The Business Model Behind the Care

0:02 Broadcasting way too early from three separate Wi-Fi connections. It's PT Breakfast Club with Tony Meritato, Dave Kittle, and Jimmy McKay. Happy Thursday morning. Dave, can you see me? I don't know if he can hear you. Wait, is this Gene Wilder? You can't hear me. You can't see me. This is Gene Wilder and Richard Pryor. This is Hear No Evil, See No Evil. Dave, can you hear me? No. So that means he's... Okay, we got Dave. You were Gene Wilder for a minute.

0:46 But Jimmy, you're still blank. You're still invisible. Can you see me? Do I exist visually? You're in the Batcave right now. There you are. You can see me. Now you're here. Now you're here. Oh, there we go. All right. How are you guys? What's Pie Foot? Pie Foot? Three, one, four, F-T on your shirt. That's right field. Is it right field or left? No, right field in Yankee Stadium. Old Yankee Stadium. Right field down the line. Come on now. It's right field down the line. It's what's written on the right field wall in Yankee Stadium. Got it. It's like inside, it's like, yeah, but pie foot would be pretty good if I put a period right here.

1:31 So just so you know, you're delayed and pixely. So I don't think you have a good connection, Jimmy, but no worries. Now you're just frozen. And while Jimmy figures that out, I am standing today. I had a marathon game of poker last night with a bunch of New Yorkers. It was rowdy. It was so much fun. My buddy, Dr. Christian Marcial, who owns Tribeca Physical Therapy, invited me to poker. It was twelve. You know how like Texas Hold'em usually is like eight, maybe ten. Yeah, yeah. Yeah. All guys at the table. You got to do two tables or just stick everybody at one large table.

2:15 One large table in this beautiful office. This this guy, this cabinet distributor office in Manhattan. And it was awesome. I didn't get home because I didn't get home until late. But you guys play Texas Hold'em. Yep. Yep. Awesome. How'd you do? How'd you walk away? was only up ten bucks i bought in for a hundred lost it bought it for another hundred so then i was you know down two hundred um made it back probably closer to three hundred had a couple wild bets at the end right before the end and uh yeah ended up ten up ten dollars up so yeah i just jumped back in where were where were you will be playing Texas Hold'em, just like a guy's night, poker in the city.

3:04 My buddy, Dr. Christian, who owns Tribeca PT, he invited me and he's created this game. Sometimes it's like only five or seven guys or whatever, but for whatever reason, it was twelve last night and it was so much fun. I used to play a ton of poker back in like two thousand four, five, six, like when it was on ESPN, it was really popular with Chris Moneymaker and all that. Yeah. And sitting down also, I was thinking of like the movie rounders with Matt Damon and Edward Norton. And like, again, like I'm thinking like, it's probably like just like a fun game, but it also might be some serious guys. So in rounders, the quote is if you sit down on a poker table and you can't identify who's the sucker, then you're the sucker.

3:48 Right. And let's just say in the first, it was very quick. It was very quick in the first, fifteen to thirty minutes I was like oh okay I can see these guys are just like for fun and like no one's making no one's making like their income off this right so we're just we're just having fun but I was like I'm super competitive right so I was like I was playing kind of tight and like there were some guys playing like loose and aggressive and just a little wild and a couple couple like sales guys they're you know they're just like a different breed of like of behavior. Sometimes there were some like finance guys that were like super stoic, like wouldn't laugh at any jokes. They like, weren't getting up. They were just sitting the whole time. Um, for me, that's also why I'm standing right now.

4:30 Cause like, I'm like, I get up and I'm like, Oh, I'm kind of like stiff today. And I gotta, I gotta move more. I can't be sitting that long. I'm not used to sitting for, you know, three, four hours. You know, you, you highlight something, which is man, poker was everywhere for about, I don't know, five years longer. And I think it started, it started well before COVID, right? Like it definitely did. Yeah. It was before COVID. Um, maybe COVID ruined it because you couldn't be in person. The government ruined it. Like poker got huge when people were gambling online. government was not regulating. Even though it was illegal, they were kind of turning a blind eye to it.

5:12 It got huge. This is exactly what happened. Then all the computers came in, all the bots came in. There were programs that you could get that would track every player. if you if you guys were sitting at a table with me i'd have an app running on my computer it would tell me okay dave does this this and this and this situation it would track all of these dave's history um i could play you know five six tables at a time which for me like that was a much more appealing game than what dave was doing sitting at one table with a group of guys because that's just so slow You're betting one in five hands.

5:53 It just takes forever to go around. But then the government came in and just shut everything down. Then a couple of main casinos got approved to do it, but it changed the whole game. That's what killed everything. I know the big jump off seemed to be in Tony because you jumped out and then you jump back into the call. But do you remember the Chris Moneymaker and that whole thing was on ESPN? That was like two thousand four, two thousand five ish. Greg Raymond. There were like a bunch of like, you know, live poker, Phil Ivey, a bunch of there's the other. What's the other guy? Phil something that's like he won like a couple.

6:36 He was the Simon Cowell of poker. Yes, yes, yes. There has to be a jack. There has to be like a heel. But anyway, you were bringing up poker. Maybe think of like, yeah, poker was everywhere. It's not completely gone now. It's probably different. And I was seeing some videos and comments about pickleball and how it's the fastest growing this and the fastest growing that. And if we want to look at things from patterns, it will grow. It will keep growing. And then something will happen, right? Like it will shrink or it will change, right? There's, you know, it reminds me, and maybe Dave has seen this. I think I mentioned this on Tuesday. I asked Tony if he had seen Air. Dave, you must have seen Air, the Michael Jordan movie.

