Starting to feel more and
more like a morning show.
I'm like, you know,
getting the sleep out of my eyes.
PT Breakfast Club.
Thanksgiving week.
Are we doing a show on Thursday?
Are we wearing turkeys on our head?
Are we eating stuff for breakfast?
I would say let's take the day off.
Maybe I'll put together like
a clip episode that I could just share.
Yeah.
I would like to say...
Two days before Thanksgiving
that I am very thankful to
both of you guys.
How much you've supported
what I've done this year
and last year and all the time, actually.
I just have so much fun doing this.
And I get to speak with you guys.
Super smart.
And we get to bounce ideas
off of each other.
And the side bonus of
there's other people that
like it and watch it and
send me emails and messages and all that.
So I just want to say...
Obviously, there's other things.
My son was born this year, my wife,
all that family, of course, thankful.
I just want to say, Jimmy and Tony,
I'm thankful for both of you.
Absolutely, Dave.
All right.
What are we kicking off with?
Um, we had some interaction going on this,
uh, in the, uh,
in the chat that we share.
And I actually, as I was, you know,
making my coffee this morning,
I saw another video and I
got in trouble for playing
the audio of that Gary Vee video,
by the way, on YouTube, YouTube is like,
yeah, you can't use that.
I'm like, oh yeah, my bad.
So I won't do that anymore.
So used to doing it on the radio.
Like no one, no one cared.
Um,
the video showed a guy who was handing
out water for free and the
name of the water was free water.
Pretty good.
Except their business model
was like a little bit different.
They just turned it.
So they don't sell water.
They give water away.
But the way they make their money is...
They let companies advertise
on the container.
And I'm like, well,
that's what CBS and NBC does, right?
Like they give you the ER or
Friends or Seinfeld for free, right?
You got to pay for cable though.
So that was a little twist in there.
They give it to you for free,
but then they get to put, you know,
Cadillac commercials and
Kleenex commercials and
Clorox commercials in there.
And I just thought this was,
it's an innovative model.
It's not like I haven't heard it before.
but I thought it was a
unique twist because Tony,
you were talking about,
and I gotta be honest yesterday,
I was like doing a lot of
work and I was watching you
guys fire messages back and
forth in the chat.
You were talking about a
little bit of a model,
a little bit of a twist on
a model that had to do with
physical products and physical therapy.
Like walk us, walk me through that.
So while I'm waking up here
so I can wrap my head around it,
it felt like free water,
free water.io was like this
thing that seemed like it
was straightforward, but it took a twist.
So you and my twelve year
old must be watching the
same content because he
came up to me yesterday and I was like,
Dad,
there's this company that give away
free water if you advertise
on the bottle.
But yeah,
that's been around for a couple of years.
I remember, you know,
we had looked into putting
advertisements on bottles.
She's like fifteen years ago.
But yesterday's conversation,
I interviewed Joseph Lowe.
I know Dave's connected with him,
and we talked about that.
He's basically starting a PT
supply company.
It's called Pure PT Supply.
This is not an endorsement.
It's just the name of the company.
And we were talking.
There you go.
Those are his bands.
One of his bands, yep.
Yeah.
So I was thinking about it.
Now, again, I'm like,
how do we start the
conversation where the
patient is rather than
where we want the patient to be?
A patient with low back pain
isn't immediately thinking,
I need physical therapy.
They're not thinking,
I need to hire Dave Kittles.
They're thinking my back hurts.
I need this to stop.
Maybe they're thinking I want a massager.
Maybe they're like a physical device,
a seat, a massage gun.
You know,
maybe they're thinking I need a cream,
an ointment.
I need a blue emu or something like that.
So I'm like,
how do we inject ourselves in
the conversation earlier?
And I said, well,
what if and I don't know
anything about Facebook ads, but I'm like,
what if we run ads for products?
that target our ideal
demographic gets us into
the conversation earlier.
And Dave and I have talked
about this for a decade where it's like,
all right, you have the physical product,
you sell the physical product.
Maybe you make a little
commission on that enough
to cover the cost of the ad.
but then the next level of
that is you sell the
product with a digital
product that I create so
it's like you're going to
buy a tens unit the tens
unit is thirty dollars the
tens unit plus my digital
course showing you how to
use the tens unit where to
use the tens unit plus
stretches and exercises to
supplement the tens unit
that's ninety nine dollars
Or the premier offer is
three hundred dollars.
You get a live one on one with me,
either in person or through
telehealth virtually.
You get the digital product
that I created and you get the TENS unit.
But the idea is the physical
product is what brings that
person to the ecosystem.
That's kind of where we were talking.
That's what I was thinking.
A lot of this this week is top of mind.
My mom in terms of physical
products or stuff along this, this route.
My mom this past week just
spent let me let me let me ask you guys.
Okay.
Custom molded orthotics from some store.
Three sets.
Guess how much?
So back in my day, back in my day,
it was three hundred
dollars to do the blue foam like imprint,
get the custom orthotic,
get it delivered and issued
to the person.
It was three hundred dollars
for one pair of custom orthotics.
And this is going back
fifteen or twenty years.
So I've got to think a thousand dollars.
Jimmy.
Yeah,
I was going to go like I was going to
say less.
I was going to say six hundred bucks.
Try sixteen hundred dollars.
Wow.
And what's amazing, by the way, and mom,
you know, if you're listening,
it is what it is, mom.
She did pay briefly out of
pocket for physical therapy,
but she also has Medicare and said,
you know,
I'd rather do Medicare physical therapy.
OK, didn't really go down that route,
like like went to a brick
and mortar place that did
Medicare physical therapy, which is fine.
Didn't opt to do the home Medicare thing.
Physical therapy, basically for free.
But so like kind of in my opinion,
like maybe Penny pinches
around the service part of it.
But then the physical
product side drops sixteen
hundred at a place called
the Good Feet Store or
whatever in South Jersey.
So obviously they already
had like the store is all
just like insoles and orthotics.
