You're listening to the P.T.
Pinecast,
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Here's your host, Jimmy McKay.
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whenever they're at a conference all right
what if what if insurance ending wasn't
the end of care pause for dramatic effect
but the beginning of a different model you
see how we're doing this
Our next guest left traditional neuro
rehab to build a nonprofit community-based
wellness model serving thousands each
year.
Live from Anaheim,
this is Melanie Brennan.
Melanie, welcome to the show.
Thank you for having me.
How close did I do on the intro?
It was great.
All right.
So walk me through this.
What angered you?
Because without a good anger or this
shouldn't be like this,
there's never a good story.
And this sounds like the beginning of a
good story.
Absolutely.
Yeah.
I worked in outpatient rehab,
inpatient and outpatient at the Mayo
Clinic in Rochester,
Minnesota for many years.
And yeah,
I had to stop seeing people that still
needed care.
You could see the runway and.
They would go home.
Mayo's a destination center,
so a lot of people aren't from the
area.
They would go home.
I would see them back in six months
to a year, and I would say,
how'd your therapy go?
And they're like,
I didn't get any where I was.
We didn't do a very good job with
our exercise program,
and they would lose everything.
If they were able to walk when they
left,
they weren't able to walk when they came
back.
They gained
They were in much worse condition.
And even our local people that would keep
coming for outpatient, you know,
there's that point where you're like,
sorry,
but insurance probably isn't going to pay
for this because we don't really know.
And so we'd stop.
But they had so much potential and the
research shows they can get better for
years.
And I was frustrated and I just told
my husband I want to do something about
it and start a practice.
Yeah,
but there's a big difference between
wanting to do something about it and
actually doing the thing because the world
has inertia.
The world doesn't want to change.
And you need to if you need something
to move an inch,
you've got to give it so much energy
to move it even that first inch.
So what'd you do about it?
Well,
I think what really sparked me to do
it was I had a patient tell me,
you're really good at this.
You think outside the box.
You make me work harder than a lot
of people.
You should have a gym.
You should start your own.
I would comp if you had a gym.
So I told my husband,
I'm motivated to do this.
It's a good time in our life.
It was a good time.
I was just working part time at the
time.
I said,
can I try starting a private practice,
which is super scary?
And he's like, yeah, OK.
Good.
Yeah, let's do it.
So how's yours different?
How is my private practice different?
Yeah, tell me about it.
Yeah,
so I knew that my ideology had to
be that insurance was not what drove care,
period.
And I had to come up with a
way to do that.
Right.
So that's nice,
but you have to figure out how to
do it.
I had to.
Yeah, I dug in.
I just did all the research myself.
I couldn't afford an attorney or a
business coach or anything.
And even back in two thousand eleven,
there weren't business coaches for PT.
We got business coaches falling off trees
now.
Yeah, it was such a different time.
I actually had to get books at the
library like there was nothing online.
Kids,
a library is a building where the Google
files live.
That was a long time ago.
But yeah, I researched it, started it.
I knew I needed to be a model
that was not just PT driven and not
just insurance driven.
So I hired a trainer to work with
me alongside, created a gym atmosphere.
Not a clinic atmosphere.
It was not a clinic atmosphere.
No beige wall, like color.
No, no.
In fact, to get started,
I actually rented space at the YMCA.
Great.
community already built in.
Yeah, already built in.
I use my minivan door to door a
lot to get started that first year,
but people heard about it.
And all of a sudden I had ten,
twelve clients and I was supposed to be
working part time.
I had my babies in the car seat
with me.
I had them playing in the pool alongside
me at the YMCA.
So I took I took them with me.
But my clients like you need you need
your own space.
and you probably need some help.
And so I hired that first person within
my first year.
And one of my clients had a strip
mall that he owned.
And he said, yeah.
He's like, hey, I got a strip mall.
You know what you need?
I got an empty space.
Space.
Yeah.
So him and I worked together back in
two thousand twelve.
built a gym in a two thousand square
foot strip mall space.
From two thousand twelve to two thousand
fifteen,
I added ten employees in that two thousand
square foot space.
