Broadcasting way too early from three
separate Wi-Fi connections.
It's PT Breakfast Club with Tony Meritato,
Dave Kittle, and Jimmy McKay.
Good morning,
physical therapy and anybody else
listening because your clinic Wi-Fi
auto-connected by accident.
Today,
we're talking about three things that
should be unrelated but are not.
An AI company just bought another AI
company.
They're just eating each other.
for a modest,
two hundred eighty five million dollars in
the grand scheme of things.
It's not a billion clinics are growing
while clinicians are well,
they've got one foot out the door.
We'll give you the numbers on it.
Plus,
Dave wants to put a fifty percent money
back guarantee on patient care.
And if that made you uncomfortable,
Good,
because today's show is about who actually
has leverage in rehab right now and who
doesn't.
Let's get into it.
Tony,
step one on having leverage is number one.
You got to have confidence.
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Dave's jumping in there as well.
There we go.
Morning.
I got my confidence spray on.
It has nothing to do with billing, man.
I just... I don't know.
It's...
It's like ax spray.
You just a little armpits,
a little on the chest,
and then we're ready to roll.
Nothing wrong with it.
All right.
We got to go with the big idea.
I just did a little video yesterday.
AI didn't kill PT.
It just bought the front door.
The news broke yesterday.
It was everywhere.
Sword Health acquires Kaya Health for two
hundred eighty five million dollars.
We said this.
We were like, Sword's going to buy Hinge.
Hinge is going to buy this.
This is going to buy all these things.
We're just going to buy each other till
there's, you know,
this is the this is the Highlander.
There can only be one.
it's consolidation, right?
This is about access, correct?
This is not about exercises or apps.
This is about access to people who's got
the best Kung Fu,
who's got the biggest bank account,
and now they're working together.
And I mean,
thank God all the CEOs probably got paid,
right?
I mean, that's the bottom line.
So what does this actually mean?
What does this matter to the average
clinic owner?
Does it?
Is it a signal?
Is it a harbinger?
What is it?
You seem more excited than anybody about
this.
I didn't think anything of it.
I saw the headline.
I was like, OK,
but you seem to feel like this has
a bigger impact.
Well, I mean,
we knew this was going to happen.
Well, here's why.
Here's why.
I hear so much of this or see
something with sword or hinge or kai or
whatever.
And then people are like,
they use words they tell us never to
use in PT school,
which is never and always.
Well,
it doesn't matter what that's happening
because AI will never be able to do
what I can do.
And we're always going to be.
And people who use never and always,
they typically don't have jobs anymore.
So that's what I'm looking at,
which is I don't think this is the
thing.
I think this is the thing on the
way to whatever the big thing is.
Okay, so before I hear from Dave,
I asked ChatGPT and it said the big
impact is market consolidation and digital
MSK care.
That is an interesting keyword.
We were talking about primary care,
primary physical therapy care.
Digital MSK care is something that
probably we should do some SEO
optimization for.
Yeah.
Significant expansion of reach,
Germany and European market access,
broader clinical and product portfolio,
strategic growth signals and digital
health,
meaning it's looking good for digital
health.
Dave, what do you think?
You know,
I used to be more interested in the
tech spaces, obviously.
And I don't know.
I just I don't think it's a big
deal there.
Like Jimmy said, it's yeah,
you're just capturing more accounts and
then they can try to cross sell the
the either the consumers and or the
decision makers of those consumers.
So the employee funded plans or whoever is
offering Hinge Health.
So if I'm sorry,
this was this was Sword who made the
deal.
It was Sword that acquired Kaya.
Yeah.
whatever hinge hinge store whatever like
yeah they're just they're just buying more
users that they can kind of try to
cross-pollinate with their core product
and then they'll try to you know put
it in front of the users they'll try
to put it in front of the other
decision makers at the other companies
where kaya health was already ingrained in
the companies using it uh i'm sorry what
did uh dan batman say dan thank you
for commenting live and being here
Dan's saying it's about investors and
debt.
Same reason why Hinch help went public.
It's about money.
Sure.
Right.
I mean,
you only have so long if you've got
whatever you've got.
Right.
And then if you know you're not going
to be around two years from now,
this is me making my best estimate.
And someone offers you something and
you're saying, well,
it's the best offer we're going to get
in the next three years.
And if we keep going,
we might be here in three years.
You take the deal.
You sell what you have while it still
has value.
That's my estimate.
And I am by no means a big
picture thinker like Dan and other people.
Just I'm just that's not my thing,
but I'm trying to understand it because I
want to know what's happening for a clinic
because here's what I see.
I looked at,
I don't know where the hell my phone
is, which is for the first time ever.
It's not more.
I don't,
I don't think this affects brick and
mortar or mobile or concierge clinics at
all.
Literally.
I don't think that's my question
completely.
I don't think it'll ever affect how,
how will it affect us?
I don't, I have, I have,
I have people that want the in-person
experience,
enough people in New York city that have
enough discretionary income and I can pay
my therapist competitively.
And the people that pay us, uh,
will laugh at this type of a platform
then there's other people that maybe
somehow they come they comment on hinge
health and sword health's facebook ads and
they're like this is cool and this is
you know i get this through my employer
and it's awesome like that's amazing like
cool where are you where where are you
where are you this is a bell curve
where are you are you in the middle
where is my practice or what do you
mean what do you
Where are you?
Are you in the middle?
Yeah, your practice.
In terms of average,
if this is beige walls.
Average of what?
Of using tech?
In terms of usage.
Like, where are you?
In terms of if this is an innovativeness
bell curve.
So I think I was telling you guys
about the AI recording sales apps and that
type of stuff.
So I'm always an early adopter in testing
things out.
But in terms of our offering of our
practice, we're on the opposite side.
We're on the small end.
Let me ask this a different way.
Are there more PT clinics in strip malls
or more clinics like Dave is doing in
New York City?
There's more clinics in strip malls.
Right.
You're over here.
I'm asking what this is going to do
for them.
Nothing.
I don't know, man.
I don't think it's going to do anything.
All right.
I saw this.
I disagree.
I agree with Dave in the sense that
it's not going to affect him.
It's not going to affect me.
But to me,
the middle of that bell curve that Jimmy
is showing is Athletico, ATI.
It's the large, multi...
It's something like Kaiser Permanente.
It's these big groups.
I do think they will see an impact.
I do think it will draw out a
lot of the excess in referrals just
because it's a cheaper, easier solution.
Back to what I said, I think,
the other day.
I don't know.
If I'm going to waste money,
I would rather waste less money than waste
more money.
If I'm going to pay for somebody to
go get useless therapy,
I would rather pay less for them to
get useless therapy.
That's what I'm saying.
