PT Breakfast Club - Behavior Change 101

0:05 That's Tony. I'm Jimmy. Dave's coming around somewhere. Good morning. It's Thursday, September fourth. This is PT Breakfast Club. Where do we start if we get a lot of different directions that we could go in? Yeah, you choose, man. I feel like I've been dominating the conversation lately. So, oh, yeah, I feel like, you know, my doctor told me to install a bar in my shower because I'm of that age. And that's what I did is that that's the mean that this is from. Right. You shared this. I did. Yeah, that's a good one. Like, we need more humor. We need more therapists sharing more humor, more funny memes, more video. I feel like we're so stuffy, stodgy. In fact, yeah, anyway, we need more humor in the profession facing the public.

0:49 It happens in the clinic, I think, but it doesn't come out to the public. What about the flip side? I remember this is years ago. I think I was still in PT school and somebody was like sort of bagging on. Don't you hate when when patients do this and this and this? I feel like that. I don't know who that helps. You know what I mean? Yeah. Hey, Dave's here. Let's see how he's doing. He's rocking Sharon. He's chair rocking. I'm back on the cabin deck. Real quick, I know we're going to talk about a bunch of things, but one thing you guys are talking about bringing humor back into physical therapy or trying to instill it into physical therapy and what we do. I think we need more results.

1:29 I think we need to focus on results only, because by doing that, I think we're focusing on the patient, the client. And Tony posted something today about Medicare physical therapy and government cheese. I think we're going to kind of get into a bunch of topics, but it brought up for me the two rows you can take. And I mean, whether now or future episodes, I think talking about results, like, yes, humor is great, social media and videos that Tony does. And yes, that would be great to have more patients and clients want to come back and continue their plan of care because of the humor aspect of it. But I think far too many practices across the country are just used to the insurance or medicare component of the billing and and the value exchange and it's hardly ever or not nearly focused enough around the results around a measurable result that the patient cares about that they agree to that they want to achieve and uh I would love to explore that well let's let's talk about it now because I don't think most clinicians and maybe I'm just you know assuming I don't think we're willing to really look at what the patient wants.

2:42 What is the result the patient wants? I can tell you right now, my clinic is full almost every day with patients who don't necessarily want the result they say they want. They don't care if their shoulder feels better, their back feels better. They don't care if they can do more things functionally. In fact, When I lay out a plan that helps them achieve independence, it's not the plan they want. They want to occupy time. I mean, we see it on social media that most of my clients, they're coming for convenience. They're coming for enjoyment. That's what they're looking. Socialization. That's what they're looking for. You may be treating a very different clientele.

3:23 You may be treating somebody who wants a physical result, a functional result. um you know but I just think that as clinicians we turn a blind eye to what the client actually wants and it's unfortunate but it's more about what we want what do I want to do as a therapist I don't care what you want as a patient you're here to serve me I'm not here to serve you that's the typical culture that I see in the profession Yeah, I worked at a few places where it was like almost predetermined based on what diagnosis that you had coming in, what was going to happen. And I felt it was a little bit like a carnival ride. Well, when you come in and you're in that, you sit in that car and then we'll put you on this track and we're really not going to vary. Might make the might make the car a different color.

4:05 Right. We might try to like customize it, but it wasn't. So I think like step number one is understanding what you're what I think I'm hearing from both of you is understanding exactly what what the person that you want to see or you want to treat actually wants, whether they what are they looking for? And trust me, there's plenty of folks in New York City that have Medicare. They call us. It could be not medically necessary. We've talked about that a bunch going into the introductory call, the initial phone call. And if it's, you know, it's not a Medicare covered type service, but they want to use their Medicare. There's plenty of folks that still say no to us. almost the majority of the time uh and and we still have the the other uh subset of folks that say yes they kind of cover all of those you know paid leads and paid ads and all that type of stuff but um that's the difference between and it doesn't matter if the if the medicare beneficiary is in ohio near tony or they're in new york city near me it doesn't matter uh the difference is someone who wants to actually go a certain path and have kind of us as like a guide and build a treatment plan and they're serious about overcoming something they want to get back to something and yes there's folks that have more discretionary income arguably in new york city than most other states or zip codes but those folks are they they will act the same meaning they many want to use their in network insurance many of them in new york city want to use their medicare and it's the certain folks that want a certain path or they

5:36 may or may not even want the outcome like Tony's talking about. But it's the folks, I was just, you know, as I was kind of shaving and brushing my teeth and getting ready for the show, I was thinking like, you know, the future of physical therapy, it's like we're at a split right now. Like it's like a fork in the road and you could continue, in my opinion, you could kind of take a lot of the insurances, including Medicare and all these things that kind of continue to get chopped in two percent, four percent, three percent, MPPR, all this other stuff. It's getting chopped and chopped and chopped. And I think in the future, because like right now, there's not a lot of practices that take Medicaid insurances and Medicaid payers. And I think in the future, I don't know at what year, but I think a lot of like Medicare Part B will be like that as well.

6:17 Like I think a lot of practices will either just fall because they're never going to change or they're They actually focus on a measurable outcome upfront that the patient or the family or the client wants. They get agreement to that and the therapist or the therapy company lays out the plan. And then guys, it's so much easier to charge three grand, five grand, you know, payment plans. I mean, so many things can come from this, but if you're in the fork in the road, you can continue one way, and folks that don't want PT, like Tony kind of talks about, and that's fine. You can make a great, profitable, busy business doing that.

7:00 But as payment continues to get squeezed, it's really, really, it becomes harder and harder to go down that road and the path of having more training, more kind of ethical sales and understanding, you know, focusing on like a result. It's not for everyone and not everyone's gonna pay three grand, five grand upfront or a third down upfront. If they have a Medicare or some in network insurance, I get it. But that's just my opinion. Like, I kind of think we're at a fork in the road and you have practices going, you know, out of network self-pay or the smaller micro practices. And then you have the bigger corporates that obviously are only going to stay in the network lane. But that's kind of where we're at. Yeah, I think even in an insurance-based model, that is so important, the alignment between what the therapist wants, what the patient wants, just to stem the burnout, to stem the frustration in the profession.

