The PT Future Is Full Stack: What That Means for You

WEBVTT

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you're listening to the pt pinecat where

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smart people in healthcare come to make

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noise here's your host jimmy mckay voice

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guy big thanks to empower emr if your

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clinic is stuck on an emr that slows

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you down

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Well, that's a choice that you are making.

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It's a bad choice.

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Empower EMR gives you speed,

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clean workflows,

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and features PTs actually asked for.

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Better notes, faster documentation,

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smoother operations.

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All wrapped up in customer support that

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doesn't ghost you.

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Upgrade your clinic's brain.

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I mean, that's kind of what it is,

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right?

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Your EMR.

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Upgrade your clinic's brain with Empower

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EMR.

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You're waiting for the website so you can

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go kick the tires?

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Good.

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EmpowerEMR.com.

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That is EmpowerEMR.com.

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Guests today have stood on both sides of

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a stethoscope.

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First as PTs,

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then architects of the digital health

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revolution.

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Intrigued, are you?

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One race cross country on skis.

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The other crushes anime marathons.

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Same thing, right?

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Together,

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they're making sense of CMS innovation

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pilots, RTM codes,

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and the hybrid care wave.

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reshaping rehab whether you like it or not

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their newsletter is where clinicians go to

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learn how tech policy and business are

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reshaping healthcare delivery you don't

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want to be surprised by these things be

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ahead of the curve at least a little

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uh get ready to meet the co-creators of

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full stack healthcare ryan and jonathan

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jumping in the studio there they are

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gentlemen welcome to the show

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Love it.

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Yeah.

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Let's start with the why.

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Write a newsletter, creating a podcast,

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doing anything.

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It's effort, man.

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It's work.

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So let's start with the why behind this.

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Why did you guys feel the need to

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create this?

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You saw something that wasn't there and

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you were like, I want it to become.

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So I don't care which one goes first,

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but there needs to be a why.

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And they could be two different whys for

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both of you.

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I mean, I'll start where, honestly,

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Sharky and I have worked together for,

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God, it was like five years.

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And we had all these conversations on the

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side about all this stuff.

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We were kind of like, hey,

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what's going on?

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How is this working?

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I had no idea how all these business

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models worked forever.

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And I was just like, hey,

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I have to talk this out.

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We had all these side conversations.

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We're like, okay, this is awesome.

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I have a better understanding.

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And at some point I was like, okay,

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when I started to talk to other people,

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they had the exact same questions.

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And I'm like,

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why am I not taking this stuff and

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just sharing it?

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Why are we not putting all these thoughts

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on paper?

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So there was like two false starts.

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To be honest,

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I tried my own personal thing.

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Didn't work.

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Tried a different one.

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Didn't work.

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I just kind of kept falling off.

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And Sharky and I,

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I think what was really helpful,

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we had coffee up here in Seattle,

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and it just came down to like, hey,

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dude, let's do this together.

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And what's been really helpful is just

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having a partner to hold each other

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accountable.

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He's like, hey, Shaki, like, okay,

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I'm going to do this because I want

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to get this out and I'm not going

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to overthink it.

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And that's been the thing that's actually

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like made it stick this time around.

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So you're like a verbal processor like me,

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which is like,

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you could give me the exact instruction

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manual.

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And I'm like, great.

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I need to talk.

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Like,

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can you read that and then explain it

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to me?

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It's just how my brain brains.

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Ryan, same for you.

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Different.

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Similar.

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Yeah, definitely similar.

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I think this is probably the most exciting

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thing that's happening to health care

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right now, in my opinion.

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And so a lot of the digital transformation

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that's happened really the last,

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I'm going to say, ten years,

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pretty much since the Affordable Care Act

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kind of kicked a lot of this off,

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has been increasingly more exciting.

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And so, yeah,

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I think John and I both kind of

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share this, you know,

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both curiosity towards like what what is

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it that's really going on underneath the

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hood here?

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But but also, you know,

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we see this as sort of a future

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that we're, you know,

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we're kind of hoping that health care runs

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runs toward that.

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It's going to have sort of this this

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inner interwoven, you know,

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human and digital aspect to it that just,

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you know,

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allows things to be so much more seamless

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for everybody.

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You're going to be naive if you say

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this isn't a thing, right?

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So first,

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we'll get it out of the way.

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Where can someone go?

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I'll put it in the show notes,

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but where can someone go if they're like,

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all right, got it.

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How can I get this delivered to me?

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Where do they find Fullstack Healthcare?

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Yeah, well,

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they can find us on Substack at Fullstack

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Healthcare is our primary newsletter.

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Also,

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feel free to follow John and I on

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LinkedIn.

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We're going to be out there continuing to

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spread the word.

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All right.

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So let's dig into this.

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You talk about new care models.

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That's what John just sort of led off

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with.

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Not just RTM or telehealth alone,

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but a full stack of delivery formats.

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I see what you did there.

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What does that actually look like in real

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clinics?

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Because I'll go through the whole,

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I think it's the Schopenhauer quote.

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said all truth passes through three stages

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first it's ridiculed second it's violently

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opposed yeah third it's then accepted and

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then people just go oh of course this

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is going to be a way so i

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don't know where we are i think we're

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still in ridicule like we're sniffing it

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around maybe we're violent i mean i think

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we all go through these phases but those

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are the three phases of grief or whatever

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whenever something new showed up

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I've got this thing in my pocket.

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I don't know if you guys have one

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of these.

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This is a smartphone.

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When I saw this in two thousand and

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eight,

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I was running multiple radio stations.

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I immediately started looking for the door

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because I was like,

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people were ridiculing it.

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Then they were violently opposing it.

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And I was like,

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that's when I know this is a thing.

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So, so I guess my question is like,

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what is,

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what does that actually look like in real

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clinics in terms of a full stack delivery

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format?

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Paint us the future or, you know,

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current picture.

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Sharky, you want to go?

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Yeah, I'll take that one.

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You know, you're,

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You're looking right now at a system that

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asks for,

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continue to bring patients into the door.

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And that's how every clinic is paid.

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They're paid simply by the number of

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bodies that come in the door.

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And that's where you get some of the

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terms of some of the mills and some

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of these clinics that are just going on

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volume.

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And what you're going to see moving

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forward is,

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That's fine.

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You're solving an access issue,

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but solve an outcomes issue.

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You're really going to start to see a

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shift towards what are the outcomes that

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you're producing.

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It doesn't matter how it's produced.

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It can be produced by having someone come

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into your clinic ten times.

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It can be produced by having them come

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in once and you're just sending them

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whatever it is,

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the exercise plan plus just checking in

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with them plus

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You know,

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whatever else you need to do to make

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sure that that outcome is achieved.

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You know, that's really what, you know,

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what the future of health care is looking

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for.

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Yeah.

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Yeah.

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What would you add to that, John?

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Yes.

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I mean,

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like we looked at this in the very

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first, I think,

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two or three articles that we wrote were

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all about this idea of, OK,

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what we see right now are these like

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pockets.

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So we see a large health system.

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They'll have a virtual telehealth team.

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They'll have some people doing RTM on the

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side.

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They may have a partnership with some

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digital health vendor that provides

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messaging only services.

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It's all kind of like broken out.

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Piecemealed.

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Super piecemeal.

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It's super fragmented.

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And then even health plans are doing this,

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right?

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It's like I've had Primera and I have

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Regions.

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You look at their thing and they have

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these things,

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but they're all like different solutions,

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right?

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So you can see they're trying to stitch

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it together, but it's just,

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it's super fragmented.

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So as a patient, you're going through,

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you're like, okay, cool.

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Like I interacted with Jimmy on the

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telephone.

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I acted with this messaging service.

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They're not talking to each other.

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So we're seeing this, like,

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they're all trying to figure it out as

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an organization,

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but nobody has really brought it together.

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So the entire thing is together.

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So that's kind of what we're,

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that's kind of how shark,

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you know what I'm saying?

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It's like, it's the parts are there.

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They just have to figure out how to

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stitch it all together.

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So we still like in the, you know,

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the baby deer Bambi side of, you know,

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situation where, you know,

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it's amazing deer come out being able to

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walk, but they're just not great at it,

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but they keep working and you got a

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lot of knees and elbows slapping around,

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but there's a reason for it.

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So if we look at a North star,

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I've only been in healthcare for ten

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years.

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Usually the government is the one to lead

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the way.

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If the government says it,

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they move slowly, but when they move,

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they are telegraphing

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what's coming.

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So you don't have to even read tea

00:08:34.322 --> 00:08:34.562
leaves.

00:08:34.582 --> 00:08:36.583
You just sort of read the slow comet

00:08:36.604 --> 00:08:36.884
trail.

00:08:37.384 --> 00:08:39.283
CMS is throwing up major signals.

00:08:39.724 --> 00:08:42.184
What do physical therapists specifically

00:08:42.644 --> 00:08:45.144
need to understand about the access model

00:08:45.205 --> 00:08:47.926
and RTM codes that I,

00:08:47.946 --> 00:08:49.926
I think forward thinking PTs jumped on

00:08:49.966 --> 00:08:50.666
this again,

00:08:50.725 --> 00:08:52.145
a lot of baby deer we're figuring out,

00:08:52.567 --> 00:08:53.966
but if you're not leaning into this,

00:08:54.506 --> 00:08:56.767
I think you're already behind still catch

00:08:56.907 --> 00:08:58.128
up, but let's start moving.

00:08:58.648 --> 00:09:00.148
So what do PTs need to understand about

00:09:00.187 --> 00:09:00.607
these things?

00:09:01.673 --> 00:09:02.354
Yeah, I mean,

00:09:02.374 --> 00:09:05.696
this all started in July of last year,

00:09:05.816 --> 00:09:06.076
really,

00:09:07.256 --> 00:09:11.059
where CMS got a big congregation of

00:09:11.320 --> 00:09:12.181
different tech leaders,

00:09:12.301 --> 00:09:15.543
and they started to hint at the idea

00:09:15.582 --> 00:09:16.964
that things were going to change,

00:09:16.984 --> 00:09:18.706
and they were going to throw out some

00:09:19.566 --> 00:09:20.826
some new innovation pilots,

00:09:20.846 --> 00:09:25.071
and really looking to create, and John,

00:09:25.091 --> 00:09:26.591
I think you've used the words of portfolio

00:09:27.812 --> 00:09:30.274
of different bets that they're taking to

00:09:30.414 --> 00:09:32.316
move things forward over the next ten

00:09:32.336 --> 00:09:32.596
years.

00:09:33.657 --> 00:09:35.839
One of those is the access pilot,

00:09:36.158 --> 00:09:38.120
and what the access pilot does quite

00:09:38.140 --> 00:09:39.042
simply is it just says,

00:09:39.682 --> 00:09:41.123
you know, we're paying you for outcomes.

00:09:41.822 --> 00:09:43.203
And so, you know, we're,

00:09:43.264 --> 00:09:44.485
we're going to pay about, you know,

00:09:44.884 --> 00:09:47.067
half upfront and then half, you know,

00:09:47.326 --> 00:09:48.567
once we actually see the data.

00:09:49.528 --> 00:09:50.849
And so they're,

00:09:50.969 --> 00:09:52.269
they're starting to put their monies

00:09:52.330 --> 00:09:53.591
where, you know, a lot of,

00:09:54.251 --> 00:09:54.471
a lot of,

00:09:54.491 --> 00:09:55.672
a lot of times their mouth has been,

00:09:55.692 --> 00:09:56.993
you know,

00:09:57.052 --> 00:09:59.575
about trying to really actually change the

00:09:59.595 --> 00:10:00.215
way that, you know,

00:10:00.254 --> 00:10:01.456
healthcare models work.

00:10:02.356 --> 00:10:03.937
So I think that's, that's sort of the,

00:10:04.878 --> 00:10:06.480
The T's are into the access model,

00:10:06.519 --> 00:10:07.720
but John, I'll let you jump into.

00:10:07.740 --> 00:10:09.061
So Jimmy,

00:10:09.140 --> 00:10:10.422
I'm literally pulling this up because

00:10:10.442 --> 00:10:11.682
there was two quotes that literally,

00:10:11.722 --> 00:10:12.984
so if you go to CMS's website,

00:10:13.004 --> 00:10:15.245
you Google access, you can see it's all,

00:10:15.346 --> 00:10:16.927
it's literally right there on the website.

