Broadcasting way too early from three
separate Wi-Fi connections.
It's PT Breakfast Club with Tony Meritato,
Dave Kittle, and Jimmy McKay.
and we're live uh good morning tony
maritato good morning jimmy mckay jimmy
from the office it's so professional it's
it's so adult do you mean my living
room isn't nearly as professional as being
in an office it's pretty dope view maybe
like you know we got cool like
skyline over there i took a i took
a picture actually i mean hoboken like
again i'm a new yorker and i you
know the office i work in is in
new jersey which is you know almost you
know sacrilege a little bit like working
in new jersey but but if you think
about it hoboken has the best views of
new york like that's the that's the esb
baby like we're you know it's pretty dope
wow all right so um this has nothing
to do with the fact that you are
at prompt headquarters but it it does you
know have to do with topics that have
been floating around the social medias
And basically, this kind of evolved from,
you know,
I have been indirectly involved with EMRs
since the beginning of time.
Back in the day, early two thousands,
I used Microsoft Access and Visual Basic
to create a ad hoc EMR for my
clinic.
I'm not a coder.
I just looked up, Googled, like,
how do I do this and how do
I do that?
And I made it happen.
Fast forward now into an AI world,
and I'm always reliving this experience of
like, what is the function of an EMR,
regardless of the brand?
What should it be doing?
How does it work?
Now, I still see a major divide.
And I don't know,
because you've had experience with
multiple companies.
I still see,
and you tell me if you see this
from your side,
there's a divide between the
administrative aspect of an EMR and the
clinical aspect of an EMR.
And I see it in my clinic.
My wife, who is a physical therapist,
runs the administrative aspect of the
business.
And so her experience with the EMR that
we use is completely different.
then me,
I never get into the administrative at
all, the money, none of that.
I'm all on the clinical side.
So, like,
have you seen just that divide first
before we get into the AI part?
Oh, a thousand percent.
I mean,
my first job or my second job out
of PT school, we were still on paper,
but even it was no EMR,
but you still saw what I did.
And the woman, bless her soul,
I can't remember her name.
She would like call me back when I
didn't maybe, you know,
she couldn't read what the hell I wrote
because we were again on paper.
And she would walk me through why she
was asking.
Like she, God bless her.
She was so nice and not just come
here.
Why are you doing that?
She was like, hey,
let me show you what I do.
And I saw what she was looking at.
I was like, oh, my God.
So it did give me a healthy appreciation
for what I'm doing shows up somewhere
else.
She's downstream of me.
And that's why me writing legibly or being
clear or all those things.
are important so i did get to see
sort of the two halves to the same
coin this was similar in radio like i'm
gonna that's all i'm gonna do tony you
know i'm telling radio stories but there's
two halves right it was programming we
played the music we said the jokes we
did the thing and sales and you'd often
see these two things at odds right the
purists would say like
don't need a commercial and i'm like do
you like paying rent because otherwise
it's just a hobby you have to understand
what happens before or after we do our
thing and i see the parallel between radio
programming and sales and clinical and
administrative or ops whatever you want to
call it those two are they're not distinct
thing they're two sides of the same coin
and you
do you need to understand them um you
need to work together i don't know if
you need to understand everything it
definitely i think it definitely helps
people when they see that they go aha
so we can dig deeper into what should
this thing be who's the master here does
do i work for the emr or does
emr work for me um and i heard
a great term the other day
uh there's an author named corey doctorow
and he's so crazy smart he writes for
like wired magazine like technology smart
but he also writes fiction so he can
put technology the first time i heard
about a three d printer or glp ones
was ten fifteen years ago in a book
and i went cool story that'll never happen
and as i started seeing the things i
was like oh my god i read about
this the two terms were
Centaur and reverse centaur.
And then I'll just explain this and stop
because I think this goes in your
argument.
The centaur is it's a man with a
horse body.
So you have the thinking ability and the
reasoning ability of a human and the power
and efficiency and endurance of a horse.
Or sometimes we're a reverse centaur.
where we have the brain of a horse,
right?
The brain of a computer with the
efficiency of a human.
The reverse centaur is obviously,
no one wants that.
That's not efficient, right?
A horse walking around with a human body.
And we have to be careful that we're
not designing processes or things that
make us reverse centaurs.
We want to be centaurs.
We want to do the higher level reasoning
and then have the thing do the horsepower
thing, the thing downstream.
So where do you want to start with
this?
Because I think we, I mean,
this is a big one.
Yeah,
so here's my thought process with this.
And a discussion came up the other day
about, again, the AI physical therapist.
Is the AI physical therapist going to
replace the human physical therapist?
I shared a post that said,
what's our obligation
to contribute to training the ai because i
said look if we're here to help people
and i know that there's a technology that
could reach every single person on the
globe for virtually zero cost as energy
comes down
I should have some obligation to
contribute my knowledge,
my experience to making it a better
service because I can't treat every human
in the world.
So why prevent those other humans from
gaining this experience?
So, you know, that got me thinking.
I was like, OK, back to the EMR.
What does it do now?
It's a passive part of the business.
It's a passive part of the clinician.
At best,
the AI aspect of ambient listening is
listening to what I say and turning it
into clinical documentation.
But it's not really doing anything else.
On the administrative side,
most EMRs today are using AI to help
post payments and find problems.
