All right, we are live.
I am back.
I'm here with Dave Kittle, Tony Maritato.
Jimmy may or may not jump on.
He's got another meeting this morning.
But I was just asking Dave
before we started about
Mother's Day in New York.
So, you know, down here, down here,
out here, southwest Ohio area.
The tradition is always we mulch,
we mulch the flower beds,
we mulch the yard, we cut the grass,
we edge, we clean it up,
make it look pretty for mom.
Tell me again what you guys did for,
is this her first Mother's
Day as a mother?
No, second,
because the baby was born last
March twenty ninth.
So the first Mother's Day
was pretty quick last year,
like in terms of like, you know,
got on us quick.
So this year,
probably a little bit more
time for her to soak it up and all that.
And yeah, it was great.
We just went out for an
early dinner in the
neighborhood here in
Brooklyn and had a good time.
Awesome.
With the baby, of course.
Yeah, of course.
So lots to talk about.
I was in D.C.
last week.
It was awesome.
But you shared this
screenshot and I think it
resonates probably with
every small private practice owner.
So I've got it up on the screen.
This comes from the physical
therapy billing group.
It's an awesome group.
Shelly, Heidi,
if you guys are PT practice owners,
OT practice owners,
go check out the group on Facebook.
But it says, love some help.
My husband, who's the owner,
has been doing his own billing,
a five therapist office.
That's a boatload.
That's a ton.
Staying up until two a.m.
every night,
seeing eighteen patients a day himself,
including Saturdays when
things went kind of bad two years ago.
So had some negative
outcomes from a previous billing company.
It sounds like says now with
my aggressive scheduling,
it's just getting to be too much for him.
No time to deal with issues.
Ideally,
he'd love a full time person in
the office.
They're in South California, I think.
But, like,
maybe we look for a virtual
company or in person.
Any input or suggestions?
So, Dave, you shared that with me.
What are your thoughts about that?
Yeah, so, I mean...
You have to do something.
You have to figure out something.
And it's either going to be
outsource it or you hire a
billing person in-house.
It depends on the total
volume of claims and visits
per week and per month and all that.
But as an aside,
This practice,
you got to treat it like a business.
I just did a solo episode
screen share of Joe Lowe's
post on LinkedIn about the
physical therapy M&A market
for twenty twenty five.
And you commented on that.
And I screen share that as
part of my episode.
And one of your comments, Tony, was,
you know,
basically like this will work or X, Y, Z,
like with that market report,
like the improvement or the
ability for practices to
grow or maintain
profitability and all that.
Your your comment said,
basically like it'll work or
this is possible if you
treat the therapy practice
like a business.
And this screen share is no different.
I think it's, respectfully, respectfully,
I think it's crazy for a practice owner,
a physical therapist
practice owner that has
five physical therapists
to be treating eighteen
patients per day and doing the billing.
You need an intervention, respectfully.
You need an intervention.
You need Sturdy McKee, Jamie Schrier.
You need a coach to help you
delegate stuff.
The first thing I'm thinking
of is you need to just get out.
I can't believe that there
are small business owners
that want to do all the stuff
It's crazy.
And then how do you have time to work out,
go to the gym, go for a jog, I don't know,
do leisurely stuff, mow the lawn,
mulching,
like Tony was just talking about.
How do you have time to do any of that?
You don't.
And your head's spinning all the time.
And then if you do some of these things,
if you outsource it,
or if you hire one or two
billion people for the practice, yes,
some of your income money
goes to their salaries.
but you have more time for
clarity to think about self pay options,
to think about hiring and
recruiting other therapists
to replace yourself.
So I have a lot of thoughts
obviously about this and I just,
I don't know, like Tony, like how,
how does this happen?
Is this something that you
see a lot or you've heard a
lot with practice owners
that like they want to do
all this stuff and then the
practice kind of gets
bigger over time and they
never get out of those initial jobs,
roles or responsibilities?
Yeah,
I think it's one of those things where,
like I said,
the comment said two years
ago they had a negative experience.
So, you know, I always share this story.
When we started, we hired a biller.
We thought a biller was a biller.
Like we didn't realize, well,
there's physical therapy
billers and non-physical therapy billers.
So we hire this random biller.
We we never get any of our claims paid.
Thankfully,
we still we started as a cash
based business.
So we had tons of income coming in.
We fired that bill or hired
a second bill or still no results.
We lost about sixty thousand
dollars back in two thousand one,
two thousand two until we
hired the third biller.
Now, the third biller was awesome.
He specialized in physical
therapy billing.
He reminds me actually now
that I think of it of Heidi
and Shelly and some of the
billers that are in that Facebook group.
It was just him and a partner.
They were a small, you know,
service provider.
And he dug us out of a major hole there.
But we still had such a
negative experience.
Now, I think for us,
what made the difference
because we were in the same boat.
We were seeing tons of patients.
We were busy.
We didn't have five clinicians.
We probably had two like myself,
my my wife, another two other therapists.
So let's say four in total.
But we were treating a full
caseload and running the
business and doing everything.
And I think you're just on
that hamster wheel.
It's going so fast.
You don't have time to take
a breath and step off.
