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

WEBVTT 00:00.450 --> 00:03.135 Um, well, let's 3, 2, 1, start this thing. 00:09.265 --> 00:10.588 Alex, welcome to the program, man. 00:10.608 --> 00:11.269 I appreciate your time. 00:12.091 --> 00:12.772 Yeah, absolutely. 00:12.792 --> 00:13.273 Happy to be here. 00:14.135 --> 00:16.056 I'll give the audience some context. 00:16.276 --> 00:18.057 Alex is the mastermind 00:18.077 --> 00:19.817 behind Resolute Physical 00:19.837 --> 00:20.877 Therapy in Denver. 00:21.078 --> 00:22.698 So I'm bragging for him that 00:22.738 --> 00:24.279 he chose a pretty cool place to live. 00:24.739 --> 00:25.419 I'm a little jealous. 00:26.439 --> 00:28.460 Like me, he's a craft beer enthusiast. 00:28.800 --> 00:29.480 But not just that. 00:30.021 --> 00:31.421 A decade of expertise in 00:31.461 --> 00:32.501 private practice and a 00:32.582 --> 00:35.102 unique perspective on making healthcare, 00:35.122 --> 00:36.883 here's the big A word, accessible. 00:37.323 --> 00:38.123 We like that because if you 00:38.143 --> 00:39.284 can't access it, it doesn't matter. 00:40.244 --> 00:40.905 We're going to challenge 00:40.925 --> 00:42.486 your views today on a 00:42.626 --> 00:44.288 six-pack episode format. 00:44.628 --> 00:46.710 So one idea or prompt and 00:46.730 --> 00:49.192 then six actionable steps. 00:50.033 --> 00:51.754 And the idea here is we'll 00:51.774 --> 00:52.515 challenge your views on 00:52.575 --> 00:54.076 physical therapy and insurance. 00:54.116 --> 00:56.218 We'll actually say here's 00:56.278 --> 00:58.020 six things every PT should 00:58.060 --> 00:59.241 know about thriving. 00:59.801 --> 01:01.022 in insurance-based practice, 01:01.042 --> 01:02.163 which I feel like, Alex, 01:02.203 --> 01:03.924 I feel like everybody sort of dumps on it, 01:04.004 --> 01:04.164 right? 01:04.244 --> 01:06.325 Oh, insurance is the big angry thing, 01:06.365 --> 01:07.426 but like, it's not going anywhere. 01:07.446 --> 01:08.547 So you better like learn how 01:08.567 --> 01:09.527 to live with it and work 01:09.567 --> 01:10.748 within the system while 01:10.808 --> 01:12.389 someone else rages against the machine. 01:12.409 --> 01:13.170 I'm not saying raging 01:13.210 --> 01:15.031 against insurance is bad, but it's here. 01:15.091 --> 01:16.592 We need to learn how to navigate, right? 01:17.611 --> 01:18.292 Right, correct. 01:18.332 --> 01:18.672 Yeah, I mean, 01:18.732 --> 01:20.274 insurance is going to be a 01:20.314 --> 01:22.397 part of healthcare for the 01:22.417 --> 01:23.197 foreseeable future. 01:23.218 --> 01:23.698 I mean, 01:23.718 --> 01:25.140 there's a lot of things we'd love 01:25.160 --> 01:25.921 to change about that. 01:26.021 --> 01:26.982 But right now, 01:27.683 --> 01:30.486 this is the current scene that we're in. 01:31.147 --> 01:32.688 And how do you adapt and 01:32.728 --> 01:34.831 work within that scene and 01:34.851 --> 01:35.592 still do a good job, 01:35.952 --> 01:37.414 still give excellent patient care? 01:37.708 --> 01:37.988 listen, 01:38.088 --> 01:39.369 this is a system that's set up 01:39.390 --> 01:40.971 before I was born, before you were born, 01:41.051 --> 01:41.391 and it is. 01:41.972 --> 01:42.973 The patients didn't choose it. 01:43.073 --> 01:43.813 We didn't choose it. 01:44.194 --> 01:44.574 It is. 01:44.594 --> 01:45.815 I'm not saying, again, 01:45.955 --> 01:46.516 this thing shouldn't 01:46.616 --> 01:48.097 continue or not be changed, 01:48.418 --> 01:49.559 but how are we digging into 01:49.579 --> 01:50.880 this to figure out what we 01:50.900 --> 01:51.761 can do to make it? 01:51.961 --> 01:53.202 And again, I'll hit that A word. 01:54.063 --> 01:55.063 So let's start with the 01:55.504 --> 01:57.946 first idea in this six pack, Alex, 01:57.986 --> 01:59.107 which is start by just 01:59.147 --> 02:00.288 talking about the value. 02:00.348 --> 02:02.530 Let's talk about the value of therapists. 02:03.190 --> 02:04.071 And I want to stress, 02:04.151 --> 02:05.192 I say this a lot with 02:05.312 --> 02:06.513 companies or individuals. 02:07.074 --> 02:07.754 There is a difference 02:07.794 --> 02:09.056 between value and cost. 02:10.049 --> 02:10.949 There is a difference 02:10.989 --> 02:12.310 between value and cost. 02:12.890 --> 02:15.971 You, the therapist or the business owner, 02:16.331 --> 02:17.531 you determine price. 02:17.891 --> 02:18.752 The other person, 02:18.972 --> 02:20.952 the person you're hoping to work with, 02:21.112 --> 02:23.033 they determine the value in their head, 02:23.073 --> 02:23.913 in their heart, in their mind. 02:23.953 --> 02:25.594 So how do you define what 02:25.634 --> 02:27.934 PTs are truly worth with that V word, 02:27.954 --> 02:29.415 that value word in the 02:29.475 --> 02:30.395 healthcare profession? 02:30.455 --> 02:31.636 How do you do that? 02:32.656 --> 02:32.856 Right. 02:34.476 --> 02:34.857 First of all, 02:34.877 --> 02:36.457 I'd love to say I've got two 02:36.557 --> 02:37.477 staff physical therapists 02:37.517 --> 02:38.178 that work for me. 02:38.638 --> 02:39.318 I would love it. 02:40.003 --> 02:42.464 if I could pay both of them $100, 02:42.464 --> 02:43.584 000 a year, right? 02:44.384 --> 02:46.665 They are 100% worth it in my mind, 02:47.085 --> 02:48.486 the value that they provide. 02:49.426 --> 02:51.106 I think their patients see that too. 02:51.847 --> 02:52.887 They do an excellent job 02:52.907 --> 02:53.867 with patients because that 02:53.927 --> 02:56.848 is their only priority is patient care, 02:57.248 --> 02:57.408 right? 02:58.309 --> 02:59.549 That is what I have tasked 02:59.609 --> 03:01.630 them with from their job is 03:01.730 --> 03:03.190 who is your end user and 03:03.230 --> 03:03.930 that's your patient. 03:04.390 --> 03:05.471 I want you to do one thing 03:05.491 --> 03:06.391 and that's do a good job 03:06.411 --> 03:07.011 with that patient. 03:07.091 --> 03:08.912 So they have bought fully into that. 03:09.986 --> 03:11.228 I don't need them to worry 03:11.268 --> 03:13.070 about the productivity standard of that, 03:13.650 --> 03:16.353 of what it means to turn a 03:16.433 --> 03:18.195 profit in physical therapy land. 03:18.616 --> 03:20.278 That is my job as the business owner. 03:21.139 --> 03:23.902 Now, to the value side of that, 03:25.964 --> 03:27.626 the insurance company will determine 03:28.857 --> 03:30.078 or the payer, I guess, 03:30.118 --> 03:30.858 at the end of the day. 03:31.379 --> 03:32.239 Let's just call it that. 03:33.000 --> 03:35.041 For 85% of our patient mix, 03:35.521 --> 03:36.082 it's insurance. 03:36.822 --> 03:38.603 The insurance will determine, hey, 03:38.643 --> 03:39.644 this is how valuable we 03:39.704 --> 03:40.464 think that you are. 03:41.205 --> 03:42.526 And now that is where you 03:42.566 --> 03:43.586 start to get this evil 03:43.686 --> 03:45.367 empire view of insurance. 03:46.848 --> 03:47.789 They don't think that my 03:47.829 --> 03:50.891 therapists are worth $100,000. 03:50.891 --> 03:54.072 Or they may say stuff in public that says, 03:54.652 --> 03:56.372 yeah, physical therapy is super valuable. 03:56.412 --> 03:57.433 We love everything that you 03:57.473 --> 03:58.473 guys do for our members. 03:58.513 --> 03:59.553 You keep them out of having 03:59.613 --> 04:00.413 expensive surgery. 04:00.453 --> 04:01.774 You get them off of pain meds. 04:02.434 --> 04:03.634 You improve their function. 04:04.034 --> 04:04.874 You do a great job. 04:05.835 --> 04:08.135 Here's $55 for that visit. 04:08.495 --> 04:09.135 And we're only gonna 04:09.215 --> 04:10.276 authorize five of them. 04:11.196 --> 04:13.717 So you got five visits at 55 bucks. 04:14.737 --> 04:15.197 Good luck. 04:15.537 --> 04:16.537 You're super valuable and 04:16.557 --> 04:17.297 you're really good. 04:17.317 --> 04:18.218 We know you can do it. 04:18.318 --> 04:19.438 Give yourself a pat on the back. 04:20.768 --> 04:20.988 Right. 