down a little bit you're listening to the
pg pinecast where smart people in health
care come to make noise here's your host
jimmy mckay all right i think we're live
I think we're being broadcast right now.
I want to know if people can hear
us.
So I need someone to comment if the
audio is actually coming through,
because how come we can't actually?
What?
There we go.
Let's do a little quick test.
Live from Graham Sessions here.
This is PT Pinecast.
You prefer Steven or is it Steve?
It's actually a story to that if we
have time.
What's the name?
All right.
So I was ten years old and at
soccer practice.
And a coach called me Steve,
and my mom turned on a dime.
I named him Steven for a reason.
And that has stuck with me for my
entire life.
Well, then Steven it is,
because I don't want Mom Cohen coming
through the live show.
No, not Mama Bear.
This I asked on LinkedIn a few weeks
ago.
because you want to test you want to
test the profession what you assume to be
true is not always true we know this
so i think i asked on linkedin and
i'll find the poll results who here knows
what graham session is and like here is
also biased this is my network or who
can see this right so i assumed because
i've been here before
A lot of the people in my network
have been to Graham Sessions before that a
majority of them know what it was.
It was ninety percent plus had like had
never been to Graham,
not just had never been to Graham
Sessions,
did not understand what what I was talking
about.
So how do you describe who's here and
the purpose of Graham Sessions?
Because you're here with Sarah Health and
we'll get to that.
I mean, I'm still learning myself, right?
Like,
if it wasn't for Max at WelcomeWare
saying, hey, you should come to this,
I wouldn't be here either.
All right.
But then you asked a few questions,
and here's how I describe it.
And you tell me if it's the same
feel that you got, which was,
I think this is twenty years ago,
Patrick Graham, Steve Anderson,
and some other people said,
we need a very small meeting.
We have PPS.
and we have CSM,
we need a smaller meeting.
Okay, what's the goal?
We want a bunch of people in the
room to really hash out.
We want to be able to hold this
meeting in one room and these are the
change makers,
whatever you want to call them,
to solve the problems that we're dealing
with now.
Twenty years ago,
And today, we still have problems.
Hopefully,
we solved some of those problems.
Now, we're dealing with new problems.
And the crux or the twist of this
idea for Graham Sessions is whatever is
discussed here, it's like Vegas.
It stays here.
Well, kind of.
Who said the thing, not what was said?
You're allowed to say, hey,
we brought up this problem.
This solution was brought up.
You...
You can out yourself.
You can say, I said that.
But you can't say someone else said that.
And that's to sort of, I mean,
for lack of a better term,
like safe space.
It's like, dude,
you want to be able to say the
things.
I've been to bars with PTs.
They say things that they would never say
on a stage because that's how the world
works.
So this is supposed to be as close
as you can to get with no repercussions
in a good way.
I mean, that makes a lot of sense,
right?
I think it was Lawrence Benz and one
of his pre-PPS, you know,
heads up to everybody that the truth serum
starts flowing at the bar.
And so it's like, hey,
why don't we just have these conversations
sober for eight hours and probably get
somewhere further than a bottle of pint
glass.
Right.
The other thing is, when this started,
and I don't know what the procedure is
now, but you had to be invited.
It was like, listen,
and we want to cherry pick.
Hey, you know,
and it was sort of the way I
looked at it.
It was sort of like, hey,
I see what you're doing over there in
that little corner.
We want to bring you here.
We want other people to see what you're
doing.
We want to hear from you.
We want you to hear from other people.
And, you know, cross-pollinate.
We want these ideas to leave.
The purpose is...
to have some ideas look at things
differently and then have the ideas of the
those things leave the room so i can't
tell you who the hundred fifty people are
i'll turn the camera around because i
don't want to out anybody this is a
super secret meeting even though ninety
eight percent of people have been saying
on linkedin i'm going to graham sessions
um you looked at the syllabus or whatever
Anything on there?
What excites you about what's going to be
discussed?
And maybe my follow-up question will be,
what are you like, hey,
where's that thing?
So what's one thing that you're excited to
hear this next couple days?
You know,
there's a talk coming up later around what
the PT industry can learn from the
dentistry industry around MSOs, IPAs.
and collective bargaining and
negotiations.
Really excited for that.
Why you?
You got a background.
