All right,
good morning to PT Breakfast Club.
Dave, Tony,
we're serving up some bold
ideas and some espresso this morning.
I'm doing a double shot.
We've got two big topics coming up,
and I want to start with
debt because you texted it
this morning to the group chat,
and I know very little about it,
which is something you
never hear on social media.
Everyone has an opinion and
cannot wait to tell you about it.
I know very little about it,
so I want you to go slow
and explain it to me,
and then you can go advanced.
Well, I mean,
I'm certainly not the expert by any means,
but I figured,
let me share how we've used
debt for twenty five years.
It's one of those things
where I think it comes with
a lot of emotional baggage.
It comes with a lot of
history from our parents
and how they handled that
either positively or negatively.
uh, spouses, future spouses.
You know, one of the things that we,
we are talking about right
now with my boys is, Hey,
if you're going to marry somebody,
you have to understand
their beliefs around
finance and the debt that
they're carrying.
And of course, you know,
big topic in media and politics is, Oh,
guess what?
You have to pay for the
money you borrowed.
Um, that's going to be a hot button,
you know?
So I just think debt from a
business perspective is,
it's probably the biggest
lever we can pull.
Like,
it is our opportunity to accelerate
growth, to improve our business.
And, you know,
blanket statement people make is,
debt is bad, stay away from it,
don't ever borrow.
That's BS.
I mean, that's absurd.
That's like saying a
deadlift is bad for your back.
It's like, you know...
So here's a little context.
And then I want to hear from
the businessman himself, Dave Kittle.
When we were starting out,
we were down in South Florida.
So we would see a third of our caseload,
like things would drop by
seventy percent August and
September because all the
snowbirds were gone.
And then we would triple our
volume January, February, March,
because all the snowbirds were there.
And so we would have to
borrow money to cover
payroll during those months.
But we knew that we were
going to make that money back.
We just had to float the
payroll until everybody
came back to town.
We would borrow money to
open new locations.
We would borrow money to buy equipment.
And we never had an issue, obviously,
paying that money.
We borrowed responsibly.
And people talk about credit card debt.
Last one, credit card debt, right?
We had credit cards.
I don't know if they're
still doing this today.
That would offer us zero interest,
six months on thirty thousand dollars.
I'd snap that up every
single time it was available.
Because I could leverage
that money to grow our business,
to buy more equipment, to hire staff,
to run ads,
to do whatever we needed to do.
And I just think now like
people have been so scared
of debt because of other
people's mistakes.
Where are you guys on this
whole debt topic?
Yeah, what do you got, Dave?
Debt is great.
You got the epidemic of credit card debt,
which is one area of debt.
And then you have,
let's say you're going to
take out a business loan.
Let's say Jimmy and I,
we're going to team up.
We're going to buy Tony's
Total Therapy Solutions.
Tony's going to ride off into the sunset.
We're going to acquire Tony's practice.
uh and let's just say um and
can I just can I pull up a
hypothetical number because
I was doing some homework
before we did this okay
let's say let's say we
agree let's let's say we
agree it's a million dollar
purchase price so and let's
say jimmy and I we're gonna
split it fifty fifty right
so it's like okay well
historically if we're not
gonna use debt we're gonna
jimmy's gonna pull up five
hundred k if we're
splitting the deal and I
gotta find five hundred k
in cash and we buy it right
If you use a seven day loan program,
which is a government
backed or it's fifty
percent government backed for loans.
We only have to put down ten percent,
so Jimmy only has to pull up,
get fifty K. I have to get
fifty K and that includes
like all the purchase, the closing costs,
all that.
So we only have to come up
with one hundred K total to
buy a million dollar business.
Assuming that,
and of course we have to
submit all the financial
documents and we have to
show the banks that this business,
Total Therapy Solutions,
has a history of doing
business and has stable
financials and all that.
So we submit all that.
We have to submit our
personal financial documents, all that.
We can buy this million
dollar business for a hundred K,
which is ten percent down.
And assuming we make all the
debt payments over the
coming months and years,
and if we don't default on
it or anything like that,
then our return on cash or
our return on equity is
about a hundred and fifty
percent per year.
people want to put in money and get,
you know,
seven to ten percent in a stock market.
This is why there's a lot of
folks doing business acquisitions,
because we can turn our, you know,
fifty K each or one hundred
K each on a annualized
basis of one hundred and
fifty percent return year over year,
which and if we're going to
buy total total therapy solutions,
that we are using debt,
but it's different than
having thirty thousand
dollars of credit card debt
where the the interest rate
of the credit card is like whatever it is,
twenty, thirty percent,
twenty five percent,
something like that depends
on the credit card and the
interest rates to buy this
business right now.
And even through COVID,
it's kind of going up and down,
but it's kind of around
seven percent to eleven percent.
So the the cash flow of the
business of Total Therapy Solutions
We check all the numbers and
the cashflow that the
practice brings in every
month covers the debt
service payments to the bank.
It does not come out of my
pocket or Jimmy's pocket.
The cashflow covers the debt
service and the overhead, the rent,
utilities, the payroll, all that.
So all of that needs to be figured out
And that's why it's extremely or very,
very safe and why folks are
able to acquire a business,
covers the debt service,
and it's an asset versus
the credit card payment
where you do thirty K in
credit card debt.
And the only way that that's
going to get settled is
your own money coming out
of your pocket or assuming
your job or whatever money
you're making from wherever
to make those payments at a
higher interest rate.
So debt is great.
Debt allows individuals,
it could be a physical
therapist that has student loan debt,
and I'm not sure if they're able to,
but it depends on the person.
They potentially could take out
let's say they have no money,
they could find an uncle or
the rich neighbor nearby, Tony Meritato,
and raise money from him.
They could raise a hundred
thousand dollars from the neighbor,
Tony Meritato,
and go buy a different
million dollar physical therapy practice.
Tony's gonna have to,
he gets some pro rata or whatever,
but you could have a
therapist that has student loan debt,
get an investor like Tony,
buy a million dollar
physical therapy practice,
And yet it's debt on the
business and it's different
than the personal debt.
So anyway, that that's long winded.
That's kind of like how,
how anyone can utilize debt
and private equity
companies do this on a big scale.
But you can also do it on a
smaller scale to acquire a business.
And that's why debt is great
because it allows someone
that is unable to come up with the cash,
but they can acquire an asset like this.
