WEBVTT 00:00:00.070 --> 00:00:00.718 No problem. 00:00:01.843 --> 00:00:02.863 And are we starting with the article? 00:00:02.923 --> 00:00:03.984 I don't remember what we just said. 00:00:04.105 --> 00:00:04.264 Yeah, 00:00:04.285 --> 00:00:05.445 I was going to do the article first. 00:00:05.464 --> 00:00:05.945 Yeah, perfect. 00:00:06.506 --> 00:00:07.966 Yeah. 00:00:08.026 --> 00:00:08.207 All right. 00:00:08.246 --> 00:00:10.489 Most health care businesses have a number 00:00:11.028 --> 00:00:13.029 they're proud of, a number they show off, 00:00:13.189 --> 00:00:14.031 a number they track, 00:00:14.230 --> 00:00:17.292 a number they think proves they're doing 00:00:17.373 --> 00:00:17.833 good work. 00:00:18.493 --> 00:00:20.135 Larry's argument in his latest article, 00:00:20.495 --> 00:00:22.957 that number might be completely 00:00:22.977 --> 00:00:23.516 meaningless. 00:00:24.018 --> 00:00:24.178 Today, 00:00:24.198 --> 00:00:25.318 we're talking about one of the most 00:00:25.439 --> 00:00:27.600 visible metrics in health care. 00:00:28.239 --> 00:00:30.181 Google reviews, five stars. 00:00:31.109 --> 00:00:32.869 Zero outcomes? 00:00:32.990 --> 00:00:33.850 Welcome to The Operator, 00:00:33.890 --> 00:00:35.530 a show about running better healthcare 00:00:35.549 --> 00:00:36.831 businesses, not from theory, 00:00:37.331 --> 00:00:39.131 from people actually doing the work. 00:00:39.192 --> 00:00:40.692 If you're responsible for patients, 00:00:40.771 --> 00:00:44.213 people, or performance, this is for you. 00:00:44.292 --> 00:00:45.573 Larry, welcome to your show. 00:00:45.594 --> 00:00:47.533 Well, thank you, Jerry. 00:00:47.594 --> 00:00:48.914 Thank you for hosting my show. 00:00:50.286 --> 00:00:50.426 Well, 00:00:50.466 --> 00:00:51.826 my job is to sort of set you 00:00:51.947 --> 00:00:52.106 up. 00:00:52.226 --> 00:00:55.207 This is the last part in a series 00:00:55.228 --> 00:00:56.048 that you've been doing. 00:00:56.067 --> 00:00:57.167 And if people want to go back to 00:00:57.228 --> 00:00:57.328 it, 00:00:57.648 --> 00:00:59.689 we'll give the link to the sub stack 00:00:59.709 --> 00:01:00.829 that they can view as well as the 00:01:00.868 --> 00:01:01.829 articles on LinkedIn. 00:01:02.530 --> 00:01:02.990 But first, 00:01:03.329 --> 00:01:04.650 why did you decide to do sort of 00:01:04.670 --> 00:01:05.790 a series on metrics? 00:01:06.031 --> 00:01:07.590 What about that made you say, 00:01:07.611 --> 00:01:09.391 I'm going to dedicate several weeks of my 00:01:09.492 --> 00:01:11.611 writing to just metrics in general before 00:01:11.652 --> 00:01:13.733 we get into the specific Google reviews? 00:01:14.379 --> 00:01:15.099 Yeah. 00:01:15.120 --> 00:01:17.141 What we tend to do in an operating 00:01:17.180 --> 00:01:19.141 business and health care platforms is we 00:01:19.201 --> 00:01:21.942 tend to get very routinized on certain 00:01:22.003 --> 00:01:23.962 metrics that are like sacred cows. 00:01:23.983 --> 00:01:26.084 They're the belief that they are the most 00:01:26.123 --> 00:01:27.043 important ones. 00:01:27.885 --> 00:01:29.644 We've had vast changes in our operating 00:01:29.685 --> 00:01:30.225 environment. 00:01:30.266 --> 00:01:32.046 If you think of sort of the post-COVID 00:01:32.066 --> 00:01:32.927 hangover days, 00:01:32.947 --> 00:01:34.706 then you had shortages and you had all 00:01:34.746 --> 00:01:36.427 the headwinds of reimbursement. 00:01:37.188 --> 00:01:39.530 and all the things around high inflation. 00:01:40.251 --> 00:01:42.753 And the business models have had to 00:01:42.793 --> 00:01:43.153 change. 00:01:43.174 --> 00:01:44.254 You've had to adjust. 00:01:44.314 --> 00:01:46.917 And so what we tend not to do 00:01:47.177 --> 00:01:49.739 in health care operations is rethink, 00:01:50.140 --> 00:01:51.540 challenge our assumptions. 00:01:52.302 --> 00:01:52.641 And say, 00:01:52.742 --> 00:01:55.063 why are we continuing to measure that? 00:01:55.263 --> 00:01:57.346 And then the objective becomes the 00:01:57.406 --> 00:01:59.406 measurement rather than the activities and 00:01:59.427 --> 00:02:01.868 the behaviors that really get the 00:02:01.968 --> 00:02:03.989 operations flowing in the right direction. 00:02:04.531 --> 00:02:06.632 And so I've tried to on each one 00:02:06.671 --> 00:02:07.852 of these metrics doesn't mean, 00:02:08.112 --> 00:02:09.253 as I point out in the articles, 00:02:09.274 --> 00:02:10.735 that you shouldn't be measuring them, 00:02:10.794 --> 00:02:12.796 but you should be understanding how 00:02:12.836 --> 00:02:14.298 they've shifted over the years. 00:02:15.157 --> 00:02:18.020 And the whole area around good hearts is 00:02:18.080 --> 00:02:20.222 a bias that we tend to default in 00:02:20.282 --> 00:02:21.703 over time if we're not careful. 00:02:22.164 --> 00:02:22.384 Yeah. 00:02:22.425 --> 00:02:25.586 When the metric becomes the measure, 00:02:25.687 --> 00:02:27.487 it fails to measure what matters is the 00:02:27.527 --> 00:02:28.848 thing that kept sticking with me. 00:02:29.229 --> 00:02:29.889 That makes sense. 00:02:29.929 --> 00:02:30.569 I mean, you're Russian. 00:02:31.110 --> 00:02:31.911 If you want to go back and read 00:02:31.931 --> 00:02:31.991 it, 00:02:32.031 --> 00:02:34.412 the Russian nail factory sort of 00:02:34.512 --> 00:02:35.812 highlights that pretty well. 00:02:35.893 --> 00:02:37.473 When you tell me to gamify, 00:02:37.493 --> 00:02:39.594 when you gamify a metric and you put 00:02:39.634 --> 00:02:42.195 my salary on the on the line for 00:02:42.216 --> 00:02:42.477 that, 00:02:42.616 --> 00:02:44.176 guess what I get really good at hitting 00:02:44.197 --> 00:02:46.399 that number is the letter of the metric 00:02:46.459 --> 00:02:47.860 or the spirit of the metric. 