7:55 I think most of us would probably accept the lower reimbursement from an insurance model if we were treating patients who valued and cared about what we were delivering. and this this goes to another post that I had shared where I said look the worst thing in the world is to have somebody in the clinic who does not value the effort that I'm putting in like I will run through a brick wall for somebody who wants what I am trying to deliver but for somebody who doesn't want it and they're wasting my time they're wasting their time they're not interested in the solution that I'm selling and to be paid less Like we only have so many levers to pull, right? I'll get paid more and allow you not to care about my life and my time and what I'm delivering to you.

8:41 But I'm not going to get paid less and have somebody who doesn't want what I'm giving them, you know? And so these are the things that we need to balance. Go ahead. And the interesting thing is not always, and I don't want to, I don't want to, what am I going to say? What am I going to say? I don't want to look at that. David's Dave. Are you in a cracker barrel right now? Yes. A sidebar air. There we go. Crack. I'm not David Rubin. I'm not at a cracker barrel. Let me, let me take, let me give you a little bit. Look at it. Look at this. You are the cracker barrel guy. He's the cracker next to the barrel. I've been added back to the logo. All right. Really, really quick of what you were just saying, Tony. So like like morale and there you go.

9:23 Cracker Barrel Physical Therapy. Jimmy made that last week, I think, on ChatGPT or some other some other AI. The thing you were just saying, Tony, about the the challenge of like burnout and physical therapists that are treating patients that. maybe don't want what they are offering. The patients don't want physical therapy or they don't actually want to come in and they're kind of showing up begrudgingly. Those are typically not always, but those are typically the types of folks that are insurance focused or insurance mindset. They wanna use their insurance. And those are typically the folks that won't ever pay out of pocket. They're not gonna pay three grand for their ankle sprain.

10:05 They're not gonna pay five grand for their ACL rehab. They're not gonna pay a self-pay or an out of network. rate upfront or over time, out of pocket. The beautiful thing is the subset of folks that are, for whatever reason, they just have a different motivation, they have a different focus around their health and wellness, whether it's mountain biking or CrossFit or pickleball or whatever, those types of folks that wanna get back to a thing that's really, really meaningful to them, are typically the best patients. They pay out of pocket. They're okay with a self-pay rate. They are easier to work with. They cancel a no-show less often. They're typically better in terms of word of mouth and folks in the community who they have like a network of folks and they tell their friends and neighbors and their family members about the physical therapy practice and business.

10:55 So that is the interesting dichotomy between these kind of like two kind of groups of physical therapy patients that we all see in my opinion. I don't know what you guys think. Yeah, no, we agree completely. Well, I said, we like, like I'm talking for Jimmy. Um, we haven't talked about this in a while, but if we go back, you know, it's, it's just basic business one-on-one it's like, all right, I've got a product. I want to sell this product. Now, I tend to be more of an exercise-based therapist or a manual-based therapist. Regardless, if I want to sell exercise as a solution, should I try to sell it to the person who hates exercise, who doesn't have a gym membership, who doesn't have a pair of tennis shoes or workout clothes?

11:40 Like, no, that's absurd. why don't I focus my exercise-based solution to your problem to people who have already spent money on exercise I was looking at a treadmill online it's a fifteen thousand dollar treadmill and I'm like I think it's an order track or something it's beautiful Beautifully designed wood structure around it, like incredible. But I'm like, why are people paying fifteen thousand dollars to do what you could do for free outside? You know, and it's because they value that experience. I would never do it. I run every day, but I'm not going to spend fifteen thousand on treadmill. But there are people who do enough people that this company would produce this product.

12:23 So, yeah, I agree. Like, I think we need to understand marketing, our target demographic. Who can we best serve? It's not anybody with insurance. And that's what the profession has been built on. The profession has been built on anybody with a pulse and insurance. My door is always open. But that's not who we should be focusing our time and effort on. And that's why we're burning our clinicians out, because we're forcing them to do things that nobody values. Nobody cares about. Nobody. Many people don't even want. Is that really the question is, you know, the world changes faster than culture. And by culture, I'm talking about, you know, the people in charge, right? The people who say, well, these kids today, those people run the companies because they started as the clinician and they built themselves up or they've now they're managed, they direct or they started their own.

13:14 the world changes faster, how we get paid, what we get paid, and it's harder to move that ship. So how long does it take before those people cycle out? Do we have to wait that long or can you speed it? Can you speed it up? One would argue we have more access to information at our fingertips to see what everybody else is doing. We should change faster. I don't know if that's the case though, is it? Who specifically with change, the practices or the patients? I would say the practices are the ones that we could actually we could actually change fastest because it's fewer people and they're incentivized right like if I'm a practice that I'm going under and you say you have to change something and the answer is go write a long facebook you know post about how this sucks and call your congressman that person's going to be underwater but that person could elicit change faster than changing what everybody else wants You work for them.

14:08 The clinic works for the market, not the other way around. But I feel like the system used to work. It used to work. I have a clinic and you have a bunch of licenses. Therefore, I'm your only route and you were told to come here. It's not that case anymore. Why is it taking so long to change is that's my question, I guess, which is we have access to all this information at this. We know we know this. You know, I work with research organizations and I love them. But my question is, do we more do we need more information or do we need more action? Do we need more information, research or more implementation? You know, the answer is action and implementation. Listen to the gurus, the really big business gurus, the ones who are honest or like, do you need another book?

