And we are live.
So Dave Kittle, Tony Meritato,
Jimmy is going to be up in the
air at some point here.
So he is not with us today.
Dave, how's it going, man?
What's the weather like in New York right
now?
It's beautiful.
It's a sixty seven right now,
high of eighty today,
but nice kind of like pre-fall morning.
So how about you?
Yeah, same thing.
It's beautiful.
It's sunny.
We're like mid-seventies.
I've been running so much,
just taking advantage of like the coming
fall weather.
I think I developed some shin splints.
Do you know anyone who could treat that?
I don't, man,
because I don't believe there's a
treatment for it.
The treatment is rest and nutrition.
So that's what I'm going to do.
I'm taking today off.
There you go.
All right.
So I grabbed a couple screenshots from
some Facebook posts that I thought would
be interesting to talk about.
They kind of fall into your area of
expertise.
But before we hit that,
do you have any thoughts or topics or
anything that's been on your mind?
So one was something you and I were
messaging publicly on,
I almost said YouTube,
on LinkedIn about selling or the
possibility of selling out-of-network
practices or solo versus staff.
Yeah, let's talk about that.
Let me just tease this for the audience.
So that's one thing.
Another thing I had sent you guys last
week was, should practices have a...
irritable client price or tax if you if
you wanted to not surge pricing i know
there's there's a certain amount of ethics
around pricing uh and all that but um
let's just say about if a practice had
someone who was a little rude or
moderately rude uh you know what how do
you know i know you probably will just
say um you know i'm not the right
fit and you know you'd probably refer them
elsewhere but let's say a practice
Didn't want to necessarily refer them
elsewhere,
but they also wanted to potentially
capture some extra dollars,
some extra value.
Is that right?
Is that OK?
That's another thing.
That's the second thing.
Third thing is that I recently got a
trial sample of Perfect Packs with some
supplements.
And I just about to open them today,
and I was able to, for free,
get a trial pack of creatine and melatonin
and some AM and some PM supplements.
And so my question to Tony is that,
first of all,
should physical therapy practices do that?
Should they sell that?
Should they upcharge it?
This is like a white label, this company.
They white label it.
So I could charge whatever to my patients
and clients.
They have a base amount to cover.
Should physical therapy practices consider
selling supplements like that?
And what's the liability if the client
gets, you know,
irritable bowels and I don't know,
whatever?
Do they, you know,
is the physical therapy practice on the
hook?
Do they get in trouble?
If so, Tony is going to say,
stay away from me.
I never want to do it.
That's just another topic.
And then any of the screenshots that I
didn't even get a chance to look at
yet.
Yeah, that's awesome.
That's a great show.
So I'm going to put it out there.
One other thing,
if we have a couple of minutes at
the end,
there was a dental practice that sued a
person who started posting negative
reviews.
It was a client of this dental practice.
I just heard the preliminary information
and the dental practice sued the person
because they were posting negative reviews
and probably took it a little too far.
Defamation or we'll get into it.
That's what I'm assuming.
Yeah, defamation, but...
All right, let's go back.
So let's talk about,
let's say it was a week,
two weeks ago,
I had shared a post on LinkedIn where
I said, look, just give it up.
Stop fighting for something we don't want.
We don't want to fight for low
reimbursement.
We don't want third party payer
reimbursement.
We don't want all the regulation and the
burden and the compliance that comes along
with low paying third party reimbursement.
I said, just let it go.
Let the hospitals have it.
Let the corporate physical therapy,
businesses have it they are built to deal
with that they have legal departments
compliance departments they have
venture-backed funding that will pay for
all that stuff and they have the risk
tolerance i can't risk medicare or some
other third-party payer coming back and
saying hey we want ten percent twenty
percent of all the payments we made to
you because you had ten or twenty percent
deficiencies in this documentation i don't
want that kind of liability um
So then some of the comments that came
along with that post,
one theme of the comments was, well,
if you don't build an insurance based
practice, you don't have value.
You don't have something that you can
resell.
You don't have something that somebody is
going to want to buy.
And I totally get it because I've said
the same thing myself.
The thing is,
now we live in a world where even
if I built an insurance based practice,
which I have.
It doesn't have any value either.
It doesn't have something that people want
to buy.
But for this conversation,
we wanted to go into, okay,
can we build a cash-based practice that
has resale value?
How do we do that?
yes absolutely um the owner ideally should
be out of treatment or not be fully
involved in the majority of delivering the
core service they shouldn't be involved in
you know everything uh how do you do
it um doing what i'm doing like i'm
treating like one patient two patients a
week
like very basically no caseload and i'm
trying to continue to set up other systems
all in google drive setting up this
playbook and the playbook is basically
like if i get hit by a bus
you know, a robot,
Tony's massage robot could come in and run
this business and know exactly like,
here's the post that we,
here's exactly the post and the images
that we post for organic,
attracting organic potential physical
therapists on LinkedIn or whatever.
And here's the new client paperwork and
here's the emails that we send out.
And here's, you know,
every little thing in a playbook.
That's one thing that I think most
practice owners are not doing.
Either they still love the treat and they
want to continue treating.
Maybe it's a little bit,
maybe because they're probably great at
treating.
They love it.
It's fulfilling for them and that's fine.
But to have something that's sellable,
it has to transfer value.
The value has to transfer from how it
currently is to another buyer.
basically like without you in the mix,
like that's when it becomes more and more
valuable.
And that's the conundrum for physical
therapy practice owners because they want
to be treating patients.
