WEBVTT

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You're listening to the PT Pinecast,

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where smart people in healthcare come to

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make noise.

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Here's your host, Jimmy McKay.

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All right.

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What happens when someone spends an entire

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career refusing to wait for someone else

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to fix the problem?

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It's probably a good thing.

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When reimbursement drops,

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when regulations pile up,

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when every year it feels like physical

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therapy is just asked to do more for

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less.

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Some clinicians complain about the system

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a lot.

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Others start working to change it,

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and it's not easy.

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But today's guest has spent more than

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three decades treating patients,

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building a private practice,

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raising a family,

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and quietly working behind the scenes to

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reshape how physical therapy is recognized

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and paid for.

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From pushing for a primary care

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designation for PT to advancing fair copay

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legislation to expanding the Utah Practice

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Act.

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He's part of a group of clinicians who

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decided to do something radical.

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Stop waiting for change and start fixing

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the profession where they are.

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Oh,

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and when he's not doing any of that,

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he's probably bass fishing with the boys.

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Today on the show,

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we're joined by Howard Quackenbush.

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Howard, welcome to the show.

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Hey, thank you, Jimmy.

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It's a pleasure to be with you.

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excited you i like people uh who just

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say well if no one's gonna fix it

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i'm just gonna do it myself it's never

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glamorous it's never ever i can imagine

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easy uh it's never quick nothing good

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usually is but i would i would assume

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someone like you would say doing it is

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worth it well you know like you said

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um

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It's always a challenge.

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You know,

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I've been doing this since nineteen ninety

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four when I graduated from Wash U and

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as an athletic trainer before and even as

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an athletic trainer, the student,

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you know, everybody is like, well,

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let's ponder this.

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Let's think about this.

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Let's see if the National Association is

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going to do.

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And then we got in,

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we have physical therapy and I've,

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you know,

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I built a practice and finally said I

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want to get involved.

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I got involved with the APTA Utah.

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and in some, you know, minor little roles.

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And then they put me in as chief

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delegate.

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And then once I got out there with

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National APTA,

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I realized that they're trying awful hard,

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but they're doing a lot of policy stuff.

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And it's like,

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this is not working for us.

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It's like, you know,

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we have a lot of concerns.

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We want to say we want to mandate

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APTA to do this.

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APTA doesn't have the ability to do a

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lot of things.

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They're a policymaking position.

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They represent us.

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They're fabulous in that.

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But we got to do it ourselves.

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Right.

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They're good at what they're good at.

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But you can't be, I mean,

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I haven't figured it out yet,

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how to be good at all the things.

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Even if you just looked at how APTA

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is structured.

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And again, I don't work for APTA,

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but I'm a member of APTA.

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APTA is a national organization.

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It's also a local organization times fifty

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one state chapters.

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I want to make sure people from D.C.

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don't throw stones at me.

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I'm not from D.C.

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But if you want things changed because we

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live in this country where things are

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different,

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as soon as you cross sort of an

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imaginary line from one state to another,

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you have to understand what the

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differences are,

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where you live and where you practice.

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And that's step one.

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Step two,

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if there's something you don't like about

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it, Howard would probably say this.

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I agree.

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Nobody's coming to look around.

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If nobody's working on that problem,

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guess what?

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You just nominated yourself to be part of

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the team to work on that problem.

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Quick little story, my Fillmore,

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Utah clinic,

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a physician and I own the building

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together.

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And so he has his physician's practice,

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it's Revere Health on one half,

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we have physical therapy on the other.

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One day his secretary came up to me

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just mad, said, you know,

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the cleaning person is not cleaning the

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toilets well enough.

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And I said, fine, go do it.

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If you don't like it, go fix it.

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Oh, she got mad.

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She marched off to Dr. Groves and says,

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Howard,

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I told him the toilets were getting

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cleaned well enough.

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And Dr. Groves laughs.

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He says,

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I know exactly what he told you.

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He says, what did he tell me?

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He told you to go do it yourself.

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And she just got mad.

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She quit.

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She quit like three days later.

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But ultimately, that's what has to happen.

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If you don't like your situation

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personally, you do something else.

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If you don't like that the bass fish

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aren't biting a jerkbait,

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you go to a tube.

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You gotta change something.

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And if you wait for somebody else to

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do it,

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somebody probably will sooner or later.

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But if you really wanna do it,

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you gotta step up and do it yourself.

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And I'd say there's a problem with that

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too,

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which is if you wait for someone else

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to do it,

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they might not do it exactly how you

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think it should be done.

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If it's somebody else from a different

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profession,

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they're never going to do it with as

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much enthusiasm,

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with as much inside knowledge,

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as fast as you probably think.

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I mean, I'm sorry to tell you,

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but if the bass aren't biting,

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you got to change the bait.

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You could scream at the bass all you

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want.

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Right?

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It's so true.

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Yeah.

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So you've been working on getting PT

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designated as primary care providers in

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Utah.

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When most PTs hear that phrase,

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they're probably not really sure what that

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means.

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So let's walk through it real slow and

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real clear.

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What does it mean?

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What does primary care providers mean?

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pts primary care providers mean and then

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what changes when that happens okay so

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before we get into what primary care

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really means we've got to you know clarify

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what direct access is okay good because i

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think sometimes we conflate those two

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things yeah

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I agree a hundred percent.

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So again,

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back in my student days and I was

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in St.

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Louis out there at Wash U and this,

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the Missouri rule was I could not even

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talk to a person at the grocery store

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about physical therapy without having a

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doctor script in my hand telling me that

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I could do ultrasound massage and heat.

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You know,

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you couldn't even speak to someone about

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it.

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Couldn't you speak to them?

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No,

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it was illegal to even talk to them

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about physical therapy without a physician

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script.

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And so over the years,

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each state got some sort of considered

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direct access, which basically just said,

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yes, you're a physical therapist,

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you have a professional degree,

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you have a skill, yes,

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you can talk to them and they can

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come talk to you also.

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And so everybody kind of termed that, oh,

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we have direct access to the patient and

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then the insurance company is going to pay

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us because they come and get there.

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But we all did the same song and

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dance of, yeah,

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you can come and see me directly,

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but check with your insurance to see if

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you need a physician's description.

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And so it may be termed direct access,

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but we have a barrier in place and

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it was insurers.

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Yeah, it was directly indirect.

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Yeah.

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Yeah,

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directly indirect is a great way to put

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it.

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And so as we pondered this,

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and now every state in the nation has

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some form of direct access,

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and a lot of people think, well,

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we've arrived,

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but then we're still not getting paid,

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we're still struggling with insurers,

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we have regulations, overburden,

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we're bitching and moaning about all this

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stuff,

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and we really gotta step up

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and say okay what do we do and

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so we did in utah um and it

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was fascinating because it was our

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executive director her name is katie

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manziel she's not a clinician but she is

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fabulous and she just said you know what

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what if we

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you know,

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got everybody together and brainstormed

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about this.

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And so we called up the six biggest

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private practice groups in the state that

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are all competitors.

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They each were, you know,

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turf battling and everything else.

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We said, okay, guys,

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come to a meeting sponsored by APTA Utah.

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And let's talk about what we could do

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to try to promote physical therapy.

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We got everybody in the same room.

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And as you'd expect,

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it was pleasantly formal.

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You know, hey, how you doing?

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I'm going to sit on my side with

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my guy.

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You sit on the side with your guy.

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And we got talking.

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It became pretty clear pretty fast that we

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all had the same concerns.

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Why can't we get the patients to come

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and see us?

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And why do we have this barrier with

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physical therapy?

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the insurance companies.

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And so we said, okay,

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what would it take for us to be

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considered primary care?

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And in Utah,

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we got digging around and we found that

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the primary care designation was not in

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practice acts,

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was not in the medical code.

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It was actually in the insurance code.

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And so we looked and said, okay,

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how's it termed?

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They said,

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primary care is considered physician,

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nurse practitioner, dentist, and DOs.

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And we said,

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what if we ran a legislation that says,

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and PT?

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And so we said, let's try it.

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And we said, okay, if we do this,

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talk to our,

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every component and association has a

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lobbyist, talk to our lobbyist.

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And he said,

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it might take you three years to push

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something like that through.

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We said, well, let's try.

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So we called up all the lobbyists.

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private practices that, okay,

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ask each one of your people to donate

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one hour's worth of their pay to a

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lobbying thing.

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So whatever your salary is,

00:09:08.496 --> 00:09:09.418
whatever you make per hour,

00:09:09.678 --> 00:09:10.440
donate one hour.

00:09:10.480 --> 00:09:13.503
And we actually had a great response.

00:09:13.523 --> 00:09:15.105
We raised some basic funds.

00:09:15.706 --> 00:09:17.067
We said, I default this legislation.

00:09:17.847 --> 00:09:18.827
Next thing we said was,

00:09:19.469 --> 00:09:20.568
let's just see how it goes.

00:09:20.609 --> 00:09:22.950
We put it out there and immediately the

00:09:23.169 --> 00:09:25.150
Utah Medical Association lost their minds

00:09:26.071 --> 00:09:27.052
and the insurers went,

00:09:27.572 --> 00:09:29.452
what are you all trying to do?

00:09:30.052 --> 00:09:32.433
We thought, let's keep trying.

00:09:33.234 --> 00:09:33.855
And so we started,

00:09:34.095 --> 00:09:38.118
we picked a senator to sponsor the bill

00:09:38.138 --> 00:09:40.740
for us and we floated it.

00:09:41.059 --> 00:09:42.780
And then, you know,

00:09:43.282 --> 00:09:44.302
we were learning as we went,

00:09:44.383 --> 00:09:46.063
it went to the Senate committee.

00:09:46.583 --> 00:09:48.265
So immediately we identified all the

00:09:48.306 --> 00:09:49.846
Senate committee members and we just

00:09:49.907 --> 00:09:50.587
reached out to, again,

00:09:50.648 --> 00:09:51.989
all the private practice people said,

00:09:52.048 --> 00:09:54.029
here's the list of the senators who are

00:09:54.049 --> 00:09:54.510
on this committee.

00:09:55.191 --> 00:09:56.251
Which one of you do you know?

00:09:56.272 --> 00:09:56.971
Who knows who?

00:09:57.072 --> 00:09:57.852
And it was amazing.

00:09:58.373 --> 00:10:00.274
Every single one of those senators had

00:10:00.573 --> 00:10:01.735
their PT,

00:10:02.034 --> 00:10:04.476
had their their guy or their gal.

00:10:05.216 --> 00:10:07.118
And so we reached out and said, hey,

00:10:07.518 --> 00:10:09.078
reach out and, you know, and see how,

00:10:09.178 --> 00:10:09.860
you know,

00:10:09.919 --> 00:10:11.541
what their their aspect of how they feel

00:10:11.581 --> 00:10:14.201
and tell them physical therapy is.

00:10:15.263 --> 00:10:16.583
saves the system money.

00:10:17.183 --> 00:10:18.044
Direct, you know,

00:10:18.065 --> 00:10:19.166
direct access is a wonderful thing,

00:10:19.186 --> 00:10:20.726
but we have barriers that can increase

00:10:20.767 --> 00:10:23.187
patient access to care.

00:10:23.807 --> 00:10:25.549
And then we can get the patients better

00:10:25.570 --> 00:10:26.990
without opioids,

00:10:27.270 --> 00:10:29.892
without unnecessary diagnostics.

00:10:30.251 --> 00:10:30.913
If they do,

00:10:31.293 --> 00:10:34.534
we're trained in triage and screening.

00:10:34.554 --> 00:10:35.716
If they do have stuff that's not in

00:10:35.755 --> 00:10:37.697
the physical therapy scope of practice,

00:10:38.136 --> 00:10:40.239
we'll send them on to the appropriate

00:10:40.298 --> 00:10:40.678
person,

00:10:40.759 --> 00:10:43.660
just like any other primary care

00:10:44.140 --> 00:10:46.261
know provider does and that was their

00:10:46.282 --> 00:10:48.022
concerns they a lot of the concerns came

00:10:48.062 --> 00:10:49.763
back for well the medical association got

00:10:49.802 --> 00:10:52.864
up and said if they do this what

00:10:52.903 --> 00:10:54.984
if they miss cancer you know what if

00:10:55.004 --> 00:10:56.965
the person's having a stroke it's like

00:10:57.585 --> 00:11:00.105
we've had direct access we've been doing

00:11:00.145 --> 00:11:03.267
it forever and and we're we're perfectly

00:11:03.307 --> 00:11:05.548
trained and capable and most of us have

00:11:05.567 --> 00:11:07.388
you know look at our syllabus we've got

00:11:07.408 --> 00:11:08.548
that covered don't worry about that good

00:11:08.629 --> 00:11:09.489
we got it

00:11:10.048 --> 00:11:11.629
yeah we got it and so we got

00:11:11.690 --> 00:11:13.490
started going through and so they started

00:11:13.669 --> 00:11:15.990
the uh medical association sure started

00:11:16.030 --> 00:11:18.051
coming out hard but we went to the

00:11:18.071 --> 00:11:20.392
first committee meeting and uh in that

00:11:20.412 --> 00:11:23.393
committee meeting um they the senator

00:11:23.432 --> 00:11:28.654
proposed the bill um i uh my colleague

00:11:28.695 --> 00:11:29.414
chad tenney

00:11:30.394 --> 00:11:32.056
physical therapist, he got up there.

