You're listening to the PT Pinecast,
where smart people in healthcare come to
make noise.
Here's your host, Jimmy McKay.
All right,
if you've ever called the clinic and
thought,
how is this still the process in twenty
twenty six?
You pressed one, got transferred,
left a voicemail, never heard back.
Who's left a voicemail in the last three
years?
Meanwhile,
patients can order groceries in twelve
seconds and get a car delivered in three
minutes.
Health care didn't fall behind.
It just stayed still.
Today's guest believes health care clinics
are losing revenue, leverage and control,
not because they're bad clinicians,
because they're running two thousand and
eight systems in twenty twenty six.
He's built companies before.
He understands venture.
And now he's building AI that answers
phones, text patients, books,
visits and removes the friction that's
quietly draining clinics every day.
If PTs want to be the first stop
for musculoskeletal care,
not the afterthought.
He believes operations need to catch up.
Please welcome Albert Katz.
Albert, welcome to the show, man.
Hello, man.
Nice to see you.
How did I do on the intro?
Was anything in there wrong?
Anything false?
Did I oversell?
The only thing that would have changed is
rather than two thousand eight this time,
thinking of nineteen ninety eight windows.
Yeah, I mean,
it does sort of feel like that.
Right.
So I think I like the way that
you sort of phrased it.
And that's where I paraphrase it for the
for the intro,
which is it's not that we stepped back.
It maybe feels that we stood still.
while the while the world sort of
progressed and progressed quickly you said
most tech though and i love bold claims
i love starting the episode with bold
claims you say most tech is actually bs
so my question to you is what separates
gimmicks from game changers what is the
actual separation from sort of bs and
fluff to the things that can really
deliver i think
Any tech in healthcare that requires the
user,
AKA the provider or the administrator to
change their workflow will more often than
not fail.
And so when you have technology,
Often they have very bold claims and often
they require a complete change in the way
that you've structured your clinic for the
past ten, twenty years.
And so what ends up happening is there's
just simply no usage.
So the tech is useless.
And something that we've
solely been focusing on is just
understanding what is the current workflow
and how do we work within the workflow
so that there's no additional buttons,
there's no dashboard to look at,
there's no additional clicks, right?
It just works seamlessly.
Yeah,
this reminds me when I was in PT
school,
I was also by accident training for a
triathlon and I realized somebody took a
look at me on my bike
and how I was holding my arms at
the end of like the triathlon.
I'm like, why do you curl your wrists?
Is that like a strategy thing?
I go, well, no,
my arms are a little too long for
this bike.
And they literally just said,
there's a screw right there that you can
lengthen these.
I remember thinking, wow,
like I didn't know that I adjusted myself
to the bike instead of the bike adjusting
to me.
And that was like sort of a learning
moment in PT school, which was,
and this is for patients,
never ask them anything.
to sort of adapt to the technology,
the technology is supposed to adapt to
them.
It sounds like you're saying the exact
same thing, but for workflows.
Exactly, exactly.
I mean, that's how technology works today.
And that's how it should work in
healthcare.
And unfortunately,
it hasn't been the case largely.
Yeah.
So we're specifically talking to physical
therapists,
but the organization you work with touches
many aspects of healthcare.
But we'll stay in PT today.
You said PTs are actually holding
themselves back.
It's always fear, though.
What are they afraid of?
And then bonus question afterward,
how do we get them past that?
Yeah.
So just a little bit more context.
Flagler solely focuses on
AI layer for musculoskeletal.
So PT, ortho, pain, podiatry,
we're in thirty six states.
We started off in pain and ortho and
now we're really growing into PT after
seeing our technology work really well
with the multispecialty musculoskeletal
practices.
And what we've noticed,
and I can't really speak so much for
all of PT,
just the PTs that I've seen in these
multi-specialty practices,
and this is true for most of
musculoskeletal,
is typically a lot of the people that
go into medicine are more risk averse and
their path has always been paved for them,
right?
So you need this type of GPA to
get into undergrad,
And from there,
you need a specific GPA and an MCAT
score to get into this medical school.
