RTM Doesn’t Suck—If You Do It Like This

0:00 down a little bit you're listening to the pg pinecast where smart people in health care come to make noise here's your host jimmy mckay all right i think we're live I think we're being broadcast right now. I want to know if people can hear us. So I need someone to comment if the audio is actually coming through, because how come we can't actually? What? There we go. There we go. Let's do a little quick test. Live from Graham Sessions here. This is PT Pinecast. You prefer Steven or is it Steve? It's actually a story to that if we have time. What's the name? All right. So I was ten years old and at soccer practice.

0:41 And a coach called me Steve, and my mom turned on a dime. I named him Steven for a reason. And that has stuck with me for my entire life. Well, then Steven it is, because I don't want Mom Cohen coming through the live show. No, not Mama Bear. This I asked on LinkedIn a few weeks ago. because you want to test you want to test the profession what you assume to be true is not always true we know this so i think i asked on linkedin and i'll find the poll results who here knows what graham session is and like here is also biased this is my network or who can see this right so i assumed because i've been here before A lot of the people in my network have been to Graham Sessions before that a majority of them know what it was.

1:23 It was ninety percent plus had like had never been to Graham, not just had never been to Graham Sessions, did not understand what what I was talking about. So how do you describe who's here and the purpose of Graham Sessions? Because you're here with Sarah Health and we'll get to that. I mean, I'm still learning myself, right? Like, if it wasn't for Max at WelcomeWare saying, hey, you should come to this, I wouldn't be here either. All right. But then you asked a few questions, and here's how I describe it. And you tell me if it's the same feel that you got, which was, I think this is twenty years ago, Patrick Graham, Steve Anderson, and some other people said, we need a very small meeting. We have PPS.

2:04 and we have CSM, we need a smaller meeting. Okay, what's the goal? We want a bunch of people in the room to really hash out. We want to be able to hold this meeting in one room and these are the change makers, whatever you want to call them, to solve the problems that we're dealing with now. Twenty years ago, And today, we still have problems. Hopefully, we solved some of those problems. Now, we're dealing with new problems. And the crux or the twist of this idea for Graham Sessions is whatever is discussed here, it's like Vegas. It stays here. Well, kind of. Who said the thing, not what was said? You're allowed to say, hey, we brought up this problem. This solution was brought up. You... You can out yourself.

2:45 You can say, I said that. But you can't say someone else said that. And that's to sort of, I mean, for lack of a better term, like safe space. It's like, dude, you want to be able to say the things. I've been to bars with PTs. They say things that they would never say on a stage because that's how the world works. So this is supposed to be as close as you can to get with no repercussions in a good way. I mean, that makes a lot of sense, right? I think it was Lawrence Benz and one of his pre-PPS, you know, heads up to everybody that the truth serum starts flowing at the bar. And so it's like, hey, why don't we just have these conversations sober for eight hours and probably get somewhere further than a bottle of pint glass.

3:25 Right. The other thing is, when this started, and I don't know what the procedure is now, but you had to be invited. It was like, listen, and we want to cherry pick. Hey, you know, and it was sort of the way I looked at it. It was sort of like, hey, I see what you're doing over there in that little corner. We want to bring you here. We want other people to see what you're doing. We want to hear from you. We want you to hear from other people. And, you know, cross-pollinate. We want these ideas to leave. The purpose is... to have some ideas look at things differently and then have the ideas of the those things leave the room so i can't tell you who the hundred fifty people are i'll turn the camera around because i don't want to out anybody this is a super secret meeting even though ninety eight percent of people have been saying on linkedin i'm going to graham sessions um you looked at the syllabus or whatever Anything on there?