We had one mat table for ten employees,
which means ten patients.
We had like four,
five spinal cord injury patients on a mat.
One mat.
It was crazy.
Yeah.
And so, yeah.
In two thousand seventeen,
we've got a ten thousand square foot gym.
It's large.
Purchased it.
I purchased it.
Wasn't going to rent it.
Twenty-four employees later.
What's the name?
Because people, of course,
want to Google it next.
Yeah, yeah.
So originally the name was Exercise
Abilities.
Okay.
Came to find that that's really hard to
type in a website,
really hard for people to spell correctly,
really hard for people to say.
Don't go multiple syllables.
It was bad.
Great name.
People loved it.
So we shortened it.
Everybody shortened it.
The world shortened it to EA.
So it became, hey, I'm going to EA.
I thought, hey, that works.
So it's EA Therapeutic Health.
Nice.
We rebanded in twenty twenty two.
It's the.
What's the model look like?
Someone needs you and they come and you're
like, hey,
we don't do that thing over there,
which is insurance.
So how does it work?
Well, funny thing is we do take insurance.
Got it.
For a portion of what we do.
So that's been an evolution.
You know,
we found that a lot of people in
our area did not have funds to pay
for what it takes to do a recovery.
And so I kind of gave in and
started taking Medicare and Medicaid and
insurances in about twenty,
twenty thirteen, twenty fourteen.
Found out that you can't pay your staff
for neuro recovery with Medicare and
Medicaid reimbursement really fast.
So in twenty fifteen,
I converted my practice to a nonprofit.
That's kind of where we shifted.
And with that,
we have really affordable rates for people
to continue once insurance
kind of that short standard therapy.
So we do both.
We charge cash for the extra hour that,
you know, they're with us for two,
three hours.
So we have a PT see them for
whatever PT they can be billable.
And then the rest are personal trainers,
rec therapists,
athletic trainers that are working side by
side with us for that cash based service.
Sure.
PT's in the room.
pt's there it's pt informed yeah yeah um
what is the uh what is the at
where does advocacy play in sustaining a
model like this huge i i'm real good
friends with my local congress should be
right you should know their name but even
more important they should they should see
you and know who you are and here
she comes again she's gonna she's gonna
bug me about this and that's their job
they have to be bugged
Absolutely.
So I advocate for payment.
I advocate for tax laws because we're a
nonprofit,
but we still have to pay sales tax
in the state of Minnesota,
which for Neuro,
you have a forty thousand dollar piece of
equipment that you get granted to you.
They give you the money.
You go buy it.
I have to pay taxes on that,
which is a real bummer as a nonprofit.
So working with them on tax laws, yeah,
payment and everything.
It's all part of my APTA role,
so I'm really busy with working for the
association as well.
Good radio segue.
What's your role with APTA in Minnesota?
I am the current president.
Congratulations.
Thank you.
Six weeks in.
Why do something like that?
And not just for you,
but we're sort of in the room where
a lot of it is happening and people
see APTA and they might have a pro
or a...
I always say they're either pro or they
might not just be clear of what the
value prop is,
but why not only be a member?
Why also do a lot of extra unpaid
work?
I don't know if you saw that.
It's six weeks in.
They're not paying you.
No, no, it's very unfair.
They're paying you in other ways.
You know, in the year,
I joined a profession and it was never
an option for me to not be a
part of my professional association
because I understood right away because I
got involved.
I was...
on the floor at the House of Delegates
in Minneapolis in, I think it was,
as a student runner.
And I saw it happening.
I knew that if we didn't have a
voice,
our profession could not move forward.
And in collective action,
I didn't want to be one of those
people that weren't active or weren't
participating.
Because with the APTA,
we're supporting all PTs and PTAs.
Every one of them.
You look at the new campaign,
PT for Future Me.
It's advertising physical therapy.
It's not just advertising members.
It's a collective action movement.
And in collective action,
there is always going to be people who
don't participate.
At whatever level that is.
I didn't want to be that.
I wanted to be a piece of our
success as a profession.
And it's important to me.
