.818
still might listen to this

00:38:50.878 --> 00:38:52.440
and they still might not take action,

00:38:52.481 --> 00:38:54.222
but that's how you unlock value.

00:38:54.242 --> 00:38:55.083
That's what we're looking at.

00:38:55.123 --> 00:38:56.184
That's what other buyers and

00:38:56.224 --> 00:38:57.246
other corporates are looking at.

00:38:57.726 --> 00:38:59.289
They potentially acquire a

00:38:59.329 --> 00:39:02.052
practice and they would do these things.

00:39:02.072 --> 00:39:03.853
They would then unlock value

00:39:05.195 --> 00:39:06.777
with a small amount

00:39:06.956 --> 00:39:07.777
dollar amount like it

00:39:07.797 --> 00:39:08.378
doesn't take a lot of

00:39:08.438 --> 00:39:09.958
effort or time or money

00:39:10.318 --> 00:39:11.039
like you said it's a little

00:39:11.059 --> 00:39:11.980
bit about the how and they

00:39:12.001 --> 00:39:12.800
just haven't done it and

00:39:12.840 --> 00:39:13.541
they don't want to like

00:39:13.942 --> 00:39:14.641
annoy their previous

00:39:14.681 --> 00:39:15.922
patients or anything like

00:39:15.943 --> 00:39:17.103
that or be too salesy or

00:39:17.143 --> 00:39:18.025
whatever but that's

00:39:18.085 --> 00:39:18.965
literally one thing on our

00:39:18.985 --> 00:39:20.666
playbook um so I'm fine

00:39:20.686 --> 00:39:21.527
with you mentioning it tony

00:39:21.547 --> 00:39:22.367
because I'm like don't I'm

00:39:22.387 --> 00:39:23.347
like I'm almost like don't

00:39:23.387 --> 00:39:24.728
tell don't say it but like

00:39:24.768 --> 00:39:25.710
no I mean it's great do it

00:39:25.789 --> 00:39:27.510
do it and then you can you

00:39:27.530 --> 00:39:29.132
know negotiate with us or

00:39:29.172 --> 00:39:30.413
another buyer and sell your

00:39:30.432 --> 00:39:31.893
practice for more well

00:39:31.914 --> 00:39:32.795
that's one question what do

00:39:32.815 --> 00:39:33.614
you guys think about

00:39:33.675 --> 00:39:36.036
physician don't pt practices like

00:39:37.632 --> 00:39:38.853
isn't that a hiring a boss?

00:39:39.434 --> 00:39:39.574
Like,

00:39:39.614 --> 00:39:41.396
let's say you're two different

00:39:41.436 --> 00:39:41.876
situations.

00:39:42.577 --> 00:39:42.898
You're going to,

00:39:43.018 --> 00:39:44.239
you're going to now sell to

00:39:44.298 --> 00:39:45.900
a physician group, right?

00:39:45.920 --> 00:39:46.922
You're like, well, I get benefits.

00:39:46.942 --> 00:39:47.541
It's like shark tank.

00:39:47.581 --> 00:39:49.724
I get benefits of patient flow,

00:39:49.844 --> 00:39:50.686
even though that's illegal.

00:39:50.706 --> 00:39:50.826
Right.

00:39:50.846 --> 00:39:51.947
But I might have an option

00:39:51.967 --> 00:39:53.027
of increasing patients,

00:39:53.467 --> 00:39:54.009
but now you're going to,

00:39:54.108 --> 00:39:56.190
now you're an employee, right?

00:39:57.713 --> 00:39:59.353
When you sell, if you're now going to be,

00:39:59.373 --> 00:40:00.155
if you're going to remain

00:40:00.175 --> 00:40:00.655
in the business,

00:40:01.202 --> 00:40:01.342
Yeah.

00:40:01.543 --> 00:40:03.043
I would say you're always an employee.

00:40:03.244 --> 00:40:04.724
You're an employee of the patient.

00:40:04.764 --> 00:40:05.965
If you're in private practice,

00:40:05.985 --> 00:40:06.985
you're an employee of the

00:40:07.045 --> 00:40:07.867
insurance company.

00:40:07.907 --> 00:40:09.387
If you're an insurance based provider,

00:40:09.407 --> 00:40:11.009
like you're always an employee,

00:40:11.509 --> 00:40:13.110
it just depends on your perspective.

00:40:13.449 --> 00:40:15.210
Now, as a consumer,

00:40:15.630 --> 00:40:16.992
if I am the person that had

00:40:17.032 --> 00:40:18.293
an ACL reconstruction,

00:40:18.572 --> 00:40:20.134
I want to go to the physical

00:40:20.153 --> 00:40:22.054
therapist who is working

00:40:22.094 --> 00:40:24.056
directly with employed by

00:40:24.416 --> 00:40:25.476
the surgeon who did my

00:40:25.536 --> 00:40:28.338
surgery from a consumer perspective.

00:40:28.378 --> 00:40:30.338
There is no better situation

00:40:30.398 --> 00:40:32.119
in my head because those

00:40:32.179 --> 00:40:33.500
two are meeting every day,

00:40:33.539 --> 00:40:34.440
which we know they're not.

00:40:35.320 --> 00:40:36.802
They have a direct communication.