And those are the referrals that I think
we're going to see sucked out of the
market.
It's not going to affect you or me,
but it's going to affect those large
organizations that are dealing with
thousands and tens of thousands of CPT
generating machines.
Ben thinks it looks like a mustache from
a guy in the eighteen hundreds.
Come on.
Ben's smart enough to know he knows the
bell curve.
He's just joking around.
He knows.
Dan says it won't affect us yet.
The longer these doors exist,
the more it will change behavior.
That's what I'm saying.
I saw this in two thousand and eight.
And I started walking towards the door out
of radio.
I understood that it's crap.
Do you guys remember the term buffering?
It's not even said anymore.
Like there was a thing, kids,
there was a thing called real player.
That's how you listen to anything on the
internet.
I listened to my first live stream in
a car with my phone plugged into an
aux cord, driving home from work.
And I was like, this sucks.
But in six months,
it's going to suck less.
I could not have convinced anybody to
listen to a crappy live stream on a
flip phone in two thousand and eight.
I'm saying in ten years,
what will this do?
I don't know.
That's what I'm worried about.
This is probably going to affect a middle
schooler right now.
That's what I'm saying.
The middle schooler who's like,
I'll be a PT,
the middle schooler who just tore her ACL,
who's like,
I'm going to go to be a PT.
I'm questioning that.
That's also going to sound smart, too,
is just say your idea is going to
be thirty years in the future and then
you're not around.
You're not around to defend it.
A couple of things that my GPT said
that I thought was interesting.
It it's saying that Hinge Health still is
by far the market dominating company.
It said that Hinge is more positioned for
wearables,
which I didn't really even think.
I don't know the difference.
Yeah,
basically it's saying Hinge is more about
wearables.
It's got a larger U.S.
member base,
larger investors with the IPO that's
happened.
Sword is just trying to kind of gain
market share,
but it's not even close to what Hinge
is capable of right now.
Hinge has the connections with the
employer base and the payer base.
But it keeps bringing back this thing
about Hinge being connected with wearables
that Sword doesn't really do.
And Sword has apparently more of an
emphasis on live clinician interaction
that Hinge doesn't necessarily do.
We briefly talked about this a while ago
about some of these companies sending like
a wearable device to someone's home so
that it can track their repetitions,
the range of motion, whatever.
My stance on this was that's ridiculous.
And in general,
over time and across the country,
People are not going to just like there's
these EMS suits.
Have you seen these EMS full body suits
with electric EMS electro simulation?
And I talked about it.
There are personal training companies
doing it.
Yeah.
It's people get sore afterwards.
People say it's a great workout and that's
fine, but there's so much to put on.
It's like,
it's literally like you're going to have a
wetsuit on.
Like you're going to go,
you're going to go,
you're going to go surfing right now in,
you know,
it's like a wetsuit with EMS and all
these electrodes and it activates your
muscles or whatever.
So it's like this big new, you know,
trend in personal training.
But that's just too much.
You're sweating into it.
Now it's got to be hard to get
off because it's wet and tight.
It sounds like a horrible...
Sounds like a good Friday night to me.
We had one client that has tried it.
One of our physical therapy patient
clients has tried that, and they liked it.
But in general, it's just too much of,
I think, a new thing,
too much stuff to do,
and even a wearable...
like it's just it's just not the right
thing i remember i poo-pooed the wearable
thing and i got tony's approval he you
agreed with that that's like not the no
like just like a wearable like a i
don't know like a wrist thing or a
leg thing or something like if hinge
health or sword health were to send yeah
to every knee pain patient or whatever
yeah if it's not a thing i'll just
normally like a watch like if it's not
going to do another thing i don't think
people will do well i don't know there
will be the edge people i mean because
people are wearing whoops
the rings,
there's also a little psychological signal
there.
You know what I mean?
This is why I get the Iron Man
tattoo.
It's like,
I want other people to see it.
You know what I mean?
It's a little bit of that.
If you're at home doing your knee
exercises with a wearable through hinge or
sword or whatever in the future,
no one else is seeing that.
Yeah, if you take some social media video,
you take a video of it and you
post it online.
If you're a true patient that's
like, it's a different wearable.
It's outside of your normal things.
Like you're saying, Jimmy,
it's not a watch.
It's not a normal thing.
And so I don't think there's going to
be long life of those wearables
regardless.
Ryan Eder, I had him on the show,
I think,
and I'm going to have him either just
out soon.
He's big into computer vision.
You're not going to have to wear anything.
Like you're going to wear a watch for
like the biometrics,
but like in terms of range of motion
or like all those things,
it'll be a camera that you won't even
have to think about looking at you to
measure all those things.
Like we're not, it's there, we're here.
Hey,
if regular exercises fixed all orthopedic
and musculoskeletal pains,
then we would never get referrals from
personal trainers.
Personal trainers would be just fixing
aches and pains and chronic pains and all
this forever.
So again, I will stand on this,
that this hinge sword health stuff is
short while it's here.
It's not going to be long lasting.
We talked about it before,
but for people that benefit from it,
that's amazing.
That's awesome.
And if you don't need to pay out
of pocket or you don't need to do
a copay and go to Tony's office, whatever,
that's great.
That's fine.
But then you're going to have questions
and you want to speak to a specialist
like Tony that has experience.
And you want, again,
then you get sucked into the environment
and the cheers experience and the office
and all that.
That forever,
I don't care what technology...
improves and changes over time the
experience of either the one-on-one what
we do or the one-to-many in tony's office
with that environment is what people will
want for millennia in my opinion
regardless of any technology
You know, I think it's interesting.
In my clinic, I would basically say,
and this is like Midwestern steel town,
you know, it's not where Dave is.
Most of my geriatric patients have a
smartwatch.
Most of them get alerts and messages,
texts and all that stuff on their
smartwatch.
I was just looking at some numbers.
So Apple,
obviously the biggest smartwatch
distributor, Hollywood.
uh,
two hundred and eighty one million million
units sold as of two thousand twenty four.
However,
Apple Watch shipments declined nineteen
percent year over year in two thousand
twenty four.
Personally,
I don't think the market is in wearables.
I think the market is implantables.
We have patients getting total knee
replacements where they're they have the
technology in the implant so that they can
measure range of motion,
they can measure step counts,
they can measure that stuff.
We have patients with the watchman
implant, you know,
pacemakers like smart devices that are in
your body.
I really like this is now getting to
the point where it's not like you forget
to put your smartwatch on.
I never wear a watch.
I hate watches.
I don't wear jewelry.
I don't have a necklace.
I barely I wear my ring.
That's about it.
But putting it in your body,
I think that's where this is going to
go.
Yeah.
I mean, guys, look,
X-Files and those sci-fi shows from back
in the day, it's amazing.