And I guess they sell shoes
and they try to also sell
her a pair of Brooks
running shoes for one
hundred forty five dollars that.
And I was like,
I don't even pay one forty
five for Brooks running shoes,
like maybe maybe one twenty.
You know, your special day.
Yeah.
I mean, so it's wild how people will spend,
they have some money and they're like,
where do I want to really spend it?
And some people will do the service,
like my type of ideal client.
And then other clients who
my mom and my dad are not my ideal client,
which is hilarious.
They will then,
I'd rather spend it on this
physical thing.
So Tony,
this is right up your alley and this is,
we're going to get into it more, but
Um, it's a great idea.
And especially Tony used to
do this with the tens unit and this,
that whole offering that
you were talking about.
And you can have those two
or three offers on the same landing page.
So they click on the ad,
they go to the landing page.
And like Tony said,
it could be first price for
the tens unit only the second price,
a little bit higher for
tens unit plus digital course,
third option, most expensive tens unit.
digital course and a custom
like telehealth visit in person visit,
whatever.
So I'm not doing this right now.
But I'm certainly reminded
of it on how it can work
and how I can maybe get
some of these consumers
that are not my ideal
clients maybe migrate my
way on the continuum.
Scott wants to know how they
fit her for the orthotics.
I'll have to ask her specifically, but she,
she said an imprint.
So it sounded more than just the,
I know there's some devices
now where you can do like a digital scan,
but it sounded like almost
like the classic way,
some type of a mold.
And then from that mold,
they made three sets while she was there,
which is kind of impressive.
I don't know how long she was there,
but to sell
a good you have to have good
marketing you have to have
a good sales pitch with the
with the person who's
helping you with this my
mom sent me a screenshot
they sent her even like a
google calendar invite for
like this appointment so
this is like all that is
dialed in everything is
legit but um to answer
scott's question yeah
molded this just this just
highlights the order of
events right like costco's
hot dog right has remained
a dollar for billion years like
If you're deciding where to
shop that day and you're like, yeah,
I could use a hot dog.
So they lose money on the hot dog,
but they understand what to
do to get you in.
So I think it's a little bit
different here because...
The physical product, I mean, some PTs,
we've talked about this before, feel icky,
like selling it.
They'd rather just tell you to,
they'd rather just look
over your shoulder and show
you what to get on Amazon.
And then that transaction is
done and that's fine.
There's a hundred percent fine.
But this is a unique twist
where it puts the product first,
where normally we'd have our, you know,
Peace Corps gene and say, no,
that's not gonna help you.
It's like, I don't know,
it helps some people or
else those things wouldn't sell.
So can you use that attention?
So like in every one of these models,
attention comes first.
It's just, what are you,
what are you trying to
shine the light on to get
them in the door?
The traditional manner
manner is you put a giant
sign outside your clinic,
you write physical and
therapy as big as you can.
Maybe you put a cadetious, right?
The staff with the,
with the snakes around it,
the said that she should show this.
Like we are medical.
We are not like those other guys,
those snake oil salesmen, which is ironic,
right?
Our cadetious has two snakes on it.
We don't sell the oil, just the snakes.
Yeah.
But what you're doing is you're saying,
hey, listen,
if you're going to get this anyway,
like here is a suggestion, by the way,
dot, dot, dot.
So you're using this as you're like,
this is your this is your taste test.
This is your if you're going
to pick this poison anyway,
I might as well be the one
pointing you toward it.
I can give you a good one.
And then, by the way,
if that didn't help or you
want and a digital product,
which is PT light or diet PT.
And then if you'd like
something in person right this way.
Yeah.
You know, it's funny for years,
twenty years.
That's all I did.
I would put a sign on the
front of the building that
said physical therapy.
It wouldn't have a name.
It wouldn't have branding.
It wouldn't have anything
because I was effectively a
vending machine producing
billable units to insurance
company beneficiaries.
So I didn't want anything to
interfere with that.
I didn't want any personalization to it.
I just wanted that vending
machine sitting out there.
With the big sign that said
you can cash in your
insurance benefits right
here for physical therapy.
Now things are changing.
Now there's no value or
there's less value in that
kind of business model.
If you're not going to scale,
if you're not going to grow.
And I think we talked about this before.
Like I talked to Joey Albritton.
is like if you're going to
do a one person operation
okay or you go to a four
plus person operation
you're gonna die in the
middle if you're trying to
run two or three providers
because they're just not
enough money there to
support what those
providers need and take on
the risk of hiring those
providers um but this
bringing those physical products in now
You guys know, but for people watching,
Amazon influencer, Amazon affiliate,
like I've been doing that
for over a decade.
When I do a video,
put it on the Amazon
influencer video program, that video,
the title of that video
shows up in YouTube search
and Google search.
Sorry.
So I optimize SEO for that.
And I've had people that are
searching Google for products.
They find the Amazon
influencer video and these
are my patients.
And they're like, oh, my gosh,
I was searching and I found
you and your videos on Amazon.
I'm like, yeah, I know that's intentional.
But these are people that
are looking for those products.
We're just meeting them
earlier in that journey.
Could you do like the twist too?
Here's a crazy idea.
Could you do two videos?
Dave,
hold up those resistance bands again.
Dave could do a video
showing you five reasons
why that resistance band is great.
Dave could then have another
video with different SEO
about how this resistance
band is the worst thing ever.
Both of them have the link
to the resistance band and
both of them eventually
land on Dave's website if
you're in New York City.
So the goal is attention, right?
Like that's what it is.
David is saying you're a
trusted professional.
You're doing a disservice, David thinks,
to your patients by not
offering professional grade
products in your clinic.
David?
Thank you.
I personally agree with you.
When I walk into – if I'm
hanging out with a
triathlon coach and there's
something that could have helped me,
but they didn't offer it to
me or suggest it to me, what do you do?
What am I paying for?
I thought I was paying for your expertise.
I thought the stuff between
your ears was the stuff I was paying for.