And from there,
you need whatever to score on,
get whatever GPA and score whatever on
your test to get into this specialty.
And you know exactly what the next step
ahead is, right?
They never stop and train them on,
You know, how to manage a clinic,
when to take risks in business.
And largely the ones that seem to
outperform,
at least from the business angle,
are those that go above and beyond their
comfort zone.
And so something that I have seen
providers do more and more as payers and
CMS has been squeezing them on rates is
they've been forced to reach out and see
where can I generate more revenue and save
more money?
And AI seems to be that really easy
valve that they can
but it just takes a little bit of
time for them to go out and explore
what company is best suited for them.
Right.
Yeah.
About a year ago,
I felt like everything just had,
it felt like cereal boxes.
Everything had AI inside.
It was like, we've got AI in everything.
And I'm sure like you,
the clinicians out there,
the practice owners just started thinking,
I'm just saturated.
I don't understand what it can do.
You're talking about the feature or the
how,
but not the what or the why.
So how do you typically talk to a
practice owner when you've said,
we've identified the fact that there's
fear or that they're risk averse,
how do you sort of speak to them
when you see that light bulb moment in
their eyes once they realize, okay,
here are the things that I should be
looking for?
A second ago,
if it's not in my workflow or it
makes me do extra work,
I'm not gonna do it.
What are the things that you think
practice owners who are typically risk
averse need to hear before they'll start
to consider adapting or adopting
something?
Yeah.
Two things.
One, very simple.
The second one is a bit more complex
and we rarely will see companies do this.
But one,
you want one company to do as many
things for you as possible because you
don't want to undergo vendor fatigue and,
you know,
Downloading all these different point
solutions that don't communicate with one
another is going to be challenging, right?
And then you're going to ask them to
connect to these APIs and you're going to
have to deal with six different account
managers and whatever.
And one of the things that we've just
been able to do is because we don't
go after every specialty and we just hyper
focus on MSK,
we're able to offer all of these products
to you because every one of the features
is specialized to the specialty.
And then two,
as far as the risk aversion,
something that we've realized our customer
makes our customers feel a lot safer is
we take the risk on with them.
So we pay for the initial installation,
right?
The ten thousand dollars,
let's say we make sure that when we
go in prior to us even installing our
software,
we do deep diligence on the account to
show them, hey, we're only going to,
for example, the call center.
We're not going to charge you a dime
unless we're able to schedule patients for
you.
Once we schedule a patient,
we'll charge you, let's say,
two dollars per scheduled patient.
Right.
Same thing with RTM.
You'll see some solutions.
or they'll charge you about seventy
dollars per provider per month right that
requires the provider to take risk what we
do instead is we say we're going to
charge you absolutely nothing and we're
going to use our care management team to
take care of the patients we'll identify
the patients you just sign one order form
a month and.
We will bill you once we've offered the
service to that patient, right?
And we'll bill you ninety to one hundred
twenty days out.
So you've already collected the money from
payers and Medicare.
So that gives a certain amount of
confidence and safety to the provider,
because really,
if you have a tech company that's telling
you they're going to save you X amount
of dollars and make you X amount of
dollars,
they should be putting their money where
their mouth is and taking that risk with
you.
And that's something we've decided to do.
So don't be a point solution and ask
the questions like,
how does this work on cashflow?
These are a couple of different questions
that maybe weren't brought up in syllabus
when you were going through your clinical
education,
but you sort of have to ask like
the point solution.
I mean, if you look at really,
really popular companies that have
achieved adoption, which really is,
I would guess like one of the high
watermarks of success in technology,
you look at like Apple or Amazon or
Google,
if it's a solution that solves a lot
of my problems and I don't need to
hunt and peck,
that seems like something I should lean
into.
So I guess one of the things a
clinician should ask himself or a practice
owner is, how many problems do I have?
Can I list them?
And how many does this check off under
one umbrella or one login or one simple
or one organization or one flag?
Right,
and you also want to make sure the
systems work well, right?
So like operating system, OS, same thing.
Mac has a great OS, right?
Like you download a MacBook,
you can send texts from there and those
texts also auto-populate to your iPhone,
right?