And as clinicians,
we tend to think nobody can
do it better than us, whatever it is.
So we want to do it all.
We're not approaching this
like a business.
We're approaching this like patient care.
I will see more patients.
I will build more units.
I will do more stuff.
And so you just can't do it anymore.
For us, we read E-Myth, revisited it.
We made the decision that
we're going to treat this
like a business and not a job.
We took our self-worth and
value away from having to
do everything and being the
best at everything.
We went through some education,
some consulting,
and we actually learned how
to structure a business and
bring people in to put them
into those roles that we had defined.
And for the next, I don't know,
probably three years,
we outsourced as we continued to grow,
outsourced our billing.
But even there,
we got to the point where like,
why are we paying, you know,
seven percent on a million
in revenue when really we
could just bring it in
house and probably do it better.
But at that point,
we had replaced ourselves as clinicians.
We were no longer treating
every patient every day.
So we had the capacity,
the bandwidth to build a
billing business.
And we've actually spun off
billing businesses as
completely separate entities because
Because we had the ability
to not spend eight to ten
hours treating patients and
then try to work on the
business afterward.
Yeah, makes a ton of sense.
I feel like for the small business owner,
the practice owners out there, it's just,
I think, a shame to not... Respectfully,
we're not saying it's not a
serious business.
Obviously, it is.
You have five physical
therapists outside of the owner.
Like you said,
that's a meaningful practice,
even if they're in network.
And so...
it's just a shame that I
don't know like is it is it
some you know small
business like uh dna or
ethos or something where
it's like my generation and
and older uh and I like to
include myself in in the
you know put your head down
like just grind it out like
it might have stopped a
little bit after my age but
like kind of like you know
your colleagues and your
friends and small business owners like
Is it just easy for practice owners,
business owners that are
independent to kind of put
their head down, just grind it out until,
you know,
your wife goes on a Facebook
group and says like, hey,
we need some help with this or that.
And it's not even it's not
even that individual.
It's not even that the practice owner,
that's the physical
therapist asking for help.
So who knows if he or she
even wants to help?
Yeah.
I think it is.
I think it's within our DNA,
but then I think there's
also a lot of baggage that
we bring with us.
You know, what did your parents do?
What were your parents'
mindsets around money?
I know I've still got tons
of baggage from mom and dad
and how they addressed money,
how your spouse addresses money,
what money is.
We were just, I mean,
every chance I get with my four boys,
I always try to instill in them
Who cares?
It's just money.
It has zero value unless you spend it.
You decide how you want to spend it.
Spend it could be investing
it or it could be just wasteful spending.
It doesn't matter.
But the point is,
I want them to understand
money can always be created.
It can always be generated.
There's no scarcity around money ever.
You could have zero money
and be completely happy.
You could have millions of
dollars and be completely miserable.
So those are the lessons
that I try to instill in my kids.
But I recognize that I still
have a ton of bad money
habits from my parents who
were successful in their own right.
I mean,
I'm not taking anything away from them.
I'm just saying it's work to
change the way we look at it.
Plus,
going back to I think a lot of
therapists just tie their value,
their identity to I'm a hard worker.
I was successful in school.
I checked all the boxes and
I did the homework.
I never saw value in any of that.
So I came to therapy from
kind of a different perspective.
But there's a lot of
identity tied to doing what
you think you're supposed to do.
So and a lot of people still think, well,
I got to work hard.
If I'm not working hard, I'm being lazy.
It's just not true at all.
Yeah, I love it.
Um, so what are, what are some,
I know there's a bunch of comments.
I know Joey Albritton commented,
a bunch of folks commented, what would be,
uh, you know, not,
not that they're asking for
our unsolicited advice.
They're asking that whole
Facebook group or whatever.
What would be like,
what would be an idea or like,
what would you do if you were that owner?
And you know,
your wife is going on the
Facebook group and, uh, or what's,
what suggestion would you have for, uh,
for this practice owner?
I think this is where you
have to bring in a new set of eyes.
This is where you have to
bring in an outside consultant.
And you have to step back
and use the logical brain.
You have a clinical brain.
There's logic in that.
It's like, well, wait a minute.
If this person is doing
eighteen visits a day.
So let's say close to two
thousand dollars in revenue
generation a day, just this person.
And then there's five,
potentially five other
people doing comparable.
You know,
this practice is doing a
significant amount of revenue within this,
probably upwards, you know,
well over half.
a five hundred thousand plus
close to a million in revenue,
you have to sit there and be like,
wait a minute, something doesn't add up.
We're generating, let's say,
seven hundred and fifty
thousand a year in revenue.
And I'm I'm killing myself
doing all this stuff like
you have to acknowledge
there's a problem.
The wife acknowledges it.
Other people around you see it.
You have to acknowledge it
and then you have to get a
fresh set of eyes.
You know,
somebody to come in and look at this,
give you their perspective
from the outside looking in.
And then you can decide like, all right,
do I agree with their perspective?
You know,
we get patients and I tie
everything back to patient care.
Patient walks in the door.
He loves smoking.
He loves drinking.
He loves eating whatever he wants,
but his back pain doesn't get better.
I can tell them, look,
this isn't a mechanical problem.
It's a chemical problem.