There was an episode...
Were you guys X-Files or am I the
only...
Well, let's go back.
We'll come back to that for one second.
No one's going to get implantables for
normal physical therapy though, Tony for,
for a surgical procedure.
Sure.
Okay.
Let's say in the future,
every surgical procedure,
you implant something that's going to then
track their range of motion or their
cadence.
They're walking,
they're standing versus sitting rate,
whatever.
That sounds super cool.
Like that makes a ton of sense,
but how many knee replacements are done in
the country per year?
Like a couple hundred thousand.
Over eight hundred thousand, I believe,
in the US,
most of which is which is which is
typically overdone,
like in other countries.
But that's the thing.
Like,
I don't think I've seen a patient come
in after their first knee replacement who
didn't book their second knee replacement
six weeks in the future.
Every single one of them is coming in.
I'm bone on bone.
You just walked across the room fine.
But yet in their mind,
they're bone on bone and can't function
without a second knee replacement.
But that being said, like,
take this through the next logical step.
OK,
so we've got smart devices being implanted
right now.
Why wouldn't there be a knee replacement
that does the exercise for me?
We had a passive range of motion.
Like now we're going to be at the
point where we put a knee replacement in
that does the range of motion for you.
You just measure it.
You skipped ahead.
I thought you were going to say implant
the knee that can measure use and range
of motion.
That's already there.
The knees are already there that measure
step count, that measure range of motion.
I didn't know that.
We've got that in the clinic right now.
They have the app on their phone next
to their electronic knee.
Why not have the knee that walks for
you, that does your range of motion,
that stimulates the muscles,
that has EMS in it,
that makes you whether you want to or
not.
It's going to need some really big chips
from NVIDIA,
and they're probably too big right now to
fit inside this knee replacement.
For all the stuff you're talking about,
for EMS.
Yeah, but those are smaller.
But in terms of like an EMS and
to make someone get up and move.
And can you imagine a patient that's like
sixty eight years old and they're like,
I don't want to move.
And their knees like making a move and
they're like having to stand up.
I don't want to move,
but the knees moving anyway.
What are you going in for for surgery?
Ah,
they got to replace my knee replacement.
They got to update my iOS on my
knee replacement.
And that's, you know, they got to do,
that's a hard replace.
They got to plug,
they actually got to plug in.
Ben said, there's a company doing this.
And frankly, the data you get,
it's not worth the cost yet.
There we go.
Ben,
I'm going to say yet after all of
that,
you can get most of the same info.
Yeah.
Unintended consequences.
Absolutely.
Yeah.
Well, I mean,
somebody in the comment section below,
right?
Whenever you start talking about this
stuff,
you start talking in logic and people
respond with emotion.
It's human nature.
I'm guilty of this ten times a day.
People will never, AI will never,
robots will never
And I just say, yeah,
like it will never replace.
This is where like now you go the
other side of the pendulum,
which is like it will never replace our
hands or our minds.
And I'm like, I don't know.
The AI robot has entered the chat.
The AI massage thing has entered the chat.
I don't think it will replace things.
All of those things.
I'm asking how much of the mustache.
will it will it capture it always affects
the middle first that's the financially
the best place to go for and it's
the easiest place because beige painted no
no it's the it's the it's the innovators
first which is the smaller one side and
then the middle is like uh mass and
then the other side would be the laggards
what i'm saying is the the early doctors
innovators and then the middle is the mask
go ahead
Right.
I'm saying any innovation in terms of
population, who's most susceptible?
It's not Dave or Tony who have innovative
anything.
Who's most susceptible to innovation?
The PT clinic who's got beige painted
walls in a strip mall who hasn't innovated
in twenty years,
they will feel this punch first.
We're going to talk about prompts report.
The clinic that's about to die will be
affected by a two percent change in
something like this in three years.
You guys won't.
It's not even a speed bump.
This is a gnat on your windshield.
This could cripple the ones that are
already circling the drain.
They're the most susceptible.
The ones that either have... Yeah,
it could be.
The ones that have slim profit margins and
or lower perceived value from their
average professional client.
That's what I'm saying.
But what I was saying a second ago
is people will say, well,
it'll never be able to do this.
It'll never be able to do that.
And I understand that.
Except all it takes is...
two percent of anything and that ram the
ramifications that math maps why are we
looking at what is that wally wally i
mean for for decades i assume the future
of humanity was this but for the first
time ever
I'm realizing like we've got the weight
loss drugs.
We've got the technology to force people
to exercise whether they want to or not.
We've got implantables,
not just wearables.
I really think we could be at a
tipping point here where whether somebody
wants to.
I was just listening to an interview where
they talked about removing memories from
your head.
So if you wanted to take a memory
out, they could find it.
They could zap it and it's gone.
Eternal Sunshine.
It's a scary time.
I'm not denying it.
That could fix some mental health.
There might be some good use cases there.
That's a movie.
That's what I was going to say ten
minutes ago.
There's an X-Files episode.
The entire episode is shot in a sushi
restaurant with Dana Scully and Fox
Mulder.
No humans...
are involved you order with an app it's
a sushi right you order with an app
and then there's machines in the back and
there's a problem of course with with
molder's order and then it's it even keyed
on the tipping how much do you want
to tip and molder was like no tip
and the app was giving him crap all
that was ridiculous ten years ago when
that thing came out it's not ridiculous
anymore do you guys have this
The shopping cart at my supermarket right
now, I'm not even that edgy.
I'm not in a big city, right?
I'm an hour from New York.
Dave, have you seen this?
Shopping cart.
I log in with my price plus number.
And then as I put things into the
cart,
I just swing it by the scanner and
boop in there.
And when I check out,
it already knows what's in the cart.
Here's the kicker.
If I put something in the cart and
didn't scan it,
it's like we have a camera.
We watch something go in that didn't scan.
There's an error.
We're going to have an associate come over
and check that.
We're there.
This is in upstate New York.
This is not the edge.
Guys,
are we going to be beaming people up?
I mean,
everything in Star Trek has happened.
That was Nextel, right?
Laser beams.
We've got those things.
It's just time.
It's time.
So to Ben's point, yes, meat sacks.
We've used that terminology before.
I just want to be a muscly meat
sack.
I want muscle, not fat.
I love the one line in The Matrix,
though,
where they're like zinging each other and
called them copper top.
And I think that went over my head
the first eighty six times I watched it.
And I was like, oh, it's a battery.
That's an Energizer battery.
Copper top.
Oh, Duracell.
Duracell.
Yeah, I don't imagine.
I mean,
this has probably been one of my biggest
friction points.
So Ben says,
even setting up your phone for computer
vision can be a friction point.
I agree.
Thinking that somebody is going to set up
a phone and record them doing videos and
the AI is going to analyze your hip
hinge and is it proper?