00:11:32.275 --> 00:11:33.255
He did a beautiful job.

00:11:33.275 --> 00:11:33.897
He said, look,

00:11:34.417 --> 00:11:37.238
physical therapy is this bike lane on the

00:11:37.298 --> 00:11:38.458
highway of healthcare.

00:11:38.899 --> 00:11:40.119
We're staying in our bike lane.

00:11:40.158 --> 00:11:41.480
We don't want to be physicians.

00:11:41.620 --> 00:11:42.500
We are smart enough.

00:11:42.519 --> 00:11:43.681
We could be if we wanted to.

00:11:43.821 --> 00:11:45.140
We didn't want to do the on-call stuff

00:11:45.160 --> 00:11:45.761
in the hospital.

00:11:46.881 --> 00:11:47.881
He was great.

00:11:47.902 --> 00:11:49.503
He just said, we're going to stay here.

00:11:49.582 --> 00:11:50.703
We know what our role is,

00:11:50.984 --> 00:11:53.044
but we want to have patient access for

00:11:53.085 --> 00:11:53.504
that role.

00:11:54.434 --> 00:11:55.976
And they liked it.

00:11:56.037 --> 00:11:57.599
And they asked for public comments.

00:11:57.619 --> 00:11:59.380
So I got to speak and I kind

00:11:59.421 --> 00:12:01.222
of followed suit, you know,

00:12:01.283 --> 00:12:02.945
explaining the cost savings and the

00:12:02.965 --> 00:12:03.265
importance.

00:12:03.346 --> 00:12:05.408
And then the insurers and everybody else

00:12:05.989 --> 00:12:07.291
came through, you know,

00:12:07.311 --> 00:12:09.253
telling us why the sky will fall,

00:12:09.352 --> 00:12:10.995
cats will start living with dogs if,

00:12:11.034 --> 00:12:12.376
you know, this happens, you know.

00:12:12.397 --> 00:12:13.076
Slippery slope.

00:12:14.259 --> 00:12:15.240
It's going to be awful.

00:12:15.840 --> 00:12:18.363
And the comments from the senators were

00:12:18.383 --> 00:12:18.822
amazing.

00:12:18.883 --> 00:12:20.865
They say, well, we understand this.

00:12:20.904 --> 00:12:22.606
And I have to ask this question because

00:12:22.787 --> 00:12:26.070
one of my donors is asking this.

00:12:26.129 --> 00:12:27.291
And then they'd all finish up with,

00:12:27.652 --> 00:12:30.173
but my physical therapist takes care of my

00:12:30.234 --> 00:12:30.695
family.

00:12:30.754 --> 00:12:32.155
And my physical therapist did.

00:12:32.596 --> 00:12:35.719
We passed that Senate committee with one

00:12:35.820 --> 00:12:37.201
hundred percent unanimous support.

00:12:37.280 --> 00:12:37.721
Wow.

00:12:40.081 --> 00:12:42.383
Went back to the Senate floor and got

00:12:42.423 --> 00:12:44.582
a hundred percent vote there also in the

00:12:44.623 --> 00:12:45.043
positive.

00:12:45.063 --> 00:12:47.144
So then it goes to the House and

00:12:47.183 --> 00:12:48.644
we did the same thing with the House

00:12:48.663 --> 00:12:48.943
committee.

00:12:48.964 --> 00:12:51.384
We had therapists for every House member

00:12:52.044 --> 00:12:53.846
and they had the exact same thing.

00:12:53.885 --> 00:12:55.645
We passed the House committee at a hundred

00:12:55.666 --> 00:12:58.927
percent and then we didn't pass the House

00:12:58.966 --> 00:12:59.706
Senate with a hundred percent.

00:12:59.726 --> 00:13:01.746
We only had one nay vote because they

00:13:01.787 --> 00:13:03.207
were, you know,

00:13:03.227 --> 00:13:04.207
they were just being obstinate.

00:13:06.124 --> 00:13:07.745
And so, so then it'd be,

00:13:07.784 --> 00:13:09.206
so we came primary care.

00:13:09.246 --> 00:13:10.988
Then everybody said, who cares?

00:13:11.427 --> 00:13:13.169
You know, you have it, big deal.

00:13:14.130 --> 00:13:14.410
And that's,

00:13:14.870 --> 00:13:16.412
in some ways it's kind of true,

00:13:17.033 --> 00:13:18.453
but what it did was it started our

00:13:18.494 --> 00:13:19.195
ball rolling.

00:13:19.455 --> 00:13:21.797
So now we, with this past year,

00:13:22.236 --> 00:13:23.658
we are promoting the aspect that we're

00:13:23.717 --> 00:13:24.698
primary care.

00:13:24.719 --> 00:13:26.900
So now we can see the patient directly.

00:13:26.941 --> 00:13:29.243
We can become referral sources, Utah.

00:13:30.923 --> 00:13:31.445
And I got more,

00:13:31.504 --> 00:13:33.046
I got some news as of yesterday for

00:13:33.086 --> 00:13:33.166
you.

00:13:33.426 --> 00:13:35.148
It's hot off the press for you.

00:13:37.490 --> 00:13:40.212
But we could do x-ray and MRI in

00:13:40.332 --> 00:13:40.712
Utah.

00:13:40.732 --> 00:13:42.394
We could do several other things.

00:13:42.414 --> 00:13:45.138
So now we can actually go to the

00:13:45.658 --> 00:13:47.440
x-ray facilities.

00:13:48.360 --> 00:13:51.004
You can accept our referrals because we're

00:13:51.063 --> 00:13:52.885
primary care.

00:13:52.926 --> 00:13:54.788
We can receive our patients because we're

00:13:54.827 --> 00:13:55.369
primary care.

00:13:55.408 --> 00:13:55.869
We can do this.

00:13:56.549 --> 00:13:57.850
So over the past year,

00:13:58.951 --> 00:13:59.893
Since we had the project, we said,

00:14:00.013 --> 00:14:01.235
what's the next step?

00:14:01.975 --> 00:14:05.880
And the next step, we decided to, well,

00:14:06.461 --> 00:14:07.823
we had two things going on.

00:14:08.264 --> 00:14:10.729
The Occupational Professional Licensure

00:14:10.769 --> 00:14:11.610
Review Board,

00:14:11.830 --> 00:14:14.094
it was our ten-year annual review.

00:14:14.594 --> 00:14:15.934
And so they were working on that last

00:14:15.975 --> 00:14:16.155
year.

00:14:16.176 --> 00:14:17.297
And they came up and said, well,

00:14:17.317 --> 00:14:18.878
we want to expand the practice act for

00:14:18.898 --> 00:14:21.159
physical therapy to give them all imaging

00:14:21.780 --> 00:14:22.301
abilities.

00:14:22.721 --> 00:14:24.844
We want to clarify dry needling.

00:14:24.903 --> 00:14:26.404
We want to change the supervision

00:14:26.826 --> 00:14:27.586
requirements.

00:14:27.625 --> 00:14:29.727
They gave us this whole laundry list of

00:14:29.788 --> 00:14:31.970
stuff, offered laboratory tests.

00:14:32.697 --> 00:14:34.177
And all the stuff that would fit our

00:14:34.216 --> 00:14:35.898
primary care designation was good timing

00:14:35.937 --> 00:14:38.658
because we were primary care designated

00:14:38.999 --> 00:14:40.499
when the OPLA review came along.

00:14:40.558 --> 00:14:41.479
And so they said, oh,

00:14:41.798 --> 00:14:42.740
since you're primary care,

00:14:42.879 --> 00:14:44.539
you should be able to do these other

00:14:44.580 --> 00:14:47.020
services because you're trained in them in

00:14:47.061 --> 00:14:47.561
school.

00:14:47.660 --> 00:14:48.821
You have the education.

00:14:49.480 --> 00:14:50.942
Let's allow you to do that.

00:14:52.051 --> 00:14:52.611
As you'd imagine,

00:14:52.631 --> 00:14:54.113
then it goes back to the legislative

00:14:54.133 --> 00:14:54.572
process.

00:14:54.953 --> 00:14:56.134
So that's the first bill.

00:14:56.215 --> 00:14:57.134
The second bill we said, well,

00:14:57.174 --> 00:14:59.317
let's go after fair co-pays.

00:14:59.697 --> 00:15:01.099
If we're primary care,

00:15:01.839 --> 00:15:03.660
we should have a primary care co-pay.

00:15:03.681 --> 00:15:04.160
In Utah,

00:15:04.581 --> 00:15:07.264
most of the commercial insurers co-pay is

00:15:07.283 --> 00:15:08.264
twenty five bucks right now.

00:15:09.005 --> 00:15:10.767
Physical therapy is ranging anywhere

00:15:10.807 --> 00:15:11.648
between fifty.

00:15:11.727 --> 00:15:14.029
I have one company that's ninety five

00:15:14.610 --> 00:15:16.731
bucks for a co-pay on a plan.

00:15:18.143 --> 00:15:19.224
Patients aren't going to complete them.

00:15:19.244 --> 00:15:20.284
First of all, they're not going to come.

00:15:21.826 --> 00:15:23.287
If they do,

00:15:23.586 --> 00:15:24.587
they're not going to complete their course

00:15:24.607 --> 00:15:25.068
of care.

00:15:25.609 --> 00:15:26.769
And if I had the choice of go

00:15:26.789 --> 00:15:28.711
to my doctor and get a pill or

00:15:28.731 --> 00:15:29.532
go to physical therapy,

00:15:29.572 --> 00:15:31.634
pay more and have to do exercise and

00:15:31.653 --> 00:15:32.894
do things and maybe get better.

00:15:34.417 --> 00:15:35.618
What's my first choice going to be?

00:15:35.658 --> 00:15:36.418
I'm going to get the pill.

00:15:36.799 --> 00:15:38.221
And we're sitting there whining about,

00:15:38.240 --> 00:15:38.520
you know,

00:15:38.701 --> 00:15:42.125
the opioid epidemic or medical

00:15:42.426 --> 00:15:44.827
complications from, you know,

00:15:45.028 --> 00:15:46.809
medication complications.

00:15:47.230 --> 00:15:49.052
We have all those issues.

00:15:49.773 --> 00:15:50.053
So we said,

00:15:50.494 --> 00:15:51.615
let's run a fair co-pay spell.

00:15:52.643 --> 00:15:55.886
So we started doing that one and just

00:15:55.927 --> 00:15:56.988
the same thing.

00:15:58.168 --> 00:16:00.912
The Opler bill was done by the state

00:16:01.312 --> 00:16:02.815
and we expected that one to go through.

00:16:02.855 --> 00:16:04.817
The only thing we lost in that one

00:16:04.937 --> 00:16:06.177
was laboratory tests.

00:16:06.538 --> 00:16:09.562
And here's my pushback on our own

00:16:09.581 --> 00:16:10.062
profession.

00:16:10.123 --> 00:16:10.623
Most of the time,

00:16:10.643 --> 00:16:11.705
we're our own worst enemies.

00:16:12.580 --> 00:16:16.903
The senator that was sponsoring the Opler

00:16:16.962 --> 00:16:18.403
bill, Senator Evan Vickers,

00:16:18.423 --> 00:16:20.544
he's actually my senator from Cedar City,

00:16:20.625 --> 00:16:20.945
Utah,

00:16:21.405 --> 00:16:23.907
he went to several of his physical

00:16:23.947 --> 00:16:25.727
therapists in the area and said,

00:16:26.269 --> 00:16:26.989
here's Opler,

00:16:27.830 --> 00:16:28.789
here's what they're suggesting,

00:16:28.850 --> 00:16:29.410
what do you guys say?