00:10:16.947 --> 00:10:18.087
They spell it out.

00:10:18.107 --> 00:10:20.788
As much as we're like conspiracy theory,

00:10:20.950 --> 00:10:22.390
they're pretty open when they start moving

00:10:22.431 --> 00:10:23.051
in a direction.

00:10:23.110 --> 00:10:23.912
They move slow,

00:10:24.312 --> 00:10:25.673
but they keep going typically.

00:10:26.095 --> 00:10:27.696
Like there's two quotes that sit out to

00:10:27.735 --> 00:10:27.855
me.

00:10:28.116 --> 00:10:29.738
One, and there's a little trailer video,

00:10:29.878 --> 00:10:31.038
highly recommend watching it.

00:10:31.099 --> 00:10:32.399
It's pretty funny.

00:10:32.539 --> 00:10:33.921
It's pretty gnarly, but it's like,

00:10:34.081 --> 00:10:35.001
it's right on the page.

00:10:35.542 --> 00:10:36.222
So here's a quote,

00:10:36.602 --> 00:10:38.403
new ways for primary care doctors to

00:10:38.465 --> 00:10:40.166
partner with technology supported care

00:10:40.186 --> 00:10:42.067
providers so they can continue supporting

00:10:42.106 --> 00:10:43.648
patients with chronic conditions,

00:10:44.109 --> 00:10:46.210
even when they step outside the doctor's

00:10:46.269 --> 00:10:46.630
office.

00:10:47.636 --> 00:10:49.557
That's pretty, it's like so obvious.

00:10:49.636 --> 00:10:50.357
Here's the second part.

00:10:50.538 --> 00:10:52.498
We value this because we understand that

00:10:52.658 --> 00:10:54.217
doing this will save us money.

00:10:54.278 --> 00:10:55.198
And we are in the,

00:10:55.759 --> 00:10:56.438
love them or not,

00:10:56.639 --> 00:10:59.120
the government is in the separating money

00:10:59.159 --> 00:11:00.480
from its constituents game.

00:11:00.500 --> 00:11:02.159
And second is spending as little money as

00:11:02.200 --> 00:11:02.580
we can.

00:11:02.600 --> 00:11:03.701
And they recognize this.

00:11:03.721 --> 00:11:04.541
So this is good.

00:11:05.140 --> 00:11:06.061
Yes.

00:11:06.740 --> 00:11:07.660
Here's the second quote.

00:11:07.721 --> 00:11:10.282
Care may be provided in person, virtually,

00:11:10.422 --> 00:11:11.201
asynchronously,

00:11:11.261 --> 00:11:12.802
or through other technology enabled

00:11:12.863 --> 00:11:14.322
methods as clinically appropriate.

00:11:14.551 --> 00:11:15.691
That is not a hint.

00:11:15.770 --> 00:11:17.272
That is not subtle, right?

00:11:17.292 --> 00:11:17.892
That's like,

00:11:17.951 --> 00:11:19.173
and that's kind of when we saw that

00:11:19.192 --> 00:11:19.812
and we're like, we,

00:11:20.273 --> 00:11:21.894
thank God I can actually say we have,

00:11:21.933 --> 00:11:22.793
we have the receipts.

00:11:22.874 --> 00:11:24.855
We, we put up our blog,

00:11:25.434 --> 00:11:26.995
our sub stack before this came out,

00:11:27.014 --> 00:11:27.975
but I looked at like, that's false.

00:11:28.135 --> 00:11:29.436
That is exactly what we're trying to

00:11:29.456 --> 00:11:29.936
describe.

00:11:30.157 --> 00:11:31.517
We're saying as a patient,

00:11:31.537 --> 00:11:33.118
you should have access to in-person

00:11:33.177 --> 00:11:35.638
virtual asynchronous and technology

00:11:35.658 --> 00:11:36.359
enabled methods.

00:11:36.418 --> 00:11:36.778
That's,

00:11:37.239 --> 00:11:38.659
that's the way it should go and clinically

00:11:38.679 --> 00:11:39.259
appropriate.

00:11:39.360 --> 00:11:39.639
That's,

00:11:40.734 --> 00:11:42.535
That's essentially what we are trying to

00:11:42.556 --> 00:11:42.696
say.

00:11:42.716 --> 00:11:44.278
Like, okay, this is where it's going.

00:11:44.717 --> 00:11:46.220
CMS is putting a big,

00:11:46.379 --> 00:11:47.301
this is not a small bet.

00:11:47.321 --> 00:11:48.442
There's a big bet.

00:11:48.682 --> 00:11:49.263
Yeah.

00:11:49.283 --> 00:11:50.823
Government typically makes big bets,

00:11:50.884 --> 00:11:51.105
right?

00:11:51.125 --> 00:11:52.326
Cause it's got to do it for everybody.

00:11:53.488 --> 00:11:56.450
It's also not novel because the employer

00:11:56.470 --> 00:11:58.291
health space has been doing this for years

00:11:58.350 --> 00:12:02.234
now where they've allowed these digital

00:12:02.254 --> 00:12:04.414
health companies to come in through their

00:12:04.855 --> 00:12:07.136
benefit system and say, okay,

00:12:08.017 --> 00:12:09.638
you're going to help to reduce some of

00:12:09.658 --> 00:12:10.958
the spend in our company.

00:12:10.979 --> 00:12:11.198
Great.

00:12:11.499 --> 00:12:12.120
All right.

00:12:12.240 --> 00:12:13.341
We'll let you kind of figure out how

00:12:13.360 --> 00:12:13.760
to do that.

00:12:14.961 --> 00:12:18.167
One of the big levers has been just

00:12:18.246 --> 00:12:19.028
the fact that it's free.

00:12:19.528 --> 00:12:22.413
If you have an employer and your employer

00:12:22.452 --> 00:12:23.934
has one of these digital health vendors,

00:12:24.174 --> 00:12:25.636
most of the time you are going to

00:12:25.677 --> 00:12:28.760
get that vendor for free as a part

00:12:28.801 --> 00:12:29.663
of your employee benefits.

00:12:30.202 --> 00:12:33.364
Access is taking that page right out of

00:12:33.384 --> 00:12:33.744
the book.

00:12:34.303 --> 00:12:35.224
They're saying, okay, great,

00:12:35.344 --> 00:12:37.403
we're going to waive co-pays for Medicare

00:12:37.423 --> 00:12:39.764
members if they're a part of this model.

00:12:41.125 --> 00:12:43.304
I think that's something that's going to

00:12:43.325 --> 00:12:46.145
be really enticing for a senior that's on

00:12:46.186 --> 00:12:48.466
a budget or a clinic that sees a

00:12:48.505 --> 00:12:49.765
senior on a budget and says, hey,

00:12:50.407 --> 00:12:51.486
how do I get them in the door?

00:12:52.267 --> 00:12:54.567
How do I actually allow them to come

00:12:54.626 --> 00:12:54.726
in?

00:12:54.927 --> 00:12:56.567
One, I can help them,

00:12:56.668 --> 00:12:58.707
but also we can have them in for

00:12:59.360 --> 00:13:00.802
for generating revenue.

00:13:00.822 --> 00:13:01.163
So yeah,

00:13:02.024 --> 00:13:03.605
I think that's another really interesting

00:13:03.645 --> 00:13:05.628
piece that CMS is taking right out of

00:13:05.648 --> 00:13:06.328
the employer book.

00:13:07.649 --> 00:13:08.270
You've said before,

00:13:08.350 --> 00:13:11.553
total caseload is the new metric.

00:13:11.854 --> 00:13:14.256
Explain that idea to PTs who've only

00:13:14.297 --> 00:13:17.821
really ever been judged on billable units.

00:13:17.860 --> 00:13:18.802
How do you reframe that?

00:13:22.332 --> 00:13:23.033
That's such a hard one.

00:13:23.053 --> 00:13:25.375
Yeah, I think it's, it goes back to,

00:13:25.495 --> 00:13:27.437
I think what Sharky said about outcomes

00:13:27.878 --> 00:13:29.399
and, you know, it's, it's hinting at,

00:13:29.419 --> 00:13:30.080
you know,

00:13:30.100 --> 00:13:31.120
we can stop beating around the bush.

00:13:31.301 --> 00:13:31.741
Ultimately,

00:13:31.782 --> 00:13:32.842
this is always goes back towards the

00:13:32.883 --> 00:13:33.943
concept of value-based care.

00:13:34.144 --> 00:13:35.424
That's kind of where this is trying to

00:13:35.445 --> 00:13:35.745
get to.

00:13:35.764 --> 00:13:36.004
Right.

00:13:36.105 --> 00:13:37.407
And it's saying essentially, it's like,

00:13:38.386 --> 00:13:39.508
As you said, as Sharkey said,

00:13:39.847 --> 00:13:41.148
you can see a patient for one visit,

00:13:41.168 --> 00:13:42.208
you can see him for ten visits,

00:13:42.308 --> 00:13:44.090
you can see him for half a visit

00:13:44.210 --> 00:13:46.831
and then remotely monitor them without

00:13:46.910 --> 00:13:47.730
worrying about billing.

00:13:47.750 --> 00:13:49.751
Let's take the billing part out of RTM,

00:13:49.932 --> 00:13:52.373
like remote monitoring and messaging by

00:13:52.432 --> 00:13:53.452
itself as a concept.

00:13:53.994 --> 00:13:54.774
You could do that.

00:13:55.014 --> 00:13:56.794
And so you have, let's say,

00:13:57.715 --> 00:13:59.956
let's say a traditional PT could see maybe

00:14:00.336 --> 00:14:02.417
one eval day, two evals a day.

00:14:02.496 --> 00:14:03.557
And then if you had a higher volume,

00:14:03.576 --> 00:14:04.498
you're going to be certainly higher than

00:14:04.518 --> 00:14:04.697
that.

00:14:05.393 --> 00:14:06.014
But in the end,

00:14:06.053 --> 00:14:08.395
if you have a population of thousands of

00:14:08.456 --> 00:14:10.597
people that you have to manage their

00:14:10.638 --> 00:14:10.878
health,

00:14:10.918 --> 00:14:12.559
how do you actually do that effectively?

00:14:13.041 --> 00:14:14.241
And if you were to say you're going

00:14:14.261 --> 00:14:15.783
to get X number of dollars to do

00:14:15.822 --> 00:14:16.083
that,

00:14:17.384 --> 00:14:18.565
Eventually then you say, okay,

00:14:18.605 --> 00:14:20.086
do whatever you have to do to manage

00:14:20.125 --> 00:14:21.086
that population's health.

00:14:21.126 --> 00:14:22.248
How would you actually do this?

00:14:22.868 --> 00:14:23.609
What I've seen in time,

00:14:23.749 --> 00:14:25.090
and I've seen this time and time again,

00:14:25.490 --> 00:14:27.692
ultimately what ends up spinning up is

00:14:28.032 --> 00:14:30.053
something like there's some virtual care,

00:14:30.173 --> 00:14:31.375
there's some asynchronous care,

00:14:31.774 --> 00:14:33.216
there's high touch care for people that

00:14:33.255 --> 00:14:33.436
need it,

00:14:33.456 --> 00:14:34.756
there's low touch care for people who

00:14:34.797 --> 00:14:35.057
don't.

00:14:35.738 --> 00:14:36.759
That's what happens.

00:14:37.019 --> 00:14:37.919
And so ultimately,

00:14:37.980 --> 00:14:40.402
it's that idea of rather than how many

00:14:40.481 --> 00:14:40.923
units, Jimmy,

00:14:40.942 --> 00:14:42.524
did you bill for that patient for that

00:14:42.563 --> 00:14:43.465
forty five minutes?

00:14:44.105 --> 00:14:46.106
It's with that hour of time.

00:14:46.767 --> 00:14:48.568
How many people did you touch and did

00:14:48.589 --> 00:14:49.929
you actually impact their health?

00:14:50.250 --> 00:14:50.429
Right.

00:14:50.450 --> 00:14:52.091
Those two completely different metric.

00:14:52.111 --> 00:14:52.351
Right.

00:14:52.952 --> 00:14:55.455
And that's that was the thing.

00:14:55.514 --> 00:14:57.697
Again, second career PT here.

00:14:58.799 --> 00:15:00.581
I think I figured this out or started

00:15:00.600 --> 00:15:02.660
to get like clued in on my first

00:15:02.701 --> 00:15:03.341
clinical rotation.

