The Future of Physical Therapy Tech is Here and It's Changing Everything

0:11 Good morning, PT Breakfast Club, Tony Maritato, Jimmy McKay, Dave Kittle, coming in soon. Dave Kittle on the way, Jimmy McKay. On the way. Doing some plumbing early in the morning, Tony? Yeah, so here's the deal, guys, and this is the reality. So we had a ton of rain last night. We lost power this morning. Everything happens for a reason, right? So we lost power this morning. When we woke up, the power was out, came back on. Awesome. Hooray. But then I was hearing this beat and my dog freaks out every time he hears a beat because he thinks he's got an e-collar on. He's going to get shocked. Oh, yeah. I'm looking everywhere. I'm like, none of the smoke detectors are beeping.

0:54 Track it down to the basement. I hear a noise. And what had happened was I installed a battery backup sump pump years ago because our basement had flooded. One of the rubber gaskets cracked. It was spraying water across like this unfinished part of the basement. That was also causing the beeping to happen. So, six thirty, six forty five this morning, I'm looking at this. I'm sending you guys pictures. I'm like, shoot, I got to figure this out. I don't have time to go to Home Depot. I got patients coming at nine. So I figured out a way, bypass the system, take the battery backup out, put a new gasket in.

1:36 Right now, things are dry. But, you know, it leads to that conversation, like how everything goes back to physical therapy and specifically business of physical therapy. So it's like, what is the lesson I could learn? Yes, I could have called a plumber, but I'm not the kind of guy to call a plumber. This is well within my scope of what I can handle. That patient's got low back pain, calf strain, shoulder impingement. He's probably not going to call a physical therapist because he feels like that's something within his scope of what he can deal with or just handle the nuisance pain. It would take something much, much more significant. It would take breaking through, you know, the cement floor.

2:18 I'm never going to do that. I'm going to call a plumber. I had another deal where one of the main shutoff valves for the incoming water into the house had a problem. I'm never going to deal with that. I'm calling a plumber, but these little jobs, I think, I think there's value makes me feel important. Makes me feel like I'm a man. toxic masculinity I can fix things with tools and I like that feeling and I like the feeling of showing my kids that hey you don't have to call a plumber when there's a leak you can fix the leak right yeah I think there's a um there's a learning component and a showing component to this and there's also like like a money component too right because like If you didn't have the time, like I heard a great line, which is like, if you have a five hundred dollar problem and you have five hundred dollars, you don't have a problem unless you've decided to keep that problem.

3:13 So I'm finishing my basement and I was just installing like laminate flooring and sheetrock. And it's not like anything I couldn't do. I'm a B minus at both of those things. Right. I'm going to get it done. Right. But I needed it done now. I was like, I need this thing done. Like, you know, I've been dragging my feet for way too long. So hired some people to do it and watching them do it for essentially five or six days. I was like, oh, maybe this was a little larger than I think I thought. Right. Because I can walk around room and go throw some sheetrock here, throw some flooring here. And in your mind, it's like poof, poof. But you're watching those things we've talked about. Figuring out your hourly rate, like here's your business component, like figuring out what your hourly rate is and being realistic and honest about that.

3:56 And then saying, if you have a job to do, can you find someone to do it for less if you have other work, right? So not if you're just sitting there twiddling your thumbs. But if you're busy doing something, you're getting paid what your hourly rate is or more, why are you putting that thing off? If it's important to get done now, why are you not subbing that thing out? And we've talked about that in terms of PT, in terms of if your clinic has a plumbing problem too, like if you have nothing to do or if you have time, do it. Or why aren't you calling a plumber if it needs to be done to keep the clinic open? Yeah. If you have an influx, why are you not partnering more with, why are you not hiring another clinician to pay them to do that?

4:38 Or why are you not hiring a physical therapist assistant? Why are you not hiring people to do? So it's this delicate balance. It's not throw money at any problem. I think the people who are good at business have this skill of figuring out what problems to solve. Money is a tool. Having the skill to figure out what tool is. I'm learning this. give you an example. Last night I was talking to some clinicians who were going to CSM. I flirted with this idea of doing an onsite video and photo shoot. I'd fly in a photographer and a videographer or two, maybe one person who can do both. I'd rent out a cool looking location. Essentially you would pay me and the videographer you'd show up. We'd tell you what to do and what to say.

5:19 I would have already pre-screened you. So I would do a part of this would be a mock interview for a You'd go home, and in a week or two, a Google Drive would show up in your inbox with six months' worth of content for you and your business. I'm sure you can do all those things, but why haven't you? Because there's a middle block, and maybe you don't know how, or maybe you're awkward. I'm going to give you this turnkey thing. So I bet Dave will have some good input for this. And I think Dave, definitely Joey, Albert, and guys give me a hard time because they're like, why are you mowing the grass? Why are you blowing the leaves and making and doing these things? You could be doing, you could make more content, do other things.

6:01 I'm like, yeah, but it makes me feel good to do those things. Makes me feel like I'm a dad. I'm a man. I'm an adult. Dave, what do you farm out? What do you do yourself that makes you feel good? Not just what do you farm out. How do you decide what to and what not to? What's your decision tree? Yeah, I don't have that close zoom up camera like Jimmy, but I would if I did, I would say, yeah, I would zoom in and I would say I delegate and outsource the things that I don't like doing. There's still some things that I don't like doing, like like laundry, like I don't know who likes to do.

6:42 Maybe that's therapy for some people, not me. Yeah. either I could be doing other activities that generate revenue and income that far exceeds that task. But now at the same time, it's like, well, uh, my wife will push back like, Oh, well, you know, our son, he needs to learn X, Y, Z. And I'm like, well, that's like years down the line right now. We need like the cleaning person. We did have, uh, this past Saturday, first time we didn't prep at all. We didn't do anything. Like Tony said, we didn't prep. We didn't do anything. That was wonderful. Um, Of course, there are certain things like, I don't know, I'm trying to think what else. There's certain things I guess like you just kind of maybe have to do nowadays, but still you can kind of cut it off in terms of like project size or if someone else has a better hang of it, like a better specialization than you do.