00:16:29.431 --> 00:16:30.431
And we had all,

00:16:30.591 --> 00:16:31.991
we had several therapists tell him, oh,

00:16:32.011 --> 00:16:33.774
we'd never need laboratory tests.

00:16:34.453 --> 00:16:35.894
but they're in the outpatient clinic.

00:16:36.034 --> 00:16:37.375
Well, what about our acute care?

00:16:37.735 --> 00:16:40.037
What about our nursing facilities?

00:16:40.297 --> 00:16:41.577
What about our primary care?

00:16:41.597 --> 00:16:43.099
If we really are gonna do Instacare

00:16:43.119 --> 00:16:44.440
physical therapy stuff,

00:16:45.139 --> 00:16:46.160
why wouldn't we wanna know if it's a

00:16:46.301 --> 00:16:48.562
UTI versus confusion versus dizziness?

00:16:49.462 --> 00:16:50.202
Why couldn't we?

00:16:50.442 --> 00:16:50.682
Anyway,

00:16:50.964 --> 00:16:52.924
so they ended up pulling it out because

00:16:52.945 --> 00:16:53.705
the therapist said, oh,

00:16:53.725 --> 00:16:55.145
we'd never use it without thinking.

00:16:56.187 --> 00:16:57.746
Pelvic health is a big issue,

00:16:57.807 --> 00:16:59.649
big area in physical therapy.

00:16:59.948 --> 00:17:01.629
I am never going to do that.

00:17:02.690 --> 00:17:03.291
I'm an old dude,

00:17:03.410 --> 00:17:05.313
I don't want to do that.

00:17:05.432 --> 00:17:06.252
But I'm not going to go tell the

00:17:06.292 --> 00:17:07.413
Senator, we don't need,

00:17:07.433 --> 00:17:09.496
we don't public health because I'm never

00:17:09.516 --> 00:17:10.115
going to do it.

00:17:10.155 --> 00:17:12.218
You speak on behalf of the profession and

00:17:12.278 --> 00:17:13.358
one of our strengths and one of our

00:17:13.398 --> 00:17:15.740
weaknesses is we are wide.

00:17:15.881 --> 00:17:17.923
We do everywhere.

00:17:18.242 --> 00:17:19.443
There is a large spectrum.

00:17:20.603 --> 00:17:20.762
Yeah.

00:17:20.823 --> 00:17:20.923
Yeah.

00:17:20.942 --> 00:17:22.463
So anyway, so long story short,

00:17:22.483 --> 00:17:23.523
that one got pulled out.

00:17:23.544 --> 00:17:24.865
So we went on to the legislative thing.

00:17:24.884 --> 00:17:26.585
The Offler bill, you know,

00:17:26.865 --> 00:17:27.685
kind of went up and down,

00:17:27.726 --> 00:17:28.226
struggled through.

00:17:28.246 --> 00:17:28.986
They actually had more.

00:17:29.246 --> 00:17:31.067
They bumped us in with nurse

00:17:31.086 --> 00:17:34.107
practitioners, PAs, occupational therapy,

00:17:34.167 --> 00:17:34.867
athletic trainers.

00:17:35.167 --> 00:17:36.148
And so we were under the radar.

00:17:36.209 --> 00:17:37.088
Our stuff all went through.

00:17:37.749 --> 00:17:40.690
But the fair co-pays was a battle.

00:17:41.510 --> 00:17:41.711
I bet.

00:17:41.730 --> 00:17:43.911
The money comes out, the claws come out.

00:17:43.931 --> 00:17:45.811
Oh, and again,

00:17:45.832 --> 00:17:48.713
the medical association started out with –

00:17:49.131 --> 00:17:50.311
I got to be the point this time

00:17:50.592 --> 00:17:51.393
on the committees.

00:17:51.752 --> 00:17:52.593
We did the same thing.

00:17:52.712 --> 00:17:53.834
We knew which committee we were going to

00:17:53.874 --> 00:17:54.213
be in.

00:17:54.775 --> 00:17:56.695
And fortunately, we were in this initial,

00:17:56.715 --> 00:17:57.175
the Senate committee,

00:17:57.195 --> 00:17:58.237
we were in the same one as we

00:17:58.257 --> 00:18:04.020
were last year with primary care.

00:18:04.881 --> 00:18:07.122
And so we already had the therapist,

00:18:07.162 --> 00:18:08.061
everybody identified.

00:18:08.423 --> 00:18:09.903
So we went into that one and the

00:18:10.282 --> 00:18:12.624
Utah Medical Association president got up

00:18:13.224 --> 00:18:15.546
and just got mad at me after I

00:18:15.605 --> 00:18:16.086
presented.

00:18:16.105 --> 00:18:17.086
And she said,

00:18:17.125 --> 00:18:19.307
you should know orthopedic surgeons are

00:18:19.366 --> 00:18:21.147
primary care and they do physical therapy

00:18:21.167 --> 00:18:22.628
in their offices all the time.

00:18:23.429 --> 00:18:25.890
And sadly, I was disrespectful.

00:18:26.349 --> 00:18:27.010
I laughed.

00:18:27.711 --> 00:18:28.550
I said, first of all,

00:18:28.570 --> 00:18:30.231
they're not going to want my little CPT

00:18:30.271 --> 00:18:31.612
code when they do a surgical code.

00:18:32.011 --> 00:18:35.012
And no, they are not primary care.

00:18:35.073 --> 00:18:36.053
They're specialists.

00:18:36.593 --> 00:18:37.292
And thirdly,

00:18:37.532 --> 00:18:39.013
they don't do physical therapy in their

00:18:39.074 --> 00:18:39.433
offices.

00:18:39.473 --> 00:18:40.794
They may have some ancillary.

00:18:40.814 --> 00:18:42.355
There might be a couple that have some

00:18:42.994 --> 00:18:45.055
incident two stuff, but no,

00:18:45.255 --> 00:18:46.194
they don't do that.

00:18:46.635 --> 00:18:47.915
And so she got mad and she left.

00:18:48.556 --> 00:18:50.017
insurance companies came up and were like,

00:18:50.477 --> 00:18:52.019
oh, again, the sky will fall.

00:18:52.098 --> 00:18:52.999
It'll be awful.

00:18:54.420 --> 00:18:56.862
Everybody's costs will go up.

00:18:57.082 --> 00:18:58.143
And I just answered and said,

00:18:58.163 --> 00:18:59.963
when was the last time your annual

00:18:59.983 --> 00:19:00.724
premiums went down?

00:19:04.977 --> 00:19:05.518
No answer.

00:19:05.538 --> 00:19:06.117
No answer.

00:19:06.137 --> 00:19:08.338
And so we got through that one because

00:19:08.358 --> 00:19:08.699
we did it.

00:19:08.759 --> 00:19:11.660
So then we went to the Senate floor,

00:19:12.079 --> 00:19:15.721
and our Senator Mike McKell was fabulous.

00:19:15.780 --> 00:19:17.201
He pushed it through the Senate floor for

00:19:17.241 --> 00:19:17.281
us.

00:19:17.642 --> 00:19:20.002
There were a few more nay votes because

00:19:20.022 --> 00:19:22.723
the insurance is the second largest lobby

00:19:23.084 --> 00:19:25.944
in Utah behind the utilities.

00:19:26.724 --> 00:19:29.048
And of course they spend an awful lot

00:19:29.108 --> 00:19:30.891
of time and effort in the summer for

00:19:30.951 --> 00:19:32.794
campaign donations and things to have

00:19:32.834 --> 00:19:33.094
influence.

00:19:33.114 --> 00:19:34.536
So it wasn't unexpected.

00:19:34.576 --> 00:19:35.297
We got through the summer,

00:19:35.317 --> 00:19:37.119
went to the house and

00:19:38.262 --> 00:19:38.923
we ended up,

00:19:39.263 --> 00:19:40.544
the insurance company got ahead of us,

00:19:40.584 --> 00:19:43.205
and so we were able to get in

00:19:43.645 --> 00:19:45.247
a different committee from the year

00:19:45.287 --> 00:19:45.826
before,

00:19:46.527 --> 00:19:49.409
and we were able to identify a lot

00:19:49.469 --> 00:19:50.730
of the, again,

00:19:50.769 --> 00:19:53.750
therapists for their representatives,

00:19:54.211 --> 00:19:56.231
and they all had the same response, like,

00:19:56.393 --> 00:19:58.913
oh, I love my therapist, they do this,

00:19:59.034 --> 00:20:00.555
and the best part was it was on

00:20:00.615 --> 00:20:02.476
a Friday afternoon, we only have,

00:20:03.215 --> 00:20:04.656
tomorrow's the last day of the legislative

00:20:04.676 --> 00:20:06.218
session, and this was last Friday,

00:20:08.070 --> 00:20:09.692
and it was Friday afternoon at

00:20:09.771 --> 00:20:11.132
five-thirty, they were done,

00:20:11.152 --> 00:20:12.633
they'd already had a heated battle about

00:20:12.712 --> 00:20:14.813
immigration and different things in the

00:20:14.853 --> 00:20:16.554
discussions, so they were tired,

00:20:16.913 --> 00:20:19.114
and the committee chairman was not having

00:20:19.173 --> 00:20:19.273
it.

00:20:19.634 --> 00:20:21.714
He let us present, let me speak,

00:20:22.134 --> 00:20:24.155
and then he just kept going, okay,

00:20:24.375 --> 00:20:25.576
we're done, we're done, we're done.

00:20:25.955 --> 00:20:26.375
They voted,

00:20:26.415 --> 00:20:27.737
we got out of committee with a vote

00:20:27.757 --> 00:20:30.557
of six to one, which was favorable,

00:20:30.617 --> 00:20:31.998
and then we went to the House floor,

00:20:32.038 --> 00:20:35.239
but our lobbyists and our House sponsor

00:20:35.878 --> 00:20:38.279
the folks that don't make this committee a

00:20:38.859 --> 00:20:40.560
representation of what you think the house

00:20:40.601 --> 00:20:41.060
is gonna be.

00:20:41.080 --> 00:20:43.061
So you're in for a battle,

00:20:43.442 --> 00:20:46.083
because the insurance companies are not

00:20:46.163 --> 00:20:46.943
wanting to change this,

00:20:47.003 --> 00:20:49.724
because they think if you change physical

00:20:49.765 --> 00:20:51.846
therapy's co-pay to primary care,

00:20:52.685 --> 00:20:54.807
Every specialty is gonna wanna do it.

00:20:54.826 --> 00:20:57.327
And we said, we're not a specialty.

00:20:57.548 --> 00:20:59.630
We are primary care in Utah,

00:21:00.210 --> 00:21:02.090
and we are a first line of access.

00:21:02.391 --> 00:21:04.172
Even though we have specialty training

00:21:04.332 --> 00:21:05.913
inside of physical therapy,

00:21:06.333 --> 00:21:07.993
the physical therapy umbrella coming out

00:21:08.034 --> 00:21:09.974
of school is really quite generalist.

00:21:11.163 --> 00:21:13.164
And so that argument worked really pretty

00:21:13.204 --> 00:21:13.424
well.

00:21:14.505 --> 00:21:19.026
We got to the main house and our

00:21:19.086 --> 00:21:20.306
people went to work.

00:21:20.365 --> 00:21:22.747
We had got the grassroots campaigns

00:21:22.846 --> 00:21:26.208
rolling and we passed sixty to nine on

00:21:26.248 --> 00:21:27.008
the House floor.

00:21:27.147 --> 00:21:29.469
And so as of yesterday morning,

00:21:29.509 --> 00:21:30.288
about ten o'clock,

00:21:30.409 --> 00:21:34.009
Utah now has primary care co-pays to go

00:21:34.029 --> 00:21:35.710
into effect January first to twenty seven.

00:21:36.029 --> 00:21:36.890
So there was a set.

00:21:36.910 --> 00:21:38.411
So we start with primary care.

00:21:38.990 --> 00:21:41.753
primary care co-pays, we have access,

00:21:41.854 --> 00:21:44.717
now we've reduced the barrier for patients

00:21:44.758 --> 00:21:46.159
to get to physical therapy.

00:21:46.859 --> 00:21:49.363
And then insurance, in the back rooms,

00:21:49.383 --> 00:21:50.344
we were having discussions with the

00:21:50.364 --> 00:21:51.424
insurance companies in the back rooms

00:21:51.505 --> 00:21:52.707
anyway, and they all said,

00:21:53.047 --> 00:21:54.828
physical therapy saves us a ton of money.

