Why PT Clinics Need Metrics (And Clinicians Should Care)

WEBVTT

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You're listening to the PG Pinecast,

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where smart people in healthcare come to

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make noise.

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Here's your host, Jimmy McKay.

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Big thanks to Sarah Health,

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the remote care platform helping clinics

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boost revenue without having to add staff

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or four thousand post-it notes.

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See,

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Sarah automates daily patient check ins

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through simple text message reminders,

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which means no app, no lost passwords,

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no logins.

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This way, clinics improve follow through.

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They meet RTM requirements and get

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reimbursed for the care they're already

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delivering between visits.

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Learn more at sarahealth.com.

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That's S-A-R-A health.com.

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In healthcare,

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clinicians often feel like they're stuck

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in the middle.

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Call between doing the right thing for

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patients

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And hitting numbers,

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the business needs to survive.

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But what if those two goals were never

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supposed to compete?

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What if they weren't supposed to be

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separate?

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Today's guest has spent a career helping

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rehab teams and clinicians stop fighting

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the business side of healthcare and start

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understanding it.

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She's trained thousands of clinicians

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across the country to translate

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complicated clinical challenges...

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into practical systems that actually work

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in real clinics it's got to be real

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uh she's part speech language pathologist

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part pretend pt and ot but we're all

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cousins part educator and part strategy

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leader let's welcome back to the show

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katie holterman katie welcome back to the

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program thank you uh what's nice in theory

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may not be practical and what's practical

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may not feel nice so the tensions

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that clinicians feel between quality care

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and productivity expectations,

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they're real.

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So clinicians often say they feel like

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business pressures conflict with patient

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care.

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Let's start with where.

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Where does that tension actually come

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from?

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I think the tension comes from clinicians

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not understanding that business is

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business and that it's okay to know that

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you are actually working for a business,

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that it's okay to know that money makes

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the world go round, right?

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And it has to be a component of

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the conversation,

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but that as long as that conversation is

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led with clinical eyes and clinical words,

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the fiscal piece will follow it and it

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just will be a good thing.

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I mean, this is why

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nursery rhymes or fairy tales or fairy

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tales because it's a story that teaches a

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lesson.

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This is why schoolhouse rocks.

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This is how a bill becomes a bill.

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You can be mad when things aren't your

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way, but when you begin to understand,

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hey, there's a process.

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If you want the outcome,

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let's go back to the beginning and see

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how this thing changes.

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I think it's probably on the syllabus.

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In fact, I know it is.

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It must be mentioned somewhere,

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but it's probably different

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program to program in terms of, hey,

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you're going into healthcare.

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And then there's like seven subtitles

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layer.

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Healthcare is a business.

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It's probably one of the businesses.

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There are others like it where it's driven

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by this mission,

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but it's still a business.

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If you'd like to get paid to do

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this,

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there needs to be some sort of financial

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exchange in order to keep the lights on

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and pay for the people involved.

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who actually provide the care.

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Larry Benz in a recent episode even said

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in a health care organization,

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your assets wear shoes.

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Your assets are the people.

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I know you might have machines or

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anything,

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but even if you're a hospital with MRI

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machines and helicopters and ambulances,

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really your most important asset, nothing,

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nothing moves unless you have people.

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Exactly.

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And here's the problem.

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I think the core of it before the

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person becomes the employee in

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PT, OT and speech,

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they're the student and the student isn't

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taught business.

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They're not taught that their product is

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what they're selling or they're not taught

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the financial aspect of it.

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So we go into this business thinking,

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okay, well,

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everything else is going to make the

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money.

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We're just going to treat.

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Right.

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You are a service, right?

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Ritz-Carlton doesn't really sell beds.

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They sell the experience,

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everything from the moment you pull up to

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when you leave,

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if there's a mint on the pillow.

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And I've heard of healthcare organizations

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bringing in, quite literally,

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the Ritz-Carlton's

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sort of management or experience school to

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understand

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you're providing experience, right?

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So your framework sort of starts with

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defining non-negotiables.

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And I like those because as creative or

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as free as we can be in how

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we treat, right?

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There should be some non-negotiables.

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In order to be really creative,

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to think outside the box,

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there's got to be a box.

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So your non-negotiables are a box.

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And I like those things.

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Exactly.

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What does that look like in a real

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clinic, your non-negotiables?

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Yeah,

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so I think of these as like clinical

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guardrails, right?

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What is that box that you're not going

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to go out of,

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but you can play within it?

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So what is the max number of patients

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or people per therapist?

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What does that look like?

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And when it starts to go outside that

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box or outside that guardrail,

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then you know you're getting a little bit

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into more of that

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sticky place of is that really a business

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motivated decision versus your clinical

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guardrail of this is patient care.

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So that's an example of just I think

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staffing is a really good one.

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What does your staffing look like?

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And is it that you're trying to have

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X number of staff for, you know,

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this day versus this day?

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And does that make clinical sense because

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of the patient makeup that you have in

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that day?

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So clinical guardrails, I think,

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are really important from a documentation

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standpoint.

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You know,

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what is your clinical guardrail there?

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And then obviously from a billing

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standpoint, you know, from CPT codes,

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you know, what does that look like?

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Of course,

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I come at everything from the lens of

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the guy who used to work at a

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radio station,

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but there's so many parallels,

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and we were taught the difference between

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policy and law.

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Now, first of all,

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you can't violate the law.

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You can't do it.

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I mean, you can, and people do,

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but you're going to get caught.

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Just pretend like you're going to get

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caught.

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Don't do it, right?

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So there was the FCC.

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Don't break any of their rules.

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I don't care what you're doing.

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Don't do it.

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Then there was policy and that's set by

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the company.

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We don't do these things.

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And that's like, Hey,

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if you want to work here,

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you can't break these laws.

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We, these rules, sorry, not laws rules.

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Cause we'll fire you for that.

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That's outside of our bounds.