7:17 Yeah, that one scene where he was like, where Matt Damon was essentially looking at Michael Jordan. He was like, they're going to build you up. You're going to become this thing. They're going to invent you. And then you're going to fall. Then they're going to tear you down. So it's like, how do we pay attention to these things? And how do we take advantage of that? Because everything that I'm seeing is, oh man, the profession's over. It's doom and gloom. Everything's done. But we know that it's just... I don't know. I wrote a LinkedIn article this morning where essentially I said, I looked at Sword and Hinge. I think there was something about one of them, right? One of them bought a gastrointestinal cylinder. Is it Hinge?

7:59 I have no idea. They bought a GI something. And I'm like, this is good because it shows that there's problems that we haven't solved. Like we're in the middle and these people are paying tons of money to try to solve the problem that we as a profession have been trying to solve for a long time. It ain't going to be solved with an app tomorrow. It's not going to be solved with an algorithm next month. this is good that enough people with money who are supposedly smart i'm going to assume that they're kind of smart they notice that this is a big hairy scary expensive problem i don't know i look at it as good when they show up like when other podcasts shows up it means there are people who want to listen Right. So this goes back to the big idea. I mean, CrossFit went through this, you know, and we've talked about, like, ice harvesting was huge before refrigeration.

8:45 Polaroid, or was it Kodak? Kodak had the digital camera. They had it first. So physical therapy was reconstruction aids. Then we became physical therapists. Why do we think that we have to stay in the cocoon that we're in? We don't. Why are we still battling for declining reimbursement? Why are we still battling for the stuff that therapists have historically done? My question on this topic to you guys, because I was researching this on the way in. I heard that they want to move to a pass-fail grading system for physical therapy school and get away from A, B, C, D, F. What do you guys think about this?

9:26 Like that would be something changing pretty significant. For every like test or like... Every class you take in PT school would be pass-fail. I mean, it is sort of right, because like if you don't pass, it sort of is right. If you don't move on, like you might get an eighty three. And if an eighty two isn't good enough, like I mean, I had my advisor talk me off a ledge a few times when like I'd study for a million hours and get an eighty eight or I'd study for six hours and get an eighty eight. And I was like she was like, what's the lesson there? There's a law of diminishing returns. Jimmy, what are you doing? But wait, before we move on. I think you hit upon something. Why are we afraid to break out of the cocoon when we understand that things hit a ceiling, then change?

10:11 I think the answer is people feel like they've earned a degree, which means they've earned a spot. I look at it as like the people movers at the airport. Like, do all this work, and eventually I get to stand on this people mover, and then there's a space for me. There's always going to be jobs. Doing the thing like Tony or Dave does is scary and harder, and I might not want to do that, so I'm going to be mad that – The thing that I was sold and I bought ten years ago isn't the same today. Everybody wants change. Nobody wants to change. Right? They want to have gone to the gym. You don't want to go to the gym. I mean, some of us like to go to the gym.

10:52 Dave, were you going to say something about anything? We can keep riffing on this. I was going to say basically like, the going to this poker, right? Like I, I, we, I and my wife, we love putting our, you know, two-year-old down to bed every night. And I, it's like a night where, so like even tonight I have a men's league baseball game. So I'm going to miss putting him down to sleep again. Um, and I love to do that. Right. And I'm lucky to be able to do that. And, um, So it's like going to do this poker night has to be worth my time, either one or multiple ways. Right. So one is I don't know what to expect, but I was great in terms of just like getting out, meeting new people, having a bunch of laughs, you know, having some drinks, wine, you know, food, whatever with the guys.

11:41 But also. Something that I kind of have gotten away from, which I just don't put a lot of time into, which is like relationship building and like word of mouth type stuff. And of course, I wore my I didn't wear this hat. I wore my concierge pain relief shirt, though. Right. And so, you know, half the guys over the course of the night were asking me about, oh, what's that? Is that your company or what's concierge? And what do you guys do? Oh, it's physical therapy, but it's concierge. Like so it's like. I didn't have to pitch anything. I get to then just kind of briefly say in between hands like what we do and all that. And I sat next to my buddy who's a physical therapist and they're out of network and cash and all that. Of course, strategically, the poker night happened to be about ten blocks away from our brick and mortar clinic.

12:25 Right. So if it was if it was like closer to like my buddy's office downtown, like I don't know, maybe I wouldn't have gone. But the point of me bringing this up is it has to be worth my time in terms of like just the socialization part. If I want that, if I wanted to do that, which I'm always open to do that as like an extrovert. But then also it's like I haven't done a lot of this. uh, you know, like group or like socialization, like networking type stuff. And I don't want to even, it's not even really like networking, but everyone that I sat around the table with, like, they're all like fairly successful. Right. And that's like the, that's the point, at least for me is like, um, I wouldn't want to go to a poker game if it was like a bunch of like new grads that were, um, in i don't know other industries maybe but it's like when i heard about who was there or like the type of people and i got the google invite and i could kind of see some of their their email addresses and all that that i'm like oh like that's kind of like that's now it now it does make a good use of my time and so I'm just trying to think moving forward of like, I'm not going into it of like what is in it for me, but it's also like, I want there to be something that could come from it in the medium to long term.