00:21:54.909 --> 00:21:56.550
We know it's a great thing.

00:21:56.911 --> 00:21:57.951
They're just worried about,

00:21:58.771 --> 00:21:59.372
where it will go,

00:21:59.412 --> 00:22:00.212
what everybody else is going to do.

00:22:00.232 --> 00:22:01.354
It's the same thing.

00:22:01.413 --> 00:22:02.954
It's a business thing for them.

00:22:03.075 --> 00:22:04.736
It always is, right?

00:22:04.756 --> 00:22:05.076
It always is.

00:22:05.136 --> 00:22:06.817
And I don't fault them one bit for

00:22:06.857 --> 00:22:07.278
bad one.

00:22:07.357 --> 00:22:07.838
They should.

00:22:08.058 --> 00:22:08.759
That's what they should do.

00:22:08.778 --> 00:22:09.078
Yeah, sure.

00:22:09.098 --> 00:22:09.339
Yeah.

00:22:10.603 --> 00:22:12.204
but we're gonna save them money.

00:22:12.365 --> 00:22:15.407
And so it went through, that's our steps.

00:22:15.428 --> 00:22:15.988
And now we're looking,

00:22:16.429 --> 00:22:17.230
where's the next step?

00:22:17.250 --> 00:22:19.412
The next step is now gonna be, oh,

00:22:19.451 --> 00:22:20.873
part of the deal we made with the

00:22:20.893 --> 00:22:22.674
insurance companies to let this go through

00:22:23.135 --> 00:22:25.698
was they're gonna let us visit with the

00:22:27.359 --> 00:22:30.102
insurance plans purchasers about the

00:22:30.122 --> 00:22:31.624
importance of physical therapy and how we

00:22:31.644 --> 00:22:33.125
can save their company's money by getting

00:22:33.165 --> 00:22:34.086
physical therapy first.

00:22:34.767 --> 00:22:36.288
And so it's this snowball.

00:22:36.667 --> 00:22:37.887
And so primary care, eh,

00:22:38.689 --> 00:22:39.808
it's a little bit better than direct

00:22:39.929 --> 00:22:40.329
access.

00:22:40.750 --> 00:22:41.809
Primary care plus co-pays,

00:22:41.970 --> 00:22:43.010
quite a bit better than that.

00:22:43.371 --> 00:22:45.612
Primary care plus co-pays plus access to

00:22:46.491 --> 00:22:47.512
insurance buyers.

00:22:47.893 --> 00:22:50.334
Then the buyers of the plans will say,

00:22:50.453 --> 00:22:50.614
no,

00:22:50.854 --> 00:22:53.035
I want better payment for physical

00:22:53.055 --> 00:22:56.076
therapy, so my people will go there.

00:22:57.057 --> 00:22:57.777
WCF,

00:22:57.797 --> 00:22:58.877
it used to be known as the Workers'

00:22:58.917 --> 00:23:00.218
Compensation Fund of Utah.

00:23:00.238 --> 00:23:01.759
They changed it to WCF because they now

00:23:01.999 --> 00:23:03.519
insure more than just workers' comp.

00:23:05.030 --> 00:23:05.530
Love this.

00:23:06.070 --> 00:23:08.211
They came to us earlier this year and

00:23:08.231 --> 00:23:09.731
said, bill us directly.

00:23:09.771 --> 00:23:11.813
You don't have to go through anybody,

00:23:12.272 --> 00:23:14.212
and we're going to pay a better rate

00:23:14.933 --> 00:23:16.054
because we're saving some of the

00:23:16.074 --> 00:23:16.814
administration.

00:23:17.334 --> 00:23:18.874
Circular thing, going to the doctor,

00:23:19.815 --> 00:23:21.055
so rates are improving.

00:23:21.654 --> 00:23:24.056
This tide will lift all boats.

00:23:24.596 --> 00:23:25.796
And now the big goal,

00:23:26.135 --> 00:23:27.977
and I've mentioned this before,

00:23:28.037 --> 00:23:28.896
if we can get...

00:23:29.769 --> 00:23:31.971
Twenty-six states that have some sort of

00:23:32.012 --> 00:23:32.772
primary care,

00:23:33.374 --> 00:23:35.936
and then we're the fifth state for

00:23:38.420 --> 00:23:40.102
co-pays, fair co-pays.

00:23:40.582 --> 00:23:42.624
If we can get twenty-six of everybody

00:23:42.644 --> 00:23:43.826
where we're the majority,

00:23:44.306 --> 00:23:47.509
now APTA has a talking point with the

00:23:47.609 --> 00:23:50.113
feds of let's change the federal stuff.

00:23:51.067 --> 00:23:52.087
Because now you have more than half the

00:23:52.127 --> 00:23:52.468
country.

00:23:52.968 --> 00:23:53.189
Yeah,

00:23:53.209 --> 00:23:55.390
you got half the country and we're a

00:23:55.450 --> 00:23:55.950
republic.

00:23:56.030 --> 00:23:58.071
And so let's – we have the majority.

00:23:58.311 --> 00:23:59.972
Let's go that way.

00:24:00.374 --> 00:24:01.554
Until then, it's just like, hey,

00:24:01.574 --> 00:24:02.335
give us more money.

00:24:02.355 --> 00:24:03.135
Like, oh, we can't.

00:24:03.155 --> 00:24:03.776
It's the budget.

00:24:03.816 --> 00:24:04.797
We've got to spend it here.

00:24:04.817 --> 00:24:05.596
We've got to spend it there.

00:24:06.458 --> 00:24:10.079
We can start changing fee schedules.

00:24:10.099 --> 00:24:12.442
This is not my area, policy.

00:24:13.083 --> 00:24:15.483
So I was trying to keep notes because

00:24:15.544 --> 00:24:18.787
you just told a story that started with

00:24:19.426 --> 00:24:20.248
an awkward meeting.

00:24:21.086 --> 00:24:22.548
of a bunch of people who were aligned

00:24:22.587 --> 00:24:23.449
against each other.

00:24:24.970 --> 00:24:26.050
Once they got in the room,

00:24:26.070 --> 00:24:28.251
they realized they pulled a page out of

00:24:28.291 --> 00:24:29.813
The Art of War, Sun Tzu.

00:24:30.413 --> 00:24:32.275
The enemy of my enemy is my friend.

00:24:32.335 --> 00:24:33.375
Like, well, hang on a second.

00:24:33.415 --> 00:24:34.537
We're actually not enemies here.

00:24:34.936 --> 00:24:35.817
We have a common enemy.

00:24:35.837 --> 00:24:36.739
It's the opposite of that.

00:24:37.798 --> 00:24:39.681
So being in the room with the five

00:24:39.701 --> 00:24:40.461
families, right,

00:24:40.480 --> 00:24:42.021
to go to the gangster meeting,

00:24:42.041 --> 00:24:43.383
let's get the five families together and

00:24:43.403 --> 00:24:45.184
figure out what are we actually,

00:24:45.244 --> 00:24:46.025
what is limiting us?

00:24:46.085 --> 00:24:47.846
Is it each other or is it something

00:24:47.926 --> 00:24:48.166
else?

00:24:50.816 --> 00:24:53.057
This is also a masterstroke that I

00:24:53.097 --> 00:24:54.500
highlighted and wanted to say again.

00:24:55.339 --> 00:25:01.246
You didn't ask for a hundred dollars.

00:25:01.266 --> 00:25:02.567
You didn't ask for a thousand dollars.

00:25:02.586 --> 00:25:03.888
You didn't ask for a business to give

00:25:03.929 --> 00:25:04.869
ten thousand dollars.

00:25:05.529 --> 00:25:06.171
You put it...

00:25:06.191 --> 00:25:08.133
This is very subtle but very powerful.

00:25:08.573 --> 00:25:10.134
You asked for something...

00:25:11.411 --> 00:25:12.952
that everybody could picture,

00:25:13.692 --> 00:25:15.875
I would be willing to do that for

00:25:15.915 --> 00:25:16.296
this.

00:25:16.957 --> 00:25:17.657
If you had said,

00:25:17.778 --> 00:25:18.959
everybody should give a hundred dollars,

00:25:19.159 --> 00:25:20.441
I can picture a hundred dollars coming out

00:25:20.461 --> 00:25:21.602
of my pocket, that doesn't feel good.

00:25:22.603 --> 00:25:23.403
You didn't say that.

00:25:23.964 --> 00:25:26.688
You said, what if tomorrow,

00:25:26.968 --> 00:25:28.549
one of the eight hours you work tomorrow,

00:25:28.569 --> 00:25:30.151
you worked not for free,

00:25:30.791 --> 00:25:32.814
but you donated that hour of time

00:25:33.737 --> 00:25:34.717
To this cause,

00:25:35.038 --> 00:25:35.897
you don't have to do the work.

00:25:36.218 --> 00:25:38.919
Your work is doing one hour and donating

00:25:38.939 --> 00:25:40.519
that money that you'd earned for the hour

00:25:40.839 --> 00:25:41.359
to this cause.

00:25:41.700 --> 00:25:42.181
I'm Howard.

00:25:42.320 --> 00:25:42.861
We got people.

00:25:43.080 --> 00:25:43.921
We're going to go do the work,

00:25:44.122 --> 00:25:44.741
but we need you.

00:25:45.580 --> 00:25:47.603
One hour, one hour, one hour, one hour.

00:25:47.962 --> 00:25:50.164
And an hour is different for everybody,

00:25:50.865 --> 00:25:51.965
but it evens us up.

00:25:52.226 --> 00:25:53.666
Now I feel like I'm, hey, listen,

00:25:53.686 --> 00:25:54.728
I don't make as much money as that

00:25:54.768 --> 00:25:55.388
guy over there,

00:25:55.689 --> 00:25:57.509
but I'm still having proportionately the

00:25:57.549 --> 00:25:58.750
same skin in the game.

00:25:59.090 --> 00:26:00.593
The person who makes more, I get it.

00:26:01.012 --> 00:26:02.413
But the rising tide, as you said,

00:26:02.773 --> 00:26:03.474
lifts all boats.

00:26:04.666 --> 00:26:05.747
You then highlighted,

00:26:06.008 --> 00:26:07.688
you paid attention to the people you were

00:26:07.708 --> 00:26:08.429
talking to,

00:26:09.009 --> 00:26:10.730
which as a communications person,

00:26:11.309 --> 00:26:12.130
you know your audience.

00:26:12.369 --> 00:26:14.431
Step one, know who you're talking to,

00:26:14.750 --> 00:26:15.672
know what they value,

00:26:15.971 --> 00:26:17.893
know where they live, what food they eat,

00:26:17.952 --> 00:26:18.593
what they like.

00:26:19.653 --> 00:26:20.953
And you did one step further.

00:26:21.173 --> 00:26:24.134
You found out they all had a PT.

00:26:24.934 --> 00:26:26.476
Now we're not talking to an audience who

00:26:26.496 --> 00:26:26.976
doesn't know any.

00:26:27.316 --> 00:26:28.356
You all have your own.

00:26:29.073 --> 00:26:31.074
Can you picture what would happen if your

00:26:31.134 --> 00:26:34.154
PT... And that is not small.

00:26:34.496 --> 00:26:35.955
That is powerful.

00:26:36.056 --> 00:26:37.237
All these things are lining up.

00:26:37.336 --> 00:26:38.396
This is not an accident.

00:26:38.998 --> 00:26:40.998
You don't knock the big domino down unless

00:26:41.038 --> 00:26:42.278
you knock the small domino,

00:26:42.318 --> 00:26:44.119
the medium domino, the next big domino.

00:26:44.920 --> 00:26:46.161
And then you went small to big.

00:26:46.240 --> 00:26:47.221
You did exactly that.

00:26:48.041 --> 00:26:49.962
If you had gone for the grand slam,

00:26:50.363 --> 00:26:52.384
you're going to miss.

00:26:52.423 --> 00:26:53.804
But it sounds like you guys looked and

00:26:53.824 --> 00:26:54.704
you're like, how do we hit...

00:26:56.178 --> 00:26:57.298
How do we draw a walk today?

00:26:57.638 --> 00:26:58.940
How do we hit a double tomorrow?

00:26:59.340 --> 00:27:00.321
Could we hit three doubles?

00:27:00.862 --> 00:27:03.025
Three doubles scores two runs.

00:27:03.805 --> 00:27:04.486
That's not bad.