I think that's a total waste of time.
I don't see any reasonable person doing
that.
Oh, no, no, no.
The first people will be not reasonable.
These are the people who already own
tonals in their house.
I was talking with someone who I love
her.
It was like, I think people should just,
I mean, wouldn't it be great?
You'd save a lot of money,
just buy a tonal.
And I'm like, what does a tonal cost?
And I can't remember what it costs,
but I remember thinking, are you insane?
What does it cost?
I mean, at least hundreds,
if not a thousand.
This person had money and they were like,
just buy tonals.
If everybody got a tonal and then a
PT could zoom in.
And I'm like, lady,
you are so far away from reality.
We're not all, we don't have tonal money.
But as that goes on,
that's going to get cheaper.
So I think the people who have that
might be, wouldn't that be a great model?
Instead of just doing telehealth with a
phone,
you zoom in on a tonal and you're
staring at them and you can know, okay,
do this exercise, boop.
And then just like the matrix,
do you know how to fly a helicopter?
Now I do.
Okay, do this exercise.
And the tonal changes to the thing and
gives the proper resistance.
That's the merging that I'm waiting for.
We're not there yet because tonals cost
ten grand.
So, Jimmy, you had two other topics.
Let's get to topic number two.
Yeah,
we have to get to topic number two,
but we also have to talk about another
sponsor.
This one...
This one could be a thing.
This one's already a thing.
I would do this one.
Students love it.
Clinicians love it.
The clipboard of authority.
This segment is sponsored by the clipboard
of authority.
The heavier the clipboard,
the more correct you are.
Perfect for nodding silently,
pretending to observe movement,
and ending conversations without speaking.
Just look at your clipboard.
Now featuring extra weight for difficult
patients and premium leather grip that
says, look...
I've been doing this for a while.
The clipboard of authority.
You don't need answers.
You just need something to hold on to.
That's all you do.
All right.
So very low, very low, very low tech,
very low tech, very low tech.
Like it carries a little cachet in it.
You know,
I was what I want to brag.
I was a VIP.
Did you guys get this?
I don't know.
I'm a VIP.
I got something very exclusive.
Probably only fifty people in the country
got this.
I'm only kidding.
I'm on the prompt mailing list or
whatever.
I got this in my inbox and I
was like, what's this?
WebPT has done this for years.
It's a state of the union.
Because if you're an EMR company and you
have access to hundreds or thousands of
clinics,
why wouldn't you ask all of them for
a survey and tell them,
we're going to put all your answers with
other people's answers and we're going to
get answered answers.
So Prompt Health,
twenty twenty six rehab therapy report.
I got to be honest,
I just started calling it the state of
the union because rehab therapy reports
didn't have any pop for me.
Eight and ten clinics are growing year
over year.
Seventy percent of clinicians are thinking
about leaving.
I don't understand that.
Eight in ten clinics are growing year over
year.
Seventy percent of clinicians are thinking
about leaving that clinic.
Burnout highest in clinics with
disconnected manual systems.
Younger PTs less than thirty are most
burned out.
I'm just throwing out statistics.
What are these things?
Do the data ever shock you guys from
these things or just like, yeah,
we knew that?
Before we talk about the data,
before we talk about the topic,
For the folks at home watching on YouTube,
Jimmy wore a tie to make this video
on PT Pinecast.
And I just want to reflect on the
power of Jimmy's diverse attire.
Sometimes it might be a hoodie.
Sometimes it might be a beanie.
Some days...
He's got the hair done.
Some days he's shaved.
Some days he's not.
Some days he's got a tie on with
a white button up.
I couldn't believe it.
And I was never sure, like,
who would wear a tie on a podcast
first.
I mean,
you know I'm close enough some days.
But I thought, you know,
would it be Jimmy?
Would it be Tony?
No, definitely Jimmy.
If we're on Kalashi or whatever that app
is where you can bet on anything,
the number for which one of us three
to wear a tie.
I was the, I was the long shot,
but you paid out if you,
if you voted on that.
Cause I wanted to do like,
I was trying to find like serious,
like I totally get it.
It made sense.
Music or whatever.
So when you guys look at these things,
You know what?
Do you look at these things?
If you do,
does it surprise any of you?
Or are you like, yeah, okay,
I figured that.
Or is it ever like there's one statistic
in there that goes, huh,
didn't think of that.
I was surprised when APTA said we were
going to have too many physical
therapists.
I remember that.
That was a while ago, right?
Seriously?
That was a while ago, right?
Yeah, yeah.
That was an old report.
Right.
I haven't really been looking at these
market reports.
I think at this point, the past,
I don't know,
before and even before and after COVID,
they're kind of approximately the same.
I think still one of the best ones
is that the WebPT one about the drop-offs,
which was like, I don't know,
whatever it was, like, uh,
ninety percent of patients drop off or
something, something insane that don't,
you know,
don't complete their plan of care.
I think that was probably one of the
best ones from, like,
the past
I don't know, ten years or whatever.
But everything else, I mean,
prompts is obviously going to be most of
this data is going to be from in-network
clinics.
So that's fine because that's like where
the volume is.
But most of what you covered,
like I watched a little bit or I
listened to a little bit.
So I wasn't surprised at all.
Yeah.
Well,
the things that the contradiction is
confusing me.
Eight out of ten clinics are growing year
over year.
except seventy percent of clinicians are
thinking about leaving which means the
clinics are doing well but they're just
shuffling and reshuffling the deck they
could be i don't know couldn't wouldn't
that say a clinic could do a lot
better if you if you stopped having to
try to attract and hire people sure yeah
you would have more focus on
know marketing or growth or stability and
less focus on recruiting and hiring i mean
you always need you always need to focus
on both but if seventy percent of your
workforce is whatever it was unsatisfied
or looking to potentially leave the leave
their job or leave the industry like yeah
that's quite significant
I liked Jared Hall's recent post where he
was talking about,
and I forget the law or the rule,
but basically as you make things more
efficient, you increase utilization.
And I think that's what we're seeing here.
Clinics are operating more efficiently.
They're getting more done with less staff.
I just that's it.
That's there's no other like secret
recipe.
Yes.
More therapists are leaving.
Yes.
Fewer therapists are joining.
We have to develop business models that
don't look like the business models of the
past.
Why are we in the insurance based market?
trying to do what Dave is doing in
the self-pay market.
Why are we still trying to do hour-long
sessions?
Why are we still selling relationships and
listening to stories when that's not what
we're being paid for?
Everybody across the board goes to
single-unit visits.
Immediately,
we quadruple our access to clinicians
because one clinician can do the work of
four if we reduce the duration of the
visit,
and I would argue the patient gets a
better outcome.
