All right.
Early bird special.
Man, Dave is a dad.
He's getting old and now
he's early to the show.
Dave, we missed you on Tuesday.
How's it going?
Good morning.
All is well.
How about you?
It's going great.
So interesting stuff.
I don't know if I'd call
myself an entrepreneur,
but I'm going to say the
life of a business owner is never quiet.
Before we started,
we're going to bring Jimmy in.
Before we started, I shared with Dave,
I effectively built a business model.
That plays to my strengths.
Right.
So what are my strengths?
I've got social media.
So a big chunk of our
revenue profitability comes
from social media income.
But I also own property.
It was always a dream of
ours to own the building we
were in for our physical therapy clinics.
We own property in Florida.
We've sold that.
We own property here.
And a big chunk of my
business income is rental income.
Well, I'm losing a big tenant.
I just got a sixty,
maybe ninety day notice on
this tenant moving out.
So now I'm like, well, shoot,
let's say that's a third of my income,
a big chunk of my profit.
Where am I going to replace that?
And this is the real
challenge that business
owners are dealing with.
You know, whether it be,
you lose a big referral source,
you go under a big Medicare audit,
like whatever,
there's always big changes
that are happening.
So we're brainstorming,
we're figuring it out.
I'm like, well, I could, you know,
replace that revenue, that rental income,
obviously with another tenant.
And that's kind of the sweet spot.
We grabbed a realtor,
we're working with a
realtor for the first time,
and we're gonna try and fill that space.
I could sell the building, you know,
use this as a time for an exit.
They're doing tons of
construction around us.
We're right off the I-
seventy five corridor.
We've got a thirty six
hundred seat convention
center and hotel being
built within the next
twelve to eighteen months
right next to us.
Bunch of commercial properties coming in,
bunch of retail.
So this could be a good time
to exit the building.
This could be a good time to
find a new tenant.
That's going to take a bigger footprint.
This could be a big time to, you know,
just change my business again.
Look at doing education,
doing conferences.
I talked to Jimmy about this,
bringing people into like,
turn it into a little mini
business university for PTOTSOP.
I don't know what we're going to do,
but you guys will hear it
as it develops live.
Meritato University.
I was going to say Dean Tony.
T-U, Tony U.
Learn from all my mistakes.
I've got millions of them.
But that's all a university is.
I know they have pomp and circumstance,
but when they say built on
the shoulder of giants,
it's built on the shoulder
of giant mistakes.
Wet t-shirt contest,
like pitchers of beer.
That's what the university was.
That's what I remember.
Started a fraternity.
I was going to say with a potential tenant,
I used to follow Grant Cardone.
I don't anymore,
but he's got some funny quotes.
And one of his quotes is,
who's got my money?
So there's tenants nearby, Tony.
You jokingly can kind of
consider your area, look around.
I feel like there's got to
be someone that would want
that space in your area
that would pay the same
dollar amount or you could
bump it up a bit or whatever.
Or maybe you give them some
rent reduction for the
first month or two or the
first six months or whatever,
or some period to lock somebody in.
But there's got to be some
healthcare provider nearby
that is looking to ramp up.
So that's one of the things
we've brainstormed with the
commercial realtor.
We have kind of a unique situation.
So we have two opposing
hospitals on opposite
corners of each other.
It's almost like there used
to be Walgreens and CVS
across the street everywhere.
These are two opposing hospitals.
One hospital has a huge
footprint in the area.
They've been here since
before I came around.
The other guys just came in.
They bought a section right off the exit.
It's an emergency room.
They have physician offices.
But they're all full.
They don't have a place for PT.
They don't have a place for
other services.
And from what I understand,
the construction costs
right now are through the roof.
It is so hard to even get a
building built.
They can come in,
and this is what I was saying,
a bigger footprint.
They can come in and take my
entire building.
It's almost eleven thousand square feet,
two floors.
It was a spine center initially.
So it's built for a medical
center and just, man,
just be my tenant for the
next fifteen years.
Like the other hospital
rented seventy five percent
of my building for five years.
It was an amazing experience.
I love hospital tenants.
So I would like to and
that's what we're going to try for.
Get somebody who wants a
footprint in this area to
come in and just take the whole building.
There's also a massage
therapy school who is
looking to come into the area.
I wish I would have owned a
massage therapy business school,
but if I can't own it,
maybe I can lease my space to them.
Yeah, there's tons of opportunities.
Be the Ray Kroc, right?
Why own the business when
you could own the ground
the business is built on?
I mean, right?
Heck yeah.
Real estate game.
So Scott's here.
Bo's here.
We've got a lot of stuff
that we can talk about.
Where do you guys want to start?
I would like to start on April first,
which is two days ago.
And we had we had talked on April first.
Was that April first?
Like April Fool's Day jokes.
And this is me.
I think I come off a little
bit more risky or like, you know,
communication adverse,
like grip it and rip it.
When it comes to April
Fool's Day and your business,
I'm actually the opposite.
And here's why.
It's either gonna go really,
you got a one percent
chance of it's going really, really well.
a ninety eight percent
chance or a ninety eight
percent chance of it just
like completely blowing up in your face.
Another one percent chance
of it just falling flat.
Like it's you have to hit
such a specific moving
target to take a chance
because everybody's trying
to like fool everybody.
And I'm like, it's twenty twenty five.
This was possible.
I gave a few examples on the
live stream on Tuesday of
like things we did in radio
back in the day.
Kids before the interwebs,
it was easier to fool
people because there's a fact check.
Right.
Like and like you got fooled
and you told six people,
watch out for that.
And the other six thousand
people in your life, you couldn't tell.
So here's what happened.
And like people are getting fired,
like people have to be
getting fired from these organizations.
So which was first?
Oh, is this one?
OK, so Sword Health.
goes on LinkedIn,
not really a Chuckles platform, but hey,
Tony and I are trying to
make it more of a Chuckles platform,
right?
We're trying to get a little
more levity on LinkedIn.
Sword Health goes old school,
guy with girlfriend looking
over the shoulder meme and
does competitor,
he's dating high quality care,
but he's looking over his
shoulder at non-clinical coaches.
So for those kids playing along at home,
Sword and Hinge are Walgreens and CVS.
Are they not?
Like, am I missing something?