And OK, that's very basic level stuff.
so so we've talked about humans are
wearing wearable technology my my apple
phone tracks steps it can tell the
authorities when i fall like call nine oh
one one for me if i have an
accident it does so much stuff we have
the pacemaker we have a smart knee we
have sleep apps that track sleeping i'm
like the emr should really become kind of
the the all-encompassing it's capturing
all of this information
it integrates with the the person the
patient's access to information the ai
aspect of it is look i've got this
little microcosm of a therapist it's not a
human therapist it's an ai therapist but
it's collecting all of this information
that i'm generating as a patient all day
long
Potentially I can put in, you know,
what did I eat today?
Snap a picture of it.
All of this stuff already exists.
None of it integrates with the EMR.
So my vision is step one.
It starts to collect all of that
information.
You know that I'm using ChachiPTA as my
running coach.
Why do I love ChachiPTA as my running
coach?
Any time of day I can put information
into it.
I can ask it questions.
It can ask me questions.
The AI never gets frustrated.
It never gets tired.
It never has a bad day.
It's never going through a divorce.
And so it's this like infinite world of
I can give it information.
It can sift through and ask me better
questions.
And even if the AI thinks I don't
know what I'm doing,
it can continue to guide me through the
process to get the real information.
Me as a human therapist,
I have an hour.
In the best of times,
I have an hour with the patient.
I can only ask so many questions.
I can only collect the information.
I assume it's truthful.
It's usually not whether the patients know
they're lying to me or not.
They're giving me their subjective
reports.
The best tests and measures I have in
the clinic are
fairly accurate at best right goniometry
off by five degrees up or down manual
muscle testing like give me a break um
so i'm like i don't have anything to
go by i am trying to make an
educated guess through a foggy window at
best it's like my cousin vinnie you know
when when they're on the stand asking the
eyewitness if they see the person in the
room you know
So this is what I'm not seeing the
EMRs and maybe it's happening behind the
scenes,
but like this would be my vision for
the future starting to integrate.
Let's start there.
You have two things.
You just described two things.
inputting the information.
We're collecting all this data,
but because it's everywhere, right?
What are we gonna do with it?
By the time Tony was able to sit
down with his patient and go, okay,
bring up your Peloton app,
bring up your Whoop app,
bring up your Apple Health app,
and let me sift through all those things,
I sit down on my Peloton and it's
like, hey, Jimmy, your last five workouts,
your average kilojoules per workout or
watts have gone up ten percent.
That's great.
Maybe you should take your FTP test again
to recalibrate your whatever.
That's it's able to collect.
And the second part is synthesize to give
me something useful.
Like I asked this question of somebody on
LinkedIn.
They're like,
how come we aren't tripling down on
wearables?
I'm like,
because no one's synthesizing that stuff
yet.
And I'm going to oversimplify this because
I am also not a coder,
but this information needs to pass through
a gate and that gate is known as
an API.
I don't even know what API stands for.
I knew at one point,
but it's a way that two computers talk
to each other, right?
We've got all these bits of information.
Companies like Vault,
they are very good at the capture.
But then are we bringing it into the
EMR?
I know that prompt is.
So that's one little nod.
I'm sure others are as well.
But that's what it needs to start to
happen because you need to be given that
Peloton snapshot because you got what?
All of six minutes in between patient one
and patient two to figure out where,
who are you?
I mean,
you asked the question the other day,
are we even attaching photos in the EMR?
So Tony and people like Jimmy,
who I can't remember a name until I've
seen someone two or three times.
Oh, yeah,
that guy with the thing and then the
facial hair.
We're still on photos.
Now we need to understand,
what was this person coming in for?
What did they look like a week ago
when I saw them?
And then what happened when they escaped
the clinic?
We can track that.
We can, and we are,
but we're tracking so much.
The question is,
are we able to actually leverage it?
And I don't know that we are at
scale or you and I wouldn't be asking
these questions.
Right.
And so there is the clinical side of
it,
which goes back to the AI is not
going to replace the therapist.
It's going to make the therapist better as
the AI is sifting through all of that
information.
I mean, in my mind today,
which I can only go by what I
know,
I have no idea what the future is
going to be.
Every patient that walks in this door,
so we're trying, not we,
we tried it and it didn't work for
us, RTM.
The profession is trying RTM.
We have this idea about RTM,
remote therapeutic monitoring.
The patient still has to be an active
participant in that.
We're not at the point where patients want
to be an active participant.
I talk to patients all day long.
They're like, I got this stupid app.
I have to log in.
I have to, they hate it.
They don't want to do that stuff.
Whereas there are apps that we actively
want to open.
I want to open Facebook.
I want to open Instagram Strava.
I don't use it,
but that would be an example.
So it's one of those things where it's
like, all right,
how do we flip the script?
How does my EMR,
which AI can code anything.
Why isn't my EMR.
coding an app or a component that my
patient wants to use.
They're actively engaging by desire,
not by requirement.
And then I'm like, OK, well,
let's go to the therapist side.
Since we started with this,
there's two sides to it,
clinical and administrative or
operational.
I said, hey,
I ran into a situation in the office
the other day,
and I've shared this before.
When I evaluate three or four people the
same day or I'm doing fifteen evaluations
in a week and three or four of
those people hit kind of the same
paradigm.
OK, it's Betty, Margaret and Mildred.
They all have, you know, come out.
They all are little old ladies in their
eighties and they all have abnormal gait.
Man,
I'm going to have a hard time remembering
which is which.
You know?
So I tell my EMR.
hey,
I need you to generate code so that
I can get a photo of every new
patient when they come in so that when
I pull up the account,
that photo is front and center.
Right now,
what I actually do in the real world
is I open my EMR,
I go to Documents, I go to IDs,
I look at their driver's license,
and I'm like, oh,
I remember who that is.