I didn't know this about you until about
a couple weeks ago when we recorded
something.
You got a little bit of a different
consulting background.
So you look at the world differently.
You just do by your nature.
Yeah.
Spent seven years at Deloitte Consulting.
So everything from helping Caterpillar
employees be able to be more efficient on
the line to negotiating software contracts
and like
the eBay PayPal when they split.
Negotiated, I don't know,
a few hundred million,
almost a billion dollars in contracts.
I couldn't say that so casually.
It was fun.
It was a lot of fun.
Well, they spent a lot of money.
As I'm driving into Arlington last night,
we're in Alexandria right now.
There's a Deloitte building overlooking
D.C.
and I'm like, oh yeah.
They pay for that because they do a
lot of work with big companies and make
a lot of money, right?
Yes, that is exactly it.
And so that,
but also I am the administrator of the
Private Practice Network, IPA.
So it's a PTOT speech IPA in New
York State.
We have six hundred,
I think maybe seven hundred now,
providers across the state,
a few hundred locations.
And we're starting to actually get
contracts for our group members.
And
seeing that, touching that, feeling that,
like seeing that contract,
I've printed it out.
Like that is a real contract that is
paying well.
I don't think I can say exactly what,
but it's paying well.
And our members are going to be able
to benefit from that.
And I don't think there's anything
necessarily like unrepeatable about what
we're doing.
And then the conversation at the bar last
night at the welcome reception is people
are talking about MSOs,
people are talking about IPAs.
And I really think that's a great way
for groups to be able to have negotiating
power and get it to the table.
And payers are much more willing to listen
now than they were prior because
musculoskeletal is, it is their cost.
Like that's it,
especially as more get into managed care.
If you can help that Medicare Advantage
patient not have a fall,
just from simple time value of money,
if you can push that off for a
year,
there's about a thousand dollars in net
benefit to the payer.
That's easy.
And we like that.
Yeah.
You're not only the hair club client,
you're also the president.
So you're here as a sponsor as well.
So you look at our profession from a
different lens again with this thing that
I feel like it popped up on my
radar or when people started talking about
it two years ago, three years ago.
I know it was before that,
but I think people really started to take
it seriously.
And that was remote therapeutic
monitoring.
For people who still don't know,
because there are.
You talk about this a lot,
but there are people who still don't know.
Give me a quick re-rack,
just a quick context on what it is
and how Sarah Health people do it.
Easy, simply,
pays for itself and then some.
You know, I think the, I will,
I will answer your question.
But I think just like ninety percent of
patients that could get PT don't.
I think there's ninety percent of
practices out there that are doing the
work required to build the codes.
They're just not building.
Closing the loop.
Exactly.
And so if you think of RTM as
payment for or a funding mechanism for
time and technology in between visits,
you're ninety nine percent of the way
there.
Right.
Like.
And I'll talk about this later when we
get up on stage for a bit.
To me,
RTM is there to help patients complete
their plan of care,
stay adherent to their home program,
and have a better outcome.
That is what it's for.
That is the purpose.
It's not six codes.
And if you're looking at this like, oh,
well,
I'm only going to be able to generate...
Forty dollars from ninety nine seven
seven.
If the only way you're looking at RTM
is going to hit your P&L is by
those six CPT codes,
you're missing the forest for the trees.
So walk me through where else it touches,
because it sounds like butterfly effect.
But if you're only looking at the forty
dollars, you're not looking downstream.
Yeah.
Where should they should look at the forty
dollars and where?
uh so plan of care completion uh so
we did a retrospective analysis someone
got mad at us for calling the study
uh because we didn't publish it uh for
four hundred eighty patients six months
six i know right we we may make
a big deal about the dumbest things we
keep going yeah that's dumb but yeah i
agree and across the different uh outcomes
measures like lefs coos etc
They saw a nineteen to sixty two percent
increase in plan of care completion.
Why?
Just go to the human level.
Because I felt connected.
I understood.
It's a better relationship.
There's greater therapeutic clients.
It's not a transaction.
Exactly.
Got it.
Exactly.
And so that lower cancellation rates.
And just even those two, right?
You start thinking about what that would
do for your P&L if you're able to
go from six point two to six point
seven visits per case.
If you're ones and twos, that one,
two visit patients that didn't drop off
become fours and fives,
which is what they saw.