They want to be getting outcomes.
They want, you know,
they want to be known in the community.
They, you know, are the go-to person,
like go see Tony, not,
not go see total therapy solutions,
but go see Tony.
So if that is how it is, um,
that could be a challenge.
I, I like to, um,
I'm basically out of treatment,
but I will then send emails,
send handwritten letters,
that type of stuff.
Eventually,
it needs to not be coming from me,
but I want to stay in the mix
a little bit of the patients who,
because we're doing mostly home visits.
Or even in the office,
the office patients,
I don't always see because I'm not always
in the office.
getting out of the vital roles is how
a practice or any type of business has
the highest resale value and it's you know
physical therapy is no different than if
you and i were going to buy an
hvac business or i don't know a
landscaping business or whatever like uh
plumbing it literally doesn't matter so if
it's almost that's why you said before
tony that like
Buyers that are not physical therapists
that come into the physical therapy world
are oftentimes more savvy because they're
not attached to the core service.
They don't even know how to do the
core service.
They don't know how to evaluate and treat
patients because they didn't go to school
for it.
They're not licensed for it.
And they often can have more of a
focus on how to like improve the practice
and they could buy a practice and then
they could improve it for three to five
years and then they could sell it to
somebody else.
Yeah.
I've shared this before, but back,
I think it was two thousand.
So we started the business in two thousand
one into two thousand two.
I think it was two thousand three.
We we were growing.
We had tons of money coming in,
but we were killing ourselves.
We were working every patient,
every visit.
I'd come in at like four thirty a.m.
because I had realtors that wanted to work
with me at five a.m.
and then I'd stay till like seven thirty
eight p.m.
because I had other professionals that
wanted to come see me after work.
And when I say we, it was myself.
I was not a physical therapist when we
started.
Most people know that story.
The person who was the physical therapist
wasn't my wife at the time.
She's now my wife.
But the idea was, you know,
we were just running ourselves into the
ground.
We had tons of money, but who cares?
Nothing to do with it.
Nothing to spend it on.
But we had no kids, no family,
no real commitments.
And so we said,
we cannot do this for twenty years.
Like we have to figure out the formula
to turning this into a real business,
because at that point you would call it
a job.
We invested thirty,
thirty two thousand dollars.
We went through the consulting route.
We learned how to turn everything into a
procedure.
How do you answer the phone?
How do you empty the trash?
How do you turn off the computers?
And that was really what gave us the
the skeleton,
the framework to step out of the business.
Then we could start hiring.
We could start, you know,
growing the business that wasn't dependent
on us.
Now, my question to you.
So.
I would still say third party
reimbursement basically takes a business
that would have, you know,
four thousand customers a year and gives
you four customers a year.
Humana, Med Mutual,
Blue Cross Blue Shield, United.
Right.
Darwin, Medicare and Medicaid.
And there you got six customers.
So it does simplify things in one respect.
But you you pay a big premium,
you pay a big price for that
simplification.
Because now those big customers that are
going to represent all of your patient
referrals,
they're going to have their own unique
demands.
And twenty five years ago,
we had higher reimbursement.
We were able to handle those demands.
We it's harder and harder today.
So my question to you is.
if we're looking at the procedures that
run a business the frameworks the systems
what are like two or three in your
opinion of the most important i mean i'll
start i think the most important is how
do you find and recruit clinicians like it
doesn't matter how good or bad they are
it doesn't matter how many referrals you
get doesn't matter a bunch of the other
stuff one of the core operating kind of
procedures in a business cash or otherwise
You need staff.
You can't sell services if you don't have
staff.
You need a way to find and recruit
staff that fit the culture,
fit the mold of what you're trying to
build.
So I would spend time trying to
understand, OK, how am I going to recruit?
How am I going to attract?
How am I going to compete against higher
paying operators and other hospitals and
nursing facilities, home health?
What are some of the other things that
you would look at to say, okay,
this is really an important procedure for
a business to be successful and have
resale value?
Yes.
Well, initially, years ago, years ago,
I was more focused on the marketing.
I was obsessed.
I was customer first.
I was client first.
whatever, you know,
we live and die by the marketing and
them, and they're more important.
And, you know,
what I've learned a little bit more
recently in the previous most couple years
is being more employee focused and
employee first.
And so, yes, part of what you said,
I a hundred percent agree with the
recruiting.
the hiring the onboarding but then also
the if that's if that's one a one
b is the retention of those therapists i
think you kind of hinted at it but
i know that's kind of what you mean
like finding great talent finding great
team members and then retaining them so if
you have therapists that come in and they
only work for you for
three to nine months at a time,
and then they leave and they churn out.
That's a big challenge.
You're always gonna be on the hamster
wheel of hiring,
similar to the whole new patient marketing
hamster wheel.
So yes, if you, I mean,
the most important,
Serti McKee says the most important thing
in a physical therapy business is
initial evaluations because if you don't
have evaluations you don't have follow
visits you don't have the plans to care
you don't have a full patient schedule
built out right and so you kind of
reverse engineer from that which would be
like well how do you how do you
have initial evaluations of course you
need the new patients calling in but you
also need the licensed physical therapist
to actually perform the evaluations to
have a calendar that's open that's
available to do the evaluations
So it's kind of like new employee
recruiting, interviewing, hiring,
onboarding.
If that's like one A,
one B is actually retaining them.
So whatever it is with like coaching,
support, mentorship, clinical education,
journal clubs, giving them,
asking what they really want,
ask what they care about.