00:40:36.822 --> 00:40:37.101
You know,

00:40:37.121 --> 00:40:38.902
there's so many advantages to that.

00:40:39.422 --> 00:40:40.784
And to Dave's point,

00:40:42.425 --> 00:40:43.105
When we're talking about

00:40:43.125 --> 00:40:44.505
like hospital on therapy

00:40:44.565 --> 00:40:45.487
and all these other things,

00:40:45.567 --> 00:40:46.387
I do think there are

00:40:46.427 --> 00:40:48.610
probably some advantages in

00:40:48.670 --> 00:40:49.731
those arrangements.

00:40:50.751 --> 00:40:52.193
There's continuity of care.

00:40:52.313 --> 00:40:53.012
I know one of the big

00:40:53.032 --> 00:40:54.293
selling points that local

00:40:54.335 --> 00:40:55.755
physicians have for keeping

00:40:55.815 --> 00:40:58.538
patients in the hospital network is, well,

00:40:58.677 --> 00:40:59.858
our therapists can access

00:40:59.898 --> 00:41:00.739
your medical record,

00:41:00.780 --> 00:41:02.101
but a private practice can't.

00:41:02.641 --> 00:41:02.760
So.

00:41:03.782 --> 00:41:04.702
As a consumer,

00:41:04.722 --> 00:41:07.603
I think that is a great solution.

00:41:07.664 --> 00:41:08.384
And truthfully,

00:41:08.403 --> 00:41:09.764
I know a lot of physical

00:41:09.784 --> 00:41:11.204
therapists that were in

00:41:11.605 --> 00:41:12.865
physician-owned practices

00:41:12.905 --> 00:41:13.945
and they did amazing.

00:41:14.306 --> 00:41:14.987
They loved it.

00:41:15.027 --> 00:41:16.106
They got paid a ton.

00:41:16.467 --> 00:41:17.887
They had total autonomy.

00:41:18.288 --> 00:41:20.088
It was a really beneficial

00:41:20.168 --> 00:41:22.690
relationship for that situation.

00:41:23.570 --> 00:41:25.371
I don't care as a private practice owner,

00:41:25.411 --> 00:41:26.231
because again,

00:41:26.251 --> 00:41:28.253
I know that I am going to

00:41:28.293 --> 00:41:30.815
have unique advantages with more freedom,

00:41:30.856 --> 00:41:31.597
more independence.

00:41:31.617 --> 00:41:33.498
I can take my practice in any direction.

00:41:34.059 --> 00:41:36.420
So as a backstory, if you guys don't know,

00:41:36.981 --> 00:41:39.682
when I opened my second or

00:41:39.722 --> 00:41:41.445
third location here in Ohio,

00:41:42.264 --> 00:41:44.126
we came into a situation

00:41:44.166 --> 00:41:45.547
that we were supposed to be

00:41:45.628 --> 00:41:46.309
physician owned.

00:41:46.989 --> 00:41:48.150
We were stepping into an

00:41:48.190 --> 00:41:50.090
arrangement where two spine surgeons,

00:41:51.150 --> 00:41:52.952
a pain management physician,

00:41:52.972 --> 00:41:55.713
a psychiatry and massage

00:41:55.733 --> 00:41:56.972
therapy and chiropractic.

00:41:57.413 --> 00:41:58.594
It was a spine center.

00:41:59.114 --> 00:42:00.114
We were coming in.

00:42:00.155 --> 00:42:01.074
They wanted us to be

00:42:01.135 --> 00:42:02.315
physician owned as the

00:42:02.355 --> 00:42:04.596
physical therapy arm of this business.

00:42:05.237 --> 00:42:05.876
We said, no,

00:42:05.936 --> 00:42:06.916
we said there is no way

00:42:06.956 --> 00:42:07.818
because we wanted to

00:42:07.878 --> 00:42:09.978
maintain outside referrals coming in.

00:42:10.498 --> 00:42:12.400
So we maintained our independence.

00:42:13.818 --> 00:42:16.081
And as a result, oddly enough,

00:42:16.242 --> 00:42:17.922
the spine center went bankrupt.

00:42:18.443 --> 00:42:19.744
We acquired everything,

00:42:19.804 --> 00:42:20.806
including the building.

00:42:21.387 --> 00:42:23.409
And for a long time, you know,

00:42:23.548 --> 00:42:26.612
we rented space to the surgeons.

00:42:27.032 --> 00:42:28.213
We received all of those

00:42:28.273 --> 00:42:29.695
referrals plus outside

00:42:29.735 --> 00:42:30.876
referrals that we wouldn't

00:42:30.916 --> 00:42:31.936
have been able to receive

00:42:32.476 --> 00:42:33.597
if we were physician owned.

00:42:33.958 --> 00:42:36.260
So there's advantages going both ways.

00:42:37.641 --> 00:42:38.603
But you know what?

00:42:38.943 --> 00:42:40.766
Again, if I was the consumer,

00:42:40.945 --> 00:42:41.967
I would think the best

00:42:41.987 --> 00:42:43.009
scenario is for my

00:42:43.048 --> 00:42:44.070
therapist to work for my

00:42:44.130 --> 00:42:45.831
surgeon and for the two of

00:42:45.871 --> 00:42:47.114
them to be on the same team.