But I don't want to do that.
I think Planet Fitness has a photo that
pops up when you scan in.
That's what I want.
The EMR company doesn't need to do the
coding to change the EMR for everybody.
We're in a day and time where I
should just be able to run the instance
where I tell my AI, hey,
run this code for me.
Pull up this,
because this is what I want.
Don't let me schedule the same person more
than once in a day.
And maybe I'm the only clinic that has
that problem,
but it's something I should be able to
generate just like that with a voice
command.
And now my EMR takes care of everything
else.
Like those are some of the little things
that it's available right now,
but we're not seeing it that I think
improves the experience for me,
the clinician.
improves the outcome for the patient maybe
reduces subjective burnout you know maybe
makes life a little bit easier and happier
uh what are you thinking about some of
that i'd love to i mean we're supposed
to give you know extreme uh extreme
thoughts right because otherwise we're if
we're in the messy middle and we're just
um mayonnaise flavored ice cream
I think we keep trying to make a
better EMR,
which I think is a race to small
improvements over time.
Instead of,
I wrote a post the other day where
I said,
if Peloton let me steer the bike for
ninety days,
here's the first three things I do.
Do you think I stole any ideas from
health care?
no i stole one idea from video games
one idea from hotels and one idea from
software like number one i've said this
before we've talked about a gamification
nowhere in an emr is badges or rewards
right now it's just do this thing and
who are you accountable to a pt i
see once a week
like i don't know tony do you floss
i floss sometimes i'm i'm beholden and i'm
accountable to the woman who knows if i'm
lying she can see the thing i can't
see like she knows i don't floss there
is a study published that said flossing
doesn't make a difference anyway
I tell my dental hygienist every time I
see him twice a year, yeah,
I've been flossing.
They're like, oh,
you can tell it looks so good.
You've got great dental hygiene.
That's the equivalent of I can tell you're
doing your clamshells.
Yes, a hundred percent.
Yeah.
Do you know what my response was to
you have more tartar buildup on your
teeth?
I just go three times a year now.
I go, okay, I do what I do.
I'm forty six.
I'm probably not going to start doing
more.
I know I'm a big I call lovingly
a big, dumb human since I know this.
But I have build up and I don't
like that feeling.
At the end of six months,
I go three times a year and they
go, whoa, whoa, whoa.
your benefits don't cover that third
visit.
I go, well, how much is it?
And they say, it's a hundred dollars.
And I go, huh?
Do I like feeling good?
And is my feeling good worth a hundred
dollars?
Yes, it is.
It is.
And I feel like I'm doing something good
for the future.
Maybe my teeth will last nine years longer
or whatever.
So number one,
video games and gamification two things
rewards we know we like points i don't
know how much about teeth we could do
but i don't know exercise and movement we
know we do that with the rings and
the thing in the strava so could you
steal something from video games the
second thing would be uh group people
together and tony's like yeah bro i do
that already you bring people into groups
i've told a story about my friend megan
brown who has not a physical therapy
clinic it's a pilates and yoga studio
run by a physical therapist so she's
giving group physical therapy but people
are paying for it with um uh cash
oh my god cash it's all cash guys
it's just it's is it flowing through your
insurance company or not flowing through
your insurance company so that was my
gamification which is you don't show up to
play video games or go on your weekend
bike ride
Because your PT told you to.
You do it because if you show up
at six or eight and the group ride
leaves at six, people go, where were you,
bro?
So there's human accountability.
We're social animals.
Video games know this with guilds and
clans within video games.
And it matters if you're not there.
They design the game.
So you're not there.
If it matters, if you're not there.
The second one I stole from software.
And this, I think, is genius.
If you're a Peloton,
you know when someone's about to quiet
quit.
You got the data.
Jimmy used to ride five times a week.
Now he's riding once a week.
What's next?
Canceling.
Is it tomorrow or three months from now?
Does not matter.
What will we do when he cancels?
We'll send him a coupon to rejoin for
ten percent off.
Bro, what's better than that?
You know when I'm fading.
imagine Peloton called me like a phone
call.
I don't know if you know, Tony,
these things send more than text me.
You can talk in this end and someone
will talk in that end.
Peloton sent me a t-shirt when I hit
my, my thousandth ride.
It said century club.
They've done nothing since nothing.
And I've paid them.
fifty dollars a month for six years.
I think it doesn't have to be a
T-shirt again.
But wouldn't you be more nervous about
losing me than gaining another client?
Because you already know all both of the
elements are in alignment for Peloton.
So software companies know this and they
send you a notification when they notice
usage going down.
The apps have that,
but Tony's got no visibility on it.
So I think that's a big one.
And then the third one was hospitality.
And this is smart and I wanna reframe
it around healthcare.
Great hotel chains don't define themselves
by the room.
Like Hilton's not bragging,
we've got six hundred and twelve square
feet.
Like that's not why you go.
they build around the experience of why
you're there and what you need.
So like,
I look at this as on ramps.
I'm surprised Peloton hasn't done it.
I'm surprised more PT clinics haven't done
it.
What I mean by that is why don't
you have already set up groups for getting
back into it?
The six AM club, you know, wanted,
I used to be a high school football
player, forty years ago.
You still have that identity, right?
And I understand that more people in that
room will be more like me.
We keep,
defining clinical care and our emrs by
make trying to make a better faster emr
and i'm trying to tell you it's the
law of diminishing returns all this money
is going into making it incrementally suck
less as rory sutherland would say you're
not really making it better you're trying
to make it suck less when i think
you flip the script and you say how
does video games get people to not only
come back but come back in droves pay
more for the newest version of the game
in-game purchases i know david rowan
is probably in there going in-game
purchases.