13:35 And the short term is more of just like meeting new folks, maybe referring business to them if, you know, we know someone that specializes or needs the specialization of what they offer. One guy was, like I said, cabinet, uh, cabinet, uh, distributor. So he sells to like residential, like real estate investors and owners and all that. So it's just like super fascinating and interesting of like how other people have a very specific focus, like with their work and all that. So anyway, just, just like just throwing it out there in terms of like the opposite of like paid ads and Google ads and, um, you know, the, the, the dialing of paid marketing. And then it's like, oh yeah, like I should maybe mix in some more of this exact stuff.

14:16 And it's fun in real time. And it's also potentially beneficial. I hear you saying two things. I hear all the money you lost was tax deductible because this was clearly a business expense. I didn't lose. I left up ten dollars. So The government can't tax my ten dollar cash because they don't know about it. I hear Jimmy needs to start a PT breakfast club poker night for recruiting. Like there's nothing better. Talk about putting a potential candidate. If I wanted to hire a therapist, put him in the hot seat of a poker table. Let's go. I didn't even think, I didn't even think we were going this way, but I love it.

14:57 Yeah. You talk, you get to know them. You see how they make decisions under pressure. Can you tell when they're lying? Can you tell? I love this. Sponsored by where Jimmy works. If we were to spin this, that's a good idea. How do you organize it? That's tough logistically. In-person is tough. But Tony already said he likes playing five hands and not one. So online actually plays well there. But then you lose some of the conversation. Or is it... If you're trying to hire PT students as they graduate, do you give them something that they think they need because they don't, but they think they need to study for the NPTE?

15:37 You actually don't need to study. You know enough. I mean, you need to review, but you need to study. Do I do a trivia show? Do I lean into my own skill and go, we're going to do an online trivia show, and then you're going to bring people on? I don't know. I'm trying to figure out what's the thing that... Clinicians is too wide because they have vast... you know, likes and dislikes and hobbies. Students are consistent because they're like, I'm in study mode for three point five years. That is a good point. Like because you wanted that's why happy hours and PT pub nights were so big for a while is because it was like, no, you mean no one thought to like get people together to talk. Like the magic of the pub night was there was no, there wasn't a cell. It was just get together.

16:18 And then the, the hanging out is the, is the magic. As soon as this, this would be that, but since PT pub night is inaccessible. It's, you know, you create the new PT pub night plus from my understanding, younger people, younger people are drinking less, you know, you, you could even make a situation where everybody gets gifted, six thousand chips and it's kind of tournament style, you know, and then maybe there's a prize at the end, but it's a combination of potential candidates plus individuals hiring. Oh yeah, yeah, yeah. The magic. And you need, you need a reason to go. You need a hook, right?

17:00 So are you saying like actual in-person things or a digital thing or try both? Probably hybrid, but actual in-person. It's got to be in-person. It's super hard. I'd love to do it, but it's super hard and not cheap. Or, so really if we think about this, what if Jimmy goes to colleges, right? At the college, you've got the entire department there. So it's like, all right, what if we did something where you did the DPT department poker tournament, whoever wants to participate, it's streamed live, even if the employer couldn't make it. I mean, the schools here by me have job fairs we used to go to all the job fairs try to talk to the the pt students like you could bring in local employers but if you streamed it live you'd get all the benefits to potential employers who wanted to watch and interact online what about like i'm surprised neither of you mentioned this what about you do a poker night at like the pps or csm or whatever so instead of like usually it's like you go to a party the poker night now is you know the night before or after or it's competing with the main party or the secondary party Oh, Jimmy's gone.

18:20 Has there never been a party with a purpose? Yeah, so I'm saying now the breakfast club-sponsored poker night would be competing with that party, which would be tough. It was going to be tough, but there's going to be certain people that are like, I absolutely would want to go to poker rather than a party. Totally agree. This is why, oh, Paul's saying during the pandemic, they had a group that played online, but on Zoom together. Yeah. So you had the online, but you had the, this is why there's an app called Discord. You guys familiar with Discord? Yeah. Yeah. I didn't understand what it was. And then it completely, it clicked. It was like, oh, got it. You, that chat feature. It's the social component to everything else. Don't disagree.

19:01 This is why, so I'm, I won't say the school because we haven't locked it in, but coming up actually somewhere in Dave's neck of the woods, I go to PT schools and instead of giving a talk, I turn it into the Johnny Carson show where I'm like, give me fun guests who are wildly different and have nothing to do with a lecture. And then I say, don't worry about it. I pre-interview all of them. And instead of a They've already told me most of their gems, and then my job is to pull it out. And then I bring in the sound effects and the music, and I zhuzh it up, and I go, it's got to be an hour, no longer than an hour. By the way, when we're done, we're going to go down the street to whatever bar.

19:41 We're going to mix it up, and you're going to talk to the speakers, and the students are going to talk to each other. To me, the recruiters, their eyes get real big. They're like, you're going to hype all the students up and then put them in a room? And I'm like, yeah, and you've got to buy them food. And they're like... Great. And I'm like, if you can't recruit from that room, hang it up, my friend. You're done. That's the magic. It's only missing the game, the playing part of that component. What's the reason for going? Right. That would be the thing. Peeling this back to the original topic of how things change and innovate. We talked about how these different sports kind of grew and changed.

20:22 I was just watching these guys do speed golf. And I could get into speed golf. Two, three clubs. You putt with a driver. You run through. It's a combination of how fast you can play and what your score is. You change and innovate how PT clinics are recruiting therapists. You change and innovate how PT clinics are delivering physical therapy services. You change and innovate how they're getting paid. Every single element, including the entirety, should change and innovate. It should grow. Dave is not the same physical therapist he was when he was a new grad. He is a very different human.

