Stop The Leaks: How To Increase Cash Flow Without Seeing More Patients With Jerry Durham

Stop The Leaks: How To Increase Cash Flow Without Seeing More Patients With Jerry Durham

Welcome back to the show. What is best for the patient is best for business. I am going to timestamp this. It is November 2025. Everything tends to be at least probably through January. I am going to put a subtitle of PPS 2025 recap. I did see Nathan at PPS. We spoke for at least two minutes. I told him, "I am going to send you a podcast invite. Please say yes." I love people who jump on it. I am glad to see you this week. I am glad to talk to you this soon. I have been on your podcast. You have been on mine before, so you are not a first timer. Nathan, why don’t you just fill in a little bit of context of who you are, what you are doing? We can go on to the discussion of where we are in 2025.

Currently, people might know me, or what I am doing, is all related to the Private Practice Owners Club. It is a podcast that I started back in 2018. It has over 300 episodes. Jerry has been on there a couple of times. We also do coaching and consulting for Private Practice Owners, PT, OT, speech, and pelvic floor. We even got a mental health practitioner and an acupuncturist in there, which is cool.

It is great that you said that. I am glad you did because I want people to hear how everything is more alike. We all claim. I spent the first twenty years telling myself how different we were. I had to go, "We are absolutely like everybody else." I am glad you said that. Thank you.

That really hit me. Within the first couple of years that I did the podcast, I had a nurse practitioner that I went and see. I told her what I was doing. The next time I went and saw her, which was 4 or 6 months later, she is like, "Dude, I have listened to all of your episodes. I listened to them on the plane. I take notes."

This is a nurse practitioner, nothing to do with physical therapy, but she recognizes that so much of what we are doing is simply just small business concepts, issues, that kind of stuff, put it into a healthcare situation. Of course, we are niche down to the allied health professions. Even this nurse practitioner, and one of our clients, is frankly an MD as well. A lot of these things can apply. Another person that we have, I just have to say this, owns a daycare.

We are coaching her on improving her business. Much of it is all about business. It is nothing about treating patients. It is how owners can make more money, have a more fulfilling life, and transform their lives so they are not run by the business. They can actually go on vacation and not get a ton of calls. They can spend time with their family. They may get a lot of fulfillment from seeing leaders within their program grow up, develop, take on greater responsibilities, and grow as individuals and people.

There is so much fulfillment in that for me that went beyond treating patients. I do not know if you were like me, Jerry, but back in the day, within those first few years, I recognized how hard it was to run a business when I opened up my own clinic. I thought, "Man, if someone could just take all the business crap off my hands," I would tell my family this at parties.

"If they could take all the business crap off my hands so I can just see patients, I would be so happy." I was hoping that some white knight in shining armor would come, take all the business off my hands. Not recognizing that that was my responsibility altogether. Once I finally figured that out, this is, I do not know about you, Jerry, but this is like twelve years into my ownership.

The Mindset Shift: From Physical Therapist To Business Owner 

By the way, I finally found someone, so I cannot claim this. I tell everybody I make these broad sweeping statements until proven otherwise. I have now found someone who actually will own that it took them longer than I did. I say it about my first eight years, so I am going to give Nathan credit now for being the twelve-year guy. I said, "Yes, it was not until about eight years in that I was like, I am going to say this out loud so we can get out of the way. What am I doing here?"

Yes, for me it was like, "I have to do something different. This s***." When I finally figured that out, I decided to focus on my business, and I found out that I loved business stuff. I got a lot of fulfillment from it. I would have never guessed I would be in this situation now that I am so many years later. We sold our clinics in 2018. We did the podcast. Now we are coaching clients. We have conferences. We just had our second conference in October of this year in Destin, Florida. It was great. I got to speak for the first time at PPS.

Between you and me, Jerry, I never went to PPS while I owned clinics. I did not see the value. I have only been to PPS since I sold my clinics, but I got to speak this last time on increasing cash flow and how to do that without seeing more patients. It has been really fulfilling to have to be on this side of it, thinking totally differently than I was fifteen years ago. I was all about the patients. Whatever I can do to see more patients, that is great. Now I had dipped my toe into seeing patients. That does not bring the joy anymore, man. It is just totally different.

If you are listening to this, there is a video version. You have to pull up the picture cause Nathan and I look a lot alike right now. It looks like we go to the same bar. It looks like he is about five years behind the color of my beard. It is so funny because you are going to watch me aggressively nodding my head yes to everything Nathan said. I went through the same journey as you did. “I will never do this. I want someone to do this. I only want to see patients. If I do not learn how to run a business, I am going to kill myself in the sense that I cannot.”