Like you said this also before, Tony,
like do they care more about money?
Do they care more about PTO and flexible
schedule?
And, you know, like-
those types of things will go a long
way and another therapist that works in a
hospital like if they want to you know
leave early on some days or come late
on some days whatever like a hospital
schedule is going to be very rigid and
you and i could be a lot more
adaptive to those types of therapists like
if they have you know child care issues
they get a flat tire or whatever like
those types of things um can certainly go
a long way right so retaining staff is
you know, maybe one B,
then right after that,
two would probably be the new patient
marketing.
And I mean, of course,
from there is everything else like the
processes and having everything documented
and all that.
But those are,
those are kind of like the foundational
few that would begin the foundation of a
practice that you can then build on for
the eventual resale value that we're
talking about.
You know,
it was interesting yesterday I was
listening to an interview with a YouTuber
and then a couple of guys that just
do Facebook ads.
And so it reminded me of Will Boyd.
We had Will Boyd on the podcast multiple
times.
He switched from all organic to all paid
ads.
And one of the things that were
interesting that they said was.
They need to manage capacity.
Now, I think they were into retail sales.
They did ads for big companies.
Crumble Cookie was one of the companies
that they worked with.
And they said, you know,
the beautiful part about paid ads is when
you need customers, you turn it on.
When you don't want customers,
you turn it off.
And we know from therapy,
like one of the biggest barriers is
managing lead flow.
We get new patients trying to get those
new patients on the schedule when you're
busy.
That's a challenge.
So it
I still don't feel like I understand and
have cracked the code to running effective
paid ads.
That's why you do it really well.
I do it horribly.
I can get a ton of organic traffic,
but I cannot run an effective paid ad
campaign.
And I'm really trying to buckle down on
that.
I really want to work well and figure
that out because I feel like that's such
an important component.
And I love the idea because we also
hear the downside.
The downside of paid ads is once you
turn them off,
you have no customers coming in.
So for me, organic,
I get a ton of organic traffic that
costs me nothing and brings leads,
brings things.
But I don't have the control to go
with paid ads.
And Hilda said PT burnout continues to be
an issue.
Some PTs have chosen to do part-time
clinical, part-time sports PT.
Would there be other pieces of advice that
you could recommend?
We'll talk about burnout in just a second.
So back to,
I think the same marketing strategies and
understanding marketing that you would use
to attract the right patient is the same
kind of infrastructure you would use to
attract the right PT.
And to Hilda's comment,
Let me see if I can put it
up here.
I haven't been in charge of the back
end in such a long time.
There we go.
In terms of like this, so, you know,
marketing,
understanding how paid ads work,
how targeting works,
how the algorithm works.
If we wanted to attract a sports-based PT,
you know,
having that skill set is important.
I would say more important is knowing how
to attract the right PT.
than it is knowing how to treat the
patient.
Because I just think you can always find
PTs to treat patients.
You don't necessarily have the ability
intuitively to attract the right PTs.
Does that make sense?
I agree, a hundred percent.
So let's talk about burnout real quick
since Hilda brought it up.
I still think the biggest contributing
factor to burnout is just being forced to
treat the wrong people.
you know being in a setting where you
have to treat everybody who walks in the
door no matter what no matter whether they
want you to treat them no matter whether
they want what you have no matter you
know their personality this will be a
segue into the the um personality tax
we'll call it where you know you are
in a situation where there is an
individual that um
Just the personalities didn't jive like
they were in a match.
I've got patients like that.
I come into my clinic and what I
do is I intentionally split them between
my PTA and myself.
I took two challenging personalities
recently because before that,
a lot of the challenging personalities
went to my PTA.
I took the last two challenging
personalities,
but then the third challenging personality
that came in the door went to my
PTA because I was like,
my docket is full.
No more room for challenging
personalities.
So, we're in a third-party payer model.
I can't charge a premium.
Obviously, you can.
So, let's talk about that experience.
Real quick.
So,
How the Gallup poll from last year,
from twenty twenty four,
the state of the global workforce report,
I want to talk about we're talking about
burnout,
but we're also talking about just either
disengagement or dissatisfaction,
unsatisfied employees across the country.
Sixty two percent of employees globally,
globally, not even domestically,
excuse me, globally,
sixty two percent of employees globally
are disengaged.
Fifteen percent are actively disengaged,
which would be you're purposefully
disengaging from your work,
which would be seventy seven percent.
So how is that?
So I'm stepping out of health care for
a second.
I'm talking about this is global and this
is across all industries.
This has to be part of the problem.
This is not just healthcare.
I pulled up something else separately,
another blog that said the top five most
burned out industries in America in twenty
twenty five, of course.
OK, yes, health care is number one,
but then education, right?
All the teachers that are doing great work
that are not recognized or they're
underpaid or whatever hospitality.
So, you know, servers, waiters,
hotel workers.
Number four, construction,
the construction industry.
Number five, I.T..
So those are some pretty big and prominent
industries, and it's not just health care,
even though health care is number one on
this list.
But let me ask you again, Tony,
sixty two percent of workers across the
entire globe are disengaged,
meaning they must have something that they
don't like about their job or something.
I think that's the bigger conversation.
I agree with you that maybe the health
care thing is there.
therapists or employees are being either
they're they're being forced to treat
patients they don't want to treat or if
you're in a hospital system and you're
having more and more roles and
responsibilities and tests added to your
plate when uh you didn't realize that was
the case when you signed on and joined
or i don't know but whether you want
to talk about and answer just directly
about uh healthcare tony that's fine
But this, I think,
is the root root cause of like,
how are sixty two percent of global
workers across every industry,
how are sixty two percent of people
disengaged?