4:08 What excites you about what's going to be discussed? And maybe my follow-up question will be, what are you like, hey, where's that thing? So what's one thing that you're excited to hear this next couple days? You know, there's a talk coming up later around what the PT industry can learn from the dentistry industry around MSOs, IPAs. and collective bargaining and negotiations. Really excited for that. Why you? You got a background. I didn't know this about you until about a couple weeks ago when we recorded something. You got a little bit of a different consulting background. So you look at the world differently. You just do by your nature. Yeah. Spent seven years at Deloitte Consulting. So everything from helping Caterpillar employees be able to be more efficient on the line to negotiating software contracts and like the eBay PayPal when they split.

4:52 Negotiated, I don't know, a few hundred million, almost a billion dollars in contracts. I couldn't say that so casually. It was fun. It was a lot of fun. Well, they spent a lot of money. As I'm driving into Arlington last night, we're in Alexandria right now. There's a Deloitte building overlooking D.C. and I'm like, oh yeah. They pay for that because they do a lot of work with big companies and make a lot of money, right? Yes, that is exactly it. And so that, but also I am the administrator of the Private Practice Network, IPA. So it's a PTOT speech IPA in New York State. We have six hundred, I think maybe seven hundred now, providers across the state, a few hundred locations.

5:33 And we're starting to actually get contracts for our group members. And seeing that, touching that, feeling that, like seeing that contract, I've printed it out. Like that is a real contract that is paying well. I don't think I can say exactly what, but it's paying well. And our members are going to be able to benefit from that. And I don't think there's anything necessarily like unrepeatable about what we're doing. And then the conversation at the bar last night at the welcome reception is people are talking about MSOs, people are talking about IPAs. And I really think that's a great way for groups to be able to have negotiating power and get it to the table. And payers are much more willing to listen now than they were prior because musculoskeletal is, it is their cost.

6:19 Like that's it, especially as more get into managed care. If you can help that Medicare Advantage patient not have a fall, just from simple time value of money, if you can push that off for a year, there's about a thousand dollars in net benefit to the payer. That's easy. And we like that. Yeah. You're not only the hair club client, you're also the president. So you're here as a sponsor as well. So you look at our profession from a different lens again with this thing that I feel like it popped up on my radar or when people started talking about it two years ago, three years ago. I know it was before that, but I think people really started to take it seriously. And that was remote therapeutic monitoring. For people who still don't know, because there are.

7:01 You talk about this a lot, but there are people who still don't know. Give me a quick re-rack, just a quick context on what it is and how Sarah Health people do it. Easy, simply, pays for itself and then some. You know, I think the, I will, I will answer your question. But I think just like ninety percent of patients that could get PT don't. I think there's ninety percent of practices out there that are doing the work required to build the codes. They're just not building. Closing the loop. Exactly. And so if you think of RTM as payment for or a funding mechanism for time and technology in between visits, you're ninety nine percent of the way there. Right. Like.

7:41 And I'll talk about this later when we get up on stage for a bit. To me, RTM is there to help patients complete their plan of care, stay adherent to their home program, and have a better outcome. That is what it's for. That is the purpose. It's not six codes. And if you're looking at this like, oh, well, I'm only going to be able to generate... Forty dollars from ninety nine seven seven. If the only way you're looking at RTM is going to hit your P&L is by those six CPT codes, you're missing the forest for the trees. So walk me through where else it touches, because it sounds like butterfly effect. But if you're only looking at the forty dollars, you're not looking downstream.

8:22 Yeah. Where should they should look at the forty dollars and where? uh so plan of care completion uh so we did a retrospective analysis someone got mad at us for calling the study uh because we didn't publish it uh for four hundred eighty patients six months six i know right we we may make a big deal about the dumbest things we keep going yeah that's dumb but yeah i agree and across the different uh outcomes measures like lefs coos etc They saw a nineteen to sixty two percent increase in plan of care completion. Why? Just go to the human level. Because I felt connected. I understood. It's a better relationship. It's a better relationship. There's greater therapeutic clients. It's not a transaction. Exactly. Got it. Exactly.