21:03 His experience, everything has changed in the way he delivers, yet we still continue to hang on to the words physical therapy. Agreed. Yeah. But the actual thing that I want to do for the patient, I believe, is the same. The core has stayed the same. How, the what and the why I believe is the same. The how, the where, the when, those things should constantly be changing. Listen, Easter egg hunts are great, but there was a company who revolutionized like the concept and they made it augmented reality and it was Pokemon Go. It's just an old idea in a new way or a new idea in an old way. One of those has to be old. So it's, well, we're just delivering musculoskeletal care in the old way.

21:46 No, we come to you. That's a vastly new way. Ironically, it's a vastly old way, but it's been away for so long that it's actually new again. All of a sudden, bell bottoms are genius. It's like, dude, they were so cool that they became not cool. And that's the idea. It's this wave of the things that go out. I don't think you need to look too far for your new idea. On Tuesday, Tony brought up some really great ads. There's nothing new about this ad, except you haven't seen these ads in the style for so long. Yeah. Yeah. Yeah, they're so old that we stopped doing it because human being brains create novelty.

22:33 When we see something too much, it becomes noise. And our job is to be signal in the noise. So I think it's time to bring ads like this back simply because we haven't done them for so long. So let me ask you guys about this, because this is still kind of related. I shared this TikTok. This is a therapist who started a practice and she's talking about, you know, kind of going through the continuum of She's got an injured athlete. She rehabs the athlete. Now the athlete wants to work on performance, taking the athlete through performance, going from two, three times a week to maybe once a month where the athlete's checking in with her.

23:17 She's updating his program. She's advancing him, improving his performance on the field. We've talked about this a lot. My question is, at what point does she or do we eliminate the word physical therapy, use it for wellness, performance training, you know, whatever it's going to be. Because she's basically saying how like, I think a lot of the profession is pigeonholed into once insurance stops paying, we're done. not really and i think a lot of the therapists want to take the person beyond just back to prior level of function dave has clearly built the business model in the niche where it's it's a lifetime investment i will take you all the way through the day you die because there isn't a point in that time where you you're gonna accept weakness and frailty and you know any of that stuff But it's like, OK, do we keep calling it physical therapy because the service is delivered by a physical therapist?

24:22 There's problems with that. Do we change what we are calling it? And now it's performance training delivered by a physical therapist. Where are you guys on that spectrum? I understand what you mean. I don't see an easy or obvious path where the clinicians or the academics will agree or change anything or the board or whatever, the FSB, PT board or whatever, and or the public. I feel like, again, I know I've mentioned it before, but like with Facebook, Instagram video, TikTok video, YouTube video, I feel like every single day, more and more of the public have a better understanding of what and a licensed physical therapist does for their patients in the U S.

25:13 And when I say that, I mean, most of the video is like obviously outpatient stuff. Right. So in terms of like musculoskeletal stuff, of course, neuro is having, you know, there's more practices that just are neuro only. And Tony knows a lot of them where they're posting a lot of content or it's home visits or it's neuro home visits. Right. But like, I feel like with all the online video, more and more of the public know what, a licensed physical therapist does in the US, right? And so to suggest a change in name, I feel like would just detract from the pace of people learning and acknowledging and understanding what physical therapists or even occupational therapists do for certain issues or challenges.

25:55 Now, if we just change it all of a sudden, if, I don't know, if the APTA or whatever the board all of a sudden today change it to, performance wellness or whatever, performance training, but then it kind of sounds like a personal trainer maybe. If you just change the name all of a sudden to... Performance wellness. I'm a wellness performer. It doesn't even make sense. If they just literally had a decree today and this is now physical therapists are now performance wellness providers or whatever, then I feel like it would just take more time for the public to even learn that and then connect their aches and pains and I'm looking for an issue.

26:39 I'm looking for a provider to solve this issue. I'm looking for a professional or someone who's competent to solve my back pain or my neck pain or shoulder pain. And I think it would just take too much time, Tony. I think it would just take too many years or decades to change public understanding if you change the name. So in my opinion, I say leave it, but I also fully agree that it's not the best name, if that makes sense. Before we hear from Jimmy, hang on. Before we hear from Jimmy, Dave, you just reminded me of Michael Scott saying, I declare bankruptcy. I want physical therapist to declare. Okay, go ahead.

27:19 Yeah, I think there's several things. Number one, some people in the profession are like, call us something different. And there are also some of the same people are mad that other people are calling themselves dynamic personal trainers. They're like, we don't need this name. It doesn't say what we do. And then also, you can't use that name. People are going to get confused. My man, they're already confused. Yeah. Google's a verb now because they showed what they did. Doctors don't doctor, right? Nurses don't nurse, right? They practice medicine. So the name, as much as I say it needs a name, it just needs a name. It doesn't need to be the most obvious name, right? Plumbers don't plumb, right?

28:00 But we still know, we understand what they do because... They've done it. They've showed that over and over and over again. That's the game. The game is showing, not telling. Show, not tell. That was my favorite day in third grade, man. I couldn't wait to bring in the G.I. Joe hovercraft. I'm like, this floats in the tub. I wasn't excited to tell them about it. I was excited to bring in a little tank and put it in there and be like, the hovercraft floats. Look at this thing. Isn't this the greatest thing ever? I'm going to bring this to the playground. And we keep trying to tell something about it. I just commented on, you guys know Alex Benderski, right? I know Tony does. yeah super smart dude my my only knock on alex i'm like alex bring it up bring it down by about grade levels for the rest of us to be able to breathe because he thinks up here and he was talking about how we don't need uh his his main idea was about pain education and i was like yes agreed we don't need education but then his post then proceeded to educate and i'm like you can't talk out of both sides of your mouth ironically you just talk out of the middle of your mouth but the issue i then said if that were true if we needed more logic in the world to be blatantly obvious and education about what pt can do well then every nike commercial would be about the chemical composition of the rubber of the shoe And every Toyota commercial would be about fuel injection.