And then obviously they want
to grow it and work in it
and expand it and all that.
Yeah,
I guess it's what we talk about in
terms of good debt versus bad debt.
If you have a plan for what
you're going to be doing
with that money and you're
going to put it to use.
Because, of course,
when I sat down to talk
about debt with you guys, I, of course,
went to my teacher,
which is now artificial intelligence.
And I said,
explain it to me like I'm in
tenth grade because I feel
like I'm perpetually in tenth grade.
I'm like, get it,
get it really basic for me.
But I but after it explained it to me,
I sort of understood it.
Right.
which is if you buy a flashy
car just to drive around, that's bad debt,
right?
How is that going to bring
you money or pay for itself?
It won't.
Social media.
Social media, right.
You could do that.
I mean, there was a guy in South Florida.
Then it's a write-off.
Yeah.
Yeah, it's a write-off.
So there are different ways to play it.
While we're talking about debt,
I actually just did pay off
my student loans.
So just shy of ten years.
Nope, nope, no big deal.
But that does feel good.
So let me twist this a
little bit because there
are conversations.
Can you hear them?
I can hear them right now.
People convincing other
people not to go into our profession,
to go into our profession
because of finances.
Just yesterday, someone was asking –
I'm a physical therapist
assistant in Canada.
I want to move to the US.
I want to get my DPT.
Should I do that?
And of course, you can hear them.
They come out of the
woodwork and they can't
wait to tell you their opinion.
And that thread goes long.
Is education a good debt in your opinion?
Because that's taking on
loans to then hopefully make more.
Would you consider getting a
DPT in twenty twenty five?
Good debt or bad debt?
Yes,
and I think this is going to be
controversial.
I think it is still good debt.
I have a lot of anecdotal
experiences right now with
buddies or younger guys
that are coming out of
college that are on
different baseball teams
that I'm playing with.
And a lot of these guys are
either not able to find work.
They're working at
restaurants and that restaurant,
on average,
that restaurant is going to go
away in two to three or
five or whatever years, right?
So that job is not a long-term job.
It's just like they're using
something to go work
somewhere and pay their
bills or whatever.
So what type of career is that,
respectfully?
I still think it's great.
I think,
especially if you're going to go
into ownership, absolutely.
Slam dunk, absolutely.
Because
Otherwise, like, I don't know, like,
where else can you do what we're doing?
Like, I'm seeing, you know,
one patient a month.
right now because I'm able
to get out of the business
and created a business and all that.
I still think with the other
options out there,
I know Tony has spoken
previously in the past
couple of months about some
of the like the sweaty
startups or like the, you know,
manual labor,
manual labor is kind of
having a little bit of a
resurgence in the U S in terms of like,
you know,
long care and tree care and what else,
you know,
HVAC and plumbing and electrical
and all that type of stuff.
And that stuff is always
going to be needed and is vital.
Absolutely.
Does that have less of a cost?
Yes.
Is it faster to get into the
workforce through those methods?
Yes,
I think you can get into the workforce
faster.
But then isn't your upside capped?
That's, in my opinion, I think it is.
I don't know.
I got a buddy who's an
apprentice electrician,
and I think it's taking him
seven years to – now,
he's doing the apprentice model,
so he's in the workforce,
but his upside is pretty huge.
I think it goes back – so I
agree with everything Dave just said.
I agree – sorry.
I think the upside is
uncapped because you could
own an electrical business
or you could run a bunch of other guys.
And I think the ultimate
deciding factor is what do
you like doing?
Like that's I mean,
you can make a million
dollars doing anything.
What do you like doing?
Tony, what were you going to say?
I was just going to say,
I think education in
general is always a good investment,
especially taking on younger because.
Dave has brought this point up,
which is the best point
anybody has ever made about
getting a PT education.
It's not about a job.
It's not about the W-II.
It's not about how much
you're going to get paid an hour.
It's about the knowledge of human anatomy,
physiology, injury prevention,
injury recovery.
That's something that is
going to affect you on a personal level.
It's going to benefit you
the rest of your entire life.
You can't.
The value of that is so outrageous.
Even right now,
like I've talked to you guys before,
you know,
I'm paying attention to my
physiology at the age of fifty.
I'm losing muscle.
I'm gaining fat.
I haven't changed anything
really in my lifestyle, but I'm like,
what the heck is going on with my body?
I feel like I'm better
prepared to try different
things now on my own than
if I was a layperson who
had none of this knowledge
and I would have to go hire somebody,
pay for something,
run medical expenses up.
Or do nothing.
Or do nothing and then wait
for something bad to happen.
Yeah.
So I think that's the huge value.
But it's about the perspective of, okay,
why are you becoming a
physical therapist?
If you think you're going to get a job,
W-to, you know,
all this stuff and make the
money you need, probably not.
It's more about just the knowledge,
going for the knowledge.
And that's where I would say...
make the money, then go to PT school.
So you have the freedom to
do whatever you want.
Just put that money in the bank account.
Since Jimmy is in the
revenue cycle management world now,
some of the stuff that
people don't talk about enough is, okay,
so back when we were in growth mode,
If I knew I was going to
open a new clinic location,
especially when we were down in Florida,
we would do things like defer income.
So I've got, you know, November,
December worth accounts
receivable and it's Medicare claims.
I know Medicare is backed by
the government.
I know I'm going to get that money.
if I'm going to open a new
clinic in the next calendar year,
I'm going to manage my revenue,
my cashflow, and just defer collections.
We would literally stop collecting.
I would borrow money if I needed to,
to cover payroll.
And then in January or February,
I would bring that money in.
That's when I would submit
my claims so that I would
push that income to the
next calendar year.
which is going to be offset
by the new clinic we're opening,
by the capital expense and
the investment we're making.
Those are some of the things
that I think a smaller provider,
somebody who doesn't have experience,
doesn't have people around them,
they don't even know.
They're not even thinking.
And then, of course,
I've got the advantage of real estate.
So I own my building.
I pay rent to myself as
tenant and landlord.
That rent comes in.
It's offset by depreciation.
I can depreciate my
commercial building over
thirty nine and a half
years or whatever the time frame is.
That's that's a way for me
to manage cash flow.
Gives me an advantage over
another clinic down the
street who maybe doesn't
own their real estate or their property.
We have to be better.
about understanding how
money works if we want to
be business owners and grow
business and be in that world.
There it is, right?