00:15:03.360 --> 00:15:03.861
I was like, oh,

00:15:04.001 --> 00:15:06.522
I'm incentivized if I'm bad at this.

00:15:06.562 --> 00:15:07.322
That sucks.

00:15:07.462 --> 00:15:09.342
Like if I could have done it in

00:15:09.383 --> 00:15:12.364
three, but I did it in ten,

00:15:12.504 --> 00:15:14.365
I'm financially better.

00:15:14.924 --> 00:15:16.585
But the patient did, you know,

00:15:16.605 --> 00:15:18.365
we wasted the patient's time and effort

00:15:18.426 --> 00:15:19.346
and we wasted money.

00:15:19.926 --> 00:15:21.586
And that just seems like a crappy system.

00:15:21.606 --> 00:15:22.886
I remember like, you know, because I came,

00:15:23.307 --> 00:15:25.368
I've seen doctors, I saw PTs.

00:15:25.967 --> 00:15:26.807
And then once I was on the other

00:15:26.827 --> 00:15:28.408
side, I was like, oh, this game sucks.

00:15:32.051 --> 00:15:32.410
Yeah.

00:15:32.811 --> 00:15:34.871
I think it, this, you know,

00:15:34.932 --> 00:15:36.613
it changes a little bit as a PT

00:15:36.692 --> 00:15:37.614
of also what you're going to do with

00:15:37.634 --> 00:15:38.173
your downtime.

00:15:38.673 --> 00:15:39.095
You know, if,

00:15:39.274 --> 00:15:40.115
if you have a new show,

00:15:40.134 --> 00:15:41.655
what does that mean?

00:15:41.735 --> 00:15:43.376
It completely changes, you know,

00:15:43.456 --> 00:15:46.217
how you're going to view that time because

00:15:46.278 --> 00:15:47.418
now you're, you're, you know,

00:15:47.458 --> 00:15:48.639
most likely going to be looking at your

00:15:48.658 --> 00:15:49.779
panel and saying, you know, Hey, who's,

00:15:49.940 --> 00:15:50.799
who's dropping off.

00:15:51.240 --> 00:15:53.822
You know, most likely you're going to see,

00:15:54.182 --> 00:15:54.402
you know,

00:15:54.442 --> 00:15:56.043
tools come out that are going to let

00:15:56.082 --> 00:15:57.864
you just assess everybody, you know,

00:15:58.402 --> 00:15:59.702
and start to reach out to them

00:16:00.482 --> 00:16:01.024
individually.

00:16:01.224 --> 00:16:02.924
Hey, you know, I got whatever it is,

00:16:03.384 --> 00:16:03.585
you know,

00:16:03.625 --> 00:16:05.846
ten percent of my caseload hasn't done any

00:16:05.905 --> 00:16:07.767
exercises this week because I can see it,

00:16:07.886 --> 00:16:09.327
you know, on this dashboard.

00:16:09.347 --> 00:16:10.489
So I'm going to reach out to them

00:16:10.729 --> 00:16:11.408
and I say, hey, you know,

00:16:11.428 --> 00:16:11.970
what's going on?

00:16:12.009 --> 00:16:13.791
Is there anything that I can do?

00:16:14.250 --> 00:16:16.272
You know, I think that changes things.

00:16:16.751 --> 00:16:17.873
This sort of just came to me.

00:16:22.195 --> 00:16:25.057
Burnout is sort of caused by doing a

00:16:25.096 --> 00:16:26.437
lot of work that doesn't have results.

00:16:28.183 --> 00:16:30.706
I never have had or have problem doing

00:16:30.726 --> 00:16:32.048
a lot of work that I felt was

00:16:32.148 --> 00:16:33.490
impactful, right?

00:16:33.669 --> 00:16:34.410
Might be overwhelmed.

00:16:34.471 --> 00:16:35.532
I'm not saying you're not tired.

00:16:35.692 --> 00:16:36.933
I'm not saying it's not difficult.

00:16:37.433 --> 00:16:39.375
I'm saying it doesn't feel burnout-y.

00:16:40.037 --> 00:16:40.216
I mean,

00:16:40.256 --> 00:16:42.058
for my example was staying in a radio

00:16:42.099 --> 00:16:43.419
station until one o'clock in the morning

00:16:43.440 --> 00:16:44.601
because we had something really big coming

00:16:44.682 --> 00:16:44.802
out.

00:16:45.101 --> 00:16:46.364
I felt like I was being pulled.

00:16:46.823 --> 00:16:47.784
It feels like when...

00:16:48.625 --> 00:16:51.207
When RTM or AI Scribes first came out,

00:16:51.327 --> 00:16:52.668
everybody's first panic was,

00:16:52.989 --> 00:16:53.429
what do we say?

00:16:53.710 --> 00:16:54.590
First, they ridicule it.

00:16:54.811 --> 00:16:55.730
Then they V it, let me impose it.

00:16:55.750 --> 00:16:56.010
Like, well,

00:16:56.032 --> 00:16:56.912
then they're just going to give you more

00:16:56.951 --> 00:16:57.472
patience.

00:16:57.712 --> 00:16:58.653
Yes.

00:16:58.913 --> 00:16:59.634
And I sort of feel like, well,

00:16:59.693 --> 00:17:00.774
if it's better work,

00:17:00.995 --> 00:17:02.375
the stuff that I showed up for,

00:17:02.897 --> 00:17:05.218
I feel like it doesn't completely remove,

00:17:05.258 --> 00:17:07.319
but it starts to improve that feeling of

00:17:07.359 --> 00:17:07.700
burnout.

00:17:07.720 --> 00:17:09.080
Like, this is what I'm here for.

00:17:09.501 --> 00:17:11.303
Give me more of the thing that I

00:17:11.343 --> 00:17:12.544
thought I was going to be doing that

00:17:12.564 --> 00:17:14.464
was on the brochure when I signed up

00:17:14.484 --> 00:17:15.346
for school, right?

00:17:15.365 --> 00:17:15.465
Yeah.

00:17:15.486 --> 00:17:16.605
Totally.

00:17:16.625 --> 00:17:16.905
Yeah.

00:17:17.246 --> 00:17:17.326
Yeah.

00:17:17.346 --> 00:17:18.906
I was talking to this one clinician owner

00:17:18.987 --> 00:17:21.487
and he, he had this strong,

00:17:21.626 --> 00:17:22.667
really strong perspective,

00:17:22.807 --> 00:17:24.048
like about RCM particularly.

00:17:24.067 --> 00:17:25.847
He's like, I was like, why are you,

00:17:25.989 --> 00:17:26.989
why are you guys doing RCM?

00:17:27.009 --> 00:17:28.148
Get to the bottom of it.

00:17:28.449 --> 00:17:28.729
Yeah.

00:17:28.868 --> 00:17:31.190
And he's like full stop patient

00:17:31.230 --> 00:17:31.630
experience.

00:17:31.650 --> 00:17:31.970
He's like,

00:17:32.589 --> 00:17:35.471
we want to deliver the best patient

00:17:35.510 --> 00:17:35.931
experience.

00:17:36.411 --> 00:17:38.151
Why would I not give them access to

00:17:38.191 --> 00:17:38.951
me between visits?

00:17:38.971 --> 00:17:40.912
Why would I not say I want to

00:17:40.971 --> 00:17:42.112
be the provider of choice?

00:17:42.132 --> 00:17:42.612
And I was like,

00:17:42.772 --> 00:17:44.393
that's a completely different view.

00:17:45.094 --> 00:17:47.116
on why you would do RTM and it

00:17:47.136 --> 00:17:48.699
said she's like I want my therapist to

00:17:48.739 --> 00:17:50.382
have a caseload of a bunch of people

00:17:50.843 --> 00:17:52.945
where their patients love them and trust

00:17:52.965 --> 00:17:54.387
them that's why we're doing RTM and I

00:17:54.407 --> 00:17:54.689
was like

00:17:55.717 --> 00:17:57.597
You're probably in the one percent right

00:17:57.659 --> 00:17:57.919
now.

00:17:58.378 --> 00:17:59.940
That is the concept.

00:18:00.019 --> 00:18:01.340
That is kind of the idea is like,

00:18:01.381 --> 00:18:02.761
how do you build stronger relationships

00:18:02.801 --> 00:18:03.462
with patients?

00:18:03.962 --> 00:18:04.564
But also,

00:18:04.844 --> 00:18:05.884
how do you do it in a scalable

00:18:05.924 --> 00:18:06.184
way?

00:18:06.285 --> 00:18:06.905
Because in the end,

00:18:06.925 --> 00:18:08.507
if you do hour long appointments,

00:18:09.307 --> 00:18:10.627
you know, five or six a day,

00:18:10.708 --> 00:18:12.068
you just you can't scale that.

00:18:12.230 --> 00:18:13.130
It's not possible.

00:18:13.170 --> 00:18:14.671
So is there a way to do it

00:18:14.691 --> 00:18:16.952
in a way that's not so intensive in

00:18:16.992 --> 00:18:17.794
the in-person side?

00:18:18.769 --> 00:18:20.230
Yeah, absolutely.

00:18:20.269 --> 00:18:21.471
That's somebody who understands what game

00:18:21.490 --> 00:18:22.952
they're playing, which is step one.

00:18:23.113 --> 00:18:24.273
Understand what game you're playing.

00:18:24.634 --> 00:18:27.537
Then you can understand which things to

00:18:27.576 --> 00:18:27.957
lean on.

00:18:28.477 --> 00:18:30.739
It also shows that people should

00:18:30.778 --> 00:18:31.299
understand.

00:18:31.579 --> 00:18:33.080
I heard this in the nonprofit world and

00:18:33.101 --> 00:18:35.442
it landed, which was no margin,

00:18:35.963 --> 00:18:36.884
no mission.

00:18:37.424 --> 00:18:38.705
I know that you're like, icky,

00:18:38.766 --> 00:18:39.666
I want to touch money.

00:18:40.287 --> 00:18:42.108
But if you're the American Cancer Society,

00:18:42.189 --> 00:18:43.730
the Leukemia Lymphoma Society,

00:18:44.930 --> 00:18:47.071
no margin, no money, no mission.

00:18:47.112 --> 00:18:48.833
You don't have money to pay the people

00:18:48.853 --> 00:18:50.054
or keep the lights on or do the

00:18:50.094 --> 00:18:51.294
things that you're set off to do.

00:18:51.734 --> 00:18:53.615
You don't have a better relationship with

00:18:53.675 --> 00:18:53.875
money.

00:18:53.935 --> 00:18:55.116
I put a post on LinkedIn the other

00:18:55.136 --> 00:18:56.758
day.

00:18:56.917 --> 00:19:00.039
We will argue with insurance companies and

00:19:00.059 --> 00:19:02.622
then poo-poo the idea of a patient giving

00:19:02.662 --> 00:19:04.063
us money for a thing that we just

00:19:04.083 --> 00:19:05.864
said was valuable.

00:19:06.545 --> 00:19:06.984
I don't know.

00:19:07.826 --> 00:19:09.266
The call's coming from the inside of the

00:19:09.306 --> 00:19:09.586
house.

00:19:09.606 --> 00:19:10.047
It's us.

00:19:10.807 --> 00:19:12.167
We are the people who have a bad

00:19:12.208 --> 00:19:12.888
relationship

00:19:13.487 --> 00:19:14.007
with money.

00:19:14.087 --> 00:19:15.949
Let me get a good relationship with money.

00:19:15.989 --> 00:19:16.769
Want to thank U.S.

00:19:16.789 --> 00:19:18.451
Physical Therapy for sponsoring the show.

00:19:18.770 --> 00:19:19.991
You've built something special,

00:19:20.192 --> 00:19:21.853
but scaling your clinic and planning for

00:19:21.893 --> 00:19:23.734
what's next can feel overwhelming.

00:19:24.075 --> 00:19:24.454
At U.S.

00:19:24.474 --> 00:19:25.195
Physical Therapy,

00:19:25.256 --> 00:19:26.817
they partner with clinic owners who want

00:19:26.836 --> 00:19:28.458
to grow without giving up their identity.

00:19:28.858 --> 00:19:29.858
You stay in control.

00:19:30.400 --> 00:19:30.640
U.S.

00:19:30.680 --> 00:19:32.201
Physical Therapy brings the support.