If you thought there was a
better seat for my bike
that would make me hurt
less or more – and you
didn't offer it to me –
Now,
I understand where that line is or
where some people might feel bad,
which is like,
are you suggesting it
because you get ten bucks
or are you suggesting it
because it's a good coach?
Dude, that's everywhere, right?
So...
Be good.
Like an Amazon influencer
program doesn't make people
do shady things.
Shady people are gonna shade.
Good people are gonna do good things.
So offer that out there.
I don't know.
The one thing Tony was just
talking about with putting videos on,
and I've never done this,
but I've seen Tony do it
and he's done it forever.
He's one of the only
physical therapists that does it.
The fascinating sidebar of
this is that consumers,
I learned this through, I think,
Chad Madden.
I think Chad Madden mentioned this.
Consumers like to stumble upon something.
They have some... I don't know what it is.
They have a feeling of like,
I found this Easter egg, whatever.
And then they pursue it
sometimes more than if they
were referred by a
physician or referred by a
running coach or the gym
owner or word of mouth.
And we know how...
Word of mouth.
We know how powerful word of mouth is.
But the idea of a consumer
searching something on Google,
they see a little thumbnail
preview of a video from
Amazon about the product or
close to the product that
they were looking for.
They click into that.
Now, all of a sudden,
they went from Google to Amazon.
There's only videos of this
physical therapist named Tony Maritato.
So obviously, he's incredible.
We know he is.
But obviously,
it means he's got some credibility,
authority, all that.
The consumer clicks on it,
then they reach out to Tony.
Maybe they're out of state
and they want to do a
telehealth visit or something.
Tony, do you know what I'm talking?
I don't know.
Is there a term for this?
I think and I might be
bending this a little bit,
but I feel like this falls
under the IKEA effect.
And the IKEA effect is
people value things that
they needed to put together.
Like the Lego effect would
be another thing.
It's like I feel a little
bit better about this.
I feel a little ownership
because I put it together
and I think I'll get my buddy.
What's that like?
I solved it.
Yeah,
it's like I have affinity towards
this desk over here because
I got it from Ikea and I put it together.
So there's this attachment to it.
I have a higher value
because I put this together.
Now, Ikea is smart.
They make it real easy.
So idiots like me can't screw it up.
So when I look at it,
I don't look at it like
Picasso put together a bookshelf.
It looks like a normal bookshelf.
But I think...
This is also the idea or
parts of the idea of how
misinformation and
disinformation spreads.
I heard from this guy.
He seemed really convincing.
I mean,
look at look at some of the leaders,
right?
Like Alex Jones and Infowars.
Like that's a TV quality
million dollar set.
And he's looking in the
camera and he says it strongly.
He says it over and over again.
He says it with conviction.
He gets other people to say it.
So you take that person who's on the edge,
who sort of thinks or wants
to believe something and
you keep repeating it.
Now it's in the middle of
their belief system.
So I think that's definitely
part of it is I feel like
everybody's going left,
and I'm not a sheep, man.
I'm not sheeple.
I'm going to go this way.
So I think there is an effect.
There is part of that.
I'm going to say it's the Ikea effect.
I'll have my buddy who's a
psychologist at Jefferson
in Philly correct me.
Yeah, I think there's that component.
I think there's also just social proof.
It's like, man, this guy is on Amazon.
This guy is on YouTube.
This guy is on TikTok and Instagram.
He's everywhere.
I think there's a level of
social proof that goes along with that,
where if it was a total fraud,
somebody would have taken him down.
And so there's that component to it.
And going back to the process.
So I think you enter the
market with a physical product.
And I shared recently,
I can go into my Amazon Analytics.
I can look at the most
popular selling products.
And for me, by far, it's TENS units.
The simple, cheap, analog,
nothing fancy TENS unit.
They sell more units than
anything on Amazon for me.
Then it goes into a little
under desk pedal cycle,
and then it goes into like
the QB and a couple of other devices.
But I can use those
analytics to guide my decision and say,
okay,
I'm going to put some money behind
tens units.
I'm going to create my ad copy.
I'm going to, you know,
Maybe I even work in the Clarity account.
So now people can click and
make a paid call to through
Clarity to me if they want
to ask me questions and do
things like this.
And when we're talking about attention,
growing social media,
we have to realize and
every therapist comes back at me with,
yeah,
but what good is it if somebody in
California watches my video
when I'm in New York?
Well,
if you're only selling in-person services,
there's not a lot of value to that.
You get a couple pennies for
some ad copy that somebody
else pays for to put on your channel.
But if you have this valuable asset,
you say, okay,
I got people in California
watching my content.
What can I create a value for them?
I can sell them the product
with the commission.
I can sell them the digital product.
I can sell them the virtual,
the telehealth, the voice only,
the voice and video.
I can put them on a continuity program.
We haven't even talked about
remote therapeutic monitoring.
Somebody buys my product.
They buy the TENS unit.
They buy the pulley.
It's only a couple pennies I
get in commission.
But now if they come in,
I start an RTM program.
I do a virtual evaluation for them.
I'm getting reimbursement, you know,
and we can talk about
across state lines and the PT compact.
It just layers on.
Yes, there's some complexity,
but at the same time,
this is where the new opportunities open.
I just recorded the episode.
I haven't released it yet.
David Mida, El Paso Physical Therapy.
He's got a YouTube channel of,
I think he's close to seven
hundred thousand.
And I loved his story.
Can't wait to share it.
And here's why.
Nothing, dude,
nothing about David is fancy.
He started shooting videos.
He's like,
I don't even know my login for Facebook.
He's like, I don't do social media, right?
Necessity is the mother of invention.
He started shooting videos
during COVID when he was like, dude,
I just jumped out of my job
to start a clinic because I
wanted to be home more for my kids.
And he's like, and now I'm homeless.
I'm like,
he's like the line that hit me
was I was leaving work.
I was leaving the house
before the kids got up and
I was coming home after
they were went to bed.
He's like, what am I doing?
So COVID hits necessity
starts shooting videos just
as a way to get a couple
patients around El Paso, El Paso.