Or maybe in the nuance,
I'm sure if I invited the
CEO of Hinge on the show,
he has not yet responded.
But they are taking shots at
each other on social media with memes.
And they're sort of like the same thing.
Maybe Coke and Pepsi, like Miller Lite,
weird great taste and less filling.
I don't know.
Like to me, from the outside,
these two organizations look very similar,
right?
So Sword Health,
shots fired on April first.
But then... Okay, go ahead.
This will be the timeline.
All right, so that screenshot,
that sword health making
fun of hinge health,
I thought it looked like
they made it for them.
They're throwing shade.
Yeah, which...
You guys probably would have
thought that I created this meme.
I don't create memes,
but I basically have said
verbally this type of meme
for both of these companies, though.
Look, look, look.
This is someone.
This is me coming from my
communications background.
Someone who makes multiple six figures.
Eventually, this got to them,
and they thought this was a good idea.
For a multi-million dollar
healthcare organization.
I don't think that social
media post went too high up
in terms of getting approval.
Well,
then everybody that it should have
gone through,
they got fired or they
should be getting fired.
Like this is a bad move.
And here's why.
I'll give you the radio
parallel because that's all I know,
right?
You don't get beat by the
songs you don't play.
You don't get beat by the
jokes you don't tell.
You don't get beat by the
risks you don't take.
Here, in this situation, in comms,
you don't.
This was a bad move.
But wait, it gets better.
Because the CEO for the
other organization that
they were throwing shade at, Hinge,
came back.
never answer like what are
you teaching the read it
read it let's let's go so
this is daniel perez ceo
and founder at hinge he's
like when competitors act
out it's often because
they're losing never punch
down like if this this was
a this was a um
this was a D minus,
this is an F like D minus.
Like if you're sword and you're,
and you are behind, I don't even know.
I'm not keeping score.
I don't know what metrics
we're looking at here.
You punch up, you try to get,
if you're Pepsi,
you try to get Coke to take the bait.
Right.
And then they took the bait
if they're ahead and Perez
comes back and he essentially is like,
okay, when competitors act out,
it's often because they're losing.
And then he goes on a diatribe of like,
here's why we're great at hinge health.
The last point matters.
Healthcare is a trust business, blah, blah,
blah, blah, blah.
This is a statement most
likely written by AI and
then massaged by a comms professional.
If we're keeping score at home,
here's the other thing too.
And it, you can never prove it,
but all the comments below
this post from other hinge employees are,
This post went out and then
a Slack message went out to
everybody that said, jump on it.
Go comment, go comment.
Go comment.
Everybody dog pile in a good way.
I can never prove it,
but I don't have to because
I run a podcast.
So it doesn't matter.
But that's what happened.
Trust me.
CEO put out a message and everybody said,
jump on it.
And everybody started getting the feels,
right?
So you figure it would be done.
Two crappy mistakes in one
day separated by a few hours.
Wait, there's more?
We were in a chat.
I was like, oh my God.
And that's why I've got to say,
I'm going to say her name
because I didn't even know
this was going on until Marla,
is it Ranieri?
She was the one who dropped
in our DMs and was like,
are you guys watching this?
And I was like, Marla,
I had no idea that this was
going on in public because no, no, Dave,
we're not done there.
We get even dumber because
the first person who shots
fired doubled down on me.
Yeah.
Hold on.
I got to get a better picture of that.
Hang on.
Let me get a different
version of that because I
got to edit the screenshot.
But yes, they doubled down on the memes.
They went with the wrong one.
And I'm showing my age here.
This is Drake.
Doing the over-the-shoulder
hand in the face and then
the gotcha meme gets
offended by an April Fool's
post mentioning one of our
competitors using
non-clinical coaches
instead of licensed clinicians.
And he's like, all right,
actually uses non-clinical
coaches instead of licensed.
You're mad at me calling you
out for the thing that we're both doing.
And then someone pointed out,
this is Drake.
Who was the guy in the Super Bowl?
This is what I'm showing.
Who was the guy who like?
Kendrick Lamar.
You used the wrong guy.
Kendrick Lamar won.
You used the Pepsi again.
Look at Jimmy going like
meta with putting all these
pieces together, Tony.
I love it.
You used the second place guy.
What are you doing?
So yeah, so that's where I'm like,
that's where I know this
had to be approved because
they did it again.
Like once was bad, twice as much.
So like, all right,
this is comms at like a
million dollar company level.
People doing it, in my opinion,
and it's all subjective, poorly.
But hey, look,
they got some attention out of it.
No attention is bad attention, right?
It is.
So it's good.
Moral of the story is the
April Fool's post should be
funny only and not negative, right?
They shouldn't be attacking.
Oh, yeah.
This came out of left field
to attack a competitor, no?
Listen, I figured this out in high school,
right?
I wanted to be funny.
What I realized was I wasn't that funny.
I was fun.
And there's a difference.
That's a different topic.
If you ever want to make
someone and make fun of
someone and you're in a
room full of twenty people, you know,
the best person to make fun of yourself,
self-deprecation, self-deprecation.
And both of these people
decided to prove how they
were taking the moral high
ground to like they beat
their chest so hard.
So like, yeah, dangerous.
Yes.
Who who who lost worst?
I would say it was Hinge.
Because if they're leading,
you just acknowledge the
fact that there's a
competitor with a D minus
going to sword with the two
different crappy memes.
So this was gold for me for
about twenty minutes.
But I will have either of
these CEOs or VPs of comms
or anybody come on the show
and tell me why I'm wrong
and this was actually good ideas.
I don't know.
Yeah, I mean, I didn't see any other.
There was one, Angie from Apex,
they put a thing out saying
that they were going to
stop doing musculoskeletal ultrasound.
Usually, didn't APTA,
and I don't even know, like this is,
I think, just as bad.
I don't even know if it ever
was confirmed.
Was it an April Fool's or not?
Like APTA had shared
something a couple of years
ago on April Fool's Day,
and people were like this
has got to be a joke is
this a joke is this an
april fools are you you you
know teasing us and I don't
even remember what it was
it was some sponsor like
business that was coming in paying apta
It was crazy stuff.
I think there's more to be
lost than to be gained.
That's a better way of saying it.
There's a bigger, bigger chance of losing.
