High-Performance Practice Series, Ep. 3: 4 Places Your Practice Is Quietly Losing Money (And How to Fix Each)



High-Performance Practice Series, Ep. 3: 4 Places Your Practice Is Quietly Losing Money (And How to Fix Each)

A quick heads up for all the audience, if you've been tuning in to the show for a while you know that it took me at least ten years of grinding in my own clinics before I finally figured out how to scale and sell my four practices for seven figures, and about three times the national average. The biggest shift wasn't some secret marketing hack. It was how I thought about profit, systems and my role as the owner. That's exactly what we're going to be working on together with you at the High-Performance Practice Conference in San Antonio, Texas from October 15th-17th.

Adam Robin and I are hosting a three-day hands-on event for PT, OT, speech, mental health, peds, pelvic floor, and medical practice owners who want to build clinics that are profitable, scalable, and best of all don't depend on them 24/7. We’ll dig into simple profit and KPI frameworks, real leadership and culture work and practical systems you can take home and plug in with your team.

If you're doing roughly 6 to 7 low figures a year and you want your client to feel more like a real business and less like a job/cage, I'd love to see you there. Frankly, I'd love to see you bring your leadership teams as well because we will have breakout sessions for them, too. You can get all the details and grab your seat at the link. Let's get into our episode.

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Finding Your True Reimbursement Rate

Welcome to the show. I got my partner Adam Robin with me. How you doing, Adam?

I’m good.

This is our third episode of the High-Performance Practice series all leading up to our conference in San, Antonio October 15th-17th. Make sure you go to the registration page at PPOClubEvents.com to get details all about how to improve profits, your freedom, build out your purpose, ton of great speakers, multiple tracks compared to other years. We’re excited about what we're building out. Bring your leadership team. Divide and conquer so they can get value and training as well.

A lot of good stuff that's going on, but this series of episodes is very similar to what we've done in the past in terms of building out your playbook for your business. We thought this would be super valuable for everybody to go over different aspects of the business and review how you can make your business more profitable, efficient, and high-performing. Adam, you still have practices. I don't have practice anymore but you're living it.

We're living it. If you're running your practice the way you used to run it, it's not going to work. You're going to have to make changes. You have to make the hard calls. You're going to have to find ways to be more efficient and more productive. Not to be too much of a Debbie Downer, but I've had mini calls with practices that are closing their doors. More so more recently than maybe I've ever had.

I had an email from somebody's like, “How do I dissolve my LLC?”

It's happening. It's good news and bad news. The good news is there are opportunities for you to pivot and change. The only way to do that is to elevate your skills, your understanding and your perspective around how to do it. Is it going to be one YouTube video or one course or one conference that's going to do that? No. It's going to be the accumulation of all the things that you consume that get you there. Get your butts to the conference, listen to the show, and learn some new skills if you want to keep your practice afloat because you're going to need it.

Episode number three is going to be about billing practices and providing revenue. It’s tied to some financial stuff. Last episode, we talked about how to maximize your scheduling to make sure the providers are productive, seeing what they're supposed to see in order to generate the revenue that they need to generate so you can break even and generate a profit. This one's a little bit more specific to a direct correlation to making the most of those visits after the schedule has been sufficiently utilized to maximize.

Getting into it, I did a presentation at PPS about how to increase cash flow in your company. Maybe we can use that framework as a starting off point, because the four areas that I talked about were, 1) Know your numbers. 2) Deal with the front desk. 3) Managing your billing collections team. 4) Optimizing your billing via the providers and their billing practices. We can use that framework to build off and maybe go step by step. Does that sound logical to you?

That sounds like a perfect idea.

When we're talking about some of the numbers that you need to know, most people are going to know their average reimbursement per visit.

You think so but yes.

What do you hear when you ask people what their average reimbursement for a visit? Are you getting ranges?