Your body is dealing with chemical issues.
If you really want to address this,
we need lifestyle change.
And then that that patient
can make the decision.
Yeah, I want to do this.
I'm ready.
I'm ready to make the change.
I'm going to change my diet,
change my lifestyle.
I'm going to start to exercise.
Or they're going to say, no,
I don't want that.
And they're going to they
would rather deal with the
pain of back back pain.
This guy would rather deal
with the pain of burnout
than make these changes
because they're so fearful
of what those changes involve.
And a lot of times those
changes are more painful.
Exercising daily and eating
a different diet is more
painful than the nuisance
back pain he's dealing with.
He'd rather just deal with
the nuisance back pain.
But you need an outside set of eyes,
somebody like you or other
people that are out there
that have been down that
road and have seen a
hundred other business models.
That's somebody that I would say, hey,
take a look at this and
tell me what you see.
I love what you mentioned
maybe ten or so minutes ago.
I don't know how long we had
a lot of five or ten
minutes ago when you
mentioned that you had
tried several different billers.
And this goes back to
remember when we were searching,
we were interviewing folks
to do home cleaning.
And I don't know if I mentioned this,
but like the first person
like we had her come twice
and like it just she was super nice,
but it just like took forever.
It was like eight hours.
Like our place,
it's a condo apartment in Brooklyn.
place for three hours.
Now,
were you paying by the hour or by the
job?
No, by the job.
It's like,
why would you not hustle to get
out of here sooner?
It was a flat rate for the whole job.
And by the way, that was her idea.
The reason I'm bringing this
up is because we tried her
a couple of times and we're like, yeah,
we're going to pause and
then we continue the search.
I think certain business
owners can get in the rut of like, well,
we tried that, so that didn't work.
It's like what you said and what I did,
then we look for another cleaner.
If that didn't work,
we're going to look for
another and another.
It's the same thing with
recruiting for therapists.
Some are just not going to
be the right fit.
They're going to be too experienced,
too inexperienced.
They're just not going to be
the right fit.
um regardless of the
challenges that this
practice had with uh
billing folks or billing
companies or whatever like
there absolutely is a great
fit out there like you said
you might need a coach or a
consultant or some practice
owner that has been there before
that hired five or ten
different billing companies
over the years,
they actually could give
you maybe like a cheat
sheet or a handout of like,
here's the proper questions to ask.
Like,
here's the savvy questions to ask
when you're interviewing
business or when you're
interviewing billing companies.
Like, you know,
those types of asking for
referrals or asking for
references and asking to
speak with other business
owners that they're already
helping on the billing side.
So I love that.
I always want to echo that,
which is like there's just
always more to assess and
check out and never think
that just because the first
option or two didn't work out,
that that's like the whole
route doesn't work.
Obviously, billing companies work.
And you would think this is
a lesson we already understand.
The patient who comes in and
says physical therapy
doesn't work because they
went down the street and they didn't do,
you know, well with that.
And that same physical
therapist will then go on
Facebook and say,
I can't believe these patients say,
you know, physical therapy won't work.
And, you know,
get physical therapy first
and get PT first or, you know, PT.
What was your choose PT first?
It's hilarious.
Yes.
What a conundrum.
What's interesting about
what you shared with the
cleaning person is you,
and correct me if I'm wrong,
you were just at least a
little bit more concerned
with the amount of time it
took than the quality of the job.
Now, a lot of people will say- No, no, no.
I'm sorry.
It was like missing dusty,
dirty spots or whatever.
So it was both.
It was low quality and it took too long.
So it's like, how did that happen?
Yeah.
Okay, let's pivot a little bit.
You've shared a ton of
information about
recruitment and hiring and
ads that you're running and
how to bring in staff.
I was listening to Dan Ariely.
Are you familiar with him at all?
Love him.
What is he like a behavioral economics?
Yeah, behavioral economics.
At Duke or something.
He's an author.
Excellent books.
Predictably Irrational is
probably in my top five of
like favorite books of all time.
So the last time I shared
some of his content,
maybe it was Joey Rossi or
somebody had shared he had
some questionable research
ethic violations and people
were investigating him
because maybe he didn't
really carry out the
research or his findings
were manipulated.
I don't know.
I read those opinions.
Nonetheless,
the idea behind the
information is still valuable.
Right.
So one of the, the like, fifteen year ago,
YouTube Ted Talks was why
we enjoy the work that we do.
And it got me thinking about
your situation.
So I'm going to share my chat GPT.
And what I did.
Folks, you got to jump over.
You got to jump over to the YouTube.
Jump over to Learn Medicare
Billing or PT podcast or
the Dave Kittle show on YouTube.
If you're listening right
now on iTunes or Spotify or
LinkedIn or wherever you're watching.
Yeah.
So if you guys don't already do this,
this is a cool little hack,
but then we'll get into the main content.
Let me get up here at the top.
So basically,
let's say you hear a YouTube
interview and you're like, yeah,
I love that idea.
How can I apply that idea to
physical therapy?
So I put in a simple prompt.
I just say, hey,
Dan Ariely talks about the
importance of meaningful work.
This is coming from a TED Talk transcript.