14:50 Do you need another course? Do you need another podcast? No. You need to do – what is the great line? Imperfect action is better than perfect plan. I don't know. I might have just made that one up. But you get the gist. Someone else said it better. But why is it – I'm curious. Why is it taking so damn long? Are we a slower profession? Is this across the board humans? I'm asking big questions. I just want your thoughts. What do you got, Tony? Yeah, I just wonder what the academic environment is these days. I mean, part of it is momentum, right? I've been in business twenty five years. You're going to try to overcome my momentum, my my history, what I've always done.

15:31 It's just so much easier for me to fall back into the old patterns. Absolutely. Part two is, okay, what is influencing the next generation? Why are there not more young entrepreneurs coming into the profession? I feel like there are. Don't you? I feel like that part is changing. I don't see it. Really? All right. Not at scale. I don't see anybody coming out who wants to do something at scale. There are individuals who do amazing things. Now, you've got somebody like Josh Funk or something like that. And they are. They're doing stuff. But I still have to think the culture of the academic programs.

16:11 All I hear in my social media feeds are the nightmare stories about what universities are like today compared to what they were like twenty years ago. I don't see anything useful business and healthcare coming out of what I see on social media. I'm not in universities. I can't speak to what the reality is. But that being said, I think we need influencers, we need people that are out in the profession. We know Jerry Durham and we know all these people that are out there, but I don't see the young ones out there really accepting the responsibility of what we've built and what we've turned into and saying, hey, I want to make a million dollars a year, and I want to do it delivering great patient care.

16:58 I think I can match those two together. Let's figure this out. I just don't see that. Okay. There's a whole bunch of, yes, I agree. And also, first of all, the physical therapy programs, they attract a certain type of person. And in school, we are taught to work by ourselves. We take tests. If you share, if you collaborate during a test, it's called cheating, right? So there is no collaboration during physical therapy school until you get to the later years and you're doing group projects or whatever, but it attracts the type of person. And I think most of the healthcare, I think physicians definitely the same way. Physicians, physical therapists, probably nurses, but a lot of healthcare is the healthcare individual that's in school and then eventually a new grad or they're in the the working world, they're in a hospital, they're in a practice, whatever, they do not like to be wrong.

17:52 Physical therapists, physicians, especially physicians, if you're watching, you guys know you always want to be right. And I think physical therapists, the same thing, like they always want to be right. They cannot be wrong. And the challenge of going from the insurance based practices to the out-of-network or self-pay practices is something I've mentioned before on the show, rejection. We get a ton of rejection. And because I've had a history in sales and selling gym memberships at LA Fitness one summer during college and different side projects and things like that, there's a lot of rejection. And so when you take network insurance and when you take Medicare Part B and you build those insurances or those payers, There's no rejection. There's maybe some partial rejection when they drop off after the second or third or fourth visit because the patient doesn't see any value.

18:39 But they drop off. They stop coming. And it's like a soft backhand. You're not really offended. You say, oh, maybe they got hurt. Something happened with their family, whatever. but no one is uh typically in the healthcare world experienced or or has a background of absorbing rejection we I I was just following up by the way here's a here's a side story I was just following up with patients that were leads from this past year uh since I was here in blue ridge I had some extra time on my computer and I was following up with previous patients previous leads previous prospective patients that did not book with us did not proceed with us And I was sending texts and emails to some of these prospective patients and just kind of saying like, hey, we talked months ago and just checking in.

19:24 I just want to make sure you got taken care of. I know you didn't start with us. That's totally cool. I just want to make sure you got taken care of. And one of these patients over text message started belligerently texting me back. I had to block the number. It was insane. Now I can absorb that all day. I eat that for breakfast and lunch and dinner. And I'm totally fine with that. I don't lose sleep or anything. And the patient had some probably psychosocial cognitive neuro component to maybe, I think a previous, TBI, traumatic brain injury or something. But I'm mentioning it because no one in healthcare is okay with rejection. No one is prepared for the rejection. And that is what is needed. That's one of the things that's needed, Jimmy.

20:04 When we're talking about these micro or these solo self-pay practice owners that are growing, and I agree with Tony, there's not a lot of these folks across the country doing it at scale. But the rejection piece is huge. And that is, you have to get over that and experience that and live with it and sit with it. If you're self-pay or out of network compared to in network and Medicare and you just, you take every payer. Here's what I found. The inertia of success. Now we're talking about physics, right? Business owners who have been around for decades have already survived reimbursement changes. And that creates this belief. If it worked before, I'll just keep doing this and it'll, it'll eventually level out. Success hardens habits.

20:47 Risk aversion, we've talked about that psychological belief. PT, very low margin, high compliance industry. Owners are often terrified of the downside. So what do we do when we're terrified of the downside? We white knuckle onto whatever it is that we know right now. Generational divide, younger PTs talk about cash pay, digital firsts, AI scribes, the things that come up. People have been around for a while, might see those as trendy or unproven, and therefore give them low value or look into them very, very infrequently as something that is not going to bring about a change. And then burnout exit horizon is what I found. If they're five to ten years from retirement, why take on the stress of reinventing their model?

21:27 Just ride it into the ground. Yeah. This is safer, right? If it's three percent is my return, I'll take three percent over a risk of losing. There's loss aversion against there's there's the reasons, right? We sort of knew that, but it's good to see that it's confirmed because I have confirmation bias. All right. What's next on the docket? All right. We got to talk about tequila. Dave, did you I don't know if you can see it. Didn't we talk about this Tuesday? We didn't. We teased it. In the messages, I made the assumption that this was at a nice restaurant where typically there's like a wine cellar and you have a key and maybe someone at the restaurant holds the key or the customer holds the key and brings it in.

22:16 And they're like, hey, go to go to, you know, I don't know, see twenty six or whatever, whatever, like the locket is or whatever, the little locker or whatever. I don't know what they call it. And it seems like the same type of thing for tequila. And Jimmy, you're saying that's fairly correct. Yeah, Tony shared this one. Yeah, it's like, you know, cigar clubs and scotch, you know, bourbon clubs and stuff like that, that sense of belonging. But why are you bringing it up here? What's the association you're going to make? So what's interesting about that photo, and this was my family and I went to a little local family owned Mexican restaurant. And I don't know, you know, New York and other bigger cities here, like you kind of have two options.

