Seize the Opportunity: Alex Bendersky on Risk, Resilience & Trillion-Dollar PT

WEBVTT

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You're listening to the PT Pinecast,

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where smart people in healthcare come to

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make noise.

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Here's your host, Jimmy McKay.

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I'm pretty much just living live today

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here at Graham Sessions,

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the top APTA's headquarters,

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live streaming during Graham Sessions.

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And I'm telling people Graham Sessions is

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this annual event called the Cool Kids

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Lunch Table, super secret.

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But you know all these people.

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If you're rubbing elbows in the

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profession,

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you've

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met or heard of or at least you

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know know asymmetrically through linkedin

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a lot of these people alex benderski but

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i'm gonna show a bunch of times is

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this your how many gram sessions my number

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one is your first one it's my first

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one i'm grand session virgin really this

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is great we get purity uh so my

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big picture question would be uh what is

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something so far that's made you someone

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who thinks writes talks acts in this

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profession and we'll get to what you do

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but what's something that

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surprised you or excited you?

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Let's go with positive first.

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I think the panel sessions,

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the panel structure is actually very good.

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It's a good format to get different

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voices.

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Go topic-wise.

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Anything that either is on the docket for

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later today or tomorrow or already that's

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made you go?

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okay cool uh the the strength of numbers

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talk is is definitely pertinent uh there's

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a laws of scale that can't long lever

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arm yeah the levers and the arms and

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the leverage talking about i mean and

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again the rule that the rule about gram

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sessions is you can't say who said what

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right let's talk about the idea and the

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idea there is uh can you find ways

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to connect with colleagues or other

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businesses without

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being bought formally, right?

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And then how can you use those economies

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of scale to get things that are better,

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either better,

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higher payment or lower cost?

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I mean, think of the European Union,

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right?

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You retain your autonomy,

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you retain your borders,

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but you open them up so that you

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can have a collective bargaining,

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you can have collective currency,

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like just use that as a narrative for

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physical therapy practice.

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So you keep your autonomy and agency,

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but you are able to share some of

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the risk, able to share your borders.

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able to share some of their common

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expenses.

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So it's logical.

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Certainly there's movement in the right

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direction.

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It's not the only organization that's

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uniting.

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Hopefully there's going to be more of a

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grassroots movement around the country to

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do this,

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but

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It's still a fractured ecosystem.

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And so by majority,

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we either lose private practices because

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they sell or we lose them because they

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close.

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What is something, my second question,

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what is something that isn't on the

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docket?

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You're the guy who reads the instructions,

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is my guess on you.

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What's something that you were reading and

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going, why are we not talking about this?

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I think the theme of diamonds under

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pressure.

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That's the theme this year, yeah.

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I don't know if it's closely related to

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the actual topics that are being

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discussed.

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I think it was just the theme, yeah.

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It's a nice theme.

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It sounds good.

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It certainly gets a buy-in.

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It's like, yeah, we're hurting.

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Let's see how we can get better.

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Teaching resilience is a skill.

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I think to teach resilience,

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you have to have topics that actually

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empower you.

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to withstand some of that stress under

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pressure.

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And if you're going to turn this coal

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into a diamond, teach people how.

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Don't give them ten thousand years until

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they actually turn into that.

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We forgot to add that.

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It is pressure that turns coal into

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diamonds.

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It is also a long time.

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Yeah, for sure.

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It takes millennia.

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And if you want to expedite the process,

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you have to have an external source.

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You have to have that pressure source from

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somewhere else.

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So, yeah.

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If you were to talk next year,

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what would you say this needs to be

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on the docket, idea-wise?

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No, that's a terrific question.

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I think next year on the docket,

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you need to have a greater voice of

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other professions that are presented here.

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You need digital health providers to be

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present.

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That's interesting.

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Half of the economic equity in physical

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therapy is digital health,

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and they're not present.

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PTAs need to be here.

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PTAs are the troops on the ground.

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They're the ones delivering care.

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I don't see them represented in any

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panels.

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So if you're going to have someone

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delivering care for you,

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they should have voice.

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Yeah, PTAs,

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and I'm not the policy politics part of

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PT.

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I like the fact that some other people

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do it,

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but PTAs were just getting basic rights in

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a PTA environment.

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mean still working for basic for sure

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right of course it was like why don't

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the ptas show up i'm like would you

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no exactly but how do you expect it

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economically to give them a bigger burden

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of delivery care process without giving

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them representation and giving them voice

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so i would love to see a broader

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representation we can maintain this

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exclusive pt only club yeah and still

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expect equity yeah

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uh what's something that not a lot of

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people have on their bingo card right now

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as we record in january that will become

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a thing in the next twelve months like

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something that people are not gonna see

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we'll say most people aren't gonna see

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coming in his issue there's a lot of

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policy changes law

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And maybe they're like, well,

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I saw the law change,

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but I haven't felt that yet.