Scaling Your Impact: How To Affect More Patients After Selling Your Practice 

You just cannot keep. I was forced into it when I went out of network because we could not keep doing things the way we were doing them. Literally, we could not. I hit a wall there and went, "We'd better figure it out." What I did not realize was that I then got the business education I should have brought in 5 to 8 years earlier. Yet the same thing. I then found out, "I like this. I can impact more people," which is interesting, Nathan, because I know you get this.

I am not even going to ask you if you get this. You talk to someone. They are thinking, you tell them what you do, and they go, "You have your own practice." You go, "No." They pause. They look at you like, "Should I trust you?" You are like, "Are you kidding me?" I am like, "I have impacted more physical therapy patients since I left my business than I ever impacted in my business because I understood about scalability and the scale of the work being done."

By doing the front-end work I am doing, by connecting it to the providers, I could actually go into clinics that were 10, 20 times larger than mine, do some work. Go, "I just impacted everybody who calls that place." It is interesting that people do not ask, "How did you get there?" I would rather people go, "How far did you get?" I would go, "Cool, good question."

"Do you still own your practice?" I am like, "Who cares?" I am putting that out there because I want people to hear that, because the value is not people still in it. It is the people like Nathan and I, I am going to say Nathan and I, who own the fact that we sucked, found a way to learn it. Now we are helping others to learn it, bringing all the resources that we bring to people.

I am so jealous of some of those owners that I talked to, some of them we coach that are just 2 and 3 years into it. They are light-years ahead of where I was at that point. They are becoming leaders. That is a mindset that so many initial owners have is that, which I talk about frequently, but I can see it in my clients when they get to that point. They recognized that when they opened their clinic, they were physical therapists who owned a clinic.

The mindset shift has to become, "Now I am a business owner. I just happen to be a physical therapist at the same time." When they make that mindset shift, it is usually when they tell me that when they are treating patients, they are spending more time thinking about what they have to do for their business than they are about the patient. At that time, I can come in. Say, "At that point, do not you think you are doing a disservice to the patients to keep treating them?

That is not fair to them." They are like, "Yes, right.” That is when they recognize, "I need to step away. I can have a greater impact if I work on the business more." It is counterintuitive, Jerry, because you and I know all these people have spent 25 years spending their whole life journey, all of their education came to this degree as a physical therapist. They passed the licensing exam. "I am a physical therapist," that defines them.

Many times in coaching, now we are telling them, "Yes, you should not be a physical therapist anymore." They are like, "If I am not a physical therapist, what am I doing? That is what I spent the last 25 years preparing myself to be." Yes, it can be really hard for them at that point. That is when it took me twelve years to figure that out. I wish I had taken 4 or 5, like some of these clients that we have. That would have been really nice. I probably would have saved a few hundred thousand dollars.

That was one of the things about PPS I will bring up. I will say by name, really, the ones I saw there. There were others there, but the High Def guys were out of Seattle. I met Zach originally when he was like two months out of school. Where I see where he is today, it's just like, "Dude, high five all the time." I am like, "Tell me what has been going on." We stay connected, but we have always connected with PPS. I say, "Tell me about the last year. Tell me what is going on."

It is like a huge high five because I am like, "These are the people that I am like, damn, I wish I had." Trying to magnify them, getting people to engage with them, follow them, and see what they are posting. Josh Funk, another one. Just you guys, like, I just posted this. Another guy I met, Carlson Pro Care Physical Therapy, is out of the Northeast. I got on a call with him. He is growing. He comes from outside physical therapy.

He took it over from his father, who was a physical therapist. He is doing it right. He is doing it well. I posted coming out of PPS, "It might be time to reevaluate who your heroes are in the profession. Start looking for the people that did not get you here, but are going to get you beyond here." I am like, the Josh Funk, the Carlsons, the High Defs. I ran into that problem. You probably did too. We were always asking for help.

I realized the person we when we got to a certain point, I cannot forget it. It probably was not even a million bucks. We said, "Cool. We are there." We high-fived the business coach. We went on. We must have been closer to a million or over a million. Said, "We need more help." We went back to the same person. They could not help us. I am not going to say it was a waste of time, money, and energy. It was on our part not to ask better questions. I always say, whenever anybody asks me questions about who to work with, "Find people who are where you want to get to."

If you want to get to 500,000, cool. Pick the people who are at 500,000. They might be easier to relate to. Once you hit $5,000, I am like, "If that is all that you are hanging out with, it is time to bump up to the next level." Again, back to this idea of the people who got us here, including me, I have to own this. The people who got us here are not always the person you need to be following, engaging with, to get you to that next step.