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And the funny part was in radio,

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it's much like it was so it's funny

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to come to healthcare and be like,

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Oh my gosh, this is,

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and I'm sure it's other, you know,

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professions too.

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Everybody on the air, we made the thing.

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We made the funny commercials and we made

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the whatever.

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We picked the music and we talked, right?

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We were the clinicians.

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We were the product.

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And we would look at sales and management

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as sort of always wanting to butt heads.

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And the minute I sort of realized that

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without them, we can't do what we do.

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And without us, they can't do.

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We are in the same boat.

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We are tied together.

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So instead,

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I sort of pulled a Bruce Lee move

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and it was only because I had smart

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bosses around me.

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be water.

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The goal is to get along,

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to go along,

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but I made sure to sort of hold

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fast to, well,

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I understand why you're trying to do that,

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but that's asking me to violate some of

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the things that keep our brand a brand.

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Which if we do an exception now,

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what's the stop of six months from now

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for doing that?

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If we eventually do it now,

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no one's listening and now you can't sell

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anything.

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And I feel like it's the same for

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clinicians.

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It's like, well, if we make exceptions,

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I understand why you're telling me that,

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but I can't do it because I've also

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got a license.

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I didn't have a license in broadcasting.

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You didn't have to have one.

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You lose that in healthcare, you're done.

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So that should be also be your guiding

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light.

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Yeah.

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And also, you know, the,

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when you start making the exceptions,

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it's easy to lose sight of when that

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exception then becomes the norm, right?

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The slippery slope idea, right?

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Yeah.

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You make that exception once,

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then you make it again.

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And then it's, well, was it really,

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was that really within our clinical

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guardrail?

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Right, right, right.

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Did I make that up?

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So it's important to really keep and take

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hold of that.

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Right.

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So this,

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I think everything I just sort of heard

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or a lot of what I just heard

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sounds like,

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understanding what you do and where you

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fit.

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And this is understanding the physics of

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the environment.

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Yes.

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Given a blank check and all the time

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in the world,

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you would treat people differently.

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But we do not have a blank check

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and unlimited time in this environment.

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That just is not.

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So we have to understanding the other

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side, management,

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if you're a clinician or clinicians,

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if you're management,

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because sometimes management are former

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clinicians like yourself.

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Sometimes you're not.

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So sometimes more understanding is

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typically always better, right?

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Like understanding is either confirming

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what you already knew or teaching you

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something new.

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Exactly.

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Exactly.

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And you, you,

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I think that that understanding and it

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goes a long way because then you can

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speak the language for the other person

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too.

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Like when you're all on the same page,

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it just makes the, the,

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it makes everything easier.

00:10:05.974 --> 00:10:07.315
And so that starts with communication,

00:10:07.375 --> 00:10:08.975
clear, clear communication.

00:10:09.195 --> 00:10:09.596
Yep.

00:10:09.635 --> 00:10:09.836
You,

00:10:09.875 --> 00:10:12.255
you say if something matters clinically,

00:10:12.515 --> 00:10:14.116
it should be measured.

00:10:14.793 --> 00:10:15.293
Yes.

00:10:15.332 --> 00:10:17.413
What are the most important metrics then

00:10:17.793 --> 00:10:19.533
that clinics should actually track?

00:10:19.573 --> 00:10:21.475
Because in twenty twenty six and beyond,

00:10:21.514 --> 00:10:21.774
believe me,

00:10:21.995 --> 00:10:24.316
we could track the list of things we

00:10:24.355 --> 00:10:26.115
can track is only listen.

00:10:26.135 --> 00:10:27.657
You can actually hear it getting longer as

00:10:27.677 --> 00:10:28.116
we speak.

00:10:28.697 --> 00:10:30.518
But what are the most important metrics?

00:10:30.557 --> 00:10:33.038
Because we can't have a million KPIs.

00:10:33.099 --> 00:10:34.119
It makes them not key.

00:10:34.178 --> 00:10:35.879
That's what K and KPI means, right?

00:10:36.659 --> 00:10:38.340
So what are what are the most important

00:10:38.360 --> 00:10:39.941
metrics that you think clinics should

00:10:40.100 --> 00:10:40.860
actually track?

00:10:41.211 --> 00:10:43.452
Yeah, well, before I answer that,

00:10:43.493 --> 00:10:45.673
I think what you just said is so

00:10:45.714 --> 00:10:47.215
important that it deserves to be kind of

00:10:47.254 --> 00:10:47.794
said again.

00:10:49.315 --> 00:10:50.556
Everything can't be important.

00:10:51.115 --> 00:10:52.236
Can't be.

00:10:52.336 --> 00:10:53.716
And if you're measuring it,

00:10:54.076 --> 00:10:55.018
for goodness sake,

00:10:55.177 --> 00:10:56.899
ensure that there's like a compelling and

00:10:56.938 --> 00:10:58.938
real story behind it, right?

00:10:59.639 --> 00:11:00.539
It has to matter.

00:11:00.960 --> 00:11:04.522
So what matters for clinical care and why?

00:11:05.121 --> 00:11:07.283
And the why part is the important part.

00:11:08.157 --> 00:11:09.719
because then that will help you figure

00:11:09.798 --> 00:11:11.299
out, is it really important to measure?

00:11:11.441 --> 00:11:14.344
So for example, frequency, right?

00:11:14.543 --> 00:11:18.528
How frequent are we seeing patients per

00:11:18.567 --> 00:11:18.889
week?

00:11:19.369 --> 00:11:20.931
That's a metric that everybody seems to

00:11:20.990 --> 00:11:22.331
want to measure.

00:11:22.432 --> 00:11:24.674
Are we seeing them three times a week?

00:11:24.715 --> 00:11:26.135
Is that appropriate?

00:11:26.953 --> 00:11:27.673
Well, why?

00:11:28.154 --> 00:11:29.154
Why is that appropriate?

00:11:29.475 --> 00:11:30.916
It may be appropriate for one type of

00:11:30.956 --> 00:11:32.017
patient and not for another.