7:35 And you have the money to obviously pay for it. So I started looking back at like other paradigms we already talk about, which is I want it good, fast and cheap. That's what we want. So I look at this as like my basement is like, well, obviously paying people is going to be more expensive than me doing it myself, right? Because myself would just be materials at my time. Although you have to take your time into consideration now, but I'd be paying myself. If I was doing this hourly, the project would actually cost me way more than what I'm paying it. Cause these guys are going to get done in five or six days. It's going to take me two months worth of Sundays and I'm going to hate it. I'm not, I'm, I'm a little bit of a handy guy, but not really guys.

8:16 Let's be honest here. And it's not going to be as good. Like these guys are, these guys are knocking it out faster, better. And if they, if I'm doing the math and I'm actually saying what my time is worth, it is going to be better, faster and cheaper. So I think that was the, that's sort of the paradigm I'm going through. Bookkeeping is something that freaks me out. Right. Like one little mistake there. Right. Like it's like, I don't know what I'm doing, like, but I know it needs to be done. Death and taxes. So do I pay someone to do that? I do now. I used to do it on my own. I used to try to figure it out. I'm like, what am I doing? I hate this. It looms over me. So good, fast and cheap. I sort of do that math now. Yeah, I agree. Those are the things like I like the physical activities.

8:59 But then like I did all the construction in every one of the clinics that I've ever opened. Everything from like drywall to painting to, you know, building the reception desk, everything. It was really, really bad for the first couple clinics. And then I realized, oh, this is why we put three coats of mud on a drywall joint and not just one. So I got pretty good at it. But like the physical things I like, but then when it came time to do our own basement at the house, I was like, heck no, because it was completely unfinished basements, just studs. We wanted drywall. We wanted electric. We wanted, you know, everything.

9:39 We hired it out. The kitchen, you guys were around. I had all the kitchen cabinets refaced. Heck no, I'm not doing that. Hired it out. It was amazing. And I will say there's value in this also in the sense that when I do a job, I am never happy with the job. I see every imperfection. I see every mistake. I'm the kind of person when somebody else does a job, I probably have rose colored glasses and I see everything as amazing. I know there are other people who see mistakes in everybody's work, but I'm just half the time I'm just paying because I don't want to see all my own mistakes. So this is the kitchen I'm sitting in and I can like I don't I won't even like look up into the left over here because there's a crown molding thing that's chipped and I'm just like.

10:24 but who do you got to blame? Like nobody, right? Like nobody is to blame. Look, we're getting quoted on our own podcast here. People don't pay you to do stuff. People pay you so they don't have to do the stuff themselves. Yeah. Like you said, like I wasn't really a handy guy when I bought this house, but like, then I got like a good ride on mower and I got some good, like, like backpack leaf blower. So like, for me, that is like, if you have the right tools and, And no offense, but a backpack leaf blower, point. But when I'm done, I see the work. It's like, it's done. There are no leaves here. There's no whatever. The sheetrock thing is a little more complicated in terms of steps. But take this to your business and say, okay, do I like doing this?

11:05 Yes, we should make a decision tree. Just give it out. There's our lead generator. Do you farm this out lead generator decision tree? Do I like doing this? No. The other thing too is, And I think I talked about this before is I used to have a couple of people help me with my podcast and they would do different tasks. And I had to know my personality type. One of my personality components is, whoa, like I need other people to like me. Like that's the thing about me. Like that's why I always say yes. Right. And I was keeping tasks from other people on the team. Like boring tasks. Jimmy thinks they're boring tasks. Then we did this like personality assessment, the strength finders thing.

11:47 Turns out another person on the team loves doing spreadsheet tasks. Jimmy hates it, but I would never give her the task because I didn't want to give her a punishment. Meanwhile, she's sitting there going, man, I wish I had more spreadsheet stuff to do. So it is also like, look around what, what resources you already have, just because you think it's something nobody likes. Like my buddy loves fixing stuff. He's like, Oh, I'd love to come over and fix your whatever tire. I'm like, really? I, I didn't want to ask because I didn't want to impose. Meanwhile, I helped him with a couple different things. So know what's at your disposal already. So what's, what's going on with sword health and your post? All right, so we can only read the tea leaves from the outside, right? So I'm working on getting somebody from the organization.

12:30 There might be some legal things, but next week we'll have somebody from the actual organization. I don't want her to talk about Sword. I want her to talk about her experience. I only want her to talk about what she can talk about. And she's agreed to that as well. But Sword Health is this AI-driven app that's going to give... I mean, how would you describe it? Like AI-driven... The future of physical therapy? It's going to wipe out all... It must be valuable. Look at Dave rolling his eyes at a podcast. It must be valuable because it's valued at three billion. We've never seen companies have a billion dollar valuation and then tank before. But they just laid out. They've just laid off like it's seven.

13:10 It's like let's just call it around twenty percent of their clinicians. But apparently it's like it was like seventeen people. So I'm not a math guy. So it's like they have like seventy five P.T. 's. on staff at a company worth three billion dollars that delivers pt so laying them off like was the demand not there because they're not releasing a whole ton of information was the demand not there um some people have said hey I think it's just a sign of things to come people thought this would take off and it didn't so there's a demand issue or are they trying to look lean before going public and this is where like jimmy's knowledge sort of stops like I don't really understand that but I get it like to a point like hey if you want to go public you want to look like You're not bleeding money or you're not spending money.

13:51 Although I got to be honest with you. If I were an investor and you're blowing out twenty percent of the PTs, unless they're trying to say we don't need PTs. So we're going to be able to keep our costs crazy low. We don't need this to keep up. So Dave, are you bearish or bullish? What is the thing where you don't like? Bull market is good. So I am bearish. Dave's a bear. AI driven care. I don't really know. What do you think? What do you think? You know, here's here's how it's going to unfold in the next couple minutes, five minutes. Tony's going to be very overly optimistic. I'm going to be, in my opinion, very realistic on the actual the actual like component of sword.