Here's the thing.
In comms,
if you have a press release or a
story you need to share,
unless it's a house fire
that is happening right now,
do it the day before or the day after.
Do it on April second.
Don't do it on April first.
Get out of the way.
Or if you actually have
something really funny and twisted,
like a twist, like something to play with,
do it on a different day
when not everybody is doing that.
The funniest post that I see
that comes up every year is April first,
the only day of the year
when people actually read
and review things
critically that they find
on the internet.
That is the most accurate
statement because
everybody's break checking on April.
But hang on, I'm not going to fall for,
hang on, I'm not going to fall for this.
Right.
The next day and the other
three hundred and sixty four,
we sort of believe it at face value.
There was one social media post,
and then we can move on,
but there was one social
media post that caught my
attention that was kind of funny,
and it was that Jeff Bezos
had acquired Hooters,
the chain of Hooters locations.
That's not that far out of
the realm of possibilities, though.
Exactly, exactly.
But, you know,
for other reasons or whatever,
someone linked that and
made that a thing.
Now, did Hooters end up going bankrupt,
though?
I think that's why I was saying that,
yeah.
I think so.
Okay, same thing, because I see it,
and I'm like, is this for real?
That was a while ago, though.
I saw that a while ago.
They were talking about how
they're – because them and
Red Lobster are even longer.
Somebody bought Red Lobster, though,
on a big loan.
Yeah, yeah, they did.
They did.
All right,
what do we got next on the agenda?
How about that screenshot I
sent you guys about the
luxury personal training?
Yeah.
I'll get that.
I'll let you.
Yeah, I'll get up on screen.
You start talking about it, Dave.
Yeah.
So I shared a post yesterday.
I think it was,
this is not my thing about it again,
probably triggered by, you know,
I lose a big tenant.
Now I need to make up the revenue.
Where's it going to come from?
Also based on conversations.
for the viewing audience my
wife came back into the
clinic she's this is her
second week back in after
seventeen years now she's
been behind the scenes
doing payroll and and other
things but she hasn't been
a therapist in the clinic
and she came back as really
running the front desk and
so she's realizing she's
like wait a minute you know
when I left what felt like
yesterday it was everything was on paper
New client would come in.
We'd take a photocopy of
their insurance card.
We take a photocopy of this,
that and the other.
Everything was done.
Now it's like manual hunt and peck.
You know, OK, I got to put in their name.
I got to put in their date of birth.
I got to do all this stuff.
Why is AI?
Why is technology not doing this for me?
Why?
And you guys could tell me
Jimmy might know.
I don't know of a single EMR
in the physical therapy space.
Guys, come at me, bro.
I don't know of a single EMR
in the physical therapy
space where I can scan the insurance card,
I can scan the driver's license,
and it instantly creates
the account for me.
um do you guys know of that
I mean we know in doctors
offices dentist office like
everybody everywhere else
in the world this happens
does it happen in pt I'm
asking I've never seen it
happen anywhere you have
doctors where you can scan
your insurance card and
driver's license and it
creates an emr account for
you yeah it uses ocr I
think that's what it is
optimal character
recognition turns it into
text puts it straight into the emr like
It just understands very
simply what's the information available.
Anyway, so she's coming in.
Will, welcome to the show.
And she's like, oh my gosh,
how is anybody supposed to survive?
Twenty minutes checking
authorization to try and
get a best guess of what
reimbursement's going to be.
We've got all these rules,
all these regulations.
We're not even touching the
compliance side of it with...
compliance officers and
attorneys and all the other
junk we're supposed to deal with.
She's realizing she went into a coma.
Seventeen years ago,
woke up today in a
completely different world.
And so I shared a post real quick.
I just said, hey,
can you deliver a ten
minute one to one
experience profitably for thirty dollars?
And that just came because I said, look,
Medicare
In an ideal world is paying
about thirty dollars a unit.
And if I can wipe out all of
the frustration, all of the regulation,
most of the documentation,
there's still state
guidelines I would need to
follow and just say, hey,
if I can build a model that
delivers ten minutes face
to face time with the
therapist for thirty bucks profitably.
Why don't I just build that?
Why don't we just make this
simplified down to its core component?
And of course,
Dave came in with the other
end of the spectrum.
I am not trying to deliver
Dave's level of patient
experience for thirty bucks.
So what did you think?
Where'd your mind go with it?
Hold on, hold on.
Before we share the luxury
personal training.
So yeah, so with this model,
I wrote and I commented,
I got a little love.
I got a few likes from you
and maybe Jimmy and someone
else or a few others.
But I mean,
we kind of talked about this before.
One is that is not the client, patient,
consumer that I'm looking to serve.
I'm not looking to have just
someone come in for thirty bucks.
I believe that if this was the model,
everyone's paying out of
pocket which is great the
money hits the bank account
in a couple days that is
great there's no revenue
cycle management there's no
uh software or anything
that we need for that um
but the no-show cancel
rates would be high I
believe for people that are
coming in kind of whenever
they want uh I jokingly
said it would be a chaotic
zoo like why would you even
schedule appointments if
it's ten minute visits so
it's like it would pro it
would have to be like a
like a walk-in like like
some of these like urgent
cares now where it's like
you just walk in and
You know,
you don't even have a scheduled
appointment.
So you're going to have like
times in a clinic where
it's like crazy busy and the therapists,
their heads are going to be spinning.
They're going to have to
write more notes unless
you're using HippoScribe or whatever.
There's just more
administrative components.
You're going to have to be
incredible with marketing.
You're going to have to run
a ton of Facebook ads.
You're going to have to run, you know,
offers and promotions and
things like that to get people in.
uh to generate enough of
these uh ten minute uh what
is it it's ten minute ten
minute slots uh you know
per hour on the hour every
day every week every month
uh you're gonna have to get
more humans to actually
come into your brick and
mortar office regardless of
typically they're coming in
for three or four units or
coming in for forty five or
sixty minutes or whatever
and you're treating however
many patients through
medicare or insurance or whatever um
If everyone's paying out of pocket,
awesome, great.
But you're actually gonna
have to have more humans
cross your threshold,
actually get dressed, drive, park,
then come into your office
and come in and all that.
So I think it would be a challenge.
I think it could be built.