00:02:47.879 --> 00:02:48.000 Well, 00:02:48.020 --> 00:02:49.120 I hit the letter of the metric and 00:02:49.139 --> 00:02:50.221 that's what gets me the paycheck. 00:02:51.002 --> 00:02:52.944 Just to that point, years ago, 00:02:53.465 --> 00:02:55.506 I'm going back into the late eighties. 00:02:56.426 --> 00:02:58.027 I had a few clinics and one of 00:02:58.048 --> 00:02:58.709 my clinics, 00:02:59.149 --> 00:03:01.250 we used to measure no-show cancellation 00:03:01.290 --> 00:03:03.331 rate and used to incentivize the front 00:03:03.372 --> 00:03:05.212 desk person for a lower no-show 00:03:05.252 --> 00:03:06.093 cancellation rate. 00:03:07.250 --> 00:03:08.129 And interesting, 00:03:08.169 --> 00:03:09.670 she went on maternity leave and she was 00:03:09.691 --> 00:03:11.931 a wonderful intake coordinator 00:03:11.951 --> 00:03:12.532 receptionist, 00:03:12.572 --> 00:03:14.073 what we called DOFI at the time, 00:03:14.092 --> 00:03:15.394 Director of First Impressions. 00:03:16.054 --> 00:03:16.593 And all of a sudden, 00:03:16.693 --> 00:03:19.414 our no-show cancellation went sky high. 00:03:19.914 --> 00:03:20.855 And I started wondering, 00:03:20.895 --> 00:03:21.996 how is that the case? 00:03:22.056 --> 00:03:22.997 Well, as it turns out, 00:03:23.037 --> 00:03:24.437 you can game that number. 00:03:24.516 --> 00:03:26.177 It's no different than the Russian nail 00:03:26.217 --> 00:03:26.698 factory. 00:03:27.139 --> 00:03:27.878 Somebody cancels, 00:03:27.899 --> 00:03:29.158 you just take them off the schedule and 00:03:29.199 --> 00:03:30.780 put them somewhere else and you never were 00:03:30.900 --> 00:03:32.401 able to see what really... 00:03:33.020 --> 00:03:33.681 happen there. 00:03:34.081 --> 00:03:36.122 And so gamesmanship working around it, 00:03:36.582 --> 00:03:40.246 our tax laws are the absolute, you know, 00:03:40.306 --> 00:03:42.568 personification of good hearts law, 00:03:42.668 --> 00:03:45.789 everybody works around the tax laws to try 00:03:45.810 --> 00:03:46.931 and save on their taxes. 00:03:46.971 --> 00:03:47.890 That's normal. 00:03:47.911 --> 00:03:47.991 Yeah. 00:03:48.812 --> 00:03:49.953 So we have to, you know, 00:03:49.992 --> 00:03:51.954 we have too many tax law issues, 00:03:52.354 --> 00:03:54.295 and good heart issues in operation. 00:03:54.716 --> 00:03:56.537 And so my challenge is somebody who's in 00:03:56.576 --> 00:03:59.179 the field every day operating is for us 00:03:59.199 --> 00:04:00.340 to challenge those assumptions. 00:04:00.659 --> 00:04:03.002 And you can tell which side of the 00:04:03.042 --> 00:04:04.503 argument someone is on with taxes when 00:04:04.524 --> 00:04:06.906 they call it a write-off or a loophole. 00:04:06.985 --> 00:04:07.826 If it's a loophole, 00:04:07.847 --> 00:04:09.829 you can tell they don't agree with it 00:04:09.868 --> 00:04:10.269 right there. 00:04:10.288 --> 00:04:12.270 All right, so let's jump into this. 00:04:12.671 --> 00:04:15.835 If someone logs on Google website, 00:04:15.935 --> 00:04:17.797 somewhere where ratings are being 00:04:18.036 --> 00:04:19.699 tabulated and shown off, 00:04:20.617 --> 00:04:23.218 what is a four point nine star four 00:04:23.259 --> 00:04:25.139 point out of five star rating actually 00:04:25.180 --> 00:04:28.300 tell you about specifically a health care 00:04:28.321 --> 00:04:30.322 business yeah honestly it tells you that 00:04:30.362 --> 00:04:32.603 they're good at asking that's not nothing 00:04:32.622 --> 00:04:35.324 not what most operators think it is you 00:04:35.343 --> 00:04:37.264 know four point nine means your patients 00:04:37.485 --> 00:04:39.446 felt well enough to leave a review that 00:04:39.485 --> 00:04:41.326 had a positive enough experience to give 00:04:41.346 --> 00:04:42.487 you close to a five star 00:04:43.067 --> 00:04:44.927 does not tell you about the patient who 00:04:44.968 --> 00:04:46.848 dropped off after the two to three visit 00:04:46.887 --> 00:04:49.088 cliff in physical therapy or in dental it 00:04:49.149 --> 00:04:50.410 doesn't tell you the patient who didn't 00:04:50.430 --> 00:04:52.329 show up for the second visit which 00:04:52.389 --> 00:04:54.490 oftentimes in dental is the most important 00:04:54.550 --> 00:04:57.512 visit from an economic standpoint it 00:04:57.552 --> 00:04:59.112 doesn't tell you about your twenty two day 00:04:59.153 --> 00:05:00.872 wait period for a new evaluation it 00:05:00.892 --> 00:05:02.293 doesn't tell you whether your functional 00:05:02.334 --> 00:05:04.173 outcomes improved or whether your hygiene 00:05:04.194 --> 00:05:05.814 appointment rate is collapsing 00:05:06.875 --> 00:05:09.418 It's a sentiment snapshot from a very 00:05:09.497 --> 00:05:11.060 self-directed audience. 00:05:11.160 --> 00:05:11.860 And in health care, 00:05:11.899 --> 00:05:14.903 that audience skews very grateful, 00:05:15.062 --> 00:05:16.343 skews compliance, 00:05:16.363 --> 00:05:18.165 skews towards the people who finished 00:05:18.225 --> 00:05:20.307 care, the people who like you. 00:05:20.367 --> 00:05:21.708 The four point nine is real. 00:05:21.728 --> 00:05:22.809 It's just not the whole story. 00:05:22.829 --> 00:05:24.990 It might not even be the important or 00:05:25.391 --> 00:05:26.992 really key elements of the story. 00:05:27.389 --> 00:05:28.649 Yeah, you want to gamify that number. 00:05:29.329 --> 00:05:31.512 Don't point out where to scan the QR 00:05:31.531 --> 00:05:32.793 code to leave a review to somebody who's 00:05:32.833 --> 00:05:33.774 disgruntled, right? 