The patient gets a faster outcome.
How would you define a better outcome?
if it was all single unit visits?
I don't know that I would say faster.
In other words, my shoulder hurts,
now my shoulder doesn't hurt.
Do I get to that end game faster?
Probably not,
because we're talking about healing
tissues, we're talking about physiology.
But I would say better because the fifteen
minutes,
ten minutes we spend with each patient is
more impactful.
They actually remember something we taught
them when they go home.
We increase compliance if we increase
frequency.
We reduce total utilization per case,
but we increase the number of cases.
Like every metric goes up in a positive
direction if we treat this in the way
that I believe it's intended to be
treated.
Meaning...
What's your problem?
This is the solution to solve your
problem.
Let's start working on that solution.
Doesn't have to be what's your problem.
Let's get to know each other.
Let's spend sixty minutes of uninterrupted
time in a private room.
Tell me about your deepest, darkest fears.
I like to know.
If you, if you, if you had a,
if you had an orthopedic issue, right,
you had the friends PT clinic nearby down
the street, which, which,
which one just for you, like,
which one would you prefer?
Like you go to his practice two times
a week and each time is an hour
or Tony's saying you go in for,
you go into Tony's version of the clinic
that is also in your neighborhood or in
your town.
And Tony's off.
Tony's offering what?
Fifteen minute visits.
But he's saying come more often.
Yeah.
So I'm saying I like both of those.
I'm going to smush them together.
Here's what I would want.
I would want the initial eval to feel
like you're measuring me to be an NFL
wide receiver.
Like I'd want the eval to be like,
let's check everything.
Let's really get to know you.
I want to find out follow up visits.
What I would prefer and I think people
would follow would be.
Hey, buddy, let's check it out.
Let's chop it up for ten minutes.
Let's do all those things.
And then here's your thing.
You've got access.
You can leave now or go do the
things.
I'll give you six things to do.
Do them or not.
But that's not one-on-one with the
therapist anymore.
So I would say the eval would make
me feel like a full diagnostic for one
hour.
And then follow-ups would be,
let's see what we did between last time
and now.
Good, based on that information,
do these things.
Steve over here is going to help you.
And then it's a one unit visit plus
access, use it or not.
I make suggestions, you make decisions.
Wait, so you were saying,
so Steve would be, what's the example?
So the therapist is with the patient for
fifteen minutes.
You said go over to do whatever with
Steve.
Right.
Yep.
Attack or whatever.
Right over here.
Here's the thing.
While I'm talking, look at Ben's comments.
Which one?
Yeah.
So Jimmy wants to feel important.
The evaluation.
He wants to be measured.
He wants all these fancy devices.
And I totally agree.
When I go to Chipotle,
I want filet mignon instead of cheap flank
steak.
But when they show me the price of
paying for filet mignon,
I choose the cheap flank steak.
Right.
Have that available.
And that's why you will never go away,
Dave, because you offer the highest level.
It is available,
but you're not trying to do it for
insurance reimbursement rates.
So give the consumer the choice.
Hey, look, I can fix your shoulder pain.
Dave can fix your shoulder pain.
Mine is going to be covered by insurance.
Dave's not.
Dave will have more fun.
Dave will have a better experience.
Dave will have better products.
I will not.
But both of us will get you there.
It just depends on how much money you
want to spend.
How do they want to get there?
How do you want to achieve your goals?
Yeah.
What I would say is to keep the
feeling high or mid, you know, six, seven,
I would do the one-on-one bougie eval,
right?
But we do that now and we can
charge for it.
Even insurance companies will say, yeah,
the eval is more work,
so we're going to pay X. And then...
Subsequent visits and all the different
policies are lower.
I would say to keep the same perceived
value because all value is perceived
value.
Keep the one on one.
Everything's about you.
Let me look deep into your soul and
learn everything about you.
That's the eval.
And follow ups are a one unit plus,
though, instead of one unit.
And then, all right, here's your code.
Get out.
Let's do the thing.
You know how this is going to change.
Not me touching you.
I did the thing.
I did the rubbies and I did the
tuggies.
Rubs and tugs.
And now go over there and get sweaty.
What do you want me to do?
And then have access to the cryo pool
and the infrared spa and the light you'd
stick somewhere.
Do whatever you want,
but it's access and you don't nickel and
dime them for that.
I think that's how you keep your perceived
value high while keeping your costs low
and go more on volume.
I'm going to pull this up.
Sorry, I'll do it.
All right.
So Ben said, let's pause there.
And this was a little earlier in the
conversation.
If drop-off is so high,
reimbursement is so low,
where are the companies like Ash who
regulate PT visit utilization when the
reality is PT is a rounding error?
Agreed.
Does that mean you know it all as
a whole?
The cost and pain of utilization
management is not needed as most patients
drop off before even hitting the seven
hundred dollars in billing.
Why does this still exist?
What does that mean?
It's a rounding error.
You said you agree.
I don't understand that means.
Yeah,
it's very it's very small in the whole
scheme of things.
You look at the total cost of health
care,
you look at what we actually I mean,
a thousand dollars is like ten visits
compared to, you know,
surgeries and anesthesia and ORs and all
this other stuff.
The only thing I can imagine now I'm
speaking completely out of speculation and
Ben can correct me.
I would imagine these companies are coming
to the payer and saying, look,
it's not going to cost you anything.
We'll take a percentage of what we save.
And so even though it is such a
tiny amount,
if they come in and run their algorithms
to say this patient needs four visits,
not thirty six visits,
they save the insurance company,
they're going to get a portion of what
they save.
Why wouldn't you do that?
That's why I think they still exist.
And then Ben said, in fact,
if PT was better utilized without friction
and reduction in TCOC,
Total cost of care and musculoskeletal as
a whole goes down,
putting friction in the wrong spots.
And that's where a couple of weeks ago
I shared it.
I asked chat GPT.
I'm like,
if there's all this research that says we
save insurance companies money,
why are we not seeing the benefit of
that?
And it's because most likely the insurance
company business model does not benefit
from what we do.
If we maybe and I don't think we
actually do save the insurance company
money, but if we did,
they're making money in other ways.
They need to spend more money,
my understanding,
in order to make more profit because
they're limited to a percentage of like
the money they spend is how much they
can take as profit.
So it doesn't help them to spend less.
It's better for them to spend more because
then they can charge more than they can
profit more.
That's that's the model.
Yeah, I mean,
this is where I love people who do
advocacy,
but that's not going to change it.
I mean, guys, let's be realistic.
It's not like insurance companies don't do
math.
They're a math company.
It's all they do is math.
And if we had a big enough math,
they would math with us.
And they would go, here's more math.
I'm using math as a verb and a
noun.
That's not it.