Are we meant to not work?
I don't understand.
Like, it's crazy.
No, I think we know.
I think we know every human needs work,
needs something challenging,
needs something productive,
needs something that has a meaningful
impact.
I think in our core,
that is a fundamental part of life is
we need something to challenge us and to
work towards.
Now, I think that, you know,
and I don't want to sound like the
classic boomer or Gen X,
but I also think we have to understand,
like, what are young people being told?
What is the expectation?
Like,
I don't think I'm going to go with
the benefit of the doubt.
I just don't think younger employees,
older employees,
I don't think they expect everything to be
amazing all the time.
But on the flip side,
we're talking about subjective judgments.
You know, it's like, this is hard.
Well, what the heck does hard mean?
Hard is a very subjective word to use.
I hate when somebody says something's not
fair, something is hard,
something is whatever.
There's zero objectivity in that.
And what I want to look at is,
okay,
where's the fulfillment you're looking
for?
What are you expecting?
And then when that doesn't happen,
What do you do next?
And that's the question.
So you get a job as a physical
therapist.
Why?
Because I want to help people.
Okay.
You get there.
You realize a lot of people don't want
your help.
They don't want your help at all,
or they don't want your help in the
way you want to help them.
You want to do manual therapy.
They don't want it.
You want to do exercise-based functional
therapy.
They don't want it.
Whatever the thing is,
now you're sitting on a decision.
What do I do next?
So Hilda was saying, okay,
we move out of home health,
skilled nursing,
we move out of these environments,
but maybe we can't find a full-time
position doing what we want to do.
So then you say, well,
I'm going to take a job that's going
to pay me a ton of money.
There was a post that I had ready
where somebody was saying,
I love outpatient ortho PT.
I'm thinking about going into home health
because there's so much more money,
so much more flexibility.
And you kind of say, okay, look,
I know I need to afford a lifestyle.
I'm going to do this for the money
I want.
And on the side,
I'm going to do this to fuel my
passion, to do the things I enjoy.
The people that I want to treat,
delivering the service that I want to
deliver,
it's just not that valuable to the people
I have available.
So I'll take less money.
But I'm going to put on my big
boy pants and I'm going to go get
a job that pays me what I need
to make to support my family and my
lifestyle and the other things that I
want.
You know,
but I think if you go in thinking,
well, no,
I want to get paid one hundred and
fifty thousand a year doing the things
that I want to do,
the way I want to do them,
the time frame that I want.
Plus, I want work life balance.
Plus, I want all of these other things.
that's where you're gonna be disengaged.
That's where you're gonna be frustrated.
You're not gonna have the alignment that
you're looking for.
But that's a personal decision.
It is totally your choice to get
frustrated,
remain frustrated because you're choosing
not to do the things that move you
toward your goal.
Okay?
Yes.
Yes, it is your situation.
If you're burnout,
find a different situation, right?
Maybe you need to change jobs.
Maybe you need to move states.
I don't know.
But if you stay in that situation and
complain on Facebook groups anonymously,
I think you're a little bit part of
the problem.
I think you're just feeding into the group
think where now you just start shouting
what other people are shouting.
Yeah.
I never understood.
And I get it.
Like, yes, there's family.
There's other commitments that are going
on.
But there's always options,
even even if you just take your clinical
brain outside of health care,
like you are kind of referencing.
There are so many other things that we
can do.
The skills we developed as a therapist
roll over into everything, even from,
you know,
plumbing and electrical equipment.
to party planning,
like taking your clinical knowledge,
taking your ability to identify a problem,
develop a plan to solve the problem and
move the customer from where they are to
where they want to be.
That would apply to every single other
profession out there.
And so if people are willing to pay
more for you to be a party planner,
then go be a party planner to make
the money.
And then you can still treat patients on
the side as a hobby.
Another thing real quick and we'll wrap it
up.
The Gallup poll of,
seventy-seven percent of employees are
disengaged at work.
Seventy percent of the variance in team
engagement is due to the manager.
If that's part of the problem,
you find a new manager.
And if you're, you talk above, you know,
if you try to go above the manager
and you know, the management's like, well,
they're a good clinic director,
they're a good manager and they're
treating patients.
So they're productive and whatever,
then you might just have to leave the
company.
You might have to go find another job.
If they're not gonna change the manager,
if the manager is not gonna change or,
you know, improve or lead differently, or,
you know,
change how they're managing you.
If that doesn't change, then yes,
you have the ability to look elsewhere.
Go on LinkedIn,
ask colleagues what else is available out
there, probably nearby,
probably in your town or city,
maybe a little bit further away.
Maybe it's a state or two away,
but there's a lot of great opportunities
out there.
You have to just go look for them,
but please don't go into Facebook groups
anonymously and continue the chant.
I saw you appreciated my call out of
the anonymous person who is like, hey,
I'm thinking about going into business.
I want you to tell me who your
customers are, how much you charge,
what you get paid.
It was like five direct questions for
pretty personal information about
business,
and they want to ask it anonymous.
I don't care.
I don't generally mind anonymous posts,
but that one was over the top.
Yes, you called it out,
and then they got mad at you.
There you go.
Which, after they made their comment,
or I don't remember what it was,
I don't think that was a therapist looking
to start their own business.
It was somebody doing market research on
something.
Yep, yep, yep, definitely.
So anyway...
Having crappy managers is nothing new.