00:11:32.057 --> 00:11:33.677
So it really doesn't make sense and we

00:11:33.697 --> 00:11:35.097
can kind of throw that away if we

00:11:35.118 --> 00:11:36.359
don't have the why behind it.

00:11:38.279 --> 00:11:39.500
Number of visits, right?

00:11:39.561 --> 00:11:41.581
That's gonna be something that people are

00:11:41.601 --> 00:11:42.501
going to measure.

00:11:42.782 --> 00:11:44.322
But again, why?

00:11:44.823 --> 00:11:46.845
What's the magic number and do we have

00:11:46.865 --> 00:11:50.285
a story behind that that gives us reason

00:11:50.346 --> 00:11:52.788
as to why we need to measure that?

00:11:54.089 --> 00:11:54.969
And then outcomes.

00:11:55.028 --> 00:11:55.208
Right.

00:11:55.249 --> 00:11:56.129
In this day and age,

00:11:56.169 --> 00:11:58.410
we're moving towards value based care.

00:11:58.750 --> 00:11:59.991
Actually, scratch that.

00:12:00.211 --> 00:12:04.355
We are in value based care.

00:12:04.455 --> 00:12:06.956
And so outcomes are of utmost importance.

00:12:08.076 --> 00:12:11.178
But if we don't if we're just measuring

00:12:11.278 --> 00:12:12.940
outcomes because we think we're supposed

00:12:12.960 --> 00:12:15.461
to measure this assessment,

00:12:15.522 --> 00:12:19.124
this this this measure that CMS says we

00:12:19.183 --> 00:12:19.884
have to measure.

00:12:21.285 --> 00:12:21.645
Okay,

00:12:22.025 --> 00:12:24.647
that does make sense because it fits into

00:12:25.307 --> 00:12:27.606
the value-based care model.

00:12:28.807 --> 00:12:30.008
But at the heart of it,

00:12:30.268 --> 00:12:33.508
what's going to say that your clinic is

00:12:33.687 --> 00:12:34.967
the best clinic out there?

00:12:35.989 --> 00:12:36.729
Is it, you know,

00:12:37.068 --> 00:12:38.408
I come from the geriatric world.

00:12:38.469 --> 00:12:40.528
So a lot of times we would measure,

00:12:40.548 --> 00:12:42.169
you know, something around falls.

00:12:42.590 --> 00:12:44.090
We would measure, you know,

00:12:44.850 --> 00:12:46.870
is the patient at risk for falling?

00:12:48.250 --> 00:12:48.551
Okay.

00:12:50.384 --> 00:12:52.027
What's the number of times they've fallen

00:12:52.047 --> 00:12:52.586
in the year?

00:12:53.008 --> 00:12:54.850
That's one measure that we can, you know,

00:12:54.889 --> 00:12:56.191
that that might matter.

00:12:57.192 --> 00:12:59.975
And then insurance companies may pay us

00:13:00.394 --> 00:13:01.716
more if

00:13:02.748 --> 00:13:04.469
their patient is not falling as much,

00:13:04.509 --> 00:13:06.029
if their patient is not at risk for

00:13:06.070 --> 00:13:06.471
falling.

00:13:07.030 --> 00:13:08.412
But wouldn't it be great if we had

00:13:08.652 --> 00:13:10.192
a better measure of, well,

00:13:10.232 --> 00:13:11.793
what's the number of times that they

00:13:11.854 --> 00:13:14.416
engaged in something or didn't engage in

00:13:14.495 --> 00:13:16.317
something because they had a fear of

00:13:16.378 --> 00:13:18.519
falling or didn't have a fear of falling?

00:13:19.240 --> 00:13:22.442
And it's because I had PT and it

00:13:22.481 --> 00:13:23.543
made a difference.

00:13:23.982 --> 00:13:24.163
Well,

00:13:24.222 --> 00:13:27.144
now we have a domino effect of all

00:13:27.184 --> 00:13:29.287
of the things that that can potentially

00:13:29.527 --> 00:13:30.067
impact.

00:13:32.037 --> 00:13:33.298
including, again,

00:13:33.418 --> 00:13:35.019
payment from insurance companies.

00:13:35.058 --> 00:13:36.299
So I think there's a number of things

00:13:36.320 --> 00:13:37.981
that we need to look at measuring.

00:13:38.142 --> 00:13:39.363
But more importantly,

00:13:39.982 --> 00:13:41.484
why are we measuring it?

00:13:41.504 --> 00:13:42.845
What is the story behind it?

00:13:42.884 --> 00:13:43.725
What is the purpose?

00:13:43.745 --> 00:13:45.606
And I was taught that early in my

00:13:45.967 --> 00:13:46.388
career.

00:13:46.408 --> 00:13:47.469
It doesn't really matter what my career

00:13:47.568 --> 00:13:47.708
is.

00:13:47.749 --> 00:13:49.049
The advice was still good.

00:13:49.490 --> 00:13:52.552
Number one, a great boss said, she said,

00:13:53.533 --> 00:13:53.833
figure,

00:13:53.974 --> 00:13:57.076
understand at least the basics of every

00:13:57.135 --> 00:13:57.996
job in this company.

00:13:59.235 --> 00:14:00.275
even if you're not going to do it.

00:14:00.855 --> 00:14:03.418
So go out, ask, volunteer.

00:14:03.577 --> 00:14:04.859
I came in as a broadcaster,

00:14:04.879 --> 00:14:06.159
but I was going out when I didn't

00:14:06.200 --> 00:14:07.821
have to to help set up events because

00:14:07.860 --> 00:14:08.240
I was like,

00:14:09.761 --> 00:14:10.842
I'm going to need to send these people

00:14:10.923 --> 00:14:11.023
out.

00:14:11.043 --> 00:14:11.943
I want to know what I'm sending them

00:14:11.984 --> 00:14:14.426
to when it's raining or snowing or when

00:14:14.466 --> 00:14:15.326
I give them no notice.