22:57 You have American Mexican, which is like Chipotle and some of the national chains, Taco Bell. but then you have like real mexican um and most of the real mexican like I don't generally like real mexican food I like fake mexican I like american mexican real mexican I don't like the rice I don't like the refried beans I don't like a lot of the stuff but this was a very different experience now it was still pretty low cost I think like six of us probably ate a full meal for like seventy two dollars something like that yeah um we had cheese and queso and all this other stuff plus the meals but I saw that wall and I was like I've never seen something like this in any of the other family-owned restaurants clearly there were like individual names family names on next to each cubby there were different bottles and different things in each of those cubbies I didn't get to actually get the background on it um but it was something that played into what jeremy sutton had mentioned where he said you know hey there's a hundred and thirty dollar cup of coffee where if you buy this it's a membership to a local coffee shop I didn't realize panera has a monthly membership I think it's like fifteen dollars you can get unlimited refills from panera And we just go back to it's like, OK, how do I layer these things into my business?

24:24 Not just to make more money, heaven forbid, but to actually improve the patient experience, you know? And so when I think about patients that are coming into my clinic, what can I do on a membership basis that genuinely improves their experience? Not OK, you get one session a month for two hundred and fifty dollar a month membership. I don't think that does anything. I think it's Is it access to something, priority scheduling? We talked about Jared, the plumber, who's all over social media. He charges forty nine dollars a month for a plumbing membership. And you're like, what the heck would I do with a plumbing membership? But you get priority scheduling. You get free maintenance like every quarter.

25:07 You get two or three other services that, you know, the right consumer is going to want. How do we bring those membership models into what we're already doing? Well, so the thing with the restaurant and the tequila, I like the, do you notice how the names of the customers are on the little placards or the little, what do you call it? Like the little crests? So it could just say a number, right? I mean, it's awesome. Obviously, it says the name because it's a little bit of status and community.

25:47 And I might recognize Jimmy's last name or I'd be like, oh my God, there's Jay McKay. I mean, that's gotta be Jimmy McKay. I'll take a picture, I'll send it to him and then I should join. And so, I mean, that's just genius on behalf of the restaurant. And also- You could buy any of those tequila bottles from whatever liquor distributor, and you could have it at your house. The fact that this is still a thing is genius for any restaurant. If I had a restaurant, I would absolutely do this. I would have wine, and I would have the tequila, or I would have lockers for anything, growlers that are, I don't know, whatever, anything. uh and so just imagine that as a funding source you know again I have no idea pricing but like they're beautiful they're elegant they look good they they're well designed what if they sold those for a thousand dollars a piece before the grand opening they have a hundred of them around the cl around the restaurant it's a hundred thousand dollars they just raised instantly before they even opened the door You know, like the there are so many opportunities for us.

26:52 And like Dave said, what are you really selling? You're selling that spot. This is your brick in the walk to show that you contributed to this this restaurant opening. You've got your name up on the wall. Why does Paycor, like here in Cincinnati, it's the Paycor Convention Center, like why does Paycor pay to be up there? Because it's that recognition, that notoriety, and you're buying it. And I think consumers would do that. It's also like a mini self-storage because it makes the customer come back. True. That is the genius thing. I just, I gave, I wanted to float it out there and none of you guys took the bait, but I was saying I could buy one of these tequila bottles and it could be in my kitchen for when Jimmy or Tony eventually come and visit.

27:39 And we can get it out at my home and I can pour you guys a glass. Or we could go to the restaurant and the fact that I have some mini temporary real estate that I'm renting or whatever the fee is per year or whatever. By the way, they probably sell it just like self-storage. They're probably like, oh, the first month or two is free. And then you get hooked because you're... bottled tequila is still there. And the restaurant, by the way, probably or maybe buys, you know, in bulk or whatever, they probably maybe they even sell you the bottle. So it's like you just you buy the little blocker and whatever tequila there and you don't even have to bring it in. Like it just shows up and it's your place there. But You know, you guys come to town, Jimmy, Tony, whoever else comes to town.

28:21 I take you to this Mexican restaurant. I get a little bit of status, a little bit of ego, like, hey, here's my name on this placard and and this locker. And it makes the customer come back to the restaurant. That's the genius part of this. Who is the hero? I mean, I worked at a country club. It wasn't super fancy, but we sort of tried to make it fancy in my little hometown when I was in high school. and I was taught early you learn everybody's name you learn everybody's name because when they walk in and you see the tea cars walking in they feel like this when you say hello mr and mrs t car and it wasn't just for tips it was to create that environment which is what are you selling you're selling exclusivity it wasn't that expensive to belong but they had a limit could only have a certain number of members right food members and golf members so you tried to make that experience a little bit different and every once in a while people's heads got a little big and then as the wait staff we talked about it in the back but we were we were we were inflating their heads right that was the whole thing of the status is I'm a member I belong there And I think that's what this is.

29:26 So before we get to Hilda's question, which I want to, we've talked about these, but I asked some AI, I dug in while you guys were talking, and these are the five membership models. I'll go through them really quickly because I don't think they need a lot of explanation. I asked five membership models for a physical therapy clinic that it could implement to make more money and improve patient experience it's got to do both right that's what that's what tony and dave were talking about so number one wellness and longevity membership tony you do that already right How much do you charge again? This was suggesting between fifty and one hundred and fifty for proactive services like injury screens, mobility classes, group strength sessions or periodic PT checkups.

30:07 You also offer just access to the facility. That's what it is. Yeah, it's one hundred dollar a month access membership. So you can come in. It's only available to people who have already been physical therapy patients. But the greatest value of this is they're in my clinic two, three times a week. and so if I get a cancellation I get a no-show there's somebody in here it fills that spot instantly it eliminates the negative impact of no-shows and cancels which allows me then to turn around and say you know what if something comes up it's okay I'm not going to charge you a cancel fee I don't care if you come or not I want you to come but if you don't come I've got redundancy built in the system and I'm getting paid for that redundancy Now, we talked about the plumber subscription model, faster scheduling.