That's gone on since the beginning of
time.
The whole function of a manager is to
kind of squash creativity,
to move the business toward the average.
It always works against the best.
It always protects the worst.
When you get to a size of an
organization that actually has a
management team in the middle,
It's not the kind of thing that's going
to support and promote you as a innovative
individual.
But I had crappy managers.
And like you said,
like the reason why I went into business
for myself was because I knew I could
get better outcomes.
I could I could be more creative.
I could build a business that I wanted
to build outside of working for a
hospital.
But, you know,
hospitals and larger corporate,
they're always going to attract a certain
type of person.
And the most successful in those
organizations are never going to be the
most successful outside of those
organizations.
It just it pushes toward mediocrity.
And that's what they were designed to do.
Right.
What was what was the second topic you
had?
Another really good one.
The the supplements, the pill pack thing,
or was it the what was the other
one?
we talked about transferring value,
selling, you know, practices.
Oh, the,
if you have a rude prospective patient.
Yeah, yeah, let's go into that.
Charging them a,
I called it something different privately.
I'm sure you don't want to mention that,
but I call,
I said like a rude person tax.
So if you get a rude caller,
they want to do business with you because
they were referred by a very big physician
or a hospital group, whatever, you know?
And they're like,
we heard about you from so-and-so.
So it's not,
it's not like they're just picking anyone.
They called us, they called us,
they called you for a reason.
They're like,
you were referred by so-and-so and yeah.
So do you want me to tell the
story or you want to just kind of
go into like what you would do with
this type of a personality calling in?
Well,
I want you to kind of give some
context, but I'll go a little bit here,
just like with pricing.
So you could go the route of saying,
Hey, this is surge pricing.
When, when competition goes up,
when more consumers want a limited
service, you raise the price.
Like that's standard market dynamics
across all of history.
But if you call it surge pricing,
you're going to get hammered on social
media.
So you can't call it surge pricing.
Instead, you say, this is our price,
but we're going to discount the slower
times.
We're going to discount.
We're going to give you a forty percent
discount,
fifty percent discount if you choose less
popular times.
this is something similar.
So when you have a high maintenance,
complex individual,
and when I say complex, I mean,
they expect more than the typical
customer.
It's not that you're charging them more
because that would be unethical and that
would be bad.
It's that this is our premium pricing for
somebody who has the needs of somebody
like you and everybody else can get
discount pricing because they don't have
quite the standard that you have.
So that would be my approach to something
like that.
You know what?
I think that's a great idea to use.
Like, let's say on a future phone call,
I could use that.
Okay.
I could use the higher dollar amount as
a price anchor and be like, well,
do you have these expectations?
And do you need us to, you know,
you're out of state and you're calling for
your son or daughter.
That happens all the time.
Or it's you're out of state and you're
calling for your daughter.
mother or father right it could be the
the parents sometimes pulling for a twenty
thirty year old yeah which first that that
right there is a red flag right there
exactly it typically is a red flag it
is typically continues to be a red flag
um sometimes the family is called there's
the
the adult is calling for their mother or
father who's, you know, sixty, seventy,
eighty.
But the son or daughter is out of
town, out of state, and they want,
you know, weekly notes and, you know,
things to be sent.
And sometimes there's like multiple
family members,
so it's someone who's calling in that's
fifty or sixty years old,
they're calling in for their mother or
father, but then there's like, you know,
their brother or sister,
so sometimes it's like two or three people
in the mix,
and it's like a group text or it's
a group email, and they want, you know,
notes sent weekly or whatever, so yes,
I could say to prospective patients today,
if you don't need any of that like
that that cost and if you want we
can get into some of the pricing that
i that i pitched that cost this but
it doesn't sound like you need all that
so by but i'm going to say it
to you tony i'm going to say it
to you over the phone and say this
is how much this costs you hear it
it actually would be a price anchor we
price anchor anyway we price anchor by
saying the weekend visits are a little bit
more expensive and the weekday visits are
a little a little less expensive weekend
visits are premium and week uh weekday
visits are this um
So I could potentially save that dollar
amount on every single phone call as a
price anchor and most of the time folks
are not gonna pay that because what I
sent to you guys is,
the highest that I've ever charged ever.
Uh,
and we can get into some of the
details of why or, and what else, uh,
what other expectations, but, um,
part of the story was the,
the parent was calling us to, uh,
get a portable treatment table, uh,
purchased with their card, not,
not my card purchased with their card and
then sent to the home in Manhattan.
But it's a
It's a walk-up, like a brownstone.
There's no doorman or anything like that.
It's not like I can just have a
ship there,
And then the client wants someone to kind
of like bring the treatment table inside,
walk it up the stairs, set it up,
whatever,
and have it ready for when my therapist
actually is going to be doing the visit.
So, of course, you know,
you could use TaskRabbit type folks for
that.
You could have your physical therapist do
it and pay them for that.
But that's kind of the situation.
And from this phone call,
as a little cliffhanger,
do you want me to go into the
pricing?
I'm happy to disclose it.
Yeah,
I think that's what people need to hear
because they will not believe it in most
cases.
Yeah, so.
So because of pattern recognition and
hearing some of these things on the phone
call and what the parent, what the actual.
Part of the decision,
one of the decision makers,
even though the patient is an adult
legally, I said, well, yeah,
so we have a concierge fee of nine
hundred and fifty dollars per month.
And then it's five fifty per visit.
Now, that is for this case,
and now we're going to call that –
you're helping me call that like that's
like our standard pricing now.
