The Role of PTs in Value-Based Care

WEBVTT

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and I want to make sure I'm

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pronouncing your name right

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it's is it strauss never

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like to assume because it's

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difficult to get your foot

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out of your mouth after you

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say the guest's name

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incorrectly it's very hard

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that's my ex-husband's name

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you're saying so got it all

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right let me see do do do

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there's my notes here's

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where we start dana welcome

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to the program thanks for having me jimmy

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All right,

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so we're doing an episode on

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value-based care, VBC.

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So we gotta start from the start.

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For people like me,

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make sure I don't get left behind.

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Help me understand,

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explain what value-based care is,

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and then why is it such a

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game changer for healthcare,

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especially for our

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colleagues who are also

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physical therapists?

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We'll start with the macro.

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Yeah, let's start big macro.

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So I'm going to define it two ways.

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So because I think

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value-based care is just a buzzword.

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I hear it thrown around and

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really without an

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understanding of the context.

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And I break it down kind of

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into two parts.

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There's the care part,

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what's different about the care,

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and then there's the payment model part.

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So when we say value-based care,

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it can be as simple as

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I'm providing care that's valuable,

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that leads to something

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that's a better outcome,

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and the dollars were useful

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to that individual and to

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that person's long-term outcomes.

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And then there is

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value-based care in sort of

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the greater alternative

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payment model sense,

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which means that providers

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are reimbursed for the care

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that they provide based on

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the outcomes of the

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individuals they provide care to,

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and that's generally at the

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population level or at the

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episode or group of episode level.

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So value-based care

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essentially means that

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you're providing care that

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is the highest quality for

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the lowest cost.

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So it's a

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It's an equation, right?

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The simplest terms.

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It means like looking for

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the best outcomes,

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providing the best care

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that leads to those

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outcomes and avoiding unnecessary care,

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right?

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That's part of value-based care,

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providing more upstream care,

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avoiding care because

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you're providing higher

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quality care on the upside.

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managing chronic conditions better,

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so you're avoiding the care

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of complex patients that

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you can do better on.

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It's all of those things.

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That's really what value-based care means.

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Got it.

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Now, why is it such a game changer?

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Why is this going to be better?

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Why is this something that

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we should do more of?

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Yeah.

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So what we've been doing up

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until now is very broken, right,

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in America.

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In America,

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we pay for care based upon the

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amount of care that

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a provider or an institution

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can get in in a day, right?

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Or get in in an episode.

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So when we're talking about like,

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let's just say a physician office,

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kind of use it as the gold standard.

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It's how many visits at high, you know,

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high unit price can you get

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done in a day?

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Right.

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If you're talking about a hospital,

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it's based upon the payment

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that the hospital gets for

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that admission.

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How quickly can we get that

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person through the

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admission and discharge to

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fill the bed again?

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So everything is based right now,

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not on the product, I call it the product,

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the outcome of an episode

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or care that's provided,

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but it's based upon the quantity.

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And when we move to value,

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we're looking at care

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completely differently.

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And that includes even things like

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what we consider worth paying for.

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And so that's,

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we'll move into why that's

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important to therapy after

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giving you a little bit

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more of the background.

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And I'm gonna use primary

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care as an example.

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So primary care docs,

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primary care providers,

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when you think about physician practice,

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traditional primary care,

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they're doing a lot of

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things that don't have

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reimbursement codes, right?

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And a lot of what is highly valuable

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in medical care doesn't have

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reimbursement codes because

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we developed the

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reimbursement system based

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on only transactions.

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So a primary care doc,

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ideally their whole team is

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working on maintaining

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engagement with their patients,

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getting in their annual wellness visits,

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making sure they have their

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colonoscopies done,

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making sure they have a

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strong way to communicate

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with the office when there's a problem,

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making sure they have

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really good access to care.

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Having time with patients.

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None of those things have

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reimbursement attached to them, right?

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Like having good access hours.

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That's not attached to anything.

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Being able to spend

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additional time with people

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to explain how things work

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rather than sending them

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right to a specialist.

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No reimbursement around that.

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Addressing people's needs for food,

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housing.

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Any of those things,

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social determinant issues,

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there's no reimbursement

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codes for those times.

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So the simplest way to think about,

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as I start to bring in the role of PT,

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is where you have care,

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providers that give care, provide care,

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that revolves around a lot

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of communication and

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behavior change you're

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trying to help with or incentivize,

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you have an opportunity to

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look at the value of those

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services differently in value-based care.

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And I'm going to segue that

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into therapy here, because as we know,

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as physical therapists and

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your listeners know,

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There is a lot,

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a lot that physical

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therapists do and the

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therapy professions do that

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does not have either a high

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value associated with it or

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any value at all.

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So when we spend, for example,

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we spend a lot of time on

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patient education, right?

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And we work on helping to

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change behavior so that

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patients follow their home

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exercise program.

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which may then involve a

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longer and a better long-term outcome.

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Those don't have billing

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codes attached to them.

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So we have a certain number

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of billing codes associated with therapy.

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They're transactional in nature,

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and they only have a

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certain value attached to

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them based upon the RUC, right?

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So if anybody's not familiar with it,

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I always have to look at it

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so I make sure I get it right.

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The Relative Value Scale Committee,

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or they call the RUC,

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determines the value of our codes.

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So therapists don't have a

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lot of codes to choose from

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in outpatient care.

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There's not a really high

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value associated with those codes.

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And there are lots of other

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things that they do now

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that there's no reimbursement for.

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And they're constantly on

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this treadmill of figuring

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out how to increase volume.

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There's only so much you can

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increase volume and still

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provide good care and

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somehow achieve a different

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level of reimbursement over time.

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And if we can look at how

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primary care providers,

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and I would argue

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therapists belong on primary care teams,

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if we look at how primary

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care providers are using

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these new payment

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arrangements to take the

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other things that they do

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as a team to add value to

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patients and to the payers

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who pay for the care,

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if it's not patients themselves,

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then we have a whole new

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opportunity that we haven't

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even considered yet for

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what could be next.

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And let me stop there.

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Well, I was gonna say, I mean,

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when you say it like that,

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and we've seen it before in practice,

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I don't think I needed to

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be a seasoned PT to realize

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I was de-incentivized to

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get someone better faster.

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Like you said,

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there's not a lot of codes

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for the other things that we did.

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So keeping someone around

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who I could charge a code

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for a longer amount of time was...

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I was de-incentivized to do

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the opposite of that.

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So it feels like nobody wins

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in that situation.

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We're all just,

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it's a race to the bottom

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is what it feels like.

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No one wins.

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That's,

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and that's honestly what I think

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from the start of treating

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as a therapist drove me crazy.

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None of it, it didn't make any sense.

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Like I would know inherently

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that I didn't need to, if I could

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bring someone in for a great evaluation,

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do a follow-up, do teaching.

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I could probably go a week

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with just a call in between

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to make sure they were

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following that program and

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then bring them back in for

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the next assessment.

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And there was no way.

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That doesn't fly in fee-for-service,

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right?

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It doesn't exist.

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We hear horror stories from

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new grads talking about, you know,

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this is how we've always

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done it or some people even

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being terminated or just

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being made you know had to

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have a really bad

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environment if they went

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about it uh in in a way

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that didn't keep someone

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coming in frequently and

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for a long time you got it

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all right so you've so you

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now that we sort of

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understand value-based care

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right and why it's maybe a

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better idea than what we're doing now um

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why is this crucial for the

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future of healthcare?

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It feels like when we start

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to talk about even more bigger macros,

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not just a profession,

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but the healthcare environment,

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if things continue this way,

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bad things will happen.

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Things might just collapse.

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Am I right?

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Yeah.

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You know, if anybody...

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If anybody listening went to

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the University of Scranton

00:09:34.145 --> 00:09:37.226
and had Dr. Gary Mattingly as a professor,

00:09:37.287 --> 00:09:38.787
he was the anatomy professor.

00:09:38.866 --> 00:09:41.168
We had him for many classes for many years,

00:09:41.307 --> 00:09:42.288
unfortunately died

00:09:42.327 --> 00:09:44.048
prematurely of brain cancer,

00:09:45.129 --> 00:09:46.250
maybe five or ten years ago.

00:09:47.129 --> 00:09:48.509
He used to say,

00:09:49.049 --> 00:09:50.831
and I took this everywhere I went,

00:09:50.890 --> 00:09:52.951
he used to say, just make it make sense.

00:09:52.971 --> 00:09:53.211
You know,

00:09:53.231 --> 00:09:54.552
when we'd ask him questions

00:09:54.611 --> 00:09:55.871
before he would want us to

00:09:55.913 --> 00:09:56.852
find the answer, he'd say,

00:09:56.873 --> 00:09:57.592
make it make sense.

00:09:58.793 --> 00:10:00.594
And I think that's part of what

00:10:01.431 --> 00:10:02.652
we should be thinking about

00:10:03.371 --> 00:10:04.613
as therapy professionals.

00:10:05.774 --> 00:10:07.214
What I see is therapists

00:10:07.235 --> 00:10:08.394
getting really stuck and

00:10:08.475 --> 00:10:09.916
narrow in their thinking about,

00:10:10.856 --> 00:10:12.457
to no fault of their own truly,

00:10:13.057 --> 00:10:14.619
but thinking narrowly about

00:10:14.759 --> 00:10:15.940
what's happening within my

00:10:15.980 --> 00:10:18.461
clinic and those walls and

00:10:18.760 --> 00:10:20.522
what I historically have

00:10:20.562 --> 00:10:21.763
been able to control or

00:10:21.783 --> 00:10:24.485
change about that piece of

00:10:24.605 --> 00:10:26.666
the healthcare pie that I live in.

00:10:27.405 --> 00:10:29.306
But the big picture here,

00:10:30.006 --> 00:10:31.466
and I try to encourage everyone,

00:10:31.586 --> 00:10:33.027
therapy or anywhere else,

00:10:33.067 --> 00:10:34.128
to think about it this way,

00:10:34.268 --> 00:10:37.067
is health care spending is not,

00:10:37.307 --> 00:10:38.268
it doesn't make sense.

00:10:38.347 --> 00:10:40.269
It's not, we're spending more and more.

00:10:40.808 --> 00:10:41.649
We're either getting the

00:10:41.688 --> 00:10:42.609
dollars through insurance

00:10:42.649 --> 00:10:43.830
premiums or through taxes

00:10:43.870 --> 00:10:47.029
when it's Medicare, Medicare taxes,

00:10:47.451 --> 00:10:49.390
or if it's states for Medicaid.

00:10:49.870 --> 00:10:52.052
And there's not enough money

00:10:52.111 --> 00:10:53.452
to keep up with the spending.

00:10:53.653 --> 00:10:55.274
And we're not getting good

00:10:55.433 --> 00:10:56.916
outcomes for that spending.

00:10:57.375 --> 00:10:58.856
And that is just a fact.

00:10:58.996 --> 00:11:00.558
We are the bottom of the

00:11:00.759 --> 00:11:02.080
barrel when it comes to

00:11:02.139 --> 00:11:03.201
health outcomes for

00:11:03.240 --> 00:11:04.240
industrialized nations.

00:11:04.260 --> 00:11:05.261
We're the worst, right?

00:11:05.302 --> 00:11:07.264
We have the high infant mortality.

00:11:08.625 --> 00:11:10.046
We're actually coming down

00:11:10.206 --> 00:11:11.187
over the course of time.

00:11:11.988 --> 00:11:12.648
It's plateauing,

00:11:12.668 --> 00:11:13.568
but we've come down and

00:11:13.609 --> 00:11:15.190
we're nowhere near the age

00:11:15.230 --> 00:11:16.350
life expectancy of

00:11:16.758 --> 00:11:18.479
European countries in the mid-eighties.

00:11:18.918 --> 00:11:20.240
We're not doing a good job

00:11:20.279 --> 00:11:22.260
with all of these dollars we're spending.

00:11:22.860 --> 00:11:24.481
And there's a breaking point, right?

00:11:24.542 --> 00:11:26.523
It just doesn't, it's not sustainable.

00:11:27.323 --> 00:11:27.724
So what,

00:11:27.844 --> 00:11:29.445
when I think of Dr. Mattingly and

00:11:29.524 --> 00:11:30.466
make it make sense,

00:11:30.846 --> 00:11:32.647
what makes sense is to

00:11:33.006 --> 00:11:35.128
reimagine how and why we

00:11:35.548 --> 00:11:36.428
reimburse for care.

00:11:36.489 --> 00:11:37.690
What care is valuable?

00:11:38.269 --> 00:11:39.850
What should we be incentivizing?