I want you to process this
and then tell me how this
applies to the physical
therapy private practice.
And on YouTube, you can copy and paste,
if you're on a desktop,
the full transcript of the interview.
So I put it in and then chat GPT, you know,
says, OK, here's the framework,
the meaningful work magnet.
The goal,
create a job ad that's emotion
that emotionally resonates
with clinicians who crave
more than just a paycheck.
Therapists want their work to matter.
And I'll just give you the headlines,
you know, stop, start with the mission,
not the money.
So instead of saying we're
hiring five thousand dollar sign on bonus,
which we see everywhere,
start with something like
your work should mean something.
Ours does every visit, every patient,
every life we touch.
And I was thinking about you
because one of your main
ads is talking about how
much a therapist could make
relative to how few visits
they need to do to make that money.
But anyway, tell a micro story of impact,
acknowledge the trade-off transparently.
I do that.
I'm like, look, guys,
you're not going to make as
much money working for me
as you would make working
in home health or a skilled nursing.
But it's because...
The difference in the population we treat,
you know, nothing will burn you out,
chew you up,
spit you out more than seeing
the same person in a
different body every single
day and knowing that you're
not really helping anybody.
You know,
somebody shared a post about a I
don't know if this is the right word,
a catatonic person on
hospice who a physical
therapist is supposed to be helping.
Like there's just there's no
meaning in that kind of work.
A lot of times describe the
challenge as a source of pride.
Right.
Why do we climb a mountain?
Because it feels good to get to the top,
even though it's hard.
Give them ownership language,
not ownership equity,
just ownership language.
Show that their work will be seen.
Use emotional, resonant call to action.
And then it gives a little sample ad.
So first,
what are some of your thoughts on this?
Just a joke because I burst
out in laughter.
Give them ownership.
Not of equity, though.
Definitely not.
That's so funny.
It's the feeling of ownership,
not actual ownership.
Hey, I need to do better at that, man.
If I can best or better
convey the staff role
that they get to take ownership of.
Well, I,
and my therapist somewhat do like
they get to make their own schedule.
They get to,
they get to make like what
time they're going to start and end, uh,
per day.
They get to fit in people, you know,
clients, whatever they want,
they can work weekends or not.
Um,
I mean,
I have one therapist that's
averaging like two point
eight patients per day and
he's making just two point eight.
Now, of course,
I know you got to travel in
between the patients and all that.
And you got to travel to the
first patient.
You got to travel to home
from the last patient.
So sometimes it might come
out to like a more of a workday,
but two point eight patients on average.
And they're making like.
They're on pace for like
ninety K by treating two
point eight patients per day.
So it's pretty good deal.
But I need to give them ownership of.
Yeah, like like I don't know,
like more of the is that
like the touchy feely stuff?
Would you say, Tony,
like more ownership around that or what?
Yeah.
Own your schedule.
You know, you, you have control.
Autonomy.
Yeah.
Who you can treat,
how you want to treat them.
Like we all went to school
to be professionals.
I want to come into a
position where I'm a professional.
I think too many of us as
business owners think, well,
they want equity in the business.
I don't think they want it.
I don't think they care.
Even me as an example of,
I wouldn't want to come in
as an equity partner
because I don't want the
liability associated with your problems,
your baggage, you know,
and we are as a profession
so risk averse.
I think of a therapist.
It thinks that they're on
the hook for mistakes that
the bigger entity makes
that freaks them out.
So it's like as business owners, we think,
oh, they want ownership in that respect.
I don't think they do.
I think they just they want
the independency, autonomy.
They want to feel good about
the work that they're doing.
And yours is a great example.
Like you are working with a
clientele that you can make
real impact with.
You can change that person's
life fundamentally.
You can keep them in their
home or their apartment longer.
You can improve their
quality of life versus others.
some of the other places
that it's just that treadmill of CPT code,
CPT code, CPT code.
Nobody is going to get better anyway.
If they do get better,
you're going to get
penalized because they're
going to want to discharge early.
The conventional system is
designed to reward the most
basic mediocre outcome.
Don't get better quicker.
Don't invest in innovation.
Don't improve your education.
That is what the system
right now is designed to encourage.
And so, yeah,
you give them the opportunity
to step out of that negative cycle.
And I do think like those
emotional triggers resonate deeply.
Anything else for this topic
or you want to move on?
No, we can move on.
I sent you a link for
Instagram in Facebook Messenger,
unless you have some other topics.
I know Jimmy's not here,
but we were joking last
week that I know you were at your DC,
your son's class trip,
but you sent us a picture.
I don't have it right now,
but it did look like you
were at the Vatican.
Jimmy,
he'll mention this the next time he
comes back,
but we had a good laugh as if
you were at the Vatican and
that you were actually
becoming the next Pope.
And you know what?
You and the new Pope,
you don't look that different.
You got the same haircut and
there's some similarities there.
So we had a good laugh.
All right,
let me see if I can get this one
up on the screen.
Tell me what's going on with this.
Okay.
All right.
So Jimmy McKay is not here.
He's got an awesome new
segment here on the show
called steal the strategy.
Jimmy,
I hope I don't want to steal your
strategy because you're not here.
I just want to highlight this.
I came up with this.