00:05:34.935 --> 00:05:36.216 Although you can look at the other side 00:05:36.235 --> 00:05:36.735 of the argument, 00:05:36.755 --> 00:05:38.716 which is sometimes when people have a bad 00:05:38.757 --> 00:05:39.298 experience, 00:05:39.317 --> 00:05:41.839 they're more likely to go rate you and 00:05:41.899 --> 00:05:44.120 leave a review versus the people who are 00:05:44.161 --> 00:05:45.603 the silent, happy, 00:05:46.242 --> 00:05:48.524 satisfied customer or patient. 00:05:49.004 --> 00:05:49.444 Exactly. 00:05:49.786 --> 00:05:50.665 And it has some meaning. 00:05:50.706 --> 00:05:52.848 It's just not all that much important from 00:05:52.887 --> 00:05:53.908 the day-to-day operations. 00:05:54.048 --> 00:05:54.288 Right. 00:05:54.588 --> 00:05:56.230 So at what point did healthcare cross the 00:05:56.250 --> 00:05:58.512 line from measuring experience to 00:05:58.591 --> 00:06:02.214 pretending experience equals quality? 00:06:02.877 --> 00:06:03.017 Yeah, 00:06:03.038 --> 00:06:04.358 so we gotta go back a little bit 00:06:04.858 --> 00:06:05.959 in place of time. 00:06:06.098 --> 00:06:08.339 In the, call it the late eighties, 00:06:08.480 --> 00:06:09.319 early nineties, 00:06:09.360 --> 00:06:10.940 there was this new thing that happened in 00:06:10.980 --> 00:06:12.822 healthcare called functional outcome 00:06:12.862 --> 00:06:17.163 measures, SF-II, the SF-XXVI, short form, 00:06:17.223 --> 00:06:18.363 long form, XXXVI, 00:06:18.384 --> 00:06:20.925 which is the healthcare quality of life. 00:06:20.964 --> 00:06:21.884 And so we started to say, 00:06:21.985 --> 00:06:23.466 what do outcomes mean? 00:06:24.026 --> 00:06:25.966 And outcomes were defined as days, 00:06:26.026 --> 00:06:29.427 dollars, utilization, functional outcome, 00:06:30.404 --> 00:06:31.305 And on top of that, 00:06:31.345 --> 00:06:32.985 we had patient satisfaction, 00:06:33.065 --> 00:06:35.307 later became patient experience. 00:06:35.346 --> 00:06:37.168 And so the combination of these dollars 00:06:37.228 --> 00:06:38.749 are sort of utilization-driven data, 00:06:39.009 --> 00:06:40.889 clinical functional outcome-driven data, 00:06:41.509 --> 00:06:43.870 and all the things around the experience 00:06:43.911 --> 00:06:46.132 became sort of the three distinct domains. 00:06:47.692 --> 00:06:49.134 But what happened is over time, 00:06:49.153 --> 00:06:50.413 we've tried to simplify it. 00:06:50.434 --> 00:06:50.615 You know, 00:06:50.634 --> 00:06:52.196 we're in business and operations. 00:06:52.255 --> 00:06:54.497 We're always trying to make the complex 00:06:54.576 --> 00:06:56.718 simple from an operation standpoint. 00:06:56.879 --> 00:06:58.040 That's a great thing. 00:06:58.279 --> 00:06:58.720 However, 00:06:58.800 --> 00:07:01.281 sometimes when we make things so simple, 00:07:01.322 --> 00:07:04.663 we destroy what the animal that we're 00:07:04.684 --> 00:07:05.625 trying to create is. 00:07:05.704 --> 00:07:07.386 So the moment we ran out of better 00:07:07.425 --> 00:07:09.627 alternatives and stopped admitting it, 00:07:09.666 --> 00:07:11.528 clinical outcome measurements in the most 00:07:11.608 --> 00:07:14.571 outpatient settings is inconsistent at 00:07:14.630 --> 00:07:16.232 best, absent at worst. 00:07:16.831 --> 00:07:19.774 Functional tools do exist, photo, promise, 00:07:20.653 --> 00:07:22.274 all the things are on Medicare, you know, 00:07:22.334 --> 00:07:24.976 PSFS, for example, but adoption is not, 00:07:25.317 --> 00:07:27.197 you know, is not evenly put. 00:07:28.059 --> 00:07:28.819 And at times, 00:07:28.858 --> 00:07:30.579 we tend to only do it on our 00:07:30.620 --> 00:07:33.041 best patients or those who complete care. 00:07:33.062 --> 00:07:34.062 And so you have to be really, 00:07:34.101 --> 00:07:34.802 really careful. 00:07:35.764 --> 00:07:37.644 And so what fills that volume, 00:07:37.665 --> 00:07:39.646 whatever is visible and Google stars are 00:07:39.846 --> 00:07:40.406 everywhere. 00:07:40.447 --> 00:07:42.149 And so let's use Google stars. 00:07:42.329 --> 00:07:44.411 I had series a couple of weeks ago 00:07:44.451 --> 00:07:45.872 about Net Promoter Score, 00:07:45.891 --> 00:07:47.353 a lot of similarities here. 00:07:47.694 --> 00:07:48.694 They're on your profile, 00:07:48.713 --> 00:07:49.935 they show up in the listing, 00:07:49.954 --> 00:07:51.737 they're a number, numbers feel like data. 00:07:51.797 --> 00:07:52.838 So we promote them, 00:07:52.918 --> 00:07:54.439 not because anyone made a deliberate 00:07:54.899 --> 00:07:55.839 decision about it, 00:07:55.879 --> 00:07:57.961 but that four point nine stars equals 00:07:58.002 --> 00:07:58.862 clinical excellence. 00:07:58.882 --> 00:08:00.884 Somehow or another, we conflated that. 00:08:01.725 --> 00:08:03.206 But because the infrastructure for 00:08:03.247 --> 00:08:05.829 measuring actual clinical excellence 00:08:05.910 --> 00:08:08.411 wasn't there or wasn't fulsome or wasn't 00:08:08.451 --> 00:08:11.214 complete, the proxy became the point. 00:08:11.615 --> 00:08:13.257 And that's always how it happens. 00:08:13.336 --> 00:08:16.019 We make a proxy a conclusion, 00:08:16.160 --> 00:08:18.161 and Google stars are now that conclusion, 00:08:18.182 --> 00:08:18.442 unfortunately. 00:08:19.511 --> 00:08:19.690 Yeah. 00:08:20.230 --> 00:08:21.732 It's funny that you bring up four point 00:08:21.791 --> 00:08:22.552 nine stars. 00:08:22.752 --> 00:08:23.833 And I think I know why. 00:08:24.153 --> 00:08:26.935 To me, five feels too perfect. 00:08:27.035 --> 00:08:29.255 It feels like I can't trust that because 00:08:29.295 --> 00:08:30.896 it's nothing's perfect. 