04:21.348 --> 04:24.509 So that's where you run into this thing. 04:24.629 --> 04:25.750 And I think that we need to 04:25.890 --> 04:27.090 shift where we put our 04:27.170 --> 04:29.751 value of are you trying to 04:29.811 --> 04:31.271 show value to the insurance company? 04:31.331 --> 04:32.492 Are you trying to show value 04:32.532 --> 04:33.332 to your patient? 04:37.333 --> 04:40.254 Where do you thrive there? 04:40.894 --> 04:43.275 For my physical therapist, hey, 04:43.615 --> 04:44.476 I want your patients to 04:44.516 --> 04:45.356 know that you're valuable. 04:46.397 --> 04:47.859 and I want you to know that 04:48.439 --> 04:49.000 I think that you're 04:49.040 --> 04:50.681 valuable and I will do my 04:50.802 --> 04:53.985 best to pay you the way 04:54.005 --> 04:54.645 that I think that you 04:54.686 --> 04:56.427 should be paid but I also 04:56.487 --> 04:57.388 let them see behind the 04:57.428 --> 04:59.270 curtain of hey this is what 04:59.290 --> 05:00.331 your insurance companies 05:00.832 --> 05:02.573 think that you're worth so 05:04.487 --> 05:05.528 I hope you guys understand 05:05.548 --> 05:07.229 that this is why I can't give you $100, 05:07.229 --> 05:08.189 000 a year. 05:08.569 --> 05:08.789 Right. 05:08.890 --> 05:10.170 Yeah. 05:10.290 --> 05:11.451 Somebody else smarter than 05:11.491 --> 05:12.471 me when I first started as 05:12.652 --> 05:15.253 a clinician set up this 05:16.774 --> 05:17.874 triangle on a dry erase 05:17.894 --> 05:19.395 board and they essentially 05:19.435 --> 05:20.896 explained it so well to me 05:21.096 --> 05:22.016 so that I could go out and 05:22.056 --> 05:23.197 explain it to other people. 05:23.257 --> 05:25.178 And I think it was that evil 05:25.218 --> 05:25.999 empire thing and I didn't 05:26.019 --> 05:26.979 know how to explain it. 05:27.699 --> 05:28.020 And then 05:28.880 --> 05:30.020 This person said, listen, 05:30.281 --> 05:31.261 here's how I explain it to 05:31.301 --> 05:34.162 patients is you you entered 05:34.202 --> 05:34.882 into an agreement, 05:34.922 --> 05:36.003 the patient and the payer 05:36.583 --> 05:37.843 where you said you're going 05:37.863 --> 05:38.964 to give X number of dollars 05:39.024 --> 05:40.985 per month for health insurance. 05:41.285 --> 05:41.885 And keep in mind, 05:42.005 --> 05:42.665 health insurance is 05:42.705 --> 05:43.646 different than health care. 05:44.366 --> 05:44.526 Right. 05:44.846 --> 05:45.466 Those are two different 05:45.486 --> 05:46.447 words and they're two different things. 05:46.907 --> 05:48.147 So you entered an agreement 05:48.447 --> 05:49.588 and there was piles and 05:49.628 --> 05:51.409 piles of paper that you got 05:51.449 --> 05:52.549 in the mail or a digital 05:52.569 --> 05:53.970 copy where it said how 05:54.010 --> 05:54.990 they'll figure out what they'll pay. 05:56.004 --> 05:57.104 You entered an agreement. 05:57.685 --> 05:59.805 I as the physical therapist was not there. 05:59.905 --> 06:00.766 That's not my agreement 06:01.266 --> 06:02.386 unless you as the physical 06:02.406 --> 06:03.307 therapist now enter and 06:03.327 --> 06:05.468 you're in network with that organization. 06:06.068 --> 06:07.328 And that's where I think we get it. 06:07.408 --> 06:10.469 I think that's the comforting thing. 06:10.629 --> 06:13.190 And the problem is you agreed to this. 06:13.571 --> 06:14.851 And the only way it changes 06:14.871 --> 06:16.272 is if the payer decides, 06:16.732 --> 06:18.432 let's pay these people more, 06:18.592 --> 06:19.333 which their job is. 06:21.078 --> 06:22.819 To keep that bottom line as 06:22.839 --> 06:23.720 strong as possible is to 06:23.760 --> 06:25.261 pay us as little as possible, right? 06:25.281 --> 06:26.542 And our job is to show more value. 06:26.582 --> 06:27.943 But when you sign the dotted line, 06:27.963 --> 06:28.824 you agree to that. 06:29.324 --> 06:31.045 And that's the thing that people have to, 06:31.506 --> 06:32.667 within healthcare and 06:33.527 --> 06:34.468 consumers of healthcare, 06:34.848 --> 06:35.829 either wrap their head around, 06:35.849 --> 06:37.210 which is this subjective view, 06:37.730 --> 06:41.733 unless the decision to pay money is yours, 06:41.753 --> 06:41.953 right? 06:42.867 --> 06:43.828 and you value me. 06:44.148 --> 06:45.149 And then we get to determine 06:45.169 --> 06:45.949 what that value is. 06:46.490 --> 06:47.150 So I think you're right, 06:47.190 --> 06:48.471 which is this triangle 06:48.511 --> 06:51.133 between three people or two people, 06:51.434 --> 06:53.135 patient, provider, and organization, 06:53.175 --> 06:53.875 which is a payer. 06:54.636 --> 06:56.397 And that is an organization. 06:56.417 --> 06:58.319 It's not a person having a 06:58.399 --> 06:59.520 subjective conversations, 06:59.560 --> 07:00.701 having very objective 07:00.781 --> 07:01.861 things because we sign on 07:01.881 --> 07:02.482 the dotted line. 07:03.323 --> 07:03.503 Right. 07:03.943 --> 07:04.303 Yeah, yeah. 07:04.403 --> 07:06.265 I mean, I'll give you a prime example. 07:06.345 --> 07:08.326 The Anthem Blue Cross Blue Shield building, 07:08.707 --> 07:11.529 their offices for the Colorado region, 07:12.893 --> 07:14.334 are right downtown and they 07:14.354 --> 07:15.855 take up an entire city block. 07:16.116 --> 07:18.678 So between 7th and 8th Avenue, 07:18.758 --> 07:19.899 between Broadway and Lincoln, 07:19.979 --> 07:23.221 it is a huge, like eight story building, 07:23.381 --> 07:24.622 downtown prime real estate. 07:25.263 --> 07:27.024 They don't pay the rent on 07:27.064 --> 07:28.085 that building every month 07:28.425 --> 07:29.086 by losing money. 07:29.466 --> 07:30.027 No, they don't. 07:30.187 --> 07:30.467 Correct. 07:30.787 --> 07:31.007 Right. 07:31.948 --> 07:33.489 Their job is to take in X 07:33.689 --> 07:34.790 and then pay out less than 07:34.910 --> 07:36.831 X and less than X enough 07:36.851 --> 07:38.072 that they can pay their 07:38.132 --> 07:40.114 people and their 07:40.214 --> 07:40.954 stockholders or 07:40.974 --> 07:42.355 shareholders and their rent 07:42.395 --> 07:43.296 and all those different things. 07:43.756 --> 07:44.857 So that is the way it works. 07:45.197 --> 07:45.418 All right. 07:45.798 --> 07:47.499 So so let's move to the second idea. 07:47.939 --> 07:49.661 So do you think insurance 07:50.041 --> 07:51.782 companies or this, you know, 07:51.802 --> 07:53.403 I'm asking you to like forecast, 07:53.604 --> 07:54.364 which is great if you're a 07:54.384 --> 07:55.205 meteorologist because you 07:55.225 --> 07:56.185 can be wrong like 60 07:56.185 --> 07:56.986 percent of the time and 07:57.006 --> 07:57.927 still have a job and be fine. 07:58.667 --> 08:00.268 um where do you think this 08:00.328 --> 08:01.609 is going you know you've 08:01.629 --> 08:02.669 been you've been in you 08:02.689 --> 08:03.690 know a clinician for 10 08:03.690 --> 08:05.571 years do you think this is 08:05.631 --> 08:06.532 trending in a positive 08:06.632 --> 08:07.772 negative direction and then 08:07.832 --> 08:08.893 what do we need to do to 08:08.913 --> 08:10.414 maybe change this in our 08:10.494 --> 08:11.655 favor and by our I mean the 08:11.695 --> 08:12.395 patient and the provider 08:13.952 --> 08:16.713 um I i want to I want to 08:16.853 --> 08:18.314 start that and shift it one 08:18.354 --> 08:20.475 spot first I think I think 08:20.515 --> 08:22.796 the profession is heading 08:22.856 --> 08:24.216 in a ultimately positive 08:24.236 --> 08:25.997 direction with this new 08:26.057 --> 08:27.538 wave of clinicians that are 08:28.258 --> 08:29.739 more apt to push back 08:29.819 --> 08:31.059 against insurance companies 08:31.139 --> 08:33.340 versus maybe the generation 08:33.360 --> 08:34.761 of clinicians before me 08:35.581 --> 08:36.741 that were happy to just have 08:36.761 --> 08:38.662 a contract and they were 08:38.702 --> 08:41.083 happy to treat 20 visits a 08:41.143 --> 08:43.304 day and use techs and use a 08:43.344 --> 08:44.104 lot of modalities and 08:44.144 --> 08:45.165 passive treatment to just 08:45.345 --> 08:46.185 get through the day. 08:47.385 --> 08:48.646 This new wave of clinicians 08:49.166 --> 08:51.527 is more apt to show their 08:51.587 --> 08:54.028 value to insurance companies. 