I don't know why I use this
example a lot because I
think it's a little bit easier to see,
but just because you're the
longest tenured nurse or
you're the best nurse does
not mean you're gonna be
good at being the charge nurse,
the nurse in charge.
That is a different job,
but many times we're promoted.
So you might be the best
clinician at a clinic and
you might be frustrated by
your growth opportunities and say,
I'm gonna take my ball and go home.
I'm gonna open my own clinic.
And here's the great phrase
that happens usually
shortly before catastrophe.
How hard could it be?
I see what the boss does.
He's not that sharp.
I'm smarter than him.
Patients respond better to me.
Why don't I make all of the monies?
And then sometimes it works
out and sometimes it doesn't.
And I think that the people
that it works out for,
They understand what game
that they're now playing
and they understand that
they're now a business
owner and they need to play
that game and act accordingly.
And that's a big differentiator.
Dave, when did you know?
Did you know before going to
PT school that you were
going to do this or were you like, hey,
I want to be a clinician or you just said,
I'm going along with this
because this feels good and
I'll figure it out later?
Did you have a plan?
I mean,
I was always doing little
entrepreneurial things when I was younger,
so I always had the
intention to have a
practice and a business.
Then I got swept up with the
tech and the apps and all that,
and I did Vinitial for a bit,
and then that was a tech
startup failure and all that.
Yeah, but that's a business too.
Yeah.
I mean, that's still business,
and that's still forward thinking.
You've got to understand a giant market.
Yeah,
but I always had it in my head to
have my own thing.
Absolutely.
Yeah.
The way you asked that made
me think I started
identifying as an
entrepreneur when I was six.
Nice.
You could take that in a
couple of different ways.
But but no, seriously, like I would,
you know, wash cars in the neighborhood.
I'd go collect leaves.
I do all this kind of stuff.
And then I'd start getting
neighborhood kids into my
business like that.
You're just born with that.
You know it from the beginning.
Let me ask you, that was my question is,
I did that too.
I was the kid who would do two things.
Number one,
start knocking on doors and be like,
we're playing baseball.
Let's go.
Grab it.
Fifteen minutes, get like the galvanizer,
right?
And then I was the kid who was like,
I'd like some pizza right now.
There's a bunch of snow on driveways.
So how could we organize and
put our collective use –
Did you,
but you and I both gravitated
towards bringing other people in.
I never wanted to do any of
these things alone.
Like to me, it was if we're doing,
I'll do it with one other person,
ten other people, but never alone.
Were you two similar to that?
Like always looking for a partner?
Because I always was and am.
No.
No, no, that, I mean,
that's why we're like,
that's why I'm an
entrepreneur and I did these things,
you know,
I wasn't looking to have the shared risk.
I, whether it was, you know, even Tony's,
um, you know,
washing cars or trying to
make money when he's six
years old or whatever.
Uh, but whether it was, um, even initial,
like started that a hundred
percent myself and then
concierge pain relief
started that a hundred percent myself.
So, um,
I think maybe that signals
like you're a different
version of a potential
entrepreneur or maybe
you're not an entrepreneur.
I don't know.
But like, yeah,
I just know like it takes
the it takes just the one
person to be the go getter.
They assume all the risks.
They have the energy,
the ambition and all that.
So they get after it.
What do you think, Tony?
Yeah, I never wanted a partner.
I wanted people working under me.
I wanted to direct and I
wanted to delegate.
But I never wanted a partner at the top.
Like I always felt and to
this day and I acknowledge
like this is probably a
shortcoming of mine that I
would be far more advanced than I am.
But I'm just one of those
people that I feel like my
idea is always the best idea.
I acknowledge your idea
might be equally good.
Dave's ideas are equally good.
But I don't want to do Dave's idea.
I want to do my idea.
I would rather do my idea
and be less successful than
do Dave's idea more
successful because it's not my idea.
It's not what I want to do.
Yeah.
I was always looking for
people to come with me.
I think that's what I was looking for.
You know,
I didn't need that person to be
at the top with me, but I wanted to,
I didn't want to be doing
the idea or executing alone.
That for me, wasn't,
wasn't really exciting.
Yeah.
Are you an only child?
I forget.
No, I got a brother.
Okay.
I was an only child.
I did everything alone.
I loved doing everything alone.
I think there was like a. A.
A. A. A. A. A. A. A. A. A.
Everything before and
everything after I love.
I never even thought I'd be married.
I never thought I'd have kids.
I'm happy that I do.
And I I am.
But seriously,
like I could easily be that
hermit in a in a shelter
living my life completely solo.
Dave, you got you got siblings?
We're getting deep here.
So yeah, we are getting deep.
So I have a half brother and a half sister,
but I was basically raised
as an only child like they were older.
So you know,
they were in a different house.
So I was just about to type
in a chat GBT like if
there's any correlation
between having one child
and entrepreneurial world or you know,
entrepreneurialism.
Real quick, Scott.
Scott's here.
One of the best fans we've
got of the show.
He said parents should teach
their children at an early age.
The best pro athlete all
start at an early age.
I'm already I'm already
asking my thirteen month
old if you've started a business yet.
I mean, you can't even fully speak.
But I'm like, hey,
did you start a business?
You know, you got to move along.
You got to do something.
You got to go wash cars.
You got to do something.
Diapers ain't cheap.
Before we started today, I told Jimmy,
my eighth graders had their
graduation yesterday and
one of their requirements,
the teachers made them
write letters to their parents.
And so I was reading the
letter last night and both
of them kind of had a
couple sentences in there
where they were so thankful
that their parents are
working and putting them through school.
But they also said that they
love that their mom and dad
are teaching them about business and
how to make money in the future.
Like it is, it's a core tenant.
And I think this is one of
those things that, you know, if,
if a parent's never done it
and they don't have exposure to it,
young people need to find it somewhere.
And I think they want it,
whether I think it's an
innate human quality,
humans want to be creative,
humans want to build,
humans want to exchange value for value.
And so, you know,
kids are looking for it and
and if we give them those
opportunities uh they're
gonna explore them did you
want to talk about that uh
ar uh idea or the ar
situation tell me about it
what I made it I made an
intro for dave's
profitability problems like
three weeks ago I've been
dying to use it I'm gonna
use it whether we're doing it or not
You were talking about in
the group chat a bunch of
companies offering to buy
your accounts receivable
for a percentage of the value.