I think it could be built,
but it doesn't make sense
when you add it up and you're like,
that's like a hundred and
eighty dollars per hour.
I believe in most states,
it's so much easier to just
charge a hundred and eighty
dollars and find four, five, six, seven,
eight,
whatever people per day on average
to treat.
And then it's two different
patient experiences.
It's two different
It's two different services.
Yeah.
There it is.
Go ahead, Jamie.
I want to be in the middle.
It's neither here nor there.
It's a different option.
It literally is like,
do you want this or that?
Which one fits you?
Because people value different things.
Some people want ninety
minutes of you listening to
me talk about my day and
then listen and then a
little bit of the rubsies
and a little bit of the
exercise and move on.
And some people want if you
can do it in fifteen minutes,
I'll pay triple the price.
So I think the answer is it
depends on what value is
being decided by the decision maker.
And to Tony's point,
which the first time Tony
ever said it was like, oh yeah,
that makes sense.
Understand who the decision maker is,
right?
Like this is where I get to
be hard on our profession by saying like,
you keep saying the
insurance companies are bad.
I'm like the insurance companies,
If nothing else, they're consistent.
They don't show their hand.
They plaster it on the wall.
They put it in a contract.
They write it down.
So you have to understand
what is being valued.
So I agree with Dave and I
agree with Tony.
That's why I'm in the middle of this.
No, you got to pick a side.
Well, no,
I don't because I think you can offer,
but you could have three of
these slots a day and five
of the ones that Dave is
talking about are vice versa.
And you can change according
to the demand.
Now, you're right.
You're absolutely right.
And the thing that I love
about these posts and these questions is,
you know,
it gives us the freedom to just
think creatively, think outside the box.
Like every single objection you raise,
Dave, is one hundred percent accurate.
But every single one of
those objections has a solution to it.
You know, and you're right.
More bodies in the clinic.
So I need a bigger clinic, more.
So I need better automation.
You know, again,
I would default to if
Planet Fitness can operate
a multimillion dollar
business at fifteen dollars a month.
How are you telling me that I can't do it?
Because no one shows up a
session because no one
shows up to Planet Fitness.
How do we build that model?
So then I say, OK,
I'm going to do a thirty
dollar for a one on one or
I'm going to do one hundred and twenty.
Come whenever you want.
One hundred and twenty for the month,
you know, and I'm hoping you don't come.
But that's OK,
because that's the business
model that I am building.
I don't need you to come.
I don't want you to come by the membership,
by the treadmill that you
never walk on for a
thousand dollars or pay me
one hundred and fifty for a month.
Never come to my clinic like that is OK.
That is a business that's
filling a need within the
demographic that wants to pay for it.
Um, but you know,
this is the fun part of business.
Like I'm a creative at heart.
I don't care about the money
in the bank account.
As long as I have enough to pay the bills,
I love creating new things
that are valuable to
somebody out there in the community.
You're more of a business person.
You're a real business person.
You want real money in your
real bank account.
That is awesome.
And I think that's why we
can approach it from such
different angles.
I just love the creative process.
I love brainstorming.
Before we got on today, I was talking,
I said exactly the same words to my PTA.
I was like, hey, we can do this.
For, you know,
four people at twenty five dollars,
they can come in.
They don't even need one on
one because I'm not billing insurance.
So who the hell cares?
Like what?
They just need to feel good.
They want to pay twenty five
dollars to satisfy something internally,
whether I touch them or not
spend ten minutes with them or not.
But then I'm like, or or.
We could do one Medicare
visit for a hundred dollars for an hour,
you know,
four to five people in the
clinic versus one person.
Like, yeah, we,
we see those same exact
comparisons and we discuss
them every single day.
I just think like,
this is the redneck party bus.
So a couple of months ago,
one of my friends rented
like this beautiful Hummer limo and
We had more fun when we went
on the redneck party bus, you know,
so both of them exist.
Both of them are available.
It just depends on what's
the experience you're looking to deliver.
So this discussion was going on when Jim,
because I don't have any
kids and I work from home,
so I was still in bed,
but I was looking at what
Dave and Tony were saying
in the group chat this
morning about the photos.
And it made me think of the
first time one of my bosses
in radio had said, just go the other way.
I'm like, what do you mean?
Like for every fancy limo,
it's like instantly you'd be like,
where's the absolute
opposite of the spectrum?
Where's the redneck party bus?
There was a...
I don't know if they were
the first to do it.
They were the first that I noticed.
There's a restaurant called Carrabba's.
It's a franchise, but it's not super huge.
Fake Italian food.
Yeah, fake Italian food.
Like Olive Garden.
Go ahead.
Like Olive Garden.
They're a little better than Olive Garden.
I got to be honest there.
I agree.
A little better than Olive Garden.
But Olive Garden solves the problem.
I love their breadsticks.
It's a little like crack.
I need more of their breadsticks.
But Carrabba's did something
a little different outside
just Olive Garden.
They took the wall down.
They made the invisible visible.
Now you can look into the kitchen.
So then you go to the other side.
What's a thing that
everybody sees and it's ugly?
Put the wall up.
Make the small big, the big small.
Make the black white, the white black.
So you could be doing this thing,
which is like, PTs,
this is where the bar is so low.
Understand that the people
watching and listening to us right now
You're probably the top one
percent of our profession.
I'm not even talking about your skill.
I'm talking about the fact
that you are taking free time.
I'm not trying to like kiss your ass.
You're taking free time to be like, OK,
how could I be a little bit better?
There's no guarantees.
Listening to these Yahoo's
twice a week is going to make me better,
but I'm going to give it a
shot to find the nugget.
The bar is so damn low.
In terms of most people are
coming in going,
I just want to go into the
model that worked twenty
five years ago and hope
that it works out and bitch
when it doesn't,
because the only constant is change.
All right.
Javier wants to know,
how do you think your
turnover rate would be in that model?
Yeah.
What do you think about that?
So I assume he means turnover in staff.
Oh, really?
I can tell you right now.
I took it impatient.
Like I took it like finding new customers.
Let's take both.
Let's approach it from both perspectives.
From a staff perspective, like Dave,
Dave would never come into my building,
come into my clinic and be
happy and fulfilled and do what he wants.