00:42:47.153 --> 00:42:47.954
What do you think, Dave?

00:42:49.117 --> 00:42:50.798
So the first two years out of school,

00:42:51.418 --> 00:42:52.099
I actually worked for a

00:42:52.159 --> 00:42:53.021
physician in practice,

00:42:53.322 --> 00:42:54.804
Princeton Orthopedic in New Jersey.

00:42:55.043 --> 00:42:55.585
And, uh,

00:42:56.652 --> 00:42:56.992
There was,

00:42:57.293 --> 00:42:58.853
luckily there was complete autonomy.

00:42:58.873 --> 00:43:00.434
There was literally no productivity.

00:43:00.474 --> 00:43:01.295
I mean, it was, yeah,

00:43:01.795 --> 00:43:03.775
we were productive and the

00:43:03.795 --> 00:43:05.677
schedule was like two patients an hour,

00:43:06.577 --> 00:43:07.318
which was, you know,

00:43:08.097 --> 00:43:09.719
doable and some days no evals.

00:43:09.778 --> 00:43:11.039
And I think the most was

00:43:11.179 --> 00:43:12.840
maybe five or six evals in one day,

00:43:12.880 --> 00:43:14.041
which sucked cause extra

00:43:14.061 --> 00:43:14.820
paperwork or whatever.

00:43:14.902 --> 00:43:17.603
But the thing about the shared EMR

00:43:18.342 --> 00:43:19.985
actually was a value add, right?

00:43:20.025 --> 00:43:22.806
So I could go in, I had a new patient eval,

00:43:23.307 --> 00:43:24.329
I could see what the

00:43:24.449 --> 00:43:25.469
physician scribbled on a

00:43:25.510 --> 00:43:26.431
piece of paper that was

00:43:26.451 --> 00:43:28.972
then scanned into the medical record.

00:43:28.992 --> 00:43:30.554
I could see the reports

00:43:30.594 --> 00:43:32.215
about x-ray or MRI or whatever.

00:43:32.235 --> 00:43:32.295
And

00:43:34.358 --> 00:43:36.980
You could message the physician.

00:43:37.000 --> 00:43:38.199
There was some chat feature,

00:43:38.380 --> 00:43:40.942
like mini email within the EMR.

00:43:42.103 --> 00:43:43.244
You could message like

00:43:43.284 --> 00:43:44.304
really quick little post-it

00:43:44.324 --> 00:43:45.425
note kind of things to the

00:43:45.465 --> 00:43:46.626
physician about like if

00:43:46.666 --> 00:43:47.766
there was any issues or whatever.

00:43:47.786 --> 00:43:50.367
And it was pretty cool where, you know,

00:43:50.387 --> 00:43:51.369
it was a shared lobby and

00:43:51.409 --> 00:43:52.289
you could just walk across

00:43:52.309 --> 00:43:53.670
the lobby from the physical

00:43:53.690 --> 00:43:55.871
therapy side to the physician side and...

00:43:56.972 --> 00:43:58.793
and talked to one of the orthopods,

00:43:58.893 --> 00:44:00.534
the surgeons, physiatrists, whatever, uh,

00:44:01.394 --> 00:44:02.416
learned a ton in terms of

00:44:02.436 --> 00:44:03.836
differential diagnosis and

00:44:03.896 --> 00:44:05.418
when to refer out and refer

00:44:05.458 --> 00:44:06.199
back and all that.

00:44:07.119 --> 00:44:10.541
Um, but I know like, uh, it's, you know,

00:44:10.581 --> 00:44:11.663
it's not necessarily in

00:44:11.722 --> 00:44:13.864
line with our practice

00:44:14.005 --> 00:44:15.005
ideals and all that,

00:44:15.126 --> 00:44:16.947
but it was a great situation,

00:44:17.007 --> 00:44:18.427
learned a ton, um,

00:44:18.527 --> 00:44:19.869
and then moved out of New Jersey.

00:44:19.989 --> 00:44:20.769
So I don't know if I

00:44:20.789 --> 00:44:21.710
mentioned that to you guys before,

00:44:21.751 --> 00:44:22.050
but yeah,

00:44:22.090 --> 00:44:23.512
physician practice was my first job.

00:44:25.623 --> 00:44:26.485
What do you guys think about

00:44:26.525 --> 00:44:26.887
this 50-50 deal?

00:44:29.949 --> 00:44:30.809
partnering with orthopedic

00:44:30.829 --> 00:44:32.771
practice to run their own therapy,

00:44:32.851 --> 00:44:34.112
like 50-50.

00:44:34.371 --> 00:44:35.293
So 50-50.

00:44:36.213 --> 00:44:38.295
The only issue with that is

00:44:38.974 --> 00:44:40.255
if there's a disagreement,

00:44:40.496 --> 00:44:42.458
it stays a disagreement when it's 50-50.

00:44:42.617 --> 00:44:45.980
So I would say, if it's me,

00:44:46.360 --> 00:44:47.721
it's almost better for me to say,

00:44:47.800 --> 00:44:49.623
I'll take 49.