00:19:32.260 --> 00:19:35.482
Learn more now at USPHPartnership.com.

00:19:35.502 --> 00:19:37.464
That's USPHPartnership.com.

00:19:39.930 --> 00:19:41.549
Why do you think there's still resistance

00:19:41.569 --> 00:19:43.171
to RTM or hybrid care,

00:19:43.290 --> 00:19:44.911
even with reimbursement outcomes and

00:19:45.010 --> 00:19:45.791
access benefits?

00:19:46.071 --> 00:19:47.352
You just talked about that example right

00:19:47.372 --> 00:19:47.652
there.

00:19:48.613 --> 00:19:49.373
I have a thought.

00:19:49.952 --> 00:19:50.873
You want me to throw my thought out

00:19:50.913 --> 00:19:51.153
first?

00:19:53.493 --> 00:19:54.394
It's always fear.

00:19:54.454 --> 00:19:55.494
We're big, dumb animals.

00:19:55.595 --> 00:19:56.174
It's fear.

00:19:56.515 --> 00:19:57.935
It's I don't like this.

00:19:58.215 --> 00:19:59.236
This is new.

00:19:59.936 --> 00:20:00.977
This is scary.

00:20:01.116 --> 00:20:02.817
If I do this and fail, what happens?

00:20:02.897 --> 00:20:04.077
So to me, it's fear.

00:20:04.097 --> 00:20:05.137
It's not technology.

00:20:05.157 --> 00:20:06.138
It's not policy.

00:20:07.298 --> 00:20:10.221
it's fear that's my assumption i think

00:20:10.240 --> 00:20:11.481
that's i mean i think that's that's

00:20:11.521 --> 00:20:12.923
probably spot on for a lot of people

00:20:12.962 --> 00:20:15.243
right it's fear fear of change fear of

00:20:15.263 --> 00:20:18.306
doing something different right um yo i'll

00:20:18.326 --> 00:20:20.126
say i i do always wonder about this

00:20:20.146 --> 00:20:21.167
because i you know i talk to a

00:20:21.208 --> 00:20:22.848
lot of different therapists and like

00:20:22.969 --> 00:20:24.809
owners all over and so one thing i

00:20:24.829 --> 00:20:26.671
hear a lot of is it's almost like

00:20:26.691 --> 00:20:31.094
this mis perception of what rtm is about

00:20:31.493 --> 00:20:33.194
right and so i think you know what

00:20:33.234 --> 00:20:33.736
i've heard is

00:20:35.267 --> 00:20:35.787
There's this,

00:20:36.086 --> 00:20:38.428
this perception is not skilled and I'm

00:20:38.468 --> 00:20:39.888
just like, okay, okay.

00:20:39.909 --> 00:20:41.148
Let's have that conversation.

00:20:41.169 --> 00:20:41.308
Yeah.

00:20:41.689 --> 00:20:41.888
Right.

00:20:41.930 --> 00:20:42.950
Let's have that combo.

00:20:43.549 --> 00:20:45.250
And it's like, they don't view.

00:20:46.290 --> 00:20:48.011
Like looking at someone's messages and

00:20:48.071 --> 00:20:49.811
responding to someone's messages,

00:20:49.832 --> 00:20:51.492
like in concerns between business is

00:20:51.512 --> 00:20:51.913
skilled care.

00:20:51.932 --> 00:20:52.232
And I'm like,

00:20:52.512 --> 00:20:54.894
I'm not really sure I have a strong

00:20:54.913 --> 00:20:56.174
opinion against I'm like,

00:20:56.255 --> 00:20:57.414
this is skilled care.

00:20:57.875 --> 00:20:58.036
Yeah.

00:20:58.155 --> 00:20:58.756
If you,

00:20:58.875 --> 00:21:00.256
if you fundamentally disagree with that,

00:21:00.276 --> 00:21:01.037
it's going to be hard to get you

00:21:01.076 --> 00:21:01.717
on board with RTM.

00:21:02.093 --> 00:21:04.233
The right message at the right time for

00:21:04.273 --> 00:21:05.794
the right person, the right situation.

00:21:06.233 --> 00:21:07.775
I mean, I'm not a policy guy,

00:21:07.815 --> 00:21:09.435
but that feels like skill.

00:21:09.895 --> 00:21:10.155
Yes.

00:21:10.476 --> 00:21:12.856
Like if you could handle it in a

00:21:12.957 --> 00:21:14.457
minute sending, hey, Jimmy,

00:21:14.877 --> 00:21:16.117
I'm going to change your exercises because

00:21:16.137 --> 00:21:19.058
you told me X. That's skilled care.

00:21:19.179 --> 00:21:20.819
And that's better care, in my opinion,

00:21:20.839 --> 00:21:22.240
than waiting for the patient to come back

00:21:22.339 --> 00:21:23.259
in six days from now.

00:21:23.361 --> 00:21:24.201
And lower costs.

00:21:24.881 --> 00:21:25.561
Yeah, exactly.

00:21:25.602 --> 00:21:28.263
So that's like a fundamental kind of thing

00:21:28.304 --> 00:21:30.125
that I want to dig more into and

00:21:30.145 --> 00:21:30.967
understand, like, okay,

00:21:31.027 --> 00:21:32.888
how do we just kind of continue that

00:21:33.128 --> 00:21:34.851
conversation and be like, okay,

00:21:34.931 --> 00:21:36.511
how can we help you understand this is

00:21:36.573 --> 00:21:36.833
skill?

00:21:37.346 --> 00:21:39.866
because the research is pretty darn good

00:21:39.987 --> 00:21:42.728
on whether it's like RPM or RTM.

00:21:42.847 --> 00:21:43.748
It's there.

00:21:44.407 --> 00:21:45.347
It could be better.

00:21:45.407 --> 00:21:46.509
Like there could be more of it,

00:21:46.528 --> 00:21:47.709
but it's pretty consistent.

00:21:47.969 --> 00:21:49.489
That's why being a researcher is a great

00:21:49.528 --> 00:21:51.369
job because at the end of every,

00:21:51.549 --> 00:21:52.430
you could just boilerplate this,

00:21:52.450 --> 00:21:53.329
at the end of every paper,

00:21:53.351 --> 00:21:54.550
like more research is needed.

00:21:54.590 --> 00:21:56.431
And that's just one researcher elbowing

00:21:56.471 --> 00:21:57.711
the next going, I got you, bro.

00:21:57.791 --> 00:21:59.132
I got you, right?

00:21:59.332 --> 00:22:00.311
You're never going to get there.

00:22:00.593 --> 00:22:01.752
You're never going to get perfection.

00:22:02.653 --> 00:22:03.893
So I think it's fear, fear,

00:22:03.952 --> 00:22:04.513
all those things.

00:22:04.913 --> 00:22:05.513
Ryan, what do you think?

00:22:07.045 --> 00:22:07.826
You know,

00:22:07.906 --> 00:22:10.873
I think that there's a lot of clinics

00:22:10.893 --> 00:22:13.337
that have figured out a great operating

00:22:13.377 --> 00:22:13.638
model,

00:22:14.240 --> 00:22:16.704
and the operating model is everything to

00:22:16.744 --> 00:22:17.666
do with fee-for-service.

00:22:19.116 --> 00:22:19.336
Again,

00:22:19.698 --> 00:22:21.259
whether you call it fear or resistance to

00:22:21.298 --> 00:22:21.679
change,

00:22:23.720 --> 00:22:25.141
going into something that's totally new

00:22:25.181 --> 00:22:26.382
and saying, well, okay,

00:22:26.402 --> 00:22:28.702
how does the model that we have today

00:22:28.782 --> 00:22:30.124
fit into this model of tomorrow?

00:22:30.144 --> 00:22:32.045
That's valid.

00:22:32.105 --> 00:22:33.546
I think that's a tough one.

00:22:34.307 --> 00:22:36.307
But yeah, fear is probably the primary.

00:22:37.588 --> 00:22:39.029
Any sort of resistance is going to come

00:22:39.089 --> 00:22:39.490
off of that.

00:22:40.151 --> 00:22:40.590
Yeah.

00:22:40.611 --> 00:22:40.770
I mean,

00:22:40.810 --> 00:22:42.011
Shrek and I have talked about that with

00:22:42.113 --> 00:22:43.433
Access in particular, too.

00:22:43.453 --> 00:22:44.615
We're like, we're looking at it.

00:22:44.934 --> 00:22:49.059
And so you can see where a company

00:22:49.079 --> 00:22:50.060
that's tech first,

00:22:50.842 --> 00:22:52.563
they could probably be pretty successful

00:22:52.583 --> 00:22:53.203
in this model.

00:22:53.384 --> 00:22:54.325
And then we're talking about, okay,

00:22:54.986 --> 00:22:57.028
how would a brick and mortar health system

00:22:57.548 --> 00:23:00.171
or a brick and mortar clinic get involved

00:23:00.211 --> 00:23:00.451
here?

00:23:01.392 --> 00:23:02.893
And I think they can.

00:23:03.032 --> 00:23:05.213
I mean, I think CMS wants them to.

00:23:05.653 --> 00:23:06.673
But we talked about like, hey,

00:23:06.713 --> 00:23:08.595
you might need to break off a pilot

00:23:08.634 --> 00:23:08.894
team.

00:23:09.214 --> 00:23:10.556
You might need to do this a little

00:23:10.576 --> 00:23:11.195
bit differently.

00:23:11.256 --> 00:23:14.217
Give them some freedom to try and figure

00:23:14.237 --> 00:23:15.117
this out on the side.

00:23:15.438 --> 00:23:16.778
If you try and cram it into your

00:23:16.817 --> 00:23:17.739
existing operations,

00:23:17.959 --> 00:23:19.479
it's going to be really, really, really,

00:23:19.519 --> 00:23:20.039
really hard.

00:23:20.339 --> 00:23:23.921
I mean, it's the inception concept, right?

00:23:23.980 --> 00:23:25.021
Make it their idea.

00:23:26.971 --> 00:23:27.951
you can only do that so much,

00:23:28.010 --> 00:23:29.471
but like when I was working with a

00:23:29.531 --> 00:23:30.471
tech organization,

00:23:30.731 --> 00:23:32.012
I would say we would do pilots of

00:23:32.133 --> 00:23:34.053
six for a piece of tech.

00:23:34.732 --> 00:23:36.094
And then I would say,

00:23:36.173 --> 00:23:37.074
and I love doing this,

00:23:37.134 --> 00:23:38.434
especially with an owner who was pretty

00:23:38.474 --> 00:23:38.954
hands-on,

00:23:39.595 --> 00:23:41.395
give me three people who are pretty

00:23:41.415 --> 00:23:42.115
forward thinking,

00:23:42.615 --> 00:23:43.875
like three people who were like, yeah,

00:23:43.915 --> 00:23:44.396
they'll enjoy this.

00:23:44.497 --> 00:23:45.076
And then I say,

00:23:45.436 --> 00:23:47.698
give me three crusty laggards.

00:23:47.718 --> 00:23:48.718
And they're like, what?

00:23:49.238 --> 00:23:50.358
And I'm like, here's the thing, man,

00:23:50.419 --> 00:23:51.778
I'm gonna, I'm selling you this.

00:23:51.818 --> 00:23:52.778
And I was upfront about it.

00:23:53.579 --> 00:23:54.299
I think this is great.

00:23:55.568 --> 00:23:56.950
You know the three people who are forward

00:23:56.970 --> 00:23:58.549
thinking are going to love this.

00:23:59.190 --> 00:24:00.971
If the three crusty laggards love it,

00:24:01.211 --> 00:24:02.192
I don't have to sell this at all.

00:24:02.511 --> 00:24:04.491
Now you know that your people will do

00:24:04.573 --> 00:24:04.712
it.

00:24:05.512 --> 00:24:08.074
You being on the phone with me tells

00:24:08.134 --> 00:24:10.375
me you understand that this is a problem

00:24:10.634 --> 00:24:12.075
and that I'm in the running to be

00:24:12.234 --> 00:24:12.816
a solution.

00:24:12.955 --> 00:24:13.576
I'm okay with that.

00:24:13.635 --> 00:24:14.336
It's a jump ball.

00:24:14.556 --> 00:24:15.717
I'll take the jump ball all day.

00:24:16.317 --> 00:24:18.137
But if I can convince the crusty ones,

00:24:18.739 --> 00:24:19.118
my man,

00:24:19.239 --> 00:24:20.279
I ain't got to do no pitch.