I'm very sorry.
They don't under...
What's that line I just used like seven
times?
The Upton Sinclair line.
It's hard to get someone to understand
something when their salary is dependent
on them not understanding it.
It's not even that.
We're so small.
It's like, oh, are you still here?
Did we?
Yeah.
Okay.
Yeah, sure.
We'll give you a nickel.
This will go down.
Reimbursement will go down.
year over year.
Act as if.
Decide if you want to be in this.
Since I released that video when I went
to Graham Sessions last weekend,
people were like,
I loved it because I just sit here.
They're like, well,
what are you going to do about it?
What's APTA going to do about it?
I'm like, guys,
I'm a dude in my living room.
Sometimes I wear a tie.
What am I going to do about it?
I'm asking you questions.
The people who want complete control are
also looking for people to solve it for
them.
And I'm like,
you still have to solve it.
What were you going to do yesterday?
Nothing.
I just held up a mirror and you're
shocked at the result.
I'm very sorry.
That ain't it.
Go ahead.
Keep the conversation going.
I'll be right back.
Ben Galen saying population health
principles deliver the solution cost that
matches the severity and need.
Yeah,
not all patients need the filet mignon.
They don't and they won't buy it.
That's why it's a pyramid.
What I mean by that is what Dave
does is higher end,
quite literally up on the pyramid.
But the pyramid,
we know how pyramids are shaped.
It's thinner up there.
You're not looking.
You don't need twenty thousand people.
You need two thousand people or a
thousand.
I don't know.
So you're like, I'm going to solve this,
which is funny.
when Dave talks about what he does and
people respond, Dave says, emotional,
sorry, logically,
I do this for this cost for these
people.
And then I've seen this happen in Dave's
comment section.
People are like,
but what about people who can't afford it?
And like, I don't know.
It sounds like you want to take care
of those people.
I think Pete,
all people should have access to care.
I agree,
but it's not going to be the same.
I understand that.
Exactly.
Why not cake for breakfast and lunch and
dinner?
Then we'll want cake with triple frosting.
This is a choice.
I don't know how else to explain.
This is not me deciding this is the
way it is.
This is the way it is.
I'm just the one explaining it.
Don't kill the messenger.
But if you want to drop it in
my comment section and increase the reach,
by all means, I'll poke the bear.
I will do that.
Yeah, I mean,
there's a bunch of practices that accept
Medicaid and Medicare and all the
different payers and insurances.
But if those patients wanted a more
one-on-one experience,
that clinic cannot offer that, right?
But we can,
but therefore we can't accept those
low-paying insurances, right?
So no clinic can offer everything to all
consumers in terms of like each little
subset,
like physical therapy or whatever the
other industries are.
So Mark, I don't know,
Mark and his comment is APTA has to
cover all PTs.
Stop.
What does that mean?
Cover what?
They're a professional association.
They drive across a bridge and talk to
people in Washington.
What does cover all PTs mean?
Cover them how?
They don't dictate rates.
They don't dictate educational
requirements.
That's CAPD.
They don't set tuition prices.
Yeah.
So I know Mark,
he's been on my podcast.
He's got a practice on the West Coast.
I think maybe he's saying that ABTA is
like representing all PTs and it's hard to
represent all PTs when there's different
sections of PTs that like want different
things and all that, right?
Agreed.
Here's the thing.
None of those things are going to happen.
They're not.
It's a professional association.
This is a place to hang out with
people who do the same thing as you
and learn what's working and what's not.
Don't look at it as big brother.
It's not.
It's not big brother.
They don't sell themselves as big brother.
I wish they were.
I wish we could just throw a bucket
of money and they'd go across the river
and solve things.
They can't.
If they lowered the reimbursement for us,
that would hurt another set of PTs.
Who is they?
Insurance companies,
if they lowered the reimbursement for us,
I'm guessing inpatient PTs,
is he an inpatient PT?
No, he's got an outpatient practice.
So Mark, thank you for joining us live.
Give us another comment or two, Mark,
if you want to just help clarify a
little bit and we can keep rolling.
John thinks we should get Ben Galen on
the show because for a deeper...
I've threatened that.
I've said Ben.
I think Ben... Yeah,
he's been on my show.
He's super smart.
This is when you know someone has
something.
Because I think I DMed Ben,
or maybe I did in my head,
and I was like, hey,
I think it was one day when one
of you guys was going to be out.
I was like, hey, do you want to...
And he was like, oh,
I don't really have anything to add.
I'm like, really?
Because...
you add a lot like maybe just add
it without text without your thumbs doing
the talking um i want to understand what
mark is saying because i hear this a
lot
But I'm a words guy.
So when people start throwing they or
cover, I'm like, cover what?
Cover how?
Cover who?
What does that mean?
I want to understand.
Because I think this is an expectation and
reality problem.
People are like,
I paid five hundred dollars for my APTA
membership for a decade and I didn't get
anything for it.
What did you expect to get?
What was on the menu?
They didn't offer that.
You felt like they did,
but you didn't read it.
I don't think you should be an APTA
member unless you understand what you're
buying.
And then if you don't like that,
don't buy.
People think I'm the biggest APTA
whatever.
I'm just here explaining stuff because I
hear these people saying the same
complaints and I'm like,
what did you expect was going to be
in the box?
I don't agree with Jimmy working on my
statement.
Okay.
This is where a guy like Mark,
I want to hear his words because most
of the time when I see that,
we wind up, we're agreeing,
we're just using different words.
Yeah, he does.
I'm not taking shots.
What do you mean by that?
We're on the same page.
Ben's got the face for radio.
Keep talking, my friend.
I got the face for radio, too.
Let's get to this.
Hold on a second.
Oh, gosh.
These guys paid triple the rate.
Uh-oh.
There's a big spender.
A big sponsor.
This is Triple the Rate.
Clinical Vibes,
this section brought to you by Clinical
Vibes.
Brought to you by Clinical Vibes,
the treatment philosophy based entirely on
how it feels.
By the way, all the visuals today,
I used Tony's prompt.
No protocols, no guidelines, just vibes.
Simply ask yourself...
Does this feel right?
If yes,
document confidently from then on out.
Clinical vibes, not evidence-based,
but emotionally compelling.
All right.
They paid triple,
but did they pay in cash or vibes?
They paid in vibes.
They paid triple the vibes.
It felt like a good deal when I
signed it.
I like the,
like when Jimmy reads through like the
little, like the real advertising.
Oh, he froze.
What are you going to give me a
compliment?
What happened?
I'm here.
You don't hear me.
yeah yeah i'm here you're good you hear
me yep i'm good now we're here go
so when you read when you when you
read through kind of like the bullet
points of the advertisement like from chat
gbt or wherever you got it um it's
it's perfect i love it i think though
in the future we should consider you put
an ad up and tony or i have
to do the ad read completely i like
that idea
Cause we never know what's coming.