14:35 Right. So it's I mean, I had a therapist that kind of like worked for them and me and whatever. So I know a little bit of the insider stuff and I won't comment much. So don't go inside or stuff like that, but just like explain like how does sort of work if I'm a patient, how does sort of work if I'm a clinician? OK, so as far as I understand, it's fairly similar to Hinge Health. We just you know, I think I ripped Hinge Health last week or the week before or something. So I mean, very, very similar in terms of like it's a typically like a free benefit to employees that work for bigger companies and sword. And, you know, the Hinge Health of the world, they go to these big companies. They say, Hey, we can, you know, how much did you pay last year in musculoskeletal, you know, lost work, you know, whatever medication, whatever their component of, you know, paid healthcare expenditures for their employees, back pain, MRI, physical therapy, you know, missed work, whatever it might be.

15:32 And that could be some like manual labor, large companies. It could also be, you know, like tech companies. It's like, sure. They go after a ton of different employers. The employees get this free benefit. Tony mentioned, you know, his family every so often will send him screenshots like, Hey, what is this thing? What's this, you know, free hinge health, sword health, whatever. Um, It's not going to be around in ten years. None of these companies. At the end of the day, we talked about this before. And I know I'm like... I actually did a paid telehealth visit two or three weeks ago to help a friend, to help another company. I wanted to challenge my biases. And by doing that, they wanted help.

16:13 I said... You want me to treat pro bono through your company, but you're going to pay me, but the patient is, we're not billing their Medicare. We're not paying, whatever. It's just like a trial pro bono. Yeah, let's do it. So I did a paid telehealth visit a couple of weeks ago, an older woman, her ankle, and they paid me two hundred fifty dollars just for my time or whatever to do it. The therapist was on a laptop at the patient's home. With chronic ankle issues, gait abnormalities, walking, limping, all that type of stuff. And I did that. I got paid. I delivered what I could technologically or digitally or whatever.

16:53 And I needed to mention that because I still wanted to go into that. I wanted to challenge my biases, bring this back to the podcast and say, I did this. I did it with my best foot forward. And I stay... Burnley, that this is an absolute joke. Telehealth and virtual physical therapy for actually delivering, you know, therapeutic exercise. I believe and I think I've trained myself enough to do this over video the way Tony's done on video. So I'm sorry that emotional side has come into the conversation. But you asked about, you know, sword health and hinge health. That's basically it, like the whole offering.

17:35 Wait, hang on a sec. What are, what was the specifics that you did not like from that experience? I'm just curious. Like, did you like, did you not like that you couldn't like grab what you needed to grab and touch what you needed to touch? Or did you not feel like the patient understood what you were trying to get them to do or say? But both, both of those, both of those, both those components, uh, Like it takes more words to actually have someone do a thing, get in a different position, stand up, walk, you know, to do like a pre and post test. It makes the evaluation and the therapeutic exercise easier.

18:16 in my opinion, it takes longer to actually get someone to do something. Now, in this one, it was sixty something or whatever. So like, how do I do balance drills? How do I do a balance assessment? How do I do single leg stance, whatever? And she of course, she had a home health aide and the therapist was there or whatever. But if this is a seventy year old patient that has no one in their home, how in the world can you do a balance assessment? You cannot you cannot do it safely. And it takes extra words, Tony. It takes extra. Yes, you can learn it over time. I believe because I'm on this podcast with you guys. I think I'm pretty good with words. I think I can communicate things as efficiently as possible over a video to a to a potential patient.

18:58 It just takes longer. It's less efficient than in person. What were you going to say, Jimmy? I appear overly optimistic for things like this, like technology. I think I'm just... Because I referenced that personality test I took. I like futurism. I like seeing what could be and being like... And trying to look through the future with rose-colored glasses. I don't... And but I'm smart enough and been around long enough to know it's going to be somewhere in the middle. Like there's going to be some components where it's good because every neuro PT that I knew when telehealth was coming out was like, well, this isn't going to work for me because I've got, you know, and I was like, oh, I didn't think about that. I think it'll be some things, but I don't think it'll be everything.

19:39 Right. So some of these companies are saying we're worth, you know, three billion dollars, you Rafi saying how much of that is a skills gap, primarily a skills gap between a primarily in person clinician and other clinician that operates primarily in telehealth? Is this a skill that you can get better at? Is this something that you could be? You know, is this good for certain patients and not for others? And then can you get better at this and not? What do you think? Yeah. I think so. Rafi is talking more about the clinician side, right? So, like, of course, the patients are going to always be very varied. They're going to be different reading levels, different comprehension levels, different degrees and all that. This is something that Tony, I think, mentioned last week, the difference between one therapist and another.

20:22 I've had video visits on my website for years. I've done telehealth visits. I've done, I did, I'm pretty sure I did virtual visits before COVID. Not as early as Rob Vining, not ten, fifteen years ago. But I definitely did some of them before COVID. I did them before COVID for like friends of friends, family, friends, whatever that lived in other states. We jumped on Zoom. They paid me. In some cases I did them, you know, for free because it was just like I wanted to do it. Next, we can joke and say, oh, now there's going to be a continuing education course on teaching a therapist how to communicate over telehealth. Oh, a hundred percent. There probably already is. I'm sure there already is.

21:03 I'm not saying I'm the best at doing a video visit. But based off of what I've seen Tony do put out online and other people have done and put out online with video visits during this whole last five or whatever years, I think I'm pretty good at doing a video visit. And I'm telling you, it is not... Yes, you could do some upper extremity things. You could do hand therapy. Yes, of course. Can you do, I don't know, with almost anyone? Probably. But I don't know how you're going to loosen up stiff joints. I don't know how Tony's going to do shockwave and TRT over telehealth, obviously.

21:43 I'm joking. No, you're right. You're right. I agree. Probably sword's not going to be around in ten years. A lot of the companies aren't going to be around. I think it's a new technology still that we're going to figure out the right use case. I could go and cook dinner at home I can go to Chipotle or I can go to a nice restaurant. Like they're all completely different experiences, even though they feed me the same. In regards to, you know, the people that I see through telehealth, it is mostly just conversational, educational. And that's what I love. Like, I don't want to waste my time showing you a calf stretch and hamstring stretch.