00:11:39.951 --> 00:11:40.010
And

00:11:40.668 --> 00:11:42.370
everything related to how we

00:11:42.409 --> 00:11:43.671
deliver care is based on

00:11:43.730 --> 00:11:44.971
incentives to your point

00:11:45.010 --> 00:11:46.711
before three times a week

00:11:46.751 --> 00:11:47.873
for ten weeks whatever

00:11:48.253 --> 00:11:49.693
right it's because there's

00:11:49.833 --> 00:11:51.394
the incentives present to

00:11:51.495 --> 00:11:53.755
do that kind of volume and

00:11:53.796 --> 00:11:55.517
if we don't reimagine and

00:11:55.557 --> 00:11:56.697
we know there's levers we

00:11:56.736 --> 00:11:57.498
can pull they're being

00:11:57.538 --> 00:11:58.898
pulled already if we don't

00:11:58.957 --> 00:12:00.698
reimagine healthcare

00:12:00.979 --> 00:12:02.000
delivery and healthcare

00:12:02.039 --> 00:12:05.782
spending and how it's done we're

00:12:06.498 --> 00:12:09.058
there's no other solution, right?

00:12:09.178 --> 00:12:10.120
That I can imagine.

00:12:10.179 --> 00:12:12.039
And I've tried imagining solutions.

00:12:12.600 --> 00:12:13.821
So which providers,

00:12:13.841 --> 00:12:14.900
this is where therapy comes

00:12:14.961 --> 00:12:16.942
in and why I am really

00:12:17.042 --> 00:12:18.062
eager to get this message

00:12:18.143 --> 00:12:19.163
out as much as I can,

00:12:19.923 --> 00:12:21.524
is which providers are

00:12:21.583 --> 00:12:23.144
really well-suited to make

00:12:23.164 --> 00:12:25.885
a difference in value-based care because,

00:12:25.926 --> 00:12:27.206
and in healthcare transformation,

00:12:27.245 --> 00:12:28.807
because a lot of what they do

00:12:29.522 --> 00:12:30.822
doesn't have either high

00:12:30.863 --> 00:12:32.365
enough reimbursement or

00:12:32.445 --> 00:12:34.547
reimbursement that makes

00:12:34.606 --> 00:12:36.448
sense for the total value

00:12:36.489 --> 00:12:38.191
they're providing to

00:12:38.291 --> 00:12:40.452
individuals and populations over time.

00:12:41.614 --> 00:12:43.535
Now we know like primary care docs,

00:12:43.655 --> 00:12:44.356
a lot of the,

00:12:45.071 --> 00:12:46.572
of the incentives are being

00:12:46.631 --> 00:12:48.072
driven to primary care teams.

00:12:48.092 --> 00:12:49.354
And we can get into that more.

00:12:49.793 --> 00:12:50.673
But behavioral health

00:12:50.714 --> 00:12:52.355
providers have done a great

00:12:52.414 --> 00:12:54.155
job of acting on this.

00:12:54.296 --> 00:12:57.057
Over the last five to seven years,

00:12:57.097 --> 00:12:58.278
they have accomplished a

00:12:58.339 --> 00:13:00.059
lot of what they have intended to do,

00:13:00.100 --> 00:13:01.080
which was to position

00:13:01.120 --> 00:13:03.201
themselves as really highly

00:13:03.241 --> 00:13:06.043
valuable members on primary care teams.

00:13:06.903 --> 00:13:09.745
And there is a void in those

00:13:09.785 --> 00:13:10.966
primary care teams.

00:13:11.025 --> 00:13:12.626
We have physicians and APPs.

00:13:12.647 --> 00:13:13.807
We have behavioral health.

00:13:14.437 --> 00:13:16.325
And then we have a void for

00:13:16.345 --> 00:13:19.457
neuromusculoskeletal mobility care.

00:13:20.066 --> 00:13:21.427
where docs and behavioral

00:13:21.447 --> 00:13:22.467
health providers on those

00:13:22.508 --> 00:13:24.028
teams cannot manage these

00:13:24.089 --> 00:13:25.288
patients well themselves.

00:13:25.328 --> 00:13:27.331
They will actively admit that, right?

00:13:27.770 --> 00:13:29.552
But we're not there, right?

00:13:29.751 --> 00:13:30.972
Our profession is not

00:13:31.013 --> 00:13:33.114
sitting at the table and we're not even,

00:13:33.153 --> 00:13:34.575
that I see generally,

00:13:35.035 --> 00:13:36.576
having these conversations.

00:13:36.596 --> 00:13:37.397
We're not even aware they're

00:13:37.417 --> 00:13:39.619
happening overall because

00:13:39.719 --> 00:13:41.019
of being used to being in

00:13:41.080 --> 00:13:42.660
our own place generally.

00:13:43.301 --> 00:13:45.322
And so our value as

00:13:45.361 --> 00:13:47.023
therapists is so much

00:13:47.062 --> 00:13:47.923
greater than what we're

00:13:47.964 --> 00:13:49.144
being reimbursed for

00:13:49.926 --> 00:13:51.566
The profession itself has to

00:13:51.625 --> 00:13:54.106
move itself forward and

00:13:54.547 --> 00:13:56.226
demonstrate its values to

00:13:56.427 --> 00:13:57.128
other healthcare

00:13:57.168 --> 00:13:58.327
professionals and policy

00:13:58.368 --> 00:14:00.808
makers before it can

00:14:00.928 --> 00:14:02.089
achieve the value that's

00:14:02.168 --> 00:14:04.349
really available to it in

00:14:04.389 --> 00:14:05.210
terms of what you can

00:14:05.250 --> 00:14:07.070
provide to populations of people.

00:14:07.509 --> 00:14:08.730
Does that make sense?

00:14:09.890 --> 00:14:10.931
You're making it make sense.

00:14:12.607 --> 00:14:14.590
So this is a PT talking to

00:14:14.610 --> 00:14:16.331
PT with a bunch of PTs listening,

00:14:16.530 --> 00:14:17.192
which is great.

00:14:17.511 --> 00:14:18.692
So of course we're gonna agree,

00:14:18.873 --> 00:14:19.714
everyone's nodding.

00:14:19.953 --> 00:14:20.195
You,

00:14:20.335 --> 00:14:22.255
I'm watching you at your car right now,

00:14:22.336 --> 00:14:23.857
driving and listening to this episode,

00:14:23.918 --> 00:14:24.839
even you're nodding.

00:14:25.259 --> 00:14:26.039
But here's the thing,

00:14:26.600 --> 00:14:28.302
what practical steps can we

00:14:28.442 --> 00:14:29.322
actually be doing?

00:14:30.222 --> 00:14:31.625
So we as a profession can

00:14:31.684 --> 00:14:35.008
demonstrate our value to them,

00:14:35.808 --> 00:14:38.730
this ambiguous they, the payers,

00:14:38.831 --> 00:14:40.813
the insurance system, Medicare,

00:14:41.293 --> 00:14:42.794
to make sure that they see

00:14:42.936 --> 00:14:45.077
us as integral to the care

00:14:45.118 --> 00:14:46.859
team in this thing that you

00:14:46.899 --> 00:14:47.559
just described,

00:14:47.600 --> 00:14:49.361
this value-based care system.

00:14:49.881 --> 00:14:50.482
What do we do, Dana?

00:14:50.503 --> 00:14:50.582
Yeah.

00:14:50.602 --> 00:14:50.722
Yeah.

00:14:52.859 --> 00:14:54.640
so it's a multi-layered

00:14:54.721 --> 00:14:56.261
answer it's not a here's

00:14:56.442 --> 00:14:58.504
the question podcast

00:14:58.543 --> 00:14:59.625
episode if it was simple of

00:14:59.664 --> 00:15:01.125
course so where do we start

00:15:01.145 --> 00:15:05.169
I mean first it's important

00:15:05.190 --> 00:15:06.730
to take into consideration

00:15:06.750 --> 00:15:08.451
that there's a lack of

00:15:08.773 --> 00:15:10.913
knowledge about this in our

00:15:10.953 --> 00:15:12.475
profession about what

00:15:13.265 --> 00:15:14.726
value based care is and what

00:15:14.787 --> 00:15:16.226
the opportunity potentially

00:15:16.267 --> 00:15:16.868
could look like.

00:15:16.908 --> 00:15:18.207
And so we have to start with

00:15:18.248 --> 00:15:19.668
just understanding some of that.

00:15:20.149 --> 00:15:21.549
How is care paid for?

00:15:21.769 --> 00:15:24.010
What models are and payment

00:15:24.051 --> 00:15:25.692
models are especially

00:15:25.751 --> 00:15:26.912
primary care providers

00:15:26.951 --> 00:15:29.714
participating in and how?

00:15:29.874 --> 00:15:31.475
And this is really what if

00:15:31.495 --> 00:15:34.395
you want to imagine the impact,

00:15:35.035 --> 00:15:36.417
like from a very high level,

00:15:36.456 --> 00:15:37.758
what's the impact primary

00:15:37.778 --> 00:15:39.337
care practices are having

00:15:39.638 --> 00:15:41.219
on reducing total spend?

00:15:41.739 --> 00:15:42.360
Sure.

00:15:42.440 --> 00:15:42.799
By

00:15:43.751 --> 00:15:45.793
by more dollars being driven

00:15:45.854 --> 00:15:46.695
into primary care,

00:15:46.715 --> 00:15:47.735
which is what's happening

00:15:47.836 --> 00:15:48.636
in payment models,

00:15:49.437 --> 00:15:51.038
that care being provided

00:15:51.078 --> 00:15:52.299
upstream is keeping people

00:15:52.340 --> 00:15:53.140
out of the hospital,

00:15:53.240 --> 00:15:54.861
which is reducing downstream spend.

00:15:54.902 --> 00:15:56.003
So essentially we're trying

00:15:56.023 --> 00:15:57.244
to move dollars upstream.

00:15:58.184 --> 00:15:59.547
So understanding that

00:15:59.586 --> 00:16:01.168
component that there

00:16:01.307 --> 00:16:03.230
literally are more dollars

00:16:03.269 --> 00:16:05.091
being given upstream,

00:16:05.131 --> 00:16:07.533
prospectively to primary care practices,

00:16:08.341 --> 00:16:09.743
that primary care providers,

00:16:09.783 --> 00:16:10.863
behavioral health providers,

00:16:10.903 --> 00:16:13.004
and teams are using to care

00:16:13.024 --> 00:16:14.764
for patients upstream, downstream,

00:16:14.804 --> 00:16:16.625
stay connected, access, et cetera,

00:16:17.966 --> 00:16:20.807
then understanding that right now,

00:16:21.307 --> 00:16:24.087
as of now, we can go to these practices,

00:16:24.369 --> 00:16:25.509
if we so choose,

00:16:25.568 --> 00:16:26.789
practices that are in these

00:16:26.830 --> 00:16:27.629
models and say,

00:16:28.552 --> 00:16:31.495
How can we contribute to your success?

00:16:31.576 --> 00:16:31.975
Meaning,

00:16:32.317 --> 00:16:34.219
how can we be part of the team

00:16:34.639 --> 00:16:36.541
that helps you care for

00:16:36.600 --> 00:16:39.143
this population that are your patients,

00:16:39.323 --> 00:16:39.823
right?

00:16:39.864 --> 00:16:40.985
That can be done right now.

00:16:41.024 --> 00:16:42.807
We don't need any policy change to do it,

00:16:42.846 --> 00:16:44.248
but we need the awareness

00:16:44.708 --> 00:16:46.250
of where these dollars are going,

00:16:46.330 --> 00:16:47.350
who's giving it to them,

00:16:47.390 --> 00:16:49.052
and the value we can

00:16:49.092 --> 00:16:50.674
already provide ourselves.

00:16:51.229 --> 00:16:51.669
Understood.

00:16:51.870 --> 00:16:52.090
Yeah.

00:16:52.490 --> 00:16:55.514
So can we follow not just the money,

00:16:55.634 --> 00:16:56.354
because I think that's what

00:16:56.394 --> 00:16:57.195
we're doing now.

00:16:57.495 --> 00:16:59.037
This is follow the value.

00:16:59.498 --> 00:17:00.639
And then what money would

00:17:00.658 --> 00:17:01.820
you not have to spend?

00:17:01.960 --> 00:17:02.760
And oh, by the way,

00:17:02.860 --> 00:17:04.041
underneath this value and

00:17:04.082 --> 00:17:05.644
money conversation is

00:17:05.683 --> 00:17:07.425
getting people what they actually need,

00:17:07.605 --> 00:17:09.208
when they need it, where they need it,

00:17:09.248 --> 00:17:10.189
for how long they need it.