29:24 And every hinge commercial would be about algorithms that match, you know, people's compatibility. And yet Toyota shows people kicking ass on a road. Nike shows dunks and hinge. They have photos on that platform for a reason. And it's the show less of it. You've got to show first. And the last thing I'll say is Donald Miller, if you're going to read a book, Not about PT that will help you in PT. It's Donald Miller's building a story brand I would do first. And then if you're like, I love this guy, go to Marketing Made Simple from Donald Miller again. I don't get any nickels from him for suggesting the books. I wish I did. You're not the hero.

30:05 The other person's the hero. Build a story in which you show you understand. Concierge Pain Relief got people asking you a question around a poker table. later on if they're in pain or they're like i think i sort of know that's the thing they're going to think of They don't care where Dave went to PT school. In fact, they might not even care that he went to PT because if the guy I had on the podcast not long ago, Sean Patush from Long Island, he might be the best guy to help you. Why? Because he's down the street and he understands what I have and I think he can help me get out of it. That's the thing you're trying to sell, but that's often not on a syllabus in a healthcare degree.

30:50 we had a question for dave um before i before i switch topics to that though i was thinking more as much as i would love to get rid of the name physical therapy in general i was thinking more switch the name of the service switch the name of the product so so that you have physical therapy delivered by a physical therapist then you have performance training delivered by a physical therapist. They are not the same service, product, whatever you want to call it. That could be done now. That could be done today. It doesn't take legislation. It doesn't take state practice act. It doesn't take anything. And I think instantly the value, especially in a cash pay world, of what you are delivering, the service or the outcome, immediately goes up as soon as you take the letters or the name physical therapy away from what it is that you're selling.

31:41 This Tuesday, Jimmy and I wanted to hear from Dave what's going on with the flyers, the mailers, the QR codes. How is that going? Yeah. So Jimmy asked me like a week or two ago, I think, Tony, when you were not on the show. So we're still at a loss. We did get some leads. We did get some people that did the evaluations. I coach my therapist on for the people that come in. So they already paid one hundred seventy five dollars because it's on the mailer. It's on the postcard. It's a hundred and seventy five dollars for it's basically like half off. It's basically like fifty percent. There's the value stack on the just if anyone's watching or listening that has no idea what we're talking about. Send out two thousand mailers to a bunch of two thousand different street addresses in Manhattan.

32:25 The value stack like you get this, this, this, you know, balance and joint assessment and whatever. and it's this money, it's this value, this dollar amount, value, this dollar amount, two thousand two hundred dollar or something value for one payment of one hundred seventy five dollars. So we would collect the one hundred seventy five dollars at least twenty four hours in advance before that first visit. It was either a home visit or a clinic visit. And for this particular I told my therapist that you're going to tell these people and I know this is recorded. So like whatever, it's like a marketing test. So I'm OK with saying it. I think you could all learn from it. I'm not that I'm teaching it. But for this approach, I said at the end of the evaluation, you talk about the prognosis and the diagnosis and the plan of care and all that.

33:12 And you're going to tell this person that we don't sell visit by visit. You're gonna say whatever their goal is, and you should have already obtained whatever the goal is in the beginning with a subjective and confirmed it with, what's the thing that they really care about that they wanna get back to? Whatever that thing is, you make a plan. I don't care if it's five visits or twenty visits or whatever. And you're not gonna give them a cookie cutter package that we currently have, which is twelve visits or twenty-four. You're going to say however many weeks or visits it's gonna take them. It could be an odd number, an even number. I don't care what the number is. You're going to say it's that dollar amount. And you're going to just grab your phone quickly without the patient looking. And you're going to go three hundred and fifty dollars times however many visits you think is going to help them get to the goal that they really care about their main goal.

34:00 And so we're still testing that. The patients, of course, my therapist need more coaching and training and mentoring around it. Because now we're not just selling a package, we're selling a results-based and time-based program to help this person either... Achieve their main goal that they care about, or if it's like multiple comorbidities and like chronic and really challenging, maybe it's a package to achieve the first step of several goals because they have like a chronic back pain that's been around for ten or twenty years or whatever. Right. So it depends on the patient. The way I'm describing it, I'm trying to make it sound as easy as possible. it is not easy to implement it's challenging i think for any senior therapist to even understand like okay i'm confident my skills to get this person better in twelve visits or achieve this goal in twelve visits and again, like Tony said before, don't have the don't have the goal focused around pain, have the goal focused around function or getting back to this particular museum, have the goal getting back to walking on the beach, going to this particular restaurant, walking this particular number of objective blocks.

35:09 whatever it is. So does that make sense? Like we, we haven't, we haven't had anyone convert to do like the time-based package, but I was like, that might be the best. I believe that approach by the way, is the, I think that should be how we only sell physical therapy, which is so, I think it's so, I think it's so aggressive and outside of the box, but to sell visit by visit is why. Ninety percent of the country falls off and drops off of physical therapy. You said it's difficult. What's the difficult part? Well, one is the physical therapist has to get comfortable saying a large number because they're going to say, it doesn't matter. Like, so we charge three fifty a visit and we for the time based package, I don't want to discount it.