22:25 You can pick that stuff up on YouTube. I want to answer your questions about why your knee still feels stiff, even though you've done all the right stuff. And I want to give you a little bit of encouragement and say, look, you know, great, no red flags. Everything makes sense. You are absolutely right. Let's find somebody locally, and I'm fine with that, who can do the hands-on things that maybe you can't do for yourself. But like anything, that doesn't mean we eliminate it. That doesn't mean that it's bad in and of itself. Like it's got a role in the profession. And I mean, we've just seen so many people blow up, like especially the neuro, the stroke, the OTs that are doing all of these things. There's that company that just got funding where they have a mechanical hand and research.

23:10 Kristen is her first name. You know her, Jimmy. I think you you met her. But anyway, she she's been doing this for years and I think they got like a three thousand or three million dollar funding deal. It could be done. Yeah. The goggles. Hello. Like, again, the goggles remotely having a BPPV specialist looking at that. That's what I was just going to say, which is like, could we take that same model we flirted with and say, like, could you have a fleet of PTAs, right? And we're just saying PTAs because I think a great PTA is a great PTA. but the cost is different because their cost to entry in the profession is different.

23:51 Like, could you, is there something in the middle, whatever this is like, this is, this is early technology and we're flirting with it. And our grandkids, again, we'll mock what we did just to be mocked at what our grandparent, how did you not see the obvious, the, the obvious answer? I think there'll be something, but I don't think it'll be, uh, what the, uh, the people getting three billion dollar evaluations. Um, Scott chiming in, if the evals take longer, how can SORT expect a therapist to manage a caselet of seven hundred? That's what they were saying, right? Like that's competitive. I think I saw this online somewhere. I I'm saying the eval might take longer. There could be, there could be sward PTs that say, Oh, I only do an eval like five or ten minutes.

24:34 Well, you're going to miss a ton of stuff because of the, because of not being able to see and feel, feel the joint. Is the joint swollen? Is it stiff? Is it this or that? And I don't know, like we, we do verbal cues. Yes. But like tactile cues give us so much more information. Lance Mabry commented the other day on LinkedIn. He was saying like, He's like, I don't know how you can do a full evaluation virtually. He's like, you know, you don't do reflexes. You can't, you know, feel like active passive range of motion. Go ahead. Tony's going to push. I don't think you need to. I look at some of the training videos that are on YouTube right now. And I'm like, oh, my gosh.

25:14 Like, do we really need these special tests? We already know special tests aren't special. We already know how much of the stuff we waste time on is completely inconsequential and And I teach this in my class. I'm like, look, I'm in the clinic right now. I can look out the front window. I can see my patient pulling into the parking space. I can understand, okay, they got out of the car. They opened the door. They walked to the front desk. They're standing there while I give them the paperwork to sign. They have the manual dexterity to pull their driver's license and their insurance card. They have the cognitive awareness to understand the difference between the insurance card and a business card. Like I can finish an evaluation within three minutes before we ever even walk into the clinic because we have looked at all this stuff now.

26:01 Now, once we pass that first point and I'm developing a plan of care, I've already got a diagnosis. I've already got all this stuff and something doesn't make sense. Two sessions, three sessions, four sessions in. Now we go deeper. Now we're like, OK, I was expecting this. That's not what I'm getting. But why would I go six levels deep on every single person who walks in the door when the majority of them are? are very basic cases. And I think as clinicians, we're like, well, if we didn't test it, we can't document it. If we didn't do this, then it doesn't exist. No, like that person is medically managed by a physician, by an MD, by probably an orthopedic, by an oncologist, by all of these other specialists.

26:42 Let's give them a little bit of credit. We are not the end all be all. And I think we think too much of ourselves and we just need to chill out. Like these people have been living independently for years with the way they're moving. Let's let them prove to us that there's something more complicated going on. Let's not assume last point. I just think, and I was guilty of it. That's why I know it. I was always that therapist who's desperately seeking the one thing that nobody else saw so that I could feel smart and I could feel special. And I see you moving in this way and it must be this, you know, imbalance and your glutes aren't firing, even though you just got out of the chair. Your glutes aren't firing and your medial arch is collapsing.

27:23 And this is why you were having left ear pain because it's something completely absurd that, you know, I'm going to tie all of these strings to. I wish we had the graphic from like a beautiful mind or whatever. It's not that complicated. Most of the time when it is, we put the time into it. That's when we really can shine. Tony, in your practice in October, how many telehealth visits did you guys do? I don't want to do any business. It's not something I push, but okay. No further questions. I probably did too. I get calls. I got a call yesterday from a guy in Albany who's like, I'm desperate.

28:03 I need you to get on a telehealth call, please. Is there any way we can do this? I turn most of them away. I don't return most phone calls. Like I don't want, but I would tell you it's the same thing about patients coming into the clinic. You know, right now today, I've got a noon and a five. I'm like, can we just move the noon? Put them at four thirty. If they can't do four thirty, let's book them up against another evaluation somewhere else. Like, don't spread my evals around. Don't give me. Yeah, that's the graphic. Don't give me more than thirty minutes between evals. Like, if I'm going to do it, let's book them all up together and then we'll get it done. I'm not a good example. That's what I'm saying.

28:43 I think time will tell. And that's the way to do it. But this is why companies have a three billion dollar valuation is because if people don't bet now, if people bet now and it hits, the small bet turns into a big bet, right? That's if you buy in. And to the point of the seven hundred patients that you're managing, I mean, doesn't a primary care physician manage like three thousand patients? Because you're not spending them all every day. For five minute interactions. You're not going to utilize this every single day, every single week if this is a benefit, if this is a resource. I think most people just won't use it at all. I mean, that's the reality. I think most people don't want the inconvenience.

29:23 They would rather deal with the discomfort than have to go through, you know, that experience. And so if you're going to get paid as a company and most of your clients don't even want to use your service, like that's why insurance is so amazing. Brilliant business model. People are paying you and hoping they never have to use your service. Wow. You're the voice of the voiceless, Tony. Wow. Impressive. Business card. All right. What do you guys want to talk about next? Dave, anything on your mind? I think we should talk about diagnostic ultrasound and self-pay. I know you were speaking to Ryan Martin recently.