It's another form of
borrowing what we're
talking about with debt.
And you said if you had effective ads,
you could borrow money
today to pay for the ads,
use the ads to generate
cash flow this week,
and use that cash flow to
pay back the ads and keep the profits.
Yeah, I brought it up,
but let's kick it over to
Dave because Dave runs way
more ads than me.
So Dave, do you want to talk about this?
We talked about selling our
accounts receivable or
financing off of our
accounts receivable before.
What can you share about that?
Yeah, I mean, well,
even so I use Stripe for
our credit card processor
and they're always sending
me emails like you instantly qualify for,
you know, thirty or sixty or a hundred,
whatever grand and
I don't usually look at it
because it's like... I mean,
they take the repayment off
of the future cash flow
going through the credit
card processor from my practice.
So there are a bunch of
businesses that are always
running ads that are saying, you know,
hey, we'll...
what is it like?
Not a margin call.
It's like they'll offer you
cash now and it almost,
it might almost sound like
a loan shark kind of thing,
like breaking thumbs.
But yeah,
they can offer cash upfront and
they'll take a,
they take the margin of the,
between what they're paying
you upfront and then they're making more,
but they have better
systems like a Phyllis or
whatever their system is to
capture the rest of that
reimbursement in the long term.
I haven't seen it for the
cash of like other like in
a business to use it for
ads or use it for
payroll or whatever uh
although usually it is for
like you know payroll and
then again I I'm just not I
just don't know too much
about this world because it
does kind of kind of it
kind of gets into the whole
you know loan sharking
thing a little bit and
maybe it's like the most
white collar maybe the most
ethical up and up side of
the like the loan sharking
kind of thing um am I am i
Thinking about it correctly, Tony,
or am I?
Yeah,
I would say it's less available in
your world because you're more cash pay.
It's more in my world.
And so if I know that I've
got one hundred thousand
sitting in accounts
receivable for Medicare,
I know that money is going to come in.
Maybe I bill three hundred thousand.
I know one hundred thousand
is going to come in.
It's guaranteed by the federal government.
But if I needed access to that capital now,
there are companies out
there that I could say, hey,
I've got a hundred thousand
that I'm expected to
collect in the next thirty
days from Medicare.
I need eighty thousand now.
They will give me the eighty thousand.
They will collect the full
hundred thousand.
So they make the profit on
the twenty percent difference there.
But then I could take that
eighty thousand.
I could use it if I know
that I want to run an ad campaign.
I know I have a profitable
ad and this is where people get stuck.
They don't have profitable ads.
I don't have profitable ads.
Dave can say if I put one hundred bucks in,
I'm going to get three hundred bucks out.
I can't do that yet.
I haven't cracked that nut yet.
But in theory, if I knew that I could,
I would snatch that eighty
thousand today instead of
waiting thirty days.
I would put it into
something that's going to
turn eighty thousand into
two hundred and forty thousand.
And I would just, you know,
ramp that until it stops working.
And at some point it doesn't work anymore.
The ads don't work anymore.
I've exhausted my local
geography if I'm not doing telehealth.
Um, so, you know, like Jimmy said,
there's lots of ways to finance.
We're financing either with our labor.
If I don't want to borrow money,
but I'm saying, well,
I'm going to work and I'm
going to bootstrap and I'm
going to do it all myself,
but it's going to take me
ten years longer.
You're still financing.
You're just financing it
with your time and labor.
Yeah.
But there are so many unspoken,
unknown strategies out
there that you could use to grow.
I think the mistakes that we
make is we don't
necessarily know enough about it.
We don't have proof of concept.
We're not sure.
And then we borrow a little bit.
We get scared.
We fail at it.
And then we never borrow again.
You know,
I picked up a fifty pound bag of
horse feed.
I hurt my back.
I'm never going to lift
fifty pounds again for the
rest of my life.
yeah I think it's I think
it's we're very tied
emotionally to money and
and fear myself right so I
mean the room I'm sitting
in I renovated when I
bought this house because
hey how hard could it be I
bought a house and I owned
a hammer and a screwdriver
right now luckily I had a
buddy who like loves doing
this stuff and was good at it but
If you had told me how much
it was going to cost to get this,
to pay someone else to do it,
I would have said, you're nuts.
And then I went and did it.
And halfway through it,
I'm sitting here covered in
dirt and sweat, and I hate doing it.
I was like,
I now understand why people pay
to renovate a kitchen.
But I'm paying for it one way or another.
And that is a side view of
what you're doing.
The thing is, if you have a plan for it,
that's the thing where I
think a lot of people, right?
Would you let a seventeen year old?
Tony, how old are your kids?
They're going to a couple
and go to high school.
Sixteen, fourteen, fourteen and twelve.
Would you in a year?
Would you let the seventeen
year old borrow two hundred
thousand dollars on their own?
But you're doing that with college.
You're saying, sure, good luck.
Sign right here and we'll do that.
So college feels like it's
bowling with guardrails,
but there's a lot of risk there.
And do you understand what
seven percent interest is
over two hundred thousand dollars?
The reason I paid off my student loans.
I owed seventy two thousand dollars left.
And I was like, I had the money,
but I like to have money
because what if something goes sideways?
Right.
And then I went to chat GPT.
Now, I understand a little bit about math,
but I sat down one day.
I was like, you know what?
I'm going to crunch these numbers.
I'm actually going to do this.
I would have I would have
had to pay two hundred and
fifty thousand dollars to pay off.
Seventy seventy was the principal.
It would have been one
hundred and eighty thousand
dollars in interest,
paying two thousand dollars
a month for a decade.
I paid it off the next day.
As soon as I understood two grand a month,
you know what I could be
doing with two grand a month?
Dave, making money.
That's what I'm going to be
doing right now.
So I risked it.
I said, you know what?
No, to me, that's bad debt.
I'm going to pay that off
and I'm going to take a
thousand dollars a month and invest it.
And the thousand dollars a month,
the other half,
I'm going to put it in my bank account.
So to me, that looked like a good move.
It felt like a good move.
And I feel better every
morning that I wake up now
and don't have damn student
loans anymore.
Answer Scott's question.
I'm curious, too.
What happened to the basement renovation,
the basement studio?
Basement studio is done.
Here's the problem.
So, all right, let's rewind.
So the basement studio was Jim.
And then let's put somewhere
where Jimmy doesn't have to
do his live streams at his kitchen table.