Yeah, that'd be fantastic.
That's the game that you're in.
So I think the answer ironically is not
from inside health.
The call is not coming from inside the
room.
It's from outside,
but we won't let it in because we're
prestigious health.
Tony, we're doctors,
doctors of physical therapy.
We don't need help from these video game
people.
Those are stupid.
So then my question is,
is it even possible, and I don't know,
for the people that are running the EMRs
today, because we've talked about this.
If I sold silverware, right?
I'm a manufacturer.
I make forks and knives and spoons.
and i open a restaurant because i'm like
a restaurant's going to be the best way
for me i'm going to open a chain
of a thousand restaurants because i want
to sell more silverware but i'm
approaching the restaurant as somebody who
is obsessed with silverware i don't care
what the food is i don't care what
you know the the experiences and the
ambiance and that it's it's all about the
silverware
Is the mindset and the culture of the
current companies in the landscape today
always going to be what it's always been?
And what we need is we need somebody
to come out of a different profession to
come into the EMR and say,
I'm going to build a new EMR that's
about this.
It's not about that.
Yep.
Right now, we're sitting around, listen,
all these organizations pay attention to
each other.
I'm not selling secrets, right?
Big PT chains pay attention to what other
big PT chains do.
Universities pay attention to one another.
Tech companies, tech companies.
It will change exactly when one person
does the, as Rory Sutherland would say,
the unreasonable thing.
We spent this much money over this much
time,
and we did a thing that no one
else was doing.
Then they do it,
and then everyone panics and goes, oh,
they're doing that.
They're going to jump ahead of us.
Well,
you know what the smarter thing would have
been done?
Doing it already.
You know the answer, right?
Build the thing.
Every once in a while,
you're supposed to do this exercise.
you go get to run your competitor for
six months in your brain,
what would you be pissed off that they
did if they did it tomorrow?
I try to use this psychological trick when
people come to me and they're like,
I want to start creating content.
I want to create podcasts,
but it's a lot of work.
And I go,
imagine this idea in your head that is
absolutely perfect and pure in your brain.
Tomorrow you wake up and somebody did it.
How pissed would you be?
You had the idea first.
You just didn't execute.
So my point is this will change exactly
when someone is bold enough to change it
and then everyone will follow and not a
second before that.
The system is designed to perfectly give a
result that it gives.
It's made up that way.
So that takes me into the next segment.
You did an awesome interview.
I don't remember the gentleman's name.
The company was Active Life.
Say it again.
Okay.
I followed him for a long time.
You know, for context,
I came out of personal training.
I had my CSCS.
I was a strength coach.
Then I became a physical therapist.
I've said it before.
I'll say it a hundred more times.
To me,
the physical therapy license gave me a
license to bill insurance for what I was
already doing.
I was already working with adults.
I was already working with individuals
with orthopedic issues that needed
fitness, needed some pain resolution,
needed these things.
The PT license gave me the license to
bill insurance, period.
I was going to get the information
somewhere.
I didn't need to be in a university
setting.
While the PT education experience was
comprehensive and it was good,
there was a lot of stuff I'm never
going to use.
I'm never going to use pediatric neuro.
I'm never going to use all of these
other things.
I had to go through that to get
the license.
I had to get the license to bill
insurance.
That's it.
That being said, I've always said, look,
if we're stuck in the insurance model,
the majority of the PT profession,
But we see,
just like earlier in the show, I said,
what's my obligation if I know AI exists?
I know I can help improve AI with
my clinical knowledge.
And AI can deliver services to people who
will never be my patient.
I should have some obligation.
This is the same thing.
What he's creating, Russon, John Russon,
I think it is.
What he is creating,
they're taking the clinical knowledge of
physical therapy,
they're delivering it to personal trainers
who are unlicensed and free to do what
they want to do.
And they're accessing a population that
either isn't in physical therapy
won't ever go i i i would never
go to physical therapy for a shoulder
problem a knee problem if i had a
stroke i'm going to physical therapy if i
had a brain injury if i had an
amputation i am going to physical therapy
but like the fitness stuff i'm just not
going to go you know but i i
would potentially hire a coach a personal
trainer or something like that so you
I thought it was an awesome interview.
I think he's got a great understanding of
where he is in the space.
There it is.
And I think that he sees that he's
filling a need that needs to be filled.
Every person who wants to work with adult
geriatrics does not need to become a
physical therapist.
And it's cost prohibitive,
and they don't have to put seven,
eight years into it.
He's saying, look, in two years,
you can have all of this information and
knowledge.
You can have a body behind you that
will say, yes, this person is trustworthy.
and you can help that population who's
happy to pay out of pocket for it
yep sean's interesting you said where you
said a where thing and not a what
thing because you have physical therapy
and then you have fitness physical therapy
does feel like a very established place
like if i had access to a database
tony i could tell you exactly how many
physical therapists there are in the
united states but i don't know how many
i don't know if i could ever tell
you how many
fitness people there are right because
there's no i could just wake up tomorrow
and decide and that feels like very
ambiguous and unsafe so sean didn't pick a
place he didn't pick physical therapy or
fitness he picked the space between and
that place is wide open and his whole
his whole i don't want to say argument
but his whole notice of a pain point
is when you're discharged from pt when
you're cleared
does that mean are you just done and
most pts know like i've got you to
the edge of a diving board you can't
you don't got to go home but you
got to get you got to get the
hiccup out of here i don't know where
home is but good luck right it's the
bartender being like we're closed and it's
like where do i go i'm like you
can go anywhere but just i stop at
the door at two a.m that's when i
turn the neon lights off and sean sees
that and he goes
Oh,
if I get one percent of those people,
if I can teach people how to find
those people, that is a need.
that's why it's valuable we see this as
like scope creep and you if you see
it as defense if you if you look
at it defensively you see it as scope
creep and that's what all of our
professions do all of us are touching each
other and in a conference setting on a
stage in a panel we love each other
we put our arms around each other and
then it comes to the facebook groups of
just our our individual professions
trainers chiropractors pts pas nurses and
that's when we're like
These Kairos are infringing on our
blabbity blues.