00:44:49.623 --> 00:44:50.862
Because then I know for sure

00:44:50.922 --> 00:44:52.744
if we have a disagreement, like they win,

00:44:52.945 --> 00:44:54.686
or maybe I bring more money to the table,

00:44:54.766 --> 00:44:56.427
or I bring more value or whatever.

00:44:56.487 --> 00:44:57.907
And I say, hey, here's why I deserve 51%.

00:44:59.588 --> 00:45:00.610
It's just not a good idea in

00:45:00.630 --> 00:45:03.411
that situation, I believe, to say,

00:45:04.291 --> 00:45:05.570
let's do something 50-50.

00:45:06.132 --> 00:45:06.371
Well, I mean,

00:45:06.391 --> 00:45:09.733
like the 50-50 is like success, right?

00:45:09.913 --> 00:45:10.452
Reward.

00:45:10.672 --> 00:45:12.793
You can say, well, you know,

00:45:12.994 --> 00:45:13.755
in disagreements,

00:45:13.775 --> 00:45:15.295
this person is the decision maker, right?

00:45:15.315 --> 00:45:16.335
This person is the arbiter

00:45:16.356 --> 00:45:16.996
and stuff like that.

00:45:18.679 --> 00:45:19.519
Five, six years ago,

00:45:19.559 --> 00:45:20.780
I would have said absolutely not.

00:45:20.960 --> 00:45:21.920
And now I'm just looking at

00:45:21.940 --> 00:45:24.101
it as like the rising tide

00:45:24.161 --> 00:45:24.922
lifts all ships.

00:45:25.282 --> 00:45:26.782
I could go back and forth on this,

00:45:26.802 --> 00:45:28.344
but looking at it initially

00:45:28.384 --> 00:45:29.083
with that question,

00:45:29.945 --> 00:45:31.105
is partnering with someone,

00:45:31.666 --> 00:45:32.686
everything depends, right?

00:45:33.166 --> 00:45:33.927
Which is like,

00:45:34.606 --> 00:45:35.327
are these people you're

00:45:35.347 --> 00:45:36.568
partnering with in terms of

00:45:38.068 --> 00:45:39.550
orthopedic practices, are they good?

00:45:39.570 --> 00:45:39.869
Yeah.

00:45:40.579 --> 00:45:42.300
Are they out for the common good?

00:45:42.702 --> 00:45:44.023
Then I would say the answer is yes.

00:45:44.744 --> 00:45:45.463
People outside your

00:45:45.503 --> 00:45:46.405
profession or your business

00:45:46.425 --> 00:45:47.106
are not your enemy.

00:45:48.746 --> 00:45:50.367
What is that razor where

00:45:50.407 --> 00:45:51.369
it's like never attribute

00:45:51.389 --> 00:45:53.110
to malice what can usually

00:45:53.150 --> 00:45:54.552
be attributed to incompetence?

00:45:54.592 --> 00:45:55.733
It's like most of the time

00:45:55.753 --> 00:45:56.853
when other people are doing stuff,

00:45:57.333 --> 00:45:59.135
they're not bad people, they're dumb.

00:45:59.775 --> 00:46:00.516
Or they just don't know what

00:46:00.536 --> 00:46:01.056
they're doing.

00:46:01.396 --> 00:46:02.237
Or you might see like

00:46:02.257 --> 00:46:03.097
they're trying to get me.

00:46:03.257 --> 00:46:03.478
Actually,

00:46:03.498 --> 00:46:04.659
they're just doing their own thing.

00:46:04.719 --> 00:46:05.699
Like they're actually just

00:46:05.820 --> 00:46:07.661
doing their own thing all the time.

00:46:07.742 --> 00:46:09.202
So I'd say partnering with

00:46:09.322 --> 00:46:10.543
orthopedic practices and say,

00:46:10.583 --> 00:46:11.844
if you believe in a common,

00:46:11.903 --> 00:46:12.565
if you have a good

00:46:12.605 --> 00:46:14.405
direction and this is a

00:46:14.505 --> 00:46:16.246
good decision for you and them,

00:46:16.427 --> 00:46:17.327
like weigh the options,

00:46:17.847 --> 00:46:18.728
I have no problem with it.

00:46:19.860 --> 00:46:20.862
Yeah, I don't know.

00:46:20.942 --> 00:46:21.902
I'm not a good partner.

00:46:21.922 --> 00:46:23.262
I've never been a good partner.

00:46:23.282 --> 00:46:25.864
I want full responsibility

00:46:25.905 --> 00:46:27.284
for my mistakes and I want

00:46:27.364 --> 00:46:29.347
full responsibility for my successes.

00:46:30.007 --> 00:46:32.407
And so that's a situation where, yes,

00:46:32.447 --> 00:46:34.528
you have the actual never

00:46:34.590 --> 00:46:35.429
get into a 50-50.

00:46:35.550 --> 00:46:37.610
It needs to be 49-51.

00:46:37.670 --> 00:46:40.512
Even with my wife, we're 49-51.

00:46:40.592 --> 00:46:42.474
Like we've never been 50-50.

00:46:43.195 --> 00:46:45.976
But from a bigger picture perspective,

00:46:45.996 --> 00:46:46.757
yeah.