9:03 And so that lower cancellation rates. And just even those two, right? You start thinking about what that would do for your P&L if you're able to go from six point two to six point seven visits per case. If you're ones and twos, that one, two visit patients that didn't drop off become fours and fives, which is what they saw. And that was dramatic. Yeah, it's a big difference. You think about it even against your point. I think about it differently. Like I think about the cost to deliver a visit, right? right? And what your payback period is to even be able to be profitable as a clinic on a patient. And so when you're doing all the work on verification of benefits, you have to have your front desk, you have to have your EMR, you have to have all these things, right?

9:44 Like you have a certain amount of cost built into delivering an eval. And from there, when do you finally turn that over, right? You, in the startup world, there's customer acquisition costs, lifetime value, payback period, and all that. I think the same thing applies in PT too. Unfortunately, I'm very sorry, but we have to talk about it in those terms. No margin, no mission. Yes, that we are here for great care, but if we don't have a roof or we can't pay our people, we're not helping anybody. No. And then beyond that, I think RTM used to be looked at as the end point, like, okay, perfect. I'm doing RTM now. I'm billing it like I'm done.

10:25 Well, I don't know if anyone checked what CMS released in December, but they released the Elevate program, the Access program. I believe before that was a Balance program. Access in particular is a value-based program that pays for improvement in musculoskeletal outcomes. So you're going to get paid based on your outcome. Now, if you can't keep patients in care, you're not gonna be able to get paid for that. So now, our team, I think what was the end point, looking at the end point, and I give folks that started in twenty-twenty-two, twenty-twenty-three, and like, hey, just didn't work. It's like, yeah, but the game has entirely changed.

11:08 Like, yes, there were two new codes added, so it went from four to six. But the impact is going to be nonlinear. So it'd be like if you increase the size of a hockey goal by fifty percent, it'd be more than fifty percent more goals. Right. Yeah. You probably have taller goalies like there'd be all sorts of stuff that would happen. Wider. Yeah. Wrestlers would now be goaltenders. I think you'd have to go straight to Japan. So when someone thinks about, OK, cool. tactically how do i do this like i remember the first time someone was explaining rtm to me i was like oh i can see pts sitting there at their desk with uh uh post-it notes or they're making their own spreadsheets to track these things and then eventually you hit a point where you're like dude this sucks This is too complicated.

11:53 But now we have apps and all these different things. So specifically with Sarah Health, if someone's still nodding and listening along, they're going, okay, how does this work? Do I have to invent more stuff or track these things? Do I have to hire one more person? That's a legit question. Hire one more person just to track all these things. Or do I have to take half of my front desk person's day to do this? Because if it is, they're asking the right question. Is the juice worth the squeeze? So is it Post-it notes? I think that's, again, part of like it's changed a lot since twenty twenty two. Right. When they came out is you're no longer customer number three, your customer number three hundred. And so there's been a lot of really good technology built. Like from what I've seen, what Sarah looked like on day one to now is almost unrecognizable in many ways.

12:38 It should. It should. Part of that was we actually asked all of our clients early on and we still do like show me every spreadsheet you have to make for this. Cause we're just going to take it and then got it. You're going to ingest it and say, well, we'll do it better, faster, cheaper, exactly. Exactly. Um, and so the way that it works with, I'll talk about Sarah, but I want to give like value to everybody. Like, I don't care if you're using us or not. Um, have your front desk enroll the patients that check in for eval. So they're there. They're checked in. They're good. Enroll the patients. Don't call it RTM. Call it something else. A lot of our groups... To a patient, you mean? Yeah. Okay. Good. I like... Yes. Now we're going into marketing and branding. My world. Yes. If it has... And Tony Maritato knows.

13:20 It sounds like I'm unreasonable on this. But if it doesn't have a name or has a dumb name... People don't attach to it. So what are good names that you've seen people call it? So a lot of groups call it their Connect. That's our typical Connect program. Unless you're on Raintree, because Raintree has a feature called Raintree Connect. So our Raintree customers call it something different. like the CareSync program, the Concierge program. Like we've seen a lot of really cool names. There's another group calls it the patient support co-pilot, which it'd be in the right part of the, you know, have the right demographic for that to work. But that's, that's it. And then we give a consent form to each and every one of our practices.