00:08:30.937 --> 00:08:32.557 So four point nine feels as close as 00:08:32.577 --> 00:08:33.198 you can get. 00:08:33.558 --> 00:08:34.099 Really good. 00:08:34.119 --> 00:08:35.480 But obviously there's some real in there. 00:08:35.539 --> 00:08:36.480 So it matters. 00:08:37.160 --> 00:08:38.841 Isn't that funny how that like we've even 00:08:39.042 --> 00:08:40.722 even on the receiving end said five's too 00:08:40.743 --> 00:08:40.863 good. 00:08:40.883 --> 00:08:41.562 I don't trust it. 00:08:42.163 --> 00:08:43.783 A four point eight that four point nine 00:08:43.803 --> 00:08:45.125 that feels perfect. 00:08:45.325 --> 00:08:46.506 More authentic. 00:08:46.667 --> 00:08:47.327 Feels more authentic. 00:08:47.488 --> 00:08:47.807 Right. 00:08:47.908 --> 00:08:49.529 Right. 00:08:49.570 --> 00:08:51.832 So you mentioned like sort of the 00:08:51.893 --> 00:08:52.874 pre-COVID, right? 00:08:52.913 --> 00:08:56.118 So are operators still chasing Google 00:08:56.158 --> 00:08:57.500 reviews based on a version of the 00:08:57.539 --> 00:08:58.701 algorithm that doesn't actually exist? 00:08:58.821 --> 00:09:00.864 Are we still having a twenty sixteen 00:09:00.923 --> 00:09:03.086 mindset in twenty twenty six? 00:09:03.806 --> 00:09:05.106 No, that's absolutely right. 00:09:05.226 --> 00:09:06.048 A lot of them are. 00:09:06.067 --> 00:09:07.729 And that's really what my research started 00:09:07.769 --> 00:09:08.249 to show, 00:09:08.328 --> 00:09:09.889 that the old mental model was pretty 00:09:09.929 --> 00:09:10.250 simple. 00:09:10.311 --> 00:09:12.312 More five star reviews equals higher 00:09:12.491 --> 00:09:14.474 ranking equals more patients. 00:09:14.573 --> 00:09:16.475 So it was all driven by how high 00:09:16.514 --> 00:09:17.115 on the Google 00:09:17.932 --> 00:09:19.913 best search engine, period. 00:09:19.932 --> 00:09:20.514 It's interesting. 00:09:20.533 --> 00:09:22.174 We're switching now from search engine to 00:09:22.355 --> 00:09:24.395 AI, LLL. 00:09:25.355 --> 00:09:25.996 And for a while, 00:09:26.037 --> 00:09:29.879 the volume of reviews was the dominant SEO 00:09:29.979 --> 00:09:30.339 signal. 00:09:30.360 --> 00:09:32.020 And this really is the main teaching point 00:09:32.061 --> 00:09:32.681 of the article. 00:09:33.020 --> 00:09:34.461 So that logic held true. 00:09:34.501 --> 00:09:36.903 But the algorithm has gotten way more 00:09:36.962 --> 00:09:38.884 sophisticated, as they always do. 00:09:38.945 --> 00:09:41.446 Technology always outpaces everything we 00:09:41.485 --> 00:09:42.287 do in health care. 00:09:42.907 --> 00:09:45.067 proximity, relevance, behavior signals, 00:09:45.087 --> 00:09:46.730 how people interact with your listing, 00:09:46.769 --> 00:09:48.291 whether they click, whether they call, 00:09:48.691 --> 00:09:50.432 these matter now as well. 00:09:50.631 --> 00:09:52.133 So it's the behavioral elements, 00:09:52.212 --> 00:09:53.833 not just the star elements. 00:09:54.455 --> 00:09:56.596 Review recency matters more than raw 00:09:56.635 --> 00:09:57.135 volume. 00:09:57.476 --> 00:09:59.998 So if you took a hundred reviews, 00:10:00.457 --> 00:10:02.200 it's like golf handicap system. 00:10:02.240 --> 00:10:04.441 It's the five top most recent ones that 00:10:04.500 --> 00:10:05.461 really matter. 00:10:06.001 --> 00:10:08.325 So the operators who ran an aggressive, 00:10:08.365 --> 00:10:10.447 let's get to two hundred review campaigns. 00:10:10.626 --> 00:10:12.769 I still see this all the time. 00:10:12.849 --> 00:10:15.052 And they sort of stop. 00:10:15.552 --> 00:10:16.893 They're potentially losing ground to a 00:10:16.952 --> 00:10:18.335 competitor with eighty reviews. 00:10:18.375 --> 00:10:19.615 So that was kind of like I got 00:10:19.676 --> 00:10:20.096 two hundred. 00:10:20.116 --> 00:10:20.756 You got eighty. 00:10:20.797 --> 00:10:21.778 So therefore, I'm better. 00:10:22.119 --> 00:10:24.421 In fact, we are competitiveness. 00:10:25.302 --> 00:10:27.863 around google stars surpassed our 00:10:27.883 --> 00:10:29.764 competitiveness around clinical excellence 00:10:29.803 --> 00:10:31.264 and doing the right thing for the patient 00:10:31.365 --> 00:10:33.485 right you know the we got we got 00:10:33.546 --> 00:10:36.347 diverted by all this um so chasing the 00:10:36.388 --> 00:10:38.489 number at one time made sense now it's 00:10:38.649 --> 00:10:41.311 it's it's table stakes and the operators 00:10:41.350 --> 00:10:43.152 treating it like it's a competitive moat 00:10:43.312 --> 00:10:45.413 are you know probably optimizing for a 00:10:45.493 --> 00:10:47.533 version of local search that's already 00:10:47.573 --> 00:10:49.475 moved way way past that right you know 00:10:49.514 --> 00:10:51.035 by the way at least in physical therapy 00:10:51.615 --> 00:10:53.155 Why do we care about local surgery much? 00:10:53.176 --> 00:10:54.596 Don't we have we have plenty of patients 00:10:54.616 --> 00:10:56.596 now, plenty of volume. 00:10:56.616 --> 00:10:56.876 Yeah. 00:10:56.976 --> 00:10:58.996 You know, really optimizing, 00:10:59.037 --> 00:11:00.217 as we talked about last week, 00:11:00.278 --> 00:11:03.298 optimizing that volume and not the churn 00:11:04.357 --> 00:11:05.499 is really, really important. 00:11:05.519 --> 00:11:07.239 So keeping the patients you have and what 00:11:07.259 --> 00:11:09.479 we're saying, milking your own cows first, 00:11:09.538 --> 00:11:10.639 you have those patients. 00:11:11.220 --> 00:11:12.740 Make sure you're getting the treatment 00:11:12.779 --> 00:11:15.559 completion on them so that you can focus 00:11:15.600 --> 00:11:16.561 attention on there. 00:11:16.600 --> 00:11:18.480 And that's where that, you know, really 00:11:19.360 --> 00:11:20.562 being extremely, 00:11:20.662 --> 00:11:22.923 extremely intentional about visit two and 00:11:22.942 --> 00:11:25.303 three and showing value there rather than 00:11:25.403 --> 00:11:26.524 routinize the visit. 