I don't,
I don't know if the audience knows,
but so you do these,
you put them up.
We have no idea what's going on on
the screen.
No.
Yeah.
What I want.
It's not going to be,
the ad read will not be as good
as whatever you usually read.
So you know what I want to do?
It could be a fun exercise.
The worst part of this,
and I need to adapt,
the worst part is when I put the
ad up,
I can see your faces in the monitors,
but the audience can't.
And I see you reacting.
So the funny thing is I'm looking at
you guys, but the audience can't see you.
And when I see one of you giggle
or do this, I go even harder.
Like I go full Phil Hartman on the
next line.
And if I look at you guys and
you guys are like, eh,
I sort of just speed through it.
I'm like,
I don't give a shit about this.
Well, let's keep moving.
All right.
Anyway, Dave's going to sell certainty,
not sessions.
We're going to call this the fifty percent
guarantee experiment.
Dave, you run with run with us.
Okay.
Yeah.
So I want your feedback.
We're doing this live.
This is what I would usually do with
like my friends or business coaches or
whatever.
So we're kind of like five fifty a
visit for Saturday, Sunday,
three fifty per visit,
Monday through Friday.
That's kind of like our pricing.
We do take some insurances and all that
type of stuff.
But
Um, I've been reading more.
I had the a hundred million dollar model,
whatever money models from Alex Ramosi.
I got a bunch of,
I got a bunch of stuff from Alex
Ramosi.
And one of the things is a,
you know,
there's money back guarantees or there's
conditional guarantees.
I want to pitch this live.
So just, let's just say, um,
Say Jimmy's got back pain.
Jimmy's got seven out of ten back pain.
He's got pain when he squats and Jimmy
wants to get back.
I'm just making all this up.
He wants to get back to Orange Theory
Fitness.
He's going three times a week,
but now he's got back pain with squatting.
So Jimmy comes in.
He does an evaluation with my physical
therapist, Dr. Andrew.
In that visit, in the first visit,
he goes through the whole one hour
comprehensive evaluation, pre post test,
all that.
The pain goes from seven out of ten
to five out of ten with your deep
squat.
So, OK, let me see a squat.
And you're like, oh, yeah, right there.
It's seven out of ten.
And then we do some treatment,
whatever the treatment is.
Then, OK, let's stand back up.
Let's squat again.
Five out of ten low back pain.
So you're already having a treatment
preview in a short period of time,
which will then help the therapist then
present financing and cost and investment,
all that type of stuff.
So then the therapist says, all right,
Jimmy,
so
based off of this and how you're feeling,
I believe that I can get this better
in twelve visits.
I think there's a good chance that I
can help you completely overcome this.
And in twelve visits from now,
we'll talk about whether we're going to do
once a week or twice a week or
whatever.
But with twelve visits,
as well as some things for you to
do at home,
I'm going to get you back to Orange
Theory.
So I'm selling your goal.
I'm selling the outcome,
the transformation,
the result of what you want,
which is getting back to Orange Theory.
And what we're going to do is to
get you there.
What it's going to cost is forty two
hundred dollars.
And so
I meant just multiplying.
So three fifty times twelve is forty two
hundred dollars.
And you're going to be like, oh,
my gosh, that's a lot.
And I wanted to use my insurance and
all the normal objections that we hear.
And that's more than I thought it would
be.
And I got to speak with my spouse
and I got to think about it and
sleep,
sleep overnight on it and get back to
you and let me think about it and
all that type of stuff.
and then we would say okay well we
want to nail down is it just price
and let's just say if it is just
price it's literally like you're fearful
of paying something and not getting the
outcome you're you're afraid of paying for
something and it not working right so then
you feel like
You know, you feel bad about yourself.
You feel like you made the wrong decision.
So then we say, hey, Jimmy,
if we do not get you back to
Orange Theory in these twelve visits and
we could do video and we're going to
make it objective and measurable as much
as possible in terms of like squat depth
or we want to just try to make
it as objective as possible.
And you have to do some check ins
along the way in terms of showing us
some exercises that you've done or
whatever it is along the way.
So you have to hit some checkpoints along
this twelve visit process.
you're not paying free by the twelfth
visit you get half your money back or
you continue to we'll continue to work
with you until we get you back to
orange theory and then there'll be some
terms and a little bit of fine print
about what that would be is it going
to be like full normal visits or is
it also remote coaching remote programming
whatever but there's a little thing a
couple things for me to iron out there
but it would basically be like
Now,
it's not a hundred percent money back
guarantee, Jimmy,
because we're going to do our side.
Like we're bringing our A gain every
single day and we need to make sure.
So like we can't refund that because it's
like a service based business.
So I can't refund a hundred percent of
your money, but it would be fifty percent.
So meaning if you if if it didn't
work for you because you didn't trust
yourself or whatever,
we'll refund half your money.
So you get to the twelfth visit.
You let us know, hey,
I want half my money back and we
send you two thousand one hundred dollars
back or whatever.
continue to work with us in whatever the
defined capacity is moving forward and i
think that the issue or the challenge of
this for me to wrap my head around
is like would some people like refunding
half the money is fine but tony what
if someone was like no i'm not a
hundred percent but they like wanted to
stay working with us like almost
indefinitely i think that's like my only
my only thought of like how this could
ever go wrong like someone who
wants to work with us for another twelve
visits.
And then like they say,
they're still not better.
And then they're like, actually,
just refund half my money.
So now they got twenty four visits and
now asking for money back.
So there's some things around there that
need to be tightened up.
And this is what I would like your
help for or help on.
Tony,
you want to go first or me to
go first?
I don't know.
I hate it.
I just don't like it.
You know,
I think about so many professional
services.
I think about like attorneys.
You're you're indicted for something,
whatever.
Like the attorney is not going to give
you fifty percent back if they don't.
If you go to jail,
there's just so many things like that.
I feel like this makes it too much
about the money.
And if we're coming down to,
and I shared the risk reversal definition,
I just think we're focused on the wrong
thing.
And for you and what you do and
how you do it,
I'm just not a fan of this kind
of interaction.
Yeah, I like it.
Here's why.
But there's going to be an asterisk
everywhere.
There needs to be specific and asterisks.
Here's what I mean.
Number one, this is not for everybody.
You tell your staff,
define who this is for.
This is for the person who that's their
primary objection.
Like what are you afraid of?
I'm afraid of if I do it and
I spend this money and I don't get
it.
Okay.
Then you pull this out.
It's holstered.
It's not on your website.
This is not, listen, this is,
this is where I call the look around.
When you pitch this,
when your clinician pitches this,
they do this.