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What's something in the next twelve months

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that people are sleeping on that they're

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going to be affected by?

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So not to be a bearer of bad

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news,

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but your bread and butter of outpatient

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physical therapy business,

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your post-operative cases are going to

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start to disappear.

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Why is that?

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Your risk-based contracts,

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your hospitals become stakeholders in your

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risk.

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And when the hospital is a stakeholder in

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the risk,

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they will retain most of their delivery

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processes.

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So your mom and pop shop that is

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now taking care of your ACL high school

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population,

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which is great because it's like six

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months of guaranteed utilization.

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Once that disappears,

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what are you going to do to occupy

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your therapist time?

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So be aware of these models that are

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emerging.

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These are tenure models.

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And the reason why they're tenure models

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is they're not expected to be fully live

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until twenty, twenty seven, twenty,

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twenty eight.

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But they're here.

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So your team, your access,

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your wiser models, they're here.

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They're a ten-year roadmap.

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They have a runway.

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And right now, you're just taking off.

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So are you ready to deliver care?

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Are you ready to collect outcomes?

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Do you have the infrastructure?

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Do you have the technology?

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So yeah, I think that's... All right,

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well, someone who's like, you said,

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I hate to be the bearer of bad

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news, but you were.

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What should someone be doing, reading?

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Where should they be skating to?

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I think one positive effect of CMS is

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there's full transparency about it.

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Right, they put it in writing.

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It's a lot of writing, but it's there.

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It's a lot of writing,

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but we live in a day and age

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where you have Chet GPT.

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Right, right, right, right.

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Ask it to summarize it for you,

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and you become an educated consumer.

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I learned logical fallacies on the drive

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down here.

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I was like,

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I know they were a thing,

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but I'm like, teach this to me,

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then give me an example,

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then give me a multiple choice quiz.

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And I learned it in two hours.

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So it's democratization of information.

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It's wild.

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We are living in an age where knowledge

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is democratized.

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It's free, almost free.

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you just have to be a smart consumer

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so go to see a master website download

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those documents and ask chad gpt to

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summarize it for you step one step two

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look into your existing infrastructure are

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you ready to create a checklist create

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like go through the same chad gpt

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conversation and say what do i need to

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do exactly what i run an outpatient

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physical therapy practice in arkansas

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what are my steps to participate in these

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risk-based models?

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Give me a checklist.

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Now you are an educated consumer.

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Now you're prepared.

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And then start checking off those boxes.

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The last part is really important too,

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checking off the boxes.

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Oh, for sure.

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We always want the brochure.

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Give me the checklist.

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I now feel safe.

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still need to act on it yeah i

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need you we need you to act on

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it you remember those days when dating was

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a thing right i remember that like i've

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been married for too long so my memory

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is very faint but uh you if you

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wanted uh somebody to respond to your

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phone call you have to make a phone

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call

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um so you you have to be the

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one taking the initiative and you have to

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be prepared so if you're gonna want to

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future proof yourself then start

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acknowledging that where your shortcomings

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are and protect yourself from them yeah uh

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what do you think of the room uh

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in terms of who's in it being this

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your first uh gram sessions and it's hard

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to see everybody right we're just seeing

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people walk around um but there's business

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There's academia.

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There's small clinic owners.

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There's large clinic owners.

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There's product companies.

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Who else?

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You mentioned PTAs.

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You mentioned digital health.

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Who else needs to be in that room?

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I mean, peers need to be here.

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Why would they come?

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We're assuming that peers is one

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homogenous system.

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It's a heterogeneous system.

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There's parts of peer ecosystem,

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there's parts of their ecology that is

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interested in what we're doing.

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Really?

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They're just getting this information

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through a secondary resources and tertiary

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resources.

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Why not be here?

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Why not extend the invitation and see what

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will come?

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We don't extend the invitation.

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That's what Lincoln would do.

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We're looking at the Lincoln Monument over

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there, right over the hill.

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That's what Lincoln would do.

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Extend the invitation.

00:08:55.356 --> 00:08:56.397
There's no enemies here, right?

00:08:56.417 --> 00:08:57.998
We're looking at the same picture from

00:08:58.057 --> 00:08:59.799
different vantage points and expecting

00:08:59.860 --> 00:09:00.460
different results.

00:09:00.519 --> 00:09:01.260
It's not going to happen.

00:09:01.801 --> 00:09:03.062
So, yeah, start the conversation.

00:09:03.162 --> 00:09:04.902
Start the conversation that's not haggling

00:09:05.001 --> 00:09:05.682
over prices,

00:09:06.062 --> 00:09:07.322
because that's already step three.