00:14:15.385 --> 00:14:16.966
When someone turns to me and says, well,

00:14:16.986 --> 00:14:18.168
it takes four hours to do that.

00:14:18.187 --> 00:14:18.528
I'm like, oh,

00:14:18.567 --> 00:14:19.349
we can do that in an hour and

00:14:19.369 --> 00:14:20.649
a half.

00:14:20.950 --> 00:14:23.292
Or I know I'm sending you to something

00:14:23.412 --> 00:14:23.731
awful.

00:14:23.851 --> 00:14:25.452
I'm going to give you more help.

00:14:25.552 --> 00:14:27.774
But understanding what the actual job

00:14:28.961 --> 00:14:30.682
entails why you're doing it.

00:14:31.384 --> 00:14:32.965
And then at some point that why might

00:14:32.985 --> 00:14:34.946
have changed and now you don't need to

00:14:34.966 --> 00:14:35.986
do that anymore.

00:14:36.027 --> 00:14:36.908
So why are we doing it?

00:14:37.307 --> 00:14:38.668
There seems to be no reason.

00:14:38.908 --> 00:14:40.250
I guess we can discontinue that.

00:14:40.629 --> 00:14:42.351
So understanding the why is everything

00:14:42.392 --> 00:14:43.331
I've heard so far.

00:14:43.432 --> 00:14:44.793
Yes, a hundred percent.

00:14:44.873 --> 00:14:45.014
Yeah.

00:14:45.793 --> 00:14:47.754
I do want to thank Empower EMR.

00:14:48.096 --> 00:14:49.356
If your clinic is stuck in an EMR,

00:14:49.376 --> 00:14:49.937
it slows you down.

00:14:49.956 --> 00:14:51.118
Empower gives you speed,

00:14:51.158 --> 00:14:51.878
cleaner workflows,

00:14:52.298 --> 00:14:54.200
and documentation tools built specifically

00:14:54.240 --> 00:14:54.860
for rehab.

00:14:55.120 --> 00:14:56.581
Better notes, faster documentation,

00:14:56.621 --> 00:14:57.722
smoother clinic operations.

00:14:57.783 --> 00:15:00.264
Learn more at empoweremr.com.

00:15:00.283 --> 00:15:01.725
That is empoweremr.com.

00:15:01.745 --> 00:15:03.086
I mean, even EMRs,

00:15:03.105 --> 00:15:05.008
they have access to so many things.

00:15:05.028 --> 00:15:06.107
So you can measure.

00:15:07.078 --> 00:15:09.020
But if you're not asking upstream what

00:15:09.061 --> 00:15:10.361
you're looking for or what you want to

00:15:10.402 --> 00:15:10.662
measure,

00:15:10.682 --> 00:15:11.822
you're not going to get that good data

00:15:12.182 --> 00:15:12.763
downstream.

00:15:13.063 --> 00:15:15.205
So let's move forward in this timeline.

00:15:15.446 --> 00:15:16.947
Once metrics exist,

00:15:17.846 --> 00:15:19.328
the real challenge now is getting

00:15:19.349 --> 00:15:22.091
clinicians to care about them.

00:15:22.931 --> 00:15:24.633
This just feels like it's a feedback loop.

00:15:24.873 --> 00:15:28.014
How do you suggest we create buy-in or

00:15:28.034 --> 00:15:29.416
what have you seen work,

00:15:29.537 --> 00:15:31.837
not only in theory, but in practice,

00:15:31.898 --> 00:15:32.519
in reality?

00:15:33.828 --> 00:15:34.528
make it visible,

00:15:34.948 --> 00:15:39.610
make the frontline clinician be able to

00:15:39.730 --> 00:15:42.070
see what those metrics are.

00:15:42.529 --> 00:15:42.791
Again,

00:15:43.971 --> 00:15:45.091
they know the metric and they know the

00:15:45.130 --> 00:15:45.711
why behind it.

00:15:48.432 --> 00:15:49.152
Once you get past that,

00:15:49.192 --> 00:15:51.251
it's kind of an easy slope to kind

00:15:51.292 --> 00:15:52.131
of glide down.

00:15:52.532 --> 00:15:53.711
But if they don't see it,

00:15:54.832 --> 00:15:57.052
then they're not going to have it

00:15:57.552 --> 00:15:59.452
constantly in their workflow,

00:15:59.513 --> 00:16:02.193
in their reminder, in their daily life.

00:16:03.802 --> 00:16:07.004
But making it visible is one thing.

00:16:07.985 --> 00:16:09.927
How are they interpreting it and are they

00:16:09.966 --> 00:16:11.528
interpreting the metric correctly?

00:16:11.668 --> 00:16:13.450
So make it visible,

00:16:13.909 --> 00:16:17.591
make it a part of conversation so that

00:16:17.792 --> 00:16:20.854
they understand what the metric is telling

00:16:20.874 --> 00:16:23.796
them and again, what that story is.

00:16:25.677 --> 00:16:29.100
I think who who talks about the metrics

00:16:29.820 --> 00:16:31.522
and what they say about them are

00:16:32.541 --> 00:16:34.322
as important as the metrics themselves.

00:16:34.361 --> 00:16:35.142
So in other words,

00:16:35.861 --> 00:16:38.163
clinic owner talks about a metric that

00:16:38.182 --> 00:16:40.004
they're, you know, let's just say it's,

00:16:40.163 --> 00:16:41.825
you know, revenue per day.

00:16:43.304 --> 00:16:45.306
A clinic owner talking about that and just

00:16:45.346 --> 00:16:46.946
saying, okay, our revenue per day is this,

00:16:46.985 --> 00:16:48.886
and here's the number and walks away.

00:16:49.567 --> 00:16:51.727
Frontline clinician does not care about

00:16:51.788 --> 00:16:51.947
that.

00:16:52.248 --> 00:16:53.349
It's tone deaf.