08:54.688 --> 08:56.889 so if I had to if I wanted 08:56.909 --> 08:58.069 to forecast in the most 08:58.129 --> 08:59.350 positive light I would put 08:59.390 --> 09:00.690 it in that context that 09:01.150 --> 09:02.331 this new wave of clinicians 09:02.471 --> 09:03.671 is going to fight harder 09:03.711 --> 09:04.712 than every generation 09:04.752 --> 09:06.212 before me ever fought and 09:06.232 --> 09:07.653 that's the only way it will 09:07.693 --> 09:09.433 change you in my opinion 09:09.473 --> 09:10.914 you can't have one crazy 09:10.954 --> 09:11.814 person standing on the 09:11.854 --> 09:12.834 corner shouting and the 09:12.894 --> 09:13.715 rest of the people going I 09:13.755 --> 09:14.815 agree with you but I'm just 09:14.855 --> 09:16.256 going to go along because 09:16.956 --> 09:18.396 until there's a danger of 09:18.436 --> 09:20.537 that organization not being 09:20.577 --> 09:21.798 able to provide something 09:21.818 --> 09:22.538 that's in writing 09:23.604 --> 09:24.184 It won't change. 09:24.204 --> 09:24.685 I don't know what the 09:24.745 --> 09:25.725 percentage of that is, 09:26.185 --> 09:27.926 but I am encouraged by how 09:28.766 --> 09:29.807 the next generation or 09:29.847 --> 09:31.848 several generations of not just PTs, 09:31.888 --> 09:34.569 but people, these generations we get, 09:34.589 --> 09:35.810 you know, we like to mock, right? 09:35.870 --> 09:35.990 Like, 09:36.010 --> 09:37.170 cause we're always the older 09:37.210 --> 09:38.951 generation saying, well, these kids today, 09:38.971 --> 09:40.892 I am excited about how they just, 09:41.052 --> 09:41.492 they sort of, 09:41.572 --> 09:42.633 they look at everything with 09:42.673 --> 09:43.873 a really discerning eye and go, yeah, 09:43.893 --> 09:44.313 I don't like that. 09:44.333 --> 09:45.194 I'm just not going to do it. 09:45.774 --> 09:47.074 And some people look at that and they go, 09:47.354 --> 09:47.494 well, 09:47.514 --> 09:48.555 these kids don't know how to just 09:49.055 --> 09:49.955 buckle up and get along. 09:49.975 --> 09:50.575 I go, good. 09:50.975 --> 09:51.995 We've been teaching them that. 09:52.276 --> 09:53.676 Question everything, except for me. 09:54.056 --> 09:54.756 Question everything, 09:54.836 --> 09:55.976 except for the thing that we know. 09:56.497 --> 09:57.657 Question everything means everything. 09:58.677 --> 09:59.617 Yeah, right. 09:59.637 --> 10:00.337 And I think you're starting 10:00.357 --> 10:01.718 to see some of that of even 10:01.758 --> 10:03.798 from the academia side of this, 10:04.118 --> 10:06.319 of the professors that have 10:06.339 --> 10:08.119 been in academia for so long, 10:08.379 --> 10:10.840 they're now sort of phasing out of 10:12.017 --> 10:13.958 the academia part and you're 10:14.058 --> 10:16.158 getting younger clinicians 10:16.198 --> 10:17.659 who have seen this and they 10:17.699 --> 10:18.999 have seen how stagnant the 10:19.039 --> 10:19.879 reimbursement rates have 10:19.919 --> 10:22.500 been for two decades, right? 10:22.560 --> 10:23.880 And you're saying, hey, 10:23.920 --> 10:25.061 the cost of living is going 10:25.121 --> 10:25.741 up everywhere. 10:26.041 --> 10:27.781 The cost of goods is going up everywhere. 10:28.622 --> 10:29.962 And our PTs can't afford to 10:30.042 --> 10:32.603 live without a roommate, right? 10:32.623 --> 10:33.903 Like they are doctorally 10:34.043 --> 10:35.864 educated clinicians who are 10:36.024 --> 10:37.304 experts at their craft and 10:37.324 --> 10:37.944 they have to have a 10:38.044 --> 10:39.485 roommate to live in a major 10:39.525 --> 10:40.405 metropolitan area. 10:41.121 --> 10:42.402 whether that's Denver or 10:42.462 --> 10:45.265 Dallas or anywhere, anywhere, 10:45.345 --> 10:46.046 they've got to get a 10:46.086 --> 10:47.267 roommate as a new grad. 10:47.947 --> 10:49.689 And it's, that's terrible. 10:49.729 --> 10:51.130 That is a sad state. 10:52.431 --> 10:53.673 The profession, right? 10:54.093 --> 10:54.754 Yeah, it is. 10:54.954 --> 10:55.434 You're not wrong. 10:55.855 --> 10:56.715 So let me ask you this. 10:56.956 --> 10:58.697 Let's go to the other side, right? 10:59.138 --> 11:00.919 Why should a PT choose to 11:00.959 --> 11:02.661 work with insurance companies? 11:02.881 --> 11:02.981 Right. 11:03.001 --> 11:03.662 There's got to be some 11:03.742 --> 11:05.423 benefit where we're not forced. 11:05.463 --> 11:07.225 There's no gun to our head to do this. 11:07.825 --> 11:07.985 You know, 11:08.025 --> 11:09.246 why should a PT choose to work 11:09.287 --> 11:10.107 with insurance companies, 11:10.227 --> 11:11.068 even in this environment 11:11.088 --> 11:14.111 where we feel like we're undervalued? 11:14.151 --> 11:15.272 Why would we choose to do that? 11:16.172 --> 11:16.353 Right. 11:17.373 --> 11:18.594 The simple answer to that is 11:20.756 --> 11:21.717 you should strive to get 11:21.757 --> 11:23.298 your value from helping people. 11:24.356 --> 11:25.657 That's why every single 11:25.697 --> 11:26.517 physical therapist that I 11:26.577 --> 11:27.918 know got into the field. 11:28.638 --> 11:29.919 It wasn't to be rich. 11:29.999 --> 11:31.900 None of us never thought 11:31.920 --> 11:33.241 that we were going to be rich. 11:33.961 --> 11:36.563 The deal was, you want to help people, 11:36.663 --> 11:38.283 you want to put your skills to the test, 11:38.904 --> 11:39.484 and you want to help as 11:39.524 --> 11:41.145 many people as you can to move better, 11:41.165 --> 11:42.586 to feel better, to live life better. 11:43.466 --> 11:43.666 Right. 11:43.786 --> 11:45.327 So the way that you do that 11:45.367 --> 11:47.848 is because 85 percent of 11:47.908 --> 11:49.128 your patient population is 11:49.188 --> 11:51.249 going to use insurance and 11:51.289 --> 11:52.289 they've already paid for it. 11:52.349 --> 11:54.210 They've paid for their health insurance. 11:54.890 --> 11:55.811 So they want to use that 11:55.891 --> 11:57.591 insurance to get health care. 11:58.412 --> 12:00.312 There are a handful of 12:00.332 --> 12:01.973 people out there who will 12:02.013 --> 12:02.953 pay no matter what. 12:03.293 --> 12:04.334 And they'll just say, hey, 12:04.474 --> 12:06.114 it's it's super valuable to 12:06.155 --> 12:07.515 me to get the best level of care. 12:08.315 --> 12:09.896 So I'll go pay out of pocket for it. 12:10.475 --> 12:10.695 Great. 12:10.855 --> 12:12.237 That person still has health 12:12.277 --> 12:13.397 insurance that they're paying for. 12:15.359 --> 12:16.880 So could you do both? 12:17.281 --> 12:18.482 Could you give them the best 12:18.522 --> 12:19.182 patient experience? 12:19.222 --> 12:20.243 Could you get them the best 12:20.283 --> 12:22.265 level of care and take the 12:22.325 --> 12:23.606 insurance that they've already paid for? 12:24.707 --> 12:24.967 Sure. 12:25.227 --> 12:26.669 That's the sweet spot that 12:26.709 --> 12:28.390 we should strive to find is 12:29.291 --> 12:31.012 how can you help the most 12:31.032 --> 12:31.473 number of people, 12:31.553 --> 12:32.934 not just the people who can afford you. 12:36.757 --> 12:38.398 Also, like we said earlier, 12:38.658 --> 12:39.839 health insurance isn't going anywhere. 