00:09:07.383 --> 00:09:08.543
You're haggling over prices,

00:09:08.563 --> 00:09:10.284
but you haven't established ground truths.

00:09:11.304 --> 00:09:13.206
Get them here to establish ground truths.

00:09:13.245 --> 00:09:15.486
Get somebody who has knowledge of payer

00:09:15.527 --> 00:09:15.886
sources.

00:09:16.006 --> 00:09:16.226
Right now,

00:09:16.246 --> 00:09:18.028
we're talking about payer sources from a

00:09:18.067 --> 00:09:19.908
consumer side only.

00:09:19.948 --> 00:09:21.649
So are you really getting an equal

00:09:21.830 --> 00:09:22.669
representation here?

00:09:22.889 --> 00:09:23.129
Yeah.

00:09:23.149 --> 00:09:24.831
The thing that frustrated me sometimes

00:09:24.871 --> 00:09:27.855
with people is we're very people-y.

00:09:27.875 --> 00:09:29.975
My first Grime Sessions was ten years ago.

00:09:31.337 --> 00:09:33.219
And then I went back a year.

00:09:33.259 --> 00:09:34.461
So I did it in twenty sixteen,

00:09:34.480 --> 00:09:35.761
twenty seventeen, or twenty seven,

00:09:35.782 --> 00:09:36.763
twenty eighteen, whatever it was.

00:09:37.342 --> 00:09:38.663
And the problem was we were talking about

00:09:38.683 --> 00:09:40.025
the same thing the second time.

00:09:40.285 --> 00:09:42.086
And I don't have patience.

00:09:42.207 --> 00:09:43.107
You and I are right now in the

00:09:43.148 --> 00:09:44.929
hallway while the talk is going on.

00:09:44.950 --> 00:09:45.990
You and I are like, got it.

00:09:46.150 --> 00:09:46.892
I'm going to be outside.

00:09:46.932 --> 00:09:47.591
I need to walk around.

00:09:47.611 --> 00:09:48.773
I need to touch some grass.

00:09:49.714 --> 00:09:51.537
um why do we fail to do that

00:09:51.657 --> 00:09:53.840
sometimes well jimmy i i've been a

00:09:53.860 --> 00:09:56.043
physical therapist for i've been talking

00:09:56.884 --> 00:10:03.453
about the value we've been talking about

00:10:03.855 --> 00:10:05.817
identity this is not a new conversation

00:10:06.278 --> 00:10:07.557
it's funny because i come in and i

00:10:07.577 --> 00:10:09.318
go this is all so new and then

00:10:09.458 --> 00:10:11.200
yeah three six nine years later i'm like

00:10:11.320 --> 00:10:13.659
oh same thing yeah it's it it is

00:10:13.700 --> 00:10:15.280
the same thing there's it's almost

00:10:15.301 --> 00:10:17.360
ridiculous how reproducible this is and i

00:10:17.380 --> 00:10:19.081
fully expect in twenty twenty six twenty

00:10:19.101 --> 00:10:21.423
twenty seven uh nothing changes when

00:10:21.462 --> 00:10:23.822
nothing changes so and and we're in that

00:10:24.023 --> 00:10:25.823
same perpetual cycle of nothing changing

00:10:25.964 --> 00:10:27.845
yeah so and then we have agents of

00:10:27.884 --> 00:10:29.145
change so we have people calling for

00:10:29.166 --> 00:10:30.547
change but just calling for change without

00:10:30.567 --> 00:10:32.467
actually that's what it felt like it felt

00:10:32.508 --> 00:10:34.849
like what do we want change when do

00:10:34.869 --> 00:10:36.429
we want it now how will we get

00:10:36.490 --> 00:10:38.691
it someone else or i already did my

00:10:38.730 --> 00:10:40.451
part i said what should be changed but

00:10:40.812 --> 00:10:44.634
people are people are out there in clinics

00:10:44.693 --> 00:10:46.754
or satisfying right like you we want to

00:10:46.794 --> 00:10:48.816
maximize because ideally we want it all

00:10:48.917 --> 00:10:50.496
right but it's not a binary it's a

00:10:50.537 --> 00:10:50.878
spectral

00:10:51.658 --> 00:10:53.239
thing so you you have to satisfy so

00:10:53.259 --> 00:10:54.960
you have to accept suboptimal change but

00:10:55.000 --> 00:10:56.900
change is gonna come regardless whether

00:10:56.921 --> 00:10:57.741
you want it or not you can just

00:10:57.761 --> 00:10:59.143
drive the direction of change to a certain

00:10:59.182 --> 00:11:01.063
degree yeah do you remember that simpsons

00:11:01.104 --> 00:11:03.946
episode when uh homer or the mayor mayor

00:11:03.985 --> 00:11:05.966
was running for re-election and he came in

00:11:05.986 --> 00:11:07.327
the balcony and he said like all right

00:11:07.927 --> 00:11:10.429
people of springfield uh abortions for all

00:11:10.750 --> 00:11:12.510
and people were like boo and then he's

00:11:12.530 --> 00:11:13.390
like all right people never mind them

00:11:13.871 --> 00:11:15.793
abortions for none and they're like boo

00:11:16.432 --> 00:11:19.115
abortions for some yeah everything's man

00:11:19.174 --> 00:11:20.956
Yeah, it is, it is.