I can't even tell you how
many therapists I've
employed over how many
years that could never
handle or enjoy the model
that I'm talking about.
But the guy that's out there right now,
he's been with me eleven, twelve years.
We both thrive in that environment.
We love having the mixture of, you know,
three people are paying out of pocket.
One person is doing insurance.
Another person is coming in pro bono.
Like we we just love having
humans in the clinic and
the capacity there.
So to Javier's point,
I'm never going to hire a
therapist who wants to
deliver a sixty minute one on one visit.
I don't like that.
I don't want to build that business.
That therapist and my model
would absolutely quit in
twenty eight days and they
would attack me for being a horrible,
you know, quote,
mill or worse in the profession.
From a patient perspective,
the whole idea is to, you know,
give them what they want
and then get them out.
Like turnover is an element
in the profit model and that's OK.
I, again, I buy a car.
The car sits in my driveway
probably ninety eight
percent of my time because
I don't use my car other
than coming here to work
every now and then, which isn't that far.
But I still paid for the entire car.
You know, I didn't do Uber to get to work.
I bought the car.
There's lots of lots of things like that.
And then the other part of
it is going back and
everybody's going to hate this.
I remember having these
conversations with new hires, with people,
therapists that were coming in.
And I said, hey, guys,
I don't expect you to be
with me for forty years
like that's not the
business I expect you to
come in work a year maybe
three but if you're not
developing and improving
and growing beyond what my
business can offer you are
not the therapist that I
want to bring into the
business I want somebody
who is going to turn over
I don't want to keep giving retention,
you know,
raises of three percent just
because you've been alive with me.
I want you to come.
I want you to improve.
And I want you to get the heck out,
go somewhere else.
Turnover can be built into
the business model,
whether it's staff or customers,
if you do it right.
I have an interesting
question that just came to mind.
In using everything that
most of what Tony just said,
are PT mills good?
because they get people in and out.
And the goal is hopefully you can,
in as many visits as
possible in a short amount of time,
get them to self-sustaining
or back on their way.
In that model,
that's sort of what Tony was saying.
It's like, hey, let's get them in,
get them moving,
and then get them out the door.
They shouldn't be here for six weeks.
They shouldn't be here for
an hour times eight weeks.
That's a nice little twist.
We should do a twisted episode.
We have to defend PT Mills.
That would get some LOLs on YouTube,
right?
And I was just going to add to that in,
not that I'm in favor of Mills,
but to partially defend
them now as a teaser for if
we could do that as a full episode.
And Tony will say it all the time.
They also are the low-cost option.
Sure.
So they have wide accessibility.
They take a lot of insurances.
They will get you booked.
Now, the whole one-on-one,
like billing units,
and is it actually
one-on-one care all the
time when it's supposed to
be one-on-one care?
That's a whole other argument.
That's a whole other component.
Yeah, there's legality.
And then there's like
there's are you delivering
what's promised, right?
Like legally, like that's where Tony said,
like you have to be legal.
Like you have to if you are
saying I am providing whatever,
like all the all the things
that have to be there need to be there.
But then we put an
assumption on patients that
they want sixty minutes one on one.
No one else in the room.
No one within one hundred yards of us.
Noise-canceling headphones.
You have to be staring at me
the entire time.
I'm watching every move with
lasers and everything.
Patients don't – I'm going
to go on a limb here.
Most of them don't care about that.
They want to be better afterwards.
How do you do that is up to you.
So going back last week or Tuesday,
somebody,
I'm not going to mention names
because we might do an
interview with him.
You know, he got really offended.
He got really fired up.
Somebody was talking about a
large corporate clinic and he said,
we don't do any of the
stuff you're talking about.
And it's true.
I think too many of us still
have this idea in our head
that large corporate
immediately means ten
patients an hour per therapist, you know,
with no help.
I don't think that's the case these days.
I think they have figured
out the model that works for them.
Hence, they're still in business.
The other part that's
interesting about this, though,
is I also think that it's a
great proof of concept.
If you strip out the
regulation and you say, OK, fine.
Forget everything about
compliance regulation, all that stuff.
Look,
no matter how much therapists
watching this here say, I hate that.
It wore me out.
I can't handle that.
It was a model that continued to sustain.
And so now we look at that and we say, OK,
maybe it wasn't perfect.
How do we refine it?
How do we improve it?
How do we make it better?
And then, of course,
you go to other models like, all right,
CrossFit, you know,
people are paying two hundred and fifty,
three hundred dollars a month.
They're in class twice a
week with twenty other people.
Like, how do I pull that element in?
I shared a I think it's
strong something with kids
where it was showing these kids, you know,
toddlers and young kids
pushing sleds and doing like great,
awesome fitness stuff.
And I'm like, OK,
so if you have a pediatric
practice that can't sustain
with Medicaid reimbursement,
what if you open the door
to some of these other
things and allow some of
these new models to come in?
Last one, I'll say we rock the spectrum.
We talked about this franchise before.
A mom had a child.
The child was on the spectrum.
The child was getting OTPT services.
The mom couldn't afford more services.
The founding story is mom
buys some of the equipment
and then realizes, hey,
I can make this accessible to everyone.
She she rents a space.
She puts like ten or eleven
core pieces of equipment
that the OTs and PTs were
using with their kids.
And then she just charges an access pass.
Fifteen dollars.
Come in.
Use the equipment.
There's no clinicians,
but you can do what your PT
or OT wants you to do.
I just bought the equipment
that we can all share, you know.
And so these models are out there.
They've they've proven to be
successful worldwide.
We just need to adopt the
one that resonates with us.
My model doesn't resonate with Dave.
Dave's model doesn't resonate with me.
But that's the beauty is we
can do whatever we want to do.
And this was a topic of discussion, too,
before I try to approach it.
Tony, like very Yoda,
like when people are like, OK,
let's go along your premise.
I'll accept for a moment
that mills equal bad.
How do you how do you define a mill?
Is it more than three locations?
Ten?
Like where where's the Mason
Dixon line of a mill?
And everybody kept coming
back with these like wildly subjective.
Well,
as soon as it's not sixty minutes and
one on one care.
So I was like, OK,
so sixty one minutes is OK,
but fifty nine is not.
Is that the line?
Well, that's not what I'm saying.
I'm like, scroll, scroll, scroll.
