Dan, welcome to the podcast, man.
PT Business Blueprint.
The goal, I've said this before,
I'm going to say it
probably for the first hundred episodes.
Because if I keep saying it,
then eventually I'll do it.
Which is,
what if I could have a thousand
conversations with practice
owners over the next five years?
Which is still pretty ambitious.
That's two hundred conversations a year.
Although...
I talk a lot.
And with the goal,
really just being able to
highlight the different
ways that we all address similar problems,
which is how do we deliver care?
How do we make that financially viable?
How do we make sure we have
a steady stream of patients?
All those different things.
So Dan, tell us about your practice.
Where is it?
What's the name?
Who do you see the whole night?
Sure.
So I'm one of the co-owners
of Advantage Physical Therapy.
It's in Long Island,
Nassau County in Woodmere, New York.
This private practice has
been around since nineteen ninety two.
I'm just one of the newest owners.
I was also born in nineteen ninety two.
So it's like a little full
circle moment type of thing.
Like I was born in it.
The practice was also born.
And historically,
it's been an anchor in this community.
So it had a really good reputation.
People love going here.
Before we took over, we had
two full-time therapists and
two part-time.
Now we have five full-time
therapists and two part-time.
We're adding in our
occupational therapist in January.
So that's a whole different topic,
but that's very complicated to do legally,
but we found a way to do it.
And so we are growing and
we're getting our second
location in twenty twenty five also.
So it's
Yeah,
so I took over a year and a half ago
with my friend and it's just been growth.
And prior to us taking over,
they were paper charting.
It was like- Wow, really?
In twenty twenty four?
Yeah, it was hard.
So and so I was just like,
I can't do this my whole career.
I wasn't paper charting.
I did a clinical out in
Peconic Bay once and I was doing that.
And I was just like,
I will never do this again.
And going through that
process where you bring in an EMR,
shout out prompt for being
my EMR and helping us get
to the twenty first century.
Right.
But it was it was a struggle.
Right.
So we did that in six months.
And now we're over a year later.
of being in in on an emr and
that has allowed us to to
grow in a lot of ways let
me ask you this um what was
the what was the hardest
part like adding so you're
a little different because
I think most organizations
might make a switch from
emr one to emr two but you
were you were doing this um
but this this is just an
example of adoption and
like everybody wants to be
innovative but nobody wants
to innovate because
innovating is hard like
there's friction hard
What were like one or two of
the hardest parts?
Was it employee buy-in?
Was it like just logistic?
Yeah.
Okay.
Yeah.
Imagine teaching.
So we have a great
demographic lineup of like
a physical therapist.
We have the thirty-two-year-old men.
So there's three
thirty-two-year-old guys
that went to PT school together and
And then the previous generation,
which is a sixty and older
physical therapist that
have been doing things
basically the same way for
like twenty years.
And so we have young men and
grandmas and it's awesome.
Patients love it.
We have fun in the clinic.
It's great.
But like,
how can we get everyone on the same page,
especially like the front office that was
wanting to do things a
certain way right so you're
taking co-pays differently
you're tracking payment
posting differently you're
you're doing everything and
it's overall more efficient
but changing practice
patterns that you've done a
certain thing for like eighteen years
twenty years is very
challenging and so uh it
was a slow process it took
us about like three to four
months to really like get
into the groove with it but
really going and sending
all these plans of cares to
doctors all over again
right coming from the new
emr versus what we used to
do that like that was crazy
like changing fax lines and
everything like
So much was done and there's so much to do,
but we're finally in like a
better groove of things, right?
That's cool.
So tell me about the practice.
Who do you treat?
You know, who comes through the door?
You said it was sort of a
staple in the community.
So I'm starting to guess, you know,
do you niche down a little
bit or are you sort of, you know,
we'll figure out how to help?
Right.
So historically,
they were Medicare Part B.
So it was basically a geriatric practice.
Since I came in,
and you can probably see
from our social media,
now we're treating like
little babies that are
learning how to walk or
have torticollis or are a
little bit developmentally delayed.
We have people that are
coming in for more like vertigo.
uh bppv and more of your
like recreational athletes
as well too so like since I
came in our percentage of
medicare part b went from
like ninety percent to like
sixty right and which is
hard to do in uh in a
practice that has been
around for thirty years is
that change that like niche
but like I came in from uh
a private practice like
I've opened up in my career
two clinics, um, one in Atlanta,
one in New Jersey.
And like,
it was all about how can I
actually grow it?
And at first I took everyone right here.
We have the opposite problem.