What's your BHAG, your big, hairy,
audacious goal in your presidency?
What's the thing that you're like, hey,
if I accomplish this or this or this,
that will have been successful in your
eyes?
Well,
when I sat down with our executive
director and said, yeah,
I'm going to run for president.
I'll do that.
I said one thing.
I said our focus will be payment.
Yeah.
My whole world is revolved around that.
Everything comes back to payment,
whether we're cash-based or
insurance-based.
It's all cash.
It's just whether you're paying it
directly or it's someone else who's paying
it for you.
It's all payment.
I've been on the board of directors in
Minnesota for six years.
We do strategic planning.
I just sit there and be like,
that problem is because of payment.
That problem is because of payment.
Go deeper.
And, you know,
unless you're in private practice and
you're in, like,
nonprofit where I'm trying to provide
services to everyone at the most
affordable rate that I can then pay my
bills.
That's it, right?
That's why I'm nonprofit.
You'll say,
why did you sell out your business?
Because I want to provide service to
everyone.
No margin, no mission.
Yeah.
And the payment's just not there.
And so I fundraise four hundred thousand
dollars to a million dollars every year.
I do that, too.
That's my job currently.
Yeah.
Where was I going with that payment?
Everything's connected to payment.
Everything.
And so I just said that's going to
be the one thing I'm probably not going
to spend a lot of time reorging.
I do this at work all the time,
like having to rewrite job descriptions.
Probably not going to spend a lot of
time on that as a president.
I'm going to be working on payments.
That's it.
So I was super excited to see the
new strategic plan come out that Kyle
really promoted.
And what's on the top?
Payment.
Well, they said it was...
Pulled the members, right?
Always good to listen.
And they said the number one issue was
payment.
And then there was four thousand miles of
nothing.
And then the number two thing.
It was payment.
Do that.
Yeah.
We just we have a survey right now
that closes tomorrow in Minnesota.
What's what's your top ten advocacy needs?
Money at the top.
Right.
Payment.
Again, everything.
Payment's going to affect what happens.
I mean, there's a lot of students.
You can't shake a stick without hitting
ten new grads or PT students here.
Or apparently children.
First time I've seen just a nine-year-old
walking around.
Maybe.
There might be a PTA student.
I'm not sure.
But you can retain staff when they don't
leave if you can pay them better.
You can afford equipment better.
You can open a second facility.
Payment.
Everything's payment.
Are we just waking up to this?
Or are we just deciding that we can
actually... What is the deal?
Because I've been in PT for ten years.
I've never heard this much movement in
that direction before.
There's been an interesting resistance and
all respect.
Like I said,
I've been for six years on the board
meeting saying it's all because of
payment.
And there's an interesting, yeah,
but we should really have more member
engagement.
So let's have a five K. Like, no,
that's not helping us with our primary
problem, which is payment.
So I don't know.
We're getting there.
And those things are important to member
engagements.
Important.
Having activities are important,
but do you want to get member engagement?
Show them you're working on payments.
Yes.
If I come with you,
are we going to kick payments ass?
Yeah, then I'm riding with you.
This is what I'm saying.
This is where our focus needs to be,
and this is where it's going to be.
Where's the biggest needle that's able to
be moved, state level, national level?
Because, like,
it's obviously if you can move it to
the national level, that's better.
It doesn't mean it's easier to do.
So where's, I mean,
you're going to answer both because you're
a state president, obviously.
But I guess the question is, like,
where are we most likely to have a
touchdown?
We are most likely to have a touchdown
at the local level.
Yeah, of course.
And that's what I mentioned in some recent
LinkedIn conversations.
But what's what worries me about the kind
of, you know,
contingent relationship of APTA with
others that aren't APTA supporters.
And it's we are the only ones at
the local level supporting the chapter.
State chapters are supporting the local
changes, which are state legislators.