00:17:10.749 --> 00:17:11.849
That's actually the last

00:17:11.869 --> 00:17:13.309
thing we've mentioned in this,

00:17:13.349 --> 00:17:14.211
but should be the first thing.

00:17:14.431 --> 00:17:15.230
But that's the reason we're

00:17:15.270 --> 00:17:16.412
having this conversation is

00:17:16.652 --> 00:17:17.972
that's the reason that

00:17:18.032 --> 00:17:19.413
we're that this that this system.

00:17:19.452 --> 00:17:20.794
So let me let me see if I follow.

00:17:21.193 --> 00:17:21.914
We used to run to this

00:17:21.954 --> 00:17:23.095
problem when I was a radio

00:17:23.115 --> 00:17:25.276
broadcaster in Scranton, Pennsylvania,

00:17:25.316 --> 00:17:25.757
by the way,

00:17:25.797 --> 00:17:28.137
where I used to work in radio.

00:17:28.198 --> 00:17:29.298
Good old five seven north

00:17:29.337 --> 00:17:30.719
east Pennsylvania radio.

00:17:31.179 --> 00:17:32.961
But people would say to us, hey,

00:17:33.020 --> 00:17:33.781
I'll give you a couple

00:17:33.821 --> 00:17:35.864
bucks if you read my script

00:17:35.903 --> 00:17:37.224
on the air a couple times.

00:17:37.925 --> 00:17:39.367
And it was a transaction.

00:17:39.448 --> 00:17:41.289
You give me fifty bucks and

00:17:41.329 --> 00:17:42.671
I'll read it for sixty seconds.

00:17:43.332 --> 00:17:44.712
And the problem that we sort

00:17:44.813 --> 00:17:45.733
of started saying was,

00:17:46.114 --> 00:17:47.174
let's say Apple was an

00:17:47.255 --> 00:17:48.777
advertiser and you paid me

00:17:48.836 --> 00:17:50.479
fifty bucks and then I ran a commercial.

00:17:50.778 --> 00:17:52.000
But then that person that

00:17:52.079 --> 00:17:53.621
heard that one commercial

00:17:53.941 --> 00:17:55.201
bought a MacBook and then

00:17:55.221 --> 00:17:56.442
an iPhone and then bought

00:17:56.702 --> 00:17:59.164
iPhones for the next twenty five years.

00:17:59.625 --> 00:18:01.125
What's the lifetime value of

00:18:01.165 --> 00:18:03.127
that one fifty dollar transaction?

00:18:03.448 --> 00:18:04.449
And how do we move to more

00:18:04.489 --> 00:18:05.470
of a relationship?

00:18:05.490 --> 00:18:05.970
That's right.

00:18:05.990 --> 00:18:07.111
So that's what I kept coming into.

00:18:07.151 --> 00:18:09.112
This value based care feels

00:18:09.152 --> 00:18:10.313
a lot like we're saying

00:18:10.633 --> 00:18:11.413
we're going to get into a

00:18:11.453 --> 00:18:13.015
relationship because the

00:18:13.075 --> 00:18:14.415
rising tide lifts all ships.

00:18:14.496 --> 00:18:15.436
And we're OK with that

00:18:15.616 --> 00:18:16.637
because we believe we

00:18:16.857 --> 00:18:18.398
actually provide a ton of value.

00:18:18.659 --> 00:18:19.680
So we'll get in this with you.

00:18:20.882 --> 00:18:23.262
That's exactly it.

00:18:23.523 --> 00:18:24.804
And that's where,

00:18:25.224 --> 00:18:26.726
like if you think about physicians,

00:18:27.685 --> 00:18:29.027
they're not great.

00:18:29.446 --> 00:18:30.728
And I mean, I'm generalizing.

00:18:30.928 --> 00:18:32.509
Oh, everything is a generalization here.

00:18:32.888 --> 00:18:34.529
They're not great at

00:18:34.549 --> 00:18:35.451
communication and

00:18:35.490 --> 00:18:36.632
connection with patients.

00:18:37.092 --> 00:18:38.393
Their business has always

00:18:38.432 --> 00:18:39.673
been based on transactions.

00:18:40.114 --> 00:18:41.875
They don't excel at that.

00:18:42.035 --> 00:18:42.194
Now,

00:18:42.255 --> 00:18:44.115
primary care is better at it than most

00:18:44.336 --> 00:18:45.977
are, again, generally speaking.

00:18:46.637 --> 00:18:48.919
But therapists, physical therapists,

00:18:48.959 --> 00:18:49.940
occupational speech,

00:18:50.509 --> 00:18:51.849
behavioral health providers,

00:18:52.130 --> 00:18:53.191
even pharmacists,

00:18:53.730 --> 00:18:55.791
great at relationships with

00:18:55.832 --> 00:18:56.712
patients and building

00:18:56.772 --> 00:18:58.173
connection and communication.

00:18:58.753 --> 00:19:00.394
That is the key to success

00:19:00.434 --> 00:19:01.655
in value-based care is

00:19:01.715 --> 00:19:04.896
connecting with patients, building trust,

00:19:05.097 --> 00:19:06.858
offering them access to you.

00:19:07.378 --> 00:19:09.500
And in doing so over time,

00:19:09.799 --> 00:19:11.181
they're doing what you

00:19:11.240 --> 00:19:12.461
recommend and you're

00:19:12.501 --> 00:19:14.042
getting reimbursed for

00:19:14.143 --> 00:19:15.884
doing that great communication.

00:19:16.740 --> 00:19:17.781
And where we remove the

00:19:17.801 --> 00:19:18.961
transactions completely,

00:19:18.981 --> 00:19:21.483
which is what just excites me to no end,

00:19:21.963 --> 00:19:22.703
where we remove

00:19:22.743 --> 00:19:24.984
transactions is when we don't,

00:19:25.425 --> 00:19:26.865
and where therapy has to be

00:19:26.885 --> 00:19:28.426
able to demonstrate to

00:19:28.666 --> 00:19:30.248
other providers their value

00:19:30.268 --> 00:19:32.368
that has to come first, I'll explain it,

00:19:33.789 --> 00:19:36.290
is in when a prac,

00:19:36.391 --> 00:19:37.412
I'm gonna explain this

00:19:37.451 --> 00:19:38.772
because I have to for background,

00:19:38.813 --> 00:19:39.972
I don't wanna get too in the weeds,

00:19:39.992 --> 00:19:41.074
but to make it make sense.

00:19:42.926 --> 00:19:45.208
primary care practices in particular,

00:19:45.248 --> 00:19:46.648
getting into these relationships,

00:19:46.689 --> 00:19:47.449
what they'll do is they'll

00:19:47.469 --> 00:19:48.329
say to the payer,

00:19:49.170 --> 00:19:50.431
we're willing to act like

00:19:50.451 --> 00:19:51.391
the insurance company.

00:19:51.770 --> 00:19:52.971
We're going to take on the

00:19:53.031 --> 00:19:54.432
full financial accountability.

00:19:54.451 --> 00:19:55.613
You're going to literally

00:19:55.853 --> 00:19:57.094
give us the insurance

00:19:57.134 --> 00:20:00.414
dollars and we are going to promise.

00:20:00.674 --> 00:20:01.756
And if we don't do it,

00:20:01.836 --> 00:20:02.875
we lose our own money.

00:20:03.237 --> 00:20:04.557
We are going to manage this

00:20:04.596 --> 00:20:06.478
population better than you

00:20:06.518 --> 00:20:07.999
can by owning the dollars.

00:20:08.078 --> 00:20:09.118
And we're going to spend

00:20:09.159 --> 00:20:10.579
those dollars not by worrying about

00:20:11.207 --> 00:20:12.867
RVUs or transactions.

00:20:12.968 --> 00:20:13.387
No, no, no.

00:20:13.448 --> 00:20:14.769
We're going to make this make sense.

00:20:15.128 --> 00:20:16.849
We're going to use the data

00:20:16.890 --> 00:20:18.030
to see who's at risk,

00:20:18.070 --> 00:20:19.592
who's had historical spend,

00:20:19.971 --> 00:20:21.732
whose risk adjustment

00:20:21.752 --> 00:20:22.874
factor is very high.

00:20:23.294 --> 00:20:24.115
And we're going to reach out

00:20:24.134 --> 00:20:25.454
to these people proactively.

00:20:25.895 --> 00:20:27.455
And when they've had falls, guess what?

00:20:27.836 --> 00:20:28.856
If it's PT on the team,

00:20:28.876 --> 00:20:29.538
we're going to bring them

00:20:29.577 --> 00:20:30.597
into work with the PT.

00:20:31.179 --> 00:20:32.378
And when they've had

00:20:32.980 --> 00:20:34.279
multiple emergency room

00:20:34.299 --> 00:20:35.401
visits for low back pain,

00:20:35.800 --> 00:20:36.362
we're going to bring them

00:20:36.422 --> 00:20:37.342
in to see the PT.

00:20:37.923 --> 00:20:38.542
And now...

00:20:39.067 --> 00:20:40.828
when the team is just

00:20:41.088 --> 00:20:42.049
earning those dollars

00:20:42.089 --> 00:20:43.431
directly from the insurance

00:20:43.451 --> 00:20:44.932
company and their job is to

00:20:45.071 --> 00:20:46.132
use them the best way they

00:20:46.172 --> 00:20:47.992
can so that the total spend

00:20:48.053 --> 00:20:49.394
is improved upon,

00:20:49.973 --> 00:20:51.055
there's no longer an

00:20:51.095 --> 00:20:52.955
incentive for a doc to see

00:20:52.976 --> 00:20:53.916
a patient first.

00:20:54.176 --> 00:20:55.998
And that's such an

00:20:56.278 --> 00:20:57.618
unbelievable opportunity

00:20:57.679 --> 00:20:59.180
when we can now show

00:20:59.675 --> 00:21:02.018
Listen, we don't need a gatekeeper.

00:21:02.057 --> 00:21:02.999
They don't need to see you

00:21:03.058 --> 00:21:04.079
first as the physician

00:21:04.279 --> 00:21:05.540
because they're not billing for it.

00:21:06.161 --> 00:21:08.022
It's not a transaction anymore, right?

00:21:08.423 --> 00:21:10.045
They care about the team

00:21:10.384 --> 00:21:11.826
providing the upstream care

00:21:11.846 --> 00:21:13.307
that reduces the total spend.

00:21:13.788 --> 00:21:15.449
So now there's a great

00:21:15.509 --> 00:21:17.750
incentive if we pitch it this way,

00:21:17.790 --> 00:21:19.471
and it's a hundred percent true.

00:21:19.813 --> 00:21:21.134
You bring a therapist on the team,

00:21:21.153 --> 00:21:21.993
you're going to reduce

00:21:22.255 --> 00:21:23.496
unnecessary specialist

00:21:23.516 --> 00:21:26.157
utilization significantly, right?

00:21:26.317 --> 00:21:27.519
Where a patient, where, you know,

00:21:28.066 --> 00:21:29.729
the primary care doc, low back pain.

00:21:29.848 --> 00:21:31.111
Okay, well, we're going,

00:21:31.131 --> 00:21:32.291
what do they usually do?

00:21:32.472 --> 00:21:33.594
Send you to an orthopedist,

00:21:34.095 --> 00:21:35.277
send you for an MRI,

00:21:35.557 --> 00:21:36.999
put you on a pain medication.

00:21:37.599 --> 00:21:38.221
Instead,

00:21:38.701 --> 00:21:40.104
we're going to schedule you with

00:21:40.124 --> 00:21:42.468
the PT on the team, right?

00:21:42.708 --> 00:21:43.890
And now we're going to

00:21:44.765 --> 00:21:46.946
largely avoid unnecessary

00:21:46.967 --> 00:21:47.946
referrals to specialists,

00:21:48.067 --> 00:21:49.248
unnecessary imaging,

00:21:49.729 --> 00:21:50.969
patients going out of

00:21:51.150 --> 00:21:52.049
getting their pain out of

00:21:52.089 --> 00:21:53.951
control of being, becoming subacute,

00:21:53.971 --> 00:21:55.132
chronic, yada, yada, yada,

00:21:55.152 --> 00:21:56.012
because we're going to

00:21:56.073 --> 00:21:57.413
address it at the right

00:21:57.453 --> 00:21:58.314
time and the right place

00:21:58.334 --> 00:21:59.654
with the right provider.

00:22:00.155 --> 00:22:01.737
But right now we're not

00:22:01.797 --> 00:22:02.917
having these conversations.

00:22:02.978 --> 00:22:03.278
It's the,

00:22:03.357 --> 00:22:05.058
we all know this is how we can

00:22:05.078 --> 00:22:05.719
have an impact,

00:22:06.140 --> 00:22:08.441
but we're not at the table there.