Listen, I'm not supposed to do this,
but I'm pretty confident.
Don't say pretty.
I'm confident we can do this.
Here's what it looks like.
What I don't like is pain-free because you
can't see or that is a symptom,
not a sign.
I would go with signs.
Can you show me that you've done this?
Because they're going to go, yeah,
I'm not a hundred percent.
I'm
So just be specific along the way.
If then, now act like a lawyer.
So what we're saying is, listen,
if you do all these things and it
doesn't happen, then my plan failed.
But are you the part that failed?
Did you not do it?
Then how is that my fault?
This is where when I first heard of
value-based care, I was like, dude,
that sounds like a huge risk.
Like,
We signed on,
but you didn't do it and I lost
money, but I did my thing.
This is where I will never do affiliate
deals for podcast sponsors.
So I definitely talked about your product
for a hundred days and you might pay
me for some of that.
I definitely build a show every day and
you might pay me.
My job is to get them to know
about your product,
not to make them buy it.
That's a human thing.
Your job is to give them the plan.
Their job is to do it.
So I like this.
I think you're ninety eight percent of the
way there.
I actually think you need less.
I don't think you need to add to
that.
I usually like put the put the specifics.
Yeah.
All of health.
Ben is saying all of health care should
be like this.
You can't put a cap on the time
duration if going to the out.
This is what we need you in the
room, Ben, because I'm reading.
I thought he just said six months,
but then he said you can't put a
cap on time.
Give like a rate.
Oh, I think what he's saying.
I'm channeling Ben.
Like, hey, listen,
then I'll give you the money back or
you can continue.
Is your goal still to get to Orange
Theory?
Yeah.
All right.
Then we'll continue to work together until
you get there.
Maybe we're just eighty five percent of
the way there.
So let's work together.
I'll continue to work together with you.
I'll give you the money back.
Now we walk away or we continue to
work together for six months to get you
there at no additional cost.
Yeah,
this is what I was going to say.
This is a risk contract.
You agree to the KPI that are realistic
to show you have done your part.
But in case the patient hasn't done
theirs,
there needs to be a way to track
it.
It doesn't need to be like a thing
that you do in the courtroom.
And here's my comment.
They'd have to – I don't know.
It could be like they have to video
record them doing their HEP.
Yeah, I don't know.
Like three days a week or something,
which would cause more –
It would be more work for the patient.
But if you could document those videos and
then you look back when they go and
you're like, well,
you only did four minutes each time.
This is where I don't like it with
Tony, which is not for everybody.
And now you guys are like splitting hairs
and you're arguing with the person you're
supposed to be helping.
This is where I don't like it.
But I will say lawyers do do this.
lawyers do take on cases like in
disability claims and they say i will work
for you for free if we win because
they know the case is huge though that's
the difference yeah and if i win i
get thirty percent and you're like thirty
percent that'll be hundreds of you and
you're like or you could just pay me
along the way which do you want that's
where i don't like this on your website
but i would like it if you're like
first you gotta decide who is this right
for
And then do that.
Do it as a test.
But first,
the hard part is defining who it's right
for, who it's not.
I think it's more important to decide who
it's not for.
And then what does it look like?
That's realistic.
Videotaping my workouts,
I would never do that.
I would just be like, okay,
this is like if you don't like the
food,
but you ate eighty percent of it and
you sent it back.
It's like, I looked like you like it,
chief.
Like, I don't know.
You didn't like it.
You ate most of it.
What do you want me to do with
it?
I made the food.
You looked at the menu, you ordered it.
I like this idea.
This is a psychological thing.
I think the amount of people that will
actually push back on you or ever ask
for their money back is terribly low.
Right.
It would help with conversions on the
front end, which is,
that's the whole point.
I don't know.
I think the advantage to being a small
business like this is we don't need large
volumes.
I don't disagree either.
I feel like this is a hard road
to try and convert a couple of potential
clients that with sales and all the other
stuff you understand,
you could do it a different way.
How many do you think you have?
Let's say you have a hundred patients.
How many would you need to give this
to push them over the edge to jump
in and go with you?
Is this the exception or the rule?
It's not the rule because you wouldn't be
in business if this was the rule.
Well, no.
So because right now we're predominantly
visit by visit.
Now, I have sold some packages.
Oh, I see what you mean.
have sold some you know we've done some
packages but this would be like here's the
thing like this also this whole idea came
from alex ramosi because he was doing this
type of a style for brick and mortar
businesses and gyms and all that and what
what it does in terms of helping the
whole flywheel of the business is if
you're selling this amount of money up
front one thousand three thousand four
thousand whatever dollars up front per
person
Understood.
That's like,
that's the return on ad spend, the ROAS,
like when you're paying for Facebook ads
and Google ads and Instagram ads,
you know, meet meta ads.
So you get that money and you're using
the profit of that new customer and you're
getting more new patients and you know,
each month and you're,
and you're using the cash of those
packages to pay for the ad spend and
to get more patients and customers.
I don't think,
I don't think you would lose doing this.
I don't know if you need to do...
Yeah, I would do this.
I would try it.
All right, we're almost at time.
We got to do parting shots.
But before we do,
I want to make sure we don't lose
money here.
Our sponsor,
what do you guys think this is?
What do you think they sell?
Up next is progress notes.
If it exists, it probably happened.
You can do things better.
Write it in paper and pen or like
the old Ten Commandments.
You could chisel it as well,
but progress notes,
just write it and do it better.
Yes.
Progress, close.
It's a regular notebook that somehow
counts as documentation.
You write whatever you want,
whatever you remember.
In handwriting, no one can read.
Now it comes with coffee stains for
authenticity and random page that just
says better.
Yeah,
I got to dig into the details better.
Progress notes.
If it exists, it probably happened.
This just backs you up.
This is a record of nothing.
That's what progress notes is.
All right, parting shots.
Parting shots.
Implantable, not wearable.
That's the future of PT.
Tony wants to be inside you.
Keep going.
Dave, parting shot.
How do I follow that?
Quickly.
It's not.
Implantables will not be the future of
physical therapy.
What's your parting shot then?
My parting shot is the future will
continue to be this bifurcation,
this split of the low cost,
extremely thin margin of physical therapy
practices or out of network self-pay that
have higher margins.
And yes, there's more of the sales hurdle,
which we're just talking about.
But those are the two options moving
forward.
My parting shot will piggyback on both of
yours.
The future will be better for the people
who pay attention.
I think the people who are paying
attention.
None of what we just said is going
to come true on this show.
Some of it kind of will.
And we're all going to be Nostradamus
because we're geniuses when we look in
reverse.
We're back on Tuesday.
Have a good weekend.
Tony Maritano 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 Podcast 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.