12:40.239 --> 12:42.080 You're going to have to have it. 12:42.100 --> 12:42.841 When I was 26, 12:42.841 --> 12:44.182 I used to make the argument of, well, 12:44.202 --> 12:45.703 I'm a healthy 26-year-old. 12:46.083 --> 12:47.364 What do I need health insurance for? 12:47.704 --> 12:50.166 It's like, well, it's one of those things. 12:51.527 --> 12:52.868 You want to need it and not have it? 12:53.268 --> 12:54.610 Or you don't need it and not have it? 12:54.630 --> 12:56.311 You'd rather have it and not need it. 12:56.751 --> 12:57.352 You don't want to think 12:57.432 --> 12:59.354 halfway when you fall off your bike, 12:59.374 --> 13:00.254 when you're halfway to the ground, 13:00.274 --> 13:01.395 I should have put the helmet on. 13:01.415 --> 13:02.917 That's the worst time to be 13:02.957 --> 13:03.597 thinking about that. 13:03.617 --> 13:04.878 So I understand the need for it. 13:05.339 --> 13:06.880 I think what we're all talking about, 13:06.900 --> 13:08.161 especially from the provider side, 13:08.241 --> 13:11.464 is we're an integral part of this system, 13:11.644 --> 13:12.244 we've been told. 13:12.725 --> 13:13.786 We've been said by everybody. 13:13.806 --> 13:14.606 Everybody values us. 13:14.626 --> 13:14.707 Yeah. 13:15.407 --> 13:17.128 It is that subjective to objective, 13:17.148 --> 13:18.088 which is like you say we're 13:18.148 --> 13:18.929 super valuable. 13:19.509 --> 13:21.450 What is super valuable mean to you? 13:21.510 --> 13:22.550 Because I have an opinion on 13:22.590 --> 13:23.611 super value and you have an 13:24.031 --> 13:25.132 opinion on super value. 13:25.152 --> 13:26.492 We see that to come to an 13:26.552 --> 13:28.193 agreement or there's going 13:28.213 --> 13:29.714 to be this imbalance of we 13:29.734 --> 13:31.255 don't like the way this is going. 13:31.295 --> 13:32.175 And then I don't know. 13:32.235 --> 13:32.855 Hopefully there's something 13:32.875 --> 13:33.816 that that's changed. 13:33.876 --> 13:35.377 But that's the thing is 13:35.437 --> 13:36.217 right now I feel like we're 13:36.257 --> 13:36.997 in a situation where 13:37.017 --> 13:38.258 there's there's no checks 13:38.298 --> 13:40.219 and balances is we the only 13:40.299 --> 13:41.980 vote we have is to is to be 13:42.060 --> 13:43.380 in the system or out of the system. 13:43.600 --> 13:44.541 That's it's like binary. 13:45.413 --> 13:45.573 Right. 13:46.594 --> 13:48.074 I'll give you one that's not 13:48.134 --> 13:49.995 quite binary that might fit into that. 13:50.616 --> 13:52.136 So say you stay in network 13:52.336 --> 13:53.357 with an insurance payer 13:53.677 --> 13:55.598 that is your low payer, right? 13:55.838 --> 13:57.019 They give you a low contract, 13:57.919 --> 13:59.040 but they're a major player 13:59.600 --> 14:01.321 in the insurance landscape, right? 14:01.461 --> 14:03.162 So you go back to them and 14:03.202 --> 14:05.363 you start your negotiations with like, 14:06.443 --> 14:06.703 hey, 14:07.043 --> 14:08.244 that number that you're paying us per 14:08.264 --> 14:09.204 visit is really low. 14:09.305 --> 14:10.645 It's really hard for us to 14:10.765 --> 14:11.426 operate on that. 14:13.049 --> 14:13.389 It makes us, 14:13.649 --> 14:14.970 it makes it tough to see 14:15.010 --> 14:16.030 patients at that number. 14:16.670 --> 14:17.751 And they say, well, you know, 14:17.811 --> 14:18.931 tough deal with it. 14:19.111 --> 14:19.732 That's what we pay. 14:20.252 --> 14:21.192 That's what your agreement is. 14:22.052 --> 14:22.272 Okay. 14:23.133 --> 14:24.133 I understand where you're coming from. 14:24.193 --> 14:25.133 You have no position to 14:25.173 --> 14:26.914 negotiate a higher rate for me. 14:27.854 --> 14:28.755 We've provided you with our 14:28.815 --> 14:29.415 outcome measures. 14:29.455 --> 14:30.095 We provide you with 14:30.135 --> 14:30.976 long-term data saying that 14:30.996 --> 14:32.416 we're getting patients better, faster. 14:33.216 --> 14:34.497 We're at the top for us. 14:34.537 --> 14:35.877 We're at the top 8% of all 14:35.937 --> 14:36.798 outcome measures across 14:36.838 --> 14:38.138 like all wet BT users. 14:38.458 --> 14:38.958 So that's great. 14:39.278 --> 14:39.999 We're doing pretty good. 14:40.259 --> 14:40.439 Right. 14:41.192 --> 14:41.812 You would think that that 14:41.852 --> 14:42.753 would give us a really good 14:42.793 --> 14:44.394 leg to stand on to negotiate. 14:45.414 --> 14:47.675 Well, the next thing that we do is we say, 14:48.716 --> 14:48.996 okay, 14:49.336 --> 14:51.397 we're not going to accept your members. 14:51.417 --> 14:53.798 We're not going to give them 14:53.838 --> 14:54.919 priority on our schedule. 14:56.468 --> 14:57.868 For whatever insurance payer that is, 14:57.908 --> 14:58.668 we just say, okay, 14:58.688 --> 14:59.369 we're only going to 14:59.409 --> 15:00.709 schedule one if we have an 15:00.829 --> 15:02.169 opening last minute. 15:02.569 --> 15:03.229 We'll put them on a wait 15:03.249 --> 15:04.269 list and just say like, hey, 15:04.930 --> 15:06.210 we don't have any openings right now, 15:06.450 --> 15:07.270 but we'll call you if we 15:07.290 --> 15:08.050 have something open up. 15:08.270 --> 15:08.550 Otherwise, 15:08.570 --> 15:11.311 we can get you scheduled three weeks out. 15:12.031 --> 15:14.191 Then you go back to that payer and you say, 15:14.231 --> 15:16.192 hey, over the last three months, 15:17.392 --> 15:20.192 we decreased your members 15:20.232 --> 15:22.113 volume by 90 percent, 15:22.133 --> 15:23.233 so your members weren't 15:23.273 --> 15:24.393 being seen at our clinic. 15:25.239 --> 15:26.320 So they're on a wait list. 15:26.360 --> 15:27.120 They're not happy. 15:27.180 --> 15:27.740 They're having to go 15:27.780 --> 15:28.601 somewhere else that gives 15:28.641 --> 15:29.841 them less quality of care. 15:30.942 --> 15:32.743 Would you like to renegotiate that now? 15:34.183 --> 15:35.544 And we'll get your members back in. 15:35.904 --> 15:36.764 Do they care, though, 15:36.804 --> 15:37.865 because they're saying, great, 15:37.885 --> 15:40.626 you saw we paid 90 percent less. 15:40.946 --> 15:41.547 So awesome. 15:43.348 --> 15:43.608 You know, 15:43.688 --> 15:45.349 I think when they start seeing 15:45.369 --> 15:46.529 their members drop their 15:46.789 --> 15:48.010 coverage because we say. 15:49.700 --> 15:52.682 I think me at Resolute Physical Therapy, 15:53.322 --> 15:53.983 I'm not going to be the 15:54.023 --> 15:54.783 difference maker there. 15:56.224 --> 15:59.946 We aren't high enough volume to create. 16:00.066 --> 16:01.127 Everybody's got to jump in 16:01.187 --> 16:02.328 on that and just say, hey, 16:02.348 --> 16:03.208 we're not going to do that. 16:03.488 --> 16:04.509 We'll keep your contract. 16:04.889 --> 16:06.070 We're not going to go out with you. 16:06.610 --> 16:07.531 We'll keep the contract, 16:07.931 --> 16:10.613 but we can't do that for that number. 16:12.008 --> 16:12.928 And here's what it is like 16:13.008 --> 16:15.289 my cost per cost per visit 16:16.229 --> 16:18.790 is X. You're paying me X 16:18.850 --> 16:20.630 minus 20 losing money by 16:21.130 --> 16:22.811 every time I treat one of your members, 16:22.971 --> 16:23.671 I lose money. 16:23.751 --> 16:24.591 So you're telling me that I 16:24.611 --> 16:25.631 need to double book them, 16:27.052 --> 16:28.032 but that doesn't give you 16:28.072 --> 16:28.912 good quality of care. 16:29.292 --> 16:30.172 That's not what I want my 16:30.232 --> 16:31.313 clinicians worried about. 16:31.333 --> 16:32.313 I don't want them worried 16:32.353 --> 16:33.873 about juggling patients in the gym. 16:34.513 --> 16:35.474 I want them focused on the 16:35.614 --> 16:36.934 one patient in front of them. 16:36.954 --> 16:37.194 That's it. 16:37.751 --> 16:38.491 Let me ask you this as 16:38.511 --> 16:40.532 someone who does two different things, 16:40.612 --> 16:40.752 right? 