35:51 This would be a way for us to make our premium rate across a package or a program into the future where we get some. Ideally, we get a paid in full. We get the full package amount today. Maybe there's a payment plan or whatever. So it's the opposite of the revenue cycle management. We're actually getting the cash flow up front. and then we're fulfilling the visits into the future. But when someone pays like this, shockingly, they're way more committed and they're more likely to achieve their goals and get the outcome and tell their friends and continue or re-up a package. I mean, it's amazing what can happen, but the challenging part is someone that's entering with back pain or balance issues or whatever, if they're calling around, they will only hear that from our practice.

36:38 No other practice is really going to pitch it that way. And obviously, we're pitching the paid evaluation first. So in this case, it was one hundred and seventy five dollars. So they have to meet us, start to know, like and trust us. Obviously, the therapist over the first hour, build rapport, build value, demonstrate value. And so it's hard because. There's no schooling. There's no DPT rotation to learn this. There's no, no one else's, there's no friends. Their physical therapist coworkers are not doing this. Like it's a little more foreign for a physical therapist to like even implement it.

37:19 They have to believe in their skills. They have to believe that they're not being salesy. There's multiple challenges, right? I've got a model in my head that I think would work. I want to hear what Jimmy's thinking. Um, that's a lot. So where do you, what do you like? This is where selling plumbing gets a lot easier. Do you have puddle in bathroom? Do you want to go away? And that's why plumbing can be a commodity because then you're going to call the second guy, the third guy and the fourth guy, and you're just going to choose on the cheapest. And that's the point is we're trying to sell the outcome. And now you can hear I'm getting rowdy about it. I'm getting like, this is a giant friction. This is a hard thing that I think some people do well.

38:01 I don't think they if they do it well, it's not they don't do one thing well. it's lots of things they do well that equal this being simple and more clear so so you're in your comparison and i'm not i'm not digging you but i'm just saying like when you compare it to plumbing of course so actually we just had we just had plumbers today they brought the snake and they cleared out the one of the the bathroom sinks and it was just a bunch of hair right uh i don't i don't know the guy's names they didn't introduce themselves i don't I will call another plumber, another company who can get here faster next time. I have no customer loyalty to that plumbing company. I don't care if those guys, as long as they leave our place, we're good, right? Now, I don't care. I have no affinity.

38:42 I'm not even going to write a Google review for that plumbing company that just came here this morning at eight a.m. That's the difference, Jimmy. The difference is we're trying. Yes, it's yes. There's more challenge to train a therapist to talk about this time based results based program. But and it's not for everyone. But the point of the offer of, OK, you pay one hundred seventy five dollars for the evaluation. You come in. The therapist does the normal evaluation treatment. HEP talks about the prognosis, diagnosis, all that. Obviously, hopefully builds rapport and trust in all of that. Then when they present this and say basically like, hey, we don't offer visit by visit. That's the difference is, yes, it's going to be a twenty five or thirty percent conversion rate from the evaluation to these.

39:29 to the packages a very low conversion rate whereas a plumber where it's like okay it's uh you know i don't know a hundred dollars or two hundred dollars for me to come out and then for me to get my snake machine and do that it's good it's like a very like uh commodity base like it's this dollar this dollar and then now they leave and i don't care yeah i have no i'm not going to tell my neighbors about the plumbing company i'm not going to say i'm not going to say it on this podcast oh the this the plumbing company was amazing they did the normal standard stuff because that's the way that the whole industry does it right so we're trying to do it differently and we're trying to offer a solution-based package that aligns our incentives with the patient and clients incentives they want to get they want to resolve their chronic back pain or get back to walking on the beach we can make a program and a package specifically around them every single thing that we do in every encounter with that client is focused on getting them back to walking on the beach.

40:21 And now our offer becomes a one of one so that they cannot compare our offer to even a nearby Medicare Part B therapist or a brick and mortar therapist that takes in that work. Yes, it's more challenging. Yes, the conversion rate is lower to the plan of care. But then the people that want to use their insurance or Medicare, sometimes not in Tony's office, but many times people will do three visits and drop off. As per the WebPT data from the last five or ten years, like people drop off because there is no skin in the game. They're not committed. They don't or they don't trust the therapist or there's multiple reasons. I think there's multiple reasons. I think what you're doing is harder, just to be clear. I know. Of course it is. I mean, I do the plumbing comparison, but I only use that.

41:04 It's hard. It's harder to demonstrate value in an industry. It's way easier to be a commodity. Sure. One hundred percent. Tony, do you agree? Disagree? I agree. I like the plumbing analogy simply because it shows us that we can't compare plumbing to what Dave's talking about. Plumbing is, I come in, I fix the leak, I'm done. Physical therapy is, it's not just me. I can't come in, rub your muscle and fix you when you're done. You have to be an active participant. So my question to Dave is, what is an existing business model right now in the world that has those same challenges? Raising kids.