Jim's done.
I'll do a full tour.
I'd say it's ninety percent
that I got put a few more
lights down there.
The problem is it's dark.
It's a basement, right?
I got a lot of lights,
but I've got skylights up here.
I got windows in all corners.
So I was using it and then
realized I didn't like
being down there for that.
So I'm moving all of the
desk equipment upstairs and
I'm going to make the gym bigger.
So renovated the gym slash studio,
realized I didn't really
like it that much,
but didn't cost me much
because I'm still just
going to use it as a bigger
gym downstairs.
Yeah.
Now,
before we go to the next segment from
Jimmy, full disclosure,
we are not financial experts.
We are not lawyers.
We're not giving you financial advice.
We are simply saying what we did.
Speak to your accountant and your lawyer.
That's right.
All right, Jimmy,
let's steal this segment.
I have a meeting with a new
accountant today, actually.
All right,
time for you to steal the strategy.
And I want to see if you two,
because you guys are owners of clinics,
virtual or brick and mortar,
could you steal this today?
Okay.
All right, steal this strategy.
I wanna take something
that's ugly and invisible
that people fricking hate doing.
I just took my dad to a
doctor's appointment and
here's the thing.
You walk into a clinic and
what's the first thing you do?
Here.
Take this clipboard,
take this clipboard and
fill out the same information.
Thirty seven times over and over.
Even if you filled it out.
Oh, yeah.
But our system doesn't
comply with this and that.
OK, great.
But what if you twisted it?
And I understand there's
information you've got to get.
Number one,
you can use agents to make
phone calls to get that
information ahead of time.
That's great.
You can have people scan cards.
What's the O.R.C.
optical reader technology, whatever.
Optical character recognition, OCR.
Take a picture of this and
just take that information.
But what if you could use
the intake psychologically?
What if you could create
personality driven intake to point out,
right?
What if it didn't just
collect basic information,
but actually gave your team
a cheat code to connect
with every patient
on day one.
Now the strategy came from slim chickens,
slim chickens.
It's a chicken restaurant.
They've been using AI and
behavioral insights to turn
ads from boring to customized.
So it's using AI and they're,
their customer behavior to
actually change the ads
that they're showing to
people geographically, right?
So this is making the invisible visible.
So what I wanna do is pull
personality and motivation
insights from new patients
before their eval.
Think about this as like
Spotify wrapped for
physical therapy and healthcare.
What if you could find out
about a patient's coaching style,
motivators, stress triggers,
learning preferences?
before ever saying hello.
Now, psychologically, I looked it up,
personalization builds trust,
identity-based goals boost compliance,
and autonomy fuels motivation.
Those are three things we want to build,
trust, compliance, motivation.
So it's like taking a personality test,
but you could make it fun.
Use like a type form or a jot form,
use ChatGPT.
I would actually suggest
using a mix of open-ended,
and multiple choice
questions because I looked
it up and psychologically
they say that gives you the
best insights.
So I would say better connections,
we say lead to better outcomes,
more completed plans of
care and fewer drop-offs
and patients feel like, oh damn,
these people get me.
Now I know a great therapist
can get this in an eval or visit one,
two or three,
but what if you could find
out about that person or
things you might not by
asking those questions beforehand?
So this was turning that
intake into something
tactical and usable.
Interesting.
Very interesting.
Question would be with the
tablet or whatever with this process,
Jimmy, is there five questions,
ten questions?
How are you pulling this
information out of me?
And would that be annoying
to most like the average patient?
Yeah,
I would probably do it before the
person ever came in and you
could do it a couple different ways.
You can do it with an AI
phone call right now.
You could do it through a
series of text messages or
you could do it with a tablet on intake.
We're seeing people do that right now.
I'd say ideally you wouldn't
want to ask more than seven
to ten questions at absolute most.
And it could also be it could also learn.
This could be a decision tree.
If you under if you could teach it,
like if we understand what
this person's motivators,
we have the information we need.
Don't ask any more questions.
We're done here.
Like questions,
like I have some example questions.
How do you like to be coached?
Directing to the point, encouraging,
collaborative, data-driven and precise.
What motivates you?
Reaching a goal, seeing visible progress,
accountability from others.
Preferred communication style, email, text,
in-person only.
Like things that annoy people,
like how am I supposed to know that?
It really drives me nuts
when you always email me
and I never see my emails.
You didn't tell me that, but I never asked,
and I didn't give you the option.
For example, at Athelas,
something I thought was kind of cool
Instead of everything being digital,
we offer people who are
talking about accounts receivable,
we can send out mailers with a QR code.
Some people of a certain age
or just communication style
prefer getting things in paper,
myself included.
I uncheck all the things
from my bank to say that
your statements go digital.
I like to see it and be
reminded to check it.
And I get like blind to email in my inbox.
So I like that.
So that's a preference for me.
And if that went away, I'm pissed.
And Wells Fargo tries to fool me into it.
because every once in a while,
they don't want to,
they don't want to send it to you.
Well, what they'll do is when I log in,
they don't want to mail it to you.
They want to save on the
postage and all that.
So when I log in,
they make me unselect and
save versus like, so it's a damn trick.
And I have to stop and be like,
wait a minute.
I want to get the paper.
So I have to unselect the thing.
Cause of course they want to
save a nickel times,
I don't know.
It's boring and it's necessary.
It's fifty five damn questions anyway.
What if you could sneak in
seven that could give you
insights to someone's
personality to boost those
things afterwards?
I don't know if you guys remember,
we talked about this months ago,
maybe even a year ago.
We did.
When I was first getting
familiar with AI scribes,
I was saying how if this is
going to listen to my conversation,
it can identify
characteristics within the
personality of the patient.
It could give me an
assessment of this person.
AI will understand our
personalities better than
we will understand our
personalities better.
So I want it'll tell me like, hey,
you should do this or you should do that.
You should understand this
anxiety or this fear.
So much of what I do on a
first visit is not about
the patient care.
It's not about the evaluation.
It's not about any of that stuff.
It's about understanding the personality.
Like,
is this a high anxiety or low anxiety
person?
Is this person fearful?
Is this person sleeping?
Is this person medicated?
Like, what is all the other stuff?
Then I, you know,
who cares about a four out
of five manual muscle test
on adult doesn't matter.
AI will do that in amazing ways.
And I think we could probably learn.