00:16:54.229 --> 00:16:55.490
But if you talk about it in the

00:16:55.529 --> 00:16:57.409
way of here's our revenue per day,

00:16:57.470 --> 00:16:59.870
and here's how we got to that number.

00:17:00.591 --> 00:17:03.113
And it was X number of units.

00:17:04.532 --> 00:17:06.233
And this is the CPT code that you

00:17:06.413 --> 00:17:06.773
used.

00:17:07.174 --> 00:17:08.894
And let's talk about your documentation.

00:17:08.914 --> 00:17:10.776
And does your documentation reflect what

00:17:10.816 --> 00:17:11.336
you did?

00:17:12.997 --> 00:17:15.337
Is that the right CPT code for what

00:17:15.377 --> 00:17:15.678
you did?

00:17:15.698 --> 00:17:17.419
And if it is, great, perfect.

00:17:17.459 --> 00:17:18.138
If it's not,

00:17:18.219 --> 00:17:19.599
maybe we need to change that.

00:17:20.880 --> 00:17:22.300
That's a clinical discussion.

00:17:22.967 --> 00:17:25.749
That turns that whole clinician's mind

00:17:25.788 --> 00:17:27.170
frame,

00:17:27.509 --> 00:17:30.352
mindset from here's a number and walk

00:17:30.392 --> 00:17:30.852
away.

00:17:31.612 --> 00:17:32.893
Here's what you did.

00:17:33.574 --> 00:17:34.773
I'd love to know more about it.

00:17:35.255 --> 00:17:37.996
Let's have a conversation about that.

00:17:38.036 --> 00:17:39.636
But the more they see that in front

00:17:39.676 --> 00:17:41.939
of their face and hear that information,

00:17:42.713 --> 00:17:44.535
at least that's a conversation they're

00:17:44.555 --> 00:17:46.416
willing to have them i think yeah

00:17:47.356 --> 00:17:50.358
clinicians are not stupid i mean they can

00:17:50.378 --> 00:17:52.901
understand this the thing is if but but

00:17:52.980 --> 00:17:54.342
you can't understand something that hasn't

00:17:54.362 --> 00:17:55.583
been put in front of you or you're

00:17:55.603 --> 00:17:57.544
not discussed or it's it's it's been

00:17:57.584 --> 00:18:00.906
hidden from you this is why revenue per

00:18:00.946 --> 00:18:02.667
day in your clinic matters and you're like

00:18:02.708 --> 00:18:04.068
why so you can buy another boat it's

00:18:04.088 --> 00:18:05.329
like no because if we if this stays

00:18:05.390 --> 00:18:06.711
low for too long we close

00:18:07.861 --> 00:18:09.502
And then we provide no care to anyone.

00:18:10.163 --> 00:18:11.884
Or if we can figure out a way

00:18:11.924 --> 00:18:15.748
to clinically improve care or find more

00:18:15.788 --> 00:18:19.291
people to help, we raise that number.

00:18:19.332 --> 00:18:20.932
We can hire another clinician or we can

00:18:20.972 --> 00:18:22.294
expand to another thing or we can give

00:18:22.335 --> 00:18:23.035
you a raise.

00:18:23.455 --> 00:18:24.997
I don't think clinicians want,

00:18:25.678 --> 00:18:26.397
for the most part,

00:18:26.878 --> 00:18:27.819
to produce more

00:18:29.076 --> 00:18:30.076
just to get a raise,

00:18:30.116 --> 00:18:31.096
and I don't think you should.

00:18:31.817 --> 00:18:34.960
But if you understand that doing a few

00:18:34.980 --> 00:18:37.142
more butterfly, you know,

00:18:37.682 --> 00:18:40.364
the butterfly flaps its wings, right?

00:18:40.483 --> 00:18:42.565
The butterfly effect, what that does,

00:18:43.086 --> 00:18:44.727
the tail shouldn't wag the dog,

00:18:44.826 --> 00:18:46.347
but the dog should wag the tail.

00:18:46.407 --> 00:18:48.308
Like, that's why we got into this.

00:18:48.609 --> 00:18:49.109
It's really funny,

00:18:49.150 --> 00:18:49.970
especially in healthcare.

00:18:49.990 --> 00:18:51.211
I say we have the Peace Corps gene.

00:18:52.491 --> 00:18:54.012
Many people, and rightfully so,

00:18:54.032 --> 00:18:54.874
would like to be paid more.

00:18:56.035 --> 00:18:57.055
But they would also like to give a

00:18:57.095 --> 00:18:59.596
lot of things away for free or included.

00:19:00.655 --> 00:19:02.215
And those two things don't math.

00:19:03.537 --> 00:19:04.096
Those two things,

00:19:05.396 --> 00:19:06.477
they don't work together.

00:19:09.397 --> 00:19:10.998
I'd love to see how that works.

00:19:11.038 --> 00:19:14.679
But you've said dashboards and scorecards

00:19:15.138 --> 00:19:15.499
matter.

00:19:15.679 --> 00:19:17.219
I sort of like that second one too.

00:19:17.839 --> 00:19:19.880
Only if people actually see them, right?

00:19:19.960 --> 00:19:21.619
An invisible scorecard that I'm getting

00:19:21.660 --> 00:19:22.320
graded on.

00:19:22.421 --> 00:19:23.701
Even in higher education,

00:19:23.721 --> 00:19:24.381
there's a rubric.

00:19:25.260 --> 00:19:27.221
I know how much percent of my grade

00:19:27.261 --> 00:19:27.803
or anything.

00:19:27.863 --> 00:19:29.123
A lot of times I think you're right

00:19:29.163 --> 00:19:30.003
where it's not visible.

00:19:30.304 --> 00:19:33.685
So what is good visibility look like in

00:19:33.705 --> 00:19:34.026
the clinic?

00:19:34.046 --> 00:19:35.586
Because I imagine too much might be

00:19:35.646 --> 00:19:36.287
paralyzing.