Are you mad they're doing it?
Or are you mad they're doing it better
than you?
Are you mad they're doing something
different that you don't agree with or you
don't believe in?
Are you mad they're communicating it
better and people are finding their way to
them and not you?
The answer is yes.
That's what you're mad at.
You are mad at you.
So you can play that Taylor Swift song
all you want.
Hi, it's me.
I'm the problem.
It's me.
I was pretty interested because also Sean
from Active Life, who I just interviewed,
great interview.
Go listen to him.
Go read his book.
I get no nickels from the book.
Go read it.
He's on Long Island.
And Mike Stella,
who is an athletic trainer,
is on Long Island.
I would love to have those guys on
stage at a PT program on Long Island.
I did a show live at NYIT.
So I'm going to reach out to my
friend, Eric Greenberg,
and see if I can get there,
because I'd love to put non-PTs in front
of a bunch of PT students.
And I'm not trying to get you to
think any which way.
I'm trying to get you to think,
heart stop,
about what it is you're actually able to
do.
Because I think you and I both agree,
what we're able to do is much larger
than what we're thinking about right now.
Most of our colleagues, I think,
are thinking about right now.
I think we're going to be hit with
the reality that
where is the scope of physical therapy?
It's in the diagnosis,
it's in the evaluation, in the assessment,
developing the plan of care,
it's in understanding the why.
Why am I prescribing this?
It's not in the how or the doing.
Anybody can do
A straight leg raise.
Anybody can do a lap pull.
Anybody can do the exercise.
Once it's been prescribed,
but you have to understand why are you
prescribing that?
Why are you doing this intervention?
Even at the most complex levels for neuro
and brain injuries and things like that,
understanding why is where we should live.
That's the bread and butter of what we
do.
teach other people how to do the how
that let them take that part of it
now what's going to make therapists go
crazy and i don't know with john i've
followed john for a long time i've never
met him in person for some reason in
my mind i feel like he used to
focus his training on training pts and now
i feel like his focus is training personal
trainers
And so, you know,
two hundred dollars a session.
He's talking about increasing from eighty
dollars a session to one hundred and
fifty.
He's talking about moving into price
points that would be considered comparable
to a cash based physical therapist.
He's focusing his his content on
successful executives who have money,
more money than time,
and they just want the solution.
you know and and so again i think
he's stepping on toes in a good way
that's going to force clinicians to figure
out like why am i not doing that
but put put that back up uh yeah
clinicians will see this and they'll get
so mad
because we're talking about money and
they'll go, ah, this is so annoying.
John isn't saying everybody should do
this.
He's saying that this is a way to
do the thing that you want.
This is a way to do the thing
that he's not speaking in absolutes.
Like again, I pay a woman,
two hundred bucks to clean my house and
people are like two hundred hours to see
a PT.
That's insane.
For some of you, it might be,
but for some people it is not.
Right?
Yeah.
John had one of the...
I wouldn't say one of the first,
but had a PT podcast with Gene,
Chirac abroad.
They had like a... Oh, he did?
I knew Gene.
They launched like...
Gene and Ben, John, Russin,
they launched like three or four podcasts
at the same time, which is a network,
which is very smart.
John was one of them.
I think it was real early in terms
of like seeing an ROI.
But figure out what you like doing.
I say that very much first.
Figure out what you like doing.
Then figure out whose problem it solved.
Don't try the other way,
which is I want to solve a problem
for blah, blah, blah.
Hold on a second.
What are you doing though?
Because John likes solving these problems
and he's, you said he's moved audiences.
Yeah.
That's a good way to go about it
in my opinion.
Cause he's like,
I'm not going to change my,
the thing that I do.
I'm going to change who I,
who I offer it to.
Cause I guess he tried to teach PTs
and they didn't want to listen or
whatever, whatever reason he moved.
And he goes, well,
I guess this doesn't work.
No, they don't want to hear it.
Sell it to someone else.
So here's the thing.
You've got John who,
who tried to do that for PTs and
then just shipped it away.
I've shifted away.
I'm nowhere near as active as I was
trying to help PTs understand business,
grow their business, because I'm just,
I'm yelling into a void.
And I think this,
which you shared with me is a great
example of that.
So Rob, Rob Jordan, right?
Yeah.
Rob Jordan says, Hey,
he talked to a UHC executive,
informed them that they want to pull out
of the network.
now i don't know how big rob clinic
is or his operation is but i can
tell you from personal experience i'll put
this back up in a second here in
ohio where i live the hospital the local
hospital told uhc hey we're not gonna
we're not gonna negotiate these rates are
too low we're dropping them and uhc said
bye bye like we have zero they don't
care and and
The thing is, here, for context,
a huge steel mill that employs thousands
of people,
they had UHC as their worker health
insurance, and they still said,
we don't care.