And that was dramatic.
Yeah, it's a big difference.
You think about it even against your
point.
I think about it differently.
Like I think about the cost to deliver
a visit, right?
right?
And what your payback period is to even
be able to be profitable as a clinic
on a patient.
And so when you're doing all the work
on verification of benefits,
you have to have your front desk,
you have to have your EMR,
you have to have all these things, right?
Like you have a certain amount of cost
built into delivering an eval.
And from there,
when do you finally turn that over, right?
You, in the startup world,
there's customer acquisition costs,
lifetime value, payback period,
and all that.
I think the same thing applies in PT
too.
Unfortunately, I'm very sorry,
but we have to talk about it in
those terms.
No margin, no mission.
Yes, that we are here for great care,
but if we don't have a roof or
we can't pay our people,
we're not helping anybody.
No.
And then beyond that,
I think RTM used to be looked at
as the end point, like, okay, perfect.
I'm doing RTM now.
I'm billing it like I'm done.
Well,
I don't know if anyone checked what CMS
released in December,
but they released the Elevate program,
the Access program.
I believe before that was a Balance
program.
Access in particular is a value-based
program that pays for improvement in
musculoskeletal outcomes.
So you're going to get paid based on
your outcome.
Now, if you can't keep patients in care,
you're not gonna be able to get paid
for that.
So now, our team,
I think what was the end point,
looking at the end point,
and I give folks that started in
twenty-twenty-two, twenty-twenty-three,
and like, hey, just didn't work.
It's like, yeah,
but the game has entirely changed.
Like, yes, there were two new codes added,
so it went from four to six.
But the impact is going to be nonlinear.
So it'd be like if you increase the
size of a hockey goal by fifty percent,
it'd be more than fifty percent more
goals.
Right.
Yeah.
You probably have taller goalies like
there'd be all sorts of stuff that would
happen.
Wider.
Yeah.
Wrestlers would now be goaltenders.
I think you'd have to go straight to
Japan.
So when someone thinks about, OK, cool.
tactically how do i do this like i
remember the first time someone was
explaining rtm to me i was like oh
i can see pts sitting there at their
desk with uh uh post-it notes or they're
making their own spreadsheets to track
these things and then eventually you hit a
point where you're like dude this sucks
This is too complicated.
But now we have apps and all these
different things.
So specifically with Sarah Health,
if someone's still nodding and listening
along, they're going, okay,
how does this work?
Do I have to invent more stuff or
track these things?
Do I have to hire one more person?
That's a legit question.
Hire one more person just to track all
these things.
Or do I have to take half of
my front desk person's day to do this?
Because if it is,
they're asking the right question.
Is the juice worth the squeeze?
So is it Post-it notes?
I think that's, again,
part of like it's changed a lot since
twenty twenty two.
Right.
When they came out is you're no longer
customer number three,
your customer number three hundred.
And so there's been a lot of really
good technology built.
Like from what I've seen,
what Sarah looked like on day one to
now is almost unrecognizable in many ways.
It should.
Part of that was we actually asked all
of our clients early on and we still
do like show me every spreadsheet you have
to make for this.
Cause we're just going to take it and
then got it.
You're going to ingest it and say, well,
we'll do it better, faster, cheaper,
exactly.
Exactly.
Um,
and so the way that it works with,
I'll talk about Sarah,
but I want to give like value to
everybody.
Like,
I don't care if you're using us or
not.
Um,
have your front desk enroll the patients
that check in for eval.
So they're there.
They're checked in.
They're good.
Enroll the patients.
Don't call it RTM.
Call it something else.
A lot of our groups... To a patient,
you mean?
Yeah.
Okay.
Good.
I like... Yes.
Now we're going into marketing and
branding.
My world.
Yes.
If it has... And Tony Maritato knows.
It sounds like I'm unreasonable on this.
But if it doesn't have a name or
has a dumb name...
People don't attach to it.
So what are good names that you've seen
people call it?
So a lot of groups call it their
Connect.
That's our typical Connect program.
Unless you're on Raintree,
because Raintree has a feature called
Raintree Connect.
So our Raintree customers call it
something different.
like the CareSync program,
the Concierge program.
Like we've seen a lot of really cool
names.