00:46:47.737 --> 00:46:48.836
I've never met,

00:46:48.936 --> 00:46:50.137
I'm trying to think in my head,

00:46:50.237 --> 00:46:51.318
I don't think I've ever met

00:46:51.657 --> 00:46:53.938
any person with MD after

00:46:53.978 --> 00:46:56.838
their name whose values and

00:46:56.958 --> 00:46:58.418
vision aligns with mine.

00:46:59.179 --> 00:47:00.400
And so, you know,

00:47:00.619 --> 00:47:02.360
once you get into that situation,

00:47:02.380 --> 00:47:04.101
I will work for that person,

00:47:04.521 --> 00:47:05.400
but I don't want to partner

00:47:05.440 --> 00:47:06.601
with that person because

00:47:06.661 --> 00:47:08.041
it's just so difficult.

00:47:08.061 --> 00:47:08.882
And I've had so many

00:47:08.922 --> 00:47:12.722
opportunities where anesthesia or,

00:47:12.742 --> 00:47:14.043
you know, for pain management or

00:47:14.463 --> 00:47:15.925
Or surgeons will approach me

00:47:15.965 --> 00:47:16.666
and they're like, hey,

00:47:16.706 --> 00:47:17.706
you've got this network.

00:47:17.726 --> 00:47:18.688
You've got all this stuff.

00:47:18.768 --> 00:47:19.650
I want to partner.

00:47:19.670 --> 00:47:21.672
And as soon as that P word

00:47:21.711 --> 00:47:23.253
comes out of their mouth, I'm like, no,

00:47:23.313 --> 00:47:25.177
there is no benefit to us partnering.

00:47:25.237 --> 00:47:27.059
We can work in alignment.

00:47:27.099 --> 00:47:28.360
We can work in parallel.

00:47:28.400 --> 00:47:29.442
We can work together.

00:47:30.356 --> 00:47:32.739
but to truly partner as in

00:47:32.818 --> 00:47:33.960
signing contracts and

00:47:34.001 --> 00:47:35.041
sharing profitability.

00:47:35.061 --> 00:47:37.204
Cause even that, like, I don't want to,

00:47:37.664 --> 00:47:37.965
you know,

00:47:38.126 --> 00:47:39.487
either be responsible or be

00:47:39.567 --> 00:47:40.869
subjugated to your

00:47:40.949 --> 00:47:42.451
decisions to spend money

00:47:42.992 --> 00:47:44.594
because I know what my,

00:47:44.773 --> 00:47:46.195
my personality is like,

00:47:46.275 --> 00:47:47.016
I don't want to spend $300

00:47:47.016 --> 00:47:47.376
on an office chair.

00:47:49.179 --> 00:47:50.460
I don't want to spend, you know,

00:47:50.460 --> 00:47:53.202
$1,000 on this thing that I

00:47:53.242 --> 00:47:54.864
know I could get cheaper somewhere else.

00:47:55.324 --> 00:47:57.266
So I personally really

00:47:57.326 --> 00:47:59.447
struggle with any kind of

00:47:59.487 --> 00:48:01.469
partnerships that involve finances.

00:48:01.769 --> 00:48:03.010
Let's just work in parallel.

00:48:03.371 --> 00:48:04.072
You have your thing.

00:48:04.132 --> 00:48:05.012
I'll have my thing.

00:48:05.452 --> 00:48:07.094
And we'll just move toward a

00:48:07.135 --> 00:48:08.295
similar vision as long as

00:48:08.335 --> 00:48:09.496
we have that similar vision.

00:48:09.516 --> 00:48:10.938
And to be fair, they did.

00:48:11.057 --> 00:48:12.059
The question was partnering

00:48:12.099 --> 00:48:13.699
with order P practices to

00:48:13.739 --> 00:48:14.900
run their own therapy like 5050.

00:48:14.900 --> 00:48:14.981
So

00:48:16.617 --> 00:48:17.958
This could be a partnership,

00:48:18.119 --> 00:48:19.418
but not necessarily ownership.

00:48:19.478 --> 00:48:20.398
I think I looked at it the

00:48:20.438 --> 00:48:23.000
first time and said, oh, ownership.

00:48:23.099 --> 00:48:24.860
But that's not what I said.

00:48:25.460 --> 00:48:26.221
There are a bunch of

00:48:26.240 --> 00:48:27.601
different ways that you can do this,

00:48:27.681 --> 00:48:29.101
which is how do we work together?

00:48:29.601 --> 00:48:30.922
And this also keeps going

00:48:30.963 --> 00:48:31.663
down the rabbit hole.

00:48:31.902 --> 00:48:32.882
This is where agreements and

00:48:32.922 --> 00:48:33.824
contracts come in.

00:48:33.844 --> 00:48:34.844
And this is where, you know,

00:48:34.864 --> 00:48:35.324
things like that.

00:48:35.344 --> 00:48:36.003
It's like, OK,

00:48:36.344 --> 00:48:37.465
so we keep going round and round.

00:48:38.530 --> 00:48:40.554
So we don't really have finances involved,

00:48:40.574 --> 00:48:42.137
but in terms of this podcast,

00:48:42.237 --> 00:48:43.579
Tony does get to share in

00:48:43.641 --> 00:48:46.005
the positive successes of it.