I went through many coaches. I never stayed with one. It always makes me sad when someone steps out of the program. They decided they do not work with us anymore. I would be happier if they left us to go to a different coach than to just drop off altogether, not get any coaching. They think, "I have arrived. I am there. This is it." We are talking about people who maybe have a clinic. They got to five providers.

You and I both know that like 4 or 5 providers in that 2,500 square foot space is a sweet spot. That is when you are maximizing profit. Things are good. You have maybe a clinic director underneath you. You have a solid front desk. Man, that is the honeypot. That is when things are really going well. They still have aspirations to expand, grow, a second location, a third location. They think, "I have made it. I have learned everything I need to know."

The Growth Trap: Why A Second Location Is A Disaster Without The Right Foundation 

"Just wait until the doors open on that second place. You thought, wait."

Yes, exactly. I talked about this at my conference. It was more about leadership in the sense of leadership being when you look at it in a Traction by Gino Wickman, it is visionary, integrator, all the departments down below. If you look at a true org chart from a large corporation, there is something above visionary and integrator, which is the board of directors.

Board of directors, then the CEO, you could put your integrator and your VPs. We lose sight of the, that all of us owners, wherever we are, need to have some board of directors. That is, there is no emotion behind it. It is all about the numbers. Either you are doing what you are supposed to be doing, hitting the goals you are supposed to be doing, running the programs that we all agreed to, or you are not.

If you are not, you have to explain.

You have to explain yourself. If you do not have a board of directors, you can get stuck with some of the emotional day-to-day stuff. You get caught up in the excuses, the reasonableness, all that kind of stuff. We need to step out and be leaders as if we are board directors, or at least have that person by you, which is a coach or a mastermind group, or someone that you are reporting to, who holds you accountable.

You can step into a leadership role and not just the day-to-day management role that comes with CEO ship, if you will, you know what I mean? I am big with you on that. There needs to be that person to guide you, direct you, and not have that person or accountability, that board of directors, if you will. It is hard to hold yourself accountable when you are at the peak of the organization. There is no one else above you.

I am just going to agree with you. Accountability, what a great word. When I discovered it better in my business, for me, for the rest of the team, it was as if I was going to hold other people accountable, which meant I knew what my accountability was to the business. If I were sitting across from someone, I would say, "What do you need my help with?" or "Why are you not hitting these numbers?" I knew whether I was doing my role in the company to make sure they were moving forward.

Accountability and responsibility are two separate words. We confuse those being responsible for something does not mean you are held accountable for it. We all know that. We have all been in those where you have not been held accountable. You start to slide. It is not a bad thing. It is just a check-in thing. Are we on the right track? Whether it is working out, whether it is diet, or exercise. Whatever sleep, it does not matter. Something to hold you accountable to say, "Yes, I am doing it, or no, I am not." Own it.

That is exactly it.

The PPS Talk: The 4 Stages To Stop Cash Flow Leaks Now 

It is huge. Tell me about your talk at PPS 2025.

All about increasing cash flow. I have given it a number of times. We know some of the statistics, you probably shared with people here, the 30% decrease in reimbursement rates, and inflation-adjusted. Some of the publicly held physical therapy organizations are in the single digits. ATI had a horrendous 2024, with even negative profit numbers for them. We are seeing issues with Select Physical Therapy now and stuff like that.

What is the answer to that, the declining reimbursement rate? I think the tendency, at least for me, maybe some of the younger owners back in the day, was, there is no problem that more new patients can fix. If I could just see more patients, get busier, that would increase the revenue, obviously, and add more profit. I am just like, "Hold on, you have got to have some kind of bucket analogy." You like to think that your organization is this bucket.

If I just pour more water into it, there is going to be more water in the bucket. Inevitably, when I do some high-level audits with people, I am seeing leaks of like $100, $150, $200, $300,000 annually because things are tightened up. There are holes in your bucket simply because of poor operations, poor systems, and poor management. Before you complain about declining reimbursement rates, your revenue, or profit margin, if you will, maybe you need to look at some of your internal operations first, especially before you are going to grow, expand.

Before you even consider a second location, let us tighten up those systems really well. Make sure we are capturing everything that we can, all of that revenue, and eliminate those holes as much as possible. The talk was all about what parts of your organization are commonly seen that you are profit? Revenue and thus profit. It was the four stages. It was like your financial numbers inside and out. Make sure you are really strong at the front desk with over-the-counter collections.