30:04 Was that on his show? Was that on your Learn Medicare billing channel? What was that? Yeah, he was gracious enough to come to me. That full interview is public right now on Learn Medicare Billing. And truthfully, I am completely ignorant to so many things within our profession. Diagnostic ultrasound was one of them. Until I got on LinkedIn, I never knew about Ryan Martin. Once I got there, I was like, what is this? And to me, I mean, he's a genius himself, like super nice guy, very humble. But one of the big takeaways that I wanted you guys to give me some feedback on, Dave especially, because you're in the field, he said there are handheld devices that are good enough to a couple thousand dollar investment, to travel with a mobile therapist, to provide this diagnostic.

30:54 I get the impression, I mean, Ryan just loves what he does, but my mind always goes to the business side. And I'm like, I talk to patients every day who cannot get in for an MRI. Either the insurance is refusing to allow them an MRI before they do therapy, quote, fail therapy, or the MRI centers just don't have available appointments. Like, they call multiple hospitals. They can't get in anywhere in the area for weeks. And so... this to me is like a golden opportunity. I would see going through the certification, purchasing the equipment and then offering a self-pay and I don't know rates, I'm gonna say, two hundred and fifty dollar diagnostic ultrasound rate where a person, whether they want to do therapy or not, they can come in, I can sound their rotator cuff or any of the extremities that are easy to visualize.

31:51 Brian said, I could probably learn enough to do a good job in about a month. And this is just be a steady stream. And then of course, some of those patients are gonna be like, oh my gosh, thank goodness. I can't believe you did that. Tell me about physical therapy and then I can bring them on for a physical therapy plan of care, which is obviously gonna give them the most benefit. I don't know of anybody doing this anywhere. What about you guys? Have you heard, Dave? Where you been, dude? I thought you knew me. We've been offering this since twenty twenty. No, I had no idea. Tell me. I thought we did an episode on it. I had the butterfly IQ. It plugs into my iPhone. I don't have it now because I just assumed you knew we did it. Did it. So I can't do a demo right now.

32:33 OK, so what are you using this for? Is it an upsell or is it included in your service? Because your service is self-pay anyway. Yeah. So we just include it. We get current patients to refer to their friends and their friends reach out to us and they don't say they, they used to say, you know, Oh, you know, therapist name and you know, whatever the just awesome service, professional, competent, all that type of stuff, whatever. And then now, you know, we'll get referrals that says like, like, Hey, you know, James referred me to, to you guys. And he said, you guys have some like amazing, you know, Portable technology, tech imaging, whatever. Can I get whatever ankle, hip, shoulder, whatever, elbow, wrist?

33:20 Can I get some imaging or diagnostics, whatever? I'm extremely bullish on it. I thought we've talked about it before. Maybe we have. I'm forty nine. I don't know. OK, so let's let's get into some specifics. Like what are the conditions or the extremities that do best with this kind of imaging? I mean, any of the peripheral joints, I think, yes. So I did I did some like sono optics course years ago, and I think they're like defunct or whatever. But I I added this in twenty twenty. This is something like what you've done, Tony, with like the the biodex treadmill and the TRT.

34:01 Right. I just had this gut feel like that this would be awesome. And it's so small and it plugs into the phone. And almost every patient, almost, ninety, ninety-five percent of patients, when they see it, that we can do it right in their home apartment. And I'm like, here's your Supraspinatus, whatever, here's your shoulder, here's your rotator cuff. And then they can actually move their shoulder and we can actually see it dynamically compared to the still images of MRI. Ninety, ninety five percent of people are blown away. I've done this for free for, you know, like my baseball buddies, you know, in in the dugout before and after games and things like that.

34:43 And I do it as like a marketing tool. It absolutely fractures. You can see some fractures. I had a BMX biker a couple years ago. He thought he cracked a rib. We tried to look at the rib from every angle. It didn't seem like there was a fracture, but you can see, especially the edges. So if this is the rib, if there was a fracture like that, if it was on the periphery of the actual bone, yes, you can see some fractures. And Ryan is obviously way more equipped to answer the clinical questions than I am. But I have a therapist now that's full time. He's going to be away for the holidays.

35:23 I'm getting him taught in probably February. He's going to start learning this as well. um and our goal is to scan as many people as possible so once I get him up and running because I don't want to do it right because I want to be I want to grow the practice I want to be home like I want to be on video with you guys like I don't want to do any of the imaging I don't want to treat right so I want to get him busy we're going to contact all the previous patients that we've ever interacted with offer maybe free scans maybe he drops by it takes five minutes little ultrasound gel plug it in a smartphone And he can see inside of someone's, you know, joint, soft tissue. What's that? What are you looking for? Like, what are you looking for in a joint? What are you looking for in a muscle, a tear damage?

36:06 So you can see, you can see partial tears. You can see ruptures. You can see things like, you know, cysts and those types of things like are going to be interesting to learn more about because then you can refer out and then build referrals, refer referring partnerships to other physicians, other concierge physicians or, or others. Um, You can see nerve entrapments, which I think is probably the highest level skill. And by the way, this whole offering is obviously way more challenging and has a higher barrier of entry, respectfully, than anything in an outpatient office, like the Biodex or the TRT or...

36:47 the stim pod that we use. And even that is a little bit of training, but, but not too much, but yeah, I agree. Like at least like a month, if not, you know, a couple of months to be super competent. Um, and therapists could be absolutely, absolutely doing this. And just in the learning phase, you tell all your patients, you have them sign the release or whatever. And you potentially just do the scans for free for the first month or three months or whatever. Just from that, they're gonna go tell other people. So it's absolutely a marketing component. It's a, I don't know, Tony will probably push back on this, but it's showing like a higher level of potential like authority, knowledge, expertise. Um, I think Tony will start to see that in the coming months when he's using things like the TRT and the sound of the TRT and the size of the device and what it does and what it, how the patients feel the TRT sensation.