41:44 Raising children. Kind of. Not really. It's an industry, but there's a lot of effort. I'm going to say higher education. Right. Like I had I had people in my program that paid for school. School did not guarantee the degree. School guaranteed. I'm going to put a teacher in a classroom. That teacher is going to teach you stuff. It's up to you, the student, to show up. It's up to you, the student, to study. It's up to you, the student, to learn, take the test, get the credential. The universities are doing this at massive scale and incredibly successful. and so and they even show like look this can be a high ticket unaffordable service that they are delivering that their students their customers are borrowing tons of money for that the problems many will never pay back um and so it's like okay well what what's this value proposition there how do i bring that model into what you're trying to sell you're right you can't promise you can't guarantee a pain-free resolution in six weeks what you do is you say just like a university degree this is what i can provide this is what i guarantee i guarantee the therapist is going to be there three days a week two days a week whatever it is i guarantee they're going to dedicate this plan of care these are the expectations just like a syllabus this is generally what you're going to be doing within

43:15 general framework and this is what it's going to cost at the end of the twelve thousand dollar six week investment maybe you feel better maybe you don't i can't control that But the things that I can control, just like a university are, the teacher is going to be there, the material is going to be available. We know that enough people who do this finish with this outcome. They can pass the test, they can get the degree, whatever it is. I would model that after how universities are selling degrees to students. And that's what I would use as my sales process.

43:56 I think it'd be awesome. And I think a therapist would kind of understand because they've already invested one fifty two hundred thousand in their education with zero guarantees on the outcome at the other end. Well, not zero guarantees, right? Because we've been told, listen, go to Indeed. Look at all these job openings. If you do this, then you do it. But look how subtly universities do that. And I'm not saying that they're doing it deceptively, but they're like, we are the bridge between where you are and where you want to go. Isn't that what Dave sells? We are the bridge between where you are and where you want to go. Exactly. Tony's analogy of the higher education is completely on point. What a sage contribution.

44:38 And it's like the saying of when the student is ready, the teacher will appear. And that's exactly what Tony's talking about. Yeah, it's the same. But it's not just what you sell because Toyota and Ferrari both sell cars. But they don't, right? Because if you're stupid enough to think the Ferrari and a Toyota are the same thing, and you buy the Ferrari, you're an idiot. But if you understand what you're buying, you're buying something wildly different. So I don't think Dave, I mean, I go back to this, I know you guys hate and love what I bring up. You're not selling things low on the pyramid here. You're selling transformation, right?

45:20 And that's higher, which is why it's worth more. It's also harder to wrap up in one sentence because that sentence, doesn't might not fit for everyone right like it what what like for one you're selling like fall prevention on the upper east side and the other it's return to run your central park you can do both but those two stories are wildly different very far apart um And also, also it's like students that are going into higher education and they like, I, I, I don't even really remember my process of like the, of like the paperwork and the financing and loans and all that.

46:00 Like, I, I don't even remember. Right. So it's almost like that's the only difference, Tony, is the process of like financing and payment. Right. So like with higher education, it's like it's like it's like, you know, it's like funny money. It's like envelopes and, you know, paper. And it just it's versus like when we're like, OK, it's going to be a three thousand, four thousand, six thousand dollar package. And now you have to, you know, oh, we have your card on file. Do you want to use that same card or whatever? Like it's like it's it's a little because it's a smaller dollar amount compared to like. your future, like your career and what you're going to study. There are some similarities. There are some differences. Did you play poker with chips or did you play poker with dollars and coins?

46:45 Seriously. Chips. yeah so so when you when you were going into college was your english teacher the one who did the financing and went through the the fafsa form and and took your payment no so like they understand we can't have the person handling the money be the person who's teaching you know algebra You identify that's the problem. You identify the weakness in the clinician. The weakness in the clinician is, yes, I could probably force that person to learn how to sell. They're never gonna sell as great as a salesperson. They're never gonna be as comfortable accepting that money as somebody who is born to take money, who wants to accept money, who sees money, dollars in Dave's bank account as points on the scoreboard, That's the person that I want taking the money and handling the deal.

47:39 So you work the business to optimize for that outcome in that role. Who is the person that literally feels good accepting money, taking more money? More money means better care. More money means better outcomes. More money is positive for the therapist, for Dave and the patient. They need to have that in their personality. That's the person that I want handling the sales and all the other stuff. Interesting question for Dave. What is the biggest differentiator with your employees? What gets them to go from uncomfortable to comfortable in explaining this? Repetition?

48:20 You coach them more? What do you think the biggest change? My guess would be the more you do it, the less it feels weird, right? Yeah. Reps is the only thing. And that's another reason why we do the all the interactions are recorded on the app. Right. So otherwise it's not measuring it and recording it when it's recorded. It gives automate like it's insane. The amount of data it tells, like a percentage of how much I talked, how much the therapist talk versus the client talked and how many questions and interruption rate. And in the transcript, You can listen to the audio. You can also look at the transcript. But in the transcript, there'll be comments that the AI will flag and give you feedback.

49:02 So it's like remote digital coaching that does not come from me. So it's amazing to have a third-party coach where the comment will say, hey, this explanation was a little long-winded. Maybe focus on tightening up a bit. Or this explanation was like... a little too much medical jargon and it was like a little more like complex, like maybe like speak at like a lower reading level or like a little bit more in layman's terms. And that's super helpful because they could see that any time, either from the email notifications or inside the dashboard. So it's like the system can give feedback and the more that they are learning and they're recording calls, like at some point they're going to go in and plus our Calls as a new therapist, like the interactions, the meetings or the the weekly and monthly coaching calls.

49:54 We're talking about that stuff, too. Right. So we'll do sales training together. But yeah, reps is definitely the biggest thing. Yeah, I was going to say, like the next hurdle you'll get into is in my imagine is people who feel like this is something that they want to be doing, because if I expected go to school and be the authority and the patients show up and I do the thing and they leave and they always listen to me. And now they're being told, I have to listen to them and change. I have to sell, which is this like, get that off me. I'm going to go take a hot shower and scrub that. Those people, you're never going to make those people like it. I've got friends who are like, I don't like running. And I'm like, do you know what exercise I'm not going to suggest?