Make sure you are managing your billing collections team, which is a really weak spot for a lot of owners. They just do not know how. They do not know what they are looking at. Same thing with their financials. A young owner does not know what a profit and loss statement is versus a balance sheet. I was that way. Fourth was managing your billing for your charges. Every therapy graduate who comes out of school is going to be billing according to CMS guidelines. That is just not how it goes.

They’re billing because they have had the fear of God put into them about the organization. I never in eighteen years caught a PT over-billing, my friends.

They are under-billing. I like to call it compassionate billing. They do not know what CPT codes to use. They just default to therapeutic exercises and manual therapy, which are the lowest reimbursements. It is that stuff. We went through those four phases, what to look for, what to expect, how to manage things better, and how to train your teams better on billing charges. By doing that, you make more revenue. All things being equal, that all goes straight down into your pocket. It increases cash flow, increases profits. Everyone is happier.

The AI & Tech Trap: Why Process Must Come Before Automation And Software 

The sub-perfect tie-in to some posts I did this week, some thoughts I left PPS with, is that your talk is what is needed in November of 2025. This is just getting bolstered more and more every day, the more calls I get in, in order for someone to move into a system where there is technology involved. You just talked about understanding your people. Your people are getting tired of me saying this, but I have said this term more in the last six months than I probably said it in the previous 34 years. You just talked about how to understand what the people and the process are.

I see all these people running towards these technology-enabled billing platforms. I am like, "If you do not understand the process, how is this going to help you?" What I am seeing is AI. Even on the front end with AI voice agents, people definitely have a misunderstanding of the role of AI in general. It does not create the process. It just does what you tell it to. If you put a process, AI will learn, "Cool, from your process you put into it."

Again, that is how you want to do it. Hold on to that process.

That is what it does. Where I learned this, Nathan, was by listening to front-end phone calls. Put a good process in. Ninety days later, I got to hear this thing delivering like none other. I heard the process. I am like, "How is it going to improve that thing?" There is no improvement to be made. By the way, I heard AI hang up on someone recently. Same platform. I keep telling people that in November of 2025, the billing, the voice agent, all of it needs our wisdom put into it, so it knows where to start learning from.

What you just said, I love it because even though you said it was your first time, it is probably the best time, in my opinion, for you to show up, put that out there for people. Go, "I have got to figure this out." Again, they can make better, not only can they make better business decisions, but you and I both know everybody is going to be running towards the tech like the huge light at the end of the tunnel. It is going to be a huge disappointment to them if they are not doing like what you laid out in your course. I am so glad you shared that because it fits perfectly.

A majority of owners out there, I can safely say a majority of owners out there, number one, do not know what to measure other than the main total visits, new patients, and arrival rate.

By the way, I would say the majority of owners. Practice size does not matter. It is not all the newer owners. "All the younger owners." I am like, "I can share some horror stories, man." I see people, this whole idea. Sorry to cut you off, but I want people to understand we are not talking about young owners, small clinic owners.

This is one of those small clinic owners who know that they do get it.

Again, these are the things people need to be thinking about as they start wondering who I should emulate, who I should follow, and who I should engage with.

Number one, I do not think they know what KPIs drive their clinics.

That is a great point. KPIs drive your clinic.

You can really leverage change to make a significant impact. Number one, they do not know them. Number two, if they know what the KPI is, they do not know what industry benchmarks are for some of them. They do not know what is good, what is bad. You can give them a number. They are like, "I do not know, is that good or that bad? I do not know." Number three, even if they find out that their KPI is bad, they do not know what to do about it.

That is, I am with you. There is room for AI to provide better support in that regard, in terms of, "Private practice owner, here are the KPIs you need to know. You do not have to go fishing for them in your EMR. Here are the ones you need to know. Here is that line in the sand where if that number dips below that, then that is what turns red. That tells you that it is bad.” Lastly, not just that it turns red. This is what you need to do.

It will, Nathan. I equate that cause I have spent so much time on the front end. The next thing I want to do is create that AI that sits on your desktop. When someone is on an intake phone call, it helps to, let us call it, direct the flow of the conversation based on what they are hearing because you are asking questions, you are taking a lot of info, you are typing. I want to make sure that it is like, "I am really doubling down on their problem being solved, so that problem being solved just keeps rotating down the screen, so you do not have to guess.”

I have had people on secret callers ask me my name up to 3 to 4 times on the same call. Again, let us just make these simple names flow through the problems we solved. Now they tell us their expectations so we can keep going. I can continue a conversation that AI is driving you to make sure. It is not telling you what to say, but it is giving you all the prompts.

It is a reverse AI thing where, instead of you prompting it, it is prompting you. Again, that real-time feedback, like you said, "Jerry, here is this KPI." You open it up. You are like, "Cool. It is above the line." By the way, do not wait for it to drop below the line to figure out what you have to do, but it will prompt you if it drops below the line.