I would say they either don't know it. It's more like, “I'd have to look back and see that thing,” or they just don't know it or they're assuming they know it because they looked at an AOB two and they just know an average. When you calculate it with a more objective position, you'll realize that when you factor in the denial rates, the misfits, the non-payments, and the write-offs, it's a lot lower than you might think. You, as an owner, it's hard to look at the numbers and look at all the problems. We tend to inflate what we think it could be. That's all your margin. That's not there. Those are the two things. Either they don't know it or they're not measuring it cleanly.

Tracking Cost Per Visit Metrics

That's a measurement that I would expect someone to calculate on a monthly basis based on the previous revenues but also know what the averages are for the trailing 6 to 12 months. Compare last month's average reimbursement to that trailing 6 to 12 month average. Down to the penny. I remember saying, “If you're giving me a range of like $88 to $95 a visit, then you don't know your average.” As you said, you might have a little bit of hope inflating that number, but it's imperative to know the number and figure it out. To go a little bit deeper, I'll say this first. A lot of people know their average reimbursement per visit. I would love to see the metric on this. How many people know they're cost per visit?

It's easier to calculate that one too, though.

You would think it would be easier to calculate and you could probably even ask your CPA or bookkeepers to send that number to you. That shouldn't fluctuate all that much unless you're going to take on another provider, buy a piece of equipment, or have three payrolls in a month. Those extraneous experiences but that number should stay relatively flat. Knowing the difference between your cost per visit and your average reimbursement per visit is going to show you your margin, that delta.

Reimbursement per visit and cost per visit, but I would go deeper into the reimbursement for a visit. Part of the course that I provide has a worksheet and it asks you what's your reimbursement per visit. Now, let's break down your top 5 to 8 insurance providers or insurance payers. What is your average reimbursement per payer? That is telling because you should know who your highest reimbursed payers are, who your lower lowest reimbursement payers are.

I'd like to use the example that a lot of us like to assume that you've got the typical United Healthcare $65 per visit flat rate contract. You might say if Adam or I asked you, what's your average reimbursement on United Healthcare? You'd say, “$65.” Is it? Are you taking into account the denials that United Healthcare might have taken out? Are you taking into account any patient balances that weren’t paid? Deductibles that weren’t paid at the time of service and you're still fighting for maybe some cuts from United Healthcare for this code or that code or wrong modifier here.

It probably doesn't end up being $65 per visit and you should know that. I remember one of my clients went through the course. He figured out his United Healthcare payment and ended up being like $58.35 instead of $65 when you consider all the denials. Knowing your reimbursement pipe provider and then comparing that again to the cost per visit, helps you make some more educated business decisions, objective business decisions. I know you're looking pretty tightly. You're looking at all these financial numbers.

When you think you got it figured out, Nathan, then all of a sudden, you don't. I will say that the numbers are a blessing and a curse because a lot of the decisions that you need to make are there. Unfortunately, none of them are easy, but if we avoid those hard decisions, then the only other decision to make at that point is to slowly go out of business.

By being willing to confront the number and to force yourself to make a decision, even if it's hard. Sometimes the decisions are hard. It’s like dropping a low-paying insurance or laying somebody off. We don't want to do that but sometimes, those are the things that we’re forced to confront. If you'd be willing to confront them, you'll find that there's always opportunities to improve it but you have to assure yourself that you got to measure it.

Evaluating Low Payer Contracts

To provide some real-world experience here. I have yet to come across someone who's dropped a little paying insurance that has regretted it. They found ways to fill the schedule with other high paying insurance and improve their net revenue per visit. Those are hard to stand. Almost everyone I know has done that, it's not been an easy decision to make.

It’s very hard.

After doing so and going through the process, and if you email me Nathan@PPOClub.com, I can give you an SOP on how to drop a low-paying insurance. Maybe give you some guidance so you're not doing it from scratch. I'd be happy to share that with you. There is a way to do it properly and well so that you can offset any possibility or concern that you might have that you're going to get some kick back from physicians or the surrounding community. It's possible and people have done it. They've done it in a positive light and it's worked out well. That is a hard decision but it is possible.