00:11:27.184 --> 00:11:28.485 What you're basically saying to the 00:11:28.524 --> 00:11:29.706 patient is you don't need to come in 00:11:29.725 --> 00:11:30.907 anymore because we're going to do the same 00:11:30.927 --> 00:11:31.687 thing every time. 00:11:32.106 --> 00:11:32.586 Yep. 00:11:32.746 --> 00:11:35.408 I can actually hear someone creating a KPI 00:11:35.448 --> 00:11:36.089 just for that. 00:11:36.129 --> 00:11:37.490 But isn't there one? 00:11:37.610 --> 00:11:38.309 Isn't it churn? 00:11:38.330 --> 00:11:39.791 So when you don't have real clinical 00:11:39.870 --> 00:11:42.532 outcome data, what does fill that gap? 00:11:42.871 --> 00:11:44.753 What is the right thing or the better 00:11:44.812 --> 00:11:46.153 thing to measure? 00:11:47.408 --> 00:11:48.210 Yeah, 00:11:50.552 --> 00:11:52.154 so what happens is we use Google Deck, 00:11:52.395 --> 00:11:53.116 Google Stars, 00:11:53.417 --> 00:11:55.919 and Net Promoter Scores because leadership 00:11:55.980 --> 00:11:57.863 needs something to say in a board deck. 00:11:58.583 --> 00:12:00.304 And this is a different topic for another 00:12:00.345 --> 00:12:01.485 time, but I think, you know, 00:12:01.544 --> 00:12:04.485 PE backed platforms and even private 00:12:04.546 --> 00:12:07.927 practices do not have the right type of 00:12:07.966 --> 00:12:08.706 board members. 00:12:08.746 --> 00:12:11.067 They have people playing by old rules of 00:12:11.107 --> 00:12:13.129 an old game, a, you know, 00:12:13.168 --> 00:12:15.808 call it college before we professionalize 00:12:15.828 --> 00:12:17.529 through revenue share and NIL. 00:12:17.570 --> 00:12:19.831 That's the type of people that are on 00:12:19.931 --> 00:12:22.250 boards right now is this new game that 00:12:22.291 --> 00:12:23.792 took place post COVID. 00:12:24.692 --> 00:12:26.754 You show me an operator who's really done 00:12:26.815 --> 00:12:28.475 well the last few years and you've got 00:12:28.535 --> 00:12:30.778 an operator because they they're the ones 00:12:30.798 --> 00:12:32.721 who've dealt with incredible amounts of 00:12:32.780 --> 00:12:34.383 inflation at the supply level, 00:12:34.442 --> 00:12:36.325 inflation at the compensation level, 00:12:36.365 --> 00:12:38.047 shortages of your suppliers, 00:12:38.606 --> 00:12:40.089 all of those kinds of things. 00:12:40.950 --> 00:12:42.770 And so we use Google stars and net 00:12:42.812 --> 00:12:44.854 promoter scores for those board members 00:12:44.894 --> 00:12:46.315 because we want to fill a board deck. 00:12:46.335 --> 00:12:47.035 It sounds cynical. 00:12:47.135 --> 00:12:49.398 but it's accurate organizations under 00:12:49.457 --> 00:12:51.460 performance pressure from either PE 00:12:51.539 --> 00:12:51.840 owners, 00:12:51.879 --> 00:12:53.841 from franchise benchmarks from year over 00:12:53.922 --> 00:12:56.283 year need visible proof of quality. 00:12:56.644 --> 00:12:59.527 And so this proxy of Google stars is 00:12:59.626 --> 00:13:02.889 now what your compliance is showing up as 00:13:02.950 --> 00:13:03.350 quality. 00:13:03.370 --> 00:13:04.552 And if you can't pull functional 00:13:04.572 --> 00:13:06.232 improvement data, very hard to do, 00:13:06.273 --> 00:13:06.693 as you know, 00:13:07.114 --> 00:13:08.575 If your outcome tool adoption is 00:13:08.654 --> 00:13:09.355 inconsistent, 00:13:09.375 --> 00:13:10.875 it's very hard to be consistent. 00:13:11.196 --> 00:13:13.517 If your discharge documentation is a mess, 00:13:13.756 --> 00:13:15.758 very hard to have that consistent as well 00:13:16.077 --> 00:13:19.740 because most patients don't read their end 00:13:19.799 --> 00:13:21.179 of treatment discharge. 00:13:21.500 --> 00:13:22.841 You reach the number you have. 00:13:22.900 --> 00:13:24.182 Google stars makes it easy. 00:13:24.241 --> 00:13:26.001 Net promoter scores make it easier. 00:13:26.062 --> 00:13:27.842 Patient satisfaction makes it easier. 00:13:28.062 --> 00:13:29.163 Those aren't bad metrics. 00:13:29.183 --> 00:13:30.923 They're just getting asked to carry weight 00:13:30.943 --> 00:13:31.804 they weren't built for. 00:13:32.985 --> 00:13:34.826 The danger isn't that operators track 00:13:34.846 --> 00:13:34.986 them. 00:13:35.027 --> 00:13:36.368 The danger is that over time, 00:13:36.388 --> 00:13:38.528 the proxy becomes the definition. 00:13:38.568 --> 00:13:39.370 You stop asking, 00:13:39.389 --> 00:13:40.571 are patients getting better? 00:13:40.870 --> 00:13:41.652 And start asking, 00:13:41.751 --> 00:13:43.293 are patients happy enough to leave a 00:13:43.312 --> 00:13:44.133 five-star review? 00:13:44.153 --> 00:13:46.654 That's entirely different dimensions. 00:13:47.034 --> 00:13:47.716 They're related, 00:13:48.216 --> 00:13:49.596 but they're not the same questions. 00:13:49.777 --> 00:13:50.738 Yeah. 00:13:50.778 --> 00:13:52.698 You highlighted something in this article 00:13:52.759 --> 00:13:54.580 that I guess I didn't think about too 00:13:54.620 --> 00:13:54.941 much. 00:13:55.581 --> 00:13:56.601 And I bet you a lot of people 00:13:56.642 --> 00:13:57.222 didn't either, 00:13:57.263 --> 00:13:59.945 which is responding to one of these 00:13:59.985 --> 00:14:02.366 reviews, if it's negative or in a way, 00:14:02.788 --> 00:14:04.708 could open you up to liability. 00:14:05.370 --> 00:14:08.393 So why are healthcare providers the only 00:14:08.432 --> 00:14:10.335 businesses that really can't actually 00:14:10.355 --> 00:14:11.716 defend themselves in public? 