And the more things you have,
whether it's an iPhone, iPad, Mac,
they all work really well together.
And that's kind of the beauty of what
we've been going for, right?
All these solutions will magnify the
others.
There's no good story without tension.
So what are the hidden costs of not
modernizing?
What are the things that maybe clinic
owners aren't even thinking about in terms
of still operating in nineteen ninety
eight windows ninety eight?
Hidden costs.
I mean,
the amount of patients here that are
falling through the care plan for certain,
right?
Like that's additional revenue you're
leaving on the table.
The additional hidden costs that I guess
most people oversee the future projection
of is your expenses aren't stagnant,
but your revenue is decreasing, right?
So the amount that you pay for salaries,
for benefits, right?
Health insurance, for example, for one K,
if you match even rent,
that will continue to increase over time.
It's forced to do inflation.
But reimbursement, crazy statistic.
Between between two thousand to twenty
twenty four,
Medicare reimbursement has decreased by
over twenty three percent for physical.
Right.
And if you look at inflation year over
year,
it's been two and a half to three
percent.
Doing the math,
the margins are going to continue
squeezing.
Right.
And that's why more and more often than
not,
you see the majority of these physical
therapists having to care for four to five
patients at the same time.
Right.
But that can only go so far.
So you really have to.
I'm seeing more and more provider groups
really turn to technology.
to relieve of all of the stress.
Yeah.
Clean up the things that fall through the
cracks.
Like you just said,
I'm thinking missed calls.
Even if the call goes through,
the intake is slow.
It's slower to get someone through.
And I bet the longer it takes someone
to get through and booked and started,
They fall off somewhere,
lost valuations completely,
and then lower patient lifetime value.
If you lose a patient now,
that would have been someone that
converted and stayed with you for five or
ten years.
I bet you clinic owners don't even want
to start doing the math on that.
Never mind burnout on your staff.
Yeah.
Yeah, a hundred percent.
I used to be the CFO of a
musculoskeletal practice,
and it is certainly hard to see
reimbursement go down and to look at your
expenses go up.
It's very painful to have to open up
that balance sheet and see exactly what's
happening.
Yeah, real painful.
All right.
Here's a question.
If someone out there runs a five clinic
PT practice, will stay in PT,
where do they even start with AI without
blowing up their workflow?
Really,
we want to move from theory to tactical.
Where does someone even start if they're
sitting in front of you and go, okay,
man, I believe everything you're saying.
I'm nodding along.
But right now,
the fear of even getting started is
overwhelming and paralyzing.
Where would you have someone start?
I think they need to,
it varies depending on the practice,
to be honest.
Like what is the largest issue, right?
Where are they having the biggest
bottleneck?
Is it where they just want to make
more money right away as quickly as
possible, lowest risk?
Then I would say download RTM,
but download,
make sure you use RTM that's not,
that doesn't require your staff to do
extra work, right?
Because if it does, it's going to fail.
But let's say that they also have a
lot of patients falling through scheduling
or not following up on their care plan,
the six visits that they're supposed to
have, right?
Then you would probably want an AI call
center to keep up with those patients,
bring them back into the practice.
And then let's just say now,
because it's becoming a bigger issue than
ever in the past three years,
it's prior authorization.
Then you want to look at a specific
AI company that can also do your prior
auth that's more seamless,
that doesn't require your people to do it.
Because again,
the number of hoops you're going to have
to jump through because of payers is only
going to increase and it's only going to
be more complex.
So you can't have these short-term
solutions where you just put more work on
your administration because something's
going to give.
Yeah,
looking to be less of a point solution
and more of a thing that could help
you out with operational efficiency.
Yeah.
Oh, sorry.
No, go ahead.
The goal of this and the way that
me and my co-founders looked at the future
clinic of tomorrow is clinics back in the
day were really just...
didn't really have many operators outside
of, let's say, just one office manager,
right?
It was just like the doctor,
maybe an MA, a nurse,
and the real estate.
And now you have this entire back office
team that has to manage all of these
extra administrative, I guess, hurdles.