00:27:04.546 --> 00:27:05.267
I'll take that.

00:27:05.988 --> 00:27:09.050
So it sounds like this is the blueprint,

00:27:09.090 --> 00:27:09.310
right?

00:27:09.371 --> 00:27:10.893
I mean, you said five states, right?

00:27:11.973 --> 00:27:13.556
We want to learn from each other.

00:27:14.712 --> 00:27:15.634
So is Howard,

00:27:15.673 --> 00:27:16.875
are you doing a road show now?

00:27:16.914 --> 00:27:17.315
What's Howard,

00:27:17.335 --> 00:27:18.876
are you traveling from state to state and

00:27:18.936 --> 00:27:20.038
going, I'll show you how to do it?

00:27:20.057 --> 00:27:21.759
Or what happens next?

00:27:22.359 --> 00:27:22.519
Well,

00:27:22.559 --> 00:27:24.902
the first thing is the idea of the

00:27:24.942 --> 00:27:26.323
dollar per hour.

00:27:26.603 --> 00:27:27.604
Brilliant idea.

00:27:27.743 --> 00:27:28.984
Was Brad Powell's idea,

00:27:29.405 --> 00:27:30.527
Foundation for Physical Therapy.

00:27:30.967 --> 00:27:31.407
Beautiful.

00:27:31.887 --> 00:27:32.989
And then-

00:27:33.628 --> 00:27:35.690
I've merged my Delta Fillmore Physical

00:27:35.710 --> 00:27:37.509
Therapy with Mountainlands Physical

00:27:37.529 --> 00:27:37.950
Therapy,

00:27:37.970 --> 00:27:40.070
and they have clinics in Idaho and

00:27:40.111 --> 00:27:40.711
Montana.

00:27:41.211 --> 00:27:43.151
So our goal is we're going there.

00:27:43.551 --> 00:27:44.912
And guess who?

00:27:45.231 --> 00:27:46.872
Montana doesn't have a legislative session

00:27:46.892 --> 00:27:47.932
this year, but Idaho does.

00:27:47.972 --> 00:27:49.932
And guess who's introduced House Bill?

00:27:49.972 --> 00:27:53.114
I think it's a five forty seven is

00:27:53.413 --> 00:27:55.233
primary care access for physical

00:27:55.253 --> 00:27:56.134
therapists in Idaho.

00:27:56.174 --> 00:27:56.914
Here we go.

00:27:58.375 --> 00:28:00.376
And then I've known that Arizona is kind

00:28:00.416 --> 00:28:01.157
of looking at things.

00:28:01.198 --> 00:28:03.239
Colorado is pondering it.

00:28:03.378 --> 00:28:04.859
Maine is pondering it.

00:28:04.880 --> 00:28:07.241
When we go to the primary care SIG,

00:28:08.363 --> 00:28:10.263
I decided to go to that just for

00:28:10.304 --> 00:28:10.644
fun.

00:28:11.164 --> 00:28:12.846
And it was amazing because it's federal.

00:28:13.646 --> 00:28:15.347
The feds have had primary care forever.

00:28:15.688 --> 00:28:16.409
Just for the audience,

00:28:16.509 --> 00:28:18.849
explain what the primary care SIG and

00:28:18.869 --> 00:28:19.330
where it is.

00:28:19.351 --> 00:28:20.771
It's under the federal section of APTA?

00:28:20.791 --> 00:28:20.951
Yeah.

00:28:21.609 --> 00:28:23.132
federal section of APTA,

00:28:23.372 --> 00:28:24.473
and it was new to me.

00:28:25.555 --> 00:28:28.337
But they've had primary care,

00:28:28.357 --> 00:28:29.298
so they kind of just had a little

00:28:29.358 --> 00:28:30.421
roadshow clinic.

00:28:30.441 --> 00:28:32.442
It'll be in Utah this coming fall in

00:28:32.482 --> 00:28:32.983
September.

00:28:33.344 --> 00:28:35.066
We've offered to do it here,

00:28:35.086 --> 00:28:36.508
so it's going to be here.

00:28:38.470 --> 00:28:39.369
Yeah, great bunch.

00:28:40.490 --> 00:28:41.550
And in pretty low key,

00:28:41.590 --> 00:28:43.490
but it was interesting that a lot of

00:28:43.510 --> 00:28:44.871
federal people are trying to give

00:28:44.971 --> 00:28:49.372
education on primary care issues or what

00:28:49.392 --> 00:28:50.132
you do and things.

00:28:50.172 --> 00:28:51.291
But once we were all in the same

00:28:51.332 --> 00:28:51.971
room, everybody's like,

00:28:52.892 --> 00:28:53.613
what are you doing?

00:28:54.032 --> 00:28:54.593
How did you do it?

00:28:54.732 --> 00:28:55.553
You're Utah.

00:28:55.712 --> 00:28:58.093
How did you pull this off?

00:28:59.074 --> 00:29:00.134
It wasn't the information.

00:29:01.394 --> 00:29:03.294
It quite literally is an information

00:29:03.334 --> 00:29:04.515
transmission problem.

00:29:05.295 --> 00:29:06.734
It was like, hey, we figured it out.

00:29:07.659 --> 00:29:09.701
But unless you make it clear, consistent,

00:29:09.721 --> 00:29:10.521
and concise,

00:29:11.143 --> 00:29:13.224
someone who could benefit from that

00:29:13.244 --> 00:29:15.047
information in Maine might never know it

00:29:15.086 --> 00:29:15.567
exists.

00:29:16.310 --> 00:29:16.951
Yeah.

00:29:17.050 --> 00:29:17.471
And of course,

00:29:17.550 --> 00:29:18.612
every state's going to be a little

00:29:18.632 --> 00:29:18.872
different.

00:29:18.892 --> 00:29:20.892
Our primary care just happened to be in

00:29:20.912 --> 00:29:22.593
the assurance code and Idaho's is really

00:29:22.673 --> 00:29:23.053
similar.

00:29:23.113 --> 00:29:24.653
So that's going to be pretty easy for

00:29:24.713 --> 00:29:26.534
us to dovetail with that.

00:29:26.973 --> 00:29:27.453
Other states,

00:29:27.493 --> 00:29:29.075
it'll be a much heavier lift.

00:29:29.095 --> 00:29:29.575
They're all different.

00:29:29.615 --> 00:29:30.515
Right, right, right.

00:29:30.734 --> 00:29:32.175
But we just got to identify where is

00:29:32.215 --> 00:29:32.355
it?

00:29:32.736 --> 00:29:33.935
And once you know where it is,

00:29:34.237 --> 00:29:35.977
then you make a plan, you know, and,

00:29:36.217 --> 00:29:38.018
and what was fascinating going back to our

00:29:38.057 --> 00:29:38.518
first story,

00:29:38.557 --> 00:29:40.238
we pulled the five different clinics into

00:29:40.258 --> 00:29:40.598
the room.

00:29:41.038 --> 00:29:41.679
It was,

00:29:42.298 --> 00:29:43.359
Yesterday's, you know,

00:29:43.440 --> 00:29:45.339
texting list of all of us, you know,

00:29:45.359 --> 00:29:46.721
it was high five and all around.

00:29:47.580 --> 00:29:49.142
All these competitors are like, you know,

00:29:49.342 --> 00:29:51.222
they're still working, but we realized,

00:29:51.702 --> 00:29:51.803
oh,

00:29:51.823 --> 00:29:53.804
there's so much more than our clinicians.

00:29:53.844 --> 00:29:55.243
There's more therapy than any of us can

00:29:55.284 --> 00:29:55.525
do.

00:29:56.545 --> 00:29:57.905
It brought us all together.

00:29:58.266 --> 00:29:59.066
And not only that,

00:29:59.266 --> 00:30:02.326
each clinician or each CEO or president

00:30:02.386 --> 00:30:02.647
or, you know,

00:30:02.667 --> 00:30:04.448
whatever their title is in each company

00:30:04.748 --> 00:30:05.709
brought a skillset.

00:30:06.657 --> 00:30:07.557
Mine just happens to be,

00:30:07.617 --> 00:30:09.038
I'm pretty good with legislative stuff.

00:30:10.499 --> 00:30:12.500
Brad Pals was pretty good at fundraising.

00:30:12.799 --> 00:30:15.181
Rick Libert was really good at bringing

00:30:15.421 --> 00:30:18.060
numbers of people to go after legislators.

00:30:18.101 --> 00:30:20.701
Everybody brought a skillset and it'd be

00:30:20.761 --> 00:30:21.662
tough to replicate,

00:30:22.202 --> 00:30:23.742
but I'm sure everybody can.

00:30:24.123 --> 00:30:24.903
You just gotta look.

00:30:24.962 --> 00:30:26.443
And once we brought those skillsets

00:30:26.463 --> 00:30:26.923
together,

00:30:27.723 --> 00:30:28.785
I just happened to go along for the

00:30:28.805 --> 00:30:29.565
ride and it was a hoot.

00:30:30.265 --> 00:30:31.625
I mean, the answer is always people.

00:30:31.946 --> 00:30:33.327
We started this by saying,

00:30:33.709 --> 00:30:35.109
if you're waiting for someone else to

00:30:35.150 --> 00:30:36.010
solve your problem,

00:30:36.030 --> 00:30:37.392
you're going to wait a long time,

00:30:37.712 --> 00:30:38.874
and the solution might not...

00:30:39.213 --> 00:30:41.236
That toilet might not be cleaned as well

00:30:41.276 --> 00:30:41.856
as you want.

00:30:41.997 --> 00:30:42.778
So it's solved,

00:30:42.798 --> 00:30:43.999
but it's not solved as well as I

00:30:44.038 --> 00:30:44.298
want.

00:30:44.720 --> 00:30:46.280
The answer is always people.

00:30:46.642 --> 00:30:46.761
And...

00:30:48.749 --> 00:30:50.769
The goal is to find the right people

00:30:51.329 --> 00:30:53.571
who can bring their natural skill and

00:30:53.652 --> 00:30:53.852
help.

00:30:53.971 --> 00:30:55.011
In isolation,

00:30:55.412 --> 00:30:57.133
one of you wouldn't have gotten this done

00:30:57.413 --> 00:30:58.653
because you would have not had...

00:30:59.233 --> 00:31:01.015
It's like the A-team, right?

00:31:01.035 --> 00:31:02.155
You needed somebody with a little bit of

00:31:02.195 --> 00:31:02.895
this, a little bit of that,

00:31:02.915 --> 00:31:03.416
a little bit of this.

00:31:03.436 --> 00:31:04.237
It's Ocean's Eleven.

00:31:04.277 --> 00:31:06.218
You needed this kind of person who's good

00:31:06.238 --> 00:31:08.298
at that or else everything else doesn't

00:31:08.338 --> 00:31:08.598
work.

00:31:08.898 --> 00:31:10.319
It's very simple to say.

00:31:10.660 --> 00:31:11.401
It's not easy,

00:31:11.441 --> 00:31:13.422
but as Hannibal used to say,

00:31:14.122 --> 00:31:15.502
I love it when a plan comes together.

00:31:17.903 --> 00:31:20.825
So what advice would you give to another

00:31:20.904 --> 00:31:23.444
chapter who's sitting there listening

00:31:23.464 --> 00:31:25.006
going, whew,

00:31:25.705 --> 00:31:27.125
sounded like a long walk there.

00:31:28.186 --> 00:31:30.166
What's their first tactical thing that

00:31:30.186 --> 00:31:30.626
you'd have?

00:31:30.666 --> 00:31:32.028
If someone's sitting there listening in

00:31:32.087 --> 00:31:32.627
APTA,

00:31:32.667 --> 00:31:34.907
Kentucky or New York or New Hampshire or

00:31:35.009 --> 00:31:37.229
Idaho or North Dakota, what's step one?

00:31:37.249 --> 00:31:38.750
Because if we give them fifty steps,

00:31:39.049 --> 00:31:40.250
it's too much overload.

00:31:40.269 --> 00:31:40.930
Right.

00:31:40.970 --> 00:31:42.230
It's why we give patients like two or

00:31:42.269 --> 00:31:42.770
three exercises.

00:31:42.971 --> 00:31:43.411
What's step one?

00:31:43.451 --> 00:31:44.230
What would you have them do?