00:22:08.781 --> 00:22:09.882
And again, generalizing,

00:22:10.041 --> 00:22:11.643
I'm sure there are some doing this,

00:22:11.963 --> 00:22:13.285
but right now we're not at the table.

00:22:14.150 --> 00:22:15.411
And this opportunity is just

00:22:15.671 --> 00:22:17.112
sitting there for

00:22:17.152 --> 00:22:18.492
therapists to take advantage of.

00:22:18.512 --> 00:22:19.013
All right.

00:22:19.574 --> 00:22:20.855
So make it make sense,

00:22:20.914 --> 00:22:22.115
which feels like the theme

00:22:22.155 --> 00:22:22.875
of the episode.

00:22:22.895 --> 00:22:23.396
It is.

00:22:23.936 --> 00:22:26.638
Who doesn't want this to change?

00:22:26.959 --> 00:22:29.121
Because it feels like this

00:22:29.141 --> 00:22:30.122
is the right direction.

00:22:30.182 --> 00:22:31.143
It feels like this is...

00:22:33.105 --> 00:22:34.365
less friction filled.

00:22:34.405 --> 00:22:36.527
It feels like this is smoother and better.

00:22:36.926 --> 00:22:38.446
And these are all positive words.

00:22:38.748 --> 00:22:39.988
So if this hasn't happened,

00:22:40.468 --> 00:22:41.729
there's a reason for it.

00:22:43.009 --> 00:22:43.909
It might be complicated,

00:22:43.949 --> 00:22:45.670
but what is or are the

00:22:45.710 --> 00:22:47.631
reasons that we're not doing this?

00:22:47.651 --> 00:22:50.192
Make it make sense.

00:22:50.211 --> 00:22:51.932
That part, this is actually simple.

00:22:52.873 --> 00:22:55.574
It's not happening because

00:22:55.594 --> 00:22:57.734
we're not offering it right now.

00:22:58.134 --> 00:23:00.316
There is not an awareness

00:23:00.455 --> 00:23:01.395
that this is an option.

00:23:02.441 --> 00:23:04.161
And I have brought this up

00:23:04.580 --> 00:23:06.981
to primary care docs taking full risk.

00:23:08.041 --> 00:23:09.643
And what they've said to me is,

00:23:10.923 --> 00:23:11.823
that's a great idea.

00:23:12.202 --> 00:23:14.023
Somebody just has to show us the ROI.

00:23:14.064 --> 00:23:14.644
Give me the ROI.

00:23:14.703 --> 00:23:16.604
We'll pitch it, right?

00:23:16.663 --> 00:23:20.325
So this is like a team taking full risk.

00:23:20.924 --> 00:23:21.545
Why don't you have a

00:23:21.585 --> 00:23:22.905
physical therapist in here?

00:23:22.925 --> 00:23:23.885
What are you doing with your

00:23:24.326 --> 00:23:26.885
arthritis pain, your patients with falls,

00:23:26.925 --> 00:23:28.567
back pain, headaches, yada, yada, yada?

00:23:29.067 --> 00:23:29.606
She said, yeah.

00:23:30.336 --> 00:23:31.517
The last conversation I had

00:23:31.537 --> 00:23:32.938
with a physician about this, she said,

00:23:32.978 --> 00:23:35.279
yeah, you know, I know we need a PT.

00:23:35.640 --> 00:23:36.980
I'll write the prescription.

00:23:37.480 --> 00:23:38.521
I'll hope that they'll go

00:23:38.602 --> 00:23:39.782
actually make the appointment.

00:23:40.042 --> 00:23:40.844
They might not be able to

00:23:40.864 --> 00:23:41.805
get to the appointment.

00:23:41.964 --> 00:23:42.885
They might not want to pay

00:23:42.905 --> 00:23:44.267
the copay for the appointment.

00:23:44.406 --> 00:23:45.347
There's a whole list of

00:23:45.407 --> 00:23:46.888
reasons why there's barriers.

00:23:47.749 --> 00:23:50.050
If I just had them right here on the team,

00:23:50.111 --> 00:23:51.172
it would be frictionless.

00:23:51.551 --> 00:23:52.593
And what they're doing now,

00:23:52.732 --> 00:23:53.733
many companies doing this,

00:23:54.423 --> 00:23:56.544
Somebody with longstanding depression,

00:23:56.584 --> 00:23:57.085
anxiety,

00:23:57.244 --> 00:23:58.526
they just walk them down the hall

00:23:58.546 --> 00:23:59.665
and introduce them to the

00:23:59.705 --> 00:24:01.247
behavioral health provider on the team.

00:24:03.888 --> 00:24:05.088
Completely different.

00:24:05.670 --> 00:24:06.851
We're talking a completely

00:24:06.891 --> 00:24:07.931
different outcome when you

00:24:07.990 --> 00:24:09.932
have that handoff, you build that trust.

00:24:10.393 --> 00:24:11.712
So I argue,

00:24:11.913 --> 00:24:12.993
I would argue this is really

00:24:13.034 --> 00:24:13.875
not complicated.

00:24:14.035 --> 00:24:17.237
It's awareness first, right?

00:24:17.557 --> 00:24:18.376
And then bringing the

00:24:18.416 --> 00:24:20.558
opportunity to primary care

00:24:20.598 --> 00:24:21.960
practices that are taking

00:24:22.059 --> 00:24:23.921
risk so that we can build

00:24:24.388 --> 00:24:27.210
and a better understanding by primary care,

00:24:27.230 --> 00:24:29.010
because it's where we have to start,

00:24:29.550 --> 00:24:30.971
build it within primary

00:24:30.991 --> 00:24:32.192
care that we're here,

00:24:32.432 --> 00:24:34.673
we are doctorally trained

00:24:34.792 --> 00:24:36.574
and fully capable of

00:24:36.634 --> 00:24:39.694
helping you and your patients succeed,

00:24:40.175 --> 00:24:40.455
right?

00:24:41.115 --> 00:24:43.018
Just give us the opportunity.

00:24:43.157 --> 00:24:45.500
And I've had this question

00:24:45.961 --> 00:24:46.701
from therapists who I've

00:24:46.741 --> 00:24:48.943
talked about this with who own practices.

00:24:49.744 --> 00:24:50.986
There's other ways to do this.

00:24:51.066 --> 00:24:52.166
I mean, being able,

00:24:52.268 --> 00:24:54.128
if you have a therapy

00:24:54.170 --> 00:24:56.551
practice that's in close

00:24:56.592 --> 00:24:58.894
proximity to practices taking risk,

00:24:59.315 --> 00:25:00.576
you can offer different

00:25:00.596 --> 00:25:02.938
ways to provide very easy access,

00:25:02.998 --> 00:25:04.119
quick communication.

00:25:04.859 --> 00:25:06.039
demonstrate a way that you

00:25:06.059 --> 00:25:08.141
can be the first and make

00:25:08.181 --> 00:25:09.260
the effort to get those

00:25:09.300 --> 00:25:10.641
patients engaged quickly if

00:25:10.661 --> 00:25:12.001
you can't put a therapist

00:25:12.021 --> 00:25:12.981
right in the practice.

00:25:13.422 --> 00:25:14.301
So there's different ways to

00:25:14.342 --> 00:25:14.882
go about that.

00:25:14.902 --> 00:25:16.061
But I would argue part of

00:25:16.102 --> 00:25:17.442
this is a cultural thing.

00:25:18.282 --> 00:25:20.903
It's how physicians perceive

00:25:20.962 --> 00:25:22.824
their role versus the role of others.

00:25:23.284 --> 00:25:25.423
And that the awareness just

00:25:25.624 --> 00:25:27.265
isn't quite there,

00:25:27.924 --> 00:25:30.085
that we have to take this step.

00:25:30.224 --> 00:25:31.145
That's what I would argue.

00:25:31.185 --> 00:25:32.645
We have to take this step.

00:25:33.353 --> 00:25:34.993
Before we can do anything else.

00:25:35.013 --> 00:25:36.055
So this is a bunch of people

00:25:36.295 --> 00:25:38.195
standing around the deep end of a pool.

00:25:38.276 --> 00:25:40.438
Everybody agrees that the water looks fine,

00:25:40.538 --> 00:25:42.199
feels fine when we go in it,

00:25:42.578 --> 00:25:43.278
but we're waiting for

00:25:43.338 --> 00:25:45.921
someone big enough to jump in first,

00:25:46.181 --> 00:25:48.123
take that plunge and make

00:25:48.143 --> 00:25:48.722
sure they don't drown.

00:25:48.742 --> 00:25:50.284
Yeah, that's, that's basic.

00:25:50.304 --> 00:25:50.804
That's it.

00:25:52.781 --> 00:25:54.323
All right.

00:25:54.343 --> 00:25:55.542
So there are misconceptions

00:25:55.583 --> 00:25:56.703
about reimbursement.

00:25:56.723 --> 00:25:58.565
And I want you to talk about,

00:25:59.144 --> 00:26:00.244
many PTs are focused on the

00:26:00.285 --> 00:26:01.326
physician fee schedule.

00:26:01.346 --> 00:26:02.786
Like it's talked about a lot, right?

00:26:02.806 --> 00:26:03.626
We focus on that.

00:26:03.646 --> 00:26:04.747
We wait with bated breath.

00:26:04.767 --> 00:26:05.367
We hold our breath.

00:26:06.667 --> 00:26:07.347
Help me understand this.

00:26:07.387 --> 00:26:08.409
Explain what the bigger

00:26:08.449 --> 00:26:09.429
challenge is in terms of

00:26:09.489 --> 00:26:10.630
payment and reimbursement.

00:26:13.191 --> 00:26:16.112
So I guess I'd slightly reframe to say,

00:26:16.471 --> 00:26:18.732
it's not that it's not important.

00:26:18.853 --> 00:26:21.974
It's that it is only a component

00:26:23.088 --> 00:26:25.049
of a much bigger issue,

00:26:25.410 --> 00:26:27.510
which we touched on before,

00:26:28.750 --> 00:26:31.573
in who it is that presently

00:26:32.113 --> 00:26:34.453
decides what services

00:26:34.493 --> 00:26:36.694
deserve a code attached to them,

00:26:36.734 --> 00:26:37.335
first of all,

00:26:38.035 --> 00:26:39.675
and then what the value of

00:26:39.736 --> 00:26:41.836
the RVUs of those codes should be.

00:26:42.297 --> 00:26:44.998
So there's that piece, the volume of codes,

00:26:45.038 --> 00:26:46.519
the value of those codes,

00:26:46.878 --> 00:26:48.219
who decides those codes.

00:26:48.278 --> 00:26:48.819
And by the way,

00:26:48.839 --> 00:26:50.599
the RUC is primarily made

00:26:50.640 --> 00:26:52.141
up of specialist physicians.

00:26:53.378 --> 00:26:55.721
And then we have a chronic

00:26:55.780 --> 00:26:59.144
year over year problem where our spending,

00:26:59.263 --> 00:27:00.984
the physician fee schedule spending,

00:27:01.165 --> 00:27:02.787
so just for background,

00:27:02.826 --> 00:27:04.087
for anybody that doesn't know,

00:27:04.508 --> 00:27:05.990
that's anyone who bills a

00:27:06.029 --> 00:27:07.029
physician fee schedule.

00:27:07.069 --> 00:27:10.653
So that is all providers and

00:27:10.732 --> 00:27:11.854
outpatient services that

00:27:11.874 --> 00:27:13.715
are billing the physician fee schedule.

00:27:13.836 --> 00:27:15.596
They're impacted by the

00:27:15.738 --> 00:27:16.738
annual cuts to the

00:27:16.778 --> 00:27:18.299
conversion factor as a whole.

00:27:19.365 --> 00:27:22.092
But that's only a part of

00:27:22.211 --> 00:27:23.715
how the conversion factor

00:27:23.776 --> 00:27:25.499
and the updates annually

00:27:25.599 --> 00:27:27.083
impact providers specifically,

00:27:27.123 --> 00:27:28.265
meaning the conversion

00:27:28.306 --> 00:27:30.289
factor keeps being reduced.

00:27:30.798 --> 00:27:32.520
But certain providers are

00:27:32.621 --> 00:27:34.663
actually shifted more of the dollars.

00:27:34.844 --> 00:27:36.445
So like every year,

00:27:36.546 --> 00:27:38.468
if you look at the physician fee schedule,

00:27:38.788 --> 00:27:39.650
there's a list of all the

00:27:39.670 --> 00:27:42.373
specialists and that goes, you know,

00:27:42.452 --> 00:27:43.855
everyone that bills the PFS.