I came across this guy's
Instagram a couple of weeks ago,
maybe a month ago.
He had like fifteen thousand followers.
Now he's got, I don't know,
like twenty or thirty thousand followers.
Thirty eight thousand.
Thirty.
This guy is.
it's kind of weird he's
adding like five thousand
followers per week here's
this so this guy does a
joke right he he holds up
his phone it's him and his
wife shopping at walmart or
they're getting pedicures
at the nail salon wherever
they're at at a restaurant
nice restaurant he holds up
his phone and he goes what
up gang hey what's going on
I'm here with tina we're
checking out the deals
today at walmart so he acts
like a fake social media influencer
And obviously his wife gets embarrassed.
So like,
that's the funny part is she gets like,
she's like, no.
And like, she like runs away.
And then you could see like, yeah,
like there, right there,
that clip of him at the nail salon.
And like the wife puts her
hand in front of her face
and all the women that are,
that are working there,
all the women that are in the nail salon,
they're all covering their face.
It's funny.
Here's the thing.
This guy owns one or two
different restaurants in Chicago.
He links to the, the, uh,
the restaurant on his profile.
And I think the, the URL in the Instagram,
the entire Instagram is a joke.
He does, he just does jokes.
He just, he just is a funny guy.
He likes to do jokes.
He goes up to the Starbucks line and he,
you know,
he does fake voices from
different movies.
Like when he goes up to the
Starbucks line in the
drive-through and he's like, you know,
yeah, can I get a, can I get a large,
you know,
can I get a medium pike in a
large venti cup?
And then they asked for his
name and he does like, you know,
like an Al Pacino voice or
he just does stupid, like, right.
The point of sharing this is
that he's adding like five
thousand followers per week.
Now, of course,
many of them are not in the Chicago area,
but he's got Johnny's
heroes and subs or whatever
his like restaurant is.
And he's getting more
eyeballs for his restaurant
that is linked here in his bio.
None of his posts are about the restaurant,
about his business.
And so that was part that was part one.
And then part two was one of
the recent posts while I
was following him is he was
featured on the news in Chicago.
And then the news anchor is mentioning,
you know, oh,
Johnny Anastopoulos has this
funny Instagram account and
he's the owner of whatever it is,
whatever the restaurant is.
We don't we don't know.
Johnny's beef, Johnny's gyros.
Beef and Gyros in, you know, Lincoln Park,
Chicago or whatever it is.
So the local news anchors
have featured him and his
Instagram account a couple times,
which then gets more exposure locally.
And they even had him in the news,
like a week or two ago,
they brought him and
invited him and his wife
into the news station.
And he was like on the live news.
Yeah.
Okay.
This was, this is long winded.
I'm going to cut to the chase.
The question for Tony
Meritato is could physical
therapists steal the strategy?
Could private practice
owners steal the strategy
where they make a,
whether it's a personal account,
a different account, whatever.
And they,
you do an amazing strategy of
video inside your clinic.
And maybe some therapists
don't want to do that or
they can't do it or they're
afraid to do it or whatever.
You also have to be kind of
outgoing to even do this.
I think to do like the selfie video,
the way he's doing it,
but maybe there's other ways to do it.
Could or should physical
therapy practice owners
steal this strategy,
create kind of like a
humorous account that they capture funny,
stupid,
laughable things in their local area,
then just link to their
physical therapy profile at
the top of the profile.
But all the content has
nothing to do with the actual business.
What are your thoughts?
Good, bad, indifferent?
Yes, a hundred percent.
Yes, you can do it.
Yes, you should do it.
What I think is interesting
about that scenario though,
and I don't know anything
besides what you just shared,
His personal profile on
Instagram has thirty eight
thousand followers.
His business profile only
has like thirty six hundred followers.
The personal and that's what I do.
You know,
I grow my personal way more than
I grow like branded business profiles.
But the whole idea here is
looking past just is this
going to put more patients
in my my physical therapy clinic?
Because with a thirty eight
thousand follower account,
he can move into true influencing.
He can get brand deals.
He can do product endorsements.
He can do so much more with that account,
even if he never sells an
extra sandwich because of it.
So there's huge value in
capturing attention.
We know we're in an
attention based economy.
I still get pretty much two
to three emails a week of
product companies that want
me to do videos and
endorsements for them.
I don't have to do them for
free anymore unless I
really want the product and
it's a high ticket product.
But a therapist who wants to build a brand,
a personal brand, absolutely,
this is a great strategy.
And if you want to monetize
that with patient care,
you probably could.
You could put out a product
like Kelly Starrett has
digital products for people
that have physical conditions.
He's never going to treat
them as a physical therapy patient,
but he sells these products.
You could do product endorsements like,
man, there's just so much you can do.
And you don't have to be outgoing.
Like, that's the funniest part.
I hate I am an introvert
through and through.
I hate socializing.
I love being silent.
I love being by myself.
But if I'm in front of the
camera and I've got a job to do,
I will do the job.
You know,
it's it's a different and I hear
this a lot from a lot of influencers.
It's like a switch that flips.
You're a different person on
camera than you are off camera.
So it's something that we
should be building for all of us.