If owners could get those reports pushed to them instead of going into their EMRs to find, navigate, pull out data, that stuff, that would be game-changing. That would help owners so much in this day and age to really learn how to manage their clinics better.

I want to echo. Nathan did not say more data, more metrics. He said the right metrics. That is where I think, I am going to say this out loud, where most of the EMRs go wrong. I will never forget when we first signed up with our EMR. They were proud to show you all this stuff they could gather, but no one ever told us what was important. By the way, I had a list. I will never forget. We lived and died by it. We had our list of metrics and KPIs, but I could not tell you which ones really drove the business, which ones mattered. The day we finally flipped that, it was down to like three that I looked at every day. If I needed to dive down into any one of them, then I did.

Focusing On The Right Metrics: The 3-4 KPIs That Truly Drive Revenue 

Do you remember which ones they were?

I am going to be biased because I am like, "If I could only measure three things," my whole thing is looking at. Let me just give a little context. Your KPIs should be like a blood panel. Normal, not normal. Let us look deeper. I always looked at things like leads, arrivals, drop offs. Probably, there was another revenue type number in there. I do not remember if it was revenue per visit or monthly revenue, or what it was.

Probably about those four things. I am not an expense guy. People still call me, “Jerry, I am looking to cut some expenses on my front desk." I am like, "Nathan, can I ask you a question? What would happen if you just drove more revenue through your front desk? That might solve more problems." I was always more of a revenue mining guy. Let us face it, all of those can tell us the health of the revenue side of the business.

There are those high-level ones, like new patients, visits, and arrival rate. A couple of those, if you do not know your average reimbursement rate per visit.

Down to the penny, I have got to know it. Again, you can take a deeper dive, but at the end of the day, I knew we had a 65% conversion. If you told me the number of leads, I did not have to go any deeper. Let us put it this way. I knew how many new patients we needed on the schedule every 30 days. I knew our conversion rate was 65%. All I had to see on the sheet was leads. I know if we run. You know what I mean?

That tells me about your organization, is you have the other systems dialed in so well. Your front desk team knew how to get them in. Your provider team knew how to keep them in. You guys knew how to do that. If you can get those all dialed in, yes, you can look at those front-end metrics and know exactly what your revenue is going to be at the end of the month, within a reasonable range. You can expect a certain profit margin. I can see a really experienced owner getting that dialed in because their systems are nice and tight.

If you came to me as a provider, because you were not responsible for marketing in my business, I was. If you came to me. You knew your accountability was X amount of completed courses of care, or whatever it was. You were not hitting it. I said, "Nathan, what do you need my help with?" You said, "Nothing." I would say, "Hey, Nathan, can we talk about this complete course care number? It is down.” “What is going on?"

You go, "Everybody did this at least 1 or 2 times until I called bullshit.” "I did not have enough leads." I was the guy responsible for it. I guarantee you, I knew if you had enough leads before you walked into the meeting. I am like, “There was no way.” I would be like, "Nathan, no, let us try the next one.” I am like, “How can I help you?" Again, this is back to when we said accountability. If I am going to hold you accountable, I have got to know, "Am I delivering?"

By the way, if you told me your completed courses are carried out, I would go, "Nathan, I know they probably are. I am going to tell you, you have not had the number of new patients put on your schedule this month. I get it." I would be like, "Nathan, let me tell you what we are doing to make sure we get the lead." It flips the whole. The accountability was on me to make sure you knew where the leads were coming next. It did not give me the right to say, "You are wrong every time."

That is what I really liked about understanding the business that way, because I did not need to know a bunch, but I knew our conversion rate. I knew how many numbers and new patients. I would just look at the lead log every day. That is the only place I had to look. How many leads flow in? "We are 25% of the way through the month. We have 25% of the leads we need." I was like, "Cool, we are on track." I would not live and die. Even though I did at the beginning, I would not live and die by the day or the week, but I would look for the trends. Go from there.

You are better than me, man.

When I was answering the new patient calls real quick, I had to say this because at the front end, someone would say no, and I would hang up. I would have to take a deep breath. Go take a walk around the block, dude.

There was that stage. I was a clinic owner in Arizona. Numbers are always down in the summer because no one is going to go out and get hurt. After all, it is too hot. No sports are going on, nothing. Every summer, I do not know how, how well I always get over it, but we would have a down week. I would be like, "This is the beginning of the end. I guess I am going to have to go find another staffing job, close the doors. This is it." That roller coaster sucked so bad. That was rough.