You'll be surprised at what opportunities become observable when you have no other choice. When you force yourself to have no choice, you'll find an option. You'll find a solution. Sometimes, as you said, it's dropping the low payer.

The other thing to consider as we're talking about metrics to follow here. In terms of billing practices and revenue and whatnot, we talked about it in the last episodes. I won't delve into it too much, but we talked about knowing your breakeven and knowing how many dollars you need to generate each week, what not you need to crack every month, and how many visits you need to see every week in order to cover expenses plus 10%. That's built-in to this as well.

You should know those things if we're going to talk about knowing your metrics from a high level perspective. You need to know your breakeven numbers. regardless of industry. I find myself sharing that with people outside of the PT space as well. Moving on to the second section in talking about the front desk. I bring up the front desk first. The reason I do so in my presentation bringing up the front desk as a place to work in your operations or find an increase in cash flow is because it's the easiest way to generate the most cash flow making the most difference.

Maximizing Over The Counter Collections

If your front desk isn't working so well and not collecting at the time of service and not scheduling efficiently in maximally. Making changes there will show up in your bank account balance the fastest. You've had a good handle on the front desk for a number of years now. You've got a solid playbook. Would you say that having a well-oiled front desk eases the lot of concerns and, frankly, led to any pop in revenue?

Maybe so. If you just understand how the practice works. I'm still somebody that's learning more about it, but the front desk is like everything. Everything starts there. You mentioned collecting over the counter payments, which is 20% or 25% or maybe even 30% of your revenue sometimes.

Especially if you consider January and February. It becomes a large portion of your revenue.

Huge Revenue driver there. Make sure you're collecting over the counter well and you're tightening that up. Number two, schedule efficiency. They are the gatekeeper to your productivity levels with your providers and ensuring that you're understanding what those breakeven is and what that schedule needs to look like in order to ensure or to fail-proof, you’re hitting your breakeven. That's number two. Number three is one we don't talk about too much.

Eliminating Front End Data Errors

Which is it might not be your main front desk person, but somebody in that admin team is verifying the insurances accurately with precision and entering patient data into the EMR with precision, accuracy and ensuring that authorization process is dialed in and being tracked. All of that impacts the back office, the billing team. Those are the things that minimize those denial rates and ensure that AR stays clean.

There's a lot of money that's all built right there. A lot of times, I see practices that are like, “My billers are not doing a good job. Let me go get onto my biller.” Maybe, but maybe you're not focused on the right payer. Maybe it's more on the front end where you can clean that up. All that to say, cleaning up those systems and having those metrics with the right person, the right system and the right team in place to keep that tight is going to help you. It's going to make it such that you can be less optimal on the coating and the billings side and still be okay. You can observe errors.

I love that you brought up those three things. The second thing regarding scheduling optimization. We talked about that in the last episode and their responsibility for that. The first one you talked about over-the-counter collections. That has to be dialed in. If you are leaving money on the table by letting people walk out the door having not paid their responsibility at the time of service, studies show that you're losing $0.50 on every dollar on average.

If they have a hundred-dollar deductible, they need to pay for this visit. They walk out the door, you can expect to collect $50. You do that a number of times every week, you're going to be losing thousands of dollars a week. I'm pretty confident I can say that if you're not collecting at the time of service at a 95% to 100% clip and hopefully, you're doing that with credit cards on file for every patient then you’re making that changing and getting over the question right up to that number as close to 100% as possible. It will increase your revenues approximately 10%. I’m pretty confident, I could say that.

As you said, those over-the-counter numbers make up 20% plus of the overall revenue that's collected. A huge jump there. You also brought up something that I haven't talked about enough and I need to add this to my presentation. I was like, “Are they getting the authorizations that they need in a timely manner? Are they getting the proper verifications and putting that into the system to make it easier for billers to do their job properly?” There's plenty of visits out there that are going unpaid because we have expired authorization, or we weren't tracking the number of authorization visits well and now they came in for their 7th visit on a 6th visit off.