And I don't know,
I'm just guessing from counselors,
from psychiatry and psychology.
And they've taken that so far online.
Like I thought I saw a
number of like thirty or
forty percent is done
through telehealth for counseling.
they've got to have the
advanced technology and
understanding of
identifying these personalities,
then getting back
information on what this person needs,
positive reinforcement,
negative reinforcement,
what's going to work best for them,
what's going to motivate them.
And, and,
We see it in Facebook, right?
We see it in all the social
media platforms.
What makes this addictive?
What triggers that dopamine release?
How can I bring that into my
physical therapy practice?
Because I promise you,
you can take all the best
con eds in the world.
If you know how to trigger
that dopamine release,
your patient's never going to cancel.
Your patient's going to get
a positive outcome.
You are going to be the best
therapist in the world if
you trigger that dopamine enough times,
but not too many times.
I like this as a potential tool.
My initial assumption would
be that these busier
in-network practices across
the country probably won't buy this tool.
They probably won't care
about it because they're just like,
you know, it's...
whatever their co-pay is to
attract the patient to come
in and they're you know
they're good enough however
what you're talking about
on the front end of like
learning more about this
person and then trying to
you could leverage this
with like making sure that
there's better completions
of you know plans of care
I think this would be way
better for the
out-of-network self-pay
practices as opposed to in-network.
If you pitch this to Tony,
if you didn't know Tony, Tony,
would this catch your eye?
Would you then start paying, I don't know,
whatever,
a hundred dollars a month or
whatever for this type of service?
I can tell you if I see
something that has a
material difference in my operations,
I'll pay in a heartbeat.
I absolutely will.
What is, how do you make,
what's material difference
in your operations?
Like make things easier, make things like,
what is like, how do you, what is that?
No extra work and more money.
More money, more money.
No extra work.
No extra work first.
But let me ask you this.
And more money.
Is this too far, honestly?
Because what I'm saying here is, listen,
by finding out these things
about patience, later on,
you're probably going to be
able to measure this.
There's a delay.
So that's my question.
Is the distance too far for you to invest?
I guess the price would have to be right.
If you were like, listen, for...
you know x number of dollars
like it's a dollar a
patient right that you use
it with or some person like
we'll do it that way and if
you're going to use it high
volume but then could you
build something into your
ehr like I would do it with
fifty percent of your
patients in the first six
months and fifty percent of
your patients don't and
then compare length of stay
right could you do that
that a b test it that way
there you go yeah so that
could be like a pilot or whatever a paid
The value of it mostly talks
about the difference
between price and value and time.
If I could give you a
thousand dollars and have a
six pack abs today, I'm going to do it.
But if you're going to tell
me I give you a thousand
dollars and I have to eat
less and exercise more and
do all these things in six
months from now, maybe I get a six pack.
I'm not going to do it.
Um, with something like this,
I think there's that,
how long is this going to take me?
And is there another way to
make this work?
Like, is this something that I can run?
Okay.
So Athelas has, um, agents or AI, you know,
telephone calls, right?
Is this something that I
could just today I can run
an AI to call patients who
are scheduled for new evaluations,
go through a series of three questions,
not
And at the end of those three questions,
how many of these patients
are going to buy my
resource pack before they
come for my evaluation?
So my resource pack has a set of pulleys,
an ice pack, and a TENS unit.
And are they going to put a
hundred dollars in my bank
account before they even
come for the eval?
Because the AI scribe
Ask the right questions and
pose this as if you really
want the best outcomes.
These are the products that
we recommend to make you
feel better today.
You know,
like that's immediate return on
the investment.
And I think that's something
that would buy build buy in for this.
so let's let's ask right so
well a couple things that
came to mind but if you had
to ask three questions you
could not ask for it
doesn't matter here's what
uh max our producer says
are the three must-have
questions I want your
thoughts number one what is
something specific you want
to get back to doing that's
number one although I feel
like dave you asked that
that's already in what you ask right
Number two,
how do you like to be coached
or motivated?
This tells the therapist how
to talk to the patient.
Push, support, explain, or cheerlead.
I hate being cheerleaded.
I do like being coached.
I do like understanding how
far I am from the finish line.
And number three,
what usually gets in the
way of you sticking with a routine?
Gives you a heads up on compliance.
So focusing on those three,
those would be the three
different questions that Max,
our producer,
the AI thinks we should ask.
So I think that's what it
thinks we should ask.
I don't think those are
effective questions.
And I've been binge watching
my six hundred pound life.
What is that?
I am unfamiliar.
I mean, I'm assuming based on the title,
I can figure it out.
But seriously,
you've never seen my six
hundred pound life.
OK, it's a TV.
Please don't don't screen share it.
Do not screen share it.
I'm not, but you gotta,
like any therapist watching
this has gotta go watch those episodes.
So these are individuals
that have accumulated a lot
of body weight.
They're going to this surgeon, Dr. Now,
and they wanna get either
gastric bypass or a lap
band or whatever it is that he does.
And so it takes you behind the scenes.
You see what the patient
says to the doctor
And then you see the reality
of the patient's life when
the doctor is not around.
And I think we see this in
physical therapy constantly.
Right.
Patient walks in the door.
They tell me one thing.
They tell me what they think
I want to hear.
Yeah.
Then they do something
likely very different behind the scenes,
whether they realize it or not.
So my problem with those questions is.
These are really, really good episodes.
My problem with those
questions is the person is
going to tell you what they
think you want to hear or
what they want the reality to be,
but it's not the reality.
I want the AI to ask
questions that the patient
can't get wrong.
In other words...
You know,
I want to get into what have you
actually paid for?
What have you actually purchased?
And I shared a post recently.
I'm like, look,
the best patients are the
ones who are already doing
everything right.
They're already eating well.
They're not telling me
they're eating well.
They're actually eating well.
They're already working out.
They're already researching
their condition.
They're already doing everything.
This person is going to get
better no matter what.
All I can do is screw it up.
Right.
These are the people that I want.
So I want an AI that
understands human behavior
enough that they're not asking questions.
They're observing what the
person is already doing,
plugging them into an algorithm,
and then giving the information back.
which is what Facebook does.
Instagram does.
Facebook doesn't ask you
what you want to see.
Facebook starts showing you stuff.
And based on how you respond
to what it shows you,
it gives you more of that.
That's the AI that I want.
That's going to grow my business.