I was like you. I had an idea, even though I did not know my metrics well, I knew if I had so many patients per week, I had a general idea of how many visits I would have in the following week. If that did not start matching up, I knew where to start looking. I just wish I had known my metrics better ahead of time, tracked things better, and recognized that the grind and small business ownership are all in developing these systems, holding people accountable. I just abdicated that responsibility all the time.

Assigning Responsibility: Using Metrics To Pinpoint The Problem 

By the way, so did I big time. I want to add one more thing on top of what you are saying because I think you have made some good points back to where we are talking about. If you know the right metrics, you will assign them to the right responsibilities because you said the thing that we have all done. We all do. You and I now try to get people to stop doing it. It's quite cramming the leaky bucket from the top. "All I need are more new patients." The beauty of understanding the value of the metrics, like this example we had from leads to conversion to new patients, is that you can assign.

If you know leads are down, there is nowhere to go but to marketing. If conversions are down, you've got a couple of places to look, but you have to know. I always tell people, mind you, you would have to be an established business, that the flow is going. "If I could only look at one metric in my business, it would be drop-offs," because I was like, "Drop-offs would tell me the health of my business." If I knew leads were flowing in, we were putting people on the schedule, drop-offs would be the canary in the coal mine.

I see that.

Yet, only after understanding leads as marketing, sales is here, drop-offs, and retention. Again, I want to go back to what you were saying, that if we understand the key metrics, what they are telling us about the business, and the phase of the business that they tie to. By the way, you and I both know revenue per visit could be tied to a lot of things.

Is it collection rate over? Again, you know where these metrics are coming from, so you can make better business decisions. I really want to know that because I think you said that perfectly. That is what is jumping out at me. I do not have to measure thirteen things because I know the four things that tell me about the health of my business every single day.

What it sounds like from this conversation is that I am getting is that I would measure four different things than you. We would still come to the same conclusion.

I have a feeling we come to the same conclusions because we understand the interconnectedness of how the business flows.

It is just understanding what some of those expectations are, what some of the benchmarks are. What should it be? Yes, I shared that in my talk. I did a really bad job as an owner in many things, but one of those things that stuck out was simply the visits per week. Letting my team know where the line was for break-even. "This is our line. This is what we need to."

That is a whole other podcast right there. I love you said break even. I find many owners will tell people what it takes to get a bonus, but they will not tell them what it takes to get their paycheck every two weeks.

What is the minimum expectation? What is it?

We do a poor job of telling people at the interview, "Here is the minimal expectation, Nathan, if you show up every day and you deliver this, you are going to get your paycheck every two weeks."

I would say most of the owners do not know what that is.

I know. By the way, I was one of those. I was not doing that, so people know.

This one time, as I said, I did a poor job at sharing that. That was on me. My lead therapist, ton of experience, was like, "We are going to be at so many visits this next week. I am really scared." I did not say anything. I just said, "We are going to be at so-and-so's visit this next week." She looked at me during the headlights because I could tell she did not know how to respond. Like, "Is that good or is that bad?"

She did not know how to take it because I had given her no context. I was like, "Yes, you need to know that your job is on the line when our numbers hit that number regularly.” I did a poor job at that. That is simply me not being a good leader, and telling the team, "This is our goal. This is where we are heading. This is what needs to be met.

This is how the ship is going to go west if we are heading west. This is what it takes to get there." I just kept that all to myself, acting like the martyr, "I am going to go down with the ship. No one else can help me." It is also naivety. Once I figured out that people needed to know the numbers, needed to know what their expectations were, then people could live up to those expectations.

Front Desk Goldmine: Unlocking 'Arrive, Pay, And Stay' With Patient Value 

Heaven forbid, we tell them. By the way, I learned this through my front desk first and foremost. All of a sudden, I started giving them. I will tell you one of the huge tipping points of my front desk journey was telling my front desk how much a new patient was worth to the company. I saw the conversion, I saw the arrival rate change in like 30 days.

I did the same thing. I noticed when I said, "Because you have not collected these copays, we are probably going to lose about $500," because he did not do that. That is when they were like, "Oh." They were ready to get fired at that point. I was not ready to fire them because, unfortunately, I had been very reasonable about losing $500 here and there all the time.

Just skip a paycheck here or there. Just skip something. That is always interesting.

Whereas I should have been hard-nosed about it. That was my fault for not having that system, that expectation in place.

Telling the front desk how much a new patient was worth because they all said the visit value. I said, "No, because when they arrived, they stayed for twelve. They are actually worth $2,400." Everybody's eyes lit up. I went, "When you pick the phone up, that is a $2,400 call."

I will never forget that.