We can take everyone.
It's just like, how do we best take them?
Do we take them in the
office all the time?
Now we can also see them at their home.
And,
and also can we try to get them to
have more access because we
have a lot of snowbirds here, right?
It's,
It's New York.
A lot of them go to Florida or overseas.
How can we make sure that
they're doing their best
and everything we've worked
so hard with here that they
can have access outside of here?
So in a year and a half,
we're trying to change the
experience to not only be in the clinic,
but also in the home, in the gym,
at work and abroad.
When you're saying in the home,
are you doing telehealth or
is this physically house calls?
Physical household.
So some people like they've
been coming on and off for like years.
But what happens when
there's barriers to that?
Maybe there's cog, cog, cog,
cog to barriers where they
can't drive a car,
but you don't want them to desaturate.
You don't want their
functional status to go down.
And this is very common in
the Medicaid population
where a lot of these people
have trouble to get to an office.
It might take them a whole day.
And I don't understand why
Medicaid doesn't pay the
providers more to just go
to them because it would
actually decrease the total
cost and the time save and
the resources across the entire board.
I think that's a huge
opportunity and I'm trying
to figure that out.
You've got the perfect...
candidate for physical
therapy is the people who
have so much trouble even
getting to a clinic that's
that's your jam and then
there's that gap right so
some practices are saying
you know I mean that you
know notably I worked for a
couple practices that were
like we do house calls like
what doctors used to do
doctors if you're sick you
don't come to an office
full of other sick people
we come to you because
you're already sick at your
house exactly in terms of that
You talked about a couple of
different behavior change,
one being an EMR,
the second being your patient population.
How did you change communicating that?
Because if you're still
operating this practice
that's been around since
nineteen ninety two,
people thought of you a certain way.
You need to change culture.
How did you go about
marketing and communicating
differently to let people
know we're still this,
but now we're also this?
We've sort of expanded.
Yeah,
so a lot of it was me just contacting
our current referral
sources to let them know like, hey,
you might see a little
different plans of cares come in, right?
And that was an opportunity
to me to coordinate and
collaborate with the people
already sending, right?
Just like showing like, hey,
we're trying to optimize.
We're trying to be cutting edge.
This is how we're doing this
on the operation side.
But I'd really like your
help to make this even better, right?
They like,
they allowed me to call them and say like,
all right,
I need a new script for this person,
this person, this person, you might see,
see, see this, like it helps.
the administrative burden if
you know it's coming in and
how it comes in is easier to tackle.
So the doctor knows, hey,
I'm going to be sending
thirty plans of cares over.
Don't kill me.
But they're all going to
come in all at once.
If you can just knock this
out in like twenty or thirty minutes,
like ideally,
what day would you like them to come in?
Right.
That communication is crucial,
especially as like a newer
owner that wasn't there.
Right.
We still have the previous ownership here,
too.
But just making sure like
everyone's on the same page
and growing that with new
referral sources that
didn't historically send
here because we weren't
cutting edge where it was
harder to communicate with us digitally.
Right.
So now they know what we can do.
They've heard a lot,
a lot of great things over the years,
but now it's easier to have
that two way communication.
I think a lot of people will
skip to the big fancy thing,
myself included.
This is why it's easy for me to spot.
So I love the fact that I
asked you a communications
and marketing question and
your answer was talking to people,
which is actually the goal
of running ads or doing
webinars or workshops.
That's actually the goal.
So you were like,
we didn't do anything fancy
and it worked.
It sounds like we didn't do anything.
And that's what you hear
people who are experts will often refer.
whether in PT or communications,
which is do the basics.
I know you want to get fancy,
but fancy is complicated
and expensive and
time-consuming and it could work.
A lot of times you're more consistent.
The basics work more frequently.
So much.
And like the easiest thing
to do is a practice that
has been around for years
has touched a lot of lives.
There's a lot of value there.
If you can just
call them like if you can
have that touch point that
has saw that have
historically seen them like
once every two years or
once a year call them even
if they don't reactivate
and become a patient right
they're going to tell their
friends like hey my
physical therapist just
called me and because it
was my birthday and because
we had such good records
like it was easy to plug
everything in and our emr
kind of told us and we just
called patients because
It's their birthday, right?
Or an anniversary.
And we have that on file now.
And they're going to tell
five of their friends that
they play Mahjong with or this or that.
And then one of their friends,
a family member might need it.
And just because you're in their head,
right?
Because you have that warm touch point.
That's the best marketing
that you can even do.
That doesn't cost you any money.
Nothing.