And we'll have to get
Jimmy's feedback on this
because I did want to share
this at a time when both of
you were here on the show.
But yeah,
so that's why I wanted to show it.
Hopefully,
Jimmy doesn't get upset that I'm
stealing his segment on
steal this strategy.
I think his segment was
steal the strategy.
So I just wanted to share that.
And you're right.
Also,
people want to follow more of the
personal accounts.
They don't want to follow
like corporate and business accounts.
Right.
So that's,
that's another reason why his
personal one also it's, it's funny,
right?
Like it's, it's funny.
Like you don't know what's
going to happen.
So you watch more and then
you're more likely to like
watch a second and a third video.
Cause you don't know,
like when he drives up to
the drive-through at Starbucks or he,
he walked into Starbucks and he ordered,
um,
With some Brad Pitt
character from some movie, you know,
any any order with the
character's name and the
accent or whatever.
So you don't know what he's going to do.
But yeah,
more people want to follow the
personal accounts and they
don't want to follow like the corporate,
you know, business accounts.
And I guess, you know, I guess that's OK.
That's just the way the
attention economy is.
There is a,
I can't say the name because Jim,
Jimmy's doing this interview.
I don't know if he's done it
already or it's on the books.
It's part of the PT pint cast series,
but I think this is a,
it's a home health
therapist who's doing funny videos.
He is on par.
He's on par with
So medical doctors that are
out there that have, you know,
million subscriber accounts.
Like,
I think it's just a matter of time
before this account blows up.
If he doesn't quit before he
hits that inflection point.
He is awesome.
I can't wait for that,
that interview to go live and go public.
And so.
I wanted to talk about
pivoting just a little bit.
I shared a post that gains
traction is gaining traction.
You're not in this world,
but in case you didn't know,
so as a Medicare contractor provider,
when I treat a Medicare beneficiary,
my plan of care has to be certified.
That means signed by the
physician or non-physician practitioner.
So it could be a physician assistant.
It could be a nurse practitioner.
There's a couple other options.
providers who can certify a plan of care.
In two thousand twenty five,
Congress or whoever updated
the laws made some changes
that said as long as I have
a referral and I have proof
that I sent the plan of
care for signature,
I don't need a signature on
the initial plan of care.
But if I extend the plan of care,
change the plan of care, do anything,
then I do need a signature.
I can't believe the comments
that I'm seeing from
physical therapists who
think a physician should be
obligated to sign my plan of care.
I've said it repeatedly.
I'm like, if I'm a doctor,
if I have MD after my name,
I am not referring patients
to physical therapy simply because...
I'm expected to sign plans of care.
I don't have the time for it.
I don't have the desire for it.
I don't have the interest in it.
Like, I'm sorry, but there is no way.
Now, these docs aren't getting paid extra.
There is no like benefit or
bonus system for them.
And think about how many
patients in a day a doctor sees,
how many patients on
caseload a doctor manages,
thousands of patients.
That's hundreds of plans of care.
When you sign that plan of care,
you're saying effectively, yes,
I agree with this plan of care.
When they've never met me,
they have no idea who I am.
They have no idea what I'm doing.
Most of the time,
they don't understand what
the plan of care even entails.
I think this is a major
issue that I've never seen
discussed or addressed.
And it's absurd that actual
licensed therapists think
doctors should be obligated
to sign plans of care.
What are your thoughts on this?
Well,
the one comment I saw from Joey Rossi
was he said there's some
physicians he's spoken with
that are no longer
referring to physical
therapy because of this specifically.
That's crazy.
I think so.
We're licensed physical therapists.
We have to have, you know, licensure.
We have to do continuing education.
We're CPR certified.
The fact that this is still
even a part of CMS is ridiculous.
I don't know.
You might think it's a good, I don't know.
I don't know.
But I think, Tony,
I think it's absolutely
ridiculous that a plan of
care even needs to be signed.
So you're saying the first initial,
so the first, what,
nine days or what is it?
Thirty days or what's the?
So the way the law was developed,
if you have a referral,
because a lot of us have direct access.
So I've got a guy coming in today.
He's been a patient of mine for a decade.
He travels back and forth to Florida.
He just texted me this morning.
He's like, hey, I got a muscle issue.
I want to come in and see you.
He's a Medicare beneficiary.
He doesn't he's not coming
in with a referral.
Now I can see him.
Medicare doesn't require a
referral and my state
allows direct access.
But because I don't have a referral,
I would still need even in
twenty twenty five a
signature on the plan of
care if this is going to be
paid for by Medicare.
If I have a referral,
I don't need a signature,
but I do have to prove that
I at least sent the plan of
care to the physician.
That's the new change.
I don't need the signature,
but I need proof that I
sent it for the initial plan of care.
If I make a plan of care for three weeks,
two times a week, six visits,
that's the initial plan of care.
If I decide to extend it...
then I need a signature.
It can be the duration you
prescribe or up to ninety days.
So if I prescribe a six month plan of care,
my initial is limited to ninety days.
But if I do it shorter than ninety days,
then that's my initial.
And, you know,
we joked about this across
the country that most
physical therapists are going to say,
you know, three times a week for,
you know, sixteen weeks or whatever.
I'm joking.