There's another group calls it the patient
support co-pilot,
which it'd be in the right part of
the, you know,
have the right demographic for that to
work.
But that's, that's it.
And then we give a consent form to
each and every one of our practices.
That's white labeled.
And so patients don't know that Sarah
exists, but there's no reason.
We're just a vessel.
Right.
You want them.
to feel the relationship with the
practitioner in practice.
Exactly.
And so from there, gets enrolled.
For us,
patient gets a text within typically one
to two seconds of the front desk
enrolling.
That is a great priming mechanism for the
clinician, that PT, to talk about, hey,
this is our
connect program it allows me to be able
to engage with you between visits because
we know that you spend ninety nine percent
of your time outside of the clinic so
you're gonna get questions can you text me
back because i'm gonna use that in your
fault visits oh so you're not asking the
patients to download an app no no because
if i get asked to download one more
app like literally to park at the airport
i have to download an app to buy
coffee it's like do you have your points
app i'm like no like you might be
giving up your points i'm like at this
point lady i don't i would like the
coffee i will give you money
And what's the probably most used app on
someone's phone anyway?
It's the text message app.
I mean,
I want to avoid calling people as much
as possible.
So they're just using,
they're just texting?
They're just texting.
So what we have is... Stunningly simple.
You have to use a software as a
medical device to be able to collect this
data.
Well,
we went to the FDA back in twenty
twenty three and have our letter for have
them have them look at all of our
functionality.
What are you doing?
They're going to tear it apart.
Exactly.
And they looked at it and said, hey,
based on these two pieces of
functionality,
this is software as a medical device under
enforcement discretion.
And so we went through that process
because we've been at this for almost ten
years now.
And we found early on,
relatively early on,
that we had patients and we were working
with a lot of fire departments.
And so we had a fire department,
Plainfield Fire, Danielle,
who I'll never forget,
she was giving us feedback of why she
wasn't logging into our app.
Wait,
why was the fire department using it?
We were working with the PT and then
PT groups that had some ATC as well,
but PT groups that were directly
contracted with fire and police.
I love hearing stuff like that.
My dad was a fireman.
I'm like, firemen, typically cops too,
EMT, will avoid...
medical care at their own detriment well
because they don't want to be the one
that's like off the truck like oh oh
yeah we've yeah yeah my dad broke both
pinkies at a fire and he was like
trying to hide it and they're like you
sort of need all ten fingers to do
the saw uh so you have to you
have to go away from work but anyway
go ahead so all right so you so
you started with plainfield fire yeah um
and a bunch of fire departments uh but
really danielle was really helpful because
like hey
She gave us a testimonial on like her
recovery process and how much our app
helps.
And then it's like, look,
I just don't need an app anymore.
What I need is a way to talk
to my PT and get reminded to do
my stuff.
Like, oh, you need a text message.
And she's like, well,
better be a good text.
And that was what started.
And then when the RTM code,
that was twenty eighteen, twenty nineteen.
And so we'd been at this for a
while.
When the RTM codes came out,
we worked with a lawyer like, hey,
we want to be like lock and stock
if there's ever a records request.
What do we need to do?
Like, well, you need to...
do this five thirteen G process.
And so that's exactly what we did.
We have had a customer who did get
a records request for one of the codes
we facilitated, gave all of our stuff.
Done.
Wow.
Good for you guys.
What's the what's the what's the thirty
thousand foot view in terms of adoption?
Like, I know you don't have the day.
I'm going to
hold but if you were like i don't
know my gut feels like five percent of
the of pts who can be using this
r or thirty i don't where are we
are we at two percent are we at
eighty i don't i am i am in
the dark and it's an unfair question for
me to ask i know you're making up
a number here i based on what i've
heard from some of the other leaders i
i
i would bet we're maybe at ten percent
have an account with an rtm technology and
is attempting this yep and that's only
gonna go up i mean like you know
five years from now six this is not
a nice to have this is a need
to again it's not the it's not the
end point anymore it's just the starting
line right to get into these other
programs that are coming out and like
If you think that CMS is going to
stop rolling out new programs,
I have a bridge to sell you.
Yeah, it's in Brooklyn.
Super cheap.
Cool.
We'll be checking in over the next couple
of hours, next couple of days.