30:51 If you don't think that's important, you've never had a plumbing emergency, right? Like you've never had one. This one I feel like should be or could be an upsell. I think it's a harder sell. It's an easier upsell. And the second was VIP access or concierge membership, an annual fee between three and six hundred dollars. You get faster scheduling, extended extended appointment times or maybe uh appointment times that are a little more popular direct email or text access like now you're selling things that don't necessarily cost you anything but but bring value or a quarterly performance review again you're selling access I was taught that a lot in radio like we didn't really didn't have a lot like we played music I can only play one song at a time you sold access or things you couldn't get somewhere else And I'll blow through the last three.

31:35 Performance and sports optimization membership. A specific sports program. That's customization is what you're selling. Corporate or family memberships. Now you're selling a bundle. You're selling a group status instead of a locker filled with tequila. It's just a different audience and a different outcome. And then a digital hybrid membership. Why not sell something a little bit less for a little bit less? And that comes into play like with RTM or it could be something a little bit differently. But if you're not paying attention to what they like and what they value, you're going to keep selling, I don't know, ice to the Eskimos, which brings up Hilda's question. Hilda is out of Columbia, Maryland.

32:15 She's a geriatric physical therapist and asks or she says, seniors with limited mobility don't value exercise and PT. Okay, let's say that's true. We know exercise and PT help a lot. What can be done to incentivize this demographic? Look, it looks like from her LinkedIn bio, she's been doing this for a while, and this is not a simple thing to solve. What would you guys say? Dave, can you reread it real quick, please? Yeah. Seniors with limited mobility don't value exercise and PT. We know these things help a lot. What can be done to incentivize or how do you reframe it? Do you offer tequila? I don't know if they like tequila. What do you offer to incentivize that demographic of older adults?

32:58 Terribly important. The upside is tremendous. What do we do here? Yes, very easy. Hilda, I mentioned at the top of the show, you have to speak to the individual on the phone or in person about, and you have to dig and find what is the thing that they care about. Maybe there is no thing. And if there is no thing, then you're right. I agree with you. They will not pay or even want to do physical therapy because of the exercise and movement and all that, although they truly need it. You have to find something that they want to get back to, even if it was one or two years ago, maybe it's Five years ago, if it's, you know, if it's longer, it's going to be harder for them to get back to. You have to find what's the thing that lights them up. What's the thing that gets them out of bed in the morning? Maybe it's that individual walk into the library for community reading or it's What's some of the other things for geriatrics, like Rotary Club, like Kiwanis, any of those types of things that the individual wants to do?

33:57 It could be playing dominoes or playing chess in the park. You have to find the thing that that person truly, truly cares about. If there's nothing, if they sit in front of the TV all day, then yeah, it's going to be a tough one. It's going to be a challenge. but you have to find that find something that they truly love to do and that they can't do or they haven't been able to do in three months or one year or whatever and then you have to agitate the problem you have to kind of well if you know you have to kind of agitate with while speaking to them in person or on the phone you have to agitate the problem so the problem is like well so you want to get back to walking to the park and playing chess in the park with your friends and you said you haven't been able to do that in three months how does that make you feel Like you have to pull emotions out of it.

34:38 You have to agitate the problem. And then as you're talking to them more, you can kind of say like, here's the thing. I have a program. It's called Return to the Park. And yes, it includes some movement and exercise, manual therapy and some drills and all that. But you highlight the thing that they really care about and you lowlight the actual work. Just like Alex Hormozy says, you want to sell the trip. You want to sell Maui. You don't want to sell the plane flight to Maui. You want to sell Maui, the destination. Not like, oh, I got to pack my bag for a week and I got to make sure I got my sunscreen and my flip flops. And then I got to sit next to someone who is snoring on the plane and the plane's really long. And then the airplane food stinks. You don't want to sell that airplane flight.

35:20 You want to sell Maui. You want to sell the destination. Same type of thing. Geriatric patient. I'm selling. Here's what lights you up. It's returning, walking back to the park to play chess with your friends. That's exactly what this program is about. It's twelve visits or it's twelve weeks and whatever, and it's three K, it's five K, whatever. Try that. That's exactly how physical therapists across the country are making thousands, tens of thousands, hundreds of thousands of dollars, millions of dollars in some cases by practices that are just selling a packaged result. based off of what the patient actually needs, then insurance and Medicare and all that, that becomes a little bit more of a secondary focus or less of a focus or less of a intent on like component of the sale focused on the result.

36:02 Tony? same thing same thing it's just learning to speak the language you know classic example limited mobility value exercise pt yeah nobody cares about that stuff I mean we do because we're geeks about therapy but the general population does not when I run my my best performing video two videos right now One is about individuals who aren't strong enough to lift their walker into the back of their car. Typical four wheel rollator is like nineteen to twenty two pounds. They can't lift it. If they can't lift it, they can't use it.

36:43 If they can't use it, they can't go out and do the things that they want to do, not come to therapy. don't care about that so like when I use the language I use it in such a way to explain look mom or dad they they they used to love going to the park or they used to love going shopping at kroger they can't do it because they can't lift the walker this is a ten pound walker and I show a woman lifting the ten pound walker and not being able to lift the twenty pound roll later The other one is the lift chair. Now, I understand these are both product videos, but still, I share the story. Everybody with an aging parent has had the story where mom or dad are on the floor.