On the fly,
you're helping me say this is our standard
pricing.
If you're outside of New York City or
San Francisco or Chicago or, I don't know,
Miami or something,
I know those dollar amounts sound insane.
I get it.
I can't even believe they said yes,
but then again, I did Google the family,
and I was like, oh, okay, yeah, yeah.
They have –
very expensive homes that are on google
let's just let's just put it like that
so uh so real quick let's pause right
there a second let me break down a
couple things so i've been going down this
new grad and student pt rabbit hole on
tick tock i sent you a couple of
videos and one of the things that you
know recent grads new grad students i
don't think they fully comprehend
You said it when you said pattern
recognition,
whether we're talking clinical or
personality,
like we can generally understand the
pattern of the individual coming in the
door,
talking to us on the phone pretty quickly
because we've got so many years of
examples that have kind of confirmed.
Now, do they establish a bias?
Yes.
One million percent.
I try to recognize my biases.
I have them.
I try to put them on a shelf,
but I don't completely ignore them because
they do help guide clinical decision
making, business decision making.
And I think the true value between you
and a new grad who might be just
as clinically skilled as you
is the fact that you can layer on
these other deeper analyses of the
personality, even for you,
like we do this at times,
we have done it,
where you go on the property tax records,
you see where they live,
you see their house,
you find all of this information.
It's not just about saying, well,
how much money can I charge?
How can I maximize my rate?
It's also about who is this person?
What can I expect?
How can I kind of predict a little
bit about what to expect from this
individual based on the information I can
collect?
What are they going to demand of me
in terms of time or effort?
And what are their expectations?
I think all that goes into it.
Yes.
Okay, so keep going.
So they said yes, and I was like,
oh my gosh,
I can't wait to tell Jimmy and Tony,
that is crazy.
So yeah, anyway,
we're in the process of the table,
the portable treatment table has been
purchased and will be sent there.
But part of that about,
the impromptu boosting of prices and
adding a monthly concierge fee,
which I've always kind of thought about
whether annual or monthly.
Um, but, uh, the, the caller was saying,
well, cause I, I, she was like, oh,
you know,
you bring a portable treatment table or,
you know, whatever.
And I was like, no, no, we don't.
Cause we're, you know,
our therapists are in the subway and all
that.
And they're like, well,
you know, well,
you were referred to us by so-and-so and,
you know,
she's not gonna get treated on a couch
or her bed or a carpeted floor on
a yoga mat.
Those are things I usually say,
that we usually say on the phone call,
like,
know and we have some people that we
have some clients by the way that like
they've been with us for like a year
or two and they're fine being on a
carpeted floor or a yoga mat or their
couch or whatever and they're fine with
not buying a portable treatment table
because some clients just don't want to
have they don't want to they don't have
the extra room for it they don't want
to slide it under the bed they don't
want to put they don't have room in
a closet whatever and so this caller was
uh
I said to you guys almost like berating
me about like, and also saying like, here,
here's a tip to it.
Here's a tip to improve your business
model for clients like us.
And I was like, Oh, I was like,
wait, I was like,
wait till you hear the new pricing.
Yeah.
So pricing didn't phaser.
In your own words, in your own mind,
like forget the sales part of it,
forget the customer,
forget all the other stuff.
Like how do you rationalize in your own
mind why you would charge almost a
thousand dollar a month fee on top of
the per visit fee?
Like what does that allow you to do?
What is the benefit, you know,
to the customer for paying a fee like
that?
so directly how i make sense of it
is if the if a parent is calling
in for their child but the child is
an adult i already know in general i'm
generalizing i already know the type of
family and and and
patient and the expectations that the
caller, the parent, expects.
They're going to expect a lot of
communication.
They're going to expect promptness of the
therapist's arrival.
So now it's like,
I got to tell my therapist, hey,
the client at this address,
you need to wear
Professional clothes.
I know you always do,
but I'm just reminding you,
like you need to like be, you know,
your hair groomed and like you need to
be prompt.
You can't just be thirty minutes late and
not text them.
Like if you're in stuck in the subway,
you need to be texting the client like
we need to be fully prompt on every
aspect.
So professional dress arrival
expectations.
That's with the adult client.
but then the caller the parent might also
want i don't know they might want some
you know weekly or monthly or whatever
check-in so all that takes time and effort
even if it's mine even if the therapist
is sending emails or text or whatever to
the parent um the the the the client
is an adult right so i think i'd
have to get like and this is rare
but i think we'd have to get like
a like a hipaa release sign i'm not
sure because they're an adult um so it's
like
I already can tell that I'm going to
be not spinning a lot of plates,
but there might be a lot of extra
random admin requests and burdens and
tasks and things to do.
So you pitch this type of pricing because
I've anticipated this.
I've been in these homes before.
I've treated both of these types of people
before.
I've treated the parent.
I've treated the son or daughter of this
type of a parent.
I know exactly what...
might be demanded of us and i thought
uh i thought you know there might be
some pushback on the price and there
wasn't and i joked with you guys that
like i didn't ask for enough money haha
but um i think also this pay structure
might also uh get their attention because
when i happened to call the caller when
i called the parent she was receiving
physical therapy somewhere else
Like she was literally in a physical
therapy visit.
So I also know that most likely that
the physical therapist she was going to
does not charge like we do.
So that's another way to catch someone's
attention.
This type of a client, they didn't say,
she could have said to me, oh wow,
that's more than my other PT elsewhere,
because I know that that physical
therapist elsewhere is not charging a
five-fifty visit,
and definitely not charging nine-fifty per
month as a concierge fee.