00:19:36.807 --> 00:19:37.527
Absolutely.

00:19:37.708 --> 00:19:38.048
Yeah.

00:19:38.147 --> 00:19:42.130
I think it's this balance, right?

00:19:42.150 --> 00:19:45.211
Where you don't want so many numbers

00:19:45.230 --> 00:19:49.012
coming at people and so many different

00:19:49.053 --> 00:19:51.413
scorecards and different dashboards and,

00:19:51.595 --> 00:19:51.855
you know,

00:19:53.003 --> 00:19:54.527
different numbers that mean different

00:19:54.547 --> 00:19:56.391
things in different ways because then it

00:19:56.431 --> 00:19:57.372
becomes white noise.

00:19:58.934 --> 00:20:03.063
But invisible metrics

00:20:04.053 --> 00:20:05.374
die quick,

00:20:05.534 --> 00:20:07.775
make the actual metric die even quicker.

00:20:07.835 --> 00:20:09.395
So it's a balance.

00:20:09.496 --> 00:20:13.817
I think that scorecards are important from

00:20:13.978 --> 00:20:16.659
how the clinician is doing themselves.

00:20:16.719 --> 00:20:17.839
Everybody wants to do well.

00:20:18.079 --> 00:20:20.961
Nobody gets into this field to say,

00:20:21.121 --> 00:20:22.461
I want to be a really can I

00:20:22.481 --> 00:20:22.981
swear on here?

00:20:23.521 --> 00:20:23.781
Sure.

00:20:24.221 --> 00:20:25.542
I want to be a really shitty clinician.

00:20:25.702 --> 00:20:26.663
No one says that.

00:20:30.692 --> 00:20:32.594
People want to take pride in the work

00:20:32.614 --> 00:20:33.354
that they do.

00:20:33.534 --> 00:20:35.055
So a scorecard is a great way to

00:20:35.134 --> 00:20:35.654
do that.

00:20:36.155 --> 00:20:37.936
And this goes back to outcomes.

00:20:38.416 --> 00:20:39.978
Nobody wants to go in and being like,

00:20:40.057 --> 00:20:41.598
I'm gonna give mediocre therapy today.

00:20:41.618 --> 00:20:44.540
And maybe this knee injury is gonna get

00:20:44.560 --> 00:20:45.461
better by itself.

00:20:45.520 --> 00:20:47.041
Maybe I'm gonna help it a little bit.

00:20:47.363 --> 00:20:47.542
No,

00:20:47.603 --> 00:20:49.763
people want their patients to walk out the

00:20:49.804 --> 00:20:51.345
door and go, oh my gosh,

00:20:51.984 --> 00:20:53.946
Katie did a fantastic job.

00:20:54.106 --> 00:20:55.487
I'm gonna refer her to all of my

00:20:55.567 --> 00:20:56.107
friends.

00:20:57.352 --> 00:20:58.773
that makes us feel good.

00:20:59.013 --> 00:21:01.757
And so that kind of a scorecard and

00:21:01.777 --> 00:21:04.220
visibility from our outcomes perspective

00:21:04.359 --> 00:21:07.544
and our cash business perspective,

00:21:08.065 --> 00:21:10.567
that all paints the picture of how good

00:21:10.607 --> 00:21:12.730
of a clinician you are at the end

00:21:12.750 --> 00:21:13.050
of the day.

00:21:13.642 --> 00:21:14.481
With a good scorecard,

00:21:14.501 --> 00:21:17.663
imagine we both understand what the number

00:21:17.743 --> 00:21:19.324
means and how it changes.

00:21:20.104 --> 00:21:21.204
If you're giving me a C and I'm

00:21:21.244 --> 00:21:21.365
like,

00:21:21.384 --> 00:21:22.505
but I don't know how I make the

00:21:22.545 --> 00:21:24.145
C a B, that's not fair.

00:21:24.786 --> 00:21:26.926
And then understanding how it lines up

00:21:27.366 --> 00:21:28.267
with the big picture.

00:21:28.307 --> 00:21:29.928
How does this move the entire boat

00:21:30.488 --> 00:21:30.928
forward?

00:21:31.327 --> 00:21:32.868
So this is just an alignment of good

00:21:32.929 --> 00:21:33.568
expectations.

00:21:33.909 --> 00:21:35.349
I mean, most things that...

00:21:36.174 --> 00:21:36.394
you know,

00:21:36.434 --> 00:21:39.656
devolve into stress or disagreement.

00:21:40.357 --> 00:21:43.960
If you rewind, it's because of missed.

00:21:43.980 --> 00:21:44.720
I said that,

00:21:45.181 --> 00:21:46.181
but that's not what I meant.

00:21:46.300 --> 00:21:47.241
Or I you said that,

00:21:47.261 --> 00:21:49.143
but I heard this or I don't understand.

00:21:49.983 --> 00:21:52.384
Sometimes it is as simple as a simple

00:21:52.424 --> 00:21:54.685
but not easy as understanding what those

00:21:54.727 --> 00:21:56.387
expectations really are and making sure

00:21:56.407 --> 00:21:56.948
they're aligned.

00:21:57.438 --> 00:21:58.438
Yeah, absolutely.

00:21:58.718 --> 00:21:59.618
And words matter.

00:22:00.199 --> 00:22:02.740
The way you say things and explain things

00:22:03.000 --> 00:22:03.779
do matter.

00:22:03.819 --> 00:22:05.060
And I'm a big believer in that.

00:22:05.101 --> 00:22:06.361
I think because I'm an SLP,

00:22:06.881 --> 00:22:09.481
I definitely always go with the, you know,

00:22:09.501 --> 00:22:11.083
choose your words carefully on how you

00:22:11.143 --> 00:22:11.823
explain things.

00:22:11.843 --> 00:22:12.604
Correct.

00:22:12.663 --> 00:22:12.903
Yeah.