Yeah.
It's smart.
It's communication.
It's the basics.
Most of the time when I do
communications presentations,
my first slide is two tin
cans and a string.
That's it.
It's you're,
you're trying to get
information from one place to the other.
Don't over complicate it.
Um, when someone walks into your clinic,
what's it look like?
We often talk about, Hey,
we can add bells and whistles.
Adding everything is usually
never a good idea,
but what do you have that
you find useful in your clinic?
Yeah,
the most useful thing we do have is
our people in the front.
So we have it evolved.
And I don't think we are a
good candidate to evolve to
where we have a screen there.
maybe one day, um,
when my front office
retires to like Florida and
she can pop up on a screen on the beach,
like people would love that
because it's the same person.
She's just in her next phase,
but she has been a bit
around here for like years.
Um, hopefully we can do that,
but like we have people, um, and, uh,
we have the same setup.
We have chairs there, this and that,
but my pet peeve is waiting
at a doctor's office.
So I try for us not to use those chairs.
That's only for like
people's aides or their
family members that feel
like they're like in the
way or their drivers, right?
Like when a person checks in,
I don't want them to
waiting in the chair unless
they're like an hour early.
And even then I'll try to
like squeeze them in early if I can.
Um, but, uh, but, uh,
I want them to come right on it.
Um,
because that just helps the patient
experience time is the like
greatest asset.
I don't want anyone waiting.
I want them moving.
I want them engaging.
I want them to have that experience.
I want them seeing their
neighbors and I want that
community feeling.
I want us to be a busy
Starbucks that people are just, you know,
talking, engaging, moving,
getting like their metabolism going.
I want all of that and I
want it to be fun.
And so I,
I ideally don't even want a waiting room,
but I have to have one for everyone else.
Right.
Yeah.
All right.
You did something or you're
doing something a little bit different.
Let's talk about private practice network.
Now this is an IPA,
which talks to me because I
do like craft beer.
It's an E like, so help me understand what,
what is it?
Why'd you formulate it?
What's it allowed you and
seven to nine other
practices to do in the state of New York?
This is new and this is innovative.
And I like talking about stuff like this.
Yeah.
So re re recently myself and, uh, I think,
uh,
eight to ten other private practice owner,
we've created a steering
committee for the first
private practice network IPA.
And IPA is an independent
physician association or
independent practice association.
um and uh what it does it
allows you to collaborate
as a group for like
contracting and billing and
credentialing and operation
but you still will have
your own entity being your
own private private
practice historically this
was done with your uh
primary care physicians
maybe a few specialists but
it hasn't trickled down to
us in the pt space a lot of
it is just because like it's hard to
So is it a way to group
yourselves together without
having to become a
franchise or having to
business-wise sign and join?
So it's a way to sort of
group together formally,
but you're not now one business entity.
Right.
Everyone is a shareholder
and they are all together
in this one thing.
So you have an equal say in
in this group and doesn't
matter if you have five
offices or one office,
but at least you can pull
together your resources in
order to get like maybe better EMR costs,
maybe better software as a
service costs for like these AI scribes,
but also negotiate with
payers and just show, hey,
we're seeing this many visits per month
All together,
this is a lot of claimed
volume over several zip codes.
This is how many providers
we have and all their
specialties and demographics.
And some of us do visits at
the home and this and that.
So it allows to provide more
access more and to help
more lives with different types of people,
which we know New York has
a lot of different types of people.
Well,
it's got to help you negotiate better too,
right?
And there's the strength in
numbers in terms of paying attention.
Now you get paid attention to,
we hate to say it, but now you're,
instead of being eight
individual squeaky wheels, right?
Which can be ignored sometimes.
It's just how things are.
You're one pretty large
squeaky wheel if you're all
squeaking in the same direction.
You got it.
And-
the payers don't have enough
resources in order to hit
all those eighty different
squeaky wheels.
They want one really good,
nice wheel that operates really well,
like they will reward that
entity that operates more
efficiently and timely and compliantly.
Right.
So it's nicer to be one
entity and they want to do
that and they want to incentivize that.
So they'll raise it up.
Right.
So
An IPA is one way of doing that,
but there's another way,
and that's with an MSO,
which is a managing service organization,
right?
So this is a service or an
entity that will handle those needs.
They might help you with
administrative burden by
like checking your eligibility,
authorizations, billing compliance.