37:25 Maybe they fell. Maybe they slipped off the toilet. Maybe they slid off the couch. They were trying to get up. Their legs couldn't do it. They ended up on the floor. It's a non-emergency, but they can't get up. The spouse can't get them up. They know that. jimmy or dave or tony we have our own lives they know that we have kids we have jobs we have things we need to do they don't want to call us at three a.m in the morning when they're stuck on the ground so they spend the whole night on the ground they don't want to call paramedics they don't want to call ems because they know that they're busy putting out fires and dealing with real emergencies so the idea is when you find the story that resonates I know my mom would be laying on the ground blood gushing out of her head because she just tripped over the the area rug but she doesn't want to get rid of it and she doesn't think she has a balance problem I'm never going to convince her to do fall prevention because she is falling that's not something that's going to resonate with her you know so you've got to find the language that they understand that resonates with them one more example my mother-in-law We have to beg her to come in.

38:34 Even though she's had falls, even though she's had injuries, she will not willingly come in to do exercise in the physical therapy clinic. You know what she'll come in to do? She'll come in to fold pillowcases. She loves folding. She loves laundry. She will stand at the plinth. We will mess up clean pillows just to give her something that she can fold for twenty minutes. but I could not get her to do standing exercises for twenty minutes. You know, so you bring that purpose, that function back in. That's why I'm saying the future physical therapy clinic is not going to look like what I have out there right now. It's going to be a shooting range where geriatric men and women can come to shoot guns because they want to work on their shoulder strength.

39:20 They want to work on stability. They want to work on core. You want to work on core, shoot something with recoil and you'll feel your core engaged like they're going to be fishing clinics they're going to be you know construction or gardening like let's bring function back into what we do and that's the best way to do it you'll never have to convince anybody to pay a copay because they'll want to pay the copay Tony Meritato running for president of something in twenty twenty eight. But with that, let's shift gears a little bit. I saw this online because you we all click things and we're targeted with ads. This was on Facebook. This is an ad for chiropractors. And I must have clicked something that I'm on this list now.

40:01 And they're essentially this company full script. is essentially offering they they understand their audience because what are what are the two words that are the only different color in the ad which is boost revenue so chiropractors boost revenue dispensing online this is man we're seeing a lot of this right especially with this maha movement right everything's about wellness and we're we're we're taking supplements so twenty thousand plus supplements you own the online store no inventory I didn't click it Because I don't know where that rabbit hole will go. Also, I didn't want more ads. But this feels a lot like, hey, listen, we have supplements. You have patience.

40:42 We'll build you your own online store. You get a cut. We sell supplements. This feels pretty – the thing about people not liking supplements is I drive around. I say there's no way this is going to work. And then drive forty two minutes in any direction and you find a GNC, which is a store one thousand like to the gills. I don't think I've ever seen a GNC go out of business and highly regulated in terms of what you can say. Right. So is this just GNC in your clinic? Is the concept good enough? disregard whether you're liking or disliking of supplements. Like this feels like a pretty, this is, this is selling TheraBand and what you're doing with Joseph Lowe, right?

41:27 This is enabling. Cause a lot of PT clinics would say, I don't know how to do it. And now it's kind of a separate thing. This is them saying, we're going to build you the website. This is when you, Leukemia lymphoma society says, we want you to fundraise for us and we'll get you in the New York city marathon. But you're like, I don't want to touch money. And like, I'll build you the website. We'll take the credit card transactions. This is simplification of this, right? Is this good, bad, or it's neither good, neither bad. It's just smooth business. Dave, what do you think? I mean, I'm fine with it. I like it. Haven't really done it or looked into it. I do get some cold emails. I'm sure Tony gets them as well from some of these other similar companies that are, I think one is called like OK Capsule or OK Capsule.com or Capsule.com, something like that.

42:09 So I get messages just like this from these types of companies that are pitching kind of the same thing. At first, I'm kind of like, well... I get a little bit of bad taste in my mouth because it's like, I'm bringing my patients and clients to you guys. I'm basically bringing you customers. But then, like Jimmy said, they handle everything. I don't need inventory. I don't need things shipped to me. I don't have to ship the patients. They take care of everything. So it's kind of like free money in a way. These companies are going to say, just like Jimmy said, Vitamin Shop, GNC, these customers, these consumers, they're going to go out and buy some of this stuff anyway and you know, all of our families that I know, like all of my families and friends and like, everyone's doing like vitamin C or vitamin B twelve and like multivitamins and all that.

42:55 Like a lot of folks are buying this stuff. Anyway, my parents buy glucose, meaning chondroitin. So I'm sure a lot of this stuff is on full script or any of these like supplement providers. So if you own a physical therapy practice, I think it makes sense. Like, why not? It's just extra money in terms of like cross cell down cell. It's Adjunctive or alternative supplements. Literally supplementary. Perfect. You could write these ads in your sleep. Are you over the age of sixty five? Yes. Do you have knees? No. Yes. Like you see these ads all the time. Right.

43:35 Do they creak sometimes? Yes. Do you know that's bad? Well, that's where that's where I draw the line. Right. When you're when you're when you're making when you're making statements like that. But like if you have knee pain and you're saying taking chondroitin or whatever fish oil and you feel better. That's fine. As long as you're not making claims that are outside the scope of being proven. But if you're like, hey, four out of five dentists agree. I got a buddy who's a dentist. He's like, I've never been asked about any toothpaste whatsoever. But apparently a lot of my colleagues have. Tony, what were you going to say before I bring up that graphic that you shared? Yeah, it's one of those things, you know, what resonates with you?

44:15 This is kind of, we can see this in lots of different, it could be equipment, it could be supplements, it could be whatever. I know for me and my clinic, my bias as a clinician, I tend to think most of what I see in the clinic is not injury. There are very few injuries that I actually see in the clinic. I get excited, like my heart beats a little faster when I see a genuine injury that I can actually help. everything that I see for the most part is lifestyle decline. I'm going to call it lifestyle decline. So it's like, yeah, okay, a little bit of vitamin D, preferably from the sun. If you're afraid of the sun, go supplement with vitamin D, a little bit of fish oil. There's no known dose that's the right dose.