That's free money going out the door or that expired plan of care that the doctor hasn't signed yet. You want to be covered. There are efficiencies that need to be maintained all through that front desk or office management space that lead to big leaks in your bucket. They can be operationally fixed and should be a focus of anyone that's having concerns regarding the efficiency and production of their company.

If I can speak to that just a little bit but not to harp too much on it. The front desk is confusing. For a growing practice, if you've never been a student of this and you're trying to juggle a growing team. Cash flow crunches, and you're trying to manage a case load. It's heavy. It's a lot. I'm talking through this in real time, but I believe that the first step is just to understand how it works as you mentioned. You have to understand what matters and what outcome you need at each of those roles such as the front desk, schedule, and over the counter.

Verification accurate on time. Authorizations reports running every day accurately on time. If you can just imagine it from a systems perspective then you can start saying, “I need this type of person at the front desk. I need this type of person on the outside. I need this type of person on the verification side. People who are good at these types of skillsets.” I see a lot of people who either don't understand the system and don't understand what good looks like objectively or they don't understand how to get their team to do what they want them to do.

They're dealing with, “This is the way we've always done it or I'm already wearing out.” Maybe some cultural issues. If that's you, if you have a weakness in your systems component, you have to learn the systems. It will learn the systems. You got to educate. This is going to build the systems. You got to go into your office with a pen and become a student of building the system, which is terrible but that's what you got to do.

Have a people component issue. The only option you have is to elevate your leadership skills, learn how to enroll people into your vision and be willing to let them go if they don't want to follow you. If that's you, hopefully, that lands for somebody who's reading. If you're trying to diagnose how to fix your issue, it's probably you. One of those two components need to be addressed or both. That's where the outcomes live. It's either systems or people.

Will and Michelle in our clinics used to always say, “We need to train them up or train them out.” Train them up and give them all the resources they need. Give them the training they need. If they're unwilling to follow them, follow those processes then train them on what it looks like to work somewhere else.

It's hard but you can do it.

The third part is managing your billing collections team. I say it all the time it's a weak spot for owners because we don't know how to manage the billing collections team. We want to offer that to somebody like just send out the bills, and collect the money. That's simple and easy. We'll just have that off to you. Hopefully, my bank account looks good at the end of the month. That's where a lot of money can get lost if you're not staying on top of it and holding your billing collections team accountable.

There's a few metrics that we track and you can add to these. I'll highlight some of the main ones and then you can share what you're looking at when you're talking to your billers, Adam. We're going to look at what was collected but then compare that to what you expected to be collected. This is where your average reimbursement rate comes into play. If we're looking at June numbers. You would take May visits times that average reimbursement rate and say, “This is what we should have collected in June.” There are some variables in there but it usually falls within about 5% to 10% of that projection.

It should be pretty tight. You were supposed to collect $80,000 and you collected $72,000. It's 10% off. Tell me what's missing here. Is there a hiccup in the billing cycle? Was there an insurance payment that didn't come through that you're expecting where there’s denials? There's a lot downstream from that they can start looking into but comparing that actual versus projected is a top line number that you can build off of and start studying. Second one being denial rate. We want to see that first pass denial rate to be less than 10%. Ideally less than 5% for a good biller. Does that sound about right?

It's going to depend on how many insurances your network has or what part of the country you're in. There's going to be some variables. I like to see under 4%. That's super good but under 5% is still good too. The point is having a number, having a benchmark and keeping it there.

The beauty of having the meetings with your billing collections team is, unfortunately, I don't think a lot of owners are having meetings with their billing teams. They're getting the reports maybe via email with some bullet points. Maybe there's some weekly interactions here and there. Having a standard meeting. We sit down and bullet point by bullet point, we go through these reports. What was collected, what was collected versus projected and what was the denial rate. All of these have subsections as to why the number is what it is and I'm expecting them to report to me.