14:01 That's white labeled. And so patients don't know that Sarah exists, but there's no reason. We're just a vessel. Right. You want them. to feel the relationship with the practitioner in practice. Exactly. And so from there, gets enrolled. For us, patient gets a text within typically one to two seconds of the front desk enrolling. That is a great priming mechanism for the clinician, that PT, to talk about, hey, this is our connect program it allows me to be able to engage with you between visits because we know that you spend ninety nine percent of your time outside of the clinic so you're gonna get questions can you text me back because i'm gonna use that in your fault visits oh so you're not asking the patients to download an app no no because if i get asked to download one more app like literally to park at the airport i have to download an app to buy coffee it's like do you have your points app i'm like no like you might be giving up your points i'm like at this point lady i don't i would like the coffee i will give you money And what's the probably most used app on someone's phone anyway?

14:57 It's the text message app. I mean, I want to avoid calling people as much as possible. So they're just using, they're just texting? They're just texting. So what we have is... Stunningly simple. You have to use a software as a medical device to be able to collect this data. Well, we went to the FDA back in twenty twenty three and have our letter for have them have them look at all of our functionality. What are you doing? They're going to tear it apart. Exactly. And they looked at it and said, hey, based on these two pieces of functionality, this is software as a medical device under enforcement discretion. And so we went through that process because we've been at this for almost ten years now. And we found early on, relatively early on, that we had patients and we were working with a lot of fire departments.

15:40 And so we had a fire department, Plainfield Fire, Danielle, who I'll never forget, she was giving us feedback of why she wasn't logging into our app. Wait, why was the fire department using it? We were working with the PT and then PT groups that had some ATC as well, but PT groups that were directly contracted with fire and police. I love hearing stuff like that. My dad was a fireman. I'm like, firemen, typically cops too, EMT, will avoid... medical care at their own detriment well because they don't want to be the one that's like off the truck like oh oh yeah we've yeah yeah my dad broke both pinkies at a fire and he was like trying to hide it and they're like you sort of need all ten fingers to do the saw uh so you have to you have to go away from work but anyway go ahead so all right so you so you started with plainfield fire yeah um and a bunch of fire departments uh but really danielle was really helpful because like hey She gave us a testimonial on like her recovery process and how much our app helps.

16:37 And then it's like, look, I just don't need an app anymore. What I need is a way to talk to my PT and get reminded to do my stuff. Like, oh, you need a text message. And she's like, well, better be a good text. And that was what started. And then when the RTM code, that was twenty eighteen, twenty nineteen. And so we'd been at this for a while. When the RTM codes came out, we worked with a lawyer like, hey, we want to be like lock and stock if there's ever a records request. What do we need to do? Like, well, you need to... do this five thirteen G process. And so that's exactly what we did. We have had a customer who did get a records request for one of the codes we facilitated, gave all of our stuff.

17:18 Done. Done. Wow. Good for you guys. What's the what's the what's the thirty thousand foot view in terms of adoption? Like, I know you don't have the day. I'm going to hold but if you were like i don't know my gut feels like five percent of the of pts who can be using this r or thirty i don't where are we are we at two percent are we at eighty i don't i am i am in the dark and it's an unfair question for me to ask i know you're making up a number here i based on what i've heard from some of the other leaders i i i would bet we're maybe at ten percent have an account with an rtm technology and is attempting this yep and that's only gonna go up i mean like you know five years from now six this is not a nice to have this is a need to again it's not the it's not the end point anymore it's just the starting line right to get into these other programs that are coming out and like If you think that CMS is going to stop rolling out new programs, I have a bridge to sell you.