We're not going to negotiate.
These are the rates.
Take it or leave it.
So no individual clinician.
Now, I've heard stories.
I've talked to therapists where they've
negotiated from the sixty dollars.
But the truth is, like Rob is saying,
and I'm one of them.
you know come talk to me if you
want to i'm one of them i will
take the sixty dollars i will take sixty
dollars a visit to deliver a physical
therapy uh experience that is worth how
much
Well, that's the thing.
So here in Ohio,
they pay a flat day rate.
I'm going to say somewhere around fifty or
fifty five.
I don't remember exactly.
So I could do ten minutes of manual
therapy if I believe that's what the
patient needs.
I get paid fifty dollars,
which is more than twice what Medicare
pays.
And then the patient can do other stuff
that I've prescribed.
But that does not require my direct one
on one time.
I can build an operation around that level
of reimbursement without losing money and
it can still be worthwhile.
The hospital can do it.
I can do it.
There's plenty of providers who can do it.
So you can't do it.
Rob perhaps can't do it.
And that's totally fine because, hey,
give John a call.
He'll teach you how to earn two hundred
dollars a session and you don't have to
worry about sixty dollars.
Right.
But what I was getting at there is
if you understand that UHG is going to
pay you sixty dollars, Tony goes, OK,
I'm going to provide forty dollars worth
of service that you're like you're going
to provide you're going to provide
adequate care.
But you're going to say if I'm being
paid sixty dollars,
I can't provide one hundred and twenty
dollars worth of care because I will be
in I will be out of business in
a month.
You will not support yourself.
So you're going, OK, I'll take the sixty.
because uhc you're not going to negotiate
them with them until you have a long
enough lever or a sharp enough sword and
individual clinics just ain't got it i
will tell you yes it does happen but
you have to be large enough this is
this is math at this point like this
is not hearts and minds you are not
winning so bring that graphic back up
because what they said was she pulled up
some data that indicated that every
provider in my county was accepting sixty
dollars a visit
I'm going to go out here and say
that that person, she was not lying.
What more can I say?
This sounds rhetorical,
but the answer to Rob is unfortunately,
and I'm sorry, nothing.
What more can you say?
It's nothing.
You decide to take sixty and provide fifty
nine dollars worth of.
invest fifty nine dollars worth of
therapist time lights electricity all
those things and make a dollar or not
those you can have some or none this
is not a this is not a middle
ground now bring that back up again
because then adam said this is a lie
we negotiated a much higher rate than that
in that county right
And then how'd you do that?
The answer might be if Adam is saying
they did that and I'm gonna go on
everything that's being said is true,
I agree with Adam,
you did it a certain way.
I don't, unless I'm wrong, right?
And there's smarter people who can point
out the nuances, but that's the breaks,
kid.
And it sucks.
So I go back to,
if you took the transcript of every
episode I've ever done over eleven years,
put it into AI and said,
what's Jimmy really saying?
It's understand what game you're playing.
As soon as you do that, decide,
do I want to play this game or
not?
And playing this game means you can play
lots of different ways.
But we hear consistently over and over
again,
I'm going to take my ball and go
home.
And UHC is going to look at you.
And before the door closes,
they forgot about you.
This is not the way.
There is a way,
and other people are doing it.
So I think this,
I'm going to put words out there.
I think the, what does he say?
Will Boyd said,
not related to the episode,
but can you guys do an episode where
you dress like the other person?
Tony needs to rock Jimmy's shirt.
I got flowers on my shirt.
I'm fashionable.
I think my kids have shirts like that,
so I'll go find one.
I got it from J. Crew Kids, probably,
is where I got it from.
It's probably a sale on the internet.
I think the opposition to my position
would say, look,
we have to protect the profession.
We have to circle the wagons.
We have to collectively say we are not-
Where's the union?
And so they're gonna say,
we need to protect the therapist.
I'm gonna say,
who's protecting the consumer?
Who's protecting the patient?
If I can deliver the service because I've
monetized it in other ways,
the hospital monetizes with surgeries and
other things.
I monetize with social media and real
estate and just the fact that I've been
at it for twenty five years.
I talked to somebody the other day.
I said, look,
I bought all this equipment about twenty
years ago.
It was way cheaper than it would be
to buy today.
I have a competitive advantage over every
other physical therapist who wants to open
a clinic today simply because I've been
alive longer and in business longer.
Does that mean that I shouldn't use my
competitive advantage,
that I shouldn't use the resources I have
to both help my consumer and to still
be profitable in the process?
Like, no, that's absurd.
That's what business is all about.
Correct.
I was going to say,
then people will say, you're the, I can,
people hear them, right?
Can you hear them, Tony?
They're screaming into their speaker.
You're the reason.
Tony's the reason.
You take sixty dollars,
which means we're never going to make
seventy dollars.
And I'm saying, no,
that that ain't that ain't it.
I wish it was right.
And then it's almost cyclical.
I sound like the old man now.
Every six months.
We should pick a day when every PT
decides we're not gonna treat a patient
today.
And that'll show them, that'll show them.
UHC is gonna see a day where they
don't spend one single nickel,
one day where they don't see one nickel,
fantastic.
You know what's gonna happen the day two?
They're gonna spend a hundred and seventy
percent more.
Or they're just gonna absorb that day's
losses and they're never gonna notice it.
It would be a blip on the radar.
And then I always,
my almost stock response is,
can you get ten people to throw a
surprise party?
I need you to organize ten of your
friends to agree on a time, date, place,
and theme of a surprise party,
and let me know how that goes.