00:22:13.564 --> 00:22:14.263
I said that,

00:22:14.304 --> 00:22:15.404
but this is what I heard or I

00:22:15.464 --> 00:22:16.045
thought that.

00:22:16.734 --> 00:22:17.095
Right.

00:22:17.214 --> 00:22:18.016
Is what this meant.

00:22:18.375 --> 00:22:19.557
Right.

00:22:19.997 --> 00:22:20.196
Katie,

00:22:20.217 --> 00:22:21.998
your hot take is that it's okay to

00:22:22.038 --> 00:22:24.878
give up a little clinical autonomy.

00:22:24.939 --> 00:22:25.819
What do you mean by that?

00:22:25.859 --> 00:22:26.559
I like that.

00:22:27.340 --> 00:22:28.461
Sounds scandalous.

00:22:28.480 --> 00:22:28.861
Gosh,

00:22:29.721 --> 00:22:31.942
you people hate to hear this usually.

00:22:33.263 --> 00:22:35.805
If I had a dime for every time

00:22:35.884 --> 00:22:36.244
I heard,

00:22:36.325 --> 00:22:38.205
you can't tell me I can only do

00:22:38.247 --> 00:22:39.047
this assessment.

00:22:39.987 --> 00:22:41.488
My clinical judgment is this.

00:22:41.969 --> 00:22:43.449
I'd be a very rich person.

00:22:43.648 --> 00:22:44.170
Yeah.

00:22:45.494 --> 00:22:47.695
And I don't mean this that, you know,

00:22:47.796 --> 00:22:48.096
yes,

00:22:48.415 --> 00:22:51.836
we're taking away all clinical autonomy.

00:22:51.936 --> 00:22:53.417
No one should think for themselves.

00:22:53.438 --> 00:22:54.417
That's not what I mean.

00:22:55.557 --> 00:22:59.339
But standardization is what makes things

00:22:59.460 --> 00:23:01.240
flow easily.

00:23:01.519 --> 00:23:04.901
It's what helps produce these numbers that

00:23:04.941 --> 00:23:06.241
we can actually measure.

00:23:07.221 --> 00:23:09.843
and produces scorecards that we can talk

00:23:09.883 --> 00:23:10.202
about.

00:23:10.323 --> 00:23:14.564
So it is okay to have some standardization

00:23:14.683 --> 00:23:15.263
in place,

00:23:15.625 --> 00:23:18.766
whether that is everybody has to use this

00:23:18.905 --> 00:23:21.506
assessment so that we level the playing

00:23:21.546 --> 00:23:23.146
field on measurement.

00:23:24.122 --> 00:23:26.823
You can use other assessments and that's

00:23:26.843 --> 00:23:28.624
where your clinical autonomy comes in.

00:23:29.443 --> 00:23:31.065
But if you want to set a standard

00:23:31.085 --> 00:23:32.645
for your clinic to say, OK,

00:23:32.685 --> 00:23:35.186
but everybody has to at least at a

00:23:35.346 --> 00:23:39.249
minimum use X, Y, Z, that's OK.

00:23:39.328 --> 00:23:41.210
It's not taking away anybody's clinical

00:23:41.250 --> 00:23:41.569
judgment.

00:23:41.589 --> 00:23:43.490
It's not saying you're going to be a

00:23:43.530 --> 00:23:44.951
cookie cutter PT.

00:23:45.471 --> 00:23:49.032
It's saying I'm going to make sure that

00:23:49.432 --> 00:23:50.513
at the very minimum,

00:23:51.034 --> 00:23:52.855
this is the standardization of workflow.

00:23:54.045 --> 00:23:55.925
And it produces a better product.

00:23:55.986 --> 00:23:56.346
Understood.

00:23:56.625 --> 00:23:56.846
Yeah.

00:23:57.105 --> 00:23:57.346
All right.

00:23:57.746 --> 00:23:58.226
I can see that.

00:23:59.247 --> 00:24:00.606
Last thing I'll ask before we do a

00:24:00.646 --> 00:24:02.867
parting shot is where do leaders usually

00:24:02.928 --> 00:24:06.068
lose their team in this sort of

00:24:06.108 --> 00:24:06.808
discussion?

00:24:07.309 --> 00:24:07.670
Right.

00:24:07.710 --> 00:24:10.151
So we just I feel like we just

00:24:10.191 --> 00:24:10.730
talked about.

00:24:11.730 --> 00:24:12.490
metrics,

00:24:12.791 --> 00:24:14.753
but brought it back to words and

00:24:14.854 --> 00:24:15.796
understanding.

00:24:16.296 --> 00:24:19.299
So where in this process do leaders

00:24:19.421 --> 00:24:23.385
usually lose their team in this?

00:24:23.425 --> 00:24:24.086
Two places.

00:24:24.948 --> 00:24:27.652
When they don't talk about the why and

00:24:27.711 --> 00:24:28.133
when they

00:24:29.412 --> 00:24:31.896
only have that business hat on and forget

00:24:31.936 --> 00:24:33.820
that that frontline clinician doesn't give

00:24:33.861 --> 00:24:35.584
a rat's ass about the business and i

00:24:35.624 --> 00:24:37.227
don't mean that that they you know we've

00:24:37.267 --> 00:24:38.769
talked about they need to give them you

00:24:38.789 --> 00:24:40.553
know they need to care about the business

00:24:40.573 --> 00:24:41.555
they need to understand it

00:24:42.486 --> 00:24:43.626
But at the end of the day,

00:24:44.448 --> 00:24:47.450
they want to know what is in it

00:24:47.470 --> 00:24:51.212
for them as a clinician and why we

00:24:51.313 --> 00:24:53.035
are doing what we're doing.

00:24:53.115 --> 00:24:54.375
So like, for example,

00:24:54.955 --> 00:24:57.499
good documentation protects revenue.

00:24:58.138 --> 00:25:00.221
That's just a fact.