Right now,
the guy's got seven hundred
thousand connections around the world.
But again, what good is that?
Who cares?
Nobody's flying to El Paso for David,
although two things.
Number one, some people do right.
He bridges it with a digital product.
He's like we I was like, David,
how do you pick your products?
And again,
I'm giving away all the secrets
of the episode.
He's like, I just watched the analytics.
He's like,
I watched what people were
searching on my thing.
Then I made a video for that.
I used to do this at the radio station.
We had a website at the
radio station when people
would start searching a band.
and I didn't have a web,
a corresponding landing
page for that band, my person created it,
and then we put them on the
new music show,
because fifty people just
told me they were looking
for that band in my area.
Maybe I should pay attention to that.
But the final thing is,
I remember interviewing Stu McGill,
the back, the back doctor,
whatever his name, whatever,
everybody knows Stu McGill, right?
He was just on Huberman, right?
He's got the McGill Three.
He was telling me,
and this is back when I was in PT school.
This is twenty fifteen, twenty sixteen.
He was saying people would
fly in from Europe to be
seen by Stu McGill for an hour.
You can't simultaneously
tell me how amazing you are
and that it's not worth someone's time.
If you are that good to get
me a very specific person
who has the money and the
problem and is willing to
part with the money to get
rid of the problem.
So.
I bet you people do fly to
El Paso because they know, like,
and trust David Bedell.
I guarantee it would,
it would be even so me as a
business owner,
it would be even better if
I have people flying in for my staff,
physical therapist who is
paid handsomely stays with
me and I don't have to
fulfill the service.
Brilliant.
But you know,
the legwork of the connection and that's,
that's a giant part of the value.
Yeah, so this is my buddy,
Dr. Sam Kellicates.
He said, TENS unit for migraines,
headaches is his best
performing video on YouTube
and drives most of the
traffic to his website, which is awesome.
That's what they heard from their friends,
sisters, brothers, neighbor.
So they start there because
that's the only place we know,
if we're not a PT, how to start.
So be there instead of saying, well,
that's actually not, actually.
If you start a sentence with, well,
actually, as a PT,
put some duct tape on that.
Open, closed, open, closed.
Try that.
Look, Sam is proof.
So the amazing Dana Strauss,
I've still got a video I'm
waiting to publish.
She's been all over the place.
I'm just holding on to my
interview with her for the
things to die down just a
little bit from all the other places.
Many people love to
self-treat if the
recommendation is from someone they trust,
content on social media,
not surprising the TENS,
passive pain relief.
Here's the thing.
If you lead someone to a
TENS unit and it helps them,
it helped them.
I want to be kabobby lame, right?
Just be like, if it didn't,
and they're still frustrated,
my guess is most likely
they're going to come back.
You have a chance at them
coming back to you and get
something different.
If tens didn't work for some people, uh,
Wouldn't be around.
And for those hardcore,
like anti-modality therapists out there,
what we had done decades ago was we said,
okay, we,
there's no clinical proof behind
tens unit.
It just feels good.
It's a buzzy sensation,
electrical massage.
Let's stop billing for it.
And let's just sell a tens unit.
If a patient wants to buy a tens unit,
why should I not allow them
to buy a tens unit?
They're cheap.
They're easy, low risk of injury.
Huh?
They do no harm.
Yeah.
So that's what we started doing.
And I think one year, you know,
we sold a ton of TENS units
in the clinic.
We buy them for twenty bucks.
We'd sell them for one hundred.
That price included some education.
But, you know, and for me,
I could allow that patient
to go buy a TENS unit on
Amazon and have no idea how to use it.
Or they can buy it from me
and I can explain, look,
this is the reality.
This is what you do.
This is how you do it.
We use TENS units on a
post-op knee replacement
while they're riding the
bike all the time.
We layer intervention.
So you put the TENS unit,
you wrap the ice around it,
you use the compression
boot while you're doing quad sets.
We do that kind of stuff all the time.
Patients love it.
I'm trying to balance what a patient wants,
what they can't do for themselves,
and what I believe has the
most beneficial clinical
impact for that person.
Wants and needs, man.
So let's go tactical, right?
We talked about either this
band or the tens unit.
Tony,
from the messaging privately in our chat,
and then also at the top of the show,
you were, I just want to clarify,
were you saying that,
let's say it would be a Facebook ad.
It's either pitching this
band or the tens unit.
And it's,
so it's a pitching this band for
seven dollars,
ten dollars or the tens unit for whatever,
twenty five, fifty, whatever.
That's the front end offer
on a potential Facebook ad, right?
Is that is that correct?
Correct.
And then on the landing page
or you drop them on your
website or whatever,
then there's the upsell,
the cross sell of like,
here's the thing that got your attention,
right?
The low dollar amount or
fairly low dollar amount
and a physical product that
people are kind of know and
trust and like,
and they've seen it and
maybe they previously had
bands and then they broke or whatever.
They buy bands on Amazon
because they just pop up all the time.
So-
That's the front end offer.
The landing page or your
website would have the
second more expensive or
the third most expensive offer on there.
And I think,
was that something that you
pitched to Joe Lowe?
Yes.
So the thing with Joe is,
and when I look at what he's trying to do,
so he's positioning this as
a relationship thing.
I want to build relationships.
I want to get to know the providers.
I want to be able to support
them however I can.
It's very similar to us in
the physical therapy clinic.
Like the physical therapy
itself is basically a
commoditized service.
You can go on YouTube,
you can go to a therapist,
you can find this information.
anywhere.
So it's like,
what's the value add coming to me?
So the value add could be,
I have connections with
orthopedic surgeons.
If I think you genuinely
need something from a surgeon,
I can get you to the front of the line.
That's a huge value add.
For Joe,
he's joseph he's got this uh
understanding of facebook
ad so it's like well what
if he doesn't just sell
these physical products
wholesale and I sell them
retail but what if we say
okay I'm gonna buy a bunch
of the the specific product
I want you to help me
either as a paid service
or something he creates on the side to say,
okay, you bought this resistance band set,
here's ad copy,
here are images that I know convert,
here's the education to run
this as a Facebook campaign.
He doesn't do the campaign
and he's not paying for the ads.
I do that.
He's providing me the
expertise and the
experience and the
information like a home exercise program,
but in Facebook ad world.
And so now when I buy ten
sets of these resistance bands,
I also get the ad copy, the images,
the other stuff to run my
own Facebook campaign to
then bring those
individuals into my
ecosystem and potentially
upsell them to a digital
product or to a live
in-person consultation.
So he wants to get these bands though.
He wants to get these bands
into like big brick and
mortar corporate physical
therapy practices.
Why would he care about this?
We all have to start somewhere.
And so, yes, it's appealing to say, okay,
I'm gonna sell the ATI.
I'm gonna be a preferred ATI
supplier while they're still in business.
But I also think, okay,
so a small provider like me
I talked to another company, and I said,
look,
I use shoulder pulleys all the time.
Rangemaster, I need you guys.
Don't make me reorder these
shoulder pulleys.
Just put me on auto fulfill.
Give me a membership.
So every month,
Rangemaster sends me a box
of ten shoulder pulleys.
If those shoulder pulleys are here,
I'm going to put more people on RTM.
I'm going to generate more
revenue from the RTM and
the shoulder pulley program
that I created that I'm marketing.
But if I run out of shoulder pulleys,
miraculously, fewer people go on RTM,
fewer people get to buy the
shoulder pulleys just
because I don't want to
spend time reordering.
I think Joseph or
Rangemaster or any of these
companies could effectively
use me as a conduit to the consumer.
Drive more sales, drive more revenue.
If you leave it up to me,
I'm going to sell one or
two pulleys a month.
But if you put a little gas on that fire,
you can get me selling
twenty or thirty pulleys a month.
So maybe I'm not ATI or
Athletico or any of the big companies,
but you could probably
still sell higher volume to
me if you help me sell
higher volume to the consumer.
Yeah.
And if I have a national presence,
a national brand between YouTube, TikTok,
Instagram,
I'm just going to push more product,
you know,
but but most of us don't have
the skill set to do that.
Joseph does.
What about the fulfillment side?
Right.
So you have the clinics in Ohio.
I'm in New York City.
Is he going to do the
fulfillment side like this came, you know,
in like a plastic bag?
Bag,
do I have to deal with the fulfillment
or it's like drop shipping
or he handles it?
Like, how would that work?
So that came up.
We discussed it.
Fulfillment is tough.
You know, if you want to go again,
I don't want to be a product company.
What I'm doing is I'm saying,
can I how many of these
convert into a thirteen,
fifteen hundred dollar plan of care?
you know and if I have to
fill a handful of these
that don't convert okay
I've got my digital
products that hopefully
bring up the value but my
intent here is get me the
marketing campaign
via the product sales so
that I can get more
conversions for paid
clients that are doing
virtual or in-person.
And again, we're just fleshing this out.
So these are great questions
because I don't have the
answer to all of them.
I'm just trying to think in
real time of how something
like this would work.
No, I have used real quick.
I have used Amazon for fulfillment.
You know, there is fulfilled by Amazon.
If I did want to go that route,
I am investigating right
now how to do the either
Shopify or TikTok shop so that again,
if it's just going to be a transaction,
I buy a hundred units from Joseph.
Then I throw them on the
Amazon shop or TikTok shop or anything.
And I let them handle the
fulfillment with the hopes
that some of those convert
into a digital product sale
or an in-person sale.
Gotcha.
Let me ask you guys this.
Do you guys change benefits
at the end of the year?
I've never worked at a place
that actually focused on that,
but I've seen some ads or
I've seen some clinics or
clinicians saying end of the year,
if you've got unused benefits,
shake that piggy bank,
make sure you get your money's worth.
Have you guys ever seen,
have you tried that?
Is the juice worth the squeeze?
I've done it with our email autoresponder.
Others do it.
Also, it's not that hard.
I'm on Chad Madden's email
list as a fake patient.
So I've seen for years what
they send to people.
They send that type of email as well,
which they send it around
October, November, you know,
if you still have unused benefits,
you know, use it.
If you don't use it, you lose it.
In terms of insurance benefits,
I've seen other clinics
because I've tested over the years,
like I'll subscribe to
their emails and it's just fascinating.
And then then I'll unsubscribe later.
But some also will say about HSA and FSA.
I think the HSA is what expired.
I think FSA rolls over.
But HSA, the pre-tax spending,
like health spending
accounts or health savings accounts,
those if you don't use it uh
you lose those funds at the
end of the year so it's a
great idea a lot of not a
lot of clinics are sending
those emails but that's
another great idea where
it's not a physical product
but it's like you have this
money allocated or
resources like in terms of
insurance you know covered
benefits if you don't use
it you lose it um yeah it's a great idea
So I know we talked about it last time,
but back to Aetna as an example,
I'm gonna share the link
for anybody who's watching
live or watching the replay.
Aetna has a six hundred
dollar fitness
reimbursement benefit for
Aetna beneficiaries.
And the idea behind that is
if you buy maybe a leg compression device,
you buy a massage gun, whatever,
you submit for reimbursement.
This is not physical therapy benefits.
This is a separate benefit
account for Aetna beneficiaries.
You get up to six hundred dollars a year.
It could pay for a fitness membership.
You know,
it could pay for different things
related to fitness.
The link is in the comments.
So this is something where Dave said, FSA,
HSA, Amazon is promoting, look,
this product qualifies for FSA,
HSA reimbursement.
There are so many directions
we could go with this.
To your point, Jimmy,
I don't feel comfortable saying, Hey,
end of the year,
you better use your
benefits because I do think
there's an ethical dilemma
that comes up with that.
It's like,
that's not the purpose of insurance.
Insurance isn't to maximize
utilization every year,
use it or lose it.
So I'm on the fence, but full disclosure,
I used to do that.
I used to go out to my patient list.
I never got good results
with that to a cold audience,
but to a reactivation
campaign for people that
have been patients before,
that tends to work really well.
Hey,
it's been six months since we've seen
you for your shoulder pain.
Usually this is when the
symptoms start to come back.
If you haven't been consistent,
you probably still have
some coverage left on your policy.
Come back in, let's do an update,
one to three visits and
take advantage before the
end of the year and your
deductible resets.
But I will say real quick, Dave,
I am planning my campaign
for January when
everybody's deductible does reset.
That's when I'm going to
make my big push for cash pay services,
for Shockwave,
for the Biodex Rehab Treadmill,
for these things that if
you're going to be paying cash anyway,
let's make a big push to
get you in the clinic,
paying out of pocket during January,
February, even into March.
I do think you should
understand the timing of
insurance coverage.
What were you going to say, Dave?
So wait, based on what you just said there,
if someone's going to pay
you out of pocket in
January for Shockwave,
those funds are not going
to go towards that deductible, right?
No.
So why would they care if it's January,
February versus December or November?
There's something that I've
noticed in the psychology.
You're saying they know that
they're going to have to
spend in January anyway.
Yes.
They're more mentally
prepared to spend money out
of pocket in January than
they are in December.
In December,
you feel like you're wasting
money if you spend it.
and it's not covered by your insurance.
But in January, you're like, well,
either way,
I'm going to be paying this
money out of pocket,
even if I get credit toward my deductible,
but I might as well use it
for something that I want
instead of using it for something that,
quote, is covered by insurance.
Because she knows this stuff.
Dana's dropping bombs there.
She says not just Aetna.
A lot of other plans have that too.
There's an example of like
if you attest to being
physically active ten days
a month and you get ten
dollars a month on your card.
Man, I'm just throwing money away.
I'm active.
I got the step counter.
Everybody wants to bash
Medicare Advantage.
Go to the website, go to eHealth Insurance,
go look at Medicare
Advantage plans in your area.
They have vision coverage.
They have dental coverage.
They have, my mother-in-law gets, I think,
seventy-five dollars a
month toward her electric
bill through her Medicare Advantage plan.
Like,
there are so many additional benefits
that traditional Medicare
with a supplemental does not offer.
I understand there's more
freedom with Medicare
traditional and a supplemental,
but you're paying for that freedom.
And if you're not interested
in paying for that freedom,
you could save a ton of money.
This is not financial advice.
I am not a financial advisor,
but I'm just saying,
go and look at what the
advantage plans offer in your area.
Yeah.
But on average,
are you comfortable discuss
or just mentioning how much
these advantage plans pay
you for a four unit visit?
generally they pay, well,
if I'm contracted, you know,
it's pretty close to the
Medicare allowed amount.
Yes,
there's a higher out-of-pocket cost to
the consumer if they have a
lower cost plan.
So if I'm going to save on monthly premium,
I'm going to say pay a higher copay.
But every time I've ever done the math,
if you're not a world traveler,
if you're not going to
Arizona and Paris and, you know,
all of these different places,
most of my geriatric patients,
they're living within a three mile radius.
Their doctor is here.
Everything is within that radius.
They don't need the freedom
that Medicare affords them.
And they don't have the
money to cover the Medicare
Part B premium, the supplemental premium.
They just don't.
So for them,
they've chosen Medicare Advantage plans.
Even if they bark a little
bit about the co-pays,
they don't realize they're
saving thousands of dollars
on the back end.
It sounds like,
it seems like that they
stack all the benefits.
You get this, you get this.
Like Tony just said,
you get this dental benefit.
We pay a little bit of the
electrical bill.
We're paying a little bit of
this and that.
But I don't know.
But then there's a higher deductible.
So it all evens out anyway.
It does.
It's a business.
Like, come on, guys.
Most people have to lose
money paying for health insurance.
So a couple people get
ridiculous returns on the investment.
And I share this story about
my mom all the time.
My mom griped and complained
about spending ten thousand
dollars a year.
The first year she was on
Medicare and then went to a
Medicare Advantage because
she'd never used her health insurance.
Well, she was diabetic.
She was a smoker.
She didn't use her health
insurance because she never
sought out medical treatment.
Year number one, she lost money.
Year number two, she lost money.
Three, four, five.
Year number five,
she's invested ten thousand
dollars a year, fifty thousand dollars.
But then then.
She goes on dialysis.
Then she goes into ICU.
Then she gets into a car
accident and has a brain bleed.
Sad story.
She eventually passes away
after being in skilled nursing.
But in that year of her life,
she probably spent half a
million dollars in medical
services that theoretically
she paid fifty thousand
dollars for over the previous five years.
You know,
I think any of us here would take
a fifty thousand dollar
investment to get a half a
million dollar return on that investment.
It's just the way the business runs.
I get it.
If you don't understand it,
it looks very harmful to the consumer,
but we can't afford.
Everybody has to lose money.
So a couple of people make a
ton of money on the return in coverage.
All right,
on a little bit of a happier note,
going back to that Aetna form,
I forgot to mention this.
So Tony posted this online
and unfortunately in my email CRM,
I don't have people
categorized by their insurance,
but I need to do this in the future.
Here's why.
I saw this form Tony posted,
the one that we just talked
about a few minutes ago,
the Aetna reimbursement up to six,
six hundred dollars per calendar year.
And I grabbed the link and I remembered,
you know,
several different people that
have Aetna insurance.
And I emailed it to them as
a goodwill email.
Right.
In terms of like touching
base with consumers, previous patients,
not no call to action.
Like, obviously, they know who we are.
It's just a reminder, like, hey,
we exist or hey, we're still here.
But there was no there was
no call to action like, hey.
And also, if you have any aches or pains,
whatever,
like they know us like the
people that spent.
hundreds or definitely
thousands of dollars with us.
Like they know we're a text
or a call or an email away.
So I grabbed that link and I
looked up some emails or in my, uh, uh,
EMR, who else has Aetna?
And I sent it to, I don't know,
and people or something manually, but,
but I need it in my,
I need it in the EMR or the
CRM to send this in the future.
Um,
automatically,
like maybe at the end of
next year or something.
And it's just a goodwill email.
And I feel like that is
something that is so overlooked.
Like how often do we not,
how often do we send emails
where it's about, well,
what's in it for us and not
what's in it for the recipient,
your current patient or
your previous patient.
Yeah,
I did a flow chart once of should we
send this email?
And the flow chart did not
have does it benefit us in
the flow chart.
Would the person receiving
this email find this beneficial?
If the answer was yes, send the email.
But we send too many emails.
I don't know, man.
I got some really close friends.
And if it's good news,
I sort of don't ever get bummed out.
I don't feel inundated.
And that's the difference,
which is what is your intent?
What is the value?
A thing I'm understanding
what you're saying is a lot
of people didn't respond or
didn't take advantage of it
when you sent that thing
that had no real benefit to Dave,
but a hundred percent
benefit to the people receiving it.
Almost,
I think almost a hundred percent of
the people emailed me back and said,
thank you so much.
Or thanks for thinking of us or whatever.
So that is just building
goodwill for future,
for working with them in
the future or future asks.
Like if they didn't write a
Google review or whatever.
You were out there looking out for me.
Appreciate you.
You know, like people understand,
people remember that a ton.
What do you got on the screen there, Tony?
So Dana brought this great point up,
and I talk to my cohort all
the time about this.
Medicare Advantage has a max
out-of-pocket.
This is a benefit not touted enough.
Every therapist needs MA
strategy in their clinic.
Let's talk about that.
So a lot of therapists want
to be out of network for
Medicare Advantage plans.
And I explained to them, I'm like, OK,
you know, that's great.
If you go to
UnitedHealthcare as an
out-of-network provider,
the allowed amount is far
higher than if you're an
in-network provider for
UnitedHealthcare or Medicare Advantage.
But there has to be a strategy in this.
And so the strategy that we
utilize that we talk about
If I want to focus my
marketing on individuals
that have had a major
surgery or a major neurologic event.
So let's say somebody has a stroke.
I don't do neuro, but they have a stroke.
They're in the ICU.
They're admitted.
They do inpatient.
They do transitional.
Then they get discharged to home.
They've likely exceeded the
out-of-pocket maximum for
the calendar year for that
Medicare Advantage plan.
Now you market to that
person as an out-of-network provider.
that person will have zero
out-of-pocket expense and
the insurance company will
pay you the higher
out-of-network allowed amount,
assuming that plan has
out-of-network coverage.
That doesn't happen with
traditional Medicare Part B
and some other plans.
When I'm looking at helping
a therapist who wants to be
out of network Medicare Advantage,
I'm like, look,
you can market to high
functioning geriatrics with
Medicare Advantage who
strain a rotator cuff in January.
They're going to have to pay
the full allowed amount.
But instead,
if you market to a person who
had a rotator cuff repair,
Following surgery,
they likely have exceeded
that out-of-pocket max.
They'll have zero expense,
and they can select you as
their therapist,
and you're going to receive
the full out-of-pocket reimbursement,
which is a much higher rate
than the in-network
contracted allowed amount.
We do this also for younger individuals.
Forget Medicare Advantage for a second.
So I have a young dad.
He's working at the steel mill.
He's really healthy.
He has no problems.
He's out with his kids on the weekend.
He tears an AC out.
goes in for surgery, I verify coverage,
we usually see them pretty
quick within a couple of days of surgery.
Well,
if the surgical charges haven't been
processed, we hold those claims.
We allow the hospital charges,
the anesthesia charges,
the surgical charges to all process,
allowing that patient's
insurance to pay all the
other stuff first.
Then when we submit our claim,
if they've exceeded their
out-of-pocket maximum,
now we receive the full reimbursement.
So that patient doesn't have
to worry about a deductible.
They don't have to worry about copay,
coinsurance.
It's all taken care of.
And one layer on top of that,
When I go to the hospital
for one of my kids who needs stitches,
I get a prompt pay discount.
If I'm the provider,
if I'm too quick to send in
my claims before the
deductible has been satisfied,
I don't want to give that
patient a fifty percent
prompt pay discount,
but the hospital will.
so I know I said a lot of
stuff I know most of it
just went over everybody's
head I just want you to
have this kind of in your
brains a little bit we
should have a strategy in
place whether you're
contracted non-contracted
in network out of network
we need to have these
conversations and
understand how all of this works
And the truth is,
when I talk to therapists,
the smartest people in the world,
they don't even understand
their own benefits.
They don't even understand
their own insurance coverage.
So I'm glad Dana brought up
that conversation.
She's putting a ton of comments out here.
That's got to be by design, right?
This thing's so complicated.
But if you ever get called on it,
you can say, look,
page sixty three section
subsection four line two.
It's in there.
We set it and we deliver.
You just never did.
You never clicked on the
thing to bring the thing.
Here's another one real quick.
Palliative care will keep growing,
address the high costs in
the last years of life.
Patient's experience last
year is often terrible.
Yeah, my mom suffered.
It was not the way she wanted to go,
but we don't talk about that stuff.
We don't get educated.
We don't get trained on it.
I think this is a huge aspect.
Hospice is amazing.
And there are some huge
social media hospice channels.
I think it's Nurse Debbie
has a huge one that my
wife's family all like
followed everything she put out.
I think there's a huge opportunity for OT,
PT,
SLP to move into that space a little
bit more.
She's adding this too,
in terms of the future.
And that's also what I want to talk about.
The last thing I want to
talk about in the episode,
but we'll go with Dana thing.
Dana's last thing.
A couple of weeks ago,
she was at a conference and
former HHS secretaries
Shalaya and Azar agreed
that prediction of Medicare
advantage will be seventy
percent of Medicare by twenty thirty.
That sounds like it's crazy
far in the future.
It's pretty much twenty twenty five.
So that's not that far.
It's a read the tea leaves kind of thing,
of course.
But these are the people who were
sort of embedded in these things.
So take that for what you will.
Yeah.
Real quick in regards to hospice, I agree.
I interviewed a super smart
guy a couple months ago, David Sands.
He's the director of
healthcare at EF Hutton.
EF Hutton is a really big
investment bank in New York City.
They do a ton of deals.
They've been around for like
a hundred years and he runs
their healthcare deals, all their deals.
he came on my show,
we did a state of healthcare,
MNA mergers and acquisitions.
And at the end of that episode,
we were talking about
hospice and he loves it.
He sees a lot of value in it.
And he,
I think he gave an example like that,
like a, like a family story.
Um,
It's something that I think respectfully,
you know,
families and consumers are more
likely to just pay out of
pocket for if they find the
right fit because of the
situation where there's
less focus around like,
is this covered by insurance or not?
Or we need to get someone in
here right away.
I think the only challenge,
and hospice is similar to
my practice for the most part,
you don't need a brick and mortar,
you're going into people's
homes if they're assuming
that they're still at home,
unless they're at a
facility or something like that.
I think the only challenge
with growing a hospice
practice would be keeping
the professionals because
of all of the like every day,
it's like all of your
patients and clients are in
like the most challenging situation ever.
And that probably can't be
great for team members,
whether it's a nurse, a therapist,
a care companion,
someone who is not even
just their coach and trained,
but they're not licensed,
depending on states and
regulation and all that.
I think that the most
challenging thing would be
retaining those team
members because all day, every day,
they're with a challenging
situation with the patient, the client,
the family members.
And there's no way that could be easy.
So this would be a situation
where you could say,
and I do think there are
individuals that thrive in
that environment.
Like they love it.
They live in it.
They get the most fulfillment from it.
You know,
back to burnout doesn't happen
because you're overworked and underpaid.
Burnout happens because you don't get joy.
You don't get, you know,
appreciation for the work
that you're doing.
And knowing some hospice
nurses that are in that world,
they live for it.
They love it.
But that being said,
you could also just sprinkle that in.
So you put a little bit of
that caseload into your overall mix,
put a little bit of
athletics into your overall mix.
You know, you mix it up.
I did want to say there's a
misconception that if a
patient's on hospice,
they do not have or they
can't qualify for Medicare
coverage for therapy services.
And that's not true.
There are modifiers you can use.
There are services you can
provide that even if the
patient is on hospice,
And especially now with the
caregiver codes and some
other services we have available to us,
you can absolutely build a
incredibly successful
business incorporating that
population as a hybrid model,
some covered by Medicare,
some self-paid by the
patient or the family.
I think there's a huge opportunity there.
I got to dip a little early.
I got to go talk to a PT program.
Let's wrap it up.
Let's do.
One last thing I want to throw out there.
We're off on Thursday.
Yeah.
I do want to before the end of the year,
but he loves to reflect.
I want to be the first people to reflect.
Right.
So I want,
we've talked about this off offline,
which is let's come together.
Let's each have two.
Big, hairy,
audacious predictions for
twenty twenty five.
I don't want to know what
yours are until we're live.
So let's do it the first week in December,
the first Tuesday in December.
Twenty twenty five predictions.
This is the skate where the puck is going,
not where the puck is sort of moments.
And what what advice would
you give for practice owners?
Parting shots.
Dave, what do you got today?
parting shots.
I'll just go back real quick.
I'm thankful for what we do,
for what we collaborate on here.
I get fulfillment and energy from it.
And I'm glad that other
owners and other practices
and physical therapists and
other therapists like what we're doing.
And I would say also that we
put out a lot of
actually tactical steps and
uh ideas and processes so
just like jeremy sutton and
other people out there like
if you hear something that
we're talking about you
test it you implement it
just give us feedback let
us know like maybe it
worked for you maybe it
didn't um like jeremy
sutton took our idea and he
started advertising for
like the next day like the
uh got like parkinson's
golf program like whatever
he was charging and you
know if you have
parkinson's I'll he would go with you to
you know nine holes of golf
or full rounds of golf or
whatever like if you have
parkinson's and if you have
if you like golf and if
you're in the louisiana
area like he would go with
you on a round of golf so
if you watch what we're
talking about if you listen
if you implement it let us
know some of the things
we're going to work for you
some of them might not but
that would be the best feedback
Yeah, and I just want to say again,
I am so thankful, so grateful, Jimmy,
Dave, you guys came into my life.
I mean, we had kind of contact before,
but this has been such an
incredible phase of the journey for me.
And those of you watching,
if you want to show your appreciation,
go to the Dave Kittle Show, subscribe,
go to the PT Pinecast, subscribe,
learn Medicare billing, subscribe,
support us.
Let us know, like it goes back to burnout.
the fulfillment we get is
knowing you guys are doing
something with the
information we share
because we've already done
it we're sharing this for
you guys and we want to see
you guys taking this and
doing something with it
yeah we didn't plan on our
parting shots aligning but
dave's and tony's like sort
of made me think like the
the person you're hiding
the ideas from that you
think like if I'm going to
keep this close to the vest
the other therapists
not your competition like
I'm very I get it I
understand traditional
thought even if they're
down the street they're not
really your competition
there's more that have an
abundance mindset I I
understand this is simple
but not easy but when you
start to do that maybe not
the first day maybe not the
first month things come
back in a big way uh dana
saying she loves the show
thank you dinner she's crazy smart
She knows a lot of things, man,
and like off-the-cuff sort of things.
Love it.
Thanks, Portia.
Appreciate it.
All right, guys.
Have a great Thanksgiving.
I am selling nothing on Black Friday.
I want you to do nothing but eat, eat,
hang out, hug,
call someone you haven't
talked to in five years.
And bring up politics at the
table when you're eating Thanksgiving.
Bring up politics at the children's table.
That's where it belongs.
All right.
All right, gentlemen.
We'll see you next week.
Have a great Thanksgiving.
All right.