00:14:11.775 --> 00:14:12.355 Or they can, 00:14:12.375 --> 00:14:13.658 but they have to be really, 00:14:14.018 --> 00:14:15.139 really careful about it. 00:14:15.447 --> 00:14:15.667 Yeah. 00:14:15.706 --> 00:14:16.187 So first of all, 00:14:16.206 --> 00:14:17.908 the reviews tend to reflect sort of your 00:14:17.988 --> 00:14:20.908 interpersonal and logistical experience as 00:14:20.948 --> 00:14:22.288 your wait times, your parking, 00:14:22.328 --> 00:14:23.089 the front desk, 00:14:23.448 --> 00:14:25.210 not clinical decision making. 00:14:25.610 --> 00:14:28.171 And so the population leaving reviews is 00:14:28.270 --> 00:14:30.711 really not a representative population. 00:14:31.851 --> 00:14:34.354 people are complex they leave incomplete 00:14:34.835 --> 00:14:37.557 survey data disappointing outcomes are 00:14:37.596 --> 00:14:39.938 less likely to review stars of any any 00:14:40.620 --> 00:14:43.162 nature at all and what ends up happening 00:14:43.442 --> 00:14:45.283 is it's you know do you like your 00:14:45.323 --> 00:14:47.285 provider all those kind of things they 00:14:47.346 --> 00:14:50.028 review it but that selection bias is baked 00:14:50.087 --> 00:14:52.870 into every star rating in the industry 00:14:53.629 --> 00:14:55.089 But the biggest thing is what you're 00:14:55.129 --> 00:14:56.330 referring to on the question, 00:14:56.350 --> 00:14:58.951 which has HIPAA in the background, 00:14:58.971 --> 00:15:01.171 which limits how providers can respond to 00:15:01.230 --> 00:15:02.270 negative reviews. 00:15:02.611 --> 00:15:04.011 You can't get into details. 00:15:04.052 --> 00:15:05.412 You can't correct the record. 00:15:05.451 --> 00:15:07.133 You can't explain context. 00:15:07.673 --> 00:15:09.754 So one-star review about a billing dispute 00:15:09.793 --> 00:15:11.274 sits on your profile essentially 00:15:11.333 --> 00:15:13.335 unchallenged because your response has to 00:15:13.375 --> 00:15:14.215 be generic. 00:15:14.875 --> 00:15:17.618 It lands and people people ignore that. 00:15:17.658 --> 00:15:19.259 And so now we've developed this whole 00:15:19.278 --> 00:15:21.120 niche industry about how to respond to 00:15:21.160 --> 00:15:22.423 bad, bad reviews. 00:15:22.462 --> 00:15:23.764 It's almost like all of us need our 00:15:23.803 --> 00:15:26.326 own PR crisis when we get a bad 00:15:27.047 --> 00:15:27.508 review. 00:15:28.268 --> 00:15:30.210 We also have to remember, you know, 00:15:30.471 --> 00:15:32.432 I always tell my therapist this and the 00:15:32.493 --> 00:15:34.073 PT side and I say the same thing 00:15:34.094 --> 00:15:34.595 in the dental. 00:15:34.654 --> 00:15:37.376 If a patient left your local clinic. 00:15:38.097 --> 00:15:40.840 because they refused to accept some level 00:15:40.879 --> 00:15:43.182 of self-responsibility in physical therapy 00:15:43.201 --> 00:15:45.864 that manifests itself by a home program or 00:15:45.903 --> 00:15:47.625 compliance with instructions. 00:15:48.206 --> 00:15:48.787 And in dental, 00:15:48.826 --> 00:15:50.727 it manifests itself with compliance with 00:15:50.788 --> 00:15:52.970 instructions on hygiene care and other 00:15:53.129 --> 00:15:55.831 aspects of post procedural care. 00:15:56.393 --> 00:15:58.934 And they would not take and therefore they 00:15:58.975 --> 00:16:00.875 disliked you because they wanted to put 00:16:00.936 --> 00:16:02.256 all their problems on to you. 00:16:03.057 --> 00:16:04.899 It's OK to fire a customer every once 00:16:04.918 --> 00:16:05.359 in a while. 00:16:05.418 --> 00:16:07.600 And if that leaves you a bad review, 00:16:08.100 --> 00:16:10.260 you could still sleep at night because 00:16:10.321 --> 00:16:13.101 self-responsibility and an active role in 00:16:13.121 --> 00:16:14.042 your own health care, 00:16:14.101 --> 00:16:16.543 your own recovery and in your own in 00:16:16.562 --> 00:16:18.604 the dental world and your own treatment is 00:16:18.683 --> 00:16:19.224 critical. 00:16:19.244 --> 00:16:21.664 A lot of patients don't want to assume 00:16:21.745 --> 00:16:23.745 any responsibility and they might write 00:16:23.765 --> 00:16:24.625 you a bad review. 00:16:24.946 --> 00:16:28.106 You can't get overly intrusive on it 00:16:28.147 --> 00:16:28.767 because you're violent. 00:16:28.807 --> 00:16:29.847 You could be violating HIPAA. 00:16:30.475 --> 00:16:33.636 Yeah, it's the juice versus squeeze ratio. 00:16:34.118 --> 00:16:35.578 You might chase after and put so much 00:16:35.599 --> 00:16:36.438 effort in this one patient, 00:16:36.458 --> 00:16:37.580 you're probably never gonna make that, 00:16:38.000 --> 00:16:40.001 you might never make that person happy. 00:16:40.402 --> 00:16:42.464 Let's take that juice versus squeeze ratio 00:16:42.844 --> 00:16:43.784 over to this question, 00:16:44.184 --> 00:16:46.005 because this takes time, effort, money. 00:16:46.046 --> 00:16:48.827 There are firms who you can hire that 00:16:48.847 --> 00:16:49.849 are specialized in this. 00:16:50.288 --> 00:16:52.291 So what are people actually spending, 00:16:52.350 --> 00:16:53.451 even if you're not hiring a firm, 00:16:53.471 --> 00:16:55.352 you're also spending brainpower, time, 00:16:55.413 --> 00:16:56.653 staff time, effort, money. 00:16:56.994 --> 00:16:58.754 What are we actually spending to maintain 00:16:58.794 --> 00:16:59.035 that 00:17:01.356 --> 00:17:04.157 And has anyone proven that it does 00:17:04.198 --> 00:17:04.618 anything? 00:17:05.259 --> 00:17:07.640 Does it drive business or patient growth 00:17:07.720 --> 00:17:08.160 at all? 00:17:08.580 --> 00:17:08.740 Yeah. 00:17:08.820 --> 00:17:11.261 So one of the questions I ask operators 00:17:11.281 --> 00:17:14.223 to think about is the concept of what 00:17:14.304 --> 00:17:17.484 is your return on the cost of quality? 