50:35 I'm not going to turn you into a runner. You're not going to turn that person into a salesperson. You're not even trying to turn them into a salesperson. You're trying to turn them into someone who will show, not tell. And science and healthcare love telling stuff and showing a different skill set. And by the way, it's important because I strive to do all this in terms of any new candidates. We have a new candidate starting in like two weeks. So any new candidate, I make sure before they ever start, we go through like point by point of like, here's like what we're going to do. Here's what we're about. But like specifically, and I want to make sure this stuff, we're going to do this stuff.

51:16 And if you don't like this, it's probably not going to be the right fit. So one is the call record or the interaction reporting. Another one is social media video. Right. So it's like right now, the way I am and you guys have helped me a ton, just like modeling what you guys do, like any therapist that comes on, like that will almost be a deal breaker. Like if they don't want to be in front of video or they're like afraid or whatever and like, you know, lapel mics and I'm going to record you and I'm going to we're going to just like talk shop. Like it's nothing crazy. Like Tony said, like they're talking to me and all that. But if they're like, not comfortable in front of video, like I probably won't hire them. Right. So it's like, you need to, like, we're going to be doing social media video. Are you cool with that? Like, are you all right with that?

51:56 Talking about conditions and you know, you treat me and I treat you and then recording the interactions and saying these dollar amounts out loud. And there's going to be some rejection. Like I, I put everything out there. right so they know they know exactly like the income opportunity the income potential and all the main roles and responsibilities including like traveling around and what's going to be your travel radius for home visits or and clinic visits and all that so they know all that up front so that when we start like they're like i can fully invest in them and pour into them and coach them but there's not going to be any like surprises we do not want any surprises I'll tell you where this is going. And I'm going to use this reference. There it is.

52:37 That is my Harley. That is not me. That is Ray. I think I said his name right for once. So I've got that Harley sitting in, you know, one of my physical therapy clinics. We're selling that building. I need to get it out of there. What do you think I did as a consumer and owner of that? The first thing I did was I go to chat GPT. I take a picture. I say, hey, I've got this. Nineteen ninety three Harley Sportster. Eight eighty three cc's. It's got under four thousand miles. I don't know what to do with it. Do I scrap it? It hasn't run in twenty five years, like it's just been sitting dry.

53:18 Do I scrap it? Do I donate it? Do I try to sell it? Who do I sell it to? What is the pricing? Do research. What's market value? I go through this whole thing. what's going to happen is chad gpt is going to sell me on what i do with that motorcycle moving forward i guarantee now joey albritton gave me a sneak preview of a tool they're building which i can't discuss but it's amazing i guarantee the future sales person is not your therapist it's ai Now you can approach it from two ways. You can say, okay, I'm going to build an AI dedicated to the sales process. And I'm going to have that AI with an artificial voice, talk to the consumer and sell the consumer on my package.

54:04 I don't think that's the approach any of us want to take. I think more what's going to happen is the consumer has their own AI. They have their own ChachiBT or Gemini or whatever. They're going to be like, look, these are my problems. This is what the therapist is offering. This is how much it costs. This is what... I would start on your side, you pretend you're the consumer, you look at the offer that you would, need a picture of Tony riding the Harley. It probably exists somewhere. I need a video, definitely a video. But you go through the consumer side of that process, talking to ChatGBT or Gemini or Claude and see what the chat is telling you back.

54:45 And you refine the sales process from the consumer side And then you take it to the producer's side and I could see a world where you might be like, look, here's what we're doing. This is the package we're offering. You give it to the person just like I would get an estimate on something. And then that person goes into their own AI, which you're not telling them to. They just do it. It's just the natural process. And the AI will sell them if you have created the package correctly. You know, it's reverse engineering what the AI is going to tell their own person because you've done it yourself on your end.

55:26 I really think that's where the sale is going to happen. I can't wait to hear about more of that because I'm trialing with them right now, Tony, with Joey and Robbie. Oh, sweet. Good for you. So we'll see how that goes. I think you're right. All right. Parting shots as we got to dip out of here. What do you guys got? Dave, go first. I don't know. We hit a bunch of stuff. For me, it's just clarity and focus on like the main thing. Right. So we talked about a lot of different topics, but finding great therapists that can kind of clearly articulate our value, like our pitch, why we're charging, what we're charging and what the client, what the prospect actually gets for that.

56:08 Okay. Twenty twenty twenty six. Fourth of July. Family poker tournament. I hit my first ever royal flush. I've never hit a hole in one, but I hit a royal flush. That's that's it. That's my parting shot. When I play poker with people, people think I'm like sandbagging and I'm trying to look bad because I'm always like, what beats four of a kind? And people are like, oh, this guy's blah, you know, whatever. I honestly cannot remember what beats what in poker. I would say clarity beats complexity. Do not confuse clarity and complexity. Clear beats clever every time. That's it. We're out. Boys, what the hell are you doing? Follow Tony Meritato on YouTube at Total Therapy Solution.

56:50 Find Dave Kittle at conciergepainrelief.com and on YouTube at The Dave Kittle Show. And follow Jimmy McKay at PG Podcasts on YouTube, the socials, and wherever you binge podcasts you pretend are for CEUs. And hey, just a reminder, none of this was for advice. This was for entertainment only. Our lawyers say that counts. Thanks, Keith.