00:27:44.335 --> 00:27:45.997
And some will be positive three,

00:27:46.037 --> 00:27:46.877
positive four.

00:27:46.998 --> 00:27:48.160
Some will be negative seven,

00:27:48.220 --> 00:27:48.859
negative eight.

00:27:48.901 --> 00:27:50.082
I mean, I've seen negative eleven.

00:27:51.044 --> 00:27:51.683
The weight,

00:27:51.744 --> 00:27:52.944
it's not just the conversion

00:27:52.984 --> 00:27:54.665
factor that's changed every year.

00:27:54.987 --> 00:27:56.807
It's that the weight of each

00:27:56.847 --> 00:27:58.808
of the codes that are used

00:27:58.828 --> 00:28:00.410
by different specialties,

00:28:01.050 --> 00:28:02.191
including therapists,

00:28:02.330 --> 00:28:04.232
is changed every year based

00:28:04.292 --> 00:28:06.034
upon what the value of

00:28:06.074 --> 00:28:08.015
those services is deemed to be.

00:28:08.655 --> 00:28:10.737
So there's how we're perceived and valued.

00:28:11.136 --> 00:28:13.759
Last year, the cut was three percent.

00:28:14.416 --> 00:28:15.916
Now, you can't, I mean,

00:28:16.096 --> 00:28:17.617
it was fixed temporarily by

00:28:17.637 --> 00:28:21.157
the Consolidated Appropriations Act,

00:28:21.178 --> 00:28:22.417
which is just a one-time

00:28:23.057 --> 00:28:24.798
update just to patch,

00:28:25.078 --> 00:28:26.239
they call it a dock fix,

00:28:26.259 --> 00:28:27.778
just to patch that gap.

00:28:28.898 --> 00:28:31.619
But the big problem of how

00:28:32.319 --> 00:28:33.380
we're spending beyond the

00:28:33.440 --> 00:28:34.539
budget every year,

00:28:34.619 --> 00:28:36.101
that's the bigger problem.

00:28:36.181 --> 00:28:37.540
And how do we reduce and

00:28:37.580 --> 00:28:38.740
control that spending?

00:28:39.300 --> 00:28:40.560
We're going to do it through

00:28:40.641 --> 00:28:42.082
shifting dollars to primary

00:28:42.122 --> 00:28:43.882
care and shifting the spend

00:28:44.451 --> 00:28:49.234
to lower costs, lower centers, lower,

00:28:50.435 --> 00:28:51.316
what's the word I'm looking for?

00:28:51.375 --> 00:28:53.077
Locations of care that

00:28:53.137 --> 00:28:55.799
provide a higher value service, right?

00:28:56.000 --> 00:28:57.141
It's not going to be these

00:28:57.201 --> 00:28:58.701
little fights of a percentage here,

00:28:58.721 --> 00:29:00.242
a half a percentage here, right?

00:29:00.804 --> 00:29:01.963
Yeah.

00:29:01.983 --> 00:29:02.744
So let me make sure I'm

00:29:02.765 --> 00:29:03.365
understanding this.

00:29:04.365 --> 00:29:05.047
What it sounds like you're

00:29:05.067 --> 00:29:06.347
saying is we're arguing

00:29:06.387 --> 00:29:08.028
over nickels and we're losing dollars.

00:29:08.589 --> 00:29:09.690
Yeah.

00:29:10.351 --> 00:29:11.971
That's a very good way to put it.

00:29:11.991 --> 00:29:12.992
So you're saying look bigger,

00:29:13.093 --> 00:29:14.074
look further upstream.

00:29:15.362 --> 00:29:15.923
If you look,

00:29:16.403 --> 00:29:18.265
just looking at primary care

00:29:19.204 --> 00:29:21.247
codes that were added the last few years,

00:29:21.307 --> 00:29:22.147
they've added something

00:29:22.167 --> 00:29:23.509
like fifteen different codes,

00:29:23.568 --> 00:29:24.690
including things like

00:29:25.730 --> 00:29:27.512
community health integration codes,

00:29:28.012 --> 00:29:29.634
principal illness navigation,

00:29:29.914 --> 00:29:30.836
social determinant of

00:29:30.895 --> 00:29:32.537
health risk adjustment codes.

00:29:32.557 --> 00:29:34.058
There's been a litany.

00:29:34.358 --> 00:29:36.800
They're all for primary care, right?

00:29:36.820 --> 00:29:39.864
The idea is even a complexity code,

00:29:39.884 --> 00:29:41.105
so an E&M code,

00:29:41.692 --> 00:29:43.253
For complexity of care,

00:29:43.294 --> 00:29:44.275
the idea is we're going to

00:29:44.295 --> 00:29:45.957
let primary care add on

00:29:45.997 --> 00:29:47.238
this additional payment so

00:29:47.258 --> 00:29:48.219
that they'll spend more

00:29:48.278 --> 00:29:51.621
time on a complex issue and

00:29:51.701 --> 00:29:52.741
not send the patient right

00:29:52.761 --> 00:29:53.823
to a specialist instead.

00:29:54.564 --> 00:29:55.585
Notice primary care is

00:29:55.605 --> 00:29:57.326
getting more money filtered

00:29:57.346 --> 00:29:59.627
to them and others whose

00:29:59.647 --> 00:30:00.929
value is not demonstrated

00:30:00.949 --> 00:30:02.830
to be as high can have cuts.

00:30:03.050 --> 00:30:04.432
You have to shift the money around.

00:30:04.451 --> 00:30:05.712
There's only a bucket, right?

00:30:06.173 --> 00:30:07.233
So specialists don't

00:30:07.295 --> 00:30:09.016
particularly generally like

00:30:09.500 --> 00:30:11.121
the fact that more codes are

00:30:11.141 --> 00:30:12.442
being created for primary

00:30:12.461 --> 00:30:14.163
care because they're losing, you know,

00:30:14.202 --> 00:30:15.284
by and large, they're losing.

00:30:16.144 --> 00:30:18.546
So it's, are we being valued?

00:30:18.586 --> 00:30:19.987
Because behavioral health keeps,

00:30:20.567 --> 00:30:21.268
behavioral health has

00:30:21.327 --> 00:30:22.248
proven their value to

00:30:22.288 --> 00:30:23.269
primary care is seeing

00:30:23.328 --> 00:30:26.371
increases every year and

00:30:26.411 --> 00:30:27.892
more codes for behavioral health.

00:30:28.352 --> 00:30:30.233
We just have to demonstrate that value.

00:30:30.273 --> 00:30:32.375
If we are to propose things like,

00:30:33.000 --> 00:30:34.060
more weight to the codes

00:30:34.241 --> 00:30:35.402
adding codes that we can

00:30:35.521 --> 00:30:36.561
provide and that's then

00:30:36.603 --> 00:30:37.083
these are still

00:30:37.103 --> 00:30:38.883
transactional right this is

00:30:38.942 --> 00:30:40.784
in regular transactional pt

00:30:40.824 --> 00:30:41.984
like if you're working in

00:30:42.025 --> 00:30:44.105
an outpatient clinic this

00:30:44.165 --> 00:30:46.006
matters to you to have your

00:30:46.066 --> 00:30:48.207
codes be more valued but

00:30:49.367 --> 00:30:51.228
that's not where our energy

00:30:51.528 --> 00:30:52.788
is really being spent from

00:30:52.828 --> 00:30:54.190
what I can see therapists

00:30:54.269 --> 00:30:56.150
will form focused on just

00:30:56.170 --> 00:30:57.510
the conversion factor as a whole

00:30:58.060 --> 00:30:59.241
okay so there's this

00:30:59.402 --> 00:31:00.942
ambiguous they that I

00:31:01.002 --> 00:31:02.544
mentioned before right and

00:31:02.564 --> 00:31:03.483
you're using words like

00:31:03.585 --> 00:31:06.286
show and value and now

00:31:06.326 --> 00:31:07.047
we're starting to cross

00:31:07.126 --> 00:31:09.228
over who knew into my sort

00:31:09.268 --> 00:31:10.848
of area of the world which

00:31:10.929 --> 00:31:13.029
is communication right but

00:31:13.069 --> 00:31:14.651
I like to understand the

00:31:14.692 --> 00:31:16.853
situation make it make sense right

00:31:17.313 --> 00:31:18.653
So we're talking about they

00:31:18.653 --> 00:31:19.854
– so that's our audience.

00:31:20.013 --> 00:31:20.815
Always know your who.

00:31:21.275 --> 00:31:21.954
Who are they?

00:31:21.994 --> 00:31:23.076
Are they policymakers?

00:31:23.115 --> 00:31:24.135
Are they insurance companies?

00:31:24.477 --> 00:31:25.436
Who is the they?

00:31:25.517 --> 00:31:26.758
And then I have follow-up questions.

00:31:26.778 --> 00:31:30.459
So who is – if you could –

00:31:28.659 --> 00:31:29.999
if Dana could wave a magic

00:31:30.058 --> 00:31:32.941
wand and put the one person

00:31:33.020 --> 00:31:34.320
or group in front of you

00:31:34.361 --> 00:31:36.182
that needed to hear this the most,

00:31:36.422 --> 00:31:37.603
who would magically appear

00:31:37.623 --> 00:31:39.044
if you waved your magic wand?

00:31:39.104 --> 00:31:41.144
Who is it?

00:31:41.545 --> 00:31:41.984
Well –

00:31:44.058 --> 00:31:46.201
PT's clients are the payers,

00:31:46.623 --> 00:31:47.904
but the payers can mean

00:31:47.944 --> 00:31:50.769
policymakers because policymakers

00:31:51.569 --> 00:31:52.971
determine the rates for

00:31:53.010 --> 00:31:54.872
Medicare and everyone else

00:31:54.892 --> 00:31:56.373
follows Medicare, essentially.

00:31:56.653 --> 00:31:58.173
So if we could change Medicare,

00:31:58.213 --> 00:32:00.414
this would maybe be the largest domino,

00:32:00.454 --> 00:32:00.815
or sorry,

00:32:00.855 --> 00:32:03.477
the domino to start the line of

00:32:03.497 --> 00:32:04.277
dominoes to fall.

00:32:04.336 --> 00:32:05.438
So perfect.

00:32:05.478 --> 00:32:07.179
Follow behavioral health's pattern.

00:32:07.318 --> 00:32:08.159
What have they done?

00:32:08.640 --> 00:32:09.160
Okay, good.

00:32:09.180 --> 00:32:09.920
That's what I would do.

00:32:09.941 --> 00:32:10.500
We're going to follow a

00:32:10.540 --> 00:32:11.441
campaign that we know has

00:32:11.480 --> 00:32:12.321
already been successful.

00:32:12.342 --> 00:32:12.922
I like that.

00:32:13.462 --> 00:32:14.423
So now we know our who.

00:32:16.701 --> 00:32:18.321
what is important to them

00:32:18.541 --> 00:32:19.522
when you're having an

00:32:19.563 --> 00:32:20.242
advertising or

00:32:20.262 --> 00:32:21.403
communications campaign you

00:32:21.443 --> 00:32:22.423
want to touch an emotion I

00:32:22.904 --> 00:32:24.085
know we're pts I know we're

00:32:24.164 --> 00:32:25.705
science we're fact based

00:32:26.125 --> 00:32:27.946
but we are big dumb animals

00:32:28.208 --> 00:32:29.667
all of us right and I

00:32:29.688 --> 00:32:30.429
always say if you want to

00:32:30.449 --> 00:32:31.308
get someone to pay

00:32:31.650 --> 00:32:33.671
attention and spend time

00:32:33.971 --> 00:32:34.631
you have to touch an

00:32:34.671 --> 00:32:36.612
emotion so what do they our

00:32:36.751 --> 00:32:37.492
audience we're talking

00:32:37.512 --> 00:32:38.933
about the people who decide medicare

00:32:39.594 --> 00:32:40.693
what do they actually care

00:32:40.733 --> 00:32:41.473
about that we could at

00:32:41.493 --> 00:32:42.795
least touch on that emotion

00:32:42.974 --> 00:32:44.595
and then slide in the back door and go,

00:32:44.674 --> 00:32:46.035
by the way, yeah, we do that.

00:32:46.335 --> 00:32:47.256
So what is the thing that

00:32:47.296 --> 00:32:48.395
they actually care about

00:32:48.836 --> 00:32:52.076
the most or some of those things?

00:32:52.176 --> 00:32:52.436
Yeah.

00:32:52.457 --> 00:32:54.156
Good question.

00:32:54.217 --> 00:32:54.517
Some.

00:32:54.737 --> 00:32:55.037
Okay.