That's the biggest impact on our
day-to-day lives is where we work,
what state we live in,
and the changes at the state level,
whether it's legislative,
whether it's Medicaid services,
which drives a ton, and payment,
like Blue Cross Blue Shield of Minnesota,
that's local.
um that we have some issues going on
there and and you have to be tackling
that local so if we don't support apta
as a whole we're not supporting our local
chapters and my worry is is that with
declining membership people don't realize
how that's going to be impacting them at
the at the state level yeah weakening
things yeah yeah yeah medicare is
important yes um but this local advocacy
effort
I think if it goes away,
people will be like, oh,
I guess in Idaho right now,
the state legislator seriously has a bill
on the floor to stop paying PT, OT,
and speech.
Stop.
They're having to fight that.
Yeah.
ABTA National provides us a lot of support
from a state perspective, but no,
it's your local volunteers.
It's your local chapter.
It's your peer that's going to the state
capitol and fighting.
So what if you went with your peer?
And we sent, you know, in Idaho,
they had all, you know, pick a number,
five thousand registered PTs and PTAs.
What if they all showed up at the
capitol?
But instead they have thirty showing up of
active volunteers.
So that's where collective action,
I think we can do better because we're
compassionate PTs and PTAs.
I think we can do better and I
think we need to.
We need to show up.
You haven't mentioned other professions,
but you think that collaboration across
professions is terribly important.
Why and what's the secret sauce there?
Collective action, again, needs numbers,
power and numbers.
We don't work enough with our OT and
speech partners.
And so that's the obvious,
the first obvious collaboration that each
state needs to do better.
And there is a movement towards forming
more trial alliances,
which I'm working on getting going in
Minnesota as a as a focus.
Because, again,
what if we did combined days on the
Hill where there are four thousand OTs and
our five thousand PTs and there, you know,
two thousand speech therapists?
What if we all showed up together?
Because payment is DBT codes.
It's not just PT.
It's not limited to one of us.
It's not just OT.
It's not just speech.
So that's the obvious one.
And then also I'm seeing in other states,
and we all need to do better on
this,
is do we have enough energy to worry
about scope creep?
Or if we're friends with everyone and we
really understood their position of why,
you know, whatever that other entity is,
why they want to maybe expand their scope
a little bit because they're needing to
meet a need because there's not enough PTs
out there.
Maybe they'll listen to us and stop
fighting our bills.
And we have a lot of that at
the state level.
We have a lot of fighting from keeping
our scope under control.
And we don't like it.
We don't like it when that profession
comes out and says PTs shouldn't do that.
We're doctors.
Yes, we should.
But when we show up and say that
another profession can't do things.
Now we're doing the thing that we just
said we didn't.
Yes,
and we can get a bad name at
the Capitol,
and that's not helping our bills go
forward either.
It's helping nothing go anywhere.
So can we all get along and be
friends?
I know that there's, you know,
there's leverage.
There's keeping some...
eye on others, helps us with leverage,
helps us with politics.
But yeah,
I think we can do a better job
of supporting all of healthcare because
we're all kind of struggling, right?
And overlap's going to happen.
And sometimes we need it to happen,
especially in rural areas.
Minnesota has a lot of rural area.
There's not enough PTs.
There's not enough ATs.
There's not enough physicians.
There's not enough PAs.
And it's only gonna get more difficult,
right?
I mean- We have a lot of hospitals
closing in Minnesota.
I'm sure that's happening everywhere.
We walk around this conference,
how many are recruiting?
It's recruiting and technology, right?
That's what it is.
Yeah, yeah.
I have some open positions at my clinic.
Put a plug in there.
You know, they're hard to fill.
Where in Minnesota?
We're in Rochester, Minnesota,
so home of Mayo Clinic.
We're a private practice working
alongside, very successfully,
a large healthcare system.
What mindset shift do PTs need to better
serve underserved communities?
I mean,
let's say someone wants to eventually open
a twenty thousand square foot thing,
that might be a little bit in the
future,
but what can they do if someone's
listening now?
Yeah, yeah.
Being, again,
being open to this idea that not
everything comes from insurance.
And that's a mind shift that still exists,
especially,
I was just talking to somebody this
morning where works at a large hospital
system.
And I told them about my model of
enhanced programming that doesn't fit the
insurance model.