So that's another thing that's kind of,
maybe you can elaborate more for me,
because it's more of something that would
catch someone's attention in this
this style, you know what I mean?
Like they would,
they would take us a little bit more
seriously.
It's you're speaking the same language,
you know?
And, and I was just, again,
I listened to a lot of media.
I was listening to a public speaker
yesterday and she was saying how,
when she had her first offer to do
a paid public speaking event,
the company that wanted to bring her in
said, you know, how much do you charge?
What's your fee?
We want an hour.
She said,
And in her mind,
five hundred dollars was unbelievable
because she was used to making fifty
dollars an hour in a W-two paid job.
And she was like,
I would have done it for free.
So I thought, oh,
I'll ten X what I'm what I make
normally and charge five hundred.
Then the story goes,
the company chose not to hire her and
they went with somebody who was charging
five thousand for the hour.
And then she asked him,
why did you not hire me?
And she said, well, truthfully,
you were only charging five hundred.
This person's charging five thousand.
We're used to paying for, you know, five,
ten,
even one hundred thousand dollar speaker.
We can't deal with a five hundred dollar
speaker, you know.
And so just by speaking the language of
a wealthy individual,
they don't understand those rates.
Like,
why would somebody who I expect to be
premier, best in class, top of the line,
why would they be charging so little?
So you kind of have to get into
that world.
And then, of course, once you get there,
you know, you start to realize, oh,
these zeros don't really have the same
impact to them as they do to me.
If anything,
an extra zero just means I'm that much
better, you know?
And so...
I think that's a huge barrier for so
many clinicians because so many are
struggling day to day to just pay their
loans.
Like they can't even fathom an extra zero
or two on the end of what they're
used to making.
So I think it's awesome.
And like you said,
I think the whole idea behind that kind
of monthly fee is it just builds in
the cushion to allow you to deliver what
the client actually wants.
These aren't individuals that are looking
for government-funded healthcare.
These are individuals that have the means
and the resources to get what they want
well beyond what government-funded
healthcare is designed to deliver.
Let me pull this up real quick,
because this is still kind of in line
with what we were talking about.
This, I'm going to share it.
Let's share this instead,
and let me pull it into the screen.
This was shared, I know it's small,
but I'll read it,
in the Doctor of Physical Therapy students
group.
And I think this kind of goes along
with the same idea.
It says, hello,
I'm writing out of curiosity and insight a
couple years out of PT school,
working in an outpatient orthopedic
setting since graduating.
I was curious if anyone has any previous
work,
previously worked in outpatient ortho,
and they've been thinking about switching
into home health.
I guess the main question is,
has anyone been in the same boat,
made the switch?
What's your take,
your experience on the decision?
There's that,
but before you answer that one,
the other one, I'm going to share it.
Let's see if it's showing.
Yeah.
This one says,
recent grad got extended a job offer in
a cash-based practice.
So one is an ortho PT thinking about
going to home health really because it
pays more.
The other one is new grad getting an
offer from a cash clinic.
Following successful interview process,
the clinic owner,
I was asked to provide a desired
compensation.
So first question, Dave, in negotiation,
they always say,
don't put the first number out there.
Let the other party put the first number
out there.
but this person saying the clinic's hourly
rate is two hundred and forty dollars an
hour i'll be responsible for attracting
patients and managing my own schedule the
clinic owner has agreed to cover
malpractice ehr utilities which i thought
that was weird and other expenses um
they're also offering a retirement plan
health insurance what do you think would
be a fair compensation package for me to
request
All right.
Which one do you want me to hit
on first?
Let's do this one.
Cause this one's more in your world.
Like what would they be looking at?
You want a dollar amount?
Like just, it could be a dollar amount.
It could be, Hey,
if this practice is billing two forties
session,
like how do you even go about figuring
out what you would charge?
If they're being paid hourly.
It didn't say whether it's hourly or being
paid per session.
I'm going to say they're probably offered
a per session rate.
Because it says they're responsible for
attracting patients and managing their
schedule.
I don't agree.
There's no way.
I know this is anonymous,
so we can't even ask the person because
they wanted to post anonymously.
There's hardly any practice.
I don't even care if they're cash-based.
If you're a cash-based practice,
you are not really relying on your staff
physical therapist to attract new
patients.
So I don't think that that is a
thing.
I don't even...
Why do you say that?
Because if there's a cash practice out
there, they've already,
and if they're hiring,
that means they typically have already
figured out the marketing.
They already have a customer client base.
There's for me, for me, Tony,
like when I hire new therapists,
they're not doing marketing.
I want them to be,
I want their calendar to be open and
available for evaluations and
and follow-up visits.
They can't get busy unless they do
evaluations.
I'm not sending them out.
I've considered it.
I thought about it.
I have some therapists that have asked
about it.
Like, oh,
do we have to do marketing or whatever?
But no,
I put that in my FAQ document that
I send to every potential candidate that's
like seven or eight pages long.
And I'm like, read this once or twice,
and then we're going to talk for the
first time.
Like when we're messaging or I message
someone on LinkedIn.
And in that seven-page document,
one of the lines is like,
one of the questions that FAQ is like,
do I need to attract and do marketing
for new patients?
Question mark.
And then my reply is, no,
we do the marketing.
We're the business.
That's our responsibility.
We're the owner.
That's that's our responsibility to be the
PT Barnum to drum up business.
That's your responsibility, Tony.