You are my vendor. You are my employee. This is your time to report to me how well you are performing and establishing that relationship. That perspective can get out of whack for some owners. Some owners are thinking they are at the mercy of the billing company because they don't know what to do. They don't know how to hold them accountable. They’ll be like, “Tell me what to do and we'll do it.” The billing collections team can just say whatever they want. Holding them to a standard and then holding to the agenda and those metrics starting with as we mentioned those two. A third one that is standard is looking at the AR or accounts receivable aging report and expecting that. Let's say we need 80% of the accounts receivable to be sitting in the 0 to 60 day category.

If you want to get details, I like to see 80% in 0 to 60, 5% in 60 to 90, 5% in 90 to 120 and 10%, 120 and above. You could even shrink that down and just say, “We want 80% to be in the 0 to 60 day range.” I'll take motor vehicle accidents or liens or no fault. Whatever you guys call them across the country. I'll take that out of the accounts receivable because we know that's going to take 18 to 24 months or longer. We'll take that AR out of it and then look at the rest of it. If you look off those three numbers, you're doing pretty well in terms of managing your billing collections team. Is there anything I'm missing?

I don't think there's anything you're missing, but I've had the opportunity to have to learn this stuff even more. I've got all kinds of stuff I can teach.

I don't think that's an opportunity that most people have.



Managing Billing AR And Denial Metrics

Everything's driven by the denial rate. There's three numbers that are going to be driving the performance. Number one, denial rate. That's going to be driven by three main things, accurate verification and accurate patient data at the front desk. Number two, accurate authorizations being submitted on time and nothing lapsing. Number three is making sure that you are scrubbing the codes that don't belong inside the EMR for that insurance. Recognizing which codes are not covered and scrubbing them in the EMR so they don't go out on the claim.

That's the three things. If you get those three things perfect, you'll have 0% denials. Unless the insurance wants to play screwball with you. If you have a denial rate issue, it's one of those three things. It's not that you have bad insurance. It's because you have bad systems on the front end. Fix that and you'll fix your denial rate. The second thing is going to be, is your billing team submitting the claims on time? Time to submit. I want to see like 10-24 hours, submit out the door. If you're waiting two weeks down the road to bill, that's just going to pile up into your AR.

The third thing is going to be, you're not your therapist not completing their documentation on time. That might not necessarily mess with your denial but that's going to drive your AR. If you clean those things up, you should have low denials and clean AR for the most part. It's good to know those three metrics but it's going to be important for you to understand, at least from a high level. What are the things that drive performance on those metrics even if you're outsourcing. How do you lead that team to execute on those things well? I want to paint that picture for everyone so that they can see low denial rates. Here's the thing. If your denials are high, if you have a 10%, 15% or 12% denial rate, that's going to all bleed into the admin overload of your billing department.

They're not going to be scrambling. The resubmission time is going to be delayed. It's just like your patient balances. Every time you have to resubmit, your chances are going down. You want timely filing issues. You got to clean up the front end to hold your building department accountable. As long as you have a good revenue per visit metric, you should be able to project well and understand how to keep all those things in check.

I love the detail that you share because knowing this much detail about your metrics gives you a clearer idea of what's coming in the future. You can project well.

You can diagnose well. If you go to your biller meeting, and it goes like, “Adam, I got bad news. We only collected 90% of what we projected.” I know exactly what question asked, “Was it an hour rate?” The hour rate last month was 12%. I want to see verification logs. Authorization logs. I want to see the things. Show me. You got to lead it. You got to be just good at this and you're going to be good at that practice. You have to have a billing department who can teach you those things.

I was going to say. If you know those numbers then you can train them on that and then they come to you with, “Our denial rate was high because of X, Y, and Z,” before you even ask the question. That's the relationship I'm expecting for my billing collections team. It’s like, “This month we're down in revenue because of the denial rate and our denial rate is high because of this. This is what we're going to do about it.” When your billing collection seems to that level like, “We saw the problem before this meeting. We've been dealing with it before. This is how we're dealing with it and this is what we're expecting to do about it. If that doesn't work, here's our plan B.”