That's exactly what you're saying.
If you can't show me what a mill is,
how can you say it's bad?
Like, we define what rules – like,
you know, drunk drivers are bad.
At this blood alcohol level, no bueno.
At this one, that's fine.
You continue on your way, sir.
So you have to define it
before you can make it bad.
So I don't know what a mill is then.
If I just – if I'm Tony's
wife – by the way,
I love the fact that we
don't know Tony's wife's name.
I never want to know Tony's
wife's name until she comes
on the show because right
now she is this amorphous being that just,
like, dropped in,
but she didn't have the curse –
Of knowledge anymore.
She dropped in like she was.
Seventeen years ago.
And she sees all this stuff.
And so all the stupid stuff.
We're doing now.
She's able to spot.
From a mile away.
In two seconds.
Real quick.
So Javier.
Thank you again.
So he said.
I don't mind the thought.
But I haven't come across.
Any young PTs.
I think we have the problem identified.
Young PTs,
that would be okay with that volume.
I only see older PTs being
in the game for it.
And this goes back to my
previous post a while ago.
Did we outgrow the profession?
And it doesn't mean that the
profession is bad.
It doesn't mean like I'm
above and you're below or the profession.
I'm just saying...
Maybe that's true.
You know,
I am not on the university campuses.
I haven't been for a very long time,
thank goodness.
I'd be that creepy old man.
I'm a creepy old man.
What?
I was that guy.
I was the second career guy back.
I was in school.
But that being said,
so if the universities are
breeding a culture of clinician,
new grad clinician who is
of the mindset that and
don't persecute me, I am a doctor.
I only do this.
I only do that.
This is, you know.
Then that's where the
profession is going to go.
And that's fine.
Like it can go there if if, you know,
I don't want to go there.
So I'm happy to leave the profession.
I'm happy to hang up my
shingle or retire my licensure.
You know, like I have zero marriage.
It's not my religion.
No problem at all.
But I would say,
I think the profession
would do well to attract
more young clinicians who
have been fitness influencers,
CrossFit coaches, you know,
have been in that world
because they also see the
value in that different model.
And I think when we go back and we look at,
okay, am I building dependency?
Am I breeding dependency?
Because this is a hot button
for a lot of clinicians.
Like,
If I, quote,
ignore my patient and make my
patient do their own
exercise from the outside, look it in.
I look like a bad therapist.
But if I do it intentionally to say, hey,
this person's not going to
have my hands when they go home.
They're not going to have me
with them the next time they flare up.
My job is not to make them dependent on me,
but rather to teach them
what needs to be done and how to do it.
This is a completely different world,
you know,
and once you're you're you're
empowering them is what
you're once once you
realize that and consciously accept.
OK, like I'm going to say in Dave's model,
which I have,
I have patients out there
for twenty years.
There are people who are dependent on me.
I've done that.
I understand it like but
they're paying me out of pocket.
Insurance isn't paying me for it.
I also think there's great
power and great honor in
being the therapist who
builds independence, resilience,
strength and, you know, sees the person,
teaches them a couple of
things and then lets them
go on their own.
But I can understand how
from a therapist perspective, you're like,
you're ignoring them.
You're not giving them, you know,
whatever.
No,
I am empowering them to be independent.
I'm kicking them out of the
nest so that they can learn
how to fly on their own.
So let's go through this, you know,
in police talk,
because I watched enough
SVU to consider myself an
expert on police procedure.
It would be like evidence
chain of custody.
It's like, this is the gun.
Who has had the gun?
So the first...
The first touch point,
because Javier is talking
about new versus older therapists, right?
So I want to call this
conversation for a minute.
That's not what was in the
brochure conversation, right?
So if you're a PT,
what's the famous story of
where you came into PT?
I was a midfielder and I
tore my ACL my senior year
and went to PT and fell in
love with the process.
Got it.
So you were sold one thing.
You bought in,
cue the harp music and the heart eyes,
right?
That's where you bought in.
Or a career fair that you
heard what that person's day was like.
Or maybe you were impatient
and you were watching your
mom go through something
traumatic or your
grandmother broke her hip, right?
So it depends on what brochure
you looked at first and you
expected the profession to
look and feel just like that.
You're like,
if I show up and I do
everything you tell me and
pass all the tests,
I get to just show up and
be on this conveyor belt.
And I get now at different stages,
different things.
This is what my day looks like.
And this is what everything looks like.
Right.
Or is it you tripped across
a university's website and, look,
become a physical therapist,
and our pass rate is this,
and the average physical
therapist is the third
happiest profession and
makes this much money, right?
Maybe that was the first
brochure that you ingested
or consumed and now said,
this is what I will now expect.
Here's the thing.
Those are all just messages.
Right.
Those are those are all
versions of the truth.
Right.
So if you're expecting it to
be easy and show up and
when you get there, it isn't like that,
because by the time you
ingested that brochure in
high school and became a
doctor of physical therapy,
however many years later,
I got news for you.
The world changed.
It changed.
And it's constantly changing.
So I could see where the
young therapist would be
pissed or confused or
people who were in the
profession on that conveyor
belt are now pissed that
they have to change and adapt.
I understand why you're angry.
It doesn't matter.
It's not going to change anything.
You have to adapt.
just because it was in the
brochure doesn't make it true.
I would love to hear from Dave.
So Dave has been in baseball a long time,
right?
So when you think of like in baseball,
you've got your batting coach,
your pitching coach,
and then you've got the
coach and the team manager
and you've got all these other people,
but there's still this whole team.
Like every single individual
on the team doesn't have a
dedicated person every single time.
Now,
some of them might have outside
trainers that they work with exclusively.
But within your model,
and I struggle with this every day,
am I a coach?
Am I a healer?
What am I even?
I don't know.
Most of the time,
I just want to be an educator.
Most of the time,
I just want to teach people
and then let them go do it
from a baseball perspective.
I was in the batting cages
pitching to my players last night.
I'm like,
I'm going to give you the pitches.
We're going to work on your batting.
And then you're going to go
hit off the tee or you're
going to do something else
to work on what I just showed you.
How do you look?
Do you make any comparisons
between like your history
as a baseball player,
working with coaches and
trainers versus what you're
doing as a physical therapist?
Not too much.