But like I oftentimes it's
going to be like a really
it's never going to be three weeks.
It's going to be a bigger number.
So, OK, so maximum ninety days.
And at that point.
What is a therapist's option?
They have to send that
patient to a different
physician to get it signed.
Say, hey,
do you have your primary won't sign it,
so I have to send you to a specialist.
Or can they, through Medicare,
can they then go visit an
urgent care or some other
primary care physician
that's not their PCP on record?
What are you going to do?
If the main doctor refuses, then yeah,
you start playing the game.
You start saying, okay,
do you have an oncologist?
Do you have a nephrologist?
Do you have a orthopedic that, you know,
can I sneak it through
someone else and try it?
Someone that's not going to
read it and just sign it.
And this is where my
frustration comes back in where I'm like,
what's the whole intent of
the law anyway?
When was the law generated?
When was the guideline created?
it was probably created before we were,
I'm not, but others were DPTs.
It was created back when
therapists were really
glorified AIDS technicians.
The doctor used to say,
get this patient out of bed,
walk this patient, you know,
and ironically in the Medicare guideline,
it specifically says if the referral is,
contains all of the required
elements for the plan of care.
You don't need a separate
plan of care and you don't
need a separate signature.
So back in the day when the doctor said,
I want this patient to get a three,
is it megahertz, whatever,
ultrasound for seven
minutes on left elbow, you know,
we come from technicians.
Like, guys,
we are not the same therapists
that we were thirty years ago.
but the laws never change.
The laws don't keep up.
The laws don't advance as
quickly as we believe we're advancing.
That goes back to my argument.
I think most of us have left
physical therapy behind.
We are no longer operating
as the way the world
perceives a physical therapist.
We are no longer operating
in that capacity.
So you can fight to drag the
credential with you
Or you can just let the credential go.
The letters are meaningless.
They don't help us in
virtually any way because
we don't get compensation
for the letters that are
worth what we're doing.
Just let them go.
Like, forget it.
What are your thoughts?
Man, I always like to push back with this,
because you're not letting them go,
right?
So a listener, a follower,
someone who's watching or
listening now or on the replay,
they're going to say, well, Tony,
are you doing that?
And you're going to say no,
because you guys are still
licensing credential and
billing Medicare and
billing all the network insurances,
right?
So I had one guy and I can't
remember his name.
I wish I could give him credit.
He gave me a great response.
He said I was basically he
said I was crazy,
that I was completely wrong.
He said that, you know,
the credentialing allows
them to do dry needling legally.
The credentialing allows
them to do all of these
services within the law
that he wouldn't be able to
do if he let his license go.
It dawned on me.
I was like, yeah, you're right.
He's a hundred percent right.
I'm a hundred percent wrong
relative to his situation.
He wants to do those things.
I don't want to do those things.
I have zero interest in dry needling.
I have zero interest in
Pretty much any of the
things that require my licensure.
So to your point, Dave, well,
why haven't I let it go?
Why haven't I followed my own advice?
Well,
it's because I still have a
successful business that
runs on a thirty year old model.
A new therapist coming into
business today doesn't have
the advantages that I have.
And you hear this stuff in
popular media when they
talk about boomers versus
younger generations.
It's true, guys.
I have zero, zero debt to any university.
I have, you know,
the history with the referral sources.
So I have zero marketing expense.
I have the history with my systems.
I can operationally deliver
services for a fraction of
the cost of somebody new
coming in and trying to
build the business that I have.
I have legacy experience.
that nobody else in my area has.
I have low overhead because
I signed a lease and I've
got a lease that hasn't
gone up in monthly rate for
like ten years.
You can't do what I do.
So I'm not going to.
It's like the guy, me,
who has a thirty year
mortgage at a three percent
interest rate.
I'm not going to sell my
house because of the
interest rate on my mortgage.
I'm not going to get rid of
those credentials because
those credentials are still
profitable for me in the
model that I have.
But if I was a big time influencer,
if I had hundreds of
thousands of subscribers,
that's where the original
context came from.
If I wanted to treat and I
wanted to treat across state lines, man,
the first thing I'd do is
I'd get rid of the letters
after my name and I would
just go independence for true,
full autonomy.
That if you're doing virtual
and you're doing, you know,
the triaging we talked
about before or the, you know,
remote programming or
you're kind of doing some
telehealth or whatever
across state lines.
That is that that is I have
to agree with you there.
That is the easiest way to
go because of the whole compact thing.
And you got to, you know,
get licensure in all these
different states.
And there's some states now
that are what is it,
fifteen or maybe twenty at the most.
That's a compact you get.
licensed in one of those
states and now you have uh
licensed reciprocity or
whatever in the compact
across all those states but
not every state and if
you're yeah if you have a
social media following and
you're going to be doing
some of the triaging and
some of the borderline
therapy medical type
questions and you know
coaching or treatment or
whatever you want to call
it virtual care then yeah
it does make sense to drop
the license I a hundred
percent agree with that
And I think we've seen
proven models from
non-licensed PTs or
clinicians that are working.
In the finance world,
we should get Will Butler back on.
It's been forever since I've
talked to him.
Definitely.