00:32:55.076 --> 00:32:56.778
So I'm going to answer that to say,

00:32:56.917 --> 00:32:57.637
we're going to make the,

00:32:57.678 --> 00:32:59.178
they CMS center for

00:32:59.218 --> 00:33:00.157
Medicare and Medicaid

00:33:00.198 --> 00:33:01.439
services because they're

00:33:01.459 --> 00:33:03.159
the ones that take the

00:33:03.199 --> 00:33:04.199
budgeted dollars that

00:33:04.239 --> 00:33:05.578
Congress gives them and

00:33:05.618 --> 00:33:06.900
decides what to do with them.

00:33:07.200 --> 00:33:07.900
Got it.

00:33:07.920 --> 00:33:07.960
So,

00:33:08.737 --> 00:33:09.758
If I were to say,

00:33:09.817 --> 00:33:11.618
what's the first step that I would take?

00:33:13.219 --> 00:33:14.740
If I'm the physical therapy

00:33:14.779 --> 00:33:16.540
community and I'm looking

00:33:16.580 --> 00:33:19.942
to advocate for start with just the value,

00:33:19.982 --> 00:33:20.624
for example,

00:33:20.703 --> 00:33:23.684
of our codes or the benefits

00:33:23.724 --> 00:33:24.945
of adding additional

00:33:24.986 --> 00:33:26.846
services that would be best

00:33:27.007 --> 00:33:27.988
used by therapy,

00:33:29.067 --> 00:33:31.568
I would want to demonstrate

00:33:31.670 --> 00:33:33.150
to the Center for Medicare

00:33:33.390 --> 00:33:35.971
that we can bring additional value

00:33:37.159 --> 00:33:38.119
where they're trying to

00:33:38.220 --> 00:33:39.420
already shift value which

00:33:39.440 --> 00:33:41.181
is to primary care teams so

00:33:41.280 --> 00:33:42.342
I would say cms is the

00:33:42.382 --> 00:33:43.563
first client that we would

00:33:43.682 --> 00:33:44.742
be wanting to influence

00:33:44.923 --> 00:33:46.243
okay okay okay but you have

00:33:46.584 --> 00:33:47.484
we're gonna put a we're

00:33:47.505 --> 00:33:48.905
gonna put a billboard

00:33:49.046 --> 00:33:51.166
across the street from that

00:33:51.567 --> 00:33:53.208
committee's office yeah

00:33:53.307 --> 00:33:55.048
right what you could put

00:33:55.128 --> 00:33:56.109
anything you want on it but

00:33:56.130 --> 00:33:57.090
you can't put a thousand

00:33:57.131 --> 00:33:57.790
words because that's not

00:33:57.830 --> 00:33:59.231
how billboards work you

00:33:59.251 --> 00:34:00.873
could put like six or a

00:34:00.952 --> 00:34:02.413
picture or a combination

00:34:02.854 --> 00:34:04.275
what is the thing do they want

00:34:04.954 --> 00:34:06.296
And you can do two ideas, right?

00:34:06.316 --> 00:34:06.915
It's not just one.

00:34:07.256 --> 00:34:09.097
They want better care for less money,

00:34:09.498 --> 00:34:10.998
right?

00:34:11.018 --> 00:34:13.659
PTs prevent unnecessary,

00:34:13.780 --> 00:34:16.661
avoidable specialty care.

00:34:16.681 --> 00:34:17.702
Would be tough to put on a billboard,

00:34:17.722 --> 00:34:18.603
but we can get there, right?

00:34:18.623 --> 00:34:19.342
It's good to have that.

00:34:19.864 --> 00:34:21.304
We want the Miller Lite campaign.

00:34:21.704 --> 00:34:23.925
Great taste, less filling, right?

00:34:23.945 --> 00:34:25.666
Great care at less cost.

00:34:25.827 --> 00:34:28.088
We help more people with fewer dollars.

00:34:28.409 --> 00:34:29.628
We can reach more, right?

00:34:30.469 --> 00:34:31.449
Great taste, less filling.

00:34:31.469 --> 00:34:33.492
So that's our campaign, right?

00:34:33.512 --> 00:34:33.692
Mm-hmm.

00:34:34.291 --> 00:34:36.414
Now, tactically, how do we do that?

00:34:36.434 --> 00:34:37.134
Because I'm not going to put

00:34:37.173 --> 00:34:38.576
Dana across the street with a billboard,

00:34:38.635 --> 00:34:38.916
right?

00:34:39.496 --> 00:34:40.717
Is this the political action

00:34:40.737 --> 00:34:42.119
committee in APTA?

00:34:42.478 --> 00:34:43.940
Is this us quite literally

00:34:44.000 --> 00:34:44.981
picking up the phone or

00:34:45.001 --> 00:34:46.202
writing emails to people?

00:34:46.242 --> 00:34:47.882
Like, this is what we hear all the time,

00:34:47.922 --> 00:34:48.083
right?

00:34:48.184 --> 00:34:49.003
APTA is great.

00:34:49.083 --> 00:34:49.605
I'm a member.

00:34:49.925 --> 00:34:51.326
Flash action strategy.

00:34:51.365 --> 00:34:52.367
Everyone gets riled up.

00:34:52.427 --> 00:34:52.927
We don't know what we're

00:34:52.947 --> 00:34:53.748
getting riled up with

00:34:54.047 --> 00:34:55.108
because I got other things to do.

00:34:55.789 --> 00:34:56.891
But if you need me to do

00:34:56.911 --> 00:34:57.931
something for forty five seconds,

00:34:58.172 --> 00:34:58.652
I'll do it.

00:34:58.692 --> 00:34:59.393
Just tell me what.

00:34:59.492 --> 00:35:00.074
Make it easy.

00:35:01.217 --> 00:35:02.438
what are the tactical things?

00:35:02.478 --> 00:35:04.239
Like how do we get great taste,

00:35:04.278 --> 00:35:05.978
less filling, better care,

00:35:06.018 --> 00:35:07.918
less money to those people

00:35:08.099 --> 00:35:09.760
and actually make it change?

00:35:09.820 --> 00:35:11.239
Like how's it happen?

00:35:12.400 --> 00:35:12.599
Yeah.

00:35:12.619 --> 00:35:14.559
I mean, you're, I'm going back to CMS.

00:35:14.599 --> 00:35:16.481
You have to bring awareness,

00:35:16.800 --> 00:35:17.840
awareness first.

00:35:17.960 --> 00:35:18.880
And when we say political

00:35:18.960 --> 00:35:20.181
action committee and all of that,

00:35:20.221 --> 00:35:21.521
that's focused on Congress

00:35:21.541 --> 00:35:23.442
and we're going too far

00:35:23.481 --> 00:35:25.001
downstream where we first

00:35:25.061 --> 00:35:28.402
have to prove our value in, in,

00:35:28.990 --> 00:35:31.494
from where I sit is to CMS itself.

00:35:31.594 --> 00:35:33.056
So you can,

00:35:33.376 --> 00:35:35.038
and for anybody who doesn't know,

00:35:35.277 --> 00:35:37.099
you can go online,

00:35:37.239 --> 00:35:39.643
you can fill out a form to

00:35:40.063 --> 00:35:42.565
meet directly with anybody at CMS,

00:35:43.106 --> 00:35:44.148
schedule a meeting,

00:35:44.768 --> 00:35:46.170
explain what you want to meet about,

00:35:46.389 --> 00:35:48.291
and then make your case for something.

00:35:48.313 --> 00:35:49.092
I mean, this is their,

00:35:49.172 --> 00:35:50.474
they work for the public.

00:35:51.112 --> 00:35:52.213
And you can schedule,

00:35:52.233 --> 00:35:53.134
you don't have to be

00:35:53.494 --> 00:35:55.255
anybody special or certain title.

00:35:55.775 --> 00:35:59.237
You can get onto their calendar, CMS,

00:35:59.257 --> 00:35:59.619
you know,

00:36:00.139 --> 00:36:02.380
anyone at CMS's calendar generally.

00:36:03.141 --> 00:36:04.442
And depending on who they are,

00:36:04.461 --> 00:36:05.782
it could take a little bit longer.

00:36:06.503 --> 00:36:09.565
And you have to bring, you're basically,

00:36:09.806 --> 00:36:10.586
it's like selling.

00:36:10.626 --> 00:36:11.967
They're your clients, right?

00:36:11.987 --> 00:36:13.369
So therapists who are going to,

00:36:13.668 --> 00:36:15.070
if they were to work

00:36:15.130 --> 00:36:16.251
together and come up with

00:36:16.291 --> 00:36:17.291
what they would want and

00:36:17.632 --> 00:36:20.413
They need to show it a good reason why.

00:36:20.773 --> 00:36:23.012
CMS wants to know how anyone

00:36:23.052 --> 00:36:25.574
is going to help their cause,

00:36:25.914 --> 00:36:27.733
which is reducing

00:36:27.954 --> 00:36:29.875
unnecessary and avoidable spend.

00:36:30.235 --> 00:36:32.096
They've done that and they

00:36:32.195 --> 00:36:33.876
feel very strongly and many

00:36:34.036 --> 00:36:35.596
agree with them that by

00:36:35.876 --> 00:36:38.737
changing the way we pay primary care,

00:36:38.777 --> 00:36:42.097
we're more likely to achieve the goal

00:36:43.442 --> 00:36:45.103
than in a lot of other ways.

00:36:45.382 --> 00:36:50.023
So by being able to show, again,

00:36:50.063 --> 00:36:50.864
the behavioral health

00:36:50.884 --> 00:36:52.005
playbook worked really well

00:36:52.045 --> 00:36:52.844
for a good reason.

00:36:53.304 --> 00:36:54.724
Behavioral health proved

00:36:54.804 --> 00:36:57.146
that their presence and

00:36:57.186 --> 00:37:00.306
additional codes added to

00:37:00.347 --> 00:37:02.208
that team-based care would

00:37:02.288 --> 00:37:05.009
help reduce overall total cost of care,

00:37:05.028 --> 00:37:07.009
would improve access to those services,

00:37:07.048 --> 00:37:08.210
would help vulnerable

00:37:08.570 --> 00:37:09.929
populations that don't get

00:37:09.949 --> 00:37:11.469
the care that they need be

00:37:11.530 --> 00:37:13.030
centered in that primary care hub.

00:37:13.686 --> 00:37:16.447
If I had to say right now what I would do,

00:37:16.666 --> 00:37:18.887
I would be advocating for a

00:37:18.947 --> 00:37:21.068
code for collaboration, for example,

00:37:21.088 --> 00:37:22.070
a collaboration code

00:37:22.110 --> 00:37:23.150
between primary care and

00:37:23.170 --> 00:37:23.931
physical therapy.

00:37:24.990 --> 00:37:27.891
That would be not a very complex ask,

00:37:27.952 --> 00:37:29.293
but you'd still have to

00:37:29.333 --> 00:37:32.554
demonstrate why it's valuable, right?

00:37:32.693 --> 00:37:34.275
What data can we come up with?

00:37:34.335 --> 00:37:35.996
What ROI can we demonstrate

00:37:36.036 --> 00:37:37.295
would come out of?

00:37:37.856 --> 00:37:38.436
And you can look at

00:37:38.516 --> 00:37:39.898
longitudinal benefit for

00:37:39.938 --> 00:37:40.938
patients over time.

00:37:41.347 --> 00:37:42.568
What benefit would there be

00:37:42.628 --> 00:37:44.771
to a collaborative code for PTs?

00:37:45.291 --> 00:37:47.032
They just created, I mean, it hasn't been,

00:37:47.112 --> 00:37:48.233
the final rule's not out yet,

00:37:48.253 --> 00:37:49.815
but this year there's a new

00:37:49.856 --> 00:37:51.237
collaborative code for

00:37:51.297 --> 00:37:52.797
behavioral health providers

00:37:53.259 --> 00:37:56.001
to be able to use to bill

00:37:56.061 --> 00:37:57.822
for collaboration with the

00:37:57.882 --> 00:37:59.164
provider that's providing

00:37:59.204 --> 00:38:01.445
the medical care for

00:38:01.706 --> 00:38:02.847
someone's mental health,

00:38:02.887 --> 00:38:04.789
behavioral health diagnoses.

00:38:05.306 --> 00:38:07.168
these codes can be created, right?

00:38:07.289 --> 00:38:09.710
They just have to be valued as something,

00:38:10.090 --> 00:38:11.172
something new can be

00:38:11.211 --> 00:38:12.193
created as long as there's

00:38:12.213 --> 00:38:13.034
a value behind it.