00:31:46.803 --> 00:31:47.903
My first step,

00:31:48.525 --> 00:31:50.827
and I've neglected to probably give a big

00:31:50.867 --> 00:31:52.390
shout out to Justin Carrier,

00:31:52.430 --> 00:31:54.372
who's our president of APTA Utah right

00:31:54.412 --> 00:31:54.612
now,

00:31:55.192 --> 00:31:59.478
because he's an educator in the physical

00:31:59.498 --> 00:32:00.980
therapy assistant program at Slick.

00:32:02.741 --> 00:32:04.222
Somebody had to say,

00:32:06.442 --> 00:32:08.144
let's just do this.

00:32:08.404 --> 00:32:09.506
Someone just has to have the idea.

00:32:09.546 --> 00:32:11.928
And then people will coalesce around that.

00:32:13.789 --> 00:32:15.191
It was the private practice people that

00:32:15.211 --> 00:32:15.811
really pushed it.

00:32:15.832 --> 00:32:19.095
When we tried to pull bigger hospital

00:32:19.134 --> 00:32:19.994
system therapy groups,

00:32:20.075 --> 00:32:21.537
they didn't want to because they have

00:32:21.596 --> 00:32:23.018
legislative challenges.

00:32:23.397 --> 00:32:24.720
So the first step

00:32:25.160 --> 00:32:27.641
I really think is for the state

00:32:27.701 --> 00:32:30.320
associations to say, we want to do this.

00:32:30.780 --> 00:32:33.102
Now, in Utah, we're pretty good.

00:32:33.142 --> 00:32:35.363
We've got a fairly high percentage of

00:32:35.442 --> 00:32:35.883
members.

00:32:36.542 --> 00:32:37.363
A lot of states,

00:32:37.383 --> 00:32:38.343
they struggle with membership.

00:32:38.442 --> 00:32:39.923
Idaho really struggles with membership.

00:32:40.463 --> 00:32:41.183
But the first thing is,

00:32:41.243 --> 00:32:43.365
you've got to have something that people

00:32:43.404 --> 00:32:44.045
want to go to.

00:32:44.065 --> 00:32:45.785
And if the association says,

00:32:46.085 --> 00:32:47.605
we're going to be the voice,

00:32:47.625 --> 00:32:49.665
and we're going to represent all

00:32:49.726 --> 00:32:50.145
therapists,

00:32:50.165 --> 00:32:51.266
whether you're a member of the association

00:32:51.286 --> 00:32:51.446
or not,

00:32:51.487 --> 00:32:52.646
and we're going to go do this,

00:32:53.487 --> 00:32:55.188
come jump on my energy bus,

00:32:55.608 --> 00:32:56.710
come get with me.

00:32:57.730 --> 00:32:58.711
Um, they're going to do that.

00:32:58.730 --> 00:32:59.632
So it's really going to have to be

00:32:59.692 --> 00:33:01.272
the, the association just saying,

00:33:01.633 --> 00:33:03.335
we want to do this.

00:33:03.355 --> 00:33:04.194
This is the target.

00:33:04.635 --> 00:33:04.836
Yep.

00:33:05.076 --> 00:33:07.478
And as soon as you have a goal,

00:33:08.198 --> 00:33:09.318
um,

00:33:09.338 --> 00:33:10.779
so I don't know if you've seen this

00:33:10.839 --> 00:33:13.102
or not, uh, for the fans out there,

00:33:13.422 --> 00:33:14.963
there's a YouTube video from years ago

00:33:15.003 --> 00:33:17.105
called the Sasquatch music festival

00:33:17.144 --> 00:33:17.986
dancing guy.

00:33:18.326 --> 00:33:19.707
I will be Googling that soon,

00:33:19.727 --> 00:33:20.366
but keep going.

00:33:20.467 --> 00:33:21.826
It is awesome.

00:33:22.207 --> 00:33:22.968
So this, you know,

00:33:22.988 --> 00:33:25.307
this is Hillside and there's open music

00:33:25.347 --> 00:33:25.749
festival.

00:33:26.148 --> 00:33:26.888
Oh, yes.

00:33:27.028 --> 00:33:27.989
I know this one.

00:33:28.249 --> 00:33:28.449
Yes.

00:33:28.789 --> 00:33:30.509
And then one person joins him and two

00:33:30.549 --> 00:33:31.230
people join him.

00:33:31.250 --> 00:33:32.770
The next thing else, everybody's going,

00:33:32.810 --> 00:33:34.632
you know, that's what you got.

00:33:34.672 --> 00:33:36.412
You've got to not be scared as an

00:33:36.451 --> 00:33:38.952
association to be the dancing guy.

00:33:39.073 --> 00:33:40.673
To be the first dancing guy.

00:33:40.693 --> 00:33:42.875
To be the first dancing guy.

00:33:43.454 --> 00:33:45.976
And don't worry if everybody thinks you're

00:33:46.036 --> 00:33:46.576
stupid.

00:33:46.635 --> 00:33:48.517
And don't worry if everybody's making fun

00:33:48.576 --> 00:33:50.938
of you because it was fascinating to watch

00:33:50.958 --> 00:33:51.617
that music festival.

00:33:51.637 --> 00:33:52.778
There'd be a couple of girls that kind

00:33:52.798 --> 00:33:53.298
of on the side,

00:33:53.378 --> 00:33:54.358
I want to be part of this,

00:33:54.398 --> 00:33:55.759
but I'm not so sure.

00:33:56.099 --> 00:33:56.359
You know,

00:33:56.380 --> 00:33:57.401
then as soon as a couple got in,

00:33:57.421 --> 00:33:58.300
more people got in.

00:33:58.381 --> 00:33:58.961
And that's what we found.

00:33:59.060 --> 00:34:00.422
Last year with primary care,

00:34:00.842 --> 00:34:01.583
We were begging,

00:34:01.722 --> 00:34:03.325
please call your representative.

00:34:03.365 --> 00:34:04.286
You know, we've got these things.

00:34:04.806 --> 00:34:05.527
Everybody's got it.

00:34:05.626 --> 00:34:06.607
Please, please, please.

00:34:06.969 --> 00:34:08.170
This year it was like, hey,

00:34:08.230 --> 00:34:09.231
so we did last year.

00:34:09.771 --> 00:34:10.612
We're going to knock this out.

00:34:10.713 --> 00:34:12.173
If we had more.

00:34:12.193 --> 00:34:12.954
Okay.

00:34:13.014 --> 00:34:14.335
And whatever we choose to do next year,

00:34:14.376 --> 00:34:15.878
we're hoping we'll have even more.

00:34:15.998 --> 00:34:17.179
Because you have social,

00:34:17.519 --> 00:34:19.061
you have public social proof.

00:34:20.380 --> 00:34:22.041
this is why on Amazon there's a star

00:34:22.081 --> 00:34:23.443
system that shows you how many times it's

00:34:23.463 --> 00:34:26.105
been bought in the last month we are

00:34:26.324 --> 00:34:28.706
big dumb animals in a good way we're

00:34:28.726 --> 00:34:30.146
sort of predictable I know we're all

00:34:30.248 --> 00:34:32.048
individual snowflakes we're all different

00:34:32.989 --> 00:34:34.570
but there's an operating system that says

00:34:34.650 --> 00:34:36.030
I don't want to be an outcast from

00:34:36.050 --> 00:34:37.731
the group that guy's doing something weird

00:34:37.751 --> 00:34:39.452
but if I watch three people do it

00:34:40.273 --> 00:34:42.114
I want to do it and next thing

00:34:42.135 --> 00:34:45.277
you know fifty people are doing it and

00:34:45.317 --> 00:34:47.257
it's a movement it starts I mean as

00:34:47.297 --> 00:34:48.579
Linkin Park would say it starts with one

00:34:49.614 --> 00:34:50.173
And, you know,

00:34:50.193 --> 00:34:52.396
so we thought maybe if Utah did this,

00:34:52.775 --> 00:34:53.777
you know, we're going to dance it.

00:34:54.036 --> 00:34:55.478
And we got, it was so funny.

00:34:55.498 --> 00:34:57.739
We went out to House of Delegates.

00:34:57.938 --> 00:34:59.500
I'm the chief delegate for Utah.

00:34:59.840 --> 00:35:02.061
And we got, what are you all doing?

00:35:02.262 --> 00:35:02.382
Oh,

00:35:02.621 --> 00:35:04.182
I was more than happy to stand in

00:35:04.202 --> 00:35:08.246
there and tell, you know, Speaker McGee.

00:35:08.346 --> 00:35:10.907
In Utah, we did this.

00:35:11.327 --> 00:35:12.027
In Utah.

00:35:12.188 --> 00:35:13.728
And finally, he got fed up with it.

00:35:13.789 --> 00:35:14.010
He goes,

00:35:14.469 --> 00:35:17.552
thank you for your shameless plug, Utah.

00:35:17.592 --> 00:35:17.771
Yeah.

00:35:20.554 --> 00:35:21.456
And then all of a sudden,

00:35:21.496 --> 00:35:22.797
people are like, well, how are you doing?

00:35:22.818 --> 00:35:24.398
So we've got Idaho trying,

00:35:24.420 --> 00:35:25.199
we've got others trying.

00:35:25.280 --> 00:35:29.065
And of course, with the Fair Copays,

00:35:29.405 --> 00:35:30.025
we're the fifth.

00:35:30.246 --> 00:35:31.007
We kind of did the same thing.

00:35:31.067 --> 00:35:34.510
Hey, Virginia, Dakotas, they did it.

00:35:35.211 --> 00:35:36.813
How about, we can do that too.

00:35:38.215 --> 00:35:39.416
Well, it starts to become a reality,

00:35:39.476 --> 00:35:40.235
right?

00:35:40.856 --> 00:35:43.378
It's the Roger Bannister story.

00:35:43.717 --> 00:35:45.179
The four-minute mile was impossible to

00:35:45.219 --> 00:35:45.619
break.

00:35:45.719 --> 00:35:47.221
Roger Bannister breaks the four-minute

00:35:47.260 --> 00:35:47.621
mile.

00:35:48.161 --> 00:35:49.561
And I forget what the statistic was,

00:35:49.601 --> 00:35:52.262
but within a year of Roger Bannister

00:35:52.284 --> 00:35:53.324
breaking the four-minute mile,

00:35:53.943 --> 00:35:54.625
I don't know what it was,

00:35:54.844 --> 00:35:56.326
ten or fifteen other people broke it.

00:35:56.385 --> 00:35:57.806
Suddenly, it wasn't impossible.

00:35:58.987 --> 00:35:59.827
It's probable.

00:36:00.188 --> 00:36:01.309
Wow, I guess we can.

00:36:01.429 --> 00:36:01.748
Okay.

00:36:02.289 --> 00:36:04.610
There was one example I saw recently.

00:36:05.989 --> 00:36:07.570
it was a track and field competition and

00:36:07.630 --> 00:36:11.771
like crazy numbers of PRs and records were

00:36:11.851 --> 00:36:14.052
set and they couldn't figure out why it

00:36:14.072 --> 00:36:14.233
was.

00:36:14.293 --> 00:36:15.753
I think it was even an indoor match.

00:36:15.773 --> 00:36:17.534
They're like, wind is out of the equation.

00:36:18.713 --> 00:36:19.614
The clock was wrong.

00:36:21.155 --> 00:36:23.916
They thought they were running slower due

00:36:23.936 --> 00:36:24.295
to this.

00:36:24.335 --> 00:36:26.137
The clock was telling them your split is

00:36:26.197 --> 00:36:26.657
slower.

00:36:26.956 --> 00:36:28.237
So everyone ran faster.

00:36:28.318 --> 00:36:28.697
Cause they're like,

00:36:28.898 --> 00:36:30.518
I'm behind what I normally am.

00:36:30.918 --> 00:36:32.039
And then when they did the math at

00:36:32.059 --> 00:36:33.079
the end, they were like, Oh no,

00:36:33.099 --> 00:36:34.119
you were crazy fast.

00:36:34.139 --> 00:36:34.260
Yeah.

00:36:35.034 --> 00:36:37.114
So it's sort of like when I want

00:36:37.135 --> 00:36:38.074
to make sure I'm on time,

00:36:38.135 --> 00:36:39.175
I set my clock ahead.

00:36:39.695 --> 00:36:41.757
So when you do it, you know,

00:36:41.777 --> 00:36:44.998
it doesn't work without knowing it worked.

00:36:45.018 --> 00:36:45.878
Yeah.

00:36:45.918 --> 00:36:47.059
So that's what we need.

00:36:47.079 --> 00:36:48.239
We need social proof.

00:36:48.440 --> 00:36:49.360
We're big, dumb animals.

