Maximizing Value in Insurance-Based PT Practice: A Craft Brew of Insights

WEBVTT00:00.450 --> 00:03.135Um, well, let's 3, 2, 1, start this thing.00:09.265 --> 00:10.588Alex, welcome to the program, man.00:10.608 --> 00:11.269I appreciate your time.00:12.091 --> 00:12.772Yeah, absolutely.00:12.792 --> 00:13.273Happy to be here.00:14.135 --> 00:16.056I'll give the audience some context.00:16.276 --> 00:18.057Alex is the mastermind00:18.077 --> 00:19.817behind Resolute Physical00:19.837 --> 00:20.877Therapy in Denver.00:21.078 --> 00:22.698So I'm bragging for him that00:22.738 --> 00:24.279he chose a pretty cool place to live.00:24.739 --> 00:25.419I'm a little jealous.00:26.439 --> 00:28.460Like me, he's a craft beer enthusiast.00:28.800 --> 00:29.480But not just that.00:30.021 --> 00:31.421A decade of expertise in00:31.461 --> 00:32.501private practice and a00:32.582 --> 00:35.102unique perspective on making healthcare,00:35.122 --> 00:36.883here's the big A word, accessible.00:37.323 --> 00:38.123We like that because if you00:38.143 --> 00:39.284can't access it, it doesn't matter.00:40.244 --> 00:40.905We're going to challenge00:40.925 --> 00:42.486your views today on a00:42.626 --> 00:44.288six-pack episode format.00:44.628 --> 00:46.710So one idea or prompt and00:46.730 --> 00:49.192then six actionable steps.00:50.033 --> 00:51.754And the idea here is we'll00:51.774 --> 00:52.515challenge your views on00:52.575 --> 00:54.076physical therapy and insurance.00:54.116 --> 00:56.218We'll actually say here's00:56.278 --> 00:58.020six things every PT should00:58.060 --> 00:59.241know about thriving.00:59.801 --> 01:01.022in insurance-based practice,01:01.042 --> 01:02.163which I feel like, Alex,01:02.203 --> 01:03.924I feel like everybody sort of dumps on it,01:04.004 --> 01:04.164right?01:04.244 --> 01:06.325Oh, insurance is the big angry thing,01:06.365 --> 01:07.426but like, it's not going anywhere.01:07.446 --> 01:08.547So you better like learn how01:08.567 --> 01:09.527to live with it and work01:09.567 --> 01:10.748within the system while01:10.808 --> 01:12.389someone else rages against the machine.01:12.409 --> 01:13.170I'm not saying raging01:13.210 --> 01:15.031against insurance is bad, but it's here.01:15.091 --> 01:16.592We need to learn how to navigate, right?01:17.611 --> 01:18.292Right, correct.01:18.332 --> 01:18.672Yeah, I mean,01:18.732 --> 01:20.274insurance is going to be a01:20.314 --> 01:22.397part of healthcare for the01:22.417 --> 01:23.197foreseeable future.01:23.218 --> 01:23.698I mean,01:23.718 --> 01:25.140there's a lot of things we'd love01:25.160 --> 01:25.921to change about that.01:26.021 --> 01:26.982But right now,01:27.683 --> 01:30.486this is the current scene that we're in.01:31.147 --> 01:32.688And how do you adapt and01:32.728 --> 01:34.831work within that scene and01:34.851 --> 01:35.592still do a good job,01:35.952 --> 01:37.414still give excellent patient care?01:37.708 --> 01:37.988listen,01:38.088 --> 01:39.369this is a system that's set up01:39.390 --> 01:40.971before I was born, before you were born,01:41.051 --> 01:41.391and it is.01:41.972 --> 01:42.973The patients didn't choose it.01:43.073 --> 01:43.813We didn't choose it.01:44.194 --> 01:44.574It is.01:44.594 --> 01:45.815I'm not saying, again,01:45.955 --> 01:46.516this thing shouldn't01:46.616 --> 01:48.097continue or not be changed,01:48.418 --> 01:49.559but how are we digging into01:49.579 --> 01:50.880this to figure out what we01:50.900 --> 01:51.761can do to make it?01:51.961 --> 01:53.202And again, I'll hit that A word.01:54.063 --> 01:55.063So let's start with the01:55.504 --> 01:57.946first idea in this six pack, Alex,01:57.986 --> 01:59.107which is start by just01:59.147 --> 02:00.288talking about the value.02:00.348 --> 02:02.530Let's talk about the value of therapists.02:03.190 --> 02:04.071And I want to stress,02:04.151 --> 02:05.192I say this a lot with02:05.312 --> 02:06.513companies or individuals.02:07.074 --> 02:07.754There is a difference02:07.794 --> 02:09.056between value and cost.02:10.049 --> 02:10.949There is a difference02:10.989 --> 02:12.310between value and cost.02:12.890 --> 02:15.971You, the therapist or the business owner,02:16.331 --> 02:17.531you determine price.02:17.891 --> 02:18.752The other person,02:18.972 --> 02:20.952the person you're hoping to work with,02:21.112 --> 02:23.033they determine the value in their head,02:23.073 --> 02:23.913in their heart, in their mind.02:23.953 --> 02:25.594So how do you define what02:25.634 --> 02:27.934PTs are truly worth with that V word,02:27.954 --> 02:29.415that value word in the02:29.475 --> 02:30.395healthcare profession?02:30.455 --> 02:31.636How do you do that?02:32.656 --> 02:32.856Right.02:34.476 --> 02:34.857First of all,02:34.877 --> 02:36.457I'd love to say I've got two02:36.557 --> 02:37.477staff physical therapists02:37.517 --> 02:38.178that work for me.02:38.638 --> 02:39.318I would love it.02:40.003 --> 02:42.464if I could pay both of them $100,02:42.464 --> 02:43.584000 a year, right?02:44.384 --> 02:46.665They are 100% worth it in my mind,02:47.085 --> 02:48.486the value that they provide.02:49.426 --> 02:51.106I think their patients see that too.02:51.847 --> 02:52.887They do an excellent job02:52.907 --> 02:53.867with patients because that02:53.927 --> 02:56.848is their only priority is patient care,02:57.248 --> 02:57.408right?02:58.309 --> 02:59.549That is what I have tasked02:59.609 --> 03:01.630them with from their job is03:01.730 --> 03:03.190who is your end user and03:03.230 --> 03:03.930that's your patient.03:04.390 --> 03:05.471I want you to do one thing03:05.491 --> 03:06.391and that's do a good job03:06.411 --> 03:07.011with that patient.03:07.091 --> 03:08.912So they have bought fully into that.03:09.986 --> 03:11.228I don't need them to worry03:11.268 --> 03:13.070about the productivity standard of that,03:13.650 --> 03:16.353of what it means to turn a03:16.433 --> 03:18.195profit in physical therapy land.03:18.616 --> 03:20.278That is my job as the business owner.03:21.139 --> 03:23.902Now, to the value side of that,03:25.964 --> 03:27.626the insurance company will determine03:28.857 --> 03:30.078or the payer, I guess,03:30.118 --> 03:30.858at the end of the day.03:31.379 --> 03:32.239Let's just call it that.03:33.000 --> 03:35.041For 85% of our patient mix,03:35.521 --> 03:36.082it's insurance.03:36.822 --> 03:38.603The insurance will determine, hey,03:38.643 --> 03:39.644this is how valuable we03:39.704 --> 03:40.464think that you are.03:41.205 --> 03:42.526And now that is where you03:42.566 --> 03:43.586start to get this evil03:43.686 --> 03:45.367empire view of insurance.03:46.848 --> 03:47.789They don't think that my03:47.829 --> 03:50.891therapists are worth $100,000.03:50.891 --> 03:54.072Or they may say stuff in public that says,03:54.652 --> 03:56.372yeah, physical therapy is super valuable.03:56.412 --> 03:57.433We love everything that you03:57.473 --> 03:58.473guys do for our members.03:58.513 --> 03:59.553You keep them out of having03:59.613 --> 04:00.413expensive surgery.04:00.453 --> 04:01.774You get them off of pain meds.04:02.434 --> 04:03.634You improve their function.04:04.034 --> 04:04.874You do a great job.04:05.835 --> 04:08.135Here's $55 for that visit.04:08.495 --> 04:09.135And we're only gonna04:09.215 --> 04:10.276authorize five of them.04:11.196 --> 04:13.717So you got five visits at 55 bucks.04:14.737 --> 04:15.197Good luck.04:15.537 --> 04:16.537You're super valuable and04:16.557 --> 04:17.297you're really good.04:17.317 --> 04:18.218We know you can do it.04:18.318 --> 04:19.438Give yourself a pat on the back.04:20.768 --> 04:20.988Right.04:21.348 --> 04:24.509So that's where you run into this thing.04:24.629 --> 04:25.750And I think that we need to04:25.890 --> 04:27.090shift where we put our04:27.170 --> 04:29.751value of are you trying to04:29.811 --> 04:31.271show value to the insurance company?04:31.331 --> 04:32.492Are you trying to show value04:32.532 --> 04:33.332to your patient?04:37.333 --> 04:40.254Where do you thrive there?04:40.894 --> 04:43.275For my physical therapist, hey,04:43.615 --> 04:44.476I want your patients to04:44.516 --> 04:45.356know that you're valuable.04:46.397 --> 04:47.859and I want you to know that04:48.439 --> 04:49.000I think that you're04:49.040 --> 04:50.681valuable and I will do my04:50.802 --> 04:53.985best to pay you the way04:54.005 --> 04:54.645that I think that you04:54.686 --> 04:56.427should be paid but I also04:56.487 --> 04:57.388let them see behind the04:57.428 --> 04:59.270curtain of hey this is what04:59.290 --> 05:00.331your insurance companies05:00.832 --> 05:02.573think that you're worth so05:04.487 --> 05:05.528I hope you guys understand05:05.548 --> 05:07.229that this is why I can't give you $100,05:07.229 --> 05:08.189000 a year.05:08.569 --> 05:08.789Right.05:08.890 --> 05:10.170Yeah.05:10.290 --> 05:11.451Somebody else smarter than05:11.491 --> 05:12.471me when I first started as05:12.652 --> 05:15.253a clinician set up this05:16.774 --> 05:17.874triangle on a dry erase05:17.894 --> 05:19.395board and they essentially05:19.435 --> 05:20.896explained it so well to me05:21.096 --> 05:22.016so that I could go out and05:22.056 --> 05:23.197explain it to other people.05:23.257 --> 05:25.178And I think it was that evil05:25.218 --> 05:25.999empire thing and I didn't05:26.019 --> 05:26.979know how to explain it.05:27.699 --> 05:28.020And then05:28.880 --> 05:30.020This person said, listen,05:30.281 --> 05:31.261here's how I explain it to05:31.301 --> 05:34.162patients is you you entered05:34.202 --> 05:34.882into an agreement,05:34.922 --> 05:36.003the patient and the payer05:36.583 --> 05:37.843where you said you're going05:37.863 --> 05:38.964to give X number of dollars05:39.024 --> 05:40.985per month for health insurance.05:41.285 --> 05:41.885And keep in mind,05:42.005 --> 05:42.665health insurance is05:42.705 --> 05:43.646different than health care.05:44.366 --> 05:44.526Right.05:44.846 --> 05:45.466Those are two different05:45.486 --> 05:46.447words and they're two different things.05:46.907 --> 05:48.147So you entered an agreement05:48.447 --> 05:49.588and there was piles and05:49.628 --> 05:51.409piles of paper that you got05:51.449 --> 05:52.549in the mail or a digital05:52.569 --> 05:53.970copy where it said how05:54.010 --> 05:54.990they'll figure out what they'll pay.05:56.004 --> 05:57.104You entered an agreement.05:57.685 --> 05:59.805I as the physical therapist was not there.05:59.905 --> 06:00.766That's not my agreement06:01.266 --> 06:02.386unless you as the physical06:02.406 --> 06:03.307therapist now enter and06:03.327 --> 06:05.468you're in network with that organization.06:06.068 --> 06:07.328And that's where I think we get it.06:07.408 --> 06:10.469I think that's the comforting thing.06:10.629 --> 06:13.190And the problem is you agreed to this.06:13.571 --> 06:14.851And the only way it changes06:14.871 --> 06:16.272is if the payer decides,06:16.732 --> 06:18.432let's pay these people more,06:18.592 --> 06:19.333which their job is.06:21.078 --> 06:22.819To keep that bottom line as06:22.839 --> 06:23.720strong as possible is to06:23.760 --> 06:25.261pay us as little as possible, right?06:25.281 --> 06:26.542And our job is to show more value.06:26.582 --> 06:27.943But when you sign the dotted line,06:27.963 --> 06:28.824you agree to that.06:29.324 --> 06:31.045And that's the thing that people have to,06:31.506 --> 06:32.667within healthcare and06:33.527 --> 06:34.468consumers of healthcare,06:34.848 --> 06:35.829either wrap their head around,06:35.849 --> 06:37.210which is this subjective view,06:37.730 --> 06:41.733unless the decision to pay money is yours,06:41.753 --> 06:41.953right?06:42.867 --> 06:43.828and you value me.06:44.148 --> 06:45.149And then we get to determine06:45.169 --> 06:45.949what that value is.06:46.490 --> 06:47.150So I think you're right,06:47.190 --> 06:48.471which is this triangle06:48.511 --> 06:51.133between three people or two people,06:51.434 --> 06:53.135patient, provider, and organization,06:53.175 --> 06:53.875which is a payer.06:54.636 --> 06:56.397And that is an organization.06:56.417 --> 06:58.319It's not a person having a06:58.399 --> 06:59.520subjective conversations,06:59.560 --> 07:00.701having very objective07:00.781 --> 07:01.861things because we sign on07:01.881 --> 07:02.482the dotted line.07:03.323 --> 07:03.503Right.07:03.943 --> 07:04.303Yeah, yeah.07:04.403 --> 07:06.265I mean, I'll give you a prime example.07:06.345 --> 07:08.326The Anthem Blue Cross Blue Shield building,07:08.707 --> 07:11.529their offices for the Colorado region,07:12.893 --> 07:14.334are right downtown and they07:14.354 --> 07:15.855take up an entire city block.07:16.116 --> 07:18.678So between 7th and 8th Avenue,07:18.758 --> 07:19.899between Broadway and Lincoln,07:19.979 --> 07:23.221it is a huge, like eight story building,07:23.381 --> 07:24.622downtown prime real estate.07:25.263 --> 07:27.024They don't pay the rent on07:27.064 --> 07:28.085that building every month07:28.425 --> 07:29.086by losing money.07:29.466 --> 07:30.027No, they don't.07:30.187 --> 07:30.467Correct.07:30.787 --> 07:31.007Right.07:31.948 --> 07:33.489Their job is to take in X07:33.689 --> 07:34.790and then pay out less than07:34.910 --> 07:36.831X and less than X enough07:36.851 --> 07:38.072that they can pay their07:38.132 --> 07:40.114people and their07:40.214 --> 07:40.954stockholders or07:40.974 --> 07:42.355shareholders and their rent07:42.395 --> 07:43.296and all those different things.07:43.756 --> 07:44.857So that is the way it works.07:45.197 --> 07:45.418All right.07:45.798 --> 07:47.499So so let's move to the second idea.07:47.939 --> 07:49.661So do you think insurance07:50.041 --> 07:51.782companies or this, you know,07:51.802 --> 07:53.403I'm asking you to like forecast,07:53.604 --> 07:54.364which is great if you're a07:54.384 --> 07:55.205meteorologist because you07:55.225 --> 07:56.185can be wrong like 6007:56.185 --> 07:56.986percent of the time and07:57.006 --> 07:57.927still have a job and be fine.07:58.667 --> 08:00.268um where do you think this08:00.328 --> 08:01.609is going you know you've08:01.629 --> 08:02.669been you've been in you08:02.689 --> 08:03.690know a clinician for 1008:03.690 --> 08:05.571years do you think this is08:05.631 --> 08:06.532trending in a positive08:06.632 --> 08:07.772negative direction and then08:07.832 --> 08:08.893what do we need to do to08:08.913 --> 08:10.414maybe change this in our08:10.494 --> 08:11.655favor and by our I mean the08:11.695 --> 08:12.395patient and the provider08:13.952 --> 08:16.713um I i want to I want to08:16.853 --> 08:18.314start that and shift it one08:18.354 --> 08:20.475spot first I think I think08:20.515 --> 08:22.796the profession is heading08:22.856 --> 08:24.216in a ultimately positive08:24.236 --> 08:25.997direction with this new08:26.057 --> 08:27.538wave of clinicians that are08:28.258 --> 08:29.739more apt to push back08:29.819 --> 08:31.059against insurance companies08:31.139 --> 08:33.340versus maybe the generation08:33.360 --> 08:34.761of clinicians before me08:35.581 --> 08:36.741that were happy to just have08:36.761 --> 08:38.662a contract and they were08:38.702 --> 08:41.083happy to treat 20 visits a08:41.143 --> 08:43.304day and use techs and use a08:43.344 --> 08:44.104lot of modalities and08:44.144 --> 08:45.165passive treatment to just08:45.345 --> 08:46.185get through the day.08:47.385 --> 08:48.646This new wave of clinicians08:49.166 --> 08:51.527is more apt to show their08:51.587 --> 08:54.028value to insurance companies.08:54.688 --> 08:56.889so if I had to if I wanted08:56.909 --> 08:58.069to forecast in the most08:58.129 --> 08:59.350positive light I would put08:59.390 --> 09:00.690it in that context that09:01.150 --> 09:02.331this new wave of clinicians09:02.471 --> 09:03.671is going to fight harder09:03.711 --> 09:04.712than every generation09:04.752 --> 09:06.212before me ever fought and09:06.232 --> 09:07.653that's the only way it will09:07.693 --> 09:09.433change you in my opinion09:09.473 --> 09:10.914you can't have one crazy09:10.954 --> 09:11.814person standing on the09:11.854 --> 09:12.834corner shouting and the09:12.894 --> 09:13.715rest of the people going I09:13.755 --> 09:14.815agree with you but I'm just09:14.855 --> 09:16.256going to go along because09:16.956 --> 09:18.396until there's a danger of09:18.436 --> 09:20.537that organization not being09:20.577 --> 09:21.798able to provide something09:21.818 --> 09:22.538that's in writing09:23.604 --> 09:24.184It won't change.09:24.204 --> 09:24.685I don't know what the09:24.745 --> 09:25.725percentage of that is,09:26.185 --> 09:27.926but I am encouraged by how09:28.766 --> 09:29.807the next generation or09:29.847 --> 09:31.848several generations of not just PTs,09:31.888 --> 09:34.569but people, these generations we get,09:34.589 --> 09:35.810you know, we like to mock, right?09:35.870 --> 09:35.990Like,09:36.010 --> 09:37.170cause we're always the older09:37.210 --> 09:38.951generation saying, well, these kids today,09:38.971 --> 09:40.892I am excited about how they just,09:41.052 --> 09:41.492they sort of,09:41.572 --> 09:42.633they look at everything with09:42.673 --> 09:43.873a really discerning eye and go, yeah,09:43.893 --> 09:44.313I don't like that.09:44.333 --> 09:45.194I'm just not going to do it.09:45.774 --> 09:47.074And some people look at that and they go,09:47.354 --> 09:47.494well,09:47.514 --> 09:48.555these kids don't know how to just09:49.055 --> 09:49.955buckle up and get along.09:49.975 --> 09:50.575I go, good.09:50.975 --> 09:51.995We've been teaching them that.09:52.276 --> 09:53.676Question everything, except for me.09:54.056 --> 09:54.756Question everything,09:54.836 --> 09:55.976except for the thing that we know.09:56.497 --> 09:57.657Question everything means everything.09:58.677 --> 09:59.617Yeah, right.09:59.637 --> 10:00.337And I think you're starting10:00.357 --> 10:01.718to see some of that of even10:01.758 --> 10:03.798from the academia side of this,10:04.118 --> 10:06.319of the professors that have10:06.339 --> 10:08.119been in academia for so long,10:08.379 --> 10:10.840they're now sort of phasing out of10:12.017 --> 10:13.958the academia part and you're10:14.058 --> 10:16.158getting younger clinicians10:16.198 --> 10:17.659who have seen this and they10:17.699 --> 10:18.999have seen how stagnant the10:19.039 --> 10:19.879reimbursement rates have10:19.919 --> 10:22.500been for two decades, right?10:22.560 --> 10:23.880And you're saying, hey,10:23.920 --> 10:25.061the cost of living is going10:25.121 --> 10:25.741up everywhere.10:26.041 --> 10:27.781The cost of goods is going up everywhere.10:28.622 --> 10:29.962And our PTs can't afford to10:30.042 --> 10:32.603live without a roommate, right?10:32.623 --> 10:33.903Like they are doctorally10:34.043 --> 10:35.864educated clinicians who are10:36.024 --> 10:37.304experts at their craft and10:37.324 --> 10:37.944they have to have a10:38.044 --> 10:39.485roommate to live in a major10:39.525 --> 10:40.405metropolitan area.10:41.121 --> 10:42.402whether that's Denver or10:42.462 --> 10:45.265Dallas or anywhere, anywhere,10:45.345 --> 10:46.046they've got to get a10:46.086 --> 10:47.267roommate as a new grad.10:47.947 --> 10:49.689And it's, that's terrible.10:49.729 --> 10:51.130That is a sad state.10:52.431 --> 10:53.673The profession, right?10:54.093 --> 10:54.754Yeah, it is.10:54.954 --> 10:55.434You're not wrong.10:55.855 --> 10:56.715So let me ask you this.10:56.956 --> 10:58.697Let's go to the other side, right?10:59.138 --> 11:00.919Why should a PT choose to11:00.959 --> 11:02.661work with insurance companies?11:02.881 --> 11:02.981Right.11:03.001 --> 11:03.662There's got to be some11:03.742 --> 11:05.423benefit where we're not forced.11:05.463 --> 11:07.225There's no gun to our head to do this.11:07.825 --> 11:07.985You know,11:08.025 --> 11:09.246why should a PT choose to work11:09.287 --> 11:10.107with insurance companies,11:10.227 --> 11:11.068even in this environment11:11.088 --> 11:14.111where we feel like we're undervalued?11:14.151 --> 11:15.272Why would we choose to do that?11:16.172 --> 11:16.353Right.11:17.373 --> 11:18.594The simple answer to that is11:20.756 --> 11:21.717you should strive to get11:21.757 --> 11:23.298your value from helping people.11:24.356 --> 11:25.657That's why every single11:25.697 --> 11:26.517physical therapist that I11:26.577 --> 11:27.918know got into the field.11:28.638 --> 11:29.919It wasn't to be rich.11:29.999 --> 11:31.900None of us never thought11:31.920 --> 11:33.241that we were going to be rich.11:33.961 --> 11:36.563The deal was, you want to help people,11:36.663 --> 11:38.283you want to put your skills to the test,11:38.904 --> 11:39.484and you want to help as11:39.524 --> 11:41.145many people as you can to move better,11:41.165 --> 11:42.586to feel better, to live life better.11:43.466 --> 11:43.666Right.11:43.786 --> 11:45.327So the way that you do that11:45.367 --> 11:47.848is because 85 percent of11:47.908 --> 11:49.128your patient population is11:49.188 --> 11:51.249going to use insurance and11:51.289 --> 11:52.289they've already paid for it.11:52.349 --> 11:54.210They've paid for their health insurance.11:54.890 --> 11:55.811So they want to use that11:55.891 --> 11:57.591insurance to get health care.11:58.412 --> 12:00.312There are a handful of12:00.332 --> 12:01.973people out there who will12:02.013 --> 12:02.953pay no matter what.12:03.293 --> 12:04.334And they'll just say, hey,12:04.474 --> 12:06.114it's it's super valuable to12:06.155 --> 12:07.515me to get the best level of care.12:08.315 --> 12:09.896So I'll go pay out of pocket for it.12:10.475 --> 12:10.695Great.12:10.855 --> 12:12.237That person still has health12:12.277 --> 12:13.397insurance that they're paying for.12:15.359 --> 12:16.880So could you do both?12:17.281 --> 12:18.482Could you give them the best12:18.522 --> 12:19.182patient experience?12:19.222 --> 12:20.243Could you get them the best12:20.283 --> 12:22.265level of care and take the12:22.325 --> 12:23.606insurance that they've already paid for?12:24.707 --> 12:24.967Sure.12:25.227 --> 12:26.669That's the sweet spot that12:26.709 --> 12:28.390we should strive to find is12:29.291 --> 12:31.012how can you help the most12:31.032 --> 12:31.473number of people,12:31.553 --> 12:32.934not just the people who can afford you.12:36.757 --> 12:38.398Also, like we said earlier,12:38.658 --> 12:39.839health insurance isn't going anywhere.12:40.239 --> 12:42.080You're going to have to have it.12:42.100 --> 12:42.841When I was 26,12:42.841 --> 