00:48:46.226 --> 00:48:47.467
And as a sidebar,

00:48:47.487 --> 00:48:49.211
I've been looking at the line...

00:48:50.460 --> 00:48:50.661
here.

00:48:50.760 --> 00:48:52.282
I'm taking screenshots ever

00:48:52.342 --> 00:48:53.963
since 50 people live and it

00:48:54.003 --> 00:48:55.585
got up to 57 people live.

00:48:55.625 --> 00:48:57.025
So guys, if you're watching and listening,

00:48:58.025 --> 00:48:58.666
we would love for you to

00:48:58.706 --> 00:48:59.768
drop comments and questions.

00:48:59.788 --> 00:49:00.989
We appreciate health mention

00:49:01.068 --> 00:49:03.429
and Boba Banco and John and

00:49:03.449 --> 00:49:04.291
all these other folks that are,

00:49:04.391 --> 00:49:04.971
I'm not looking at the

00:49:05.291 --> 00:49:06.052
comments unless you're

00:49:06.072 --> 00:49:06.932
putting them up on the screen.

00:49:07.213 --> 00:49:07.612
Oh, there we go.

00:49:07.652 --> 00:49:08.193
Karen, uh,

00:49:09.994 --> 00:49:11.077
Any of the other comments

00:49:11.137 --> 00:49:13.440
that we missed over today or recently,

00:49:14.161 --> 00:49:15.244
we just appreciate your

00:49:15.744 --> 00:49:17.407
tuning in live and let us

00:49:17.427 --> 00:49:17.847
know if you have any

00:49:17.867 --> 00:49:18.949
questions now or in the future.

00:49:18.989 --> 00:49:19.590
So thank you guys.

00:49:19.630 --> 00:49:20.592
Yeah, I'm always confused.

00:49:20.612 --> 00:49:21.132
I'm like, oh my gosh,

00:49:21.152 --> 00:49:22.114
people actually listen to us.

00:49:23.541 --> 00:49:26.922
And I will say for the record, Dave, no,

00:49:27.043 --> 00:49:27.324
Jimmy,

00:49:27.384 --> 00:49:29.844
Jimmy and I did another live stream

00:49:30.085 --> 00:49:31.465
later in the day recently,

00:49:31.945 --> 00:49:34.505
and we didn't have 55 viewers, you know,

00:49:34.545 --> 00:49:35.967
so it's not even like we could say, well,

00:49:35.987 --> 00:49:36.927
those are all bots.

00:49:37.527 --> 00:49:40.047
Those are actual people tuning in.

00:49:40.108 --> 00:49:40.668
That's awesome.

00:49:41.369 --> 00:49:41.568
Yeah.

00:49:43.297 --> 00:49:43.538
I mean,

00:49:43.938 --> 00:49:45.019
I always like when people just ping

00:49:45.079 --> 00:49:46.219
us and say like, hey, listen,

00:49:46.239 --> 00:49:48.202
you don't have to write me a soliloquy.

00:49:48.242 --> 00:49:49.503
I'm not looking for a pat on the back.

00:49:49.563 --> 00:49:51.364
Just like I listen two,

00:49:51.403 --> 00:49:52.784
three times a month, something like that.

00:49:52.824 --> 00:49:54.567
Like we're 49 minutes in.

00:49:54.606 --> 00:49:55.286
If you're actually listening

00:49:55.327 --> 00:49:56.728
to this either on a video

00:49:56.967 --> 00:49:58.750
today live six weeks from

00:49:58.789 --> 00:50:01.050
now or wherever we share this audio,

00:50:01.092 --> 00:50:01.231
like...

00:50:01.831 --> 00:50:01.992
just,

00:50:02.371 --> 00:50:03.773
it's amazing how many people are out

00:50:03.813 --> 00:50:05.072
there that you don't

00:50:05.172 --> 00:50:07.213
actually see or might not

00:50:07.233 --> 00:50:08.793
be the loudest voice on social media.

00:50:08.813 --> 00:50:09.195
Cause they're,

00:50:09.394 --> 00:50:10.295
they're listening and not

00:50:10.335 --> 00:50:12.155
necessarily speaking or yelling,

00:50:12.556 --> 00:50:13.255
but they're out there.

00:50:14.876 --> 00:50:15.817
Bo's brushing his teeth.

00:50:15.896 --> 00:50:16.856
Good dental care, Bo.

00:50:17.117 --> 00:50:17.777
Fantastic.

00:50:18.378 --> 00:50:19.237
All right.

00:50:19.418 --> 00:50:20.659
Time to slide to the parting shot.

00:50:21.099 --> 00:50:21.318
Yes.

00:50:22.239 --> 00:50:22.438
All right.

00:50:22.478 --> 00:50:22.978
Parting shot.

00:50:22.998 --> 00:50:23.159
Dave,

00:50:23.179 --> 00:50:24.300
what do you got for your parting shot?

00:50:25.563 --> 00:50:26.244
A parting shot.

00:50:26.344 --> 00:50:26.585
Okay.

00:50:26.605 --> 00:50:27.726
So we talked about a lot of things.