Because that person who says,
we're going to pick one day,
it's going to be Black Friday for PT,
and they're going to see,
they're going to feel us.
I agree with your emotion,
and I wish this were true.
It's just realistically not going to
happen,
or matter even if you have pulled off
the emotion.
It's not going to happen.
Yeah, my response,
and I have no connection to go sign
up for this course,
go make two hundred dollars an hour,
drop all the insurance companies.
You know,
if that's not the business you want to
be in,
you can't complain if there are solutions
available and you just want to ignore
them.
Now, I will say, Tony.
is is john russon speaking in absolutes
and what i mean by that is is
he saying you have to treat everybody for
two hundred dollars an hour is that what
he's saying because if you want to do
pro bono and we have said this on
this show and people do this
You raise your rates for some people,
and then you are free.
I mean, I'm looking outside.
It still looks like a free country.
You are free to give stuff away or
give it away at a reduced rate or
do whatever the heck you want.
You cannot do that if you are out
of business, though.
So understand what game you're playing.
So John is saying you can do this.
This is how things work.
If you decide not to,
that is a you problem.
we're not a political show,
but you hear the same thing with the
people who want to raise taxes,
just pay more in taxes.
There's nothing stopping me from paying
more.
Send the government a bigger check.
I can monetize my day, my time,
my patient care with media.
I let Facebook and YouTube and other
online platforms pay me the money I need.
I own the real estate.
I have the investments.
I can give stuff away for free.
I can accept lower reimbursement.
Like none of that stuff,
it's not going to move the needle if
somebody comes in for fifty dollars
instead of one hundred and fifty dollars.
It makes no difference in the big scheme
of things to me because of the business
that we've built.
And there's other business models out
there.
You know,
so we don't I know you're at work.
We don't have to hit the full hour.
Let's kind of wrap it up now.
Can I give one good example?
Just one good example.
So we talk about these psychological
theories.
I love them.
Some people like listening to me talk
about them, but they're embedded places.
And I like to spot them when they're
in the wild, right?
And this is one of them.
And I shared this in our group chat.
This is a great example of price
anchoring.
And that's the psychological theory.
And the funny part is even when we
know the trick is happening,
we still fall for it.
I still look at this ad and I
go, those are dope cycles.
So I'm showing an ad for cycling shoes
from Pace Bikes.
And the ad reads,
why seventy four ninety five?
Why seventy four dollars and ninety five
cents and not five hundred?
What they've done there is they've placed
an anchor at five hundred because there is
a picture of six dope looking clean,
modern cycling shoes.
So if you are this only applies if
you're a cyclist.
If you're not a cyclist, you're like,
I'm not paying seventy dollars.
I'm paying seven dollars.
But this drops an anchor.
and anchors your brain at worth five
hundred,
but w gut is I better hurry up
that's a steal.
It would I said on sale for seven
there's no place to star at five hundred
and then
so these this these little psychological
lessons these little gems i love sharing
them just as tidbits i don't think we
need to go deep into it just that's
how like i literally just want to put
that that's how it's done people it's not
complicated you don't need to over explain
it was one headline i never even read
beyond that i went headline shoe i didn't
even read the middle words
So that is similar to what John did.
I would redesign John's ad.
Too many words.
He's overselling here.
If he A,
B tested and changed his ad here.
And for John,
if somebody passes this along,
literally drop this image into chat GPT
and say, make my ad more like this.
And I bet you sales conversions go up.
Yeah.
Quick aside,
we never used to buy anything from Dick's
Sporting Goods.
And then lately we had to buy a
couple of things here and there from
Dick's,
but my kids never want to go to
Dick's and like they'll go begrudgingly
and get their baseball pants or whatever.
now the dicks here they re redesign the
store now they have the simu golf
simulator now they have the batting cages
now they've brought in the stuff that
we've heard about and you and i have
talked about dicks i think they acquired a
media company um because they're going to
start producing a lot of that kind of
content now literally my kids are like dad
can we go to dicks i want to
go to dicks i want to check out
the new stuff like
Just because they changed the environment,
it went from RTM.
Dix used to be what RTM is today
to what we want RTM to be.
We want the patient to want to pull
up the app and get the information and
interact with it and have fun with it.
Let me ask a few questions.
Number one,
somebody at Dix Corporate probably saw,
hey, kids don't care about coming to Dix.
For me going to Dix when I was
a kid,
it was cool to see the next hat.
And there was probably a drop.
So what is it like?
Is it very experiential and gamified?
Yeah, hands on.
That's it.
Hands on.
You can touch all this stuff.
You can swing the bat in the batting
cages.
You can't.
yeah so they probably sat there they go
well what are we competing against they
did not go to another sporting goods store
most likely because they're not competing
they looked at an oculus or a playstation
or an ipad and they said we're competing
against that what's our competition for
that i want that to be the hard
lesson because if you hear dicks i'm not
in i'm not competing with dicks
You aren't,
but we're all competing for the same
thing, which is attention.
Attention leads to trust.
Trust leads to action.
This is going to be a theme forever.
That's the math, right?
It's not just doing it for the gram.
It's attention leads to trust.
You just said that magic phrase.
Now my kids want to go to a
store.
to do that.
Your clinic could be that.
Decide what that is that makes people want
to come.
And I got news for you.
Beige painted walls ain't it.
And a thirty year old, you know,
assault bike ain't it.
But it could it does not need to
be a twenty five thousand dollar golf
simulator, but it needs to be something.