00:17:17.925 --> 00:17:20.446 The cost is the time, effort, resources, 00:17:20.567 --> 00:17:20.967 money, 00:17:21.507 --> 00:17:24.888 all these things we do to ensure some 00:17:24.949 --> 00:17:25.950 level of quality. 00:17:26.609 --> 00:17:28.171 And so you have to be cognizant of 00:17:28.191 --> 00:17:28.431 that. 00:17:28.911 --> 00:17:31.551 The spending is extremely real and it's 00:17:31.652 --> 00:17:33.413 often invisible in the budget. 00:17:33.893 --> 00:17:34.113 You know, 00:17:34.133 --> 00:17:35.794 people aren't you're not budgeting this as 00:17:35.834 --> 00:17:38.375 much staff time training and review 00:17:38.815 --> 00:17:41.476 technology platforms with automatic post 00:17:41.536 --> 00:17:43.016 visit review sequences. 00:17:43.076 --> 00:17:45.156 Now we have all this stuff that goes 00:17:45.217 --> 00:17:47.637 into your phone that automatically asks 00:17:47.738 --> 00:17:49.318 you all of these kinds of things. 00:17:49.939 --> 00:17:51.700 And for a multi-site operator, man, 00:17:51.740 --> 00:17:52.460 that adds up. 00:17:52.579 --> 00:17:54.461 fast and keep in mind all the SAS 00:17:54.481 --> 00:17:55.702 software providers, 00:17:55.742 --> 00:17:56.804 how do they make more money? 00:17:57.223 --> 00:18:00.146 The same customers adding additional APIs 00:18:00.547 --> 00:18:02.848 that allow you to do more functions is 00:18:02.909 --> 00:18:04.190 how they make more money. 00:18:04.250 --> 00:18:04.410 You know, 00:18:04.430 --> 00:18:06.031 we'll talk about the EMRs and other kinds 00:18:06.051 --> 00:18:08.493 of things later because the LZRs miniature 00:18:08.534 --> 00:18:09.034 versions. 00:18:09.434 --> 00:18:11.757 So now I'm not only doing your EMR, 00:18:12.217 --> 00:18:14.698 I'm doing your point of service pay at 00:18:14.758 --> 00:18:15.358 times. 00:18:15.578 --> 00:18:17.298 I'm doing your outcome studies. 00:18:17.680 --> 00:18:20.181 I'm doing your documentation AI. 00:18:20.580 --> 00:18:22.422 All of these things keep adding costs. 00:18:22.461 --> 00:18:23.682 And so we say as operators, 00:18:23.701 --> 00:18:25.303 where's my cost of RCM? 00:18:25.343 --> 00:18:26.363 Should be going down. 00:18:26.544 --> 00:18:27.523 All of a sudden it's going up. 00:18:27.544 --> 00:18:28.304 Why is it going up? 00:18:28.324 --> 00:18:29.785 Because all these providers are adding 00:18:29.884 --> 00:18:30.525 APIs. 00:18:30.805 --> 00:18:33.826 They're increasing your cost and you have 00:18:33.866 --> 00:18:35.567 to do the tough decisions and make 00:18:35.607 --> 00:18:36.048 choices. 00:18:36.528 --> 00:18:38.348 about all of those kinds of things. 00:18:38.410 --> 00:18:40.151 And so in health care, 00:18:40.171 --> 00:18:42.211 a lot of choice is constrained. 00:18:42.272 --> 00:18:44.054 Insurance networks, referral patterns, 00:18:44.094 --> 00:18:44.713 geography, 00:18:44.773 --> 00:18:46.875 they're still doing an incredible amount 00:18:46.915 --> 00:18:47.517 of routing. 00:18:47.557 --> 00:18:49.817 And so if you're investing to maintain a 00:18:49.857 --> 00:18:52.079 four point nine in a market where a 00:18:52.140 --> 00:18:53.820 meaningful portion of your new patients 00:18:53.861 --> 00:18:55.502 are coming through other referral channels 00:18:55.823 --> 00:18:57.544 that aren't looking at your Google rating 00:18:57.604 --> 00:18:57.884 at all, 00:18:57.924 --> 00:18:59.266 that doesn't mean the investment is 00:18:59.826 --> 00:19:00.226 wasted. 00:19:00.626 --> 00:19:02.867 It just means that ROI calculation is 00:19:02.948 --> 00:19:03.269 messy. 00:19:03.909 --> 00:19:06.131 They're the platform selling requests. 00:19:06.471 --> 00:19:08.553 So we see all of these efforts now 00:19:08.673 --> 00:19:11.776 in the AI world of lead generation and 00:19:11.895 --> 00:19:13.218 all of these things around it. 00:19:13.778 --> 00:19:15.759 And I talk to practices and they say, 00:19:15.779 --> 00:19:17.121 I'm not having trouble getting new 00:19:17.161 --> 00:19:18.021 patients right now. 00:19:18.442 --> 00:19:18.742 Well, 00:19:18.923 --> 00:19:20.443 you're spending an incredible amount 00:19:20.483 --> 00:19:22.445 between your foot marketers, 00:19:22.826 --> 00:19:25.308 your advertising, your digital marketing, 00:19:25.788 --> 00:19:27.430 and all of these things have accreted to 00:19:27.471 --> 00:19:27.810 a level. 00:19:27.891 --> 00:19:28.490 And you have to say, 00:19:28.530 --> 00:19:30.032 does the business model support it 00:19:30.053 --> 00:19:30.192 anymore? 00:19:31.128 --> 00:19:32.069 And in healthcare, 00:19:32.230 --> 00:19:33.612 it's a penny nickel business, 00:19:33.652 --> 00:19:34.893 a nickel dime business. 00:19:35.012 --> 00:19:38.136 You can't afford to spend an enormous 00:19:38.156 --> 00:19:39.698 amount of money on a problem that you 00:19:39.738 --> 00:19:41.099 think is there, but it really isn't. 00:19:41.519 --> 00:19:42.159 Yeah. 00:19:42.179 --> 00:19:42.359 All right. 00:19:42.380 --> 00:19:43.220 So I'm going to hold your feet to 00:19:43.259 --> 00:19:43.640 the fire. 00:19:43.819 --> 00:19:47.021 I actually put your article into test. 00:19:47.041 --> 00:19:47.382 I said, hey, 00:19:47.982 --> 00:19:51.125 how would some leading brands actually 00:19:51.244 --> 00:19:51.944 optimize this? 00:19:51.984 --> 00:19:55.686 And one of the best responses was Disney. 00:19:56.248 --> 00:19:58.848 They said Walt Disney himself would 00:19:58.929 --> 00:20:01.611 optimize for miles per hour, 00:20:01.651 --> 00:20:03.531 not miles per hour, not stars. 00:20:03.912 --> 00:20:06.012 So if Google stars don't tell the truth, 00:20:06.814 --> 00:20:08.994 what should operators be measuring 00:20:09.476 --> 00:20:10.056 instead? 