44:56 We just know it's probably anti-inflammatory in nature and a good fat. And then usually some sort of gelatin-based supplement to get the protein in if you're not eating enough protein in general. Those are my go-tos. Now, I don't think there's enough margin in that for me to make recommendations. But I think Alex Hermosi, like a big thing that he started with was supplements. And it wasn't like, hey, would you like to do this? It was, OK, you just told me you want to put on ten pounds of muscle. This is what you're going to buy. and it's like it just you automatically write it up give them the order slip and they're giving you the credit card there is no like well do you want this and it's not really proven and clinically there's no research to support it like that's where we live as clinicians so that being said I created the graphic you're going to show Um, it's just, we know that, okay, even if there's no value in the product itself, right?

45:52 The fact that somebody is willing to buy something, a physical product is a commitment for themselves to say, Hey, I'm taking this serious. I go to school. I buy the textbooks. I go, you know, start a new job. I buy the uniform. Like these are things you do. And if a patient's coming to me back to don't waste my time. if you really want to make a change show yourself don't show me show yourself that you're going to make that change by committing some sort of capital buy something and so this is a simple you know we're experimenting with something like this as a mock-up Got the products that you love. I'm not saying these are the ones I love. QR codes.

46:33 You rip it off like a referral pad. You give it to the patient. Let them go buy it on Amazon if you don't want to earn the profit selling products. But the whole idea here is I think this one thing would improve patient outcomes because it improves the commitment or the buy-in on the patient side. Yeah, just as we're talking about supplements, Scott says- You got hit with another one? Yeah, nutraceuticals for physical therapy practices. Like whoever this is, Lasso Wellness, is literally saying like, we offer this. These are for physical therapy practices. No financial investment, so you don't have to hold inventory.

47:14 This person did exactly what we're just talking about with that Cairo thing. But specifically, this is the PT version of that. Stand out in a competitive market, recurring revenue, ordering via QR code. These are all the objections, right? Well, I don't want to take the hit. I want to spend three grand a whole inventory. Nope, don't have to do that. Well, it's super complicated. Tony just showed a quick graphic. They're saying here, order by QR code, third party fulfillment, drop shipped recurring revenue opportunities. Is the juice worth the squeeze of me even bringing this to my clinicians or my or my patients? And then why would I do that? Stand out in the competitive market like the person who created the site under understood. I don't know who they are, but they understood who they were, at least.

47:55 trying to sell oh it's ron ron is uh doesn't say what he is for the record though scott scott shared this link with us like this is not an endorsement we're not saying you guys should do that but you know just like everything else we have our biases like this to me makes me very uncomfortable sure but what's interesting is I've looked into the food delivery services I can't like blue apron and things like that they have affiliate programs I would not feel uncomfortable joining one of their affiliate programs and saying, hey, look, if you're not like me and you're not going to cook every meal and you're not going to put time into choosing good food and preparing it and making it delicious, go consider one of these food service delivery things.

48:44 And here's my affiliate link for it. You know, so I have no problem recommending food as a income source. I would never recommend supplements as an income source. So you got to start with what you'd be like. And that's what I say. Like, if you're not uncomfortable doing this, this goes back to Hilda's statement, right? Like seniors with limited ability don't value exercise and PT. You're in trouble. Can you sell it as something else? No, they don't value anything. My dad, my dad likes playing golf. He can't now. You know, we were working with a nurse and she's like, I feel like everything should be around golf. And I said, yes, except he's so far away from golf. Like he can't stand without a cane or a walker that that's not an option.

49:27 We got to back down. Backing down. Living room putting. Yeah, I tried that. I bought one of those little carpet things, right? And that became a tripping hazard because it had to be there enough for him to be like, yeah, I'll use it for five or ten minutes. So, like, this is what Hilda's asking is very simple for us to sit here and say. It's just not really easy. Like, he can't read, right? My dad post-stroke isn't able to read. Wasn't a big reader anyway. Didn't play cards. But even if he did, can't identify. What does he like? Golf. So what's he do? Watch his golf on TV. Is that good? No. But does it pacify him? Yes. So what is a son to do? I don't know. Hire people that are smarter than me, but I can't remove the PT element going, I understand you're saying everything needs to be about golf and firefighting, except those two things are so far away that I don't know how to make anything relatable to those things that he actually values to see him doing those things.

50:25 So like this is where then again, you say, okay, we know he'll buy golf. And when I say buy, it could be with his cash or his time or his effort or his energy or whatever. We know he won't buy into like standing trunk rotation, PNF pattern D one and D two. so you say okay well we know that the putting may be a good idea tripping hazard what if we had a facility that had an overhead harness that we can hook them up to what if we go to like a golfing simulator what if we go to even just a game like a wii or some sort of virtual reality or something where he could maybe you don't even have to stand up but sits at the edge of the seat loading through the legs a little bit controlling the trunk going through the golfing motion um I'm going to create something like that.

51:14 And I'm thinking as a business owner, I'm going to create something like that specifically for this demographic. And I'm going to sell it to the people who are really involved in this person's life. I'm going to sell that service to Jimmy. Jimmy's going to buy it for his dad because he knows his dad won't buy it. And his dad's not even looking for it. But I know Jimmy has enough that he will do it. And he knows that his dad's going to say, well, it's not therapy, it's golf. I'm going to do this. So, you know, and that goes back to the discrete pricing. If you remember before, Dave and I, we talked about like, you don't want to tell the patient how much it costs if you're selling it to the patient's adult children.

51:56 The adult child will pay five hundred dollars for an experience that the patient would never pay for. And you might even go as far as giving them a fake invoice so that they can show, look, dad, it's only fifty bucks or it's only five bucks or look, dad, your insurance will cover this, even though they're paying the five hundred dollar bill for it. Like these are all the things that go into creating an amazing experience that maybe the ideal consumer who receives it isn't interested in. But we know it's for their best. Sell them what they want. Give them what they need. Blah, blah, blah. You heard it here first. Tony says create fake invoices. Rather than that, I want to highlight Tony just saying something amazingly interesting, which is the overhead harness golf simulator.