00:25:01.701 --> 00:25:03.923
But talking to the clinician about how

00:25:03.962 --> 00:25:05.944
good documentation protects their license

00:25:06.025 --> 00:25:09.188
and keeps them out of jail is actually

00:25:09.229 --> 00:25:09.868
going to help.

00:25:10.189 --> 00:25:11.471
It's going to do the but what about

00:25:11.550 --> 00:25:12.991
me factor.

00:25:14.394 --> 00:25:15.835
And remembering that clinicians aren't

00:25:15.875 --> 00:25:16.915
taught about business.

00:25:17.215 --> 00:25:18.557
So, you know,

00:25:18.798 --> 00:25:20.380
we need to talk about it frequently

00:25:20.740 --> 00:25:21.980
because they aren't,

00:25:22.201 --> 00:25:23.663
it's not in their daily routine.

00:25:24.383 --> 00:25:25.084
thought process.

00:25:25.505 --> 00:25:28.130
But if we talk to them again as

00:25:28.150 --> 00:25:30.654
a clinician and how it relates to clinical

00:25:30.835 --> 00:25:31.435
care,

00:25:32.136 --> 00:25:35.022
it's going to take that clinician and that

00:25:35.083 --> 00:25:36.045
business a long way.

00:25:36.604 --> 00:25:40.244
Yeah, words matter from an SLP.

00:25:40.444 --> 00:25:42.144
Parting Shot is brought to you by our

00:25:42.164 --> 00:25:43.365
friends at US Physical Therapy.

00:25:43.405 --> 00:25:46.967
Today's show is brought to you by USPH,

00:25:47.406 --> 00:25:49.106
partners with clinic owners who want to

00:25:49.126 --> 00:25:50.508
grow without losing their identity.

00:25:50.548 --> 00:25:51.988
You stay local and in control while

00:25:52.008 --> 00:25:53.448
getting the support and resources of a

00:25:53.508 --> 00:25:54.189
national network.

00:25:54.249 --> 00:25:57.950
Learn more at usphpartnership.com or find

00:25:57.990 --> 00:25:59.470
out at usph.com.

00:26:00.490 --> 00:26:02.250
I'm going to pitch you a question for

00:26:02.270 --> 00:26:04.332
the parting shot instead of letting you or

00:26:04.372 --> 00:26:06.532
making you sort of go from scratch.

00:26:06.933 --> 00:26:08.054
Here's your parting shot question.

00:26:09.194 --> 00:26:12.256
If rehabilitation is going to survive,

00:26:12.797 --> 00:26:15.657
right, as a whole, PTOT speech,

00:26:15.678 --> 00:26:16.458
whatever you want to call it,

00:26:16.498 --> 00:26:17.419
rehab is going to survive,

00:26:17.719 --> 00:26:19.920
the shift that we're already in to

00:26:19.960 --> 00:26:20.721
value-based care,

00:26:21.280 --> 00:26:24.061
what's one mindset the clinicians need to

00:26:24.102 --> 00:26:25.442
change right now?

00:26:29.481 --> 00:26:34.604
Gosh, your parting shots always kill me.

00:26:36.384 --> 00:26:43.186
I would say that without good clinical

00:26:43.207 --> 00:26:47.449
care and without showing evidence of what

00:26:47.509 --> 00:26:48.568
that looks like,

00:26:50.369 --> 00:26:51.750
there's no point in actually even

00:26:51.790 --> 00:26:52.290
providing it.

00:26:54.030 --> 00:26:55.711
So making sure that you, you know,

00:26:55.731 --> 00:26:57.352
showing the evidence behind showing the

00:26:57.392 --> 00:26:57.612
work.

00:26:57.872 --> 00:27:00.232
Like I, I have a, a.

00:27:00.252 --> 00:27:03.654
Fifteen year old son who is complaining to

00:27:03.694 --> 00:27:05.615
me every day that he has to show

00:27:05.654 --> 00:27:07.855
his work and in his, you know,

00:27:07.895 --> 00:27:09.557
homework that he's doing for math and for

00:27:10.237 --> 00:27:10.777
LA and all that.

00:27:11.778 --> 00:27:11.978
Mom,

00:27:12.018 --> 00:27:12.958
why do I have to show my work?

00:27:13.837 --> 00:27:14.739
Because at the end of the day,

00:27:14.778 --> 00:27:15.798
that's what you're getting graded on.

00:27:15.838 --> 00:27:16.558
It's not the output.

00:27:16.598 --> 00:27:17.880
It's actually the work that you've put in.

00:27:18.279 --> 00:27:19.480
And so outcomes are the same way.

00:27:19.500 --> 00:27:20.580
It's a great analogy.

00:27:21.020 --> 00:27:21.661
Uh, Katie Holderman,

00:27:21.701 --> 00:27:22.781
thanks for coming on here and talking

00:27:22.801 --> 00:27:23.122
about this.

00:27:23.182 --> 00:27:23.741
Much appreciated.

00:27:27.260 --> 00:27:27.641
Absolutely.

00:27:27.661 --> 00:27:28.280
Thanks for having me.

00:27:28.300 --> 00:27:28.942
That's it for this one.

00:27:28.961 --> 00:27:30.442
We're just getting warmed up.

00:27:30.903 --> 00:27:31.784
Smash follow,

00:27:31.844 --> 00:27:33.665
send it to a friend or crank up

00:27:33.705 --> 00:27:34.707
the next episode.

00:27:35.207 --> 00:27:36.228
Want to go deeper?

00:27:36.387 --> 00:27:40.612
Hit us at pgpiecast.com or find us on

00:27:40.672 --> 00:27:43.233
YouTube and socials at pgpiecast.

00:27:43.634 --> 00:27:45.915
And legally, none of this was advice.

00:27:45.976 --> 00:27:47.698
It's for entertainment purposes only.

00:27:49.398 --> 00:27:51.260
See, Keith, we read the script.

00:27:51.560 --> 00:27:52.201
Happy now.