That's what I want to know and that's what you need to know. You shouldn't be the solution to all those. Over time, either they come well equipped and expert enough to give you that information or they've worked with you enough that they know they can foresee what questions you're going to give them. You've LED them to the point where, when you come to this meeting, it's not enough to tell me that the denial rate was high and then be crickets. That's not okay. You get to tell me why it's high and what you're doing about it so we can talk about that. You shouldn't be the one finding this out during the course of the meeting.

This is a great topic. If you understand this stuff, bake this into the contract that you sign at the beginning of the billing engagement. It’s like, “This is how we're going to run. These are the metrics that I'm going to run. This is what I'm going to expect.” Preload all of that into the agreement with your billing company so that you can hold them accountable to that. I made a mistake. We just entered into this relationship. We hope they're going to do the best. The next thing you know, we don't read the fine print and we get in trouble. It all comes down to empowering the owner to know their business well. That is what's going to drive the higher performance practice. You've got to know it. If they know your business better than you do, that's the problem.

You brought up documentation time. You have an AI scribe now. Is there any reason why it provider shouldn't have their documentation down in a timely manner? Is there any excuse that's acceptable at this point?

Apparently, there is. We have AI scribes. I'm not going to sit here and say that it's easy to be a therapist. It's hard. It's hard work. It's a labor of love, and that goes for you as an owner. That goes for your team. The last thing I want to do is beat our team up with rules, but you can support your team well and care for them. Also have some expectations, like, “I love you. It's part of the job that this documentation is done by Friday or we're going to have problems.” I've been pretty vocal about the cultural issues that I've had in my practice over the last 6 to 12 months. I would say 90% of it is tolerating behavior that we shouldn't have.

Going into that leadership component like you are going to get what you tolerate. There's never going to be enough time and enough money. There's never going to be a convenient circumstance. You're going to have to decide to eat the frog, have the hard conversation and fire if needed. Hopefully, you don't but you got to hold that line. I'd say elevate your leadership skills and enroll your team.



Educating Providers On Optimal Coding

The last part in terms of billing practices and increasing provider revenue, in general. The fourth section I'd have you look at is training your providers to build optimally for the services that they provide. A lot of providers come out of school, they don't know the difference between AMA and Medicare billing. You might not know which contracts have AMA versus Medicare billing requirements. Knowing the difference, training them on how to do it appropriately, and knowing which CPT codes reimburse better than others and how to ethically justify the usage of those codes. Depending on the purpose of the therapy that's provided.

You and I both know that we could have a patient do some body weight squats and depending on how we document that. you can build it 3 to 4 different ways. Training your team on how to best document for that and also how to generate the most value for the services they provide. There is training online such us Kuenda and Medbridge. I'm sure other people have written to a lengthy extent how to build separately for Amy in Medicare. Have into your onboarding processes or maybe some annual training or quarterly training that you do with your team.

That, too. I would say never assume. One of the mistakes that I made with this situation is putting myself in a box and thinking there's only one way you can do it. There have been times even in my practice and even more recently where I felt like, “We've scheduled this way. We build this way. This is the way we have to do it. I never like exploring other possibilities enough and it ended up costing me a lot of money. If you would n't do that and get on the phone with other practice owners that are maybe outside of your sphere of competition and be like, “How do you guys handle this? How do you guys handle that? What do you guys do for that schedule? How does that work? How does your team land for that?”

Start asking. Be more curious. You'll probably find some unique perspectives on how people are being creative with how they both schedule and deliver in a different way that can allow you to create more of an angle on the way that you bill. I would encourage you guys to do that and as well as like looking at the window stuff online. Another thing is becoming a student of the problem. Becoming a student and learning that. You might be leaving some money on the table.