I mean, I think at the end of the day,
I think I look at what we
do or what I am as a service provider.
So some people,
we go to someone's home and
they kind of are yearning for the healer.
Maybe we go into that mold.
Maybe we fit that mold.
Maybe we don't.
where someone is on Park Ave
or Fifth Ave in Manhattan,
and they're looking for a professional.
They're looking for a
physical therapist that comes in.
They're clean-shaven.
Then we've got a button-up collar,
whatever.
And oftentimes,
we're going to fit that if
that's what they're looking for.
Sometimes someone needs more
of the touchy-feely stuff.
And sometimes we'll kind of
mold into or fit the mold
of what someone like that is looking for.
I don't know if we're always
going to say we're one
thing or the other.
We're not going to say like we're always,
you know,
we're healers or we're just therapists or,
you know, we're professionals.
We want to be professionals, right?
Like we just,
we always want to be
consummate professionals.
But at the end of the day,
we're delivering our service.
And to loop back around with
like the ten minutes for, you know,
thirty dollars versus what
we do is we're providing a
service and we want to have
big enough margins to be
profitable to be
sustainable so that we can
pay our therapist whatever
they want whatever they
demand whatever they
actually deserve in the
marketplace because if they
can't get it with me
they're going to go get it
with someone else and also
a service where sometimes
there's a little bit of
that tony there's a little
bit of like yes they stay
with us for potentially
long periods of time so we are
optimizing oftentimes for
the lifetime value of the
patient or client.
They come to us for an episodic issue,
ankle pain, back pain, whatever,
and then they stay with us
and they do tune-ups, maintenance visits,
wellness, some personal training, hybrid,
whatever you wanna call it.
Some people are gonna be
independent and they're like, hey,
I just need you to help me
with my pain and then I'm
gonna go back to my trainer
at Equinox or whatever, right?
Okay, that's fine.
And then some people stay
with us for three, four, five years,
right?
we have a service we deliver
a service we are optimizing
for the high margin so that
we can pay we can get
aggressive with paid ads we
can get aggressive with
mail promotions and paying
our therapist a high rate
per visit uh and keeping
some of amount of these
clients for the long term
uh that optimize the long
term the lifetime value of
some of those clients
And some of that cash we use
for the paid promotions, the paid ads,
compensating our therapists and all that.
So I'm not sure if that
answers your question,
but that's how I kind of
look at it in terms of like what we are,
what we deliver.
No, we're not necessarily healers.
We're not Reiki.
We're not pretending to do, you know,
I'm healing you with my energy,
with my positive energy.
Positive vibes.
Yeah, so we're not necessarily healers.
We do say we're Dr. Mo, we're Dr. Dave,
we're Dr. Chris, whatever,
like doctors in physical therapy.
We're not gonna pretend like,
we don't say we're physicians.
We don't say we're MDs.
We are therapists.
We are professionals.
Sometimes maybe we're healers.
At the end of the day,
we're professionals.
We're professionals delivering a service.
Yeah, I just thought of something, Dave,
like what you're saying there.
And I asked this question.
I'll make an official
LinkedIn poll when the live
stream is over.
But if the physical therapy
profession had an animal mascot,
what should it be?
I think some of them would
like to be rigid, non-changing,
like a mule.
I think some people would
want to just walk in and
just be brilliant.
Like I know the answer.
I'm going to tell you what the answer is,
like an owl, right?
Traditionally,
if we're going to go stereotyping animals,
I don't want PETA showing
up on the podcast.
But I would say a chameleon,
like within a range.
Within a range, you can or need, should be,
should, not could, should,
you need to be certain
things for certain people.
If,
but all of us are going to be different
chameleons.
And I'm sure my buddy Emery,
who's a zoology major,
could tell me there's
thirty seven different
kinds of chameleons.
Some change color, some do this.
If it's outside your range, like, look,
Dave and Tony are both PTs.
They're both chameleons.
Right.
But it's too far of a
stretch for Dave to want to
do Tony's model.
So don't do that.
Don't do that.
And vice versa.
Don't do that.
So there's a range.
See what fits in it.
Maybe your first job at a PT school.
I mean, if I got some of this advice,
maybe I'd still be in a clinic.
But because I went to a few jobs, I'm like,
nope, nope, nope.
I'm out doing this weird other thing.
I'm weird.
Like, don't don't worry.
You're not like me.
You're better.
But I think chameleon should be our mascot,
which is what can you be
for that person in front of you?
So hundred percent agree.
I've never agreed with Jimmy
McKay more than this, then chameleon,
because you have to be, you,
you absolutely have to be a chameleon,
especially like,
I think you have to be
maybe less of a chameleon.
Maybe you could push back.
Maybe it's another episode,
maybe less of a chameleon with a,
with Tony's model or with
an insurance model.
And you just,
you accept like any insurance
and here's the service,
take it or leave it with us.
We have people that are like, oh, well,
if I'm paying two, three, whatever,
hundred dollars per visit,
they have higher expectations.
They have higher desires.
They're going to make their voices heard.
They're going to demand certain things.
Sometimes that actually disqualifies them,
but it's a whole other conversation.
I a hundred percent agree, chameleon.
I was on Facebook yesterday.
I think I shared a post
yesterday and somebody who
I love her to death, but she said,
and I can't believe
somebody is still saying this,
people in my area won't pay cash.
Everyone in my area won't pay cash.
I think we've disproven that, you know,
a hundred percent,
but I'm not going to change your mind.
I'm not going to try to change your mind.
It's a false belief.
Yeah, it is.
Are they bartering?
Are they bartering with, with,
with vegetables that they
grow in their garden?
How are they getting gasoline?
They won't pay cash.
Okay.
And then this morning though, I did share,
and I know we're coming close to the end.
I did share a post and I'm curious to see,
we've established Dave's
customer is the client.
My customer is still the
insurance company.
I shared a post where I was like, you know,
what's interesting to me,
there are third party
payers right now that
require you to get
authorization after you do the evaluation,
if you want to continue to
treat the patient.
And I think anybody who
watching this right now, hearing this,
You probably already know if
Anthem Blue Cross Blue
Shield Medicare Advantage requires auth,
I submit auth through AIM, A-I-M,
what are you going to get?
You're going to get an approval for four.