37:37 They're going to go, they're going to refer their friends and family. They're going to say, Hey, go to that. office with that guy, those guys and, and there's some softwave device, right? And Tony's gonna get significantly more referrals in the coming months, just because of this new technology. The big challenge for therapists and owners is the clinical education around not just relearning or reviewing anatomy, but it's anatomy via an image that you've never really seen before. Right? What's the what's the ballpark cost of some of these units? The back in twenty twenty, the butterfly was like two grand and I think it was the first the first year of the software.

38:17 The software is like I can save videos and images. I can text and email the images, the still images and video of the imaging right from the app. I think the first year was like five hundred bucks for the software. And then after that, it's like optional. So it's like that was twenty five hundred up front. Dr. Boba Benko over in Colorado, he just bought another completely wireless portable diagnostic ultrasound called I think it's called Clarius. That's probably in the same range, maybe around two to five K. And then the big units that, you know, Ryan Martin and all those guys that have like an outpatient office, those are like the bigger units that look like a hospital or physician's office ultrasound. Those are like fifteen, twenty, twenty five K like they go up from there.

39:03 It's an absolute no brainer. I think therapists watching or listening should only consider it if they want to help more people get more results and make a ton more money. I love it. You'd be an idiot not to do it. Dave's got an affiliate code. And I know I have nothing to sell you. So I don't care if you don't do it. And if you're in New York city, don't do it. Just don't offer it. Yeah. All right. Quick question. Um, how long does it take to actually get, uh, an image or a scan or diagnostic? You know, are we talking like five minutes, Yeah. The better, the better you are, the faster you'll get. Right. So like in the beginning, I'm, you know, stumbling it around and probably was doing wasting time, fifteen or twenty minutes or something.

39:45 The Ryan Martins of the world, he he probably he's probably getting, you know, a diagnosis in ninety seconds or a couple of minutes. So what would be a reasonable rate? I'm going to say reasonable in New York and reasonable in Ohio. If somebody comes in, they're like, we suspect a rotator cuff tear. I can't go in for an MRI. I just want to pay out of pocket just to confirm now. Guys, if you're listening, I understand the research behind rotator cuff tear. I understand the sham studies. I understand. I understand all of it. I am just looking for the diagnostic. Uh, what, what would somebody charge for something like that? Not treatment, just the diagnostic.

40:27 I mean, you could go two routes at the very least. You could go a hundred bucks at least, you know, something like it could be higher than that. Um, also if you were, I know you're not trying to hire therapists, which, We've covered before. You could also not charge at all. You could have scanning events every Wednesday, the first Wednesday of every month or once or twice a month or whatever in an office. I've seen this on Instagram. I've seen other practices do this. So they have like from six to eight p.m. or whatever. If you have shoulder pain, if you have aches and pains, if you have foot, ankle, elbow, wrist, you can list the joints or whatever. Come on, come on down. Uh, you know, we'll take a look, sign a waiver totally for free.

41:10 We won't even bill your insurance, whatever. And then you can do it like mass market. You can try to get in front of more people. Even the people you scan for free, they might go tell someone and they might not have enough of the urgency to like start a plan of care with you guys, but they might tell other people about it. Or you could juice it. You could say like, Hey, uh, free scans, uh, stop on by, but sign the waiver, but you have to like take an Instagram story or, or a picture, you have to post it on Facebook or whatever and tag our, our practice or drop the website or whatever, but post the picture of it. Like you could kind of juice it and use some, you know, social cred, but then not charge for the actual imaging. I think that's a great way to go. But yeah, at the, at the very least a hundred bucks, I mean, we could, I know there's another mobile house call practice in New York City that I think it's physician and nurses only.

41:59 And they're charging like four or five hundred bucks for a diagnosis. I would have thought two fifty. I was going to say two fifty. Yeah. Especially if it's to you. any state practice act restrictions or governance or anything like that. Ryan, you gotta, we gotta get him on here. I know it's a, he's in Arizona. So they're like, what's that? Like two hours or whatever. He posted something. I probably saved it. I can share it with you guys. I think I saved it on LinkedIn or he can post it again. He posted like a map of the U S and like certain States where it's like clearly allowed in the practice act. And then like maybe a few that are like clearly not allowed. And then it's like a whole bunch of like, Doesn't specifically mention it in the practice act, you know, so it's it's pretty wide open, in my opinion.

42:46 OK, I am shocked that I had no idea, but I kind of somewhere in the back of my head, it does seem familiar that we might have talked about that. But awesome. Yeah. So that was a great interview. Tons of information. I love their educational model, you know, and I'm not an affiliate for them or anything. I just think they do a really solid job. I am learning, Jimmy, I want to hear what you're saying. I am learning that there are so many more things. that we could be doing beside just the straight standard of care. And look, I've been in this twenty plus years and I'm still learning all of this new stuff that we could get excited about.

43:26 You know, talk about those therapists that are burnout. It's just so sad because they're stuck behind the wall and they can't see what's on the other side. So this is where, this is what I was going to say. Perfect radio segue, Tony, which is I just talked to Holly from Vi five. Are you familiar with Vi five? Are you, have you seen Holly on LinkedIn? We just connected the other day. I forget how that's how social media works, right? I said something, she said something and she's like, I'd love to give you a demo. And I said, sure, but it's gotta be a live stream. Like if I'm going to sit there for a half hour and she was like, okay. So she like stepped right up. So we tested out StreamYard plus her tech because it's a virtual platform, but it's sort of like it's doing like map.

44:07 It's like a wireframe. I stood right over here and did like a bunch of squats and she was able to measure everything, but I didn't have to put a bunch of dots on me or anything like that. What I'm getting at is people, the people who are good at this technology are Don't hire people like Tony to help them create content. They don't hire people like us. And that's where they're stuck. I mean, I've talked to some tech people that say, our marketing budget is zero because we have a great product. And product, all you need is a great product. And that's it. And it's like, well, okay. How's that working? How many phone calls? How many demos have you had in the last week? Well, none, but... It's going to happen.

44:47 Yeah, because Apple and Facebook have never run ads. Google is a perfect product, but they've never run an ad. Exactly. Tell me more about how that works. But anyway, my point is I'm starting to say to these organizations, pitch it to me, almost like mini Shark Tank. And we understand what the product is of this podcast, which is the audience. It's actually not the podcast. It's the audience with the podcast. Um, so we're doing Vi five in the next couple of days or weeks. She's going to walk people through that. But I think the more exposure people have, in my opinion, the better make a decision. Because I think a lot of my decisions when I was working in clinic was made by the person next to me. And the person next to me had been a clinician for ten or fifteen years longer than me.