So could you use something
that was predictive?
So something that you would
ask a question and then the
second question would only
be based on the answer the first?
Is that what I mean?
I would say probably still
not asking questions.
Figure out a way to get the
information without ever
asking the question.
Like, I don't know,
I don't know how we just,
we just need the AI to
maybe we'll talk to Apple,
we'll get a little,
a little earbud that plugs
into their brain.
And then you know, we find out their true,
the true likelihood of
their willingness to change
their behavior and invest
time and money into their
health and wellness.
I mean, look,
imagine a credit card company.
They have unreasonable
amounts of information
about what we actually buy,
what we're actually putting
our dollars behind.
They are the ones that have
the best predictive
information about how to
approach this person for
better healthcare decisions.
It's got that whole big data
thing that became popular years ago that
This is where we're going to
get the information,
because I still think if
you ask me what I want,
even if I think I know what I want,
it's not really what I want.
I don't know what I want.
It's a blind spot for me.
You have to see what I've done.
What are the decisions that I've made?
Like, I want to eat less sugar,
but I still go get a piece of cheesecake.
Right.
So you've got to find what
is it that's driving me the
physiology to eat that cheesecake.
Even when I know I don't
want to eat the cheesecake,
my body is telling me to
eat the cheesecake.
I understand Tony's stance
on it might not even be
questions that actually is so important.
high level iq of
understanding this topic
because I'm I'm typing in
chat gpt as we're talking
like you know what are the
best three questions to
actually understand
someone's likelihood of
behavior change and all
that and it said you know
what happens if nothing
changes in the next three
to six months right so then
they have to emotionally
describe like then they're
still stuck in that rut of
whatever uh or why now
as the second question or on
a scale from one to ten,
how committed are you to
doing what it takes, including time,
effort and financial
investment to fix this?
So those are those are awesome.
I love these.
I love the ones Jimmy was talking about.
But I also I'm also now
stepping back and I'm like, of course,
Tony's right, like most of the time.
And if let's say if you had a patient,
if they would have to agree to this,
but you're talking about
the credit cards and the
financial history,
could a personal trainer or
a nutritionist or a
dietitian or a physical
therapist or whatever have
some ai program that the
patient approves of and
then you're using ai to
pull in like where do they
go for food what you know
restaurants or grubhub or
mcdonald's versus some
healthy greek food or
whatever could that
actually change behavior
more because then they have
oversight into their actual
transactions the things
that they're buying on
amazon that are you know
wasting money and they're not
I don't know, no one buys DVDs anymore,
but on Amazon Prime,
every night they're buying
a new digital rental on
Amazon Movies or whatever it is,
Amazon Video, as opposed to, I don't know,
buying like resistant bands
and new shoes for walking or whatever.
Tony, I'm just so impressed with you.
Like, I'm thinking like, yeah, of course,
it's question based.
And I'm going to double
double down on what we're talking about.
And these are the questions
that we ask anyway.
But then it's like, wow,
like Tony comes at this different angle.
And it's like that actually
makes the most sense to try
to get into someone's brain
and not through a questions
based framework.
So real quick, you know,
what's funny about it is I
remember my wife and I,
when we went through,
like when we were getting
ready to be married, we were engaged.
We went through this thing
through the church and we
had to like answer these questions.
And both of us came out of
it saying the same thing.
We're like,
Why are you asking me these questions?
We know what the answer is supposed to be.
We're going to give you the
answer that it's supposed to be.
And for personality tests
and all of those kinds of tests, I just,
I always remember from a childhood,
I know what you want me to say.
I'm going to say what you want me to say.
But Dave, you made me think of this.
So there are apps,
biometric tracking apps right now,
continuous glucose monitors.
We look at all of these step
counters and stuff.
Give me access to that or,
and this is where I think
AI replaces a physical therapist,
Or give me a personal AI
that can analyze my
behavior across multiple platforms.
So what am I buying?
What am I doing?
How am I moving?
When does my heart rate,
my physiology change?
When does my heart rate go up?
What was I doing at that
moment that made me excited
and made me happy?
Now,
how do I leverage that dopamine response?
I'm going to keep saying that.
To enhance the behavior that
I think I want, at least, you know,
so if I want to feel good
about making these choices,
how am I feeling good right now?
And how do I replicate that
into feeling good in future choices?
I don't think a human
physical therapist can ever
do that by themselves.
They either need to be
augmented by AI or they're
going to be replaced by AI
to create that kind of solution.
Yeah,
too much information would be needed.
But we have apps like this.
I use rocket money, right?
It tracks what I'm spending.
It can actually do AI phone calls.
to at t to negotiate for me
to try to negotiate you
know ten dollars off of my
monthly bill does that like
every three months because
I told it to and I pay like
six bucks a month but look
what rocket money has
access to everything that
I'm buying and I bet you in
the terms of service it's
like by the way we can sell
that information when I was
working in a research lab at mount sinai
I remember the people in the
lab saying the data from
this product that we're
creating or researching is
going to be worth more than
all the money that they'll
make from the product being sold.
Even if they make millions,
the data is going to be
worth hundreds of millions or a billion.
And I remember being like,
I don't understand that and
then watching what they
could do with that information.
So you could have...
I was reading an article the other day.
I know the data they call
from an Apple Watch, like dirty data.
It's pretty good,
but it's not precise enough.
But it's pretty damn good in
terms of activity and what you're doing.
Could you make it easy to
track what you're eating or
doing at that particular moment?
I mean,
I have to think that we're there at
this point just –
Is someone motivated to take
all that information together?
Because now your treatment plan changes.
When I was doing my last Ironman,
I hired a coach,
not because I didn't know
how to train for an Ironman.
I'd done a couple before,
but I wanted to get better.
So I realized I had to change something.
So he didn't just give me a
plan for the month and say,
I'll see you in a month.
Like we changed it every two
or three days based on how
I did and how I was feeling
or how I was sleeping or
how much I was traveling for work.
Could AI adapt to that?
I mean,
I don't even think I need to ask
that out loud.
You know, the answer is yes.
Yeah.
Do we have another segment?
I didn't have another segment.
Real quick, with that app,
are we going to call it the Jimmy app?
The Jimmy app?
I mean, that service, though,
is originally, again,
we're talking about the
questions-based framework,
and then we're talking
about pulling in someone's
transactions and purchase history.