00:11:20.976 --> 00:11:21.717
You just expect,

00:11:22.418 --> 00:11:23.179
if you want to be the agent of

00:11:23.220 --> 00:11:23.440
change,

00:11:23.460 --> 00:11:24.620
you have to be the active ingredient.

00:11:24.660 --> 00:11:26.003
You have to drive energy into it.

00:11:27.004 --> 00:11:29.125
I've got a social experiment going on that

00:11:29.186 --> 00:11:30.827
I thought would have some reaction,

00:11:30.908 --> 00:11:32.529
and it turned out having no reaction.

00:11:32.870 --> 00:11:33.811
I'll talk to you about it.

00:11:34.744 --> 00:11:36.544
What I needed to do was go further

00:11:36.565 --> 00:11:37.466
with this, and I will.

00:11:37.546 --> 00:11:39.126
So I dropped this in a Facebook group

00:11:39.147 --> 00:11:41.828
that, are you in Tony's Facebook group?

00:11:42.109 --> 00:11:42.788
I'll get you in there.

00:11:43.809 --> 00:11:45.591
It's meant to be a bunch of people

00:11:45.610 --> 00:11:47.272
looking to create content,

00:11:48.092 --> 00:11:49.153
alternative revenue streams for

00:11:49.274 --> 00:11:49.653
practitioners.

00:11:49.874 --> 00:11:50.855
What it's turned into,

00:11:51.294 --> 00:11:52.655
a bunch of people trying to solve problems

00:11:52.676 --> 00:11:53.716
different ways, which I like.

00:11:54.317 --> 00:11:55.337
Tony Meritato,

00:11:55.437 --> 00:11:57.899
my normal co-host on our livestream,

00:11:58.820 --> 00:12:00.441
he tries to solve a thing a thousand

00:12:00.461 --> 00:12:03.081
different ways tony tries to fail as fast

00:12:03.121 --> 00:12:04.602
as possible which is good so i dropped

00:12:04.623 --> 00:12:06.024
this little social experiment i'm calling

00:12:06.083 --> 00:12:08.065
ninety nine problems pt edition and the

00:12:08.144 --> 00:12:09.885
idea was um

00:12:11.034 --> 00:12:13.756
We can't usually change the big thing

00:12:13.797 --> 00:12:14.957
first, right?

00:12:14.998 --> 00:12:16.278
Knock down a small domino,

00:12:16.340 --> 00:12:17.460
it'll loop to a second, third,

00:12:17.480 --> 00:12:18.500
then you get bigger.

00:12:19.501 --> 00:12:20.423
So my thing was,

00:12:20.503 --> 00:12:21.663
this came from an idea,

00:12:21.764 --> 00:12:24.225
I saw a guy talking in his community

00:12:25.287 --> 00:12:26.868
about medium problems.

00:12:27.369 --> 00:12:28.610
Medium problems are,

00:12:29.090 --> 00:12:30.971
first we need to describe large and small

00:12:31.032 --> 00:12:31.412
problems.

00:12:31.591 --> 00:12:32.393
Small problems are,

00:12:32.653 --> 00:12:33.974
you come out of your house and someone

00:12:33.994 --> 00:12:35.316
just left a bag of trash there.

00:12:36.840 --> 00:12:37.541
I just throw it away.

00:12:37.740 --> 00:12:39.121
I don't call the cops.

00:12:39.663 --> 00:12:40.263
I'll solve it.

00:12:40.283 --> 00:12:40.783
It's stupid.

00:12:40.803 --> 00:12:41.884
It's rude, but I'll just solve it.

00:12:42.044 --> 00:12:43.726
Big problems are someone drives a dumb

00:12:43.767 --> 00:12:46.429
truck through City Hall.

00:12:46.950 --> 00:12:47.551
That's big.

00:12:48.350 --> 00:12:49.832
The town is going to take care of

00:12:49.852 --> 00:12:50.013
that.

00:12:50.394 --> 00:12:52.375
The medium-sized problems are like it's

00:12:52.436 --> 00:12:53.576
too big for one person,

00:12:53.697 --> 00:12:56.659
but not big enough to ever hit the

00:12:56.700 --> 00:12:59.442
number one list on the town.