I do not know what I was expecting from it. Most of my stuff was felt, I am not going to lie, was, "I think I need to do this. I do not know why." They started doing it. I saw the impact. That was a big one. The other one was making sure the front desk saw. I wanted them to understand the bills being paid every two weeks by the copay collection. I actually showed them, "All these things get paid through what you are collecting. If you do not collect it, we have trouble paying that."

That is a good one.

By the way, your accountability was to collect it, not pay it. Nathan, like we are saying, "What is the end result of that?" If I put a new patient on the schedule, what is the end result I want? I want them to arrive, pay, and stay. How do I hold people accountable? Make sure that I want the front desk person to know the ultimate goal is to get that person to agree, complete a plan of care, you start that journey. That ultimate result, how your role plays into that ultimate result. Just as an example.

Some of these metrics showed their value to me when I started talking that way. I went, "Getting people scheduled is useless because scheduled people do not pay the bills, nor do they complete a course of care." I was like, "We have got to talk about getting people to show up." Again, things started to change. Same people, same everything. It was on me, not on them. The same people who started to deliver once they understood a little more because I understood the metrics and their role, that metric's role in achieving that bigger metric, which was a complete course of care.

I love that because the front desk does not get told enough exactly what they are responsible for.

Yet, they know every step better than anybody else. I am going to say this. I have said this a lot this week. They know it better than anybody else, but nobody else ever asks them, or goes, "Let us break this down together." It took me again, 8 to 10 years, to do that in the business.

They have misconstrued ideas exactly what they are responsible for because you give them so much. They are responsible for so much. They have all these things going through their head, but as you said, they need every patient to arrive, pay, and stay. They need to fill the schedule, get everyone to come in, pay their copay, co-insurance, and stay on the schedule. Come in at the frequency, and finish their plan of care.

Modern Revenue Goldmine: Strategies For Keeping Credit Cards On File 

If your front desk person can do that on a regular basis, you have a gold mine. If they are good at that. We can say, "They are amazing.” I am jealous. I do not plan on going back into clinic ownership at all. One thing I wish we had back in the day was what I am seeing as a big trend in and that is keeping credit cards on file.

Someone brought that up in something I was in. I was like, "Man, dude, we used to have to write stuff down. We had a credit card."

I got pilfered by so many sticky fingers taking the cash.

I do not think people understand how valuable that is today. The ability to keep it on file as opposed to what you and I were having to do.

The AR aging for patient balances should be zero nowadays because you can keep all the credit cards on file. At the end of the month, after the insurance has processed the claims, "Mr. So-and-so, this is a text.” “Mr. So-and-so, yes, you owe $74.37 after the insurance has paid its portion. We are going to charge your card in five days. If you have any questions, call our billing collections team at this number." People I talked to, no one calls. The patients appreciate it. They are like, "You mean I do not have to open an envelope, write a check, go to the post office, and mail it back to you?

My wife is currently going through it. She joined a new provider group, loves them. She is about ready to end the relationship because of how difficult it is. "Just pay through the portal." She is like, "Do you know how many times I have tried to pay through your portal?" They make it so difficult to pay. “Just charge my card.” They make it so hard. She is literally gone. She was like, "Maybe I'll go," and it is down the street. I go, "Why don't you just walk in there, pay it?" I know she loves them. I am like, "Do not quit them. I will walk down there, pay it for you. Let them know that their portal is not what they think it is."

Isn't that crazy that they could have a six-star experience out of five stars? Just because she is having a hard time paying her bill.

She is ready to quit it.

Isn't that crazy? Could be a miracle worker.

People underestimate that.

There are always older people in the room. They are going to be like, "I am going to get a lot of pushback," "No one wants to leave their credit card on file." Like, "Let us put this in perspective. Everyone who is coming through that door has bought something online 2 or 3 times with that same credit card. They have left their credit card on file with Netflix and Hulu, and Amazon Prime, and you name it." They are going to draw a line at their physical therapy provider. Come on.

By the way, again, I am going to pat myself on the back because I excel in setting up. After all, what everybody is missing is, "Nathan, let us get your credit card on file." I am like, "Will you tell them what you are going to do with it, please?" I am going to argue. I am not going to argue with you. I am going to jump on top of what you said. Everybody knows what they are committing to with Amazon and everybody else, as opposed to this physical therapy place, where they just met you.

"What do you do with my card? Scripting that out increases the acceptance rate?” All I am going to say to people is that there is a lot of uncertainty with going, "Let us put your credit card on file." Just give people a reason to. I always say all I default to, Nathan, is give them a reason to leave it. "Nathan, by the way, here is my favorite line. Nathan, let me tell you what all our most successful patients do here at ABC Physiotherapy when it comes to payment. Do you not want to be the most successful patient, Nathan?"