And you get to pick and plant your
flag into what that thing is.
or don't,
or wait for UHC to send you sixty
dollars.
Like you choose, decide.
Yeah.
What do you have coming up this week?
We'll end with that.
We're looking forward and then parting
shots.
What do you have coming up this week?
Anything special?
No, nothing special.
I've been a hundred percent focused on
growing the Facebook page.
We just hit twenty five million views.
That's wild.
We're on track to hit five thousand in
revenue for the month from just from ads.
I still cannot get myself to create the
digital product that every single human
and AI is telling me I need to
create.
So pay someone to do it.
I'm going to get AI to get into
my psyche and figure out how to make
me want to do it.
Okay, all right.
I've got, Jerry Durham just posted,
prompt, this is not an ad,
I'm just saying this.
Although it's gonna feel like an ad
whenever you're talking about where you
work.
So I'm sorry, this feels icky for me.
But I do work,
they're doing something cool,
which is they're bringing a bunch of
practice owners in,
to teach them things,
but I'll pull the curtain back too,
because it's pretty obvious.
They want to learn and be like,
what are your real frustrations?
So the dangle is come here and learn,
grow your practice.
We've got expertise on that.
But the magic, I think,
for Prompt anyway is we're going to listen
to you.
Let me go real high tech for you.
We're going to listen to you.
And these are some people, you know,
who've been using the product or don't,
whatever.
It's a cross section of practice owners.
And then they're going to listen.
Then they're going to do stuff around what
those practice owners are saying.
I'm giving away the secret sauce,
but it's not secret sauce.
It's quite literally like really smart
product.
Not even product,
it's really smart humanism.
I heard a great bit of parenting,
which was be the parent that drives the
kids to the thing.
enough that the kids forget that you're in
the front seat because you're the cool
mom.
And then they start talking about the
stuff that they're actually talking about
and they forget you're there.
That's what this is.
I'll play your music and I get you
comfortable.
And then I get to hear you talk
about, oh, so-and-so is kissing so-and-so.
You start to hear from the person you're
trying to influence or help in their
language.
This is that version of that.
Jerry Durham's coming to town.
So I'm interested to see what Jerry...
says about this this is my first time
doing this i've never done it before um
because that's jerry's whole thing sit in
your own waiting room long enough that the
patients in the front desk people forget
you're there and they continue to act as
they act when you're not around that's how
you find your leaks so jerry jerry is
the originator of secret caller when it
got in physical therapy
Yep, he is.
Oh,
let's answer this one question real quick.
Metal Mark asked this at the beginning of
the show, but we didn't get to it.
Metal Mark says,
today's my first day at an independent and
assisted living facility as a PTA,
but I have ten years experience in
outpatient workers' comp setting.
What advice would you give me to excel?
Now,
figure out the game you're playing and
play it real well.
Do you like this setting?
If the answer is yes,
figure out how to do it.
Figure out how to do it adequately today
and then a little bit better tomorrow and
a little bit better tomorrow.
And if you like it, keep going.
And if you don't, switch.
That's the advice I would give.
He said skilled nursing?
First aid at an independent and assisted
living facility.
I think you just got to forget everything
that you learned in the workers' comp
world.
Probably.
Because this is a completely different
fish tank.
There are sharks all around you.
I remember going into those kinds of
settings.
You decide.
He decides.
She decides.
Are you there to do the best job
you can do?
Are you there to fit in?
I got in trouble constantly just
because...
I was always changing things.
I was doing what I thought was best
for the person rather than what's best for
the organization.
Well, how does this work?
Does he work for the assisted living
facility?
Like where my dad lives,
it's a third party.
Yeah, I have no idea.
I mean,
it's either a third party or the facility
itself.
Somebody is employing this person.
And with that, there's other employees.
And assuming you're not going to be seeing
the same person every day or throughout
the plan of care, you know,
you got to adapt to the environment you're
in,
which I guarantee is going to be very
different than a workers' comp clinic that
this person's coming out of.
It's all physics, man.
Figure out how gravity works here.
Figure out who the cool colleagues are.
Learn from them.
Don't just pretend to learn.
Actually learn from them.
That's been my secret,
using air quotes here,
my secret at every job.
I'm like,
can I do this job as a B-minus
employee right now?
Yes.
Great.
How can I do an A job but
still put B-minus effort into it?
Figure out how to do it better.
Figure out how to leverage gravity.
I talked about Centaur and reverse
Centaur.
great example is like put a human on
a bicycle now that's a that's a centaur
you put the human brain on a thing
that makes me really efficient so figure
out how to do adequate and then figure
out if you like that and then how
to do that figure out how to jump
on a bicycle and do that i feel
like the bicycle in the room is ai
i feel like for right now like in
terms of documentation because if that's
the thing slowing you down and eating
unnecessary calories how could you remove
that in in my opinion it's a scrub
it's a scribe or whatever
uh, those are our parting shots, right?
We don't need to react.
Absolutely.
You're playing, play it better.
We'll be back on Thursday.
Enjoy your enjoy out, put,
put the digital course together.
That's it.
We're out.
Boys, what the hell are you doing?
Follow Tony Meritato on YouTube at Total
Therapy Solution.
Find Dave Kittle at
conciergepainrelief.com and on YouTube at
The Dave Kittle Show.
And follow Jimmy McKay at PT Podcasts on
YouTube, the socials,
and wherever you binge podcasts you
pretend are for CEUs.
And hey, just a reminder,
none of this was for advice.
This was for entertainment only.
Our lawyers say that counts.
Thanks, Keith.