I'm actually fascinated with it,
and it is maybe bigger than just,
obviously,
it's just bigger than physical therapy.
Yeah, so the ultimate app, right,
would be access to everything that you do,
your biometric data from your Apple Watch,
your search history, your food,
what you're buying, but more importantly,
what you're eating and when
do things spike and things like that.
That's like, I don't know.
That's the government oversight.
But I might now change...
where the app is,
since we have an AI scribe
and there's fifty million of them, right?
And some of them are better
than others or different than others.
Why wouldn't you use an AI
agent to have this phone call?
Like we give options like
answer the phone call now
or don't or answer these
questions at a kiosk or don't.
Or do you bake this into the
first conversation of the
evaluation and now train the AI like, hey,
part of these questions or
I need you to get some
semblance of the motivation
of of this patient out of
this to tell the the
clinician how to style this
and when you give
suggestions for the
treatment in subsequent
visits that needs to be
taken into consideration
not just their diagnosis
their psychology so I don't
know does this have to live
in the emr or is this part
of the intake or is this
always part of the process
and should always be part of the process
I think it should always be
part of the process.
I think good therapists
inherently do this to some level already.
I modify my treatment based
on the personality and
based on the response.
You know, so when I get an angry,
frustrated,
fearful individual who walks
into my clinic,
Everything that I was
planning on doing goes out the window.
I completely changed the way
I'm approaching this individual.
I'm matching their personality.
I'm matching their tone.
I'm trying to build trust.
And what were you going to say?
No, no, keep going.
Whereas if I get that super jolly,
super friendly little old
lady who loves everybody
and just wants to talk,
I'm going to approach that
very differently.
I definitely think AI can
figure that stuff out over the phone,
by voice, and even to the point of, okay,
if we're going to have this
AI conversation,
I think it can definitely know,
does this person want to talk to me,
the AI, longer?
Or does this person want to
wrap up this conversation?
And so for us to say like three questions,
that's stupid because it
should adjust to the
context of the situation.
Correct.
Just had an idea.
Hey, listen,
Dave asking for a
recommendation might be a
little awkward from Dave's part.
It might also be a little
awkward from the person
you're asking because now I
feel obligated, right?
It's a good way to get recommendations,
but is it a good recommendation?
asking someone else to ask
is a different thing.
So after visit four,
could you have an AI agent
trained and say, listen,
we just want to see what
your thoughts are.
Is Dave a good fit for you?
Like,
would you want to maybe consider a
different therapist or how's it going?
Oh, it's going great.
Great.
This, this sounds overwhelmingly positive.
Now's the time to ask for.
Yeah.
a a a recommendation or
what's the word I'm looking
for how come I can't come
up with it uh uh leave a
review review review leave
a google review like I'm
losing nouns for some
reason at nine twenty seven
in the morning um leave a
review is this
overwhelmingly negative how
can we make this better
like so could you train it
could be part of the
ongoing process but it's
not dave doing it it's a
third party so you feel
like a chance to be a little bit more
honest maybe it's even
better than it's ai because
now I don't feel like I'm
trashing dave I'm talking
to a computer but I do want
to you want that feedback
that person probably would
like the result of that
feedback make it easier
Let's look at parting shots.
One of the things I want to
talk about next week is do
we want patients, clients,
prospects to know they're
talking to an AI?
Now, I know there's laws.
I know there's regulations.
I know compliance is going
to come into play.
But just in a perfect world
where we could actually
make our own decisions for ourselves,
Would there be an advantage
to the person on the phone
knowing this is a robot I'm talking to?
Or if the AI is at the level
that it's imperceptible,
I wonder if there is benefit to, you know,
let the person on the phone
just assume this is a human
that I'm talking to.
Real quick,
my parting shot and then Dave
and then Jimmy, you close it out.
So today was a great conversation.
Guys, if you don't have mentorship,
if you don't have people
around you that are willing
to share their personal experiences,
share what worked, what didn't work,
even if it's not going to work for you.
That's why you get on social
media and connect with people like us,
people like Stephen Dunn,
people like Scott.
Like there are so many
people at all stages of
business development.
go find them, connect with them,
answer questions, talk to each other,
build those relationships.
You will advance so much
faster if you have other
people that are ahead of
you and behind you.
Man,
parting shot earlier in the conversation,
leverage is all about for
entrepreneurship,
leveraging other people's
money in that acquisition example,
or leveraging other
people's time with hiring
team members and employees.
That's why I'm able to
only treat one patient a
month or whatever.
So thankful for that.
But it took a lot of effort
and time to get to that point.
But that was part one of today.
And then the second part
about the fascinating
navigation that we just did
through the the idea stages
of a potential technology or app for
the intake or just for, I don't know,
patient experience overall.
And then also a sidebar,
I just had Jerry Durham on
the Dave Kittle show.
It's coming out soon.
We covered, Tony,
exactly what you just said.
So next Thursday, we'll talk about it,
about the AI agents on the
phones and all that.
We covered it,
but I have some opinions and
thoughts on it.
So I'll take it over to Jimmy.
Yeah,
I would yes say on both of those
things and say the idea is really great,
but are you...
if you think you're going to
hide that idea because it's
worth so much and you don't
want to give it out um like
the idea I you know gave
out this morning it's sort
of nothing and I think the
conversation we had
probably if I was going to
take this idea to market I
think even the twenty
minute conversation we had
sped that process up by six
to eight months if if just
I was sitting here looking
at it right but again the
idea versus execution
light years difference right
an idea is worth kind of
nothing unless you're
willing to do something
about it there's a guy
who's got an instagram
account who just walks
around and says um do you
have a business idea right
that's his whole thing and
he just walks around the
streets and just jams a mic
a microphone in people's
faces but he this is a
brilliant media move
because there he's I think
he's from like a vc company
where he's trying to show, not tell, hey,
if you've got a great idea
and you pitch it and you're
willing to go all in on it,
we're willing to fund it.
So what's your big idea?
Don't keep it to yourself.
I think that sort of yes
ands what Tony is saying in
terms of building the network.
So we'll be back on Thursday.
I don't know why Tony is
saying we want to talk
about that next week.
I thought today was Thursday.
Today is Tuesday, Tony.
We are only at Tuesday.
But check out the Dave Kittle show,
Total Therapy Solutions,
and we'll see you on the
Pinecast pretty soon.
Gentlemen, have a great day.
You too, guys.