00:13:00.495 --> 00:13:02.898
So he gave an example of how they

00:13:02.937 --> 00:13:04.119
solved medium problems.

00:13:04.139 --> 00:13:04.619
And he's like,

00:13:04.940 --> 00:13:06.640
I'm giving you an example that you should

00:13:06.681 --> 00:13:07.942
take to other places.

00:13:08.062 --> 00:13:10.806
So the medium example was there were parts

00:13:11.206 --> 00:13:13.688
of the city infrastructure like sidewalks

00:13:13.889 --> 00:13:15.429
in neighborhoods that were just overgrown.

00:13:16.250 --> 00:13:17.351
It's not really big enough.

00:13:17.371 --> 00:13:18.173
It's not causing a fire.

00:13:18.192 --> 00:13:19.033
It's not causing a flood.

00:13:19.053 --> 00:13:20.034
So the town's not going to take care

00:13:20.054 --> 00:13:20.195
of it.

00:13:20.635 --> 00:13:22.798
But uncovering a sidewalk.

00:13:23.186 --> 00:13:24.067
is like a pain in the ass for

00:13:24.167 --> 00:13:24.626
one person.

00:13:24.667 --> 00:13:25.126
So he's like,

00:13:25.768 --> 00:13:26.847
we got a group of three people,

00:13:27.087 --> 00:13:28.489
and the three people all brought a friend,

00:13:28.548 --> 00:13:29.309
and now it's six.

00:13:29.809 --> 00:13:30.630
And then we did it,

00:13:31.030 --> 00:13:31.831
and while we were doing it,

00:13:31.850 --> 00:13:32.652
we shot a video,

00:13:33.032 --> 00:13:34.052
and then ten people were like,

00:13:34.092 --> 00:13:34.952
where's your next one?

00:13:35.033 --> 00:13:35.494
Next thing you know,

00:13:35.514 --> 00:13:36.293
you've got thirty people.

00:13:36.394 --> 00:13:37.514
So that was one problem.

00:13:37.934 --> 00:13:40.856
So the idea is, you've now got experience,

00:13:41.096 --> 00:13:41.918
you've got people who are like,

00:13:42.097 --> 00:13:42.837
that wasn't that hard,

00:13:43.318 --> 00:13:45.059
and there's more than one person,

00:13:45.440 --> 00:13:46.561
and now you've got cred.

00:13:47.341 --> 00:13:48.260
So this is one of the things he

00:13:48.280 --> 00:13:48.780
was talking about,

00:13:48.821 --> 00:13:51.302
the important aspects of what maybe talk

00:13:51.322 --> 00:13:53.582
about this was now you're like,

00:13:53.682 --> 00:13:54.763
we solve problems.

00:13:54.783 --> 00:13:55.962
So the next time you go to solve

00:13:56.023 --> 00:13:56.604
a problem, you're like,

00:13:57.043 --> 00:13:59.724
I have a resume of problems solved.

00:13:59.764 --> 00:14:00.644
I solved this little one,

00:14:00.745 --> 00:14:01.945
then a bigger one, then a bigger one.

00:14:02.205 --> 00:14:02.725
So I said,

00:14:02.764 --> 00:14:04.046
could we take this to PT?

00:14:04.505 --> 00:14:06.745
What are the ninety nine problems?

00:14:06.905 --> 00:14:08.586
Let's rank them small to big.

00:14:08.947 --> 00:14:10.527
And then who wants to help me help

00:14:10.547 --> 00:14:12.508
me solve the smallest one?

00:14:12.947 --> 00:14:14.587
And we don't move on until we solve

00:14:14.628 --> 00:14:15.548
the smallest one.

00:14:15.948 --> 00:14:16.249
And then.

00:14:16.928 --> 00:14:18.249
We solved the next biggest one.

00:14:18.288 --> 00:14:19.009
But along the way,

00:14:19.029 --> 00:14:20.710
we picked up three or four more people

00:14:20.750 --> 00:14:22.210
who were like, I'll solve that problem.

00:14:22.410 --> 00:14:24.270
And now you've got a team who are

00:14:24.311 --> 00:14:25.971
now skilled at problem solving.

00:14:26.831 --> 00:14:28.331
They have a variety of skill sets and

00:14:28.371 --> 00:14:28.951
experience.

00:14:29.533 --> 00:14:30.893
The problem was, Alex,

00:14:30.952 --> 00:14:31.712
I put this post in.

00:14:31.773 --> 00:14:34.173
I said, help me figure out the problems.

00:14:34.974 --> 00:14:36.333
Nobody suggested one problem.

00:14:36.474 --> 00:14:37.394
So you have to remember,

00:14:37.434 --> 00:14:37.975
there's a couple of...

00:14:38.674 --> 00:14:39.596
problems with your problem.

00:14:39.816 --> 00:14:40.296
Okay.

00:14:40.716 --> 00:14:41.898
I can't figure out what it is because

00:14:41.937 --> 00:14:42.498
I thought it was cool.

00:14:42.618 --> 00:14:44.120
A problem with your problem is that

00:14:44.159 --> 00:14:45.279
there's a selection bias.

00:14:45.299 --> 00:14:46.701
People who will react to that post are

00:14:46.721 --> 00:14:48.082
the people that are already problem

00:14:48.102 --> 00:14:48.243
solvers.

00:14:48.263 --> 00:14:48.903
You're probably right.

00:14:49.283 --> 00:14:49.903
Yes, yes.

00:14:49.923 --> 00:14:50.544
So you're not asking,

00:14:50.764 --> 00:14:52.326
like the problem solvers are the ones that

00:14:52.365 --> 00:14:53.647
will get a reaction out of it and

00:14:53.667 --> 00:14:55.128
the ones that actually do need to be

00:14:55.148 --> 00:14:56.369
the ones for solving problems are not the

00:14:56.409 --> 00:14:57.470
ones that are reacting.

00:14:57.509 --> 00:14:58.191
Yeah, I felt that trap.

00:14:58.490 --> 00:15:00.572
right right so the second one is like

00:15:00.653 --> 00:15:02.333
you're discussing thresholds right the

00:15:02.433 --> 00:15:04.576
threshold for change there's a really good

00:15:04.596 --> 00:15:06.457
book it's called cascades uh and the

00:15:06.477 --> 00:15:09.000
gentleman is a journalist and a uh i

00:15:09.019 --> 00:15:11.461
think political scientist but uh the point

00:15:11.481 --> 00:15:13.283
is he looks into the these environmental

00:15:13.302 --> 00:15:15.565
cascades that that are agents for change

00:15:15.605 --> 00:15:17.826
so essentially it's not linear uh change

00:15:17.866 --> 00:15:19.908
right and he talks about the eastern

00:15:19.967 --> 00:15:21.570
europe when the soviet bloc fell through

00:15:22.269 --> 00:15:23.811
and it didn't happen right away but

00:15:23.850 --> 00:15:25.390
initially there was a little protest and

00:15:25.410 --> 00:15:28.072
it was people who left then there was

00:15:28.091 --> 00:15:29.712
a little bit bigger protest and then the

00:15:29.753 --> 00:15:31.413
police instead of just letting people

00:15:31.432 --> 00:15:33.333
protest started reacting which caused even

00:15:33.354 --> 00:15:34.874
bigger changes so the cascade is that

00:15:34.994 --> 00:15:37.634
non-linear amplification of a response

00:15:37.654 --> 00:15:39.716
like a hockey stick until the certain and

00:15:39.735 --> 00:15:41.596
the threshold is past a certain threshold

00:15:41.616 --> 00:15:44.157
the cascade turns into change so what is

00:15:44.277 --> 00:15:46.057
the better question would be here is what

00:15:46.118 --> 00:15:48.158
is the threshold of stress on the system

00:15:48.999 --> 00:15:50.120
for the change to occur.

00:15:50.541 --> 00:15:52.182
When is our community going to be right

00:15:52.201 --> 00:15:52.722
at that point?

00:15:52.763 --> 00:15:54.625
We're going to be like, that's it.

00:15:54.664 --> 00:15:55.765
We have to do something different.

00:15:55.885 --> 00:15:56.605
We're not there yet.

00:15:56.645 --> 00:15:56.947
Right now,

00:15:56.966 --> 00:15:58.008
we're still talking about problems.

00:15:58.028 --> 00:15:59.109
We're not talking about solutions because

00:15:59.129 --> 00:16:00.549
we're not at that threshold of change.

00:16:00.610 --> 00:16:01.510
It's not scary enough?

00:16:01.951 --> 00:16:02.792
It's not pressing enough?

00:16:02.812 --> 00:16:03.352
It could be scary,

00:16:03.552 --> 00:16:04.673
but we're okay with scaries, right?

00:16:05.054 --> 00:16:06.995
Scary is not actionable.

00:16:07.356 --> 00:16:09.099
Actionable is when I actually don't have

00:16:09.399 --> 00:16:10.480
Brad to feed my family.

00:16:10.919 --> 00:16:11.780
Then it becomes actionable.

00:16:11.801 --> 00:16:12.400
So when you,

00:16:12.780 --> 00:16:15.482
there was scary that was actionable was in

00:16:15.503 --> 00:16:17.024
two thousand two when Medicare came up

00:16:17.043 --> 00:16:18.804
with a cap and fifty percent of physical

00:16:18.826 --> 00:16:19.745
therapists lost their jobs.

00:16:20.346 --> 00:16:21.967
All of a sudden that was scary because

00:16:21.988 --> 00:16:22.947
you are not employable.

00:16:23.408 --> 00:16:25.129
You have your student loans and you have

00:16:25.149 --> 00:16:25.730
to pay for them.

00:16:26.390 --> 00:16:27.490
That is actually actionable.

00:16:27.591 --> 00:16:28.711
That's when change occurred.

00:16:28.792 --> 00:16:30.173
If you look at the fundamental change in

00:16:30.212 --> 00:16:32.153
our profession early two thousands was

00:16:32.215 --> 00:16:32.495
good.

00:16:32.794 --> 00:16:34.336
Like we made a lot of positive change

00:16:34.836 --> 00:16:35.797
and then become complacent.

00:16:35.817 --> 00:16:35.996
Right.

00:16:36.216 --> 00:16:37.258
Then we have bread on the table.

00:16:37.337 --> 00:16:37.577
Right.

00:16:37.618 --> 00:16:38.438
I'm not hungry anymore.

00:16:38.578 --> 00:16:38.698
So.

00:16:38.999 --> 00:16:39.759
Oh, the line like,

00:16:39.820 --> 00:16:41.480
hard times create hard men,

00:16:41.520 --> 00:16:42.740
hard men create easy times,

00:16:42.821 --> 00:16:44.602
easy times create easy men.

00:16:44.923 --> 00:16:45.523
Now it's a cycle.

00:16:45.682 --> 00:16:46.384
That fable, right?

00:16:46.423 --> 00:16:47.804
Like it went to war, like came back.

00:16:48.065 --> 00:16:50.365
There's an entire Chinese fable that goes

00:16:50.405 --> 00:16:50.785
into that.

00:16:50.826 --> 00:16:51.927
Like each step of the cycle,

00:16:51.947 --> 00:16:52.947
there's a positive and a negative.

00:16:53.467 --> 00:16:55.428
But yeah, we're not there yet.

00:16:55.448 --> 00:16:56.710
So we're still just discussing this

00:16:56.750 --> 00:16:56.990
change.

00:16:57.009 --> 00:16:58.010
And we have been for years.

00:16:58.230 --> 00:16:58.530
Yeah.

00:17:00.172 --> 00:17:02.293
i foresee that the way the government is

00:17:02.313 --> 00:17:04.435
looking at our utilization matrix is

00:17:04.455 --> 00:17:06.397
they're going to try to cap our

00:17:06.438 --> 00:17:08.138
environment and we have a potential of

00:17:08.159 --> 00:17:10.721
becoming a very niche fringe industry

00:17:11.281 --> 00:17:12.903
unless we change and part of it is

00:17:12.942 --> 00:17:14.545
what we discussed about this risk-based

00:17:14.565 --> 00:17:15.625
contracts but part of it is

00:17:16.306 --> 00:17:18.067
just identifying that what you're doing is

00:17:18.087 --> 00:17:20.108
not good enough yet like it's it's good

00:17:20.128 --> 00:17:22.691
enough for you to satisfy the bare minimum

00:17:22.891 --> 00:17:24.932
now yeah when that changes you're in

00:17:24.992 --> 00:17:26.433
trouble unless you're prepared but the

00:17:26.453 --> 00:17:28.015
threshold of failure is based on your

00:17:28.115 --> 00:17:29.876
ability to handle the stress right like

00:17:30.076 --> 00:17:33.660
your your business resilience is dependent

00:17:33.720 --> 00:17:35.641
not on your execution right now it's

00:17:35.821 --> 00:17:38.163
dependent on how tolerant are you to when

00:17:38.182 --> 00:17:39.443
you fifty percent of your patient volume

00:17:39.463 --> 00:17:39.904
disappears

00:17:40.285 --> 00:17:42.506
can you still keep the doors open right

00:17:42.526 --> 00:17:43.705
or if the peers are going to turn

00:17:43.726 --> 00:17:44.906
away and say that you know we're just

00:17:44.926 --> 00:17:45.826
going to discount you another fifty

00:17:45.866 --> 00:17:47.267
percent and you're accepting these

00:17:47.287 --> 00:17:49.428
payments can you maintain that well and i

00:17:49.448 --> 00:17:51.288
think you can still operationalize it but

00:17:51.308 --> 00:17:52.769
are you ready i do you have these

00:17:52.949 --> 00:17:55.450
uh contingency plans and you're and you're

00:17:55.470 --> 00:17:58.010
prepared to until you're not and then you

00:17:58.030 --> 00:17:59.612
might not know what that point is but

00:17:59.632 --> 00:18:00.932
you'll know it when you get there the

00:18:00.991 --> 00:18:03.512
known unknowns and the unknown yeah like

00:18:03.532 --> 00:18:05.933
yeah so these are known unknowns but you

00:18:05.953 --> 00:18:07.273
have to protect yourself from unknown

00:18:07.334 --> 00:18:08.414
unknowns you have to have enough of a

00:18:08.494 --> 00:18:08.815
buffer

00:18:09.375 --> 00:18:10.816
That allows you to be more resilient to

00:18:10.836 --> 00:18:11.355
these changes.

00:18:11.576 --> 00:18:11.756
Yeah.

00:18:11.776 --> 00:18:12.717
All right.

00:18:12.737 --> 00:18:13.977
We're doing quick live streams.

00:18:14.897 --> 00:18:15.938
And every episode we have,

00:18:15.978 --> 00:18:17.398
we do something called the parting shot.

00:18:17.419 --> 00:18:20.480
This is the parting shot.

00:18:21.020 --> 00:18:22.422
One last mic drop moment.

00:18:23.082 --> 00:18:23.903
No pressure.

00:18:24.343 --> 00:18:26.443
Just your legacy on the line.

00:18:27.761 --> 00:18:27.942
All right.

00:18:27.981 --> 00:18:28.522
Parting shot.

00:18:28.542 --> 00:18:29.943
What do you want to leave with people?

00:18:29.963 --> 00:18:32.365
What's what's either words of scary or

00:18:32.424 --> 00:18:33.905
words of encouragement?

00:18:34.086 --> 00:18:35.146
Which way are we going to go?

00:18:35.166 --> 00:18:36.228
Oh, this is a huge opportunity.

00:18:36.807 --> 00:18:38.068
It has been a huge opportunity.

00:18:38.128 --> 00:18:39.309
I think now we just have to seize

00:18:39.329 --> 00:18:39.931
that opportunity.

00:18:40.330 --> 00:18:41.571
We have a chance that there's still

00:18:41.932 --> 00:18:43.192
probably fifty percent of the market has

00:18:43.212 --> 00:18:44.594
not been captured by anyone.

00:18:45.875 --> 00:18:47.115
Digital health providers came in and

00:18:47.155 --> 00:18:48.896
captured some parts of that market and now

00:18:48.916 --> 00:18:50.178
they have billion dollar valuation.

00:18:50.577 --> 00:18:51.699
and that's not even half of the market

00:18:51.719 --> 00:18:52.819
that's available if you look at the

00:18:52.900 --> 00:18:54.721
overall economic cost of musculoskeletal

00:18:54.740 --> 00:18:56.863
problems in a society it's a trillion

00:18:56.883 --> 00:18:59.345
dollar venture and we're capturing sixty

00:18:59.365 --> 00:19:02.046
five billion of it right uh so so

00:19:02.086 --> 00:19:04.989
the people who risk or the people who

00:19:05.108 --> 00:19:06.849
do the work who follow the last step

00:19:06.869 --> 00:19:08.651
give me the help me understand give me

00:19:08.671 --> 00:19:10.972
the checklist and follow the checklist

00:19:11.353 --> 00:19:13.234
will be the people who people there were

00:19:13.275 --> 00:19:15.375
the people are going to capture the other

00:19:15.977 --> 00:19:17.377
one billion dollars or one trillion

00:19:17.417 --> 00:19:17.698
dollars

00:19:18.038 --> 00:19:19.921
wow that is like it's it's just an

00:19:19.941 --> 00:19:22.265
immense financial and economic opportunity

00:19:22.926 --> 00:19:24.809
for those that are prepared yeah all right

00:19:24.890 --> 00:19:26.392
alex live from uh graham sessions

00:19:26.432 --> 00:19:28.095
appreciate your time thanks for doing this

00:19:28.395 --> 00:19:30.479
on your very first graham sessions amen

00:19:30.578 --> 00:19:31.019
thanks for being

00:19:32.405 --> 00:19:33.467
That's it for this one,

00:19:33.747 --> 00:19:35.409
but we're just getting warmed up.

00:19:35.888 --> 00:19:37.810
Smash follow, send it to a friend,

00:19:38.010 --> 00:19:39.672
or crank up the next episode.

00:19:40.192 --> 00:19:41.173
Want to go deeper?

00:19:41.574 --> 00:19:45.597
Hit us at pgpinecast.com or find us on

00:19:45.657 --> 00:19:48.180
YouTube and socials at pgpinecast.

00:19:48.619 --> 00:19:50.902
And legally, none of this was advice.

00:19:50.981 --> 00:19:52.703
It's for entertainment purposes only.

00:19:52.743 --> 00:19:54.365
Bullshit!

00:19:54.384 --> 00:19:54.965
See, Keith?

00:19:55.185 --> 00:19:56.247
We read the script.

00:19:56.547 --> 00:19:57.188
Happy now?