52:45 Jimmy, if you saw an ad on Facebook for a nearby physical therapy practice or a golf training facility or whatever, overhead harness for helping older folks get back to golf. And, you know, it's a, you know, I don't know, three thousand or it's a hundred or two bucks for the first time. Now, of course, you got to get your dad there. And that's that's a little bit of a challenge maybe with transport. But wouldn't that sound like a perfect offering or offer for your dad in his situation right now? Say it one more time like you cut out. wouldn't wouldn't the overhead harness for safety so no falls sure in front of a golf simulator at a golf training facility or a physical therapy office or a gym or whatever wouldn't that if it's a hundred dollars two hundred dollars for the first time as like an introductory you know swing or whatever wouldn't that be perfect for your dad I mean there's the challenge of getting him there and transporting him but other than that like he's safe in the harness wouldn't that be perfect for him Completely, yeah.

53:45 I looked into putting one in my garage, like one of those legit systems because my dad, as much as he's impaired from the stroke, is going to understand if this is like bull or not bull. So I was looking to put one of those legit systems in, but I would need the harness because even if it was dope on screen, if he can't stand there and take a full swing, he ain't going to do it. And then you just bought a bunch of stuff. You just bought an exercise bike and you're hanging laundry on it. So I just shared with you, which got me thinking about this. I could see a therapist being like, oh, an overhead harness is going to limit their ability to flex and rotate and stuff. I was like, OK, so if we're turning this into a real business, so let's look at the equipment that's out there.

54:27 There are those robotic leg orthoses that you can get. If I'm going to invest and I'm going to finance it and this is going to be a real business, there's a potential for something like this. Couple more months, Elon Musk is going to have devices out there most likely that are reactive and maintain balance so that even if they do start to over lean or go somewhere, there are just so many things. But we have to get out of the world of I can't buy a twenty thousand dollar device that helps my patients swing a golf club if I'm relying on nineteen dollars and thirty two cent reimbursement from Medicare.

55:09 You know, and we already know it's not a coverage service. This is golf performance. I don't care what the condition is. We are not doing this to improve your standing posture. We are doing this to let you swing a golf club. And that has a different price tag. You know, we have to be comfortable with that. Yeah, you thought you were done with golf forever. Guess again. Here's how we're going to get you back to golf tomorrow or today. You got to get the equipment. So what are the triggers? Going back to – that's one of the devices. I just grabbed it off of Google. But going back to Hilda's original question – I can't even tell you how many people are still trying to sell golf performance for parkinson's and all these conditions no it's not the language to use what's the language to use why does somebody stop golfing because they know they can't walk across the fairway they can't walk across the green they can't get on and off the golf cart safely they don't want to be laying on the ground embarrassed all of their buddies are walking around playing golf they don't want to slow down the pace of play they don't want to trip and fall laying on the grass and then they have everybody looking at them one of the biggest triggers that I talk about with the lift chair is, yes, we said, you know, they don't want to call EMS.

56:30 They don't want to call their adult kids. They also don't want an ambulance showing up at their house three a.m. in the morning because everyone in the neighborhood is going to be gossiping about why is there an ambulance at the Maritato house? What happened? Did somebody have a heart attack? Did somebody get killed? Like, did somebody commit suicide? Nobody wants that conversation. So they will intentionally lay on the floor unless they can discreetly have a tool or a device that can help them perform. And so it's the same with golf. It's the same with other things. They don't want to be embarrassed. They don't want to give up the perception of independence. What better service can we deliver than to give them that autonomy and that sense of self-control?

57:15 I can't get up on my own, but I can use this tool to get me up. Understood. We got three minutes to go. You guys want to do parting shots before we go? Yeah, let's do parting shots. I think the biggest message, the biggest takeaway, whether you're marketing to therapists like those supplement companies are, you're marketing to the consumer, you're marketing to whoever, you have to understand who's making the buying decision and what is the language that resonates with them. Why are they buying the solution to the problem? Because if you don't know that, it's really hard to get somebody to buy. A hundred percent. I mean, you have to know the consumer in and out. You have to know about their pride, their ego, a little bit of their, you know, their perceived status or yearning for status, all the types of things that we talked about, all those like emotional triggers, focus on that rather than the front end of what we have historically always focused on, which is like therapeutic exercise and coding and billing for Medicare and insurance and all that.

58:16 So yeah, hopefully this helps others that watch and listen. I mean, it's always a good refresher for me to hear what you guys think too. I would say you got to let go before you can grab onto something. Let go that you're going to be the thing for everybody. Like, look who's Hilda Hilda's asking about. Well, they don't value exercise and PT. Like take, take three nose and move on. Like embrace that rejection. Like, and say, I'm, I'm saying no to you or I'm agreeing to your rejection. I'm not going to try to jam my solution into your world. And move on to someone who actually might accept that. That's simple to say, but it's not easy. We're also not taught that. We're taught that we can help everybody, everybody over the age of sixty five. But they're not going to take it. And you're going to spend too much time trying to help the person who's rejecting you.

58:59 And you're not going to have any time left, the person who would actually accept that situation. So understand what you're selling and who values it. I'll do the wrap up real quick. If you know you have a solution that would benefit the individual and they say no or they don't want it or they're resistant to it, it should be a gut check to you to say, hey, you're just using the wrong language. You're using the wrong words. You're saying it the wrong way. That should motivate you to figure out how to communicate the message better because once you can communicate the message, everybody is going to say yes. them. Guys, don't forget Tuesday, Thursday morning, eight thirty a.m. Eastern. Come back.

59:39 Watch. Watch P.T. Pinecast. Watch the Dave Kittle show. Watch Learn Medicare Billing. Support the channel. Subscribe. And we'll catch you guys next week.