So you can do both, right?
You can take insurance and you can take
cash.
Because if you look at the manuals,
these enhanced programs,
these neuro recovery programs,
They don't fit what Medicare pays for.
So therefore, we can take cash.
And she said,
but I work for a large system.
We're not allowed to take cash.
Right?
Or I work with a low-income population,
so I can't take cash.
So this is true.
They don't have a lot of funds.
But there's things like GoFundMe.
If you're open to a nonprofit arm or
a nonprofit model,
I write grants and I don't take any
state or federal grants.
It's all family foundations.
It's banks.
It's our local Rochester area foundation.
They support what we do because they see
the difference we're making.
And you're in the community.
And so then something that's one hundred
and forty dollars an hour.
becomes fifty dollars an hour or maybe
even twenty five dollars an hour or maybe
they have a gofundme that pays full right
because i'm able to subsidize right the
full cost pay my bills pay my staff
they get health insurance they we but none
of this is on the syllabus in pt
school this is simple not easy this is
not on the beaten path that's why you
doing an episode on this is so rare
right it's not that it's nowhere but it's
it's not everywhere it's definitely not
everywhere
Very rare.
I haven't actually met anyone that has a
model like mine.
And so, yeah, it's very rare,
but it's doable, and it's possible.
You have to have legal support.
You have to have accounting support.
I mean, I have an accountant.
I have an attorney now.
I didn't at first, actually.
Yeah, how hard could it be?
It's a bunch of math.
It's a bunch of numbers.
How hard could it be?
I don't recommend it,
but I wrote my own contracts,
and I did a lot, you know.
first to get going but now i would
highly recommend legal support um lots of
great consultants out there to help um you
know we are a member member of pps
even as a non-profit and i'm definitely
the unicorn and i definitely sometimes
when i talk but you can still steal
and borrow ideas and spin and we are
a private practice
Yeah, we have to pay our bills.
We actually have to make extra money for
our savings account, right?
Non-profit doesn't mean no income.
No profit, right.
And so I love to share that it's
possible.
My heart feels happy that I provide so
much to the community and we have our
goal is access for everyone.
Good.
And the website one more time.
Oh, it's easy.
ChooseEA.org.
Smart.
Rochester, Minnesota.
I mean, by the time they get hired,
it'll probably be spring.
It'll be a little cooler.
Sorry, a little warmer in Rochester,
Minnesota.
It is a beautiful,
beautiful year-round state.
But you do have to like some snow.
Or curling.
Your husband's taking up curling.
Yeah, he'd like to.
We'll see.
The Olympics has sparked some interest.
Melanie, we have a tradition on the show.
Every episode,
we do something called The Parting Shot.
This is The Parting Shot.
One last mic drop moment.
No pressure.
Just your legacy on the line.
All right,
Parting Shot brought to you by U.S.
Physical Therapy.
We're at the booth right now, U.S.
Physical Therapy.
National network of clinics focused on
developing clinicians,
not burning them out.
Leadership tracks, mentorship,
career growth.
Find them online at usph.com or find them
here if you're watching the live stream.
I swear, this is not prerecorded.
We are at the Expo Hall at USPH's
booth, which is twelve...
I might, I'm probably,
look for the guy in the ridiculous tuxedo
that I bought on Amazon.
You buy tuxedos on Amazon.
No, parting shot.
What do you want to leave as your
mic drop moment with the audience today?
I would like to leave that private
practice is not just for orthopedics.
Yeah.
That community wellness and neurologic
recovery.
We need a neuro gym in every town.
Yeah.
And but you might need to be open
to a different model.
Yeah.
So it might you I would encourage looking
at nonprofitness as one way to make that
happen.
But in the end,
you're now able to provide great care for
people who desperately need it.
And isn't that why most of us showed
up?
It is why most of us showed up.
Yeah,
we need to also take on an ideology
that insurance doesn't pay for everything.
And people should continue to get care
after ten, fourteen visits.
Melanie Brennan, APTA Minnesota.
Good luck in your presidency.
We'll check back in before your presidency
is over.
Sounds good.