And our goal is to go back to
the sixties, seventies and eighties,
where AI will handle all of that for
you.
And you can go back to the way
things were,
where you just really have to focus on
the medicine.
Like a PT's goal should only be recruiting
more PTs, finding the right real estate,
making sure that their staff is trained,
and that's it, right?
Let everything else be handled by an
automated tool.
If PTs truly want to be first response
for musculoskeletal issues,
what operational standards do they need to
hit?
What are the things that they need to
make sure are smooth from a consumer
facing perspective?
They need to be really good with referrals
and bringing patients back in and
establishing the right connections with
primary care.
What we've seen is primary care seems to
more often than not send patients directly
to orthopedics.
which is wrong because the orthos,
most of those patients don't need
procedures.
The orthos will see them.
Ninety percent of the patients that go to
ortho for initial visit don't need surgery
and don't get surgery.
Right.
So you have that wasted amount of money
that could be sent directly to PT.
Sure.
And then following that, of course,
is just making sure they don't fall
through the care plan.
The most difficult part of the care plan
is really just that, you know,
keeping up with the patients because you
guys will and do already have a large
influx of patients.
But you need someone to continue calling
them and bringing them back.
And if not that,
at least offering some telehealth
alternative.
Right.
And that's a bit more difficult.
But what you can do,
and this is one of the things we're
going to,
that's slated for us in Q three of
twenty twenty six.
is allowing PT providers to essentially
hire one of our ten ninety nine
contractors that will see their patients
that essentially refuse to come in to the
clinic to see them virtually,
essentially allowing that clinic who
had initial contact with the patient to
now have a revenue share agreement with
the ten ninety nine PTs that we hire.
So they're still able to treat the
patient, go through the care plan,
let's say on their third, fourth,
fifth visit,
because otherwise the patient would have
fallen through.
So the original clinic is benefiting
monetarily and medically because their
patient's getting better.
And all of the notes is brought back
into the EMR.
And then the PT just needs to have
a really good form of communication with
the initial provider.
And so one of the tools we built,
and I don't want to...
I'm happy to take any call with any
potential PT that would like to have a
conversation on this.
One of the additional tools we've built is
essentially this referral system front
office tool where it takes in all of
these e-faxes, scans them,
creates a patient chart,
and then reaches out to the patient within
the first eighteen minutes to book an
appointment.
Right.
um and that's something that further
amplifies pts to be the de facto
quarterback in msk because it is true like
it's a large part of the spend you
need someone uh to take charge and pts
are best suited for it right they're the
most conservative yeah um where does ai go
wrong in healthcare most often where do
you see it either failing or not living
up to what was what was just what
was what was um promised
Billing.
So right now it is just not ready
to be fully hands-off.
It certainly can improve billing and prior
authorization,
But you still need a human in the
loop, right?
So think of it more like a steroid
and less of like just like a terminator
that's like able to combat payers.
And so I would be very weary of
companies that come and advertise
themselves as fully autonomous revenue
cycle management because it's not true.
Yeah,
I think that description of the Terminator
was how a lot of things,
eighteen months ago, were sold.
And I think a lot of the early
adopters felt burned and might be a little
gun-shy with jumping back in after what
was promised and what wasn't delivered.
Yeah, I mean, look,
like I think you'll see a constant pattern
of what companies have promised and under
delivered.
And it's really just a Google search,
like, you know, typing X,
just think of a company that does billing
type in X company and type in made
mistakes billing.
And you'll see multiple articles of
different practices that have tried and
unfortunately even failed.
And yeah,
I think we're maybe a year or two
away from,
being closer,
but still it's something so sensitive and
it affects your cashflow.
You want someone there the whole time
overseeing it, right?
That's not something you put down easily.
If you walked into a PT clinic tomorrow,
what would make you nervous?
Either something that's there or something
that's not there.
If you were gonna go work with a
PT clinic for the next year and you
walked in on day one,
what would make you nervous?
What would you look around to hopefully
see and or not see?
Well, one, if they don't have an EMR,
that would make you very nervous.
But I'm assuming.
Let's not assume.