00:38:13.583 --> 00:38:16.367
So you're telling me that someone like me,

00:38:16.586 --> 00:38:17.909
some Yahoo in upstate New

00:38:17.929 --> 00:38:19.389
York could book a time with

00:38:19.449 --> 00:38:22.733
someone at CMS because we are their boss,

00:38:22.793 --> 00:38:22.974
right?

00:38:22.994 --> 00:38:23.755
They're the government.

00:38:24.255 --> 00:38:26.097
And I could give a fifteen

00:38:26.137 --> 00:38:29.139
minute PowerPoint presentation to them.

00:38:29.641 --> 00:38:31.222
Now, their job is to listen.

00:38:31.302 --> 00:38:32.384
They then decide what they

00:38:32.403 --> 00:38:34.306
ask questions and ask questions.

00:38:34.346 --> 00:38:34.485
Right.

00:38:34.525 --> 00:38:34.907
They can do that.

00:38:36.407 --> 00:38:37.947
And then that's actually

00:38:38.748 --> 00:38:39.668
schoolhouse rocks.

00:38:39.688 --> 00:38:41.228
That's how the bill becomes a bill.

00:38:41.248 --> 00:38:42.610
That's how the change at

00:38:42.650 --> 00:38:44.070
least hopefully starts or

00:38:44.090 --> 00:38:44.489
that's where the

00:38:44.530 --> 00:38:46.150
conversation is because us

00:38:46.210 --> 00:38:47.690
yelling about it on a PT podcast.

00:38:47.791 --> 00:38:48.311
I got news.

00:38:48.811 --> 00:38:49.652
They're probably not listening.

00:38:49.931 --> 00:38:51.291
I mean, I wish they were, but they're not.

00:38:52.192 --> 00:38:53.632
You're telling me I could do that.

00:38:53.893 --> 00:38:55.152
I could actually do that.

00:38:55.693 --> 00:38:56.574
Anybody can do that.

00:38:56.653 --> 00:38:57.474
It's thirty minutes.

00:38:57.494 --> 00:38:58.014
They'll give you.

00:38:58.965 --> 00:38:59.726
And it takes,

00:38:59.766 --> 00:39:01.807
they have to hear it from a

00:39:01.927 --> 00:39:03.530
lot of sources and begin to

00:39:03.570 --> 00:39:07.333
put energy towards, okay, we now hear it.

00:39:07.614 --> 00:39:08.876
Now we understand it.

00:39:09.115 --> 00:39:10.016
Now we believe it's

00:39:10.036 --> 00:39:10.838
something that we can

00:39:10.878 --> 00:39:12.159
incorporate into the

00:39:12.179 --> 00:39:13.900
physician fee schedule maybe next year.

00:39:14.342 --> 00:39:15.983
Or maybe we put an RFI out,

00:39:16.083 --> 00:39:17.364
a request for information

00:39:17.425 --> 00:39:20.027
to see what others think about this.

00:39:20.849 --> 00:39:21.028
You can't.

00:39:21.380 --> 00:39:22.260
Besides a meeting,

00:39:22.280 --> 00:39:23.380
you can write specific

00:39:23.460 --> 00:39:25.402
letters to those who think

00:39:25.443 --> 00:39:26.103
about these things.

00:39:26.704 --> 00:39:27.503
But generally,

00:39:27.643 --> 00:39:28.585
you want to start with the

00:39:28.644 --> 00:39:30.465
regulators because the regulators,

00:39:30.505 --> 00:39:32.708
the CMS, they already have the budget.

00:39:32.827 --> 00:39:34.909
They get to make decisions

00:39:34.929 --> 00:39:38.150
and proposals about new things, new codes,

00:39:38.190 --> 00:39:39.251
new services, whatever.

00:39:39.853 --> 00:39:41.152
But they're not going to

00:39:41.172 --> 00:39:42.333
come up with it themselves.

00:39:42.534 --> 00:39:43.315
Understood.

00:39:43.474 --> 00:39:44.856
Yeah, right?

00:39:44.876 --> 00:39:46.056
But yes, anybody can do that.

00:39:46.097 --> 00:39:47.898
You can schedule a time.

00:39:48.304 --> 00:39:49.929
There's forms you fill out online.

00:39:50.268 --> 00:39:51.612
You can bring several people.

00:39:51.693 --> 00:39:52.735
You can bring a team.

00:39:53.777 --> 00:39:54.778
There's lots of avenues.

00:39:55.538 --> 00:39:56.858
But you will get a meeting

00:39:56.878 --> 00:39:59.219
with who you would like to by doing that.

00:39:59.239 --> 00:40:00.378
So you said it's thirty minutes.

00:40:00.719 --> 00:40:01.298
Keep in mind,

00:40:01.358 --> 00:40:03.139
TED Talks are capped at seventeen.

00:40:03.519 --> 00:40:05.099
So you don't need thirty to

00:40:05.340 --> 00:40:07.239
communicate a concept or

00:40:07.280 --> 00:40:08.181
complicated concept.

00:40:08.501 --> 00:40:09.420
You can do it in seventeen.

00:40:09.460 --> 00:40:10.240
I do it all the time.

00:40:11.141 --> 00:40:12.981
This is now got my wheels spinning.

00:40:13.442 --> 00:40:15.282
You know, I cared about these things,

00:40:15.322 --> 00:40:16.181
but I never really thought

00:40:16.342 --> 00:40:17.681
I would be able to do anything.

00:40:17.702 --> 00:40:19.202
But I could put together ten

00:40:19.282 --> 00:40:22.063
slides and a coherent presentation.

00:40:22.143 --> 00:40:23.164
Of course.

00:40:23.184 --> 00:40:24.543
Because here's the best part, too.

00:40:25.463 --> 00:40:26.565
The data is out there.

00:40:27.065 --> 00:40:27.644
The citation.

00:40:27.824 --> 00:40:29.166
So you can find this information.

00:40:29.186 --> 00:40:30.766
It's not at all.

00:40:31.447 --> 00:40:31.847
Okay.

00:40:32.186 --> 00:40:33.987
I might make a YouTube video about this.

00:40:34.108 --> 00:40:36.949
My day talking to CMS, right?

00:40:36.989 --> 00:40:38.150
Like this is what I did and

00:40:38.190 --> 00:40:39.010
this is why we did it.

00:40:40.070 --> 00:40:41.032
Of course do that because I

00:40:41.052 --> 00:40:42.152
think it would be fun and interesting,

00:40:42.211 --> 00:40:43.172
but good gosh,

00:40:43.213 --> 00:40:44.492
what if ten more people did it?

00:40:44.873 --> 00:40:45.634
What if fifty?

00:40:46.313 --> 00:40:47.074
What if a hundred?

00:40:47.795 --> 00:40:49.476
That's what I'm, you know,

00:40:49.496 --> 00:40:52.637
going on some select excellent podcast,

00:40:52.677 --> 00:40:54.117
trying to share this message.

00:40:54.871 --> 00:40:56.472
You've done a great job of pinpointing it.

00:40:56.492 --> 00:40:58.833
I mean, that's a really great first step.

00:40:59.034 --> 00:41:00.335
And it does work.

00:41:00.375 --> 00:41:02.815
It just can take time.

00:41:02.856 --> 00:41:04.215
We didn't plan on talking about this.

00:41:04.255 --> 00:41:05.737
This just sort of came up organically,

00:41:05.797 --> 00:41:08.338
right?

00:41:08.458 --> 00:41:10.778
If we had no more than three

00:41:10.798 --> 00:41:13.181
meetings for thirty minutes, right,

00:41:13.201 --> 00:41:13.800
because we need to keep

00:41:13.840 --> 00:41:15.282
this a realistic ask.

00:41:15.402 --> 00:41:16.422
This can't be the next

00:41:16.541 --> 00:41:19.242
crusade for the Holy Grail for you and I,

00:41:19.282 --> 00:41:20.784
because we just met forty

00:41:20.864 --> 00:41:22.324
one minutes ago when I pushed record.

00:41:24.193 --> 00:41:25.177
What I would do is I would

00:41:25.317 --> 00:41:26.480
act as your de facto

00:41:26.981 --> 00:41:27.903
marketing department.

00:41:28.125 --> 00:41:28.706
And I would say,

00:41:28.887 --> 00:41:29.849
we're going to put together

00:41:29.989 --> 00:41:31.715
no more than ten slides of

00:41:32.219 --> 00:41:33.559
And we have to tell a story

00:41:33.619 --> 00:41:35.001
in those ten slides or less

00:41:35.021 --> 00:41:36.322
than thirty minutes that

00:41:36.442 --> 00:41:37.862
clearly communicates one

00:41:37.963 --> 00:41:40.244
idea to try to plant the

00:41:40.324 --> 00:41:41.985
seed in whoever's listening to us.

00:41:42.726 --> 00:41:43.547
And we might need to do it

00:41:43.786 --> 00:41:45.128
for the next five years, right?

00:41:45.447 --> 00:41:47.228
Once a year for five years or ten years.

00:41:47.548 --> 00:41:49.369
But I would love to do that

00:41:49.389 --> 00:41:50.371
with you because you're the

00:41:50.411 --> 00:41:51.871
brains and I just know how to use Canva,

00:41:51.891 --> 00:41:53.313
let's be honest with you.

00:41:53.333 --> 00:41:54.253
I can use sound effects and

00:41:54.293 --> 00:41:55.353
I can make it sort of fun.

00:41:56.257 --> 00:41:58.018
But we'll document that

00:41:58.057 --> 00:42:00.079
process in public and maybe

00:42:00.199 --> 00:42:01.480
three other people will do it.

00:42:01.559 --> 00:42:04.360
Let's keep our expectations real, right?

00:42:05.041 --> 00:42:06.402
Hundreds of people listen to this podcast,

00:42:06.481 --> 00:42:06.722
right?

00:42:07.503 --> 00:42:08.422
But actually getting someone

00:42:08.443 --> 00:42:09.344
to do something is a little

00:42:09.384 --> 00:42:10.083
trickier than that.

00:42:10.143 --> 00:42:10.443
Otherwise,

00:42:10.463 --> 00:42:11.664
we wouldn't be having this conversation.

00:42:12.065 --> 00:42:13.005
But the goal would be to get

00:42:13.085 --> 00:42:15.126
three other people to do

00:42:15.246 --> 00:42:17.887
thirty-minute presentations with CMS.

00:42:18.188 --> 00:42:18.809
I feel like that's a

00:42:18.869 --> 00:42:19.889
realistic – and we're PTs,

00:42:19.909 --> 00:42:21.070
so we like to set realistic goals.

00:42:21.969 --> 00:42:22.751
I would do that.

00:42:23.311 --> 00:42:24.431
I would spend thirty minutes

00:42:24.471 --> 00:42:26.972
times three with you and then do it.

00:42:27.092 --> 00:42:27.291
Right.

00:42:27.311 --> 00:42:28.192
And then actually get on the

00:42:28.231 --> 00:42:29.552
books because I don't know.

00:42:29.572 --> 00:42:30.273
That'd be kind of a cool

00:42:30.293 --> 00:42:31.373
thing to be able to say you did.

00:42:31.472 --> 00:42:33.594
I spoke to CMS on behalf of

00:42:34.253 --> 00:42:35.173
physical therapy.

00:42:35.233 --> 00:42:35.494
I mean,

00:42:35.653 --> 00:42:36.614
I'm blushing a little bit just

00:42:36.655 --> 00:42:37.295
thinking about it.

00:42:37.755 --> 00:42:40.255
So if you help me, I'm in.

00:42:40.675 --> 00:42:42.115
I'm one hundred percent in.

00:42:42.335 --> 00:42:44.115
And we can record this process.

00:42:44.356 --> 00:42:45.717
They called it building in public.

00:42:45.797 --> 00:42:45.916
Yeah.

00:42:46.317 --> 00:42:48.077
We could record our meetings, right?

00:42:48.318 --> 00:42:50.099
Chop them up into segments, right?

00:42:50.119 --> 00:42:51.000
Condense a thirty minute

00:42:51.019 --> 00:42:51.980
meeting and down to three

00:42:52.019 --> 00:42:53.740
minutes and go at the end.

00:42:54.141 --> 00:42:55.382
I'll share the slide deck

00:42:55.461 --> 00:42:56.541
online and then we can

00:42:56.603 --> 00:42:57.862
record address rehearsal

00:42:57.922 --> 00:42:58.963
before we do our call.

00:43:00.284 --> 00:43:00.824
You didn't think you were

00:43:00.844 --> 00:43:02.425
going to get homework on this podcast,

00:43:02.465 --> 00:43:02.606
did you?

00:43:04.086 --> 00:43:04.726
So think about it.