This is the first time I've ever really
done live streaming on site,
but I live stream from my living room,
so I'm like, how hard can it be?
This is APTA headquarters in Alexandria,
Virginia.
Graham Sessions,
which is put on by APTA Private Practice
Section.
Thank you guys for letting me set up
my mobile studio in your living room here.
I call it Avengers Tower.
Sort of has Avenger Tower vibe.
It does.
That part could get blown up easily.
Yeah, yeah, yeah.
But the goal here is...
I'll be asking everybody who's in a
session right now.
I'm speaking very quietly.
Is there a session?
But just a couple of big picture questions
that I asked you.
What is something you are excited to hear
more about and you want to hear thoughts?
What's something you wish we had?
Oh, it's not on the docket.
Why isn't that being taught?
I was like...
Where's all the AI stuff?
I didn't see one thing on AI really
in there.
AI or even these new programs that are
coming, like the Access program.
I feel like there could have been a
whole thing on that.
Right.
Because if you want to be in the
first round, you need to apply by,
I think, April first.
Oh, we're in January.
I will give APJPPS some grace.
To put on a conference,
you have to get speakers months in
advance.
I get that.
And it came out in December.
Right.
So what I'm saying, though, is, hey,
how do we shorten the cycle of
conversations in places like this,
having conversations?
The answer is live stream.
Why aren't we doing it?
What are you doing in between Graham
Sessions' meetings?
You should be doing live streams,
but I'll be asking big picture questions.
So forgive me.
I'm going to be blowing up your feed
with that.
Damn.
Jimmy McKay is live again.
Again.
Usually it's like once or twice a day.
Now it's thirty seven times and I have
no idea.
I DM to a bunch of people that
I knew were coming and everybody was like,
yeah,
but I don't know who I'll be talking
to.
We're talking to one person at a time
or we talk to a group.
I don't know.
But we have a tradition on the show
and it is called the parting.
This is the parting shot.
One last mic drop moment.
No pressure.
Just your legacy on the line.
What's your parting shot for right now?
Something you just want to leave the
audience as we kick off the live stream.
Thanks for being our guinea pig,
by the way.
I literally just called Stephen over and I
was like, hey, we're doing a lot.
I got to see if this camera works.
And he was like, great.
He didn't say, what are we talking about?
Is this actually live?
All right.
What's your parting shot?
What's just one little thing you want to
leave with the audience?
A story.
And I'll tell it later,
but I can say it again here.
PT Indianapolis told me something that
really changed the way I look at this.
She said,
I never thought I would save a life.
Patient texted through Sarah,
shortness of breath,
three days post-op total knee.
She gets that, has a quick conversation,
ends up calling him an ambulance.
Hospital, only one day, one night.
Fluid on the chest,
as benign as one night in the hospital
stay can be.
Went home with his family the next day.
All it takes is one missed visit because
he doesn't feel well.
And that story ends a lot differently.
So that is what that connectivity can
mean.
That's also why these payers are paying
for it.
Because that patient also could have been
half million plus instead of thirty
thousand.
And the answer,
the solution to that or the facilitator,
that wasn't something terribly high tech.
It was access.
The text.
It's access to someone when they needed
it.
The right person at the right time.
Wow.
That's powerful.
And the right question.
Yeah.
This doesn't feel right.
What do I do?
Wow.
Red flag.
Good for you.
Where can people go to find out more
about Sarah Health?
SarahHealth.com.
So S-A-R-A-Health.com.
And then I'm Steven.
So S-T-E-V-E-N at SarahHealth.com.
Not Steve, as we talked about earlier.
Don't do Steve, everybody.
It's a way to put your foot in
your mouth.
Always make sure you know what your
guest's name is before you start.
Live from Graham Sessions atop the APTA
Avengers Tower here in Alexandria with
PPS.
That's it.
We're out.
Boys, what the hell are you doing?
Follow Tony Meritato on YouTube at Total
Therapy Solution.
Find Dave Kittle at
conciergepainrelief.com and on YouTube at
The Dave Kittle Show.
And follow Jimmy McKay at PT Podcasts on
YouTube, the socials,
and wherever you binge podcasts you
pretend are for CEUs.
And hey, just a reminder,
none of this was for advice.
This was for entertainment only.
Our lawyers say that counts.
Thanks, Keith.