You're going to get an approval for six.
Like that's the typical approval.
I think one time in the
history of the universe,
I got an approval for twelve.
But generally,
you're going to get four or six.
So if I'm getting
automatically the algorithm
is spitting out, we'll give you four,
we'll give you six.
And then, of course,
I can request more and I'll get two,
you know,
but that should be assigned to us to say,
OK,
the systems on the third party payer
side are set up and designed to say, OK.
This is what we are approving.
This is what we are expecting.
This is what we were doing.
Now,
where I find it funny is what do you
think those therapists
requesting their plan of
care visit number is?
Twelve, eighteen, twenty four, thirty six,
you know, which, of course,
I think it's funny that
it's always twelve, eighteen, twenty four,
thirty six.
It's never seventeen.
It's not six.
You know, it's these round numbers, you
I think that is our biggest sign to say,
hey, the algorithms,
which really is what insurance is,
they're looking at charts,
they're looking at numbers,
where do we expect this to fall?
they're telling us this is
what we're here to buy.
And it's like a customer.
So if you take a customer who says, hey,
I want to buy a widget,
how much is that going to cost me?
Versus the customer who says,
I'll pay you ten bucks for a widget.
What are you going to give me?
Dave's world, the customer is saying,
I need to feel better.
I need to walk better.
I need to do better.
What is it going to cost me?
My world, third party payer is,
I'm deciding what can I give
for ten dollars, you know?
And so obviously my world is
incentivized by its nature
to find the lowest possible
widget that I could deliver
at the lowest possible cost
to satisfy the dollar
amount being offered.
Whereas Dave's world is
incentivized to give the
highest possible value to
deliver the the exceptional experience.
And I'm OK with that.
You know, again, I am OK with that.
I am very happy as a
therapist delivering the
lowest possible cost to
secure the income that I
agree to accept for what I am delivering.
You know,
and I think we need providers at
both ends of that.
Agreed.
All right.
Are we doing closing thoughts,
farting shots?
Parting shots.
I want to come back to the
luxury personal training on Tuesday.
We ran out of time.
We didn't share that image.
We can preview it.
I'll go.
I'll go first.
Yeah, there we go.
A little teaser.
I'll go first.
I felt like a chameleon back in twenty.
Sixteen, I had, you know,
initial had failed and I was like,
I got to do and I was kind
of scrambling for a couple
of different jobs.
I was doing an outpatient pediatric.
part-time job,
I was doing sensory integration and stuff,
stuff that my wife is great with.
I was doing coverage for a
buddy's one-on-one outpatient office.
So that was out of network and self-pay.
And then eventually,
I was doing the home visits
through another company.
So at some point, I was doing two,
three jobs at the same time.
And I absolutely was a chameleon.
And the folks that I think,
the therapists out there,
anyone that's a health care
provider or whatever,
if you're able to be nimble
and navigate different
experiences learn from
different experiences even
if you have to take a job
or you're working somewhere
and there's too many
patients booked per hour or
per day or whatever like
you got to learn from that
and and and if you don't
like it find something
that's different it's out
there like if you don't
like tony's model find
something that's different
if you don't like my model
and you don't like that you
got to like confirm and you
know you got to book your
own patients and build your own schedule
like then you got to find
like Tony's model and you
have a front desk person,
like Mrs. Meritato,
who's going to book your
business for you or whatever.
So like, you know,
you got to find what's best
for you out there.
Um,
and you can only do that sometimes
through resistance or
issues and challenges and, uh, you know,
things that are not great in the,
in the short term,
but in the longterm you learn from it.
So, um,
uh I cannot believe like
because I used to consider
myself and I would say in
my head like that I was
like a chameleon at that
time twenty sixteen twenty
seventeen going through
that transition I cannot
believe that jimmy said
chameleon as the physical
therapy mascot uh and yes
uh he is a hundred percent
right with that we should
make a flag we should be
I'll create our logo
I would reiterate,
my parting shot would be
make sure you understand
that you're selling a
solution for the problem
that the person you're
trying to help actually has.
I mean, I learned this in really,
really different context
when I was working for
Mount Sinai and working at
a rehab innovation lab.
I worked in a lab.
That's weird, right?
Even to say out loud now.
But it was a great experience.
And most of the time,
these technology companies
would come in to help these
disabled people with this solution.
And David Petrino,
who is the physio who was
in charge of the lab, would be like,
how many people on your
board of directors or in
your organization have that
disability and live with it every day?
And often the answer was round and zero.
And then he would bring
those people in and say,
here's a great solution.
It's going to solve all your problems.
It's going to be a billion dollar idea.
And they would say that
isn't even in our top
thirty problems every day.
Like, I don't care about this problem.
Never mind your solution.
Like, think about that.
I don't care about what you
think is a problem.
So what are you solving?
Who do you want to solve it for?
And then work backwards.
It's actually a lot easier
when you do that instead of
trying to jam your model
down someone else's pocketbook.
All right, guys.
Kendrick, thank you so much.
Kendrick's here from the
mental health space.
Listen,
whenever you have a choice to go
with Drake or Kendrick,
you go with Kendrick, people.
You go with Kendrick.
Kendrick,
can you comment also live how you
heard about this?
I'm curious as to how you,
you're in the mental health space.
Wonderful.
Welcome in.
Let us know how you found us,
whether it was PT Pinecast
or Learn Medicare Billing
or Dave Kittle Show.
Yeah, we need more people like that.
And while we're waiting on that,
as soon as Kendrick does that,
we'll wrap the show.
But, you know,
the greatest advantage we have,
which is also probably the
greatest detriment we have,
is the fact that we can do anything.
You know,
we can do anything within the profession,
everything from pediatric to geriatric,
from neuro to ortho, from everything.
healing and Reiki to, you know,
no scientific clinical stuff.
There are therapists that
can do everything.
Um,
we don't have definitive direction with
that, but we also have then the freedom.
So, all right, guys, what,
what the line from Jurassic park,
your scientists were so
concerned of if they could,
they didn't stop to think if they should.
Yes, exactly.
All right.
We'll let Kendrick leave a comment later.
I'm going to wrap it up.
Come back Tuesday, Thursday, every morning,
eight thirty a.m.
Eastern.
We will see you guys on the next episode.