So this is another thing,
but you don't have a say there,
but they operate
very efficiently and they
can help you and you pay
them a percent or a fee
like every year and they'll
help you with the pair
relationship piece where
like they have a legal team
that will like to look
through the contracts and
everything and be like we
don't want this no prior
authorizations right uh we
need a higher fee um so all
of that so um that's
another vehicle to
negotiate with uh payers
that you can do as a small
mom and pop because
You have to because I tried
for six months to get them on the phone.
They didn't want to talk to me.
The network was closed.
I wasn't allowed to see those patients,
but it was a lot easier to
go through them.
I got credentialed in thirty days.
Got it.
So this is available.
This is a thing.
So, I mean, you and I are, you know,
we were on LinkedIn and
you're in Facebook groups
and you see people
complaining about things.
And listen, I love me some complaining,
but you're actually being
able to execute and say,
what are the strengths if
we pool together,
if we come together and be able to say,
now we can affect change.
Right, right.
I think the worst thing we
can do is try to compete.
Like this time...
Right.
Like that's not good for our
profession as a whole.
And we have a shortage.
Like we know there's a
shortage of pro providers.
Like this is our time to
strike because we have supply demand,
right?
We're all super busy.
We're just, our X isn't high enough.
What we're getting paid per
visit is not enough to keep
our lights on.
And that's not good for
business because if there's
only one option, it's never a good thing.
You need a competitive
landscape to innovate, to push.
And I'd rather us compete on our people,
like the, like,
having the best specialists
in the clinic that we pour
resources into and we have
a good culture with and how
we operate as businesses.
Like,
do you get people in within twenty
four to forty forty eight hours?
Do you communicate?
Well,
I would rather us compete on that
rather than try to just
compete to have the most business,
because
there's not enough physical
therapists and we know this
and what I'm trying to do
is we need legislation and
policy that says hey you
need a certain amount of
pts this for ten thousand
lives or a hundred thousand
lives because that exists
for primary care exists for
you your dentist but it
doesn't exist for us and
that's a problem because
there has to be some sort
of what is enough
and what is too much,
and we have to be able to regulate that.
Kudos to you.
Eighty organizations,
we said this before I hit record,
like getting eight people
to agree on something is not easy.
Never mind eighty business owners,
who this is their livelihood, who say,
okay,
I'll invest time and money and
resources into coming
together and doing this.
That's not easy.
So kudos for you and the
rest of the board on that
organization for going
ahead and organizing.
Yeah, we have...
eight to ten people on the
board that have been
private practice owners for
way longer than me.
I'm learning so much from all of them,
but we have eighty types of
practices across New York
State that have pledged to even join.
That's great.
Biggest lesson in putting
something like that together?
Biggest thing that you've
taken away or learned that
wasn't expected when you went in?
Make sure there's one mission, one voice.
And having someone with
legal background is so crucial.
It's so crucial to simplify things, right?
Yeah, it's funny.
We look at these things and
they say they shouldn't be that hard,
but there's some things
that you just can't go around.
Legal is typically one of
those things where it's like, well,
and it's also one of those things,
it's a landmine,
you step on it or it could
really sting you.
You want to make sure you
don't get stung there.
Last thing we do on these short episodes,
parting shot.
What's something you'd want
to leave with the audience?
A mic drop moment, a soapbox statement,
something you want to leave
as we wrap up.
Yeah, so especially in twenty twenty four,
I think all of us as
physical therapists need to
be more involved with with policy.
We have to collaborate more,
especially with our peers
in in government,
our peers in private practice.
in hospitals,
like our biggest enemy is ourselves.
If we can all pull our
resources and time together,
whether it's five minutes or one hour, um,
every month where we can
actually just write to a
rep or a representative or
get them to visit us in the
clinic or get them to be a
patient of ours, right.
To demonstrate our value and
our biggest barriers.
That's all it takes to get
that ball rolling in the right direction.
And we're starting to see
that in the past three years.
There's been Health
Transparency Act where we
know what everyone's getting paid.
We're seeing better access points,
less administrative burden.
You go APTA.
You've been crushing it for three years.
Let's try to get that
economic shift where the
fee schedule is going the
opposite direction.
And I'm seeing...
Potentially, it might go up this year,
but it's requiring all of
us to get involved politically,
just send letters out.
And if we have enough, if, you know,
twenty therapists in every zip code,
you know, just messages it, that's huge.
Yeah.
Understood.
Make your voice heard.
That's how decisions are made.
Dan,
appreciate you doing this for the
profession.
Maybe it'll catch on.
Maybe other people will
start paying attention to
these different ways that
we can connect and make
your collective voice heard.
Appreciate you coming on the
show and doing this for us.
You got it, man.