00:24:20.339 --> 00:24:20.900
At the end,

00:24:21.220 --> 00:24:22.701
you just said the people who would want

00:24:22.721 --> 00:24:24.162
to resist this the most are cool with

00:24:24.182 --> 00:24:24.823
it.

00:24:24.843 --> 00:24:25.663
That's a risk,

00:24:25.683 --> 00:24:26.663
but I try to get to the no

00:24:26.703 --> 00:24:27.605
as quick as possible.

00:24:28.746 --> 00:24:29.526
Yeah, I think that's smart.

00:24:29.566 --> 00:24:30.126
Yeah, it's smart.

00:24:30.166 --> 00:24:31.587
Rather than kind of dragging the feet and

00:24:31.627 --> 00:24:33.449
then like seeing it kind of trail off,

00:24:33.489 --> 00:24:34.009
you're saying like,

00:24:34.088 --> 00:24:37.050
let's do this and let's actually see.

00:24:37.070 --> 00:24:38.531
Let's get the people on board, right?

00:24:38.593 --> 00:24:39.593
Yeah, because I think that's...

00:24:40.173 --> 00:24:42.134
This is the format of every episode of

00:24:42.194 --> 00:24:42.894
Bar Rescue.

00:24:43.276 --> 00:24:44.537
First, they see the ugly...

00:24:45.497 --> 00:24:47.319
Then they come in and they poke and

00:24:47.339 --> 00:24:49.321
then the owner yells and John Taffer yells

00:24:49.362 --> 00:24:52.586
back and then they do a pressure test.

00:24:52.726 --> 00:24:53.446
They bring in,

00:24:53.787 --> 00:24:55.128
if the bar can hold a hundred people,

00:24:55.148 --> 00:24:57.171
they bring in two hundred and they watch

00:24:57.191 --> 00:24:57.912
where it fails.

00:24:57.971 --> 00:24:58.752
And that's good.

00:24:59.634 --> 00:25:01.336
I think we're resistant to that.

00:25:01.355 --> 00:25:01.435
Yeah.

00:25:01.673 --> 00:25:02.713
I'm like, dude,

00:25:02.733 --> 00:25:03.973
I need to know where the leak is.

00:25:03.993 --> 00:25:05.355
Like a good plumber is going to go

00:25:05.375 --> 00:25:06.174
turn the pressure up.

00:25:06.615 --> 00:25:07.715
Well, there's going to water squirt.

00:25:07.756 --> 00:25:09.217
I go, this is dripping already.

00:25:09.277 --> 00:25:11.018
Like let's squirt it for ten minutes and

00:25:11.038 --> 00:25:11.778
let's figure it out.

00:25:11.798 --> 00:25:12.838
What are we doing here?

00:25:13.278 --> 00:25:15.740
Are we just giving the leaky pipe vibes?

00:25:15.759 --> 00:25:16.601
That doesn't do anything.

00:25:16.861 --> 00:25:17.760
Let's get to the point.

00:25:17.800 --> 00:25:18.942
I'm here to solve problems.

00:25:19.301 --> 00:25:20.403
You're here to solve problems.

00:25:20.423 --> 00:25:21.222
Let's solve problems.

00:25:21.363 --> 00:25:22.243
Avoiding it.

00:25:23.413 --> 00:25:25.314
Although I recently found out ostriches

00:25:25.334 --> 00:25:26.815
don't actually put their head in the sand.

00:25:26.855 --> 00:25:27.955
That's a fallacy.

00:25:28.036 --> 00:25:28.356
I know.

00:25:28.896 --> 00:25:29.576
Welcome, internet.

00:25:30.018 --> 00:25:31.719
But that's, you know, using that cliche,

00:25:31.739 --> 00:25:32.859
that's you just burying your head in the

00:25:32.900 --> 00:25:34.260
sand and pretending that it's not going to

00:25:34.280 --> 00:25:35.060
be a problem or it's not going to

00:25:35.080 --> 00:25:35.642
slowly kill you.

00:25:36.082 --> 00:25:36.382
I don't know.

00:25:36.643 --> 00:25:37.442
I heard the line once,

00:25:37.462 --> 00:25:38.884
there's always going to be a leading cause

00:25:38.923 --> 00:25:39.284
of death.

00:25:39.484 --> 00:25:40.806
There's always going to be a leading

00:25:40.846 --> 00:25:41.965
problem in your business.

00:25:42.807 --> 00:25:44.367
Why solve the smaller ones?

00:25:44.508 --> 00:25:45.588
Because they feel easy.

00:25:45.648 --> 00:25:46.710
Because I feel like I get to check

00:25:46.730 --> 00:25:47.269
something off.

00:25:47.589 --> 00:25:48.951
And the bigger ones are hairier and

00:25:48.990 --> 00:25:49.432
scarier,

00:25:49.711 --> 00:25:50.913
except they're the reason you're going to

00:25:50.932 --> 00:25:52.433
close, not the small ones.

00:25:54.622 --> 00:25:56.932
What's one question every PT should ask

00:25:57.093 --> 00:25:58.196
their clinic owner?

00:25:59.201 --> 00:25:59.961
or director,

00:26:00.541 --> 00:26:01.521
this is what I'm talking about.

00:26:01.561 --> 00:26:03.163
You have the forward thinking PTs at your

00:26:03.182 --> 00:26:04.644
clinic, you got the laggards,

00:26:04.983 --> 00:26:06.904
but what's a question they should ask if

00:26:07.125 --> 00:26:09.425
they want to explore innovation where they

00:26:09.465 --> 00:26:09.705
work?

00:26:10.326 --> 00:26:11.446
We hear from owners saying, oh,

00:26:11.467 --> 00:26:13.268
we want our clinicians to be intrapreneurs

00:26:13.288 --> 00:26:13.627
and bring up,

00:26:13.667 --> 00:26:15.189
you want to make more money?

00:26:15.489 --> 00:26:16.730
Let's make more money and you get a

00:26:16.789 --> 00:26:17.069
cut.

00:26:17.349 --> 00:26:19.490
So what's the question a clinician could

00:26:19.530 --> 00:26:21.432
be or should be asking an owner or

00:26:21.451 --> 00:26:21.991
a director,

00:26:22.011 --> 00:26:23.313
no matter what situation you're in?

00:26:25.939 --> 00:26:26.680
Such a good question.

00:26:27.181 --> 00:26:28.622
I'll go first.

00:26:28.843 --> 00:26:30.904
I think every clinician should be asking

00:26:31.204 --> 00:26:33.067
their owner, manager,

00:26:33.367 --> 00:26:36.290
give me three pain points that you have

00:26:36.611 --> 00:26:38.854
that is just sort of eaten away at

00:26:38.894 --> 00:26:40.375
you throughout the day.

00:26:41.537 --> 00:26:45.741
Because what these types of models are all

00:26:45.761 --> 00:26:47.564
of a sudden doing is they're opening the

00:26:47.584 --> 00:26:51.087
floodgates for forward-thinking clinicians

00:26:51.127 --> 00:26:52.410
to be able to see that pain point

00:26:52.509 --> 00:26:54.112
and say, oh, we got a no-show issue?

00:26:54.311 --> 00:26:55.212
Okay, great.

00:26:55.532 --> 00:26:57.556
I think I have somewhat of a solution.

00:26:57.596 --> 00:26:58.457
In fact, John and I just...

00:26:58.957 --> 00:27:01.338
put out an article that we,

00:27:01.380 --> 00:27:02.681
we built a startup, you know,

00:27:02.820 --> 00:27:04.583
quote unquote, where we, you know, said,

00:27:04.603 --> 00:27:05.864
Hey, there's, there's a, you know,

00:27:05.903 --> 00:27:07.905
nationwide issue with no shows, you know,

00:27:07.925 --> 00:27:10.268
about, you know, clinics that, you know,

00:27:10.307 --> 00:27:12.930
have, you know, are, are dealing with,

00:27:14.352 --> 00:27:15.932
you know, what,

00:27:16.854 --> 00:27:17.193
I think it's

00:27:18.134 --> 00:27:19.875
so great let's use access to you know

00:27:19.915 --> 00:27:21.698
create all of a sudden a a network

00:27:21.877 --> 00:27:23.638
where you know if you have a space

00:27:23.659 --> 00:27:26.141
of time great get on a virtual visit

00:27:26.181 --> 00:27:27.501
with the senior because they're just right

00:27:27.521 --> 00:27:29.784
there um you know you'll have a company

00:27:29.824 --> 00:27:31.605
do the marketing or your company will do

00:27:31.625 --> 00:27:32.945
the marketing and then all of a sudden

00:27:32.986 --> 00:27:34.807
you you have a whole new you know

00:27:34.887 --> 00:27:38.430
influx of patients starting with solutions

00:27:38.450 --> 00:27:41.112
is a bad idea start with the problem

00:27:41.232 --> 00:27:42.854
then test out solutions

00:27:43.932 --> 00:27:46.253
Start with the problem and then, yes,

00:27:46.434 --> 00:27:49.736
just don't go right to your first solution

00:27:49.776 --> 00:27:50.537
and then stop there.

00:27:50.977 --> 00:27:53.637
Take it, you know, five, six, seven, ten,

00:27:53.857 --> 00:27:54.097
you know,

00:27:54.157 --> 00:27:56.199
different ideas and then see what sticks.

00:27:56.779 --> 00:27:57.220
Yeah.

00:27:57.799 --> 00:27:59.201
Yeah.

00:27:59.221 --> 00:27:59.320
Okay.

00:27:59.361 --> 00:28:00.241
I got two on this.

00:28:00.321 --> 00:28:01.501
One's a question, one's not a question.

00:28:01.781 --> 00:28:04.243
One is, or actually neither are questions.

00:28:04.483 --> 00:28:06.664
Tell me how the business works.

00:28:08.171 --> 00:28:09.330
From a money perspective,

00:28:09.391 --> 00:28:10.412
if they're willing to share with you,

00:28:10.612 --> 00:28:12.071
tell me how the money flows.

00:28:12.092 --> 00:28:13.353
Cause I think that's one thing, honestly,

00:28:13.613 --> 00:28:13.752
I,

00:28:14.313 --> 00:28:15.792
I did not ask the question of early

00:28:15.813 --> 00:28:16.393
in my career.

00:28:16.453 --> 00:28:17.834
And I realize now like how important that

00:28:17.854 --> 00:28:19.374
really is because whether it's like

00:28:19.413 --> 00:28:21.335
private practice, health system contracts,

00:28:21.375 --> 00:28:22.914
all that stuff, it's like, you,

00:28:23.215 --> 00:28:25.215
you really can't understand what the

00:28:25.355 --> 00:28:27.376
actual pain point of that director of the

00:28:27.396 --> 00:28:29.057
business owner is until you have a better

00:28:29.096 --> 00:28:30.317
understanding of how the money flows.

00:28:30.337 --> 00:28:31.278
You're like, oh,

00:28:31.337 --> 00:28:32.617
I get reimbursements going down.

00:28:33.018 --> 00:28:33.778
How do we solve that?

00:28:33.898 --> 00:28:34.338
Oh, I get it.

00:28:34.398 --> 00:28:36.038
No shows are a problem and that's driving

00:28:36.078 --> 00:28:36.660
revenue down.

00:28:37.000 --> 00:28:38.019
How do we solve that problem?

00:28:38.589 --> 00:28:40.171
that's like if you don't have that

00:28:40.270 --> 00:28:42.271
understanding of how this works it's going

00:28:42.291 --> 00:28:44.492
to make it really hard to actually

00:28:44.512 --> 00:28:46.354
understand the financial drivers that are

00:28:46.394 --> 00:28:48.595
kind of moving it the second is almost

00:28:48.615 --> 00:28:51.855
just ask for ask for forgiveness so just

00:28:51.935 --> 00:28:54.857
start doing something i'm that guy yeah go

00:28:54.877 --> 00:28:58.118
to your owner yeah and they'll be like

00:28:58.179 --> 00:29:01.461
hey i tried something and it works uh-oh

00:29:02.968 --> 00:29:04.528
That's almost like, in a way,

00:29:04.548 --> 00:29:05.289
an easier way.

00:29:05.470 --> 00:29:06.810
It's just like,

00:29:07.832 --> 00:29:08.892
I forgot what the podcast was,

00:29:08.932 --> 00:29:09.792
but basically it was just like,

00:29:09.833 --> 00:29:10.813
just do things.