16:40.772 --> 16:41.932 Because you're treating 16:41.952 --> 16:42.913 patients and you're also 16:42.953 --> 16:43.593 someone who runs an 16:43.633 --> 16:44.893 organization that treats a 16:45.333 --> 16:45.974 volume of patients. 16:45.994 --> 16:46.954 You have clinicians under you. 16:47.854 --> 16:49.074 What do you personally find 16:49.375 --> 16:50.255 more gratifying? 16:50.375 --> 16:51.855 Is it direct patient care? 16:51.875 --> 16:52.556 You have to answer. 16:52.576 --> 16:54.136 You can't say you love both 16:54.156 --> 16:55.897 of your kids the most, right? 16:55.977 --> 16:56.257 Got it. 16:56.477 --> 16:56.637 Okay. 16:57.757 --> 16:58.977 One-on-one care or now that 16:58.997 --> 16:59.798 you get to do this thing, 16:59.818 --> 17:01.078 which is run a business, 17:01.518 --> 17:01.998 where do you find, 17:02.038 --> 17:03.819 where do you get more gratification? 17:06.673 --> 17:07.194 At this point, 17:07.214 --> 17:08.014 I'd probably get more 17:08.054 --> 17:10.397 gratification running the business, 17:10.437 --> 17:11.078 but I'm going to give you 17:11.098 --> 17:12.019 the caveat of that, 17:12.219 --> 17:13.180 and that is helping to 17:13.300 --> 17:14.381 mentor my clinicians. 17:14.801 --> 17:15.202 That's great. 17:16.023 --> 17:16.343 That's it. 17:18.755 --> 17:20.356 this is this is my ethos 17:20.396 --> 17:21.537 that I live by running this 17:22.458 --> 17:23.859 and it is please the end 17:23.959 --> 17:25.560 user for me my end user is 17:25.580 --> 17:27.321 my staff right some of that 17:27.361 --> 17:28.402 is my patients when I put 17:28.462 --> 17:30.144 on just my pt hat and I go 17:30.164 --> 17:31.905 out and treat but my 17:32.205 --> 17:33.526 biggest hat is being the 17:33.846 --> 17:35.628 ceo and owner and my end 17:35.708 --> 17:37.829 user is my staff so how do 17:37.889 --> 17:39.270 I keep my staff happy and 17:39.310 --> 17:41.312 engaged and that's by 17:41.372 --> 17:42.393 simplifying it for them 17:43.683 --> 17:44.844 That's it for my front desk. 17:44.884 --> 17:46.885 It's make this make this the 17:47.045 --> 17:49.207 best hour of everyone that you deal with. 17:49.367 --> 17:50.288 Make it the best hour of 17:50.308 --> 17:51.468 their day of their week. 17:52.469 --> 17:52.669 Right. 17:52.709 --> 17:54.590 And the rest of it will figure itself out. 17:55.151 --> 17:56.212 We'll be busier than you can 17:56.232 --> 17:56.872 shake a stick at. 17:57.252 --> 17:58.293 I think that's I think 17:58.313 --> 17:59.074 that's the way to do it. 17:59.094 --> 18:00.895 I think I think the first 18:00.935 --> 18:03.517 couple of times people heard that mindset, 18:03.557 --> 18:04.617 they were like, no, no, no. 18:05.318 --> 18:06.579 As an owner, patience first. 18:07.403 --> 18:08.644 But if you operate the way 18:08.684 --> 18:09.484 you just mentioned, 18:10.245 --> 18:11.305 that gets taken care of. 18:11.526 --> 18:13.487 Like step one is find great people, right? 18:13.967 --> 18:14.988 Number two is keep those 18:15.028 --> 18:17.149 people well taken care of. 18:17.309 --> 18:18.310 They will do the thing that 18:18.330 --> 18:19.671 you hired them to actually do. 18:20.808 --> 18:21.649 Right. 18:23.010 --> 18:23.771 Look at the best run 18:23.831 --> 18:25.652 companies in the world and that is it. 18:25.853 --> 18:27.234 They pour into their staff 18:27.274 --> 18:28.275 so that their staff has one 18:28.295 --> 18:32.158 thing to focus on and that's end user. 18:32.519 --> 18:33.119 Do your job. 18:33.179 --> 18:34.861 That's it. 18:35.461 --> 18:37.103 We're talking about the next generation. 18:37.123 --> 18:37.883 You mentioned the next 18:37.923 --> 18:39.445 generation of these PTs who 18:39.465 --> 18:40.326 might be listening right now. 18:40.346 --> 18:41.467 They're either in school or 18:41.527 --> 18:42.628 they're fresh out of school. 18:42.648 --> 18:43.949 We get a lot of DMs from 18:45.570 --> 18:47.231 from students who are still in undergrad, 18:47.271 --> 18:48.032 which is kind of cool. 18:48.292 --> 18:50.073 They're like, this is what I want to do. 18:50.113 --> 18:51.694 So I get excited about that. 18:51.714 --> 18:53.755 They're focused on PT so far away from it. 18:53.775 --> 18:55.596 So I want to ask a question for them. 18:56.057 --> 18:57.317 For those aspiring to 18:57.377 --> 18:58.998 eventually start their own practice, 18:59.819 --> 19:01.580 is it feasible for them now 19:01.620 --> 19:02.941 or in the near future to go 19:03.081 --> 19:05.322 solo and still work well 19:05.382 --> 19:07.364 with insurance companies starting out? 19:07.464 --> 19:08.845 So you've been doing this for a while. 19:09.145 --> 19:10.185 If someone were to start out, 19:10.225 --> 19:12.047 is it feasible for them to 19:12.087 --> 19:12.647 begin like that? 19:14.306 --> 19:15.027 I think you can, 19:15.067 --> 19:15.967 but you're fighting a big 19:16.067 --> 19:17.288 uphill battle at that point. 19:18.489 --> 19:18.829 For me, 19:18.950 --> 19:20.371 I'm partnered with an organization. 19:20.551 --> 19:22.012 I was in practice for seven 19:22.052 --> 19:23.393 years before I partnered in 19:23.413 --> 19:24.614 with a company called 19:24.634 --> 19:25.655 Health and Rehab Solutions, 19:25.895 --> 19:27.956 which is PT owned and PT run. 19:28.016 --> 19:29.458 So they've got PTs in all of 19:29.498 --> 19:30.498 the upper level spots. 19:31.319 --> 19:32.920 So they helped me to look at 19:33.601 --> 19:34.621 what are we doing well? 19:34.722 --> 19:36.543 Where are we losing patient visits? 19:37.023 --> 19:38.244 What are our outcomes doing? 19:38.304 --> 19:39.325 Where are we dropping off? 19:39.505 --> 19:41.947 And then how do you run a business better? 19:42.427 --> 19:42.567 Sure. 19:44.013 --> 19:44.734 Four years ago, 19:44.754 --> 19:46.656 you put a patient in front of me, 19:46.717 --> 19:47.878 and I'm going to get them better. 19:48.339 --> 19:49.260 I will figure that out. 19:49.280 --> 19:50.241 I can work through that. 19:51.182 --> 19:52.384 You put a business in front of me, 19:52.524 --> 19:53.685 and I will probably run it 19:53.765 --> 19:54.346 into the ground. 19:56.148 --> 19:57.530 I'm four years into this thing, 19:58.621 --> 20:00.283 And we're successful, we're thriving, 20:00.363 --> 20:01.144 we're making profit, 20:01.184 --> 20:02.205 and we're doing a great job. 20:02.265 --> 20:03.506 And my staff is happy. 20:04.147 --> 20:04.988 Life is good. 20:05.048 --> 20:06.249 Patients love coming here. 20:07.110 --> 20:09.853 We've got the culture that I 20:09.933 --> 20:11.575 set out to have that I 20:11.635 --> 20:12.296 didn't have at the 20:12.356 --> 20:13.737 organization that I was with before, 20:13.757 --> 20:15.639 where they didn't care about culture. 20:16.000 --> 20:18.502 It was, see patients, 20:18.523 --> 20:19.564 we don't care if you do a good job, 20:19.604 --> 20:20.324 just see more of them. 20:21.701 --> 20:24.182 Because that's the profit margin game. 20:24.522 --> 20:24.862 Correct. 20:26.362 --> 20:27.622 Which leads me to my next question. 20:27.662 --> 20:28.963 The last thing I wanted to touch on, 20:29.003 --> 20:31.063 which is how do you do that, 20:31.723 --> 20:33.384 is what are some levers 20:33.424 --> 20:34.244 that you can pull? 20:34.304 --> 20:35.264 What are some things that 20:35.324 --> 20:37.144 you can do as a clinician 20:37.264 --> 20:39.205 owner that you still keep 20:39.245 --> 20:40.625 the quality care high, 20:40.885 --> 20:42.446 which is why we started doing this thing. 20:42.466 --> 20:43.166 When we went to school, 20:43.186 --> 20:43.906 we did all those things. 20:44.801 --> 20:47.102 but avoid having to turn into that, 20:47.242 --> 20:48.643 and I'm gonna use air quotes on a podcast, 20:48.663 --> 20:50.424 which is PT mill while 20:50.464 --> 20:51.404 accepting insurance. 