00:20:10.753 --> 00:20:11.193 Yeah, 00:20:11.413 --> 00:20:13.275 so we'll get into this a little bit, 00:20:13.295 --> 00:20:14.736 but I noticed one of the comments from 00:20:14.756 --> 00:20:18.117 the article last week was somebody saying 00:20:18.137 --> 00:20:20.759 the best metric they measure is how many 00:20:20.818 --> 00:20:22.279 smiles are leaving their clinic. 00:20:22.728 --> 00:20:24.167 And I thought that was a real interesting 00:20:24.228 --> 00:20:24.728 one. 00:20:24.827 --> 00:20:26.409 In dental, at least in our company, 00:20:26.469 --> 00:20:28.009 we say our mission is to create a 00:20:28.048 --> 00:20:29.548 lifetime of healthy smiles. 00:20:29.608 --> 00:20:30.930 And how are we doing that? 00:20:30.970 --> 00:20:33.190 Doing meaningful and purposeful work and 00:20:33.230 --> 00:20:33.789 remembering. 00:20:34.230 --> 00:20:35.711 In fact, that's what we're here for. 00:20:36.310 --> 00:20:38.431 But there's a short list with teeth. 00:20:38.510 --> 00:20:41.011 New patient arrival rate is a real 00:20:41.051 --> 00:20:41.672 critical one. 00:20:41.711 --> 00:20:43.291 Are new patients choosing you? 00:20:43.811 --> 00:20:45.432 Is that number growing? 00:20:45.553 --> 00:20:47.673 Is your number of new patients growing? 00:20:48.393 --> 00:20:51.134 We talk about growth in organic and all 00:20:51.153 --> 00:20:52.253 these things and platforms, 00:20:52.273 --> 00:20:55.095 and most PT operators measure that wrong. 00:20:55.435 --> 00:20:59.757 They measure growth in terms of number of 00:20:59.797 --> 00:21:01.518 visits per patient, all kinds of things. 00:21:01.538 --> 00:21:02.998 They ought to be measuring it by growth 00:21:03.038 --> 00:21:03.798 and cash flow. 00:21:03.917 --> 00:21:05.298 Different topic for another time. 00:21:05.959 --> 00:21:06.980 But is the number growing? 00:21:07.000 --> 00:21:07.980 That's a market signal, 00:21:08.060 --> 00:21:10.123 not just a sentimental drop. 00:21:10.182 --> 00:21:11.703 PlanetCare completion, very, 00:21:11.743 --> 00:21:13.265 very difficult, but really, really, 00:21:13.605 --> 00:21:14.205 really difficult. 00:21:14.346 --> 00:21:16.448 Are patients staying through their episode 00:21:16.508 --> 00:21:17.288 of completion? 00:21:17.628 --> 00:21:19.131 To me, that would be the best proxy. 00:21:21.115 --> 00:21:23.135 of a patient you know satisfaction really 00:21:23.615 --> 00:21:25.896 because dropout is the quiet killer that a 00:21:25.957 --> 00:21:27.917 four point nine doesn't capture right 00:21:27.978 --> 00:21:30.018 functional outcome improvement discipline 00:21:30.157 --> 00:21:33.459 specific systematically collected not 00:21:33.538 --> 00:21:36.740 cherry-picked reactivation rate are former 00:21:36.779 --> 00:21:38.540 patients coming back when they have a new 00:21:38.601 --> 00:21:40.701 need i call it friends family and former 00:21:40.760 --> 00:21:42.682 patient percentage what percentage of your 00:21:42.721 --> 00:21:45.462 new patients fall into that bucket that is 00:21:45.522 --> 00:21:47.182 really critical to me because it means 00:21:47.202 --> 00:21:48.844 you're spending zero dollars 00:21:49.364 --> 00:21:51.424 under what you should be doing to get 00:21:51.464 --> 00:21:52.026 your marketing, 00:21:52.066 --> 00:21:53.807 which is providing great care. 00:21:54.207 --> 00:21:55.867 That's continuity and it's its most 00:21:55.928 --> 00:21:56.749 measurable form. 00:21:57.729 --> 00:21:58.950 None of these are as clean or as 00:21:58.970 --> 00:22:00.270 visible as a star rating. 00:22:00.490 --> 00:22:00.810 You know, 00:22:01.511 --> 00:22:03.212 in order to get to the answer, 00:22:03.272 --> 00:22:05.034 it's not a simple answer like a star 00:22:05.074 --> 00:22:05.354 rating. 00:22:05.374 --> 00:22:06.974 That's exactly why they matter more. 00:22:07.035 --> 00:22:09.156 The metrics that are easy to show off 00:22:09.196 --> 00:22:10.477 are usually the ones that have already 00:22:10.518 --> 00:22:11.137 been gained. 00:22:11.178 --> 00:22:12.778 The ones that are harder to show off 00:22:12.818 --> 00:22:14.259 are the ones that's actually happening. 00:22:14.894 --> 00:22:15.976 Yeah. 00:22:15.996 --> 00:22:17.396 Anything you'd want to leave the audience 00:22:17.436 --> 00:22:19.157 with as we wrap up? 00:22:19.198 --> 00:22:20.179 Your parting thoughts? 00:22:20.618 --> 00:22:21.900 No, just, you know, 00:22:22.119 --> 00:22:23.901 not telling you not to do Google ratings. 00:22:24.000 --> 00:22:26.403 Just don't overvalue them and don't spend 00:22:26.462 --> 00:22:28.163 all you're trying to get more of them. 00:22:28.663 --> 00:22:30.746 Reroute that same effort into something 00:22:30.786 --> 00:22:32.507 that brings meaningful change into the 00:22:32.547 --> 00:22:33.768 operations of your practice. 00:22:33.788 --> 00:22:34.488 I mean, 00:22:34.587 --> 00:22:36.769 as a guy who's spent some years in 00:22:36.809 --> 00:22:37.950 marketing and communications, 00:22:37.970 --> 00:22:39.391 the best marketing is a really, 00:22:39.451 --> 00:22:41.613 really great product and or service. 00:22:42.212 --> 00:22:43.253 If you're trying to become a better 00:22:43.354 --> 00:22:44.315 operator in healthcare, 00:22:45.111 --> 00:22:45.833 you're in the right place. 00:22:45.893 --> 00:22:46.775 If this episode hit, 00:22:46.815 --> 00:22:48.419 Larry goes deeper inside his writing. 00:22:48.819 --> 00:22:50.304 Look for the operator on Substack. 00:22:50.324 --> 00:22:51.948 We'll also drop a link below. 00:22:51.968 --> 00:22:53.191 That's where the full breakdown lives. 00:22:53.211 --> 00:22:53.873 We'll see you next time.