00:50:28.666 --> 00:50:30.688
I think that the screenshot about the,

00:50:30.909 --> 00:50:31.929
the physician, the,

00:50:32.090 --> 00:50:34.452
the PCP and the referrals and all that,

00:50:34.512 --> 00:50:34.692
again,

00:50:34.731 --> 00:50:36.052
it's no different in physical therapy.

00:50:36.092 --> 00:50:38.155
So I think if you're the

00:50:38.175 --> 00:50:39.496
parting shot for me, you're watching,

00:50:39.536 --> 00:50:40.577
you're listening to this type of stuff.

00:50:40.597 --> 00:50:41.137
You're already,

00:50:41.277 --> 00:50:43.440
I would say forward thinking you're,

00:50:43.519 --> 00:50:44.920
you're on the cutting edge of like,

00:50:46.157 --> 00:50:48.778
I don't want to say we're

00:50:49.139 --> 00:50:50.018
not knowledge workers.

00:50:50.519 --> 00:50:51.940
We're certain minds.

00:50:51.960 --> 00:50:52.480
I don't know.

00:50:52.739 --> 00:50:53.880
In terms of what we're offering,

00:50:54.161 --> 00:50:55.260
we're not that different than you.

00:50:55.280 --> 00:50:56.061
We're in the trenches.

00:50:56.342 --> 00:50:57.742
We're trying to help each other out.

00:50:58.021 --> 00:50:59.322
We're putting our reviews out there.

00:50:59.342 --> 00:51:00.722
Again, with

00:51:02.384 --> 00:51:02.963
How do you fight it?

00:51:03.063 --> 00:51:04.485
We talked about different options,

00:51:04.545 --> 00:51:06.226
whether you're a little cash based,

00:51:06.246 --> 00:51:07.487
you're going more cash based,

00:51:08.246 --> 00:51:09.387
competing on experience,

00:51:09.447 --> 00:51:10.688
competing on value,

00:51:11.088 --> 00:51:12.708
competing on speed to scheduling,

00:51:12.728 --> 00:51:13.869
you know,

00:51:13.889 --> 00:51:15.530
a concierge approach of

00:51:15.590 --> 00:51:16.371
communicating with the

00:51:16.391 --> 00:51:17.632
patient and all the family

00:51:17.652 --> 00:51:19.213
members so that they have

00:51:19.253 --> 00:51:20.693
some affinity for you.

00:51:20.813 --> 00:51:21.954
And then when that happens,

00:51:21.974 --> 00:51:22.833
they'll be more likely to

00:51:22.875 --> 00:51:24.534
pay out of pocket at higher

00:51:24.574 --> 00:51:25.096
dollar amounts.

00:51:25.175 --> 00:51:25.335
Right.

00:51:25.376 --> 00:51:26.135
So it's like doing the

00:51:26.175 --> 00:51:27.277
things that like Ritz

00:51:27.317 --> 00:51:29.077
Carlton would do for their customers.

00:51:29.958 --> 00:51:31.400
And the things that Motel 8

00:51:31.400 --> 00:51:32.240
cannot do for their

00:51:32.260 --> 00:51:33.023
customers because of the

00:51:33.043 --> 00:51:33.903
two different business models.

00:51:33.943 --> 00:51:35.246
So that's kind of like my parting shot.

00:51:35.286 --> 00:51:37.307
How about either one?

00:51:37.568 --> 00:51:38.269
Who's going to take it next?

00:51:38.786 --> 00:51:41.427
Yeah, so lately I've been, you know,

00:51:42.688 --> 00:51:44.248
my thoughts follow trends.

00:51:44.349 --> 00:51:46.331
And so one of the trends in my head,

00:51:46.411 --> 00:51:48.112
we used to watch Loki.

00:51:48.211 --> 00:51:48.911
I don't know if it was on

00:51:48.972 --> 00:51:50.632
Netflix or one of Disney,

00:51:50.693 --> 00:51:51.414
something like that.

00:51:52.273 --> 00:51:53.414
And the idea behind that

00:51:53.494 --> 00:51:54.936
series was there's the

00:51:54.976 --> 00:51:56.197
timeline and then you have

00:51:56.237 --> 00:51:57.617
these offshoots.

00:51:57.657 --> 00:51:58.878
So every decision you make

00:51:58.958 --> 00:52:00.599
creates a new parallel timeline.

00:52:02.041 --> 00:52:04.264
We have no idea what things

00:52:04.284 --> 00:52:05.806
are going to be like a year, five years,

00:52:05.806 --> 00:52:06.827
10 years down the road.

00:52:07.407 --> 00:52:09.650
And so every decision we make,

00:52:09.931 --> 00:52:11.532
you just respond to that decision,

00:52:11.693 --> 00:52:12.994
respond versus react.

00:52:13.815 --> 00:52:15.579
And I think about that when

00:52:15.639 --> 00:52:17.822
I'm looking at the posts on

00:52:17.862 --> 00:52:18.922
Facebook and LinkedIn.

00:52:20.063 --> 00:52:21.184
I have no idea where we're

00:52:21.204 --> 00:52:24.206
gonna be in a week, let alone five years.

00:52:25.148 --> 00:52:26.809
Just make decisions to the

00:52:26.849 --> 00:52:29.411
best of your ability, follow your heart,

00:52:29.592 --> 00:52:31.132
but also understand that

00:52:31.634 --> 00:52:33.275
you don't know what's gonna happen.