12:44.182I used to make the argument of, well,12:44.202 --> 12:45.703I'm a healthy 26-year-old.12:46.083 --> 12:47.364What do I need health insurance for?12:47.704 --> 12:50.166It's like, well, it's one of those things.12:51.527 --> 12:52.868You want to need it and not have it?12:53.268 --> 12:54.610Or you don't need it and not have it?12:54.630 --> 12:56.311You'd rather have it and not need it.12:56.751 --> 12:57.352You don't want to think12:57.432 --> 12:59.354halfway when you fall off your bike,12:59.374 --> 13:00.254when you're halfway to the ground,13:00.274 --> 13:01.395I should have put the helmet on.13:01.415 --> 13:02.917That's the worst time to be13:02.957 --> 13:03.597thinking about that.13:03.617 --> 13:04.878So I understand the need for it.13:05.339 --> 13:06.880I think what we're all talking about,13:06.900 --> 13:08.161especially from the provider side,13:08.241 --> 13:11.464is we're an integral part of this system,13:11.644 --> 13:12.244we've been told.13:12.725 --> 13:13.786We've been said by everybody.13:13.806 --> 13:14.606Everybody values us.13:14.626 --> 13:14.707Yeah.13:15.407 --> 13:17.128It is that subjective to objective,13:17.148 --> 13:18.088which is like you say we're13:18.148 --> 13:18.929super valuable.13:19.509 --> 13:21.450What is super valuable mean to you?13:21.510 --> 13:22.550Because I have an opinion on13:22.590 --> 13:23.611super value and you have an13:24.031 --> 13:25.132opinion on super value.13:25.152 --> 13:26.492We see that to come to an13:26.552 --> 13:28.193agreement or there's going13:28.213 --> 13:29.714to be this imbalance of we13:29.734 --> 13:31.255don't like the way this is going.13:31.295 --> 13:32.175And then I don't know.13:32.235 --> 13:32.855Hopefully there's something13:32.875 --> 13:33.816that that's changed.13:33.876 --> 13:35.377But that's the thing is13:35.437 --> 13:36.217right now I feel like we're13:36.257 --> 13:36.997in a situation where13:37.017 --> 13:38.258there's there's no checks13:38.298 --> 13:40.219and balances is we the only13:40.299 --> 13:41.980vote we have is to is to be13:42.060 --> 13:43.380in the system or out of the system.13:43.600 --> 13:44.541That's it's like binary.13:45.413 --> 13:45.573Right.13:46.594 --> 13:48.074I'll give you one that's not13:48.134 --> 13:49.995quite binary that might fit into that.13:50.616 --> 13:52.136So say you stay in network13:52.336 --> 13:53.357with an insurance payer13:53.677 --> 13:55.598that is your low payer, right?13:55.838 --> 13:57.019They give you a low contract,13:57.919 --> 13:59.040but they're a major player13:59.600 --> 14:01.321in the insurance landscape, right?14:01.461 --> 14:03.162So you go back to them and14:03.202 --> 14:05.363you start your negotiations with like,14:06.443 --> 14:06.703hey,14:07.043 --> 14:08.244that number that you're paying us per14:08.264 --> 14:09.204visit is really low.14:09.305 --> 14:10.645It's really hard for us to14:10.765 --> 14:11.426operate on that.14:13.049 --> 14:13.389It makes us,14:13.649 --> 14:14.970it makes it tough to see14:15.010 --> 14:16.030patients at that number.14:16.670 --> 14:17.751And they say, well, you know,14:17.811 --> 14:18.931tough deal with it.14:19.111 --> 14:19.732That's what we pay.14:20.252 --> 14:21.192That's what your agreement is.14:22.052 --> 14:22.272Okay.14:23.133 --> 14:24.133I understand where you're coming from.14:24.193 --> 14:25.133You have no position to14:25.173 --> 14:26.914negotiate a higher rate for me.14:27.854 --> 14:28.755We've provided you with our14:28.815 --> 14:29.415outcome measures.14:29.455 --> 14:30.095We provide you with14:30.135 --> 14:30.976long-term data saying that14:30.996 --> 14:32.416we're getting patients better, faster.14:33.216 --> 14:34.497We're at the top for us.14:34.537 --> 14:35.877We're at the top 8% of all14:35.937 --> 14:36.798outcome measures across14:36.838 --> 14:38.138like all wet BT users.14:38.458 --> 14:38.958So that's great.14:39.278 --> 14:39.999We're doing pretty good.14:40.259 --> 14:40.439Right.14:41.192 --> 14:41.812You would think that that14:41.852 --> 14:42.753would give us a really good14:42.793 --> 14:44.394leg to stand on to negotiate.14:45.414 --> 14:47.675Well, the next thing that we do is we say,14:48.716 --> 14:48.996okay,14:49.336 --> 14:51.397we're not going to accept your members.14:51.417 --> 14:53.798We're not going to give them14:53.838 --> 14:54.919priority on our schedule.14:56.468 --> 14:57.868For whatever insurance payer that is,14:57.908 --> 14:58.668we just say, okay,14:58.688 --> 14:59.369we're only going to14:59.409 --> 15:00.709schedule one if we have an15:00.829 --> 15:02.169opening last minute.15:02.569 --> 15:03.229We'll put them on a wait15:03.249 --> 15:04.269list and just say like, hey,15:04.930 --> 15:06.210we don't have any openings right now,15:06.450 --> 15:07.270but we'll call you if we15:07.290 --> 15:08.050have something open up.15:08.270 --> 15:08.550Otherwise,15:08.570 --> 15:11.311we can get you scheduled three weeks out.15:12.031 --> 15:14.191Then you go back to that payer and you say,15:14.231 --> 15:16.192hey, over the last three months,15:17.392 --> 15:20.192we decreased your members15:20.232 --> 15:22.113volume by 90 percent,15:22.133 --> 15:23.233so your members weren't15:23.273 --> 15:24.393being seen at our clinic.15:25.239 --> 15:26.320So they're on a wait list.15:26.360 --> 15:27.120They're not happy.15:27.180 --> 15:27.740They're having to go15:27.780 --> 15:28.601somewhere else that gives15:28.641 --> 15:29.841them less quality of care.15:30.942 --> 15:32.743Would you like to renegotiate that now?15:34.183 --> 15:35.544And we'll get your members back in.15:35.904 --> 15:36.764Do they care, though,15:36.804 --> 15:37.865because they're saying, great,15:37.885 --> 15:40.626you saw we paid 90 percent less.15:40.946 --> 15:41.547So awesome.15:43.348 --> 15:43.608You know,15:43.688 --> 15:45.349I think when they start seeing15:45.369 --> 15:46.529their members drop their15:46.789 --> 15:48.010coverage because we say.15:49.700 --> 15:52.682I think me at Resolute Physical Therapy,15:53.322 --> 15:53.983I'm not going to be the15:54.023 --> 15:54.783difference maker there.15:56.224 --> 15:59.946We aren't high enough volume to create.16:00.066 --> 16:01.127Everybody's got to jump in16:01.187 --> 16:02.328on that and just say, hey,16:02.348 --> 16:03.208we're not going to do that.16:03.488 --> 16:04.509We'll keep your contract.16:04.889 --> 16:06.070We're not going to go out with you.16:06.610 --> 16:07.531We'll keep the contract,16:07.931 --> 16:10.613but we can't do that for that number.16:12.008 --> 16:12.928And here's what it is like16:13.008 --> 16:15.289my cost per cost per visit16:16.229 --> 16:18.790is X. You're paying me X16:18.850 --> 16:20.630minus 20 losing money by16:21.130 --> 16:22.811every time I treat one of your members,16:22.971 --> 16:23.671I lose money.16:23.751 --> 16:24.591So you're telling me that I16:24.611 --> 16:25.631need to double book them,16:27.052 --> 16:28.032but that doesn't give you16:28.072 --> 16:28.912good quality of care.16:29.292 --> 16:30.172That's not what I want my16:30.232 --> 16:31.313clinicians worried about.16:31.333 --> 16:32.313I don't want them worried16:32.353 --> 16:33.873about juggling patients in the gym.16:34.513 --> 16:35.474I want them focused on the16:35.614 --> 16:36.934one patient in front of them.16:36.954 --> 16:37.194That's it.16:37.751 --> 16:38.491Let me ask you this as16:38.511 --> 16:40.532someone who does two different things,16:40.612 --> 16:40.752right?16:40.772 --> 16:41.932Because you're treating16:41.952 --> 16:42.913patients and you're also16:42.953 --> 16:43.593someone who runs an16:43.633 --> 16:44.893organization that treats a16:45.333 --> 16:45.974volume of patients.16:45.994 --> 16:46.954You have clinicians under you.16:47.854 --> 16:49.074What do you personally find16:49.375 --> 16:50.255more gratifying?16:50.375 --> 16:51.855Is it direct patient care?16:51.875 --> 16:52.556You have to answer.16:52.576 --> 16:54.136You can't say you love both16:54.156 --> 16:55.897of your kids the most, right?16:55.977 --> 16:56.257Got it.16:56.477 --> 16:56.637Okay.16:57.757 --> 16:58.977One-on-one care or now that16:58.997 --> 16:59.798you get to do this thing,16:59.818 --> 17:01.078which is run a business,17:01.518 --> 17:01.998where do you find,17:02.038 --> 17:03.819where do you get more gratification?17:06.673 --> 17:07.194At this point,17:07.214 --> 17:08.014I'd probably get more17:08.054 --> 17:10.397gratification running the business,17:10.437 --> 17:11.078but I'm going to give you17:11.098 --> 17:12.019the caveat of that,17:12.219 --> 17:13.180and that is helping to17:13.300 --> 17:14.381mentor my clinicians.17:14.801 --> 17:15.202That's great.17:16.023 --> 17:16.343That's it.17:18.755 --> 17:20.356this is this is my ethos17:20.396 --> 17:21.537that I live by running this17:22.458 --> 17:23.859and it is please the end17:23.959 --> 17:25.560user for me my end user is17:25.580 --> 17:27.321my staff right some of that17:27.361 --> 17:28.402is my patients when I put17:28.462 --> 17:30.144on just my pt hat and I go17:30.164 --> 17:31.905out and treat but my17:32.205 --> 17:33.526biggest hat is being the17:33.846 --> 17:35.628ceo and owner and my end17:35.708 --> 17:37.829user is my staff so how do17:37.889 --> 17:39.270I keep my staff happy and17:39.310 --> 17:41.312engaged and that's by17:41.372 --> 17:42.393simplifying it for them17:43.683 --> 17:44.844That's it for my front desk.17:44.884 --> 17:46.885It's make this make this the17:47.045 --> 17:49.207best hour of everyone that you deal with.17:49.367 --> 17:50.288Make it the best hour of17:50.308 --> 17:51.468their day of their week.17:52.469 --> 17:52.669Right.17:52.709 --> 17:54.590And the rest of it will figure itself out.17:55.151 --> 17:56.212We'll be busier than you can17:56.232 --> 17:56.872shake a stick at.17:57.252 --> 17:58.293I think that's I think17:58.313 --> 17:59.074that's the way to do it.17:59.094 --> 18:00.895I think I think the first18:00.935 --> 18:03.517couple of times people heard that mindset,18:03.557 --> 18:04.617they were like, no, no, no.18:05.318 --> 18:06.579As an owner, patience first.18:07.403 --> 18:08.644But if you operate the way18:08.684 --> 18:09.484you just mentioned,18:10.245 --> 18:11.305that gets taken care of.18:11.526 --> 18:13.487Like step one is find great people, right?18:13.967 --> 18:14.988Number two is keep those18:15.028 --> 18:17.149people well taken care of.18:17.309 --> 18:18.310They will do the thing that18:18.330 --> 18:19.671you hired them to actually do.18:20.808 --> 18:21.649Right.18:23.010 --> 18:23.771Look at the best run18:23.831 --> 18:25.652companies in the world and that is it.18:25.853 --> 18:27.234They pour into their staff18:27.274 --> 18:28.275so that their staff has one18:28.295 --> 18:32.158thing to focus on and that's end user.18:32.519 --> 18:33.119Do your job.18:33.179 --> 18:34.861That's it.18:35.461 --> 18:37.103We're talking about the next generation.18:37.123 --> 18:37.883You mentioned the next18:37.923 --> 18:39.445generation of these PTs who18:39.465 --> 18:40.326might be listening right now.18:40.346 --> 18:41.467They're either in school or18:41.527 --> 18:42.628they're fresh out of school.18:42.648 --> 18:43.949We get a lot of DMs from18:45.570 --> 18:47.231from students who are still in undergrad,18:47.271 --> 18:48.032which is kind of cool.18:48.292 --> 18:50.073They're like, this is what I want to do.18:50.113 --> 18:51.694So I get excited about that.18:51.714 --> 18:53.755They're focused on PT so far away from it.18:53.775 --> 18:55.596So I want to ask a question for them.18:56.057 --> 18:57.317For those aspiring to18:57.377 --> 18:58.998eventually start their own practice,18:59.819 --> 19:01.580is it feasible for them now19:01.620 --> 19:02.941or in the near future to go19:03.081 --> 19:05.322solo and still work well19:05.382 --> 19:07.364with insurance companies starting out?19:07.464 --> 19:08.845So you've been doing this for a while.19:09.145 --> 19:10.185If someone were to start out,19:10.225 --> 19:12.047is it feasible for them to19:12.087 --> 19:12.647begin like that?19:14.306 --> 19:15.027I think you can,19:15.067 --> 19:15.967but you're fighting a big19:16.067 --> 19:17.288uphill battle at that point.19:18.489 --> 19:18.829For me,19:18.950 --> 19:20.371I'm partnered with an organization.19:20.551 --> 19:22.012I was in practice for seven19:22.052 --> 19:23.393years before I partnered in19:23.413 --> 19:24.614with a company called19:24.634 --> 19:25.655Health and Rehab Solutions,19:25.895 --> 19:27.956which is PT owned and PT run.19:28.016 --> 19:29.458So they've got PTs in all of19:29.498 --> 19:30.498the upper level spots.19:31.319 --> 19:32.920So they helped me to look at19:33.601 --> 19:34.621what are we doing well?19:34.722 --> 19:36.543Where are we losing patient visits?19:37.023 --> 19:38.244What are our outcomes doing?19:38.304 --> 19:39.325Where are we dropping off?19:39.505 --> 19:41.947And then how do you run a business better?19:42.427 --> 19:42.567Sure.19:44.013 --> 19:44.734Four years ago,19:44.754 --> 19:46.656you put a patient in front of me,19:46.717 --> 19:47.878and I'm going to get them better.19:48.339 --> 19:49.260I will figure that out.19:49.280 --> 19:50.241I can work through that.19:51.182 --> 19:52.384You put a business in front of me,19:52.524 --> 19:53.685and I will probably run it19:53.765 --> 19:54.346into the ground.19:56.148 --> 19:57.530I'm four years into this thing,19:58.621 --> 20:00.283And we're successful, we're thriving,20:00.363 --> 20:01.144we're making profit,20:01.184 --> 20:02.205and we're doing a great job.20:02.265 --> 20:03.506And my staff is happy.20:04.147 --> 20:04.988Life is good.20:05.048 --> 20:06.249Patients love coming here.20:07.110 --> 20:09.853We've got the culture that I20:09.933 --> 20:11.575set out to have that I20:11.635 --> 20:12.296didn't have at the20:12.356 --> 20:13.737organization that I was with before,20:13.757 --> 20:15.639where they didn't care about culture.20:16.000 --> 20:18.502It was, see patients,20:18.523 --> 20:19.564we don't care if you do a good job,20:19.604 --> 20:20.324just see more of them.20:21.701 --> 20:24.182Because that's the profit margin game.20:24.522 --> 20:24.862Correct.20:26.362 --> 20:27.622Which leads me to my next question.20:27.662 --> 20:28.963The last thing I wanted to touch on,20:29.003 --> 20:31.063which is how do you do that,20:31.723 --> 20:33.384is what are some levers20:33.424 --> 20:34.244that you can pull?20:34.304 --> 20:35.264What are some things that20:35.324 --> 20:37.144you can do as a clinician20:37.264 --> 20:39.205owner that you still keep20:39.245 --> 20:40.625the quality care high,20:40.885 --> 20:42.446which is why we started doing this thing.20:42.466 --> 20:43.166When we went to school,20:43.186 --> 20:43.906we did all those things.20:44.801 --> 20:47.102but avoid having to turn into that,20:47.242 --> 20:48.643and I'm gonna use air quotes on a podcast,20:48.663 --> 20:50.424which is PT mill while20:50.464 --> 20:51.404accepting insurance.20:51.744 --> 20:52.084And again,20:52.164 --> 20:53.185no one's been able to give me a20:53.225 --> 20:54.425definitive line in the sand20:54.445 --> 20:56.206of what makes a high volume,20:56.246 --> 20:57.467great quality clinic20:58.263 --> 21:00.545And when they tip over into milk, we can't,21:00.685 --> 21:01.646I don't know where that line is,21:01.706 --> 21:02.266but people are like,21:02.547 --> 21:03.487I know it when I see it.21:03.507 --> 21:04.668I'm like, okay, well,21:04.748 --> 21:06.049how do you flirt with that?21:06.129 --> 21:07.551How can you stay so high in21:07.591 --> 21:08.752terms of volume and care?21:09.252 --> 21:10.493Because volume means that21:10.533 --> 21:11.754your business is running21:11.794 --> 21:12.515well and you're able to21:12.555 --> 21:13.335take care of your people21:13.395 --> 21:14.656financially in other ways.21:15.377 --> 21:16.918And you're still treating lots of people,21:16.958 --> 21:17.719but treating them well.21:18.279 --> 21:19.160What are some things that21:19.200 --> 21:20.141you can do to set yourself21:20.181 --> 21:21.322up so you stay on the good21:21.402 --> 21:23.163side of that line of21:23.644 --> 21:25.065crossing over into a PT milk?21:26.078 --> 21:26.298Right.21:26.558 --> 21:29.361The big thing is like avoid21:29.381 --> 21:30.561the shiny things, right?21:30.581 --> 21:31.522Like when you're starting out,21:33.384 --> 21:35.165do you need a PT clinic and21:35.345 --> 21:36.826like a retail shopping center?21:37.387 --> 21:38.087Probably not.21:38.167 --> 21:39.588Like how many people got to21:39.608 --> 21:42.450your PT clinic because they drove by it?21:42.971 --> 21:43.211Right.21:44.012 --> 21:44.932Probably zero.21:45.493 --> 21:46.413Most of them were referred21:46.433 --> 21:47.694by their physician or they21:47.794 --> 21:49.195Googled you and they found21:49.215 --> 21:50.737your location and they drove there,21:51.317 --> 21:51.497right?21:51.617 --> 21:52.618Or their friends and family21:52.658 --> 21:53.299told it about it.21:54.124 --> 21:54.604whatever it is.21:55.045 --> 21:56.226They didn't drive by this21:56.286 --> 21:57.467busy intersection that's21:57.487 --> 21:59.228gonna cost you four times21:59.328 --> 22:00.249what you need in rent.22:00.970 --> 22:02.411And another hidden cost that22:02.431 --> 22:03.292people don't think about,22:03.832 --> 22:05.233if you go into a retail space,22:06.054 --> 22:07.055you gotta put a sign up.22:07.675 --> 22:08.656Signs are expensive.22:09.977 --> 22:11.399That's five grand right off22:11.439 --> 22:12.259of your budget from the22:12.299 --> 22:13.881startup to have a sign.22:14.821 --> 22:15.962I'm in an office building22:16.123 --> 22:17.143with a ton of parking22:18.001 --> 22:20.383People can walk in, find us really fast.22:21.043 --> 22:21.543It's easy.22:22.164 --> 22:23.905My power and water is paid22:23.965 --> 22:24.886for by my lease.22:25.086 --> 22:26.927I get janitorial included in this.22:27.687 --> 22:28.808Like I'm in a sweet spot.22:28.828 --> 22:30.309So avoid the shiny stuff.22:30.809 --> 22:31.690Like your patients don't22:31.730 --> 22:33.131care that in Denver,22:33.231 --> 22:34.612if you're on the 13th floor22:34.672 --> 22:36.073facing West with a great22:36.133 --> 22:37.113view of the Rocky mountains,22:37.694 --> 22:38.855they're here for 40 minutes.22:39.195 --> 22:39.535Right.22:40.636 --> 22:41.516I love when you come in and22:41.536 --> 22:42.377like have good care.22:42.788 --> 22:44.189I love that our conversation22:44.229 --> 22:46.050went from one side of the conversation,22:46.090 --> 22:47.732which it needs to be, which is like,22:47.812 --> 22:49.593how do we get paid more for22:49.653 --> 22:50.774the value we're providing?22:51.034 --> 22:51.794Value for value.22:52.575 --> 22:53.776And then you went to the other side,22:53.816 --> 22:54.817which is a lot of people22:54.857 --> 22:55.857will stay on that side of22:55.877 --> 22:57.559the conversation, which needs to be had.22:58.119 --> 22:59.080I think there are fewer22:59.120 --> 23:00.621people having that conversation.23:00.761 --> 23:01.361More and more,23:01.401 --> 23:02.942but it's still in the minority, which is,23:03.303 --> 23:04.383how do you lower your costs?23:04.704 --> 23:06.004Because by lowering your costs,23:06.045 --> 23:07.906you're actually ending with more money.23:08.697 --> 23:09.558which you're able to then23:09.618 --> 23:11.339reinvest in people and the business.23:11.719 --> 23:13.841So I think avoid the shiny things is gold.23:14.662 --> 23:14.842Yeah.23:15.082 --> 23:15.903Do you need a tech?23:16.383 --> 23:17.684Well, probably not.23:18.185 --> 23:20.066Make your PTs fold towels and pillowcases.23:21.067 --> 23:22.808Like when you have downtime,23:23.209 --> 23:25.050go fold some laundry, right?23:25.471 --> 23:27.192Everybody can answer a phone, right?23:27.212 --> 23:27.892Like you don't need to have23:27.933 --> 23:28.693two receptionists.23:29.194 --> 23:29.434Right.23:30.254 --> 23:30.815One receptionist,23:30.855 --> 23:32.056have your PTs answer the phone.23:33.537 --> 23:33.917Yeah.23:35.692 --> 23:37.874What's one more that someone23:37.914 --> 23:39.835maybe beginning in a23:39.895 --> 23:41.337business or thinking about23:41.357 --> 23:42.458it might not see?23:42.498 --> 23:43.579I think avoid the shiny23:43.599 --> 23:45.561things is already their23:45.861 --> 23:47.422head and shoulders above the rest.23:48.603 --> 23:49.504Yeah.23:50.065 --> 23:50.605The other one,23:51.006 --> 23:53.068and I struggled with this early on,23:53.828 --> 23:56.050was just watch your hiring efficiency.23:56.691 --> 23:56.851Okay.23:58.590 --> 24:02.933So early on, and mind you,24:02.993 --> 24:04.734I opened January of 2020.24:04.734 --> 24:07.896So like, best time ever to open a business,24:07.916 --> 24:08.037right?24:08.057 --> 24:09.237You're like, what could go wrong?24:09.297 --> 24:10.658And then 2020 was like, I don't know,24:10.678 --> 24:11.279hold my beer.24:12.039 --> 24:12.560Yeah, right?24:12.600 --> 24:13.080Like, hey,24:13.420 --> 24:14.621do you want to get kicked in the teeth?24:14.861 --> 24:16.402Like, yeah, sure.24:16.442 --> 24:17.223Let me sign up for that.24:18.003 --> 24:20.965So early on, right?24:20.985 --> 24:23.147Like I felt like I got busy24:23.347 --> 24:24.988as the clinician, right?24:25.008 --> 24:26.149Like I was treating full time.24:26.189 --> 24:27.150I was doing marketing, right?24:28.095 --> 24:28.735All of this stuff.24:28.775 --> 24:29.676And I felt like I was24:29.716 --> 24:31.457getting busy and I had a24:31.477 --> 24:33.037past student of mine that24:33.057 --> 24:33.938had just graduated.24:34.218 --> 24:34.878He's awesome.24:34.998 --> 24:36.419Like I knew from the start24:36.459 --> 24:37.379when he was a student of24:37.399 --> 24:39.660mine in my last job that I24:39.700 --> 24:41.001wanted this guy on my team.24:41.661 --> 24:43.242And so he had graduated.24:43.322 --> 24:44.502We delayed it a little bit24:44.522 --> 24:45.883because we weren't quite there.24:45.923 --> 24:46.723And then all of a sudden we24:46.763 --> 24:47.804kind of got there and I was like,24:47.984 --> 24:49.285all right, I'm going to give you a job.24:50.285 --> 24:51.325Hired and paid him more24:51.365 --> 24:52.326money than I was paying me.24:52.346 --> 24:55.287And we just weren't busy for24:55.327 --> 24:55.908the two of us.24:56.648 --> 24:56.828Right.24:57.839 --> 24:59.180It worked out like a month24:59.240 --> 25:00.721into it that my front desk left.25:01.442 --> 25:02.443So I just became the front25:02.463 --> 25:03.884desk guy again for three25:03.924 --> 25:05.165months and let him treat patients.25:05.245 --> 25:07.827So you gotta be able to sit25:07.907 --> 25:09.909in times when you feel like you're busy,25:10.149 --> 25:11.550where it almost feels like25:11.570 --> 25:12.191you're in a mill.25:12.811 --> 25:13.632Like I don't ever wanna,25:13.732 --> 25:15.073I don't wanna throw that word out either,25:15.413 --> 25:15.894just like you.25:17.435 --> 25:19.316like yours your schedule25:19.336 --> 25:21.297should be full right some25:21.337 --> 25:22.237of our things that I want25:22.277 --> 25:23.658my therapist to like find25:23.698 --> 25:25.779value in is that their25:25.819 --> 25:26.900schedule should be full25:27.380 --> 25:28.420they should have patients25:28.580 --> 25:29.861on their schedule all day25:29.981 --> 25:30.581they don't need to be25:30.621 --> 25:32.062double booked but their25:32.082 --> 25:32.823schedule should be full25:32.863 --> 25:33.543because that means that25:33.563 --> 25:34.904they are doing a really25:34.944 --> 25:36.064good job right their25:36.084 --> 25:37.365patients want to show up to25:37.405 --> 25:38.605see them they're referring25:38.645 --> 25:39.646friends and family to them25:40.410 --> 25:41.992the our referral sources our25:42.032 --> 25:43.254physicians in the community25:43.334 --> 25:44.756know who they are and25:44.796 --> 25:45.977they're referring patients25:46.097 --> 25:47.659to those therapists not to25:47.699 --> 25:48.861resolute physical therapy25:48.921 --> 25:51.104not to alex at resolute but25:51.144 --> 25:52.265they're referring them to25:52.305 --> 25:54.548alyssa and to kelly and so25:54.928 --> 25:56.831that's who they they should25:56.891 --> 25:59.294strive to have a busy day right25:59.963 --> 26:01.023But I think what you're26:01.063 --> 26:02.284really highlighting is,26:03.464 --> 26:04.365and I don't love car26:04.405 --> 26:05.325analogies all the time,26:05.345 --> 26:06.125but this feels good.26:06.165 --> 26:07.686Like if you drive a manual transmission,26:07.706 --> 26:09.366it's like, don't shift too early.26:09.466 --> 26:10.707Don't shift into a higher26:10.767 --> 26:12.887gear before you actually26:12.988 --> 26:14.228need it because you might stall out.26:15.063 --> 26:15.263yeah,26:15.363 --> 26:16.745you'll just sort of drag and putter26:16.785 --> 26:17.566along at that point.26:17.626 --> 26:21.350So like, and I think me as the owner and,26:21.550 --> 26:23.051you know, de facto clinic director,26:23.111 --> 26:23.312right?26:23.952 --> 26:24.713When we start getting to26:24.753 --> 26:25.794that point where everybody26:25.834 --> 26:26.855starts to feel busy,26:27.496 --> 26:28.717sometimes we just sit in that.26:29.258 --> 26:31.040And I'm very clear about what that means.26:31.080 --> 26:31.680It's like, God's,26:32.341 --> 26:33.241We're doing really good.26:33.261 --> 26:35.462I know everybody, it feels busy right now.26:36.023 --> 26:36.963We're going to just sit in26:37.003 --> 26:38.524this and let's ride it for26:38.544 --> 26:40.525a minute and let's see what this does.26:41.065 --> 26:41.985I'm not scared to hire26:42.005 --> 26:43.746someone if the time is right.26:44.326 --> 26:45.267But just because we get a26:45.307 --> 26:46.627little pop in business here26:46.667 --> 26:47.808and a pop in business there,26:48.828 --> 26:49.749is that sustainable?26:50.029 --> 26:51.610Can we operate there for a little while?26:52.597 --> 26:52.797Right.26:53.197 --> 26:53.357And if,26:53.838 --> 26:55.158if it makes us really profitable26:55.719 --> 26:56.599and we start taking home26:56.639 --> 26:57.980some profit as an owner,26:58.000 --> 26:59.761I will reinvest that.27:00.001 --> 27:01.242Like, let's go do something fun.27:02.062 --> 27:04.484Let's like, let's bonus you guys out.27:04.544 --> 27:05.804You guys crushed it for like27:06.365 --> 27:08.546eight weeks and now we27:08.566 --> 27:09.506hired someone new and now27:09.586 --> 27:10.487everybody can go back to27:10.547 --> 27:11.387being just a little bit27:11.427 --> 27:12.928light when we get this new27:12.988 --> 27:13.989one on and we ramp them up.27:15.410 --> 27:16.731I think this goes back to, you know,27:16.751 --> 27:17.992what Marcus Limonis and I27:18.052 --> 27:19.614referenced you from Marcus Limonis,27:19.634 --> 27:21.295the prophet from MSNBC.27:21.615 --> 27:22.236Great show.27:22.736 --> 27:23.717And he's number one.27:23.737 --> 27:24.638He's like, know your numbers.27:25.419 --> 27:26.139So if you're able to know27:26.159 --> 27:27.540your numbers and I guess27:27.560 --> 27:28.701the longer you do stuff,27:28.741 --> 27:30.323the longer you more data27:30.343 --> 27:31.644you have to predict, like, hey,27:31.684 --> 27:33.425we've seen this kind of a spike before.27:33.626 --> 27:33.706Oh,27:33.746 --> 27:36.228we've never seen this kind of a spike27:36.268 --> 27:36.568before.27:36.628 --> 27:38.350Maybe this does require a27:38.390 --> 27:39.491shift into a higher gear.27:39.551 --> 27:40.632So it's paying attention to27:42.745 --> 27:43.526The KPIs.27:43.566 --> 27:44.366I was having a talk with27:44.386 --> 27:45.467someone the other day and they were like,27:45.547 --> 27:46.928I have 27 KPIs.27:47.068 --> 27:48.890I'm like, you know the first word,27:49.050 --> 27:51.452the first letter in KPI is key, right?27:51.732 --> 27:53.273You can't have 27 key27:53.333 --> 27:54.795performance indicators, right?27:55.215 --> 27:55.935So understanding your27:55.955 --> 27:56.496numbers and what they27:56.576 --> 27:58.618actually mean sounds like27:58.838 --> 27:59.999that's the best way to know28:00.539 --> 28:01.640when it's time to shift.28:02.561 --> 28:03.201Yeah, right.28:03.541 --> 28:05.143Your key performance indicators should be28:06.479 --> 28:08.460I don't know, four, maybe five,28:08.740 --> 28:09.780depending on how deep you28:09.800 --> 28:10.761want to go with that.28:10.781 --> 28:11.741Think of your car dashboard.28:11.761 --> 28:14.022I got RPMs, I got speed, I got gas,28:14.082 --> 28:15.443I got oil, I got temperature.28:16.003 --> 28:18.844Beyond that, I've got cognitive overload.28:18.864 --> 28:19.965And I think cognitive28:20.025 --> 28:21.125overload can translate to28:21.165 --> 28:21.966business as well.28:22.026 --> 28:22.986So ask yourself,28:23.066 --> 28:24.807what are the actual things28:25.407 --> 28:27.128that this dashboard or this28:27.168 --> 28:28.068information can teach me28:28.088 --> 28:29.609that I can actually use?28:30.570 --> 28:30.750Alex,28:30.770 --> 28:32.991are you ready to play a game called28:33.011 --> 28:33.531Three Questions?28:34.679 --> 28:35.140Absolutely.28:35.160 --> 28:35.620Let's do it.28:35.860 --> 28:37.041On the hot seat with three28:37.081 --> 28:38.823questions on the PT Pinecast.28:38.843 --> 28:39.043All right,28:39.063 --> 28:40.505three questions brought to you by ATI,28:40.545 --> 28:41.506leading the charge in PT28:41.526 --> 28:42.547clinical research with all28:42.547 --> 28:44.128900 clinics achieving top28:44.148 --> 28:46.090marks in CMS's merit-based28:46.130 --> 28:46.971incentive program.28:46.991 --> 28:48.552They're a team to join for career growth.28:48.632 --> 28:51.115Explore opportunities at atipt.com.28:51.815 --> 28:52.516All right,28:52.616 --> 28:54.077first question on three questions.28:54.958 --> 28:55.879outside of PT,28:56.379 --> 28:58.120and I mentioned you like craft beer.28:58.701 --> 29:00.222What's an unexpected hobby29:00.262 --> 29:01.343or interest that you might29:01.443 --> 29:02.743have that would surprise29:02.804 --> 29:04.044someone who didn't know you?29:04.244 --> 29:05.265What's something weird?29:08.067 --> 29:08.227Oh.29:10.309 --> 29:11.549This may not surprise a lot of people.29:11.630 --> 29:13.651I did home brew beer for a while.29:14.972 --> 29:16.053I got a little burned out on29:16.073 --> 29:17.353it because I wasn't very good at it.29:17.774 --> 29:19.655So as much as I like to drink beer,29:19.735 --> 29:21.276I could not brew beer very well.29:21.776 --> 29:22.477Yeah.29:23.080 --> 29:24.441And for those people who brew beer,29:24.722 --> 29:24.922you know,29:24.942 --> 29:25.883you just sort of end up with29:25.923 --> 29:27.024about 50 beers.29:27.444 --> 29:28.665And when you brew a batch29:28.685 --> 29:29.526and it's just not good,29:29.586 --> 29:31.548you got 50 not so good beers.29:31.848 --> 29:32.008Yeah.29:32.048 --> 29:32.529You got suffered.29:32.569 --> 29:33.270You don't want to share.29:33.610 --> 29:33.730Yeah.29:33.750 --> 29:35.251You don't want to share them with people.29:35.372 --> 29:38.014My wife won't drink them.29:38.054 --> 29:39.295Did you have fun and name them?29:39.335 --> 29:40.657Like, did you play with like funny names?29:41.958 --> 29:42.278Oh yeah.29:42.518 --> 29:42.719Yeah.29:42.759 --> 29:44.160We, uh, I had some good names.29:44.180 --> 29:45.861I'm trying to think I brewed a, uh,29:45.922 --> 29:47.263like a grapefruit IPA and I29:47.303 --> 29:48.364just called that the brunch beer.29:48.899 --> 29:49.339There you go.29:49.379 --> 29:49.579Yeah.29:49.659 --> 29:49.919Great.29:50.159 --> 29:50.379Yeah.29:50.399 --> 29:51.179Great for just stuff.29:51.219 --> 29:51.880And it's for brunch.29:52.260 --> 29:52.440Right.29:52.460 --> 29:52.580Yep.29:53.140 --> 29:57.380Uh, I brewed a basic bro.29:57.961 --> 29:59.721It was a, uh, pumpkin porter.30:00.601 --> 30:02.361So it was the basic bro, the label.30:02.421 --> 30:04.522I was like flannel, you know, I like it.30:05.382 --> 30:06.662That's kind of, let's,30:06.742 --> 30:07.802let's jump in a time machine.30:07.962 --> 30:08.782If you could have dinner30:08.802 --> 30:11.183with any three individuals from history,30:11.243 --> 30:11.883who would they be?30:11.963 --> 30:13.483Who's, who's on your radar?30:13.503 --> 30:13.943Like, Ooh,30:13.963 --> 30:15.503this person really interests me30:15.884 --> 30:17.704alive or dead time machine travel.30:17.744 --> 30:18.424Who's coming to dinner?30:19.594 --> 30:20.114Oh, that's great.30:20.414 --> 30:21.735Um, Kobe Bryant would be one of them.30:22.355 --> 30:22.975Yeah.30:23.175 --> 30:24.035Mama mentality.30:24.815 --> 30:25.055Yeah.30:25.195 --> 30:27.316Love to have a dinner with Kobe Bryant.30:27.436 --> 30:33.698I think, um, I think Teddy Roosevelt or no,30:33.798 --> 30:34.078sorry.30:34.378 --> 30:34.578Yeah.30:34.598 --> 30:36.658Teddy Roosevelt would be probably, um,30:37.158 --> 30:38.499yeah.30:38.759 --> 30:39.899Number two on my list.30:42.140 --> 30:42.360Um,30:43.920 --> 30:44.960I want to give something out of the30:45.040 --> 30:46.161music genre here.30:46.181 --> 30:46.221Um,30:50.729 --> 30:52.130I feel like Mick Jagger30:52.150 --> 30:53.911would be really fun at a dinner party,30:54.192 --> 30:56.193but that could go either way.30:56.353 --> 30:57.534That could be a disaster.30:57.574 --> 30:59.175Well, yeah, but I mean,30:59.255 --> 31:00.336it's going to be a story31:00.697 --> 31:01.497with Mick Jagger.31:02.218 --> 31:02.458Yeah.31:02.498 --> 31:03.679The stories would be great31:03.999 --> 31:07.682if he's coherent enough to.31:07.742 --> 31:08.903Honestly, even if he's not.31:09.103 --> 31:09.283All right.31:09.323 --> 31:10.504That's the second question.31:10.564 --> 31:11.224Third question.31:12.205 --> 31:12.926Desert Island.31:13.026 --> 31:14.107You're stranded out there.31:14.407 --> 31:16.028One book for company.31:16.308 --> 31:17.749What do you choose and why?31:17.789 --> 31:18.590What are you reading?31:18.650 --> 31:20.011If you're like, I got time on my hands.31:23.424 --> 31:25.026If I got time on my hands, man,31:25.066 --> 31:26.627I'm probably going to take31:26.667 --> 31:27.688a John Grisham novel.31:28.148 --> 31:29.850It's going to take me a year31:29.870 --> 31:30.911to get through that thing anyway.31:33.393 --> 31:35.474He was Pelican Brief, right?31:35.494 --> 31:36.095Was that Grisham?31:36.936 --> 31:37.696Yeah, I think so.31:37.716 --> 31:39.097Pelican Brief and Some of31:39.177 --> 31:41.339All Fears and Rainbow Six.31:41.419 --> 31:42.500No, that's Tom Clancy.31:43.101 --> 31:43.841Oh, Tom Clancy.31:44.342 --> 31:46.484Maybe shift that to Tom Clancy then.31:48.376 --> 31:51.499And I think Clancy was Air Force One.31:52.260 --> 31:53.782Grisham was more like courtroom,31:53.822 --> 31:56.545like Pelican Brief, Time to Kill.31:56.605 --> 31:57.986So yeah, Tom Clancy was great.31:58.206 --> 31:58.947And he spawned a bunch of31:58.967 --> 31:59.768really great video games.31:59.968 --> 32:01.070All right, you're off the hot seat.32:01.090 --> 32:01.870That's three questions.32:02.331 --> 32:03.712Last thing we do on the show32:03.872 --> 32:05.114is the parting shot.32:05.234 --> 32:06.836This is the parting shot.32:07.236 --> 32:08.017Parting Shot brought to you32:08.037 --> 32:08.597by our friends from the32:08.657 --> 32:09.718Academy of Orthopedic32:09.738 --> 32:11.540Physical Therapy with their32:11.800 --> 32:13.541fifth edition of current32:13.581 --> 32:15.583concepts of orthopedic physical therapy.32:15.843 --> 32:17.124This thing, the perfect roadmap,32:17.785 --> 32:18.685take you from wherever you32:18.825 --> 32:19.746are in your orthopedic32:19.786 --> 32:23.209career to maybe taking that OCS exam,32:23.229 --> 32:24.370to getting to the starting32:24.410 --> 32:25.811line of that OCS exam.32:26.371 --> 32:27.192Always up to date,32:27.352 --> 32:28.733created by the leaders in PT.32:29.154 --> 32:32.256OrthoPT.org is where you can find that.32:33.397 --> 32:34.638Alex, Parting Shot,32:34.658 --> 32:35.199what do you want to leave32:35.239 --> 32:35.739with the audience?32:35.759 --> 32:36.820What's your mic drop moment?32:38.892 --> 32:41.053Um, insurance is not evil.32:41.994 --> 32:42.094Um,32:42.474 --> 32:44.976and your patients deserve quality care.32:45.116 --> 32:46.337So, um,32:46.937 --> 32:48.558it's a flawed system that we're in.32:48.578 --> 32:48.618Um,32:49.779 --> 32:52.280but your patients and every patient32:52.400 --> 32:53.341perspective patient out32:53.361 --> 32:54.461there deserves the best32:54.541 --> 32:55.382quality of healthcare,32:55.442 --> 32:56.843whether they can afford you or not,32:57.783 --> 32:58.544they're already paying32:58.564 --> 32:59.504their insurance premium.32:59.564 --> 33:01.906So let's do a good job for our patients.33:01.986 --> 33:04.968And, you know, if you do that,33:05.308 --> 33:06.128then we can push back33:06.188 --> 33:07.109against insurance companies.33:07.435 --> 33:07.935There you go.33:07.996 --> 33:08.676It starts with that.33:08.696 --> 33:09.417All right.33:09.517 --> 33:11.018Every PT should know those33:11.138 --> 33:12.280things about thriving with33:12.340 --> 33:13.381insurance-based practice.33:13.481 --> 33:14.642Alex, appreciate your insight, man.33:14.682 --> 33:15.222Thanks for the time.33:15.903 --> 33:16.503Yeah, absolutely.33:16.523 --> 33:17.164Thanks for having me on.33:17.584 --> 33:18.065They say the best33:18.105 --> 33:19.606conversations happen at happy hour.33:20.127 --> 33:20.827Thanks for coming to ours.