00:36:49.400 --> 00:36:51.001
But if we know how our operating systems

00:36:51.061 --> 00:36:51.340
work.

00:36:52.280 --> 00:36:54.521
You have five dominoes that have fallen.

00:36:54.541 --> 00:36:57.822
Well, that's not fifty, but it's not zero.

00:36:57.961 --> 00:36:59.543
And if three more happen in the next

00:36:59.583 --> 00:36:59.862
year,

00:36:59.902 --> 00:37:02.523
it's like now we're now we're eight and

00:37:02.684 --> 00:37:04.923
eight's pretty heavy and eight goes to

00:37:04.983 --> 00:37:06.445
twelve and twelve's half.

00:37:06.465 --> 00:37:06.684
You know,

00:37:06.724 --> 00:37:08.105
it's a quarter of the country now.

00:37:08.784 --> 00:37:10.525
I like how that feels now.

00:37:11.286 --> 00:37:12.905
I don't mind jumping in and being a

00:37:12.965 --> 00:37:14.586
Sasquatch and just dancing on the

00:37:14.606 --> 00:37:15.007
hillside.

00:37:15.458 --> 00:37:16.239
Yeah.

00:37:16.259 --> 00:37:18.440
My thought, too, is here next month,

00:37:18.480 --> 00:37:20.561
I'm going to go out to the day

00:37:20.601 --> 00:37:21.041
on the hill.

00:37:21.061 --> 00:37:21.862
I'm going to be there.

00:37:21.882 --> 00:37:22.702
I think I'm going to be there in

00:37:22.722 --> 00:37:23.103
April.

00:37:23.143 --> 00:37:23.744
Let's hang.

00:37:25.204 --> 00:37:25.606
All right.

00:37:25.626 --> 00:37:27.146
But because, yeah,

00:37:27.547 --> 00:37:29.509
the national stuff is a really heavy lift.

00:37:30.108 --> 00:37:32.371
We're getting it on the state side.

00:37:32.751 --> 00:37:35.152
But if we are priming this over here,

00:37:35.353 --> 00:37:38.014
once we get there,

00:37:38.074 --> 00:37:39.436
we might as well start trying to rock

00:37:39.476 --> 00:37:42.338
that domino while we're getting all the

00:37:42.398 --> 00:37:43.259
momentum coming.

00:37:43.539 --> 00:37:43.719
Right.

00:37:43.739 --> 00:37:44.099
It's inertia.

00:37:44.119 --> 00:37:44.378
Yeah.

00:37:45.380 --> 00:37:46.539
So, you know, the states, you know,

00:37:46.579 --> 00:37:48.501
some of the state associations say we want

00:37:48.521 --> 00:37:48.780
to.

00:37:48.880 --> 00:37:51.222
I think the second step then is go

00:37:51.302 --> 00:37:52.362
after private practice.

00:37:53.282 --> 00:37:54.782
Why private practice?

00:37:55.523 --> 00:37:57.364
They have probably the most to gain,

00:37:57.844 --> 00:37:58.884
you know, from that.

00:37:59.164 --> 00:38:00.284
Biggest biggest win.

00:38:00.605 --> 00:38:02.266
You've probably got some more resources

00:38:02.306 --> 00:38:03.865
than the average single person.

00:38:04.106 --> 00:38:04.346
Right.

00:38:05.487 --> 00:38:07.166
But you're saying if we win this,

00:38:07.226 --> 00:38:08.007
you win this, too.

00:38:08.047 --> 00:38:08.668
So come along.

00:38:09.369 --> 00:38:09.949
Yeah.

00:38:09.969 --> 00:38:11.030
So go after the private practice because

00:38:11.050 --> 00:38:12.311
they have resources.

00:38:12.351 --> 00:38:13.853
They're willing to bet on them.

00:38:14.132 --> 00:38:16.034
They're usually risk takers because going

00:38:16.054 --> 00:38:17.775
to business,

00:38:18.317 --> 00:38:20.398
it's not just doing physical therapy to

00:38:20.418 --> 00:38:21.079
have a business.

00:38:21.278 --> 00:38:22.539
You got to run payroll.

00:38:22.559 --> 00:38:23.541
You got to do taxes.

00:38:24.342 --> 00:38:25.461
You got to have attorneys.

00:38:25.503 --> 00:38:27.143
You kind of have learned the game.

00:38:27.364 --> 00:38:30.146
But you understand that to get an outcome,

00:38:30.567 --> 00:38:32.027
sometimes the answer is I have to spend

00:38:32.108 --> 00:38:32.527
something.

00:38:33.329 --> 00:38:34.750
But I'm going to monitor that spend.

00:38:34.869 --> 00:38:35.811
And here's the best part.

00:38:35.891 --> 00:38:36.391
If you're in...

00:38:37.434 --> 00:38:39.376
Idaho or New York or New Hampshire,

00:38:39.396 --> 00:38:40.797
you can be like, well,

00:38:40.817 --> 00:38:42.557
they spent X and they got Y in

00:38:42.677 --> 00:38:43.077
Utah.

00:38:44.099 --> 00:38:45.579
I wouldn't mind spending X because I'd

00:38:45.639 --> 00:38:46.199
love Y.

00:38:46.320 --> 00:38:49.201
So how do we spread that spend across

00:38:49.641 --> 00:38:50.161
our state?

00:38:50.541 --> 00:38:51.202
I think you're right.

00:38:51.802 --> 00:38:52.963
Just in my experience, too,

00:38:52.983 --> 00:38:55.045
when you work with a super large

00:38:55.085 --> 00:38:56.545
organization like a hospital system,

00:38:56.985 --> 00:38:58.967
you got to get fifty yeses.

00:38:59.106 --> 00:39:00.226
It'll take three years.

00:39:00.967 --> 00:39:02.268
They're aircraft carriers.

00:39:02.748 --> 00:39:03.809
It would be great to have one of

00:39:03.829 --> 00:39:04.889
their help.

00:39:06.612 --> 00:39:08.914
Except those boats don't turn as quick.

00:39:09.775 --> 00:39:11.155
You need more of a destroyer.

00:39:11.335 --> 00:39:13.237
You need enough firepower.

00:39:13.677 --> 00:39:15.518
Fifty destroyers might be better than one

00:39:15.579 --> 00:39:16.898
aircraft carrier because they can turn on

00:39:16.938 --> 00:39:18.099
a dime and you can organize them,

00:39:18.119 --> 00:39:18.880
and there's more of them.

00:39:20.201 --> 00:39:21.942
Yeah, so get them going,

00:39:22.322 --> 00:39:24.563
and then they will know who the other

00:39:24.583 --> 00:39:25.164
players are.

00:39:25.423 --> 00:39:25.885
Correct.

00:39:26.204 --> 00:39:29.045
They'll be able to pull that key therapist

00:39:29.085 --> 00:39:29.786
from the hospital.

00:39:29.806 --> 00:39:31.628
They'll be able to pull that key therapist

00:39:31.648 --> 00:39:34.108
from the rehab bunch that has influence.

00:39:34.128 --> 00:39:35.210
They already know who people are.

00:39:35.429 --> 00:39:37.210
It's the same model as the movie Ocean's

00:39:37.271 --> 00:39:37.692
Eleven.

00:39:38.152 --> 00:39:41.554
The target is we're robbing this casino

00:39:41.673 --> 00:39:43.155
vault.

00:39:43.315 --> 00:39:44.956
Okay, that's the end.

00:39:45.856 --> 00:39:47.338
What do we need if we start going

00:39:47.378 --> 00:39:47.838
backwards?

00:39:47.878 --> 00:39:47.958
Well,

00:39:47.978 --> 00:39:49.199
we need a guy who's good at this.

00:39:49.239 --> 00:39:50.280
We got to get a guy who's good

00:39:50.300 --> 00:39:50.780
at that.

00:39:50.880 --> 00:39:52.780
Okay, well,

00:39:53.001 --> 00:39:54.342
you start with what Stephen Covey said,

00:39:54.382 --> 00:39:54.523
right?

00:39:54.543 --> 00:39:55.943
You start with the end in mind and

00:39:55.963 --> 00:39:56.804
you work backwards.

00:39:57.304 --> 00:39:58.485
If you didn't have the person who knew

00:39:58.505 --> 00:40:00.266
how to fundraise,

00:40:00.646 --> 00:40:02.347
that was Elliot Gould's character.

00:40:02.467 --> 00:40:03.889
He was the bankroll, right?

00:40:03.989 --> 00:40:04.128
Mm-hmm.

00:40:04.389 --> 00:40:05.010
Without it,

00:40:05.050 --> 00:40:06.677
you don't have the toys for the explosives

00:40:06.717 --> 00:40:07.619
guy and the tech guy.

00:40:07.639 --> 00:40:10.248
And then everybody plays their part.

00:40:12.304 --> 00:40:12.545
Mm-hmm.

00:40:12.565 --> 00:40:12.644
Yeah.

00:40:12.945 --> 00:40:14.086
And that's where I would start.

00:40:14.106 --> 00:40:15.947
You know, those three steps, want to,

00:40:16.748 --> 00:40:17.989
get a good group behind you,

00:40:18.250 --> 00:40:19.771
and then let that group bring their skill

00:40:19.811 --> 00:40:20.172
set.

00:40:20.851 --> 00:40:22.653
Then you can do about anything you want

00:40:22.693 --> 00:40:22.994
to do.

00:40:23.695 --> 00:40:24.255
And, you know,

00:40:24.295 --> 00:40:25.835
some states will be a tough battle.

00:40:26.056 --> 00:40:26.336
Sure.

00:40:26.976 --> 00:40:28.518
And others will be a slam dunk.

00:40:29.219 --> 00:40:32.541
But we've tipped that first snowflake on

00:40:32.561 --> 00:40:33.822
the top of that avalanche,

00:40:34.264 --> 00:40:35.764
and we got a snowball that's starting.

00:40:35.784 --> 00:40:36.826
You know,

00:40:36.885 --> 00:40:37.927
I think we got a great thing ahead

00:40:37.947 --> 00:40:38.186
of us.

00:40:38.510 --> 00:40:39.730
A lot of analogies today,

00:40:39.750 --> 00:40:40.570
and that's right in my world.

00:40:40.590 --> 00:40:42.431
I love that.

00:40:42.971 --> 00:40:45.251
And then you got to stand up on

00:40:45.311 --> 00:40:47.193
stage with a bunch of our colleagues at

00:40:47.233 --> 00:40:48.932
CSM just a couple of weeks ago,

00:40:49.632 --> 00:40:51.213
and you got to get handed an award.

00:40:52.693 --> 00:40:53.994
Talk to me about what that award really

00:40:54.014 --> 00:40:54.534
meant to you.

00:40:54.554 --> 00:40:55.135
What was it about?

00:40:56.297 --> 00:40:59.079
You know, it was certainly flattering.

00:40:59.619 --> 00:41:00.699
It was very kind.

00:41:01.740 --> 00:41:03.001
When I got the first email that says,

00:41:03.021 --> 00:41:03.101
hey,

00:41:03.121 --> 00:41:04.563
you're going to be receiving this reward,

00:41:04.902 --> 00:41:07.525
this award, I said, why?

00:41:08.085 --> 00:41:12.608
You know, what did I do, you know?

00:41:12.688 --> 00:41:13.369
And then, of course,

00:41:14.010 --> 00:41:15.231
I walked right into it.

00:41:15.990 --> 00:41:17.690
One of my colleagues, Jamie Christensen,

00:41:17.710 --> 00:41:18.871
said, hey, I just got this.

00:41:18.911 --> 00:41:19.931
And I said, do you know about this?

00:41:19.992 --> 00:41:21.492
Oh, yeah, I wrote a really good letter.

00:41:22.273 --> 00:41:23.632
You're a dog, man.

00:41:24.233 --> 00:41:26.373
So that's the academic leadership and

00:41:26.393 --> 00:41:26.873
innovation,

00:41:26.914 --> 00:41:30.394
which I still think flies under the radar.

00:41:30.795 --> 00:41:32.494
Oh, because it's not clear.

00:41:32.594 --> 00:41:33.594
It's not ortho.

00:41:33.655 --> 00:41:34.456
That's pretty clear.

00:41:34.615 --> 00:41:35.916
It's not geriatrics.

00:41:36.056 --> 00:41:37.115
It's not education.

00:41:38.077 --> 00:41:39.456
I call it and they don't like this

00:41:39.496 --> 00:41:40.536
analogy, but I do.