You know that.
So the fact that this says that the
new grad team member is responsible for
attracting patients
What practice anywhere is making their
employees go drum up new business?
That's insane.
I don't think it is.
I really think there are a lot of
smaller cash-based practices that expect
the therapist to attract more patients.
And I'll tell you the typical example.
Usually what it is,
is these are operating out of
CrossFit gym or fitness facility or yoga
studio or Pilates.
They want their therapist.
And I see this in personal training also.
They want the therapist to go connect,
network,
make connections and bring business in.
I think these business owners think that.
The value prop is I've got the platform.
You go out and get customers,
bring them in and we'll do a fifty
fifty or a sixty forty split.
I think they think their business is so
amazing that they shouldn't have to do
their own recruiting and marketing and
stuff like that.
A therapist who's so lucky to come work
for me.
It's your responsibility to go do it.
Okay, let's unpack this a little bit more.
Bo said there's a few like that in
Colorado.
Who said that?
Bo?
Bo.
That's crazy, man.
OK, well, so it's a new grad.
It says, hello, I'm a recent graduate.
That means respect, respectively,
because we all were there.
And man, Tony,
can you imagine my ego in the first
one, two, three years out of school?
I thought I knew everything.
And then I realized whatever the quote is,
like you realize how much you didn't know
or how much you don't know.
so the first couple years out of school
like you might have a little bit of
an ego like you had rotations and you
think you can fix any injury and all
that and maybe you do have great clinical
skills but as a recent grad you're going
to also require some
some coaching, some support.
You're going to get a case,
you're going to get a diagnosis,
a presentation in front of you,
and you're going to have no idea what
to do.
You're going to come out of the evaluation
and be like, I don't know.
I have to blur.
I don't know what just happened.
And I don't know if I even made
a dent in their situation.
So
real quick so the clinic rate they're
charging two forty visit if the new grad
is pulling clients from crossfit or some
other you know running club or they're
bringing in patients to be treated there
then i agree with you tony i think
maybe like a fifty fifty split per hour
so the therapy the new grad therapist is
making one twenty an hour if you're doing
a pre-tax fifty fifty split on that
If the cash practice is supplying the new
patients,
the marketing and the malpractice and the
EMR and the overhead of the practice and
all that, then we're talking like,
twenty-five to thirty-three percent.
We're talking about sixty dollars to
eighty dollars per visit if a cash
practice is charging two-forty because
ideally that would be a great,
that would be a sweet spot.
the therapist is then making, you know,
twenty five to thirty three percent of the
top line revenue of the of the two
forty per visit.
So it depends on the marketing.
If you're a practice owner out there,
if you're watching this and you are making
your team members attract new patients,
you're teaching them how to be a business
owner and they're going to leave you and
they're going to take all these patients
from you.
So please just go learn marketing,
go watch Alex Ramosi videos,
go watch Tony Meritato,
learn Medicare billing on YouTube and
learn more about, you know, marketing.
What's Beau saying here?
Clinician gets about forty four percent.
I agree with Dave.
I think thirty three percent at the top
level
if if um the business is bringing the
client if the business is bringing the
client thirty three percent top level is
totally reasonable that leaves a third for
profitability that leaves a third for
covering expenses and overhead forty four
percent now you're you're starting to step
into
That therapist better be an asset to the
business.
That therapist better start building a
book of business.
They're kind of, you know,
consistently their clients are not
canceling, not no showing,
completing plans of care,
all of that kind of stuff.
But for a typical kind of, you know,
I'm a good enough therapist.
I can get my patients better.
My patients don't hate me.
Thirty three percent, I think,
is where you pretty much top out.
Right on.
Agreed.
All right.
We're at the nine thirty mark.
Let's do parting shots.
So I'll go and then, Dave, you go.
I'm going to say the biggest thing,
the biggest theme from today is.
is understanding the balance between the
business of physical therapy and the
treatment, the care,
the other side of physical therapy.
We're all going to change.
We're all going to go through evolution.
I spent a lot of my twenty five
years focused on the patient care.
It was all about the patient care.
I'd go home and research.
I'd read studies.
I'd learn things that I didn't know if
I had a case that I didn't understand.
Like everything was about the patient.
Now I've kind of moved past that to
my passion is the business.
I love the business.
I love the systems of the business.
I want to make the business better to
support other clinicians who are more
interested in focusing on the patient at
this point.
Doesn't matter where you are in the
journey,
just understand where you are and,
you know,
put your time and effort into what has
the greatest impact.
Dave, what you got?
love it if you're watching and listening
this far in if you're a physical therapist
out there that wants to make a hundred
thousand dollars and treat four to six
patients per day call us reach out find
me you'll i'm easy to find on the
internet uh send me an email apply we
would love to speak with you
If you're a practice owner out there,
it doesn't matter if you're in network.
We do prefer a little bit more of
the out-of-network cash pay models.
But if you're a practice owner looking for
a transition, looking for a buyer,
we have practice owners reaching out to us
all the time,
whether they have a broker or not.
If you're looking to sell,
if you're looking to sell
sixty seventy eighty percent of your
practice and then keep some of the upside
while we grow it reach out if you're
looking to get out a hundred percent and
you're looking to sell and go on to
the next chapter of your life reach out
to us uh at the field maker group
or send me an email find me again
on linkedin or on the internet somewhere
and that's it for me all right guys
come back and see us tuesdays thursdays
eight thirty a.m we'll catch you hi my
name is karen and welcome to the pt
breakfast club podcast