00:29:10.933 --> 00:29:12.734
Just start doing stuff.

00:29:13.154 --> 00:29:14.576
You probably can figure it out.

00:29:14.635 --> 00:29:15.737
You may need to spend a little time

00:29:15.777 --> 00:29:18.097
outside work doing it, but just do it.

00:29:18.198 --> 00:29:19.199
And you'll be surprised.

00:29:19.239 --> 00:29:20.920
And that's initiative.

00:29:21.480 --> 00:29:23.682
That's like showing innovation.

00:29:24.281 --> 00:29:25.403
It's just doing something.

00:29:25.542 --> 00:29:26.804
And you don't want to break the rules

00:29:26.824 --> 00:29:27.064
or anything,

00:29:27.104 --> 00:29:28.424
but that's not what I'm telling you.

00:29:28.464 --> 00:29:30.086
Just do something, try it out,

00:29:30.145 --> 00:29:30.666
prove it out,

00:29:30.686 --> 00:29:32.127
then bring the value back to them.

00:29:34.148 --> 00:29:34.469
I mean,

00:29:34.729 --> 00:29:36.730
I was in a profession as a broadcaster,

00:29:36.769 --> 00:29:36.930
right?

00:29:37.049 --> 00:29:38.530
Working at a radio station where I was

00:29:38.550 --> 00:29:41.192
in a studio alone for four or five

00:29:41.232 --> 00:29:41.553
hours.

00:29:41.692 --> 00:29:42.854
It was my show.

00:29:43.394 --> 00:29:44.654
I couldn't run and ask my boss every

00:29:44.694 --> 00:29:45.575
time I was going to turn the microphone

00:29:45.595 --> 00:29:45.634
on.

00:29:45.694 --> 00:29:46.556
Hey, I was going to say this.

00:29:46.576 --> 00:29:47.036
What do you think?

00:29:47.076 --> 00:29:47.455
What do you think?

00:29:47.695 --> 00:29:48.416
He was like, dude,

00:29:48.436 --> 00:29:49.717
you have the chair and the microphone.

00:29:50.018 --> 00:29:50.678
If you can't fit,

00:29:50.698 --> 00:29:52.638
your job is literally figure out what's in

00:29:52.679 --> 00:29:54.039
bounds and what's good and what's bad.

00:29:54.319 --> 00:29:55.540
I'm paying you for taste.

00:29:56.181 --> 00:29:57.281
I'm not paying for you to read a

00:29:57.301 --> 00:29:57.903
liner card.

00:29:57.923 --> 00:29:59.443
We used to call those liner card jocks.

00:29:59.744 --> 00:30:00.846
That was somebody who was on the air,

00:30:01.066 --> 00:30:02.326
who they just sort of read what was

00:30:02.366 --> 00:30:04.288
in front of them in radio voice,

00:30:04.328 --> 00:30:05.210
which is not a skill.

00:30:05.509 --> 00:30:05.951
It's not.

00:30:06.852 --> 00:30:08.333
And I was always taught when I got

00:30:08.353 --> 00:30:09.994
a little higher and became program

00:30:10.015 --> 00:30:11.236
director of the station, it was like...

00:30:12.297 --> 00:30:13.719
And I was always nervous about screwing

00:30:13.778 --> 00:30:13.959
up,

00:30:14.038 --> 00:30:15.299
partly because I got like a woo

00:30:15.661 --> 00:30:18.242
personality and I wanted my bosses to like

00:30:18.282 --> 00:30:18.363
me.

00:30:19.280 --> 00:30:20.682
but I wanted to be seen as clever.

00:30:21.201 --> 00:30:22.502
And literally my boss just sat me down.

00:30:22.522 --> 00:30:23.323
He goes, Jimmy,

00:30:23.363 --> 00:30:24.683
just run this through your head.

00:30:24.723 --> 00:30:26.865
Like you're going to have to explain

00:30:26.884 --> 00:30:27.744
whatever you're doing.

00:30:27.964 --> 00:30:29.905
If you're okay saying this happened,

00:30:30.145 --> 00:30:32.347
I did this to me in my office,

00:30:32.627 --> 00:30:33.307
then do it.

00:30:33.528 --> 00:30:34.107
Like we're all make,

00:30:34.669 --> 00:30:36.529
we're monkeys on a rock in space, dude.

00:30:36.549 --> 00:30:37.910
We're all, this is all made up.

00:30:37.990 --> 00:30:39.211
Everything's made up, right?

00:30:39.570 --> 00:30:41.352
So it's like, if you're okay with saying,

00:30:41.811 --> 00:30:43.452
I saw this, I did this,

00:30:43.813 --> 00:30:44.673
that's the filter.

00:30:44.973 --> 00:30:46.875
And if the answer is yes, hell yes.

00:30:47.494 --> 00:30:48.115
Then don't do it.

00:30:48.215 --> 00:30:49.537
I also had kids that were younger than

00:30:49.576 --> 00:30:50.898
me who were my broadcasters.

00:30:51.419 --> 00:30:53.260
I'm thinking about doing that, and I go,

00:30:53.381 --> 00:30:55.623
if you're asking me, the answer is no.

00:30:55.682 --> 00:30:57.065
We're not going to win or lose based

00:30:57.105 --> 00:30:58.566
on this ridiculous Hail Mary.

00:30:58.826 --> 00:30:59.267
We're not.

00:30:59.467 --> 00:31:00.867
We're not going to win on that,

00:31:01.088 --> 00:31:02.710
but we sure might be able to lose

00:31:03.171 --> 00:31:03.530
on that.

00:31:03.611 --> 00:31:04.172
So I like that.

00:31:04.311 --> 00:31:04.912
Ask the questions.

00:31:04.952 --> 00:31:05.833
Just do stuff, kids.

00:31:06.213 --> 00:31:08.155
Are you guys ready to play a quick

00:31:08.195 --> 00:31:08.556
game?

00:31:08.576 --> 00:31:09.497
We're going to do a quick game.

00:31:09.517 --> 00:31:10.178
You guys cool with that?

00:31:10.198 --> 00:31:11.078
Let's do it.

00:31:18.749 --> 00:31:19.750
The game is brought to you by Sarah

00:31:19.769 --> 00:31:20.029
Health.

00:31:20.069 --> 00:31:21.210
Big thanks to Sarah Health.

00:31:21.250 --> 00:31:21.830
Good timing.

00:31:21.871 --> 00:31:23.530
The remote care platform helping clinics

00:31:23.571 --> 00:31:25.192
boost revenue without adding staff.

00:31:25.451 --> 00:31:26.532
It's almost like we timed it.

00:31:27.133 --> 00:31:30.035
Sarah automates daily patient check-ins

00:31:30.075 --> 00:31:30.954
via text.

00:31:31.375 --> 00:31:32.135
You just did the math.

00:31:32.496 --> 00:31:34.317
No app, no logins.

00:31:34.777 --> 00:31:35.396
All you have to tell me is I

00:31:35.416 --> 00:31:36.478
don't have to log in or I can

00:31:36.518 --> 00:31:37.898
log in with my face and I'll show

00:31:37.959 --> 00:31:38.078
up.

00:31:38.538 --> 00:31:39.378
Just better outcomes.

00:31:39.439 --> 00:31:40.779
It's a simple way to meet RTM

00:31:40.819 --> 00:31:42.339
requirements, improve follow-through,

00:31:42.619 --> 00:31:44.960
and actually get reimbursed for care

00:31:45.180 --> 00:31:46.141
between visits.

00:31:46.540 --> 00:31:47.280
Sarah Health.

00:31:47.601 --> 00:31:49.280
It's Sarah without the H.

00:31:49.480 --> 00:31:50.682
There's always that girl in your class

00:31:50.701 --> 00:31:53.362
who's like, no H. S-A-R-A health.com.

00:31:53.382 --> 00:31:55.603
That's S-A-R-A health.com.

00:31:55.702 --> 00:31:58.722
This game is called Full Stack Fire.

00:31:59.163 --> 00:32:00.584
So I'm going to throw out a line

00:32:00.663 --> 00:32:01.284
or a question.

00:32:02.320 --> 00:32:03.681
And then you guys have to respond.

00:32:04.000 --> 00:32:06.041
We'll go John, Ryan, John, Ryan.

00:32:06.061 --> 00:32:07.162
Those will be the lines.

00:32:07.182 --> 00:32:09.383
So first question on full stack fire

00:32:09.423 --> 00:32:09.623
round.

00:32:10.143 --> 00:32:13.003
RTM or telehealth, you have to keep one.

00:32:13.263 --> 00:32:14.544
You have to ditch the other.

00:32:14.584 --> 00:32:17.545
You can only have RTM or telehealth.

00:32:17.865 --> 00:32:18.486
Which one is it?

00:32:18.925 --> 00:32:19.865
Keep RTM.

00:32:20.632 --> 00:32:20.811
Got it.

00:32:20.892 --> 00:32:21.152
Why?

00:32:21.231 --> 00:32:22.212
Real quick, just a second.

00:32:22.232 --> 00:32:23.354
Yeah, yeah, for sure.

00:32:23.394 --> 00:32:24.094
You know, in the end,

00:32:24.134 --> 00:32:26.015
telehealth is always going to have a

00:32:26.055 --> 00:32:26.174
point.

00:32:26.214 --> 00:32:28.537
By the way, telehealth is part of RTM.

00:32:28.676 --> 00:32:30.438
It's lodged in there, if y'all want to.

00:32:31.097 --> 00:32:32.419
No, but I think in the end,

00:32:32.499 --> 00:32:34.980
I think that's the one that scales better.

00:32:35.421 --> 00:32:36.781
And it's actually the one I think patients

00:32:36.801 --> 00:32:39.182
will like and adopt in the future.

00:32:39.343 --> 00:32:40.304
You don't need to talk to one on

00:32:40.324 --> 00:32:41.144
the video.

00:32:41.444 --> 00:32:42.505
You can just text with somebody.

00:32:42.525 --> 00:32:43.346
You can message them.

00:32:43.986 --> 00:32:44.547
It's monitoring.

00:32:44.646 --> 00:32:45.946
I think that's the way it's going to

00:32:45.967 --> 00:32:46.127
go.

00:32:46.468 --> 00:32:47.748
Ryan, RTM or telehealth?

00:32:48.328 --> 00:32:48.949
It's a Highlander.

00:32:49.249 --> 00:32:50.029
There can only be one.

00:32:51.946 --> 00:32:53.689
Yeah, I'm going to go RTM as well.

00:32:53.769 --> 00:32:54.829
Okay.

00:32:54.849 --> 00:32:56.852
Yeah, as John mentioned,

00:32:57.291 --> 00:32:58.614
I don't think it's just the scale,

00:32:58.634 --> 00:33:02.136
but anything that's a little bit more

00:33:02.217 --> 00:33:04.740
asynchronous is going to play better.

00:33:05.460 --> 00:33:08.282
So forcing patients to get on a screen

00:33:08.442 --> 00:33:10.345
every time is going to be really

00:33:10.384 --> 00:33:11.165
cumbersome for them,

00:33:11.205 --> 00:33:12.487
and it's just not a great patient

00:33:12.527 --> 00:33:12.968
experience.

00:33:13.564 --> 00:33:14.545
Okay.

00:33:14.565 --> 00:33:15.285
Here's the second one.

00:33:15.345 --> 00:33:18.467
Clinical pilot or product prototype?

00:33:18.826 --> 00:33:20.949
What gets you more excited personally?

00:33:21.229 --> 00:33:22.670
Do you want to see a clinical pilot

00:33:23.029 --> 00:33:24.351
or a product prototype?

00:33:24.371 --> 00:33:25.031
This is personal,

00:33:25.051 --> 00:33:26.471
so there's no right answer here.

00:33:26.532 --> 00:33:27.873
John?

00:33:27.893 --> 00:33:29.473
I'll go clinical pilot because I want to

00:33:29.513 --> 00:33:30.974
see how it actually works and what

00:33:31.035 --> 00:33:31.175
happens.

00:33:31.195 --> 00:33:31.836
Pressure test.

00:33:31.996 --> 00:33:32.115
Yeah.

00:33:32.155 --> 00:33:32.916
It's cute.

00:33:32.957 --> 00:33:33.957
It looks great on the shelf,

00:33:33.977 --> 00:33:36.159
but how's this thing swim in the deep

00:33:36.219 --> 00:33:36.338
end?

00:33:36.723 --> 00:33:37.203
Yeah, exactly.

00:33:37.244 --> 00:33:38.965
And people do the craziest things and

00:33:38.986 --> 00:33:39.486
you're like, oh,

00:33:39.507 --> 00:33:40.688
I had no idea you could work around

00:33:40.708 --> 00:33:41.107
like that.

00:33:41.208 --> 00:33:42.328
That's pretty wild.

00:33:42.348 --> 00:33:42.888
Like you learn a ton.

00:33:42.910 --> 00:33:43.549
So, yeah.

00:33:44.590 --> 00:33:45.511
Ryan?

00:33:45.531 --> 00:33:46.633
I'm going to go product prototype.

00:33:46.732 --> 00:33:49.355
Okay, awesome.

00:33:49.375 --> 00:33:50.375
Because they're more fun.

00:33:51.656 --> 00:33:52.557
I mean, yeah,

00:33:52.577 --> 00:33:54.199
you get to kind of take what's in

00:33:54.220 --> 00:33:55.279
your head and then all of a sudden

00:33:55.339 --> 00:33:57.261
it's just there and then you can kind

00:33:57.301 --> 00:33:58.042
of play around from there.

00:33:58.988 --> 00:34:00.148
You got to pick a side here.

00:34:00.650 --> 00:34:04.054
Clinician led or VC backed?

00:34:04.294 --> 00:34:06.817
Which one do you choose?

00:34:06.877 --> 00:34:09.581
This is like the Civil War.

00:34:09.601 --> 00:34:11.182
Clinician led or VC backed?

00:34:14.929 --> 00:34:16.190
Who's going first on this one, Jimmy?

00:34:16.590 --> 00:34:17.389
You're going to go first.

00:34:17.530 --> 00:34:18.630
I like that there's a pause.

00:34:18.710 --> 00:34:19.490
It means you're thinking.

00:34:19.530 --> 00:34:21.291
I like it.

00:34:21.371 --> 00:34:22.152
Okay.

00:34:22.672 --> 00:34:24.273
I will say clinician-like because that's

00:34:24.313 --> 00:34:25.755
what Shark United are doing with our thing

00:34:25.775 --> 00:34:25.974
here.

00:34:25.994 --> 00:34:26.614
It's like, hey,

00:34:27.175 --> 00:34:28.695
we think there's a lot of room.

00:34:28.815 --> 00:34:29.817
There's a lot of room.

00:34:30.137 --> 00:34:31.777
And they're completely different games.

00:34:32.097 --> 00:34:33.079
I think that Shark United have had that

00:34:33.099 --> 00:34:33.418
conversation.

00:34:33.739 --> 00:34:34.539
They're not the same game.

00:34:34.559 --> 00:34:36.920
I understand what game you're playing.

00:34:36.940 --> 00:34:38.722
There's a ton of space for...

00:34:39.942 --> 00:34:44.663
smaller more nimble companies people to do

00:34:44.702 --> 00:34:47.284
things just just go do it and start

00:34:47.304 --> 00:34:48.304
it up and see what happens like that's

00:34:48.344 --> 00:34:49.403
good that's literally what shark and i're

00:34:49.423 --> 00:34:50.864
trying to do is right we think we

00:34:50.903 --> 00:34:52.324
can actually do something and have an

00:34:52.364 --> 00:34:54.224
impact at a very small level like we

00:34:54.244 --> 00:34:56.766
have no desire to be a vc backed

00:34:57.286 --> 00:35:00.106
sub stack um you said it on february

00:35:00.146 --> 00:35:04.347
it's recorded it's recorded well i feel

00:35:04.467 --> 00:35:05.568
all right ryan you answer then i'll

00:35:05.648 --> 00:35:06.748
actually chime in for this one so there's

00:35:06.768 --> 00:35:07.367
no wrong answer

00:35:08.309 --> 00:35:09.570
Well, since John said that,

00:35:09.590 --> 00:35:10.911
I'm going to go beat BC back.

00:35:10.931 --> 00:35:11.851
Got it.

00:35:12.032 --> 00:35:12.251
Yeah.

00:35:12.711 --> 00:35:17.713
And this is not in any way a

00:35:17.773 --> 00:35:19.454
dig at anything that's clinician-led.

00:35:21.666 --> 00:35:23.487
Having having voices that are outside of

00:35:23.507 --> 00:35:26.170
the industry come in and question what's

00:35:26.230 --> 00:35:29.512
going on in the industry is is something

00:35:29.532 --> 00:35:30.751
that I think is very healthy.

00:35:31.632 --> 00:35:35.315
And so there's there's that VC backed

00:35:35.675 --> 00:35:38.217
portion that gets too far away from what

00:35:38.257 --> 00:35:38.896
good care is.

00:35:38.916 --> 00:35:41.038
And that's why you need clinicians in VC

00:35:41.057 --> 00:35:43.800
backed companies to be able to help to

00:35:43.820 --> 00:35:45.360
kind of make sure that the ship is

00:35:45.400 --> 00:35:46.501
continuing to steer in the right

00:35:46.521 --> 00:35:46.902
direction.

00:35:47.697 --> 00:35:50.501
But yeah, I think it's healthcare.

00:35:50.581 --> 00:35:51.643
It's, it's funky.

00:35:51.864 --> 00:35:53.425
And people ask, you know,

00:35:53.867 --> 00:35:55.369
like really great questions about things

00:35:55.389 --> 00:35:56.931
that have happened in healthcare for,

00:35:57.090 --> 00:35:58.572
you know, twenty, thirty plus years.

00:35:58.592 --> 00:35:59.233
I was like,

00:35:59.313 --> 00:36:00.054
why do you all do this?

00:36:00.094 --> 00:36:02.036
And we all kind of sit around.

00:36:02.056 --> 00:36:02.498
We don't know.

00:36:02.777 --> 00:36:03.518
So, yeah,

00:36:03.539 --> 00:36:04.621
I think it's good to ask those questions.

00:36:05.077 --> 00:36:06.358
So clinician-led, VC-backed,

00:36:06.378 --> 00:36:08.501
plus the money's not too bad when you

00:36:08.521 --> 00:36:09.360
get VC involved.

00:36:09.380 --> 00:36:09.922
But then, hey, man,

00:36:09.942 --> 00:36:10.942
you're giving up some control.

00:36:11.503 --> 00:36:12.784
But hey, listen, listen,

00:36:13.123 --> 00:36:14.684
this is why it's not necessarily one or

00:36:14.724 --> 00:36:15.065
the other.

00:36:15.126 --> 00:36:16.467
It's like clinician-led,

00:36:16.646 --> 00:36:17.646
who are the clinicians?

00:36:17.706 --> 00:36:18.708
I need to know more information.

00:36:19.108 --> 00:36:20.969
VC-backed, who's the VC?

00:36:20.989 --> 00:36:21.750
What are their goals?

00:36:21.789 --> 00:36:22.510
What's their experience?

00:36:22.530 --> 00:36:23.170
What's their motivation?

00:36:23.251 --> 00:36:24.592
What do they bring to the table?

00:36:25.333 --> 00:36:26.253
It's a simple question.

00:36:26.293 --> 00:36:27.293
It's just not an easy one.

00:36:27.333 --> 00:36:27.893
Last one.

00:36:28.353 --> 00:36:32.476
Substack post you wish every PT would

00:36:32.576 --> 00:36:33.016
read.

00:36:33.076 --> 00:36:35.677
What's one thing you've taken time and

00:36:35.737 --> 00:36:37.458
effort to put out there that you're like,

00:36:37.798 --> 00:36:39.318
listen, if I could have one,

00:36:39.838 --> 00:36:40.820
this is the one I'd want you to

00:36:40.860 --> 00:36:41.019
read.

00:36:42.983 --> 00:36:44.824
I'll say the very first one that we

00:36:44.864 --> 00:36:45.364
put out,

00:36:45.545 --> 00:36:46.865
that was kind of that whole idea of

00:36:47.045 --> 00:36:48.786
what the heck is full-stack healthcare.

00:36:48.846 --> 00:36:49.726
And I think that was the one that

00:36:49.746 --> 00:36:50.206
was just kind of,

00:36:50.266 --> 00:36:52.307
that was burning in my mind for years.

00:36:52.347 --> 00:36:53.007
And I was like, I just,

00:36:53.827 --> 00:36:55.369
we got to start thinking about it.

00:36:55.449 --> 00:36:56.668
And it's just like,

00:36:57.050 --> 00:36:59.389
care is not just in-person care.

00:36:59.469 --> 00:37:03.552
I think that's like fundamental belief

00:37:03.612 --> 00:37:04.251
number one,

00:37:04.271 --> 00:37:05.652
that if you can get over that,

00:37:07.306 --> 00:37:08.827
it opens up a ton of doors.

00:37:09.007 --> 00:37:10.369
And that's kind of literally the first one

00:37:10.389 --> 00:37:10.690
we put out.

00:37:10.710 --> 00:37:13.351
I was just trying to describe like you

00:37:13.371 --> 00:37:15.052
can do care a lot of different ways.

00:37:15.112 --> 00:37:17.054
Patients kind of don't care how they get

00:37:17.094 --> 00:37:18.394
it as long as they get their problem

00:37:18.454 --> 00:37:19.036
solved.

00:37:19.115 --> 00:37:21.217
Like they don't care the delivery method.

00:37:21.538 --> 00:37:23.619
It's just, just get it to them.

00:37:23.978 --> 00:37:24.599
And I think that's, yeah,

00:37:24.699 --> 00:37:25.840
that's like number one.

00:37:26.317 --> 00:37:27.559
So you had your whole life to write

00:37:27.579 --> 00:37:28.521
your first post.

00:37:28.722 --> 00:37:29.563
And then the second one,

00:37:29.583 --> 00:37:30.925
that's the struggle with artists.

00:37:30.945 --> 00:37:32.108
You had your whole life to release your

00:37:32.148 --> 00:37:32.710
first album.

00:37:32.730 --> 00:37:33.731
And then the company's like, great,

00:37:33.751 --> 00:37:34.452
here's a bag of money.

00:37:34.833 --> 00:37:35.514
Do that again.

00:37:36.237 --> 00:37:36.577
Ryan,

00:37:36.617 --> 00:37:38.099
Substack posts you wish every PT would

00:37:38.119 --> 00:37:38.219
read.

00:37:38.813 --> 00:37:41.715
uh i'm i'm gonna i agree with john

00:37:41.775 --> 00:37:44.197
i think that first post is probably um

00:37:44.338 --> 00:37:46.199
the the most impactful for for any

00:37:46.298 --> 00:37:49.001
clinician though i'm gonna go with we we

00:37:49.021 --> 00:37:51.302
did a post on different models of care

00:37:51.663 --> 00:37:54.164
uh and i i feel like this is

00:37:54.384 --> 00:37:56.326
one of those that uh a lot of

00:37:56.346 --> 00:37:58.507
clinicians when they read it they their

00:37:58.967 --> 00:38:00.168
brain starts to kind of open up and

00:38:00.188 --> 00:38:01.869
say oh there's there's other models other

00:38:01.889 --> 00:38:04.670
than fee-for-service like yes there's

00:38:04.690 --> 00:38:06.652
there's a number of those and let's learn

00:38:06.672 --> 00:38:08.032
about them and i think that kind of

00:38:08.052 --> 00:38:08.634
like gets the

00:38:09.094 --> 00:38:11.701
the curiosity going for clinicians on,

00:38:11.902 --> 00:38:12.222
you know,

00:38:12.282 --> 00:38:13.425
learning a little bit more about,

00:38:13.545 --> 00:38:15.670
you know, the broader scope of healthcare.

00:38:16.496 --> 00:38:16.755
Yep.

00:38:17.036 --> 00:38:18.757
And I mentioned that Schopenhauer quote,

00:38:18.797 --> 00:38:18.976
right?

00:38:19.016 --> 00:38:19.956
First, it's ridiculed.

00:38:20.396 --> 00:38:21.677
Then it's violently opposed.

00:38:22.036 --> 00:38:23.777
Then it's accepted as being obvious.

00:38:23.818 --> 00:38:24.297
And of course,

00:38:24.358 --> 00:38:25.838
I believed in this thing the whole time.

00:38:25.918 --> 00:38:27.458
I remember I got ridiculed launching a

00:38:27.498 --> 00:38:28.858
podcast as a PT student.

00:38:29.119 --> 00:38:30.119
Classmates were like,

00:38:30.300 --> 00:38:31.119
are you still doing that?

00:38:31.139 --> 00:38:31.739
That's cute.

00:38:32.099 --> 00:38:33.679
I had a professor tell me it was

00:38:33.699 --> 00:38:35.021
a giant waste of time.

00:38:35.460 --> 00:38:36.641
And I was like, all right.

00:38:36.701 --> 00:38:38.422
So there's the violent opposition.

00:38:38.601 --> 00:38:39.641
I think she just wanted to like...

00:38:40.322 --> 00:38:42.503
exert force and was like that's silly you

00:38:42.523 --> 00:38:44.346
should just study more and i'm like i

00:38:44.385 --> 00:38:46.146
gotta be honest i am studying when i'm

00:38:46.246 --> 00:38:47.869
asking these questions and getting great

00:38:47.949 --> 00:38:50.070
answers i'm a verbal processor as we

00:38:50.110 --> 00:38:52.052
started the episode off uh last thing we

00:38:52.072 --> 00:38:53.733
do on the show guys is called the

00:38:53.813 --> 00:38:58.277
parting shot this is the parting shot one

00:38:58.318 --> 00:39:02.442
last mic drop moment no pressure just your

00:39:02.501 --> 00:39:03.623
legacy on the line

00:39:05.079 --> 00:39:06.880
Whenever you want to be your last, yeah,

00:39:07.141 --> 00:39:08.521
just your entire legacy on the line.

00:39:08.581 --> 00:39:09.021
Not really, though.

00:39:09.702 --> 00:39:10.702
Whatever you want to leave with the

00:39:10.762 --> 00:39:12.302
audience as your parting shot.

00:39:12.322 --> 00:39:12.842
What do you got, John?

00:39:12.862 --> 00:39:13.842
All right.

00:39:13.882 --> 00:39:15.202
So I think my,

00:39:15.543 --> 00:39:17.603
I really challenge anyone listening.

00:39:17.664 --> 00:39:18.764
So whether you're a PT,

00:39:18.885 --> 00:39:19.945
you're a leader in the field,

00:39:21.025 --> 00:39:22.746
really take a step back and think about

00:39:22.865 --> 00:39:25.067
what will change the trajectory of the

00:39:25.086 --> 00:39:25.527
profession.

00:39:26.809 --> 00:39:28.210
I guarantee it's not going to be,

00:39:28.331 --> 00:39:29.813
it's the new best exercise.

00:39:29.873 --> 00:39:30.552
It's the new investment.

00:39:30.592 --> 00:39:32.375
It's not in the new best manual therapy

00:39:32.394 --> 00:39:32.735
technique.

00:39:32.795 --> 00:39:33.996
It's not going to be that it is

00:39:34.036 --> 00:39:37.179
going to be how technology changes care.

00:39:37.278 --> 00:39:38.659
It's going to be payment models.

00:39:39.681 --> 00:39:40.942
Like those are the two things that will

00:39:40.961 --> 00:39:41.541
literally change.

00:39:41.561 --> 00:39:41.842
They will,

00:39:41.943 --> 00:39:44.724
they will change how you practice without

00:39:44.744 --> 00:39:45.945
you even knowing it.

00:39:46.266 --> 00:39:47.648
And I think that that took me for,

00:39:47.947 --> 00:39:49.188
I did the whole fellowship route.

00:39:49.248 --> 00:39:50.090
I did all that stuff.

00:39:50.150 --> 00:39:51.271
I tried to go there and I was

00:39:51.291 --> 00:39:52.791
like, that's just incremental.

00:39:53.655 --> 00:39:54.335
And it's fine.

00:39:54.396 --> 00:39:54.956
We need that.

00:39:55.016 --> 00:39:56.117
I'm not saying we don't need that.

00:39:56.257 --> 00:39:57.579
But if you're really going to take the

00:39:57.880 --> 00:39:59.521
PT as a profession,

00:40:00.503 --> 00:40:01.784
technology and payment,

00:40:03.367 --> 00:40:04.128
you got to look there.

00:40:04.608 --> 00:40:05.969
You just got to start to understand that

00:40:05.989 --> 00:40:06.992
stuff better.

00:40:07.052 --> 00:40:07.192
Ryan?

00:40:09.507 --> 00:40:11.409
If you are a PT and you hang

00:40:11.429 --> 00:40:17.592
your hat on diagnosing the perfect injury

00:40:17.632 --> 00:40:19.914
type and creating the best exercise plan

00:40:19.954 --> 00:40:20.273
for that,

00:40:21.094 --> 00:40:23.996
you will readily be made obsolete in the

00:40:24.016 --> 00:40:24.815
next five years.

00:40:26.737 --> 00:40:28.318
What's going to what's going to separate

00:40:29.018 --> 00:40:30.940
really great clinicians from someone who's

00:40:31.081 --> 00:40:32.262
average is going to be the way that

00:40:32.302 --> 00:40:34.242
you communicate, you know,

00:40:34.322 --> 00:40:35.523
and it's going to be your communication

00:40:35.543 --> 00:40:35.804
style.

00:40:35.844 --> 00:40:37.666
There's a ton of research that's starting

00:40:37.686 --> 00:40:39.668
to come out on communication,

00:40:39.728 --> 00:40:41.409
a lot like how we were starting to

00:40:41.429 --> 00:40:43.510
understand habits about fifteen years ago.

00:40:43.831 --> 00:40:45.192
We're starting to understand that there's

00:40:45.211 --> 00:40:48.034
just different ways of communicating and

00:40:48.054 --> 00:40:49.295
there's different conversations that are

00:40:49.355 --> 00:40:51.297
happening in the exact same way.

00:40:52.197 --> 00:40:53.599
In the exact same conversation,

00:40:54.059 --> 00:40:55.521
are you having a logical conversation?

00:40:55.541 --> 00:40:56.983
Are you having an emotional conversation?

00:40:57.063 --> 00:40:59.867
And being diagnosed that is going to

00:41:00.168 --> 00:41:02.630
massively improve how you're able to

00:41:02.690 --> 00:41:03.371
connect with people.

00:41:04.324 --> 00:41:06.005
my parents are so excited that i got

00:41:06.025 --> 00:41:07.646
a journalism and communications degree

00:41:07.806 --> 00:41:09.809
then came to healthcare and it didn't make

00:41:09.889 --> 00:41:11.869
any sense but now i'm like guys guys

00:41:12.371 --> 00:41:14.052
this is my jam look at this this

00:41:14.112 --> 00:41:15.914
intersection i live here this is my house

00:41:15.954 --> 00:41:17.635
come on in let's solve this thing yeah

00:41:17.835 --> 00:41:19.376
it's a communication thing you mentioned

00:41:19.637 --> 00:41:21.617
uh emotion or logic if i'm having an

00:41:21.657 --> 00:41:23.059
emotional conversation

00:41:23.760 --> 00:41:26.041
if i'm sorry not a conversation i'm having

00:41:26.400 --> 00:41:28.362
if i'm giving emotional statements and

00:41:28.382 --> 00:41:30.001
you're having a logical you're sending me

00:41:30.061 --> 00:41:32.182
logical statements back that's when we're

00:41:32.202 --> 00:41:33.543
just starting we're just two dubbermans

00:41:33.663 --> 00:41:35.003
yet barking at each other through a fence

00:41:35.744 --> 00:41:37.644
understand what game you're playing

00:41:37.844 --> 00:41:39.405
understand what kind of conversation

00:41:39.425 --> 00:41:42.346
you're having or it will not progress it's

00:41:42.365 --> 00:41:43.786
just not going to do it the book

00:41:43.887 --> 00:41:46.907
i would suggest would be uh chris voss

00:41:48.505 --> 00:41:49.405
never split the difference,

00:41:49.425 --> 00:41:51.748
communicate like your life depends on it.

00:41:52.047 --> 00:41:53.869
Former FBI hostage negotiator.

00:41:54.349 --> 00:41:55.791
He deeply understood

00:41:57.014 --> 00:41:59.094
how to do this with little to no

00:41:59.195 --> 00:42:01.855
scientific like formal background but he

00:42:01.875 --> 00:42:03.496
was like i'm in a high-stakes situation i

00:42:03.516 --> 00:42:05.275
gotta figure this out that's why i love

00:42:05.295 --> 00:42:06.856
the title of the book too it's like

00:42:06.876 --> 00:42:08.077
never split the difference he couldn't

00:42:08.097 --> 00:42:09.436
roll up to a bank robbery like all

00:42:09.456 --> 00:42:10.237
right what do you got you got a

00:42:10.277 --> 00:42:11.938
million dollars and ten hostages all right

00:42:11.998 --> 00:42:14.179
why don't you keep five i'll take five

00:42:14.378 --> 00:42:15.639
take you half a million dollars we'll take

00:42:15.659 --> 00:42:16.518
the half a minute we'll call it a

00:42:16.539 --> 00:42:19.159
day that's not how it works it's sort

00:42:19.179 --> 00:42:20.900
of a zero-sum game and that's how it

00:42:20.920 --> 00:42:21.840
is in your business

00:42:22.420 --> 00:42:24.420
That's every and the line I love there

00:42:24.561 --> 00:42:27.242
is every conversation is a negotiation for

00:42:27.302 --> 00:42:27.862
information,

00:42:28.282 --> 00:42:29.663
whether you're trying to get someone to

00:42:29.722 --> 00:42:31.242
understand or you're trying to get

00:42:31.282 --> 00:42:33.222
information out, treat it as such.

00:42:33.943 --> 00:42:35.583
And I don't think it's a silver bullet,

00:42:35.603 --> 00:42:36.643
but it's pretty dang good.

00:42:36.704 --> 00:42:38.364
It's pretty dang close and starts to make

00:42:38.385 --> 00:42:38.784
things better.

00:42:39.184 --> 00:42:42.166
Say it again where people can go read

00:42:42.186 --> 00:42:43.146
these full stack health.

00:42:43.365 --> 00:42:44.206
Hit the website one more time.

00:42:44.724 --> 00:42:48.105
Yeah, so fullstackhealthcare.substack.

00:42:48.565 --> 00:42:52.927
Fullstackhealthcare.substack.

00:42:53.027 --> 00:42:54.226
I'll put it in the show notes.

00:42:54.246 --> 00:42:55.427
That's why I like the show notes after.

00:42:55.467 --> 00:42:56.807
It makes me look like I took notes

00:42:56.847 --> 00:42:58.389
in class, but it's all at the end.

00:42:59.168 --> 00:43:00.409
Gentlemen, thanks so much for doing this.

00:43:00.429 --> 00:43:02.309
We'll have you back on when we've got

00:43:02.449 --> 00:43:03.590
something that pops, right?

00:43:03.610 --> 00:43:05.751
Something that's the great thing.

00:43:06.510 --> 00:43:07.811
The only constant is change.

00:43:07.871 --> 00:43:09.592
Something will change and it'll shift and

00:43:09.612 --> 00:43:10.793
then you guys will be there to explain

00:43:10.833 --> 00:43:11.172
it to me.

00:43:11.632 --> 00:43:12.313
Appreciate your time, guys.

00:43:12.333 --> 00:43:13.074
Thanks, Jimmy.

00:43:15.070 --> 00:43:16.132
That's it for this one,

00:43:16.411 --> 00:43:18.094
but we're just getting warmed up.

00:43:18.554 --> 00:43:20.476
Smash follow, send it to a friend,

00:43:20.675 --> 00:43:22.336
or crank up the next episode.

00:43:22.858 --> 00:43:23.759
Want to go deeper?

00:43:24.219 --> 00:43:28.282
Hit us at pgpiecast.com or find us on

00:43:28.302 --> 00:43:30.864
YouTube and socials at pgpiecast.

00:43:31.264 --> 00:43:33.547
And legally, none of this was advice.

00:43:33.626 --> 00:43:35.268
It's for entertainment purposes only.

00:43:35.309 --> 00:43:36.250
See you.

00:43:36.389 --> 00:43:37.630
Bulls**t. See, Keith?

00:43:37.831 --> 00:43:38.891
We read the script.

00:43:39.192 --> 00:43:39.833
Happy now?