My last job in PT,
we used paper and pens.
But yes, hopefully by twenty twenty six,
we're still doing that.
That's horrible.
We saw one practice doing that and they
had this massive filing cabinet.
I'm like.
I brought my dad to an appointment a
few months ago and I literally leaned in.
I was like, you have an entire room.
I mean,
I guess you could pull that off in
areas where real estate isn't that
expensive,
but this woman had two different rooms
with file folders.
And I was just like, man,
what if a fire happened?
I also don't even...
I do wonder, I'm like,
if you are adopting at least an EMR,
are you reading into like the latest
medical literature or something like that?
Like there has to be,
something's wrong there, you know?
But whatever.
I digress.
What would make you nervous,
seeing there or not seeing it?
An EMR is one.
I think it's less about what the practice
has and more of the ethos of the
practice.
like if you go into an account and
everyone is very weary of technology or
they're very stuck in their ways and
haven't changed anything since like,
you know, the, let's say,
the early two thousands, things like that,
then I would be quite worried because
there seems to just be a bunch of
hesitation with AI is gonna take your job,
right?
And those that,
the capabilities and the benefits of it i
think are going to be more so enemies
to the cause rather than supporters all
right uh last question before we hit you
with the parting shot what's something
clinic owners think matters but it
actually doesn't what is something that
clinic owners buy into that they think
matters but when it all is said and
done it really doesn't matter it's not
that big of a deal oh man oh
man
that's really hard i would have to think
about that because there's a couple things
there are you can pick you can pick
more than one that's all right i i
would have to get back to you on
that i i really i don't
Well,
I guess I think you might have already
answered this one too,
which was if it has AI in it,
then it's good.
And I feel like that's not actually true.
Oh, I see.
Yeah, I see.
I mean, I think a lot of people...
Oh, here's one.
This is the one I learned myself.
Yes, obviously, if it has AI,
it doesn't mean it's true.
But it's also...
People look at administrators, right?
And they see like these fancy MBA business
degrees.
Like I went to Wharton and they typically
associate you with being able to just be
standardly good at business and knowing
how to operate a clinic.
And that's also false.
That's completely false.
I think that to be honest,
I made a lot of mistakes early on
when I was operating and I,
realize that it doesn't matter what school
or program you graduated from.
It's really just a combination of
experience and creativity.
And if you're able,
like health care in itself is a separate
monster, right?
Like the way that our system works is
like none other.
And what you really need is just to
understand the system in and out,
understand how your specific clinic works,
and then figure out what are the levers
you can pull and be very creative.
Don't follow everything you hear from
other people.
Take bits and pieces and figure out how
to incorporate it into your own.
That's, I would say,
that's one thing that
I think that stuck with me, right?
Fancy degrees are fancy degrees and
nothing else.
Yeah.
Can you execute or not?
Yeah.
All right.
Last thing we do on each episode is
called the parting shot.
This is the parting shot.
One last mic drop moment.
No pressure.
Just your legacy on the line.
Parting Shot is brought to you by our
friends at Empower EMR.
Oh, it slows you down.
If you've chosen an EMR that slows you
down, that is a personal choice.
They give you speed at Empower,
clean workflows and features PTs actually
ask for, better notes,
faster documentation, smoother operations,
and customer support that doesn't ghost
you.
Upgrade your clinic's brand at
EmpowerEMR.com.
Albert, Parting Shot,
just the last thing you'd want to leave
with the audience.
Mic drop moment, soapbox statement,
can be anything, it's yours.
If you're looking to bring your practice
in the the twenty second century,
just give us a call.
Yeah.
Say it one more time.
FlaglerHealth.io.
Perfect.
Excellent.
We'll put all that information and the
link in the show notes as well.
Albert,
appreciate you for the time and for the
insights.
Thank you, Jimmy.
That's it for this one,
but we're just getting warmed up.
Smash follow, send it to a friend,
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Hit us at pgpinecast.com.
Or find us on YouTube and socials at
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And legally, none of this was advice.
It's for entertainment purposes only.
See, Keith?
We read the script.
Happy now?