What a great way to start a conversation. Again, then tell them. I make my clients say this, “Decide, are you going to collect copays at the beginning or the end? I want it. Nathan, by the way, when you arrive," I am going to keep going with this. If I take your credit card on file, I am going to tell you, "Nathan, here is how it is going to work going forward. When you arrive for your visits, we will log you in. You will not be charged until you log out."

Again, something like that, just, but you have got to come up with the system. Stick with it. If you tell Nathan, "Yes, here is my card." If you just go, "Can we get your credit card on file?" "No, I will just pay at the time of service," I say. I guarantee you, you will increase that acceptance astronomically.

Again, just looking at these things, how to do this, it is not rocket science. Here we are back to the metrics. What metrics tell me the story I need today? We tell people we want their credit cards on file. I am like, "Cool, do you tell what you are going to do with it once you get it on file?" Let us face it, by the time I get to Amazon. I got three things. I see what I am buying. I see what the delivery date is. The exact amount. Again, yes.

Another big fear is that people are going well. "I am not going to go down that rabbit hole." All I am going to say is people are bringing their past health care experiences to your physical therapy office. Do not assume anything. They have probably been burned by a surprise bill. If you just say we are going to hold your card, charge you, they are going to think about that $2,000 surprise bill they got. I am done.

I love it. I have not gone down that road. I need to add that. Just this conversation. It is like 2 or 3 sentences. It is not a lot.

It really is not. We used to have a sign. When I started answering the first phone call, I sat in the back with my benefits team, my billing team. We had a bunch of signs in the back. All it said was, “Nathan, were no surprises.” If someone's card was going to get charged, I wanted them to know when. If they were going to get asked to pay it, I wanted them to know when. By the way, because my thing was, "We will collect your copay at the end of service."

That is what we always said. Now people would walk in, pay before, I get it. If you were headed out the door, I said, "Nathan, can I collect that copay?" You would go, "Yes, sorry, I forgot." It was not, "I will get you next time." You knew that it was going to happen. No surprises, decreasing that uncertainty with all of this will go a long way to drive some of those metrics we brought up.

I can promise you that anyone tuning in, if you have the credit card on file and you have the system like you are talking about, you are going to add tens of thousands of dollars to your revenue. Just by doing that one thing, you do not have to see an extra patient. You are going to add thousands of dollars.

Rather than go pay some AI bot to chase down people to pay their bills. How about you just collect it over the front desk, and we call it a day?

Hundred percent of the time.

There is another AI tool out there. I know the founder. We have had this conversation. They take your wait list. They will move it down when there is a cancel. I am like, "That is cool. How about we just prevent the cancellations?" Again, back to my point of collecting copays. How about we prevent the cancellations? We still use the AI tool, but how about we do not let it fill the slots? Pretend like that is a victory. How about we prevent the council? Let us change the right questions.

Let us put the light on something else just for a moment. Let us keep that plan B.

Systems Over Solutions: Why Foundation Is Key Before New Programs Or Tech 

By the way, you pay per fill. I am like, "What an awesome tool, but that should not be your largest expense every month." I just want to throw that out there. We do not need to go. Again, I want to double back on your talk. It's in November of 2025. I am going to say it is always timely. Yet as we move forward, information like yours that you are sharing is going to be most valuable because it is going to help people make better decisions on how they want to build out their systems and processes if they understand the process.

I take it for granted because I have been giving that talk for a year and a half.

I hear you talking. I am like, "That is valuable today."

I am assuming that I am speaking to the choir. Everyone knows this already, but the feedback after my talk was like, "These people know this. They need to know it. There needs to be more people in this room who hear it." Even if people are doing parts of each one of those things very well, something sticks out. There is, "Yes, I could improve on that."

That one improvement could increase my revenue $10,000, $20,000, $30,000, $40,000 in the next four months. It is timely. It is going to continue to be timely because I do not know if there is a microphone or a speaker loud enough to get through to all the owners that are out there. You just do what you can. Spread it out as much as you can. It is really interesting feedback that I got.

Nathan, if I understand that process, we institute other programs or products or anything. The front desk and the team are used to owning revenue. I am not going to call it cycle revenue management. Instituting all this stuff, like collecting at the time of service for a wellness program, is not going to be a big deal. Again, it grows into something even bigger. Again, if you have this process in place. Your people know we have a program around money, collecting money, tracking money, and then it really does not matter where the money is coming from.

They are going to understand that it is important to do that work. I would say it is the foundational work that has to be done, