She Refused to Discharge Patients Who Still Needed Help

WEBVTT

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You're listening to the P.T.

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Pinecast,

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where smart people in healthcare come to

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Here's your host, Jimmy McKay.

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Thanks, Voice Guy.

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from CSM.

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Empower EMR.

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They're just down there.

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I mean,

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I'm referencing a direction on a podcast,

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which doesn't make any sense.

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Empower EMR.

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If your clinic is stuck in an EMR

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that slows you down,

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that's a decision that you made.

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bad decision uh empower gives you speed

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clean workflows and features pt's actually

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asked for better notes faster

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you that's what you're looking for upgrade

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your clinic's brain with empower emr visit

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empoweremr.com or visit their booth

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whenever they're at a conference all right

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what if what if insurance ending wasn't

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the end of care pause for dramatic effect

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but the beginning of a different model you

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see how we're doing this

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Our next guest left traditional neuro

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rehab to build a nonprofit community-based

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wellness model serving thousands each

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year.

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Live from Anaheim,

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this is Melanie Brennan.

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Melanie, welcome to the show.

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Thank you for having me.

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How close did I do on the intro?

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It was great.

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All right.

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So walk me through this.

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What angered you?

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Because without a good anger or this

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shouldn't be like this,

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there's never a good story.

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And this sounds like the beginning of a

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good story.

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Absolutely.

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Yeah.

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I worked in outpatient rehab,

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inpatient and outpatient at the Mayo

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Clinic in Rochester,

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Minnesota for many years.

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And yeah,

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I had to stop seeing people that still

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needed care.

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You could see the runway and.

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They would go home.

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Mayo's a destination center,

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so a lot of people aren't from the

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area.

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They would go home.

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I would see them back in six months

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to a year, and I would say,

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how'd your therapy go?

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And they're like,

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I didn't get any where I was.

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We didn't do a very good job with

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our exercise program,

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and they would lose everything.

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If they were able to walk when they

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left,

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they weren't able to walk when they came

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back.

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They gained

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They were in much worse condition.

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And even our local people that would keep

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coming for outpatient, you know,

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there's that point where you're like,

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sorry,

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but insurance probably isn't going to pay

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for this because we don't really know.

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And so we'd stop.

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But they had so much potential and the

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research shows they can get better for

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years.

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And I was frustrated and I just told

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my husband I want to do something about

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it and start a practice.

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Yeah,

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but there's a big difference between

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wanting to do something about it and

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actually doing the thing because the world

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has inertia.

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The world doesn't want to change.

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And you need to if you need something

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to move an inch,

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you've got to give it so much energy

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to move it even that first inch.

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So what'd you do about it?

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Well,

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I think what really sparked me to do

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it was I had a patient tell me,

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you're really good at this.

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You think outside the box.

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You make me work harder than a lot

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of people.

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You should have a gym.

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You should start your own.

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I would comp if you had a gym.

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So I told my husband,

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I'm motivated to do this.

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It's a good time in our life.

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It was a good time.

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I was just working part time at the

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time.

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I said,

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can I try starting a private practice,

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which is super scary?

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And he's like, yeah, OK.

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Good.

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Yeah, let's do it.

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So how's yours different?

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How is my private practice different?

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Yeah, tell me about it.

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Yeah,

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so I knew that my ideology had to

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be that insurance was not what drove care,

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period.

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And I had to come up with a

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way to do that.

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Right.

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So that's nice,

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but you have to figure out how to

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do it.

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I had to.

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Yeah, I dug in.

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I just did all the research myself.

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I couldn't afford an attorney or a

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business coach or anything.

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And even back in two thousand eleven,

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there weren't business coaches for PT.

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We got business coaches falling off trees

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now.

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Yeah, it was such a different time.

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I actually had to get books at the

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library like there was nothing online.

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Kids,

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a library is a building where the Google

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files live.

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That was a long time ago.

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But yeah, I researched it, started it.

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I knew I needed to be a model

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that was not just PT driven and not

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just insurance driven.

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So I hired a trainer to work with

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me alongside, created a gym atmosphere.

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Not a clinic atmosphere.

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It was not a clinic atmosphere.

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No beige wall, like color.

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No, no.

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In fact, to get started,

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I actually rented space at the YMCA.

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Great.

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community already built in.

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Yeah, already built in.

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I use my minivan door to door a

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lot to get started that first year,

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but people heard about it.

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And all of a sudden I had ten,

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twelve clients and I was supposed to be

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working part time.

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I had my babies in the car seat

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with me.

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I had them playing in the pool alongside

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me at the YMCA.

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So I took I took them with me.

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But my clients like you need you need

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your own space.

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and you probably need some help.

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And so I hired that first person within

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my first year.

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And one of my clients had a strip

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mall that he owned.

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And he said, yeah.

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He's like, hey, I got a strip mall.

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You know what you need?

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I got an empty space.

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Space.

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Yeah.

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So him and I worked together back in

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two thousand twelve.

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built a gym in a two thousand square

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foot strip mall space.

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From two thousand twelve to two thousand

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fifteen,

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I added ten employees in that two thousand

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square foot space.

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We had one mat table for ten employees,

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which means ten patients.

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We had like four,

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five spinal cord injury patients on a mat.

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One mat.

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It was crazy.

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Yeah.

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And so, yeah.

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In two thousand seventeen,

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we've got a ten thousand square foot gym.

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It's large.

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Purchased it.

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I purchased it.

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Wasn't going to rent it.

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Twenty-four employees later.

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What's the name?

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Because people, of course,

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want to Google it next.

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Yeah, yeah.

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So originally the name was Exercise

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Abilities.

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Okay.

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Came to find that that's really hard to

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type in a website,

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really hard for people to spell correctly,

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really hard for people to say.

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Don't go multiple syllables.

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It was bad.

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Great name.

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People loved it.

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So we shortened it.

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Everybody shortened it.

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The world shortened it to EA.

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So it became, hey, I'm going to EA.

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I thought, hey, that works.

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So it's EA Therapeutic Health.

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Nice.

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We rebanded in twenty twenty two.

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It's the.

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What's the model look like?

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Someone needs you and they come and you're

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like, hey,

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we don't do that thing over there,

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which is insurance.

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So how does it work?

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Well, funny thing is we do take insurance.

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Got it.

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For a portion of what we do.

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So that's been an evolution.

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You know,

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we found that a lot of people in

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our area did not have funds to pay

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for what it takes to do a recovery.

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And so I kind of gave in and

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started taking Medicare and Medicaid and

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insurances in about twenty,

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twenty thirteen, twenty fourteen.

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Found out that you can't pay your staff

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for neuro recovery with Medicare and

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Medicaid reimbursement really fast.

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So in twenty fifteen,

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I converted my practice to a nonprofit.

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That's kind of where we shifted.

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And with that,

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we have really affordable rates for people

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to continue once insurance

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kind of that short standard therapy.

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So we do both.

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We charge cash for the extra hour that,

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you know, they're with us for two,

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three hours.

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So we have a PT see them for

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whatever PT they can be billable.

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And then the rest are personal trainers,

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rec therapists,

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athletic trainers that are working side by

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side with us for that cash based service.

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Sure.

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PT's in the room.

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pt's there it's pt informed yeah yeah um

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what is the uh what is the at

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where does advocacy play in sustaining a

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model like this huge i i'm real good

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friends with my local congress should be

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right you should know their name but even

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more important they should they should see

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you and know who you are and here

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she comes again she's gonna she's gonna

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bug me about this and that's their job

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they have to be bugged

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Absolutely.

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So I advocate for payment.

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I advocate for tax laws because we're a

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nonprofit,

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but we still have to pay sales tax

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in the state of Minnesota,

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which for Neuro,

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you have a forty thousand dollar piece of

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equipment that you get granted to you.

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They give you the money.

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You go buy it.

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I have to pay taxes on that,

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which is a real bummer as a nonprofit.

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So working with them on tax laws, yeah,

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payment and everything.

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It's all part of my APTA role,

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so I'm really busy with working for the

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association as well.

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Good radio segue.

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What's your role with APTA in Minnesota?

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I am the current president.

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Congratulations.

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Thank you.

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Six weeks in.

00:08:31.778 --> 00:08:32.938
Why do something like that?

00:08:34.039 --> 00:08:34.960
And not just for you,

00:08:35.000 --> 00:08:36.922
but we're sort of in the room where

00:08:36.942 --> 00:08:38.864
a lot of it is happening and people

00:08:38.923 --> 00:08:40.846
see APTA and they might have a pro

00:08:40.905 --> 00:08:41.066
or a...

00:08:42.586 --> 00:08:44.128
I always say they're either pro or they

00:08:44.989 --> 00:08:46.811
might not just be clear of what the

00:08:46.850 --> 00:08:47.591
value prop is,

00:08:47.631 --> 00:08:48.993
but why not only be a member?

00:08:49.052 --> 00:08:52.855
Why also do a lot of extra unpaid

00:08:52.916 --> 00:08:53.196
work?

00:08:53.797 --> 00:08:54.596
I don't know if you saw that.

00:08:54.636 --> 00:08:55.378
It's six weeks in.

00:08:55.398 --> 00:08:56.097
They're not paying you.

00:08:56.118 --> 00:08:57.538
No, no, it's very unfair.

00:08:57.557 --> 00:08:58.958
They're paying you in other ways.

00:08:59.538 --> 00:09:02.580
You know, in the year,

00:09:02.600 --> 00:09:07.442
I joined a profession and it was never

00:09:07.501 --> 00:09:08.961
an option for me to not be a

00:09:09.001 --> 00:09:10.602
part of my professional association

00:09:10.643 --> 00:09:12.783
because I understood right away because I

00:09:12.823 --> 00:09:13.524
got involved.

00:09:13.604 --> 00:09:13.844
I was...

00:09:14.663 --> 00:09:16.245
on the floor at the House of Delegates

00:09:16.264 --> 00:09:19.066
in Minneapolis in, I think it was,

00:09:19.145 --> 00:09:20.167
as a student runner.

00:09:20.986 --> 00:09:22.048
And I saw it happening.

00:09:22.227 --> 00:09:25.188
I knew that if we didn't have a

00:09:25.229 --> 00:09:25.708
voice,

00:09:26.208 --> 00:09:27.669
our profession could not move forward.

00:09:28.571 --> 00:09:29.910
And in collective action,

00:09:29.971 --> 00:09:30.971
I didn't want to be one of those

00:09:30.991 --> 00:09:34.773
people that weren't active or weren't

00:09:34.812 --> 00:09:35.614
participating.

00:09:35.653 --> 00:09:36.953
Because with the APTA,

00:09:38.554 --> 00:09:40.375
we're supporting all PTs and PTAs.

00:09:41.235 --> 00:09:42.216
Every one of them.

00:09:42.416 --> 00:09:43.557
You look at the new campaign,

00:09:43.616 --> 00:09:44.677
PT for Future Me.

00:09:45.076 --> 00:09:46.277
It's advertising physical therapy.

00:09:46.336 --> 00:09:49.278
It's not just advertising members.

00:09:49.398 --> 00:09:50.697
It's a collective action movement.

00:09:50.738 --> 00:09:51.738
And in collective action,

00:09:51.918 --> 00:09:53.698
there is always going to be people who

00:09:53.719 --> 00:09:54.859
don't participate.

00:09:55.599 --> 00:09:56.779
At whatever level that is.

00:09:56.899 --> 00:09:57.519
I didn't want to be that.

00:09:57.899 --> 00:10:00.679
I wanted to be a piece of our

00:10:00.700 --> 00:10:02.581
success as a profession.

00:10:02.660 --> 00:10:03.301
And it's important to me.

00:10:03.668 --> 00:10:06.309
What's your BHAG, your big, hairy,

00:10:06.350 --> 00:10:08.530
audacious goal in your presidency?

00:10:08.571 --> 00:10:09.571
What's the thing that you're like, hey,

00:10:09.591 --> 00:10:11.432
if I accomplish this or this or this,

00:10:11.912 --> 00:10:13.153
that will have been successful in your

00:10:13.192 --> 00:10:13.952
eyes?

00:10:14.013 --> 00:10:14.253
Well,

00:10:14.673 --> 00:10:16.374
when I sat down with our executive

00:10:16.394 --> 00:10:17.453
director and said, yeah,

00:10:17.953 --> 00:10:19.615
I'm going to run for president.

00:10:19.975 --> 00:10:21.515
I'll do that.

00:10:21.635 --> 00:10:22.336
I said one thing.

00:10:22.556 --> 00:10:24.216
I said our focus will be payment.

00:10:24.256 --> 00:10:24.397
Yeah.

00:10:25.547 --> 00:10:27.107
My whole world is revolved around that.

00:10:28.388 --> 00:10:30.589
Everything comes back to payment,

00:10:31.129 --> 00:10:32.809
whether we're cash-based or

00:10:32.889 --> 00:10:33.649
insurance-based.

00:10:33.750 --> 00:10:34.269
It's all cash.

00:10:34.309 --> 00:10:35.591
It's just whether you're paying it

00:10:35.610 --> 00:10:36.931
directly or it's someone else who's paying

00:10:36.951 --> 00:10:37.152
it for you.

00:10:37.172 --> 00:10:38.072
It's all payment.

00:10:38.351 --> 00:10:39.913
I've been on the board of directors in

00:10:40.052 --> 00:10:41.153
Minnesota for six years.

00:10:41.173 --> 00:10:42.533
We do strategic planning.

00:10:42.653 --> 00:10:43.714
I just sit there and be like,

00:10:44.474 --> 00:10:45.475
that problem is because of payment.

00:10:46.215 --> 00:10:47.216
That problem is because of payment.

00:10:47.235 --> 00:10:47.756
Go deeper.

00:10:48.277 --> 00:10:49.479
And, you know,

00:10:50.179 --> 00:10:51.541
unless you're in private practice and

00:10:51.561 --> 00:10:52.081
you're in, like,

00:10:52.282 --> 00:10:53.524
nonprofit where I'm trying to provide

00:10:53.563 --> 00:10:55.446
services to everyone at the most

00:10:55.485 --> 00:10:57.268
affordable rate that I can then pay my

00:10:57.288 --> 00:10:57.567
bills.

00:10:57.989 --> 00:10:58.809
That's it, right?

00:10:58.870 --> 00:10:59.951
That's why I'm nonprofit.

00:11:00.051 --> 00:11:00.311
You'll say,

00:11:00.370 --> 00:11:01.472
why did you sell out your business?

00:11:02.033 --> 00:11:04.395
Because I want to provide service to

00:11:04.556 --> 00:11:04.976
everyone.

00:11:05.057 --> 00:11:05.898
No margin, no mission.

00:11:06.097 --> 00:11:06.578
Yeah.

00:11:06.739 --> 00:11:07.759
And the payment's just not there.

00:11:07.840 --> 00:11:09.461
And so I fundraise four hundred thousand

00:11:09.480 --> 00:11:10.923
dollars to a million dollars every year.

00:11:11.682 --> 00:11:12.264
I do that, too.

00:11:12.364 --> 00:11:14.206
That's my job currently.

00:11:16.048 --> 00:11:16.148
Yeah.

00:11:16.168 --> 00:11:17.129
Where was I going with that payment?

00:11:17.469 --> 00:11:18.610
Everything's connected to payment.

00:11:19.110 --> 00:11:19.991
Everything.

00:11:20.091 --> 00:11:21.673
And so I just said that's going to

00:11:21.692 --> 00:11:23.495
be the one thing I'm probably not going

00:11:23.514 --> 00:11:25.197
to spend a lot of time reorging.

00:11:26.878 --> 00:11:28.058
I do this at work all the time,

00:11:28.078 --> 00:11:29.640
like having to rewrite job descriptions.

00:11:29.900 --> 00:11:30.861
Probably not going to spend a lot of

00:11:30.881 --> 00:11:32.043
time on that as a president.

00:11:32.464 --> 00:11:33.985
I'm going to be working on payments.

00:11:34.086 --> 00:11:35.427
That's it.

00:11:36.128 --> 00:11:37.850
So I was super excited to see the

00:11:37.889 --> 00:11:40.472
new strategic plan come out that Kyle

00:11:40.533 --> 00:11:41.594
really promoted.

00:11:41.693 --> 00:11:43.196
And what's on the top?

00:11:43.456 --> 00:11:43.817
Payment.

00:11:43.937 --> 00:11:44.998
Well, they said it was...

00:11:46.879 --> 00:11:48.061
Pulled the members, right?

00:11:48.120 --> 00:11:48.922
Always good to listen.

00:11:48.942 --> 00:11:51.023
And they said the number one issue was

00:11:51.082 --> 00:11:51.423
payment.

00:11:51.903 --> 00:11:54.186
And then there was four thousand miles of

00:11:54.245 --> 00:11:54.546
nothing.

00:11:54.625 --> 00:11:55.626
And then the number two thing.

00:11:55.927 --> 00:11:56.547
It was payment.

00:11:57.187 --> 00:11:57.687
Do that.

00:11:58.008 --> 00:11:58.249
Yeah.

00:11:58.288 --> 00:12:00.570
We just we have a survey right now

00:12:00.870 --> 00:12:02.971
that closes tomorrow in Minnesota.

00:12:03.812 --> 00:12:07.436
What's what's your top ten advocacy needs?

00:12:08.076 --> 00:12:08.917
Money at the top.

00:12:09.017 --> 00:12:09.317
Right.

00:12:10.897 --> 00:12:11.118
Payment.

00:12:11.138 --> 00:12:11.658
Again, everything.

00:12:11.697 --> 00:12:13.337
Payment's going to affect what happens.

00:12:13.357 --> 00:12:14.158
I mean, there's a lot of students.

00:12:14.177 --> 00:12:16.058
You can't shake a stick without hitting

00:12:16.099 --> 00:12:18.139
ten new grads or PT students here.

00:12:18.539 --> 00:12:20.419
Or apparently children.

00:12:20.480 --> 00:12:22.681
First time I've seen just a nine-year-old

00:12:22.721 --> 00:12:23.280
walking around.

00:12:23.740 --> 00:12:24.041
Maybe.

00:12:24.282 --> 00:12:25.162
There might be a PTA student.

00:12:25.201 --> 00:12:25.501
I'm not sure.

00:12:27.582 --> 00:12:30.024
But you can retain staff when they don't

00:12:30.065 --> 00:12:31.446
leave if you can pay them better.

00:12:32.506 --> 00:12:33.788
You can afford equipment better.

00:12:33.847 --> 00:12:35.370
You can open a second facility.

00:12:35.830 --> 00:12:36.169
Payment.

00:12:36.370 --> 00:12:37.792
Everything's payment.

00:12:37.912 --> 00:12:39.952
Are we just waking up to this?

00:12:40.813 --> 00:12:42.154
Or are we just deciding that we can

00:12:42.235 --> 00:12:43.475
actually... What is the deal?

00:12:43.515 --> 00:12:44.636
Because I've been in PT for ten years.

00:12:44.657 --> 00:12:46.538
I've never heard this much movement in

00:12:46.558 --> 00:12:47.158
that direction before.

00:12:47.158 --> 00:12:49.421
There's been an interesting resistance and

00:12:49.541 --> 00:12:50.301
all respect.

00:12:50.380 --> 00:12:50.761
Like I said,

00:12:50.802 --> 00:12:52.982
I've been for six years on the board

00:12:53.003 --> 00:12:54.384
meeting saying it's all because of

00:12:54.403 --> 00:12:54.724
payment.

00:12:54.844 --> 00:12:57.245
And there's an interesting, yeah,

00:12:57.326 --> 00:12:59.388
but we should really have more member

00:12:59.447 --> 00:13:00.087
engagement.

00:13:00.368 --> 00:13:02.590
So let's have a five K. Like, no,

00:13:02.669 --> 00:13:04.451
that's not helping us with our primary

00:13:04.530 --> 00:13:05.532
problem, which is payment.

00:13:05.552 --> 00:13:07.072
So I don't know.

00:13:07.092 --> 00:13:07.592
We're getting there.

00:13:07.913 --> 00:13:08.313
We're getting there.

00:13:08.433 --> 00:13:09.595
And those things are important to member

00:13:09.615 --> 00:13:10.034
engagements.

00:13:10.054 --> 00:13:10.414
Important.

00:13:10.534 --> 00:13:11.816
Having activities are important,

00:13:11.855 --> 00:13:13.717
but do you want to get member engagement?

00:13:14.197 --> 00:13:15.458
Show them you're working on payments.

00:13:15.479 --> 00:13:15.538
Yes.

00:13:16.119 --> 00:13:16.820
If I come with you,

00:13:16.860 --> 00:13:18.541
are we going to kick payments ass?

00:13:18.561 --> 00:13:19.522
Yeah, then I'm riding with you.

00:13:19.542 --> 00:13:20.542
This is what I'm saying.

00:13:20.562 --> 00:13:21.322
This is where our focus needs to be,

00:13:21.342 --> 00:13:24.205
and this is where it's going to be.

00:13:24.365 --> 00:13:28.947
Where's the biggest needle that's able to

00:13:28.988 --> 00:13:30.950
be moved, state level, national level?

00:13:31.009 --> 00:13:31.289
Because, like,

00:13:31.389 --> 00:13:32.331
it's obviously if you can move it to

00:13:32.350 --> 00:13:33.191
the national level, that's better.

00:13:33.431 --> 00:13:34.471
It doesn't mean it's easier to do.

00:13:34.851 --> 00:13:35.753
So where's, I mean,

00:13:36.153 --> 00:13:37.474
you're going to answer both because you're

00:13:37.494 --> 00:13:38.495
a state president, obviously.

00:13:38.815 --> 00:13:40.836
But I guess the question is, like,

00:13:40.876 --> 00:13:42.197
where are we most likely to have a

00:13:42.258 --> 00:13:42.638
touchdown?

00:13:43.504 --> 00:13:45.144
We are most likely to have a touchdown

00:13:45.164 --> 00:13:45.765
at the local level.

00:13:45.785 --> 00:13:46.365
Yeah, of course.

00:13:47.047 --> 00:13:49.729
And that's what I mentioned in some recent

00:13:49.749 --> 00:13:51.289
LinkedIn conversations.

00:13:51.330 --> 00:13:54.711
But what's what worries me about the kind

00:13:54.751 --> 00:13:57.013
of, you know,

00:13:57.153 --> 00:14:00.014
contingent relationship of APTA with

00:14:00.174 --> 00:14:01.836
others that aren't APTA supporters.

00:14:01.876 --> 00:14:04.778
And it's we are the only ones at

00:14:04.798 --> 00:14:07.440
the local level supporting the chapter.

00:14:07.559 --> 00:14:10.562
State chapters are supporting the local

00:14:10.601 --> 00:14:12.583
changes, which are state legislators.

00:14:14.465 --> 00:14:17.307
That's the biggest impact on our

00:14:17.326 --> 00:14:18.847
day-to-day lives is where we work,

00:14:18.868 --> 00:14:19.727
what state we live in,

00:14:19.807 --> 00:14:21.448
and the changes at the state level,

00:14:22.230 --> 00:14:23.350
whether it's legislative,

00:14:23.370 --> 00:14:25.131
whether it's Medicaid services,

00:14:25.172 --> 00:14:28.254
which drives a ton, and payment,

00:14:28.293 --> 00:14:30.195
like Blue Cross Blue Shield of Minnesota,

00:14:30.355 --> 00:14:31.196
that's local.

00:14:32.255 --> 00:14:34.457
um that we have some issues going on

00:14:34.477 --> 00:14:36.719
there and and you have to be tackling

00:14:36.739 --> 00:14:39.721
that local so if we don't support apta

00:14:39.980 --> 00:14:42.283
as a whole we're not supporting our local

00:14:42.302 --> 00:14:45.764
chapters and my worry is is that with

00:14:46.024 --> 00:14:48.966
declining membership people don't realize

00:14:49.527 --> 00:14:51.227
how that's going to be impacting them at

00:14:51.268 --> 00:14:53.509
the at the state level yeah weakening

00:14:53.529 --> 00:14:55.291
things yeah yeah yeah medicare is

00:14:55.331 --> 00:14:59.352
important yes um but this local advocacy

00:14:59.493 --> 00:14:59.893
effort

00:15:01.134 --> 00:15:02.195
I think if it goes away,

00:15:02.254 --> 00:15:08.596
people will be like, oh,

00:15:09.057 --> 00:15:10.038
I guess in Idaho right now,

00:15:10.097 --> 00:15:12.538
the state legislator seriously has a bill

00:15:12.578 --> 00:15:14.940
on the floor to stop paying PT, OT,

00:15:14.960 --> 00:15:15.379
and speech.

00:15:16.059 --> 00:15:16.179
Stop.

00:15:17.221 --> 00:15:17.561
Stop.

00:15:18.360 --> 00:15:19.501
They're having to fight that.

00:15:19.522 --> 00:15:19.601
Yeah.

00:15:21.129 --> 00:15:23.390
ABTA National provides us a lot of support

00:15:23.730 --> 00:15:26.092
from a state perspective, but no,

00:15:26.214 --> 00:15:27.855
it's your local volunteers.

00:15:28.414 --> 00:15:29.797
It's your local chapter.

00:15:30.136 --> 00:15:32.899
It's your peer that's going to the state

00:15:32.918 --> 00:15:33.580
capitol and fighting.

00:15:33.639 --> 00:15:35.041
So what if you went with your peer?

00:15:35.542 --> 00:15:37.984
And we sent, you know, in Idaho,

00:15:38.583 --> 00:15:42.327
they had all, you know, pick a number,

00:15:42.408 --> 00:15:44.490
five thousand registered PTs and PTAs.

00:15:44.990 --> 00:15:45.931
What if they all showed up at the

00:15:45.951 --> 00:15:46.171
capitol?

00:15:47.711 --> 00:15:49.393
But instead they have thirty showing up of

00:15:49.472 --> 00:15:50.173
active volunteers.

00:15:50.193 --> 00:15:51.333
So that's where collective action,

00:15:52.215 --> 00:15:53.554
I think we can do better because we're

00:15:53.735 --> 00:15:56.397
compassionate PTs and PTAs.

00:15:57.356 --> 00:15:58.758
I think we can do better and I

00:15:58.778 --> 00:15:59.359
think we need to.

00:15:59.379 --> 00:15:59.938
We need to show up.

00:16:00.423 --> 00:16:02.466
You haven't mentioned other professions,

00:16:02.525 --> 00:16:04.749
but you think that collaboration across

00:16:04.788 --> 00:16:06.831
professions is terribly important.

00:16:06.870 --> 00:16:10.115
Why and what's the secret sauce there?

00:16:10.735 --> 00:16:12.357
Collective action, again, needs numbers,

00:16:12.658 --> 00:16:13.938
power and numbers.

00:16:14.580 --> 00:16:16.282
We don't work enough with our OT and

00:16:16.302 --> 00:16:17.102
speech partners.

00:16:18.124 --> 00:16:19.304
And so that's the obvious,

00:16:19.345 --> 00:16:21.264
the first obvious collaboration that each

00:16:21.284 --> 00:16:22.245
state needs to do better.

00:16:22.285 --> 00:16:23.926
And there is a movement towards forming

00:16:23.946 --> 00:16:24.866
more trial alliances,

00:16:24.907 --> 00:16:26.447
which I'm working on getting going in

00:16:26.466 --> 00:16:28.827
Minnesota as a as a focus.

00:16:29.869 --> 00:16:30.509
Because, again,

00:16:30.729 --> 00:16:32.149
what if we did combined days on the

00:16:32.168 --> 00:16:34.789
Hill where there are four thousand OTs and

00:16:34.850 --> 00:16:38.251
our five thousand PTs and there, you know,

00:16:38.292 --> 00:16:39.451
two thousand speech therapists?

00:16:39.471 --> 00:16:40.673
What if we all showed up together?

00:16:42.114 --> 00:16:44.976
Because payment is DBT codes.

00:16:45.037 --> 00:16:45.837
It's not just PT.

00:16:45.857 --> 00:16:46.940
It's not limited to one of us.

00:16:46.960 --> 00:16:47.500
It's not just OT.

00:16:47.539 --> 00:16:48.260
It's not just speech.

00:16:48.662 --> 00:16:50.203
So that's the obvious one.

00:16:50.303 --> 00:16:52.986
And then also I'm seeing in other states,

00:16:53.027 --> 00:16:54.408
and we all need to do better on

00:16:54.428 --> 00:16:54.668
this,

00:16:54.828 --> 00:16:57.251
is do we have enough energy to worry

00:16:57.293 --> 00:16:58.573
about scope creep?

00:16:59.734 --> 00:17:02.176
Or if we're friends with everyone and we

00:17:02.235 --> 00:17:04.557
really understood their position of why,

00:17:04.577 --> 00:17:06.919
you know, whatever that other entity is,

00:17:07.579 --> 00:17:10.541
why they want to maybe expand their scope

00:17:10.561 --> 00:17:13.044
a little bit because they're needing to

00:17:13.064 --> 00:17:14.904
meet a need because there's not enough PTs

00:17:14.944 --> 00:17:15.224
out there.

00:17:16.566 --> 00:17:18.808
Maybe they'll listen to us and stop

00:17:18.868 --> 00:17:20.029
fighting our bills.

00:17:20.471 --> 00:17:21.711
And we have a lot of that at

00:17:21.751 --> 00:17:22.252
the state level.

00:17:22.292 --> 00:17:25.655
We have a lot of fighting from keeping

00:17:25.875 --> 00:17:27.377
our scope under control.

00:17:28.960 --> 00:17:29.641
And we don't like it.

00:17:30.361 --> 00:17:32.604
We don't like it when that profession

00:17:32.624 --> 00:17:34.266
comes out and says PTs shouldn't do that.

00:17:35.287 --> 00:17:35.926
We're doctors.

00:17:36.667 --> 00:17:37.269
Yes, we should.

00:17:39.861 --> 00:17:41.702
But when we show up and say that

00:17:41.943 --> 00:17:43.404
another profession can't do things.

00:17:43.424 --> 00:17:44.586
Now we're doing the thing that we just

00:17:44.606 --> 00:17:45.086
said we didn't.

00:17:45.146 --> 00:17:45.807
Yes,

00:17:46.028 --> 00:17:47.630
and we can get a bad name at

00:17:47.670 --> 00:17:48.290
the Capitol,

00:17:48.351 --> 00:17:49.792
and that's not helping our bills go

00:17:49.813 --> 00:17:50.433
forward either.

00:17:50.453 --> 00:17:51.634
It's helping nothing go anywhere.

00:17:51.755 --> 00:17:53.076
So can we all get along and be

00:17:53.116 --> 00:17:53.537
friends?

00:17:53.678 --> 00:17:55.599
I know that there's, you know,

00:17:56.921 --> 00:17:57.721
there's leverage.

00:17:57.741 --> 00:17:58.723
There's keeping some...

00:18:00.549 --> 00:18:02.111
eye on others, helps us with leverage,

00:18:02.131 --> 00:18:03.132
helps us with politics.

00:18:04.133 --> 00:18:05.113
But yeah,

00:18:05.212 --> 00:18:06.374
I think we can do a better job

00:18:06.594 --> 00:18:08.476
of supporting all of healthcare because

00:18:08.516 --> 00:18:10.096
we're all kind of struggling, right?

00:18:10.336 --> 00:18:11.498
And overlap's going to happen.

00:18:12.678 --> 00:18:13.679
And sometimes we need it to happen,

00:18:13.699 --> 00:18:14.859
especially in rural areas.

00:18:14.900 --> 00:18:16.520
Minnesota has a lot of rural area.

00:18:17.141 --> 00:18:18.001
There's not enough PTs.

00:18:18.382 --> 00:18:19.383
There's not enough ATs.

00:18:19.863 --> 00:18:20.884
There's not enough physicians.

00:18:21.523 --> 00:18:22.325
There's not enough PAs.

00:18:22.825 --> 00:18:24.946
And it's only gonna get more difficult,

00:18:24.987 --> 00:18:25.186
right?

00:18:25.207 --> 00:18:26.628
I mean- We have a lot of hospitals

00:18:26.669 --> 00:18:27.589
closing in Minnesota.

00:18:27.609 --> 00:18:28.349
I'm sure that's happening everywhere.

00:18:28.369 --> 00:18:28.971
We walk around this conference,

00:18:28.990 --> 00:18:29.731
how many are recruiting?

00:18:29.892 --> 00:18:31.574
It's recruiting and technology, right?

00:18:31.594 --> 00:18:32.074
That's what it is.

00:18:32.094 --> 00:18:32.575
Yeah, yeah.

00:18:32.694 --> 00:18:35.317
I have some open positions at my clinic.

00:18:35.497 --> 00:18:36.258
Put a plug in there.

00:18:36.858 --> 00:18:38.000
You know, they're hard to fill.

00:18:38.259 --> 00:18:39.020
Where in Minnesota?

00:18:39.260 --> 00:18:40.882
We're in Rochester, Minnesota,

00:18:41.221 --> 00:18:42.603
so home of Mayo Clinic.

00:18:42.843 --> 00:18:45.085
We're a private practice working

00:18:45.125 --> 00:18:46.506
alongside, very successfully,

00:18:46.546 --> 00:18:47.506
a large healthcare system.

00:18:47.726 --> 00:18:51.088
What mindset shift do PTs need to better

00:18:51.169 --> 00:18:54.090
serve underserved communities?

00:18:54.230 --> 00:18:54.431
I mean,

00:18:54.750 --> 00:18:57.752
let's say someone wants to eventually open

00:18:57.772 --> 00:18:59.153
a twenty thousand square foot thing,

00:18:59.173 --> 00:18:59.894
that might be a little bit in the

00:18:59.913 --> 00:19:00.234
future,

00:19:00.535 --> 00:19:02.936
but what can they do if someone's

00:19:02.957 --> 00:19:03.457
listening now?

00:19:03.839 --> 00:19:04.641
Yeah, yeah.

00:19:04.681 --> 00:19:05.741
Being, again,

00:19:05.761 --> 00:19:08.923
being open to this idea that not

00:19:08.963 --> 00:19:10.125
everything comes from insurance.

00:19:11.185 --> 00:19:14.229
And that's a mind shift that still exists,

00:19:14.269 --> 00:19:14.788
especially,

00:19:14.969 --> 00:19:16.049
I was just talking to somebody this

00:19:16.089 --> 00:19:17.951
morning where works at a large hospital

00:19:17.991 --> 00:19:18.392
system.

00:19:19.031 --> 00:19:21.193
And I told them about my model of

00:19:21.855 --> 00:19:24.416
enhanced programming that doesn't fit the

00:19:24.457 --> 00:19:25.176
insurance model.

00:19:25.198 --> 00:19:26.377
So you can do both, right?

00:19:26.397 --> 00:19:27.499
You can take insurance and you can take

00:19:27.519 --> 00:19:27.799
cash.

00:19:28.059 --> 00:19:29.240
Because if you look at the manuals,

00:19:29.280 --> 00:19:30.402
these enhanced programs,

00:19:30.442 --> 00:19:31.762
these neuro recovery programs,

00:19:32.123 --> 00:19:33.805
They don't fit what Medicare pays for.

00:19:34.164 --> 00:19:35.445
So therefore, we can take cash.

00:19:36.207 --> 00:19:36.907
And she said,

00:19:37.107 --> 00:19:38.068
but I work for a large system.

00:19:38.088 --> 00:19:40.190
We're not allowed to take cash.

00:19:40.590 --> 00:19:42.792
Right?

00:19:42.992 --> 00:19:45.494
Or I work with a low-income population,

00:19:45.535 --> 00:19:46.655
so I can't take cash.

00:19:47.116 --> 00:19:48.617
So this is true.

00:19:48.637 --> 00:19:49.959
They don't have a lot of funds.

00:19:50.019 --> 00:19:51.941
But there's things like GoFundMe.

00:19:53.061 --> 00:19:55.604
If you're open to a nonprofit arm or

00:19:55.624 --> 00:19:56.845
a nonprofit model,

00:19:57.986 --> 00:20:00.626
I write grants and I don't take any

00:20:00.686 --> 00:20:01.748
state or federal grants.

00:20:01.807 --> 00:20:03.648
It's all family foundations.

00:20:03.729 --> 00:20:05.128
It's banks.

00:20:05.210 --> 00:20:07.411
It's our local Rochester area foundation.

00:20:07.770 --> 00:20:09.550
They support what we do because they see

00:20:09.570 --> 00:20:10.531
the difference we're making.

00:20:10.632 --> 00:20:11.392
And you're in the community.

00:20:11.531 --> 00:20:13.313
And so then something that's one hundred

00:20:13.333 --> 00:20:14.294
and forty dollars an hour.

00:20:15.213 --> 00:20:17.535
becomes fifty dollars an hour or maybe

00:20:17.555 --> 00:20:19.714
even twenty five dollars an hour or maybe

00:20:19.734 --> 00:20:22.635
they have a gofundme that pays full right

00:20:22.855 --> 00:20:26.096
because i'm able to subsidize right the

00:20:26.175 --> 00:20:28.916
full cost pay my bills pay my staff

00:20:29.196 --> 00:20:31.637
they get health insurance they we but none

00:20:31.657 --> 00:20:32.837
of this is on the syllabus in pt

00:20:32.857 --> 00:20:35.117
school this is simple not easy this is

00:20:35.298 --> 00:20:37.239
not on the beaten path that's why you

00:20:37.278 --> 00:20:39.798
doing an episode on this is so rare

00:20:39.919 --> 00:20:41.180
right it's not that it's nowhere but it's

00:20:41.359 --> 00:20:42.619
it's not everywhere it's definitely not

00:20:42.660 --> 00:20:42.960
everywhere

00:20:43.180 --> 00:20:43.599
Very rare.

00:20:44.019 --> 00:20:45.961
I haven't actually met anyone that has a

00:20:46.000 --> 00:20:46.961
model like mine.

00:20:48.761 --> 00:20:50.182
And so, yeah, it's very rare,

00:20:50.221 --> 00:20:51.702
but it's doable, and it's possible.

00:20:52.262 --> 00:20:54.044
You have to have legal support.

00:20:54.144 --> 00:20:55.604
You have to have accounting support.

00:20:55.624 --> 00:20:56.424
I mean, I have an accountant.

00:20:56.505 --> 00:20:57.265
I have an attorney now.

00:20:57.605 --> 00:20:58.785
I didn't at first, actually.

00:20:58.805 --> 00:21:00.546
Yeah, how hard could it be?

00:21:00.566 --> 00:21:01.066
It's a bunch of math.

00:21:01.086 --> 00:21:02.106
It's a bunch of numbers.

00:21:02.126 --> 00:21:04.086
How hard could it be?

00:21:04.106 --> 00:21:04.867
I don't recommend it,

00:21:04.907 --> 00:21:07.167
but I wrote my own contracts,

00:21:07.208 --> 00:21:08.169
and I did a lot, you know.

00:21:09.815 --> 00:21:12.256
first to get going but now i would

00:21:12.316 --> 00:21:14.455
highly recommend legal support um lots of

00:21:14.496 --> 00:21:16.777
great consultants out there to help um you

00:21:16.797 --> 00:21:19.057
know we are a member member of pps

00:21:19.718 --> 00:21:21.498
even as a non-profit and i'm definitely

00:21:21.518 --> 00:21:23.618
the unicorn and i definitely sometimes

00:21:23.638 --> 00:21:25.459
when i talk but you can still steal

00:21:25.499 --> 00:21:28.180
and borrow ideas and spin and we are

00:21:28.200 --> 00:21:28.759
a private practice

00:21:29.440 --> 00:21:31.561
Yeah, we have to pay our bills.

00:21:32.402 --> 00:21:34.303
We actually have to make extra money for

00:21:34.323 --> 00:21:35.403
our savings account, right?

00:21:36.704 --> 00:21:38.645
Non-profit doesn't mean no income.

00:21:38.665 --> 00:21:39.145
No profit, right.

00:21:41.007 --> 00:21:43.288
And so I love to share that it's

00:21:43.328 --> 00:21:43.828
possible.

00:21:44.449 --> 00:21:47.851
My heart feels happy that I provide so

00:21:47.931 --> 00:21:50.992
much to the community and we have our

00:21:51.012 --> 00:21:52.973
goal is access for everyone.

00:21:52.993 --> 00:21:53.173
Good.

00:21:53.855 --> 00:21:54.875
And the website one more time.

00:21:54.994 --> 00:21:56.175
Oh, it's easy.

00:21:56.336 --> 00:21:57.497
ChooseEA.org.

00:21:57.817 --> 00:21:58.156
Smart.

00:21:58.497 --> 00:21:59.356
Rochester, Minnesota.

00:22:00.518 --> 00:22:01.998
I mean, by the time they get hired,

00:22:02.018 --> 00:22:02.738
it'll probably be spring.

00:22:02.758 --> 00:22:03.519
It'll be a little cooler.

00:22:03.638 --> 00:22:05.499
Sorry, a little warmer in Rochester,

00:22:05.519 --> 00:22:05.858
Minnesota.

00:22:05.939 --> 00:22:08.059
It is a beautiful,

00:22:08.220 --> 00:22:10.740
beautiful year-round state.

00:22:10.760 --> 00:22:12.701
But you do have to like some snow.

00:22:13.161 --> 00:22:13.740
Or curling.

00:22:13.941 --> 00:22:15.021
Your husband's taking up curling.

00:22:15.061 --> 00:22:15.701
Yeah, he'd like to.

00:22:15.721 --> 00:22:16.162
We'll see.

00:22:16.201 --> 00:22:19.363
The Olympics has sparked some interest.

00:22:19.442 --> 00:22:20.603
Melanie, we have a tradition on the show.

00:22:20.663 --> 00:22:21.163
Every episode,

00:22:21.182 --> 00:22:23.163
we do something called The Parting Shot.

00:22:24.166 --> 00:22:26.212
This is The Parting Shot.

00:22:26.733 --> 00:22:28.157
One last mic drop moment.

00:22:28.819 --> 00:22:29.622
No pressure.

00:22:30.063 --> 00:22:32.189
Just your legacy on the line.

00:22:33.669 --> 00:22:33.909
All right,

00:22:33.929 --> 00:22:35.550
Parting Shot brought to you by U.S.

00:22:35.671 --> 00:22:36.211
Physical Therapy.

00:22:36.230 --> 00:22:37.311
We're at the booth right now, U.S.

00:22:37.352 --> 00:22:38.012
Physical Therapy.

00:22:38.532 --> 00:22:39.894
National network of clinics focused on

00:22:39.913 --> 00:22:40.795
developing clinicians,

00:22:41.234 --> 00:22:41.895
not burning them out.

00:22:41.935 --> 00:22:43.297
Leadership tracks, mentorship,

00:22:43.317 --> 00:22:43.817
career growth.

00:22:43.856 --> 00:22:47.059
Find them online at usph.com or find them

00:22:47.119 --> 00:22:48.800
here if you're watching the live stream.

00:22:48.901 --> 00:22:50.422
I swear, this is not prerecorded.

00:22:50.742 --> 00:22:53.365
We are at the Expo Hall at USPH's

00:22:53.404 --> 00:22:54.326
booth, which is twelve...

00:22:55.026 --> 00:22:56.888
I might, I'm probably,

00:22:56.969 --> 00:22:58.711
look for the guy in the ridiculous tuxedo

00:22:58.731 --> 00:22:59.593
that I bought on Amazon.

00:22:59.792 --> 00:23:00.894
You buy tuxedos on Amazon.

00:23:01.315 --> 00:23:02.317
No, parting shot.

00:23:02.376 --> 00:23:03.218
What do you want to leave as your

00:23:03.238 --> 00:23:05.461
mic drop moment with the audience today?

00:23:06.854 --> 00:23:08.596
I would like to leave that private

00:23:08.655 --> 00:23:10.116
practice is not just for orthopedics.

00:23:10.136 --> 00:23:10.978
Yeah.

00:23:10.998 --> 00:23:13.440
That community wellness and neurologic

00:23:13.480 --> 00:23:13.980
recovery.

00:23:14.099 --> 00:23:15.922
We need a neuro gym in every town.

00:23:15.942 --> 00:23:16.261
Yeah.

00:23:16.962 --> 00:23:18.304
And but you might need to be open

00:23:18.324 --> 00:23:18.983
to a different model.

00:23:19.545 --> 00:23:19.845
Yeah.

00:23:20.005 --> 00:23:22.007
So it might you I would encourage looking

00:23:22.047 --> 00:23:24.709
at nonprofitness as one way to make that

00:23:24.729 --> 00:23:24.929
happen.

00:23:25.068 --> 00:23:25.689
But in the end,

00:23:26.009 --> 00:23:27.849
you're now able to provide great care for

00:23:27.910 --> 00:23:29.029
people who desperately need it.

00:23:29.109 --> 00:23:30.809
And isn't that why most of us showed

00:23:30.869 --> 00:23:30.950
up?

00:23:31.190 --> 00:23:32.891
It is why most of us showed up.

00:23:33.391 --> 00:23:33.730
Yeah,

00:23:33.790 --> 00:23:36.632
we need to also take on an ideology

00:23:36.652 --> 00:23:37.951
that insurance doesn't pay for everything.

00:23:38.451 --> 00:23:40.492
And people should continue to get care

00:23:40.772 --> 00:23:42.712
after ten, fourteen visits.

00:23:43.333 --> 00:23:45.473
Melanie Brennan, APTA Minnesota.

00:23:45.634 --> 00:23:47.153
Good luck in your presidency.

00:23:47.374 --> 00:23:49.115
We'll check back in before your presidency

00:23:49.295 --> 00:23:49.634
is over.

00:23:49.835 --> 00:23:50.275
Sounds good.