Two things to share. I did an interview with Lance Gross leading up to 2025’s conference and he's got probably close to twenty clinics now. He admitted that he spent about 40 hours on this particular topic, how to bill properly, ethically, optimally for PT services and spent about 40 hours putting a training together for all of his providers across the twenty clinics. He said he spent that time and then rolled it out. He did the training. Trained the clinic directors, they trained the providers, held them accountable and over the course of the year, that made a $1.4 million difference in their revenue based off similar visit numbers just by doing that. I would think that would be a great return on investment. Forty hours generating $1.4 million is pretty good.

I can take my wife to Disney World. We'll stay on site. We'll do the whole thing.

Is that how much it costs now at Disney World?

It's $1.4 million.

The second thing to your point, I met with an owner of a company that has over 110 clinics throughout the West and Midwest. It's been a mix. Some clinics do the 40-minute visits and some clinics do the 30-60 minute visits. Even there, like whatever works for their situation and their payer mix. To your point, there's not one certain way that has to be done this way. What is certain is, this is how you maximally optimize your cares so that you can get the greatest reimbursement ethically. There are some pretty certain ways on how to do that but when it comes down to how many visits you schedule each and eval time frames and you name it. There's some flexibility there. For some clinics, one way works better than another.

I agree.

I said Kuenda and Medbridge. BCMS has some training they can look at in order for you to learn the difference between different billing procedures and the different CPT codes and how to justify for those. You as the owner need to be the expert. What I would recommend and tell me what you think about this. I wouldn't recommend the owner be the one doing the training. I would recommend the third party or a peer within the organization be doing that training. There could be some thoughts amongst the team. If you're doing this training, tell us to build better to make more money. Obviously, it's just to line your pockets. There could be that default.

This is an important topic. I'm going to say we're not-not recommending you to roll this out. We’re telling you don't roll this out as the owner. We’re telling you. We’re not giving you an option. Do not roll this out as an owner. I would recommend building some close relationships with some key people of influence in your company and aligning incentives through the form of some type of profit sharing or bonus compensation that makes sense. There's a shared interest and have them roll that out. You get them bought in and have them roll out is a much better play for your culture. It will be a lot easier to lift for you, too.

For sure. Whether it's some video training backed up with some worksheets that you might create, having someone else be the in-person moderator and doing the training themselves. It will make things. go much smoother, that's for sure. We covered the four sections. Is there anything you want to add for this?

I don't know what our next few episodes are about. We talked a little bit about read negotiating, contracts, and building out of the network.

Next time.

Is that our next?

That is our next one.

Perfect. I'm going to leave it as a teaser then because I'm learning about that stuff, too. Tune in the next episode                    .

I would say as we're looking through this, especially to that fourth point. Tying all this increase in revenue, accountability, billing practices, the best thing I can say is to tie it back to the values. We were doing all these things because when we do these things, we do these things well. We can live out our values and our purpose to a greater extent. There can be an obvious default or a natural default. This is all about making money, but if you're not able to connect what you're doing and why you're doing it to, “This is how we fulfill our purpose better. This is how we have a greater impact in the community. This is in line with X, Y, and Z values.” It's going to feel like a money grab, both for you and for the team, and that's not good for culture.

I would make sure as you're doing these presentations, as you're going through it yourself, as you're talking to other team members that you are highlighting the values that you're living by doing these things properly. It will carry forward into a better culture for everybody. I'll just share that last piece. Again, this is all leading up to our conference on October 15th-17th in San Antonio. Go to PPOClubEvents.com to be part of the High-Performance Practice Conference. We have multiple speakers, multiple discounts for spouses and team members. We would love to see you guys there, so check out the web page. We'll catch you in the next episode about contract negotiations and pay relationships, and get into that a little bit. I look forward to the next episode.

Important Links 

• Adam Robin on LinkedIn
• Nathan Shields on LinkedIn
• PPOClubEvents.com
• Nathan@PPOClub.com
• Kuenda
• Medbridge
• BCMS
• Private Practice Owners Club