00:41:41.277 --> 00:41:42.677
I call it it's sort of the junk

00:41:42.717 --> 00:41:42.878
drawer.

00:41:43.697 --> 00:41:45.539
that's not a negative term because if you

00:41:45.579 --> 00:41:47.179
think about it the junk drawer is the

00:41:47.219 --> 00:41:50.282
drawer you can't let anything go you're

00:41:50.302 --> 00:41:53.744
like no no that's very specialized i you

00:41:53.784 --> 00:41:55.445
cannot get rid of that weird shaped

00:41:55.465 --> 00:41:57.226
screwdriver because that's for eyeglasses

00:41:57.806 --> 00:42:00.489
or the random things it is this thing

00:42:00.509 --> 00:42:02.710
that it's you're not sure what fits there

00:42:03.688 --> 00:42:05.110
And once you start looking around,

00:42:05.130 --> 00:42:06.851
you're like, oh, damn,

00:42:07.010 --> 00:42:09.313
this has a lot of different.

00:42:09.532 --> 00:42:10.353
But it's not clear.

00:42:10.393 --> 00:42:11.213
It's not one thing.

00:42:11.253 --> 00:42:11.693
It's many.

00:42:11.713 --> 00:42:12.875
That's probably their weakness.

00:42:13.135 --> 00:42:15.416
But their strength is it's not one thing.

00:42:15.496 --> 00:42:15.896
It's many.

00:42:16.615 --> 00:42:17.175
Yeah.

00:42:17.235 --> 00:42:18.637
And then the second thought I had with

00:42:18.657 --> 00:42:20.298
the award was that, you know,

00:42:20.358 --> 00:42:22.641
being flattered and surprised,

00:42:23.661 --> 00:42:26.182
it was like, it was not mine.

00:42:26.423 --> 00:42:28.985
You know, this was all a Utah.

00:42:29.206 --> 00:42:30.867
This was the Utah Association.

00:42:30.887 --> 00:42:32.708
This was all those private practices that

00:42:32.748 --> 00:42:33.088
stepped in.

00:42:33.108 --> 00:42:34.429
It's everyone that wrote a letter.

00:42:34.929 --> 00:42:36.530
You know, I just happened to, you know,

00:42:36.550 --> 00:42:38.753
receive the pretty thing.

00:42:38.992 --> 00:42:40.474
But it was certainly nice to be recognized

00:42:40.494 --> 00:42:42.295
because, again, we did something.

00:42:42.936 --> 00:42:44.958
Somebody else is, you know, great.

00:42:45.478 --> 00:42:47.297
you know, association said, Hey,

00:42:47.717 --> 00:42:48.659
that was cool.

00:42:48.918 --> 00:42:49.179
Right.

00:42:49.579 --> 00:42:51.518
And now, now, you know, other people,

00:42:51.579 --> 00:42:52.458
other people are going to be able to

00:42:52.478 --> 00:42:53.800
see it and they'll say, Hey,

00:42:53.840 --> 00:42:54.820
maybe we can too.

00:42:54.900 --> 00:42:56.780
So I'm just hoping that it moves on,

00:42:56.800 --> 00:42:57.920
but I certainly flattered.

00:42:57.940 --> 00:42:58.740
It's so awesome.

00:42:58.760 --> 00:42:59.800
I was so grateful, you know,

00:42:59.820 --> 00:43:01.701
for the fun night we had and all

00:43:01.740 --> 00:43:02.902
the good people that were there and

00:43:02.922 --> 00:43:03.641
everything they're doing.

00:43:04.001 --> 00:43:04.222
But it,

00:43:04.262 --> 00:43:05.621
but it wasn't me that this was all

00:43:05.661 --> 00:43:06.762
our association and stuff.

00:43:06.802 --> 00:43:08.583
You, you just got to be George Clooney.

00:43:08.603 --> 00:43:10.702
You got to be Danny Ocean and you

00:43:10.742 --> 00:43:11.742
can't give the award, you know,

00:43:11.983 --> 00:43:13.143
you couldn't give the award to everybody.

00:43:13.264 --> 00:43:14.643
Maybe they weren't at CSM, but.

00:43:15.543 --> 00:43:16.925
You know, like Hannibal Smith, you know,

00:43:16.945 --> 00:43:18.625
it's just love it when a plan comes

00:43:18.664 --> 00:43:20.186
together and that was the embodiment of

00:43:20.226 --> 00:43:20.326
it.

00:43:20.585 --> 00:43:21.387
Well, that's fantastic.

00:43:21.407 --> 00:43:22.746
Well, congratulations to you,

00:43:23.168 --> 00:43:24.128
the rest of your team,

00:43:24.608 --> 00:43:26.009
the next state that does it.

00:43:26.688 --> 00:43:28.449
I want them to be proud of doing

00:43:28.489 --> 00:43:28.610
that.

00:43:28.630 --> 00:43:29.791
And if you're thinking about it,

00:43:30.550 --> 00:43:31.650
this is the, the,

00:43:31.710 --> 00:43:34.192
at least the first few steps, uh, Howard,

00:43:34.213 --> 00:43:35.213
we have a tradition on the show.

00:43:35.253 --> 00:43:37.134
It's called the parting shot.

00:43:38.257 --> 00:43:40.302
This is The Parting Shot.

00:43:40.824 --> 00:43:42.246
One last mic drop moment.

00:43:42.909 --> 00:43:43.710
No pressure.

00:43:44.152 --> 00:43:46.257
Just your legacy on the line.

00:43:47.673 --> 00:43:48.175
No pressure.

00:43:48.215 --> 00:43:48.835
Just your legacy.

00:43:48.875 --> 00:43:49.235
I'm a lot.

00:43:49.295 --> 00:43:50.335
I do want to say thanks to our

00:43:50.356 --> 00:43:53.358
friends at Empower EMR.

00:43:53.918 --> 00:43:55.079
If you're sitting around and you feel like

00:43:55.099 --> 00:43:56.481
your EMR is just slow,

00:43:56.882 --> 00:43:57.601
slowing everything down,

00:43:57.661 --> 00:43:59.824
Empower EMR was built to do the opposite,

00:43:59.844 --> 00:44:00.985
which is, I'm not a math guy,

00:44:01.005 --> 00:44:01.985
but fast.

00:44:02.025 --> 00:44:03.766
Faster documentation, cleaner workflows,

00:44:03.806 --> 00:44:05.989
and support that actually responds when

00:44:06.048 --> 00:44:06.929
you need help.

00:44:07.010 --> 00:44:09.751
Learn more at empoweremr.com.

00:44:09.771 --> 00:44:11.873
That is empoweremr.com.

00:44:12.735 --> 00:44:14.456
Also want to say thanks to our friends

00:44:14.496 --> 00:44:15.175
at Sarah Health,

00:44:15.436 --> 00:44:17.297
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00:44:17.317 --> 00:44:18.898
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00:44:18.918 --> 00:44:21.519
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00:44:22.360 --> 00:44:22.820
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00:44:22.900 --> 00:44:23.802
this is just an aside,

00:44:24.021 --> 00:44:24.561
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00:44:24.581 --> 00:44:25.722
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00:44:25.802 --> 00:44:26.543
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00:44:33.228 --> 00:44:34.449
All right, Howard, parting shot.

00:44:35.088 --> 00:44:37.630
What's the idea, the sentiment, something,

00:44:37.650 --> 00:44:38.951
whatever you want to leave the audience

00:44:38.971 --> 00:44:39.711
with as we wrap up?

00:44:43.451 --> 00:44:45.052
My boys, I've got six kids,

00:44:45.072 --> 00:44:46.032
I've got seven grandkids,

00:44:46.414 --> 00:44:48.114
but I have two trailers.

00:44:48.295 --> 00:44:49.416
My two youngest,

00:44:49.735 --> 00:44:51.157
twelve years younger than their older

00:44:51.197 --> 00:44:51.998
siblings and stuff.

00:44:52.077 --> 00:44:54.880
One's a senior, one's a junior.

00:44:54.920 --> 00:44:55.501
My seniors,

00:44:56.702 --> 00:44:58.403
we are members of Church of Jesus Christ

00:44:58.423 --> 00:44:58.884
of Latter-day Saints.

00:44:58.903 --> 00:45:01.626
He's got a mission call to Belgium this

00:45:01.666 --> 00:45:04.268
summer, you know, and he's super excited.

00:45:04.869 --> 00:45:06.590
But they get sick and tired of me

00:45:06.630 --> 00:45:07.871
teaching them the same thing.

00:45:09.284 --> 00:45:10.664
phrase all over the place.

00:45:11.085 --> 00:45:14.789
I tell them that everything in life is

00:45:14.829 --> 00:45:15.829
about relationships,

00:45:16.190 --> 00:45:17.512
your relationship with God,

00:45:17.652 --> 00:45:19.893
with your spouse, with your employer,

00:45:21.096 --> 00:45:21.856
with everybody,

00:45:21.936 --> 00:45:24.938
and that you will never have influence on

00:45:25.059 --> 00:45:26.920
anybody that you don't have a relationship

00:45:26.940 --> 00:45:27.141
with.

00:45:27.880 --> 00:45:30.021
And so I tell them to build relationships

00:45:30.141 --> 00:45:32.081
and guard those relationships because

00:45:32.822 --> 00:45:33.581
they're important.

00:45:33.601 --> 00:45:35.182
That's how things get done.

00:45:36.483 --> 00:45:39.224
And that's how you grow as a person

00:45:39.264 --> 00:45:41.103
because I learn from others.

00:45:41.664 --> 00:45:43.184
I take the best things from others.

00:45:43.244 --> 00:45:43.965
I put them in me.

00:45:44.364 --> 00:45:46.525
I try to emulate good qualities.

00:45:47.065 --> 00:45:49.106
But the best thing we can do is

00:45:49.186 --> 00:45:50.606
develop and keep relationships.

00:45:50.925 --> 00:45:54.106
We're in a society of hyperbole.

00:45:54.186 --> 00:45:55.887
We like to be angry about everything.

00:45:56.367 --> 00:45:57.108
We like to scream and yell.

00:45:57.807 --> 00:45:59.909
We got to guard relationships because

00:46:00.389 --> 00:46:01.309
that's what's most important.

00:46:02.068 --> 00:46:03.449
That's the Quackenbush philosophy.

00:46:03.829 --> 00:46:04.070
I mean,

00:46:04.110 --> 00:46:05.610
if you could sum up a parting shot

00:46:05.630 --> 00:46:07.271
that goes exactly with the topic of

00:46:07.311 --> 00:46:08.851
today's discussion,

00:46:08.972 --> 00:46:11.152
the thing that you did is every little,

00:46:11.411 --> 00:46:11.811
every,

00:46:11.911 --> 00:46:14.452
nothing in that story happened without the

00:46:14.492 --> 00:46:16.574
relationships and how those relationships

00:46:16.594 --> 00:46:17.414
were interconnected.

00:46:19.014 --> 00:46:20.155
That's a perfect parting shot.

00:46:20.355 --> 00:46:21.295
Howard, appreciate your time.

00:46:21.315 --> 00:46:22.835
Thanks for doing this and congrats on the

00:46:22.876 --> 00:46:23.295
award again.

00:46:24.110 --> 00:46:24.550
Thanks, Jimmy.

00:46:24.570 --> 00:46:26.010
It's a pleasure to speak with you.

00:46:26.030 --> 00:46:26.510
This will be fun.

00:46:26.550 --> 00:46:27.371
I look forward to seeing you out in

00:46:27.391 --> 00:46:27.530
D.C.

00:46:27.590 --> 00:46:29.751
Sounds great.

00:46:29.771 --> 00:46:30.853
That's it for this one,

00:46:31.132 --> 00:46:32.793
but we're just getting warmed up.

00:46:33.273 --> 00:46:35.193
Smash follow, send it to a friend,

00:46:35.393 --> 00:46:37.054
or crank up the next episode.

00:46:37.574 --> 00:46:38.534
Want to go deeper?

00:46:38.956 --> 00:46:42.996
Hit us at pgpintcast.com or find us on

00:46:43.036 --> 00:46:45.577
YouTube and socials at pgpintcast.

00:46:45.998 --> 00:46:48.259
And legally, none of this was advice.

00:46:48.338 --> 00:46:49.960
It's for entertainment purposes only.

00:46:51.762 --> 00:46:52.405
See, Keith?

00:46:52.545 --> 00:46:53.650
We read the script.

00:46:53.911 --> 00:46:54.554
Happy now?