20:51.744 --> 20:52.084 And again, 20:52.164 --> 20:53.185 no one's been able to give me a 20:53.225 --> 20:54.425 definitive line in the sand 20:54.445 --> 20:56.206 of what makes a high volume, 20:56.246 --> 20:57.467 great quality clinic 20:58.263 --> 21:00.545 And when they tip over into milk, we can't, 21:00.685 --> 21:01.646 I don't know where that line is, 21:01.706 --> 21:02.266 but people are like, 21:02.547 --> 21:03.487 I know it when I see it. 21:03.507 --> 21:04.668 I'm like, okay, well, 21:04.748 --> 21:06.049 how do you flirt with that? 21:06.129 --> 21:07.551 How can you stay so high in 21:07.591 --> 21:08.752 terms of volume and care? 21:09.252 --> 21:10.493 Because volume means that 21:10.533 --> 21:11.754 your business is running 21:11.794 --> 21:12.515 well and you're able to 21:12.555 --> 21:13.335 take care of your people 21:13.395 --> 21:14.656 financially in other ways. 21:15.377 --> 21:16.918 And you're still treating lots of people, 21:16.958 --> 21:17.719 but treating them well. 21:18.279 --> 21:19.160 What are some things that 21:19.200 --> 21:20.141 you can do to set yourself 21:20.181 --> 21:21.322 up so you stay on the good 21:21.402 --> 21:23.163 side of that line of 21:23.644 --> 21:25.065 crossing over into a PT milk? 21:26.078 --> 21:26.298 Right. 21:26.558 --> 21:29.361 The big thing is like avoid 21:29.381 --> 21:30.561 the shiny things, right? 21:30.581 --> 21:31.522 Like when you're starting out, 21:33.384 --> 21:35.165 do you need a PT clinic and 21:35.345 --> 21:36.826 like a retail shopping center? 21:37.387 --> 21:38.087 Probably not. 21:38.167 --> 21:39.588 Like how many people got to 21:39.608 --> 21:42.450 your PT clinic because they drove by it? 21:42.971 --> 21:43.211 Right. 21:44.012 --> 21:44.932 Probably zero. 21:45.493 --> 21:46.413 Most of them were referred 21:46.433 --> 21:47.694 by their physician or they 21:47.794 --> 21:49.195 Googled you and they found 21:49.215 --> 21:50.737 your location and they drove there, 21:51.317 --> 21:51.497 right? 21:51.617 --> 21:52.618 Or their friends and family 21:52.658 --> 21:53.299 told it about it. 21:54.124 --> 21:54.604 whatever it is. 21:55.045 --> 21:56.226 They didn't drive by this 21:56.286 --> 21:57.467 busy intersection that's 21:57.487 --> 21:59.228 gonna cost you four times 21:59.328 --> 22:00.249 what you need in rent. 22:00.970 --> 22:02.411 And another hidden cost that 22:02.431 --> 22:03.292 people don't think about, 22:03.832 --> 22:05.233 if you go into a retail space, 22:06.054 --> 22:07.055 you gotta put a sign up. 22:07.675 --> 22:08.656 Signs are expensive. 22:09.977 --> 22:11.399 That's five grand right off 22:11.439 --> 22:12.259 of your budget from the 22:12.299 --> 22:13.881 startup to have a sign. 22:14.821 --> 22:15.962 I'm in an office building 22:16.123 --> 22:17.143 with a ton of parking 22:18.001 --> 22:20.383 People can walk in, find us really fast. 22:21.043 --> 22:21.543 It's easy. 22:22.164 --> 22:23.905 My power and water is paid 22:23.965 --> 22:24.886 for by my lease. 22:25.086 --> 22:26.927 I get janitorial included in this. 22:27.687 --> 22:28.808 Like I'm in a sweet spot. 22:28.828 --> 22:30.309 So avoid the shiny stuff. 22:30.809 --> 22:31.690 Like your patients don't 22:31.730 --> 22:33.131 care that in Denver, 22:33.231 --> 22:34.612 if you're on the 13th floor 22:34.672 --> 22:36.073 facing West with a great 22:36.133 --> 22:37.113 view of the Rocky mountains, 22:37.694 --> 22:38.855 they're here for 40 minutes. 22:39.195 --> 22:39.535 Right. 22:40.636 --> 22:41.516 I love when you come in and 22:41.536 --> 22:42.377 like have good care. 22:42.788 --> 22:44.189 I love that our conversation 22:44.229 --> 22:46.050 went from one side of the conversation, 22:46.090 --> 22:47.732 which it needs to be, which is like, 22:47.812 --> 22:49.593 how do we get paid more for 22:49.653 --> 22:50.774 the value we're providing? 22:51.034 --> 22:51.794 Value for value. 22:52.575 --> 22:53.776 And then you went to the other side, 22:53.816 --> 22:54.817 which is a lot of people 22:54.857 --> 22:55.857 will stay on that side of 22:55.877 --> 22:57.559 the conversation, which needs to be had. 22:58.119 --> 22:59.080 I think there are fewer 22:59.120 --> 23:00.621 people having that conversation. 23:00.761 --> 23:01.361 More and more, 23:01.401 --> 23:02.942 but it's still in the minority, which is, 23:03.303 --> 23:04.383 how do you lower your costs? 23:04.704 --> 23:06.004 Because by lowering your costs, 23:06.045 --> 23:07.906 you're actually ending with more money. 23:08.697 --> 23:09.558 which you're able to then 23:09.618 --> 23:11.339 reinvest in people and the business. 23:11.719 --> 23:13.841 So I think avoid the shiny things is gold. 23:14.662 --> 23:14.842 Yeah. 23:15.082 --> 23:15.903 Do you need a tech? 23:16.383 --> 23:17.684 Well, probably not. 23:18.185 --> 23:20.066 Make your PTs fold towels and pillowcases. 23:21.067 --> 23:22.808 Like when you have downtime, 23:23.209 --> 23:25.050 go fold some laundry, right? 23:25.471 --> 23:27.192 Everybody can answer a phone, right? 23:27.212 --> 23:27.892 Like you don't need to have 23:27.933 --> 23:28.693 two receptionists. 23:29.194 --> 23:29.434 Right. 23:30.254 --> 23:30.815 One receptionist, 23:30.855 --> 23:32.056 have your PTs answer the phone. 23:33.537 --> 23:33.917 Yeah. 23:35.692 --> 23:37.874 What's one more that someone 23:37.914 --> 23:39.835 maybe beginning in a 23:39.895 --> 23:41.337 business or thinking about 23:41.357 --> 23:42.458 it might not see? 23:42.498 --> 23:43.579 I think avoid the shiny 23:43.599 --> 23:45.561 things is already their 23:45.861 --> 23:47.422 head and shoulders above the rest. 23:48.603 --> 23:49.504 Yeah. 23:50.065 --> 23:50.605 The other one, 23:51.006 --> 23:53.068 and I struggled with this early on, 23:53.828 --> 23:56.050 was just watch your hiring efficiency. 23:56.691 --> 23:56.851 Okay. 23:58.590 --> 24:02.933 So early on, and mind you, 24:02.993 --> 24:04.734 I opened January of 2020. 24:04.734 --> 24:07.896 So like, best time ever to open a business, 24:07.916 --> 24:08.037 right? 24:08.057 --> 24:09.237 You're like, what could go wrong? 24:09.297 --> 24:10.658 And then 2020 was like, I don't know, 24:10.678 --> 24:11.279 hold my beer. 24:12.039 --> 24:12.560 Yeah, right? 24:12.600 --> 24:13.080 Like, hey, 24:13.420 --> 24:14.621 do you want to get kicked in the teeth? 24:14.861 --> 24:16.402 Like, yeah, sure. 24:16.442 --> 24:17.223 Let me sign up for that. 24:18.003 --> 24:20.965 So early on, right? 24:20.985 --> 24:23.147 Like I felt like I got busy 24:23.347 --> 24:24.988 as the clinician, right? 24:25.008 --> 24:26.149 Like I was treating full time. 24:26.189 --> 24:27.150 I was doing marketing, right? 24:28.095 --> 24:28.735 All of this stuff. 24:28.775 --> 24:29.676 And I felt like I was 24:29.716 --> 24:31.457 getting busy and I had a 24:31.477 --> 24:33.037 past student of mine that 24:33.057 --> 24:33.938 had just graduated. 24:34.218 --> 24:34.878 He's awesome. 24:34.998 --> 24:36.419 Like I knew from the start 24:36.459 --> 24:37.379 when he was a student of 24:37.399 --> 24:39.660 mine in my last job that I 24:39.700 --> 24:41.001 wanted this guy on my team. 24:41.661 --> 24:43.242 And so he had graduated. 24:43.322 --> 24:44.502 We delayed it a little bit 24:44.522 --> 24:45.883 because we weren't quite there. 24:45.923 --> 24:46.723 And then all of a sudden we 24:46.763 --> 24:47.804 kind of got there and I was like, 24:47.984 --> 24:49.285 all right, I'm going to give you a job. 24:50.285 --> 24:51.325 Hired and paid him more 24:51.365 --> 24:52.326 money than I was paying me. 24:52.346 --> 24:55.287 And we just weren't busy for 24:55.327 --> 24:55.908 the two of us. 24:56.648 --> 24:56.828 Right. 24:57.839 --> 24:59.180 It worked out like a month 24:59.240 --> 25:00.721 into it that my front desk left. 25:01.442 --> 25:02.443 So I just became the front 25:02.463 --> 25:03.884 desk guy again for three 25:03.924 --> 25:05.165 months and let him treat patients. 