00:52:33.416 --> 00:52:34.335
A year from now,

00:52:34.416 --> 00:52:34.936
you might be in a

00:52:34.976 --> 00:52:36.659
completely different situation.

00:52:37.438 --> 00:52:39.340
If we know anything as physical therapists,

00:52:39.400 --> 00:52:40.561
we know that we are highly

00:52:40.601 --> 00:52:42.284
adaptable and we just bring

00:52:42.324 --> 00:52:43.144
that into business.

00:52:43.184 --> 00:52:44.505
We bring that into patient care.

00:52:44.545 --> 00:52:46.166
We bring that into our family life.

00:52:46.628 --> 00:52:48.869
You guys are amazing at adapting.

00:52:49.090 --> 00:52:51.032
Embrace that and just know that.

00:52:51.672 --> 00:52:53.333
Take that next step and see

00:52:53.373 --> 00:52:53.875
where you land.

00:52:54.601 --> 00:52:56.822
Yeah, I'd say, and this is from personal,

00:52:56.862 --> 00:52:57.702
like a lot of the stuff,

00:52:57.762 --> 00:52:58.724
it's funny how this works,

00:52:58.804 --> 00:53:00.103
where the stuff we talk about,

00:53:00.443 --> 00:53:02.304
the topics we talk about change,

00:53:02.905 --> 00:53:04.065
but we always apply our own

00:53:04.126 --> 00:53:05.146
filter to them, right?

00:53:05.206 --> 00:53:06.106
So when I talked about why

00:53:06.166 --> 00:53:07.246
people aren't taking action,

00:53:07.606 --> 00:53:08.467
there's several things in

00:53:08.507 --> 00:53:10.369
my life that I hesitate to take action.

00:53:10.789 --> 00:53:12.128
So then how do I look smart

00:53:12.168 --> 00:53:12.949
to know why other people

00:53:12.969 --> 00:53:13.650
don't take action?

00:53:14.110 --> 00:53:16.010
I take stock at why I'm not taking action.

00:53:16.411 --> 00:53:17.711
And so when I say it's fear

00:53:18.112 --> 00:53:19.092
or not knowing what to do

00:53:19.172 --> 00:53:20.293
or not thinking you're good enough,

00:53:21.012 --> 00:53:21.972
you're seeing an insight

00:53:22.012 --> 00:53:23.974
into my brain or my brain.

00:53:23.994 --> 00:53:24.614
Go deeper.

00:53:24.795 --> 00:53:25.994
Go heart and what you're

00:53:26.014 --> 00:53:26.795
actually thinking.

00:53:27.896 --> 00:53:29.876
And the success that you're

00:53:29.896 --> 00:53:30.856
seeking is hiding in the

00:53:30.896 --> 00:53:31.998
work you're not doing.

00:53:32.018 --> 00:53:33.297
That's one of those

00:53:34.079 --> 00:53:35.039
motivational quotes that

00:53:35.079 --> 00:53:35.858
circulates the internet

00:53:35.878 --> 00:53:36.639
every once in a while.

00:53:37.300 --> 00:53:39.001
I got good and bad news for you.

00:53:39.021 --> 00:53:40.161
The bad news is it's true.

00:53:40.621 --> 00:53:41.661
The success you're seeking

00:53:41.722 --> 00:53:43.001
is lying on the other side

00:53:43.041 --> 00:53:44.163
of the work you're not doing.

00:53:45.565 --> 00:53:47.606
The barrier to get over is perfectionism.

00:53:48.306 --> 00:53:49.688
None of us knows what's going on.

00:53:49.807 --> 00:53:51.108
I mean, we do, but we don't.

00:53:51.327 --> 00:53:52.668
None of us knows what's going on.

00:53:52.789 --> 00:53:53.568
And the people that look

00:53:53.608 --> 00:53:54.329
like they know what they're

00:53:54.349 --> 00:53:56.030
doing are the people that just do stuff.

00:53:56.610 --> 00:53:57.871
You're not seeing the failures.

00:53:57.891 --> 00:53:58.791
You're not seeing the things

00:53:58.811 --> 00:53:59.351
that didn't work.

00:54:00.012 --> 00:54:01.972
So go do the things that you

00:54:02.012 --> 00:54:02.693
know right now.

00:54:03.112 --> 00:54:03.713
And then the thing that

00:54:03.733 --> 00:54:04.454
you're supposed to do three

00:54:04.474 --> 00:54:05.074
steps from now,

00:54:05.393 --> 00:54:06.693
you'll figure it out when you get there.

00:54:06.873 --> 00:54:08.155
That's just how it works, guys.

00:54:09.976 --> 00:54:10.396
All right.

00:54:10.715 --> 00:54:13.016
We'll see you guys Tuesday.

00:54:14.226 --> 00:54:14.967
Today's Tuesday.

00:54:15.148 --> 00:54:15.610
Today's Tuesday.

00:54:15.630 --> 00:54:17.494
We'll see you guys Thursday at 8 30 AM.

00:54:17.534 --> 00:54:18.356
Thanks for watching.

00:54:19.018 --> 00:54:19.199
Yep.

00:54:19.840 --> 00:54:20.101
Thank you.