18:10 Yeah, it's in Brooklyn. Super cheap. Cool. We'll be checking in over the next couple of hours, next couple of days. This is the first time I've ever really done live streaming on site, but I live stream from my living room, so I'm like, how hard can it be? This is APTA headquarters in Alexandria, Virginia. Graham Sessions, which is put on by APTA Private Practice Section. Thank you guys for letting me set up my mobile studio in your living room here. I call it Avengers Tower. Sort of has Avenger Tower vibe. It does. That part could get blown up easily. Yeah, yeah, yeah. But the goal here is... I'll be asking everybody who's in a session right now. I'm speaking very quietly. Is there a session? But just a couple of big picture questions that I asked you.

18:51 What is something you are excited to hear more about and you want to hear thoughts? What's something you wish we had? Oh, it's not on the docket. Why isn't that being taught? I was like... Where's all the AI stuff? I didn't see one thing on AI really in there. AI or even these new programs that are coming, like the Access program. I feel like there could have been a whole thing on that. Right. Because if you want to be in the first round, you need to apply by, I think, April first. Oh, we're in January. I will give APJPPS some grace. To put on a conference, you have to get speakers months in advance. I get that. And it came out in December. Right. So what I'm saying, though, is, hey, how do we shorten the cycle of conversations in places like this, having conversations?

19:32 The answer is live stream. Why aren't we doing it? What are you doing in between Graham Sessions' meetings? You should be doing live streams, but I'll be asking big picture questions. So forgive me. I'm going to be blowing up your feed with that. Damn. Jimmy McKay is live again. Again. Usually it's like once or twice a day. Now it's thirty seven times and I have no idea. I DM to a bunch of people that I knew were coming and everybody was like, yeah, but I don't know who I'll be talking to. We're talking to one person at a time or we talk to a group. I don't know. But we have a tradition on the show and it is called the parting. This is the parting shot. One last mic drop moment. No pressure. Just your legacy on the line.

20:13 Just your legacy on the line. What's your parting shot for right now? Something you just want to leave the audience as we kick off the live stream. Thanks for being our guinea pig, by the way. I literally just called Stephen over and I was like, hey, we're doing a lot. I got to see if this camera works. And he was like, great. He didn't say, what are we talking about? Is this actually live? All right. What's your parting shot? What's just one little thing you want to leave with the audience? A story. And I'll tell it later, but I can say it again here. PT Indianapolis told me something that really changed the way I look at this. She said, I never thought I would save a life. Patient texted through Sarah, shortness of breath, three days post-op total knee. She gets that, has a quick conversation, ends up calling him an ambulance.

20:57 Hospital, only one day, one night. Fluid on the chest, as benign as one night in the hospital stay can be. Went home with his family the next day. All it takes is one missed visit because he doesn't feel well. And that story ends a lot differently. So that is what that connectivity can mean. That's also why these payers are paying for it. Because that patient also could have been half million plus instead of thirty thousand. And the answer, the solution to that or the facilitator, that wasn't something terribly high tech. It was access. The text. It's access to someone when they needed it.

21:38 The right person at the right time. Wow. That's powerful. And the right question. And the right question. Yeah. This doesn't feel right. What do I do? Wow. Red flag. Good for you. Where can people go to find out more about Sarah Health? SarahHealth.com. So S-A-R-A-Health.com. And then I'm Steven. So S-T-E-V-E-N at SarahHealth.com. Not Steve, as we talked about earlier. Don't do Steve, everybody. It's a way to put your foot in your mouth. Always make sure you know what your guest's name is before you start. Live from Graham Sessions atop the APTA Avengers Tower here in Alexandria with PPS. That's it. We're out. Boys, what the hell are you doing? Follow Tony Meritato on YouTube at Total Therapy Solution. Find Dave Kittle at conciergepainrelief.com and on YouTube at The Dave Kittle Show.

22:23 And follow Jimmy McKay at PT Podcasts on YouTube, the socials, and wherever you binge podcasts you pretend are for CEUs. And hey, just a reminder, none of this was for advice. This was for entertainment only. Our lawyers say that counts. Thanks, Keith.