45:30 So my view of the world, unless I pushed back, was sort of shaped by it's not going to. And then I'd ask, well, what do you know about it? Well, nothing, but we're better. And I was like, oh, that seems like a shady way of advancing your profession or your knowledge, which is it's new and it's not me. So I don't like it. You know, talking about that yesterday, I was researching the short videos because you guys know. So that one short video I shared with you guys. Yeah, like a billion. Yeah. I think it just crossed four hundred thousand views in like twelve days. It's slowed way down now, but it bumped the whole channel up.

46:10 So like my my total new channel usually gets about a thousand subscribers a month. We're over three thousand subscribers for the month right now. Revenue and everything goes up. But it got me thinking again. I'm like, I need to get better at the kind of short videos that are product-based videos. So I was doing some research. I found a guy who, I think he's the developer or the owner of something called Study Buddy. So this is an AI study Chrome plugin and app. And they had started on a different like profession and they never really did much.

46:53 And then they moved over to this and it just exploded. And so I'm looking at his TikTok videos. I'm like, I could do this. Anybody could do this. It's so simple, yet we don't do it, you know? And so you should see my short videos start to change a little bit, more of the product voiceover kind of videos, more of the highlight videos. I put out that video about the shockwave where I put the emoji over the guy's face. I've got the release form, the media release form to show his face. And I told him and I've got everything like, hey, I'm going to share this on social media. It's like, yeah, that's great. Go ahead. I love it. But I intentionally did the emoji to cover him up just to experiment, to see like, OK, what is this going to do?

47:35 What does it do when there is no music? What does it do when there's branded music like all of these different things? But Dave, I'm doing the research for you. And maybe next week, we can talk about like, what are RPM CPMs? What can somebody actually expect? What is a video and spoiler alert, in general, a million view, long form video, not short, long form. We'll generate about ten thousand dollars, a million views, ten thousand dollars. So you can kind of put numbers behind that. But the ranges go from two dollars for a thousand views up to like my learn Medicare billing channel does thirty four dollars per thousand views because it's insurance and finance.

48:18 So CPM is cost per milli, which is cost per thousand. I don't know why it's not CPT, but whatever, because that's a different code. And then, but the CPM is different in different industries, right? Because if you're selling a high ticket item, it's going to be harder to get those views because it's more competitive, but for everyone connection or sale, it's going to be worth more. Where's healthcare in the hierarchy of CPMs? So finance will be up in like the thirty, forty dollar CPM, RPM. RPM is what you actually make per thousand views. CPM is what they're selling a thousand views for. Right. Yeah.

48:59 But then my health care channel, so my shoulder channel, my knee channel, they average about eight dollars per thousand views. And then I've seen like I've talked to therapists who have pediatric channels and they were down at like two dollars or less per thousand views. So the pediatric stuff is really hard to make money on. But most of the health care that I've seen, you can just say eight dollars per thousand. Yeah. And this is different when you also, when you also change who the audience is too, because a tech company who wants to sell the therapist, you might say, well, there's a limited audience, right? There's three hundred thousand PTs in the country.

49:40 And you can say to a tech bro CEO who goes, I don't need any marketing. I'm like, great. How have you penetrated the market? I mean, here's the cheat code. I told you guys before I walk around APTA CSM Expo Hall and And I do mental math of what that organization paid to be in front of eighteen thousand physical therapists. That's how many people go knowing that you're not in front of all eighteen thousand of them. Right. I knew I knew from working at large companies. If you got if you got if you got a thousand badge scans in a day, that is a bad. That is a crazy number. Like you're not like the ATIs, WebPTs, the prompts with like the. the balloon, the blimp, and the lasers, and the fifteen different flat screens, if they're getting a thousand badge scans a day, that's a really, really, really good day.

50:24 Knowing that even though those badge scans, because they're trying to hire, the prompts of the world want customers, the web PTs want customers, the ATIs and the athleticos, they want to hire PTs, right? Your close rate is not a hundred percent. So you just paid how much money for three thousand email addresses knowing you're closing five percent of those maybe as a customer or a hire. So I say do the math. What are you doing the other three hundred and sixty two days a year because CSM is only three days. do the math this is a viable market if you're looking to if you're looking to do stuff for clinicians and then you change it and you say now I want the general public like your your knee channel is not for therapists it's for it's for people who have knee issues right your billing your medicare billing channel is for therapists correct right right different audience and you can charge differently because the value changes dave what were you gonna say Ten thousand dollars for a million views.

51:19 It seems like a joke. Like if I had if I had a million views on a video, like I would be creating a CPK, a cost per kiddle. I would make up my own. I would I would have it would be way more than ten. It would be way more than ten K. I don't care what the video is. I mean, the CPM thing is a joke. When Rob Vining and I, we used to have people pay to come on PT Tech Talk when they were really bugging us and we were like, I mean, if we ask people, we would ask, you know, Tony Maritato and Jerry and all everyone else. And obviously there was no cost there because we were asking them. But then we'd have companies ask us. I mean, we didn't have I have no idea. We had like basically no viewership back then.

52:00 And we had people paying us like two, three, four hundred dollars to come on for an episode. One person was paying a couple hundred bucks. that is that's that's your own cpm that's creating your own cpm at not relying on this throttle down version of the not the current cpm but you change your product there so when you're on youtube the product is the viewer right so it's the viewer when you when you when you talk to a tech bro who wants to come on they're paying access to your audience I'm guaranteeing you access I'm letting you in the studio and I'm handing you a microphone I'm saying go for it YouTube's only paying you or they're going to pay you when people actually stick around for things like this. Here's the thing. I showed a graphic a couple of days ago.

52:41 This was this. Different types of content based on age and how they engage. And if you look at the middle of this, this is the middle of the bell curve. Long and short form video are fives across the board. Just off the edge, images, podcasts, webinars. Off the fringes, email newsletters. which still is interesting to me. I thought email newsletters would be higher, but whatever. This is a new graphic from Neil Patel. I just did a screenshot real quick, but this is showing close rate and yeah, crappy graphic. You got to zoom in. But what it's saying is it's showing the effectiveness of those different content types. So I'll just sort of give you like the nuts and bolts since the graphic is crappy and most people listening on a podcast anyway.

53:21 But podcast is on one far one end, great for awareness, but lower on decision making. It's saying, listen, it's eighty five percent effective in terms of awareness, five percent decision making. On the other side of the funnel is a case study or a webinar. Not great for awareness, getting people to know about you. But if they're already there, it's further down the funnel, as we'd call it. They're more apt to make a decision that doesn't mean a good decision for you or bad decision for you. but they're going to either opt in or opt out. Like, yes. So if you were selling diagnostic ultrasound, launching a podcast about diagnostic ultrasound, great for awareness of that, not necessarily great to close and sell those things, but, But if you pair that with a case study about how Dave uses it in his practice and how much money he makes, right, the case study, not great for awareness.

54:10 But when you get those people there further down the funnel, they're more apt to make a decision. Not saying if it's a yes or no decision, but they're like, yes, this is great because it's more dense. So what I'm getting at is curate who you're trying to talk to. who, what their problems are, what your solutions are, and where their problems and your solutions cross, that's your why. That's what Simon Sinek says, start with why. I disagree a little bit again. I think you start with who and what. Then when you get to why, that's when the magic actually happens. But I think these two graphs, I'll get a better one of this one, help people say when they say, I gotta start creating content. What kind? For who? What problems are you solving? Why are you doing this?

54:52 I think a lot of therapists specifically are just like, I know I need to do stuff because I see other people doing stuff and everybody's saying content, content. They try it. It doesn't work. So I think you do need to create content. This also means you need to put some money behind that as well. If you think you're just going to fling things into the void and have it work, I'm very sorry. It's probably not. now dave I think I think you guys were ahead of the curve like yeah you monetize with paid you monetize with sponsorships you monetize with affiliate income like um I know therapists that have reached out to me that have you know channels in the several hundred thousand subscribers they're doing five-figure deals for sponsored content so one of my goals was If I could get ten product companies to sponsor a thousand dollars a month, that's one hundred and twenty thousand dollars, you know, just income to to support the YouTube channel.

55:46 Dave, what were you going to say? With that graphic that Jimmy just shared, I feel like we've kind of verbally done informal type case studies. I feel like like when you've talked about like. whether it's Shockwave, whether it's Biodex, different... Now we talked about diagnostic ultrasound. I talked about Stimpod. I talked about Stimpod like once or twice here and then once on my show. And I have PTs that reach out to me and then they've gone and bought the five thousand dollar Stimpod. So I feel like, yes, I agree, Jimmy. Like, yes, of course, this is like top of the funnel awareness, like anything online like this. But do you guys agree or have we done...

56:29 some informal style case studies or is it case studies? I know it's really like that's like white paper with real data and all that. Have we done things in the middle or not really? I think it's reality. I think it's reality. I think the minute every one of these things had a great camera and a microphone on it, you became your own TV station. So you democratized attention. You didn't need an FCC license and a hundred thousand dollar transmitter to then reach a million people in your neighborhood. So yeah, I think this is the new version of that. I think we're well past that. Yeah, I think we have. I think we have. I think it's more impactful when it's not a hard sell webinar, go buy this thing. And that goes back to my original idea.

57:10 I'm like, shoot, if I'm taking recording content every single day in my clinic, product placement, just like you see in a movie where there's a Diet Coke sitting in the actor's hand product. You guys remember, was it what was the movie where the guy lives on camera and Truman show. And like they turn the brand, you guys are going to start seeing me do that kind of stuff. But seriously, like, do you think, do you think it's an accident? that there's a vestibular model in the background right there. I had no idea. I had no idea. That is really subconscious. Just subliminal. Now, my new studio, the shelf will be a lot closer.

57:52 You don't think that there's going to be a vestibular model just over my shoulder every single video? Oh, this has nothing to do with vestibular. No, it's just there. It's just art. All right, let me kick off closing thoughts, parting shots. I agree with Dave on everything. So much of today's show, yeah, we were in total agreement. I think we agree that telehealth has its place. It's not going to replace hands-on PT. We agree on a lot of stuff. And, you know, hopefully once I get home today, my basement won't be underwater. Dave, parting shot. Parting shot, I am gobsmacked that Tony just said he's agreed with everything I said on the show.

58:36 Wonderful. Great to finally have him migrate to my side. Parting shot with the diagnostic ultrasound, it's high barrier to entry, but very, very rewarding in terms of like the therapeutic alliance and all that type of great stuff where we can redirect patients to our physical therapy plan of care. And like that road of health and wellness, instead of historically, it's like, you know, MRI pills, medications, injections, surgery, like a little bit more of like the medical model overuse, in my opinion, of all those medical services for patients. Orthopedic conditions that usually would get better regardless of almost regardless of which physical therapist you go see.

59:21 So that's my parting shot. Jimmy, what do you got? We'll start with the thing we were talking about in the beginning, Tony and I, which is good, fast, or cheap. Decide the cost of this project or this process or this thing you're going to implement. Look at it from good, fast, and cheap. Is it going to save you time? Is it going to be better? Is it going to be cheaper than you could do it yourself? And then decide from there, right? Because your time is actually your most valuable asset. Dave? Sorry, that was one A. My one B parting shot. It literally does not matter if Sword Health and Hinge Health and all these others do artificial intelligence physical therapy. It will be an absolute joke. No one will even take it seriously.

1:00:01 No one's really going to pay for it if it's standalone service. Don't get mad. Don't get mad on Facebook or LinkedIn or anywhere else. If you're a physical therapist and you're scared, AI is going to treat the seven hundred patients and we're going to fire all the physical therapists. Great. Like it is never going to replace. what physical therapists do in person, in my opinion. All right, guys, we'll see you guys next Tuesday. Uh, Tony, good luck. Thank you.