00:43:04.766 --> 00:43:05.827
I won't put you on the spot.

00:43:05.867 --> 00:43:06.467
We're recording.

00:43:06.748 --> 00:43:07.628
Are you in?

00:43:07.668 --> 00:43:08.447
Okay, great.

00:43:08.527 --> 00:43:10.047
And I do that.

00:43:10.168 --> 00:43:12.889
So just to kind of,

00:43:12.929 --> 00:43:13.829
because I'm going to give

00:43:13.889 --> 00:43:16.070
really an intro to sort of what I do.

00:43:16.630 --> 00:43:18.190
I don't get to talk about

00:43:18.210 --> 00:43:19.989
physical therapy at my day job.

00:43:20.469 --> 00:43:23.851
I'm working in public policy

00:43:23.911 --> 00:43:25.891
for a large publicly traded company.

00:43:27.192 --> 00:43:28.731
And I get to work with and

00:43:28.831 --> 00:43:31.913
meet with these regulators and

00:43:33.244 --> 00:43:33.483
You know,

00:43:34.005 --> 00:43:36.407
it's not as hard as it sounds like it is.

00:43:36.628 --> 00:43:38.650
You do have to have a good

00:43:38.889 --> 00:43:41.452
argument for or good presentation.

00:43:42.353 --> 00:43:43.235
There are really smart

00:43:43.275 --> 00:43:44.096
people who want to

00:43:44.255 --> 00:43:45.797
understand without it being

00:43:45.838 --> 00:43:47.940
complicated how they can

00:43:48.541 --> 00:43:50.322
see value in it and how it fits.

00:43:51.043 --> 00:43:51.824
And this is the key.

00:43:52.380 --> 00:43:53.442
how does it fit in what

00:43:53.461 --> 00:43:54.282
they're already thinking

00:43:54.322 --> 00:43:55.322
about and what their plans

00:43:55.342 --> 00:43:56.402
are you can't make them

00:43:56.463 --> 00:43:58.244
think about like pulling

00:43:58.284 --> 00:43:59.324
things out of a hat that

00:43:59.344 --> 00:43:59.945
don't make sense to them

00:43:59.965 --> 00:44:02.166
right right right but which

00:44:02.226 --> 00:44:03.206
is where this comes full

00:44:03.246 --> 00:44:04.666
circle to awareness by

00:44:04.726 --> 00:44:06.728
therapists like can how

00:44:06.768 --> 00:44:07.989
many therapists can say I

00:44:08.028 --> 00:44:09.409
know what like what has

00:44:09.429 --> 00:44:10.710
cms's goals been in the

00:44:10.730 --> 00:44:12.550
last the number one payer in the country

00:44:12.851 --> 00:44:14.211
What are CMS's goals for the

00:44:14.231 --> 00:44:15.032
next five years?

00:44:15.072 --> 00:44:16.193
They've articulated them.

00:44:16.554 --> 00:44:18.056
Primary care strategy, specials.

00:44:18.496 --> 00:44:19.657
They articulated them

00:44:19.817 --> 00:44:21.077
beautifully in health affairs.

00:44:21.418 --> 00:44:22.278
Does anybody know them?

00:44:22.318 --> 00:44:23.380
Because if you know them,

00:44:23.679 --> 00:44:24.701
you then know what's going

00:44:24.721 --> 00:44:25.862
to resonate with them.

00:44:26.282 --> 00:44:28.824
And you can make an effective argument.

00:44:28.905 --> 00:44:29.626
But really,

00:44:29.646 --> 00:44:32.108
you're selling a concept that

00:44:32.148 --> 00:44:35.570
has to resonate with them and help them.

00:44:35.630 --> 00:44:36.791
Everyone wants to achieve that.

00:44:36.811 --> 00:44:37.652
How can you help me?

00:44:38.233 --> 00:44:39.193
They're just going to want to know.

00:44:39.614 --> 00:44:40.215
Well, that's great.

00:44:40.255 --> 00:44:41.496
How can you help me?

00:44:41.655 --> 00:44:42.637
And by me, I mean,

00:44:42.657 --> 00:44:44.038
how can you help us reach our goals?

00:44:44.297 --> 00:44:45.099
That's why I ask you,

00:44:45.778 --> 00:44:47.541
what is the emotion that we

00:44:47.561 --> 00:44:48.481
could put on a billboard

00:44:48.501 --> 00:44:49.463
that would at least get

00:44:49.483 --> 00:44:51.503
them to read it and go, huh?

00:44:51.985 --> 00:44:52.144
Dana,

00:44:52.184 --> 00:44:53.405
I already know the title of our

00:44:53.445 --> 00:44:54.146
presentation.

00:44:54.186 --> 00:44:54.907
Do you want to know what it is?

00:44:54.927 --> 00:44:55.106
Go ahead.

00:44:56.568 --> 00:44:58.990
Make it make sense.

00:44:59.130 --> 00:45:00.251
Where'd you get that great phrase?

00:45:00.835 --> 00:45:02.137
Listen, themes emerge.

00:45:02.257 --> 00:45:03.436
That's how magic works.

00:45:04.237 --> 00:45:04.918
Um, Dana,

00:45:04.958 --> 00:45:06.177
last thing we do on the show is

00:45:06.217 --> 00:45:07.358
called the parting shot.

00:45:07.559 --> 00:45:08.458
This is just your last

00:45:08.498 --> 00:45:10.159
chance to sort of have a mic drop moment.

00:45:10.440 --> 00:45:11.480
You can repeat an idea

00:45:11.500 --> 00:45:13.340
you've already had something new,

00:45:13.360 --> 00:45:14.581
whatever you want to do, a quote,

00:45:14.641 --> 00:45:15.581
a feeling, an emotion.

00:45:15.902 --> 00:45:16.822
What would you want to leave

00:45:16.862 --> 00:45:17.762
the audience with as we

00:45:17.802 --> 00:45:23.304
wrap up this episode?

00:45:23.324 --> 00:45:23.465
Hmm.

00:45:23.505 --> 00:45:24.925
Give me just a second to think.

00:45:24.965 --> 00:45:25.666
And I know you already

00:45:25.706 --> 00:45:26.746
prompted me on this and I

00:45:26.766 --> 00:45:27.465
know you can edit.

00:45:27.606 --> 00:45:27.666
um,

00:45:34.193 --> 00:45:36.954
So I mean, not to be too controversial,

00:45:37.074 --> 00:45:39.916
but maybe I'm going to just

00:45:39.996 --> 00:45:41.335
mention what frustrates me

00:45:41.376 --> 00:45:43.735
right now and why I'm

00:45:43.775 --> 00:45:44.976
willing to stick my neck out,

00:45:45.077 --> 00:45:45.996
even though sometimes I

00:45:46.016 --> 00:45:47.836
think therapists look at me like, oh,

00:45:47.876 --> 00:45:48.998
you're not on our side.

00:45:51.677 --> 00:45:52.757
Maybe it's a call to action,

00:45:52.797 --> 00:45:53.498
not a mic drop.

00:45:53.898 --> 00:45:57.719
And the call to action would be pan out.

00:45:58.018 --> 00:45:59.000
I write about this on

00:45:59.039 --> 00:46:00.380
LinkedIn kind of frequently.

00:46:00.911 --> 00:46:01.871
therapists,

00:46:02.251 --> 00:46:03.512
if we're going to do any of

00:46:03.552 --> 00:46:05.313
these things as a profession,

00:46:05.454 --> 00:46:07.815
we need to pan way out and

00:46:07.856 --> 00:46:09.056
realize that we are

00:46:09.257 --> 00:46:12.838
mainstream medical professionals, right?

00:46:12.938 --> 00:46:14.219
I went to school for PT

00:46:14.260 --> 00:46:15.601
because I realized it was a

00:46:15.740 --> 00:46:17.242
mainstream medical profession,

00:46:17.762 --> 00:46:19.804
yet we're largely living in

00:46:19.844 --> 00:46:21.724
a world in our own.

00:46:21.764 --> 00:46:21.985
I mean,

00:46:22.025 --> 00:46:24.086
we have referral relationships and

00:46:24.266 --> 00:46:25.887
we work with other providers,

00:46:25.947 --> 00:46:28.909
but less than we should think...

00:46:30.481 --> 00:46:31.762
How do I fit in?

00:46:32.362 --> 00:46:34.824
And how can I be a closer

00:46:34.864 --> 00:46:36.744
collaborator and team member?

00:46:37.605 --> 00:46:39.126
And how can I demonstrate my

00:46:39.186 --> 00:46:40.847
value to those providers

00:46:40.867 --> 00:46:42.588
that are incentivized to care?

00:46:44.028 --> 00:46:44.889
And I would encourage

00:46:44.909 --> 00:46:45.869
therapists to understand

00:46:46.630 --> 00:46:48.050
much better about incentives.

00:46:48.271 --> 00:46:49.652
Why do people do what they do?

00:46:49.672 --> 00:46:52.574
Because I read a lot about, well,

00:46:52.594 --> 00:46:54.614
they should just understand this, right?

00:46:54.655 --> 00:46:55.856
Like, why don't they get it?

00:46:56.414 --> 00:46:57.856
Because everyone is driven

00:46:57.876 --> 00:46:59.436
by their own incentives and

00:46:59.476 --> 00:47:01.179
incentives are created in a

00:47:01.400 --> 00:47:02.481
lot of different ways.

00:47:03.061 --> 00:47:03.822
In healthcare,

00:47:04.083 --> 00:47:06.545
they're created by who's paying for care.

00:47:06.985 --> 00:47:08.827
And that's either an insurance provider,

00:47:09.108 --> 00:47:09.688
the government,

00:47:09.708 --> 00:47:10.969
who's an insurance provider,

00:47:12.211 --> 00:47:13.353
patients who pay on their own.

00:47:14.076 --> 00:47:14.376
Right.

00:47:14.516 --> 00:47:14.856
Small,

00:47:14.996 --> 00:47:17.077
generally very small percentage or

00:47:17.277 --> 00:47:19.199
providers acting as

00:47:19.259 --> 00:47:21.260
insurers or taking on the

00:47:21.300 --> 00:47:23.221
financial risk or owning

00:47:23.240 --> 00:47:24.101
the health care dollars.

00:47:24.460 --> 00:47:25.981
That's who has the incentive to care.

00:47:26.402 --> 00:47:27.422
No one else cares.

00:47:27.722 --> 00:47:28.222
They don't.

00:47:28.362 --> 00:47:30.023
No one else has the

00:47:30.083 --> 00:47:31.885
incentive to hear what we're saying,

00:47:31.925 --> 00:47:32.545
which is, I think,

00:47:32.585 --> 00:47:33.525
why we're speaking into

00:47:33.545 --> 00:47:35.246
this black hole of people

00:47:35.266 --> 00:47:37.507
should understand why we're so valuable.

00:47:37.847 --> 00:47:38.307
Well,

00:47:38.528 --> 00:47:40.349
but are you showing it to the right

00:47:40.369 --> 00:47:40.670
people?

00:47:40.769 --> 00:47:42.690
So show your value to the right people.

00:47:43.775 --> 00:47:44.496
I've said before,

00:47:45.097 --> 00:47:46.277
if you actually provide

00:47:46.318 --> 00:47:47.818
value as a physical

00:47:47.838 --> 00:47:49.880
therapist or a lawn care

00:47:50.059 --> 00:47:52.702
specialist or a male person,

00:47:53.802 --> 00:47:55.284
doing that is half the equation.

00:47:56.317 --> 00:47:57.318
you have to show it too.

00:47:57.577 --> 00:47:58.760
You have to communicate it,

00:47:58.780 --> 00:47:59.619
communicate it.

00:47:59.661 --> 00:48:00.762
And when you think you've

00:48:00.802 --> 00:48:03.244
reached maximum saturation,

00:48:03.744 --> 00:48:05.666
you're a tenth of the way there.

00:48:05.686 --> 00:48:06.768
You have to keep singing it

00:48:06.788 --> 00:48:07.489
from the rooftops.

00:48:07.949 --> 00:48:08.228
All right.

00:48:08.248 --> 00:48:10.010
For Dana Strauss on her first appearance,

00:48:10.030 --> 00:48:10.751
but not last,

00:48:10.771 --> 00:48:11.413
because she's going to come

00:48:11.432 --> 00:48:12.813
back on the podcast.

00:48:13.054 --> 00:48:15.076
Thanks for sharing.

00:48:15.255 --> 00:48:16.938
Oh, so happy to be here.

00:48:16.958 --> 00:48:17.679
Thank you.

00:48:18.880 --> 00:48:19.561
Perfect.

00:48:19.581 --> 00:48:19.701
Let me