25:05.245 --> 25:07.827 So you gotta be able to sit 25:07.907 --> 25:09.909 in times when you feel like you're busy, 25:10.149 --> 25:11.550 where it almost feels like 25:11.570 --> 25:12.191 you're in a mill. 25:12.811 --> 25:13.632 Like I don't ever wanna, 25:13.732 --> 25:15.073 I don't wanna throw that word out either, 25:15.413 --> 25:15.894 just like you. 25:17.435 --> 25:19.316 like yours your schedule 25:19.336 --> 25:21.297 should be full right some 25:21.337 --> 25:22.237 of our things that I want 25:22.277 --> 25:23.658 my therapist to like find 25:23.698 --> 25:25.779 value in is that their 25:25.819 --> 25:26.900 schedule should be full 25:27.380 --> 25:28.420 they should have patients 25:28.580 --> 25:29.861 on their schedule all day 25:29.981 --> 25:30.581 they don't need to be 25:30.621 --> 25:32.062 double booked but their 25:32.082 --> 25:32.823 schedule should be full 25:32.863 --> 25:33.543 because that means that 25:33.563 --> 25:34.904 they are doing a really 25:34.944 --> 25:36.064 good job right their 25:36.084 --> 25:37.365 patients want to show up to 25:37.405 --> 25:38.605 see them they're referring 25:38.645 --> 25:39.646 friends and family to them 25:40.410 --> 25:41.992 the our referral sources our 25:42.032 --> 25:43.254 physicians in the community 25:43.334 --> 25:44.756 know who they are and 25:44.796 --> 25:45.977 they're referring patients 25:46.097 --> 25:47.659 to those therapists not to 25:47.699 --> 25:48.861 resolute physical therapy 25:48.921 --> 25:51.104 not to alex at resolute but 25:51.144 --> 25:52.265 they're referring them to 25:52.305 --> 25:54.548 alyssa and to kelly and so 25:54.928 --> 25:56.831 that's who they they should 25:56.891 --> 25:59.294 strive to have a busy day right 25:59.963 --> 26:01.023 But I think what you're 26:01.063 --> 26:02.284 really highlighting is, 26:03.464 --> 26:04.365 and I don't love car 26:04.405 --> 26:05.325 analogies all the time, 26:05.345 --> 26:06.125 but this feels good. 26:06.165 --> 26:07.686 Like if you drive a manual transmission, 26:07.706 --> 26:09.366 it's like, don't shift too early. 26:09.466 --> 26:10.707 Don't shift into a higher 26:10.767 --> 26:12.887 gear before you actually 26:12.988 --> 26:14.228 need it because you might stall out. 26:15.063 --> 26:15.263 yeah, 26:15.363 --> 26:16.745 you'll just sort of drag and putter 26:16.785 --> 26:17.566 along at that point. 26:17.626 --> 26:21.350 So like, and I think me as the owner and, 26:21.550 --> 26:23.051 you know, de facto clinic director, 26:23.111 --> 26:23.312 right? 26:23.952 --> 26:24.713 When we start getting to 26:24.753 --> 26:25.794 that point where everybody 26:25.834 --> 26:26.855 starts to feel busy, 26:27.496 --> 26:28.717 sometimes we just sit in that. 26:29.258 --> 26:31.040 And I'm very clear about what that means. 26:31.080 --> 26:31.680 It's like, God's, 26:32.341 --> 26:33.241 We're doing really good. 26:33.261 --> 26:35.462 I know everybody, it feels busy right now. 26:36.023 --> 26:36.963 We're going to just sit in 26:37.003 --> 26:38.524 this and let's ride it for 26:38.544 --> 26:40.525 a minute and let's see what this does. 26:41.065 --> 26:41.985 I'm not scared to hire 26:42.005 --> 26:43.746 someone if the time is right. 26:44.326 --> 26:45.267 But just because we get a 26:45.307 --> 26:46.627 little pop in business here 26:46.667 --> 26:47.808 and a pop in business there, 26:48.828 --> 26:49.749 is that sustainable? 26:50.029 --> 26:51.610 Can we operate there for a little while? 26:52.597 --> 26:52.797 Right. 26:53.197 --> 26:53.357 And if, 26:53.838 --> 26:55.158 if it makes us really profitable 26:55.719 --> 26:56.599 and we start taking home 26:56.639 --> 26:57.980 some profit as an owner, 26:58.000 --> 26:59.761 I will reinvest that. 27:00.001 --> 27:01.242 Like, let's go do something fun. 27:02.062 --> 27:04.484 Let's like, let's bonus you guys out. 27:04.544 --> 27:05.804 You guys crushed it for like 27:06.365 --> 27:08.546 eight weeks and now we 27:08.566 --> 27:09.506 hired someone new and now 27:09.586 --> 27:10.487 everybody can go back to 27:10.547 --> 27:11.387 being just a little bit 27:11.427 --> 27:12.928 light when we get this new 27:12.988 --> 27:13.989 one on and we ramp them up. 27:15.410 --> 27:16.731 I think this goes back to, you know, 27:16.751 --> 27:17.992 what Marcus Limonis and I 27:18.052 --> 27:19.614 referenced you from Marcus Limonis, 27:19.634 --> 27:21.295 the prophet from MSNBC. 27:21.615 --> 27:22.236 Great show. 27:22.736 --> 27:23.717 And he's number one. 27:23.737 --> 27:24.638 He's like, know your numbers. 27:25.419 --> 27:26.139 So if you're able to know 27:26.159 --> 27:27.540 your numbers and I guess 27:27.560 --> 27:28.701 the longer you do stuff, 27:28.741 --> 27:30.323 the longer you more data 27:30.343 --> 27:31.644 you have to predict, like, hey, 27:31.684 --> 27:33.425 we've seen this kind of a spike before. 27:33.626 --> 27:33.706 Oh, 27:33.746 --> 27:36.228 we've never seen this kind of a spike 27:36.268 --> 27:36.568 before. 27:36.628 --> 27:38.350 Maybe this does require a 27:38.390 --> 27:39.491 shift into a higher gear. 27:39.551 --> 27:40.632 So it's paying attention to 27:42.745 --> 27:43.526 The KPIs. 27:43.566 --> 27:44.366 I was having a talk with 27:44.386 --> 27:45.467 someone the other day and they were like, 27:45.547 --> 27:46.928 I have 27 KPIs. 27:47.068 --> 27:48.890 I'm like, you know the first word, 27:49.050 --> 27:51.452 the first letter in KPI is key, right? 27:51.732 --> 27:53.273 You can't have 27 key 27:53.333 --> 27:54.795 performance indicators, right? 27:55.215 --> 27:55.935 So understanding your 27:55.955 --> 27:56.496 numbers and what they 27:56.576 --> 27:58.618 actually mean sounds like 27:58.838 --> 27:59.999 that's the best way to know 28:00.539 --> 28:01.640 when it's time to shift. 28:02.561 --> 28:03.201 Yeah, right. 28:03.541 --> 28:05.143 Your key performance indicators should be 28:06.479 --> 28:08.460 I don't know, four, maybe five, 28:08.740 --> 28:09.780 depending on how deep you 28:09.800 --> 28:10.761 want to go with that. 28:10.781 --> 28:11.741 Think of your car dashboard. 28:11.761 --> 28:14.022 I got RPMs, I got speed, I got gas, 28:14.082 --> 28:15.443 I got oil, I got temperature. 28:16.003 --> 28:18.844 Beyond that, I've got cognitive overload. 28:18.864 --> 28:19.965 And I think cognitive 28:20.025 --> 28:21.125 overload can translate to 28:21.165 --> 28:21.966 business as well. 28:22.026 --> 28:22.986 So ask yourself, 28:23.066 --> 28:24.807 what are the actual things 28:25.407 --> 28:27.128 that this dashboard or this 28:27.168 --> 28:28.068 information can teach me 28:28.088 --> 28:29.609 that I can actually use? 28:30.570 --> 28:30.750 Alex, 28:30.770 --> 28:32.991 are you ready to play a game called 28:33.011 --> 28:33.531 Three Questions? 28:34.679 --> 28:35.140 Absolutely. 28:35.160 --> 28:35.620 Let's do it. 28:35.860 --> 28:37.041 On the hot seat with three 28:37.081 --> 28:38.823 questions on the PT Pinecast. 28:38.843 --> 28:39.043 All right, 28:39.063 --> 28:40.505 three questions brought to you by ATI, 28:40.545 --> 28:41.506 leading the charge in PT 28:41.526 --> 28:42.547 clinical research with all 28:42.547 --> 28:44.128 900 clinics achieving top 28:44.148 --> 28:46.090 marks in CMS's merit-based 28:46.130 --> 28:46.971 incentive program. 28:46.991 --> 28:48.552 They're a team to join for career growth. 28:48.632 --> 28:51.115 Explore opportunities at atipt.com. 28:51.815 --> 28:52.516 All right, 28:52.616 --> 28:54.077 first question on three questions. 28:54.958 --> 28:55.879 outside of PT, 28:56.379 --> 28:58.120 and I mentioned you like craft beer. 28:58.701 --> 29:00.222 What's an unexpected hobby 29:00.262 --> 29:01.343 or interest that you might 29:01.443 --> 29:02.743 have that would surprise 29:02.804 --> 29:04.044 someone who didn't know you? 29:04.244 --> 29:05.265 What's something weird? 29:08.067 --> 29:08.227 Oh. 29:10.309 --> 29:11.549 This may not surprise a lot of people. 29:11.630 --> 29:13.651 I did home brew beer for a while. 29:14.972 --> 29:16.053 I got a little burned out on 29:16.073 --> 29:17.353 it because I wasn't very good at it. 29:17.774 --> 29:19.655 So as much as I like to drink beer, 29:19.735 --> 29:21.276 I could not brew beer very well. 29:21.776 --> 29:22.477 Yeah. 29:23.080 --> 29:24.441 And for those people who brew beer, 29:24.722 --> 29:24.922 you know, 29:24.942 --> 29:25.883 you just sort of end up with 29:25.923 --> 29:27.024 about 50 beers. 29:27.444 --> 29:28.665 And when you brew a batch 29:28.685 --> 29:29.526 and it's just not good, 29:29.586 --> 29:31.548 you got 50 not so good beers. 29:31.848 --> 29:32.008 Yeah. 29:32.048 --> 29:32.529 You got suffered. 29:32.569 --> 29:33.270 You don't want to share. 29:33.610 --> 29:33.730 Yeah. 29:33.750 --> 29:35.251 You don't want to share them with people. 29:35.372 --> 29:38.014 My wife won't drink them. 29:38.054 --> 29:39.295 Did you have fun and name them? 29:39.335 --> 29:40.657 Like, did you play with like funny names? 29:41.958 --> 29:42.278 Oh yeah. 29:42.518 --> 29:42.719 Yeah. 29:42.759 --> 29:44.160 We, uh, I had some good names. 29:44.180 --> 29:45.861 I'm trying to think I brewed a, uh, 29:45.922 --> 29:47.263 like a grapefruit IPA and I 29:47.303 --> 29:48.364 just called that the brunch beer. 29:48.899 --> 29:49.339 There you go. 29:49.379 --> 29:49.579 Yeah. 29:49.659 --> 29:49.919 Great. 29:50.159 --> 29:50.379 Yeah. 29:50.399 --> 29:51.179 Great for just stuff. 29:51.219 --> 29:51.880 And it's for brunch. 29:52.260 --> 29:52.440 Right. 29:52.460 --> 29:52.580 Yep. 29:53.140 --> 29:57.380 Uh, I brewed a basic bro. 29:57.961 --> 29:59.721 It was a, uh, pumpkin porter. 30:00.601 --> 30:02.361 So it was the basic bro, the label. 30:02.421 --> 30:04.522 I was like flannel, you know, I like it. 30:05.382 --> 30:06.662 That's kind of, let's, 30:06.742 --> 30:07.802 let's jump in a time machine. 30:07.962 --> 30:08.782 If you could have dinner 30:08.802 --> 30:11.183 with any three individuals from history, 30:11.243 --> 30:11.883 who would they be? 30:11.963 --> 30:13.483 Who's, who's on your radar? 30:13.503 --> 30:13.943 Like, Ooh, 30:13.963 --> 30:15.503 this person really interests me 30:15.884 --> 30:17.704 alive or dead time machine travel. 30:17.744 --> 30:18.424 Who's coming to dinner? 30:19.594 --> 30:20.114 Oh, that's great. 30:20.414 --> 30:21.735 Um, Kobe Bryant would be one of them. 30:22.355 --> 30:22.975 Yeah. 30:23.175 --> 30:24.035 Mama mentality. 30:24.815 --> 30:25.055 Yeah. 30:25.195 --> 30:27.316 Love to have a dinner with Kobe Bryant. 30:27.436 --> 30:33.698 I think, um, I think Teddy Roosevelt or no, 30:33.798 --> 30:34.078 sorry. 30:34.378 --> 30:34.578 Yeah. 30:34.598 --> 30:36.658 Teddy Roosevelt would be probably, um, 30:37.158 --> 30:38.499 yeah. 30:38.759 --> 30:39.899 Number two on my list. 30:42.140 --> 30:42.360 Um, 30:43.920 --> 30:44.960 I want to give something out of the 30:45.040 --> 30:46.161 music genre here. 30:46.181 --> 30:46.221 Um, 30:50.729 --> 30:52.130 I feel like Mick Jagger 30:52.150 --> 30:53.911 would be really fun at a dinner party, 30:54.192 --> 30:56.193 but that could go either way. 30:56.353 --> 30:57.534 That could be a disaster. 30:57.574 --> 30:59.175 Well, yeah, but I mean, 30:59.255 --> 31:00.336 it's going to be a story 31:00.697 --> 31:01.497 with Mick Jagger. 31:02.218 --> 31:02.458 Yeah. 31:02.498 --> 31:03.679 The stories would be great 31:03.999 --> 31:07.682 if he's coherent enough to. 31:07.742 --> 31:08.903 Honestly, even if he's not. 31:09.103 --> 31:09.283 All right. 31:09.323 --> 31:10.504 That's the second question. 31:10.564 --> 31:11.224 Third question. 31:12.205 --> 31:12.926 Desert Island. 31:13.026 --> 31:14.107 You're stranded out there. 31:14.407 --> 31:16.028 One book for company. 31:16.308 --> 31:17.749 What do you choose and why? 31:17.789 --> 31:18.590 What are you reading? 31:18.650 --> 31:20.011 If you're like, I got time on my hands. 31:23.424 --> 31:25.026 If I got time on my hands, man, 31:25.066 --> 31:26.627 I'm probably going to take 31:26.667 --> 31:27.688 a John Grisham novel. 31:28.148 --> 31:29.850 It's going to take me a year 31:29.870 --> 31:30.911 to get through that thing anyway. 31:33.393 --> 31:35.474 He was Pelican Brief, right? 31:35.494 --> 31:36.095 Was that Grisham? 31:36.936 --> 31:37.696 Yeah, I think so. 31:37.716 --> 31:39.097 Pelican Brief and Some of 31:39.177 --> 31:41.339 All Fears and Rainbow Six. 31:41.419 --> 31:42.500 No, that's Tom Clancy. 31:43.101 --> 31:43.841 Oh, Tom Clancy. 31:44.342 --> 31:46.484 Maybe shift that to Tom Clancy then. 31:48.376 --> 31:51.499 And I think Clancy was Air Force One. 31:52.260 --> 31:53.782 Grisham was more like courtroom, 31:53.822 --> 31:56.545 like Pelican Brief, Time to Kill. 31:56.605 --> 31:57.986 So yeah, Tom Clancy was great. 31:58.206 --> 31:58.947 And he spawned a bunch of 31:58.967 --> 31:59.768 really great video games. 31:59.968 --> 32:01.070 All right, you're off the hot seat. 32:01.090 --> 32:01.870 That's three questions. 32:02.331 --> 32:03.712 Last thing we do on the show 32:03.872 --> 32:05.114 is the parting shot. 32:05.234 --> 32:06.836 This is the parting shot. 32:07.236 --> 32:08.017 Parting Shot brought to you 32:08.037 --> 32:08.597 by our friends from the 32:08.657 --> 32:09.718 Academy of Orthopedic 32:09.738 --> 32:11.540 Physical Therapy with their 32:11.800 --> 32:13.541 fifth edition of current 32:13.581 --> 32:15.583 concepts of orthopedic physical therapy. 32:15.843 --> 32:17.124 This thing, the perfect roadmap, 32:17.785 --> 32:18.685 take you from wherever you 32:18.825 --> 32:19.746 are in your orthopedic 32:19.786 --> 32:23.209 career to maybe taking that OCS exam, 32:23.229 --> 32:24.370 to getting to the starting 32:24.410 --> 32:25.811 line of that OCS exam. 32:26.371 --> 32:27.192 Always up to date, 32:27.352 --> 32:28.733 created by the leaders in PT. 32:29.154 --> 32:32.256 OrthoPT.org is where you can find that. 32:33.397 --> 32:34.638 Alex, Parting Shot, 32:34.658 --> 32:35.199 what do you want to leave 32:35.239 --> 32:35.739 with the audience? 32:35.759 --> 32:36.820 What's your mic drop moment? 32:38.892 --> 32:41.053 Um, insurance is not evil. 32:41.994 --> 32:42.094 Um, 32:42.474 --> 32:44.976 and your patients deserve quality care. 32:45.116 --> 32:46.337 So, um, 32:46.937 --> 32:48.558 it's a flawed system that we're in. 32:48.578 --> 32:48.618 Um, 32:49.779 --> 32:52.280 but your patients and every patient 32:52.400 --> 32:53.341 perspective patient out 32:53.361 --> 32:54.461 there deserves the best 32:54.541 --> 32:55.382 quality of healthcare, 32:55.442 --> 32:56.843 whether they can afford you or not, 32:57.783 --> 32:58.544 they're already paying 32:58.564 --> 32:59.504 their insurance premium. 32:59.564 --> 33:01.906 So let's do a good job for our patients. 33:01.986 --> 33:04.968 And, you know, if you do that, 33:05.308 --> 33:06.128 then we can push back 33:06.188 --> 33:07.109 against insurance companies. 33:07.435 --> 33:07.935 There you go. 33:07.996 --> 33:08.676 It starts with that. 33:08.696 --> 33:09.417 All right. 33:09.517 --> 33:11.018 Every PT should know those 33:11.138 --> 33:12.280 things about thriving with 33:12.340 --> 33:13.381 insurance-based practice. 33:13.481 --> 33:14.642 Alex, appreciate your insight, man. 33:14.682 --> 33:15.222 Thanks for the time. 33:15.903 --> 33:16.503 Yeah, absolutely. 33:16.523 --> 33:17.164 Thanks for having me on. 33:17.584 --> 33:18.065 They say the best 33:18.105 --> 33:19.606 conversations happen at happy hour. 33:20.127 --> 33:20.827 Thanks for coming to ours.