But every time I've pushed
him to get on social media,
he always says he can't
because there's so much
restriction on what he can
say and what he can share.
And when you look at Dave
Ramsey and you look at the
big social media
influencers in the finance space,
they've all let go of their
their licensing.
because they can't say the
things that they want to
say and still be compliant
with the regulations.
And I think the same applies
to healthcare.
There's a bunch of medical
doctors and healthcare
influencers that had to let
go of their licensure
But they're making ten
million a year because of
the social media reach that
they've built and the
businesses and the tools around that.
So I just – With Dave Ramsey,
was he a CPA or was he like
a financial – what do you call it –
CFA or whatever.
Or yeah.
Yeah.
I think he had all of those licenses.
He, I don't even know that world,
but I had read interviews
and looked into it.
But a lot of the newer ones, too,
same thing.
They're attorneys, you know,
attorneys that had their
they passed the bar.
They were licensed and then
they let it go so they can
go on to social media
because that was the
direction that they wanted to go.
And they couldn't do it,
but they still had their knowledge.
And that's the same thing with us.
Like,
you're never going to take away my
knowledge of physical therapy.
I just I can't deliver one
on one physical therapy advice,
but I can basically provide education,
information, influence, you know,
all of those kinds of things,
not practicing physical therapy.
not having liability
insurance for physical therapy,
not having to do ridiculous
waste of time continuing
education for the twenty
four hour credit hours that
are virtually meaningless.
Because, you know,
we know so many people that just go there,
check the box and they get the credit.
Like none of this stuff has any impact.
Agreed.
yeah I uh there's a there's
a ton of therapists that
just what is there's
different websites that are
like ninety nine dollars a
year or something and you
just the physical therapist
I won't mention any names
but go on there like the
day before their ceus or uh
you know your your license
is about to be renewed or
whatever they go on like
the night before and they
you know do a bunch of like
whatever courses and just
to just to get the
amount of courses done for
license renewal.
And then I think I don't
know about your state,
but like our license
renewal is like it's like
the honor system.
It's like, yes, I just click a box like,
yes,
I certify or I don't even know if it
says certify.
I agree or yes, I
I don't know if it is.
It doesn't say a test like I
attest that I have or
whatever that I have
completed all the
continuing education courses.
And maybe if there's a random audit,
I guess you have to show
your content certificates
or whatever to the board or
the licensing body or
whatever of your state.
But yeah,
I agree that whole thing is a joke too.
Yeah, I mean, I use physicaltherapy.com.
It's ninety nine dollars for
twelve months.
But if you do it, you know,
like four months before they're due,
you can get your twenty
four credit hours and then
you can do another twenty
four credit hours in the
next calendar year for the
next two year period.
So theoretically,
it's forty nine dollars or
whatever for each one.
Now, look, I'm not against education.
I work every single day to
learn new stuff and I want
to learn new stuff.
My point in this is the
person who doesn't care
about learning new stuff
isn't going to learn new stuff.
You can't mandate it.
You can't force it.
And there's nothing worse
than a law that has no real
impact and no real effect.
And the law just burdens the
people who want to do a
good job more because the
people who don't care,
they're not following the laws anyway.
So it's just a waste of time, money,
effort, compliance.
Uh, that was great.
I know we're a little bit early,
but let's wrap up the episode.
So what do you think?
I want your,
I'm going to give you your parting shot.
What do you think is the
most like emotional impact
of finding a new therapist
to join your organization?
What is,
what is the thing that's the most
rewarding?
That is the most meaningful in what you do,
the way you do it.
And I don't know if I'm
going to get this right.
I mean,
it's not even for anybody else for you.
Okay.
No, I thought you were saying, Oh, for me,
the emotional part of me
finding a new staff, physical therapist.
What?
No, in your business,
you as a therapist in your business,
what's the most meaningful
part of you doing your job for you?
Uh,
having the patient or client
voice that they were able
to do XYZ emotional thing
like travel to their son's college in St.
Louis or being able to walk
confidently in public with
less of a tremor or with
better balance so that they
are able to walk their dog
in the park so that they
can do something in the world better
than they could without me,
like before they met me.
I think, I mean, that's one for sure.
And I think you would say
you would take a little
less money a year to have
that kind of meaningful
impact on somebody's life
versus maybe making a
thousand or two more a year,
but knowing that nothing
you did all year had any
benefit or any real impact
on the patients you were working with.
Don't you agree?
I agree.
Yeah.
Same for me.
Like my at this stage of my life,
especially fifty years old,
I am I am working for the
meaningful impact more than
I am working for the money, you know,
and so I will do hard things.
I will sacrifice more if I
know the sacrifice has
meaning on the other side,
as opposed to just working harder daily.
doing meaningless jobs,
meaningless tasks for a
little extra money.
The extra money just isn't
worth sacrificing the
importance of having an
impact on someone.
So guys, we're done.
And I think today is Tuesday.
It is Tuesday, May thirteenth.
Come back Thursday.
Jimmy McKay will be back with us.
Eight thirty a.m.
Tuesday, Thursday morning.
Dave Kittle show.
Go check it out on iTunes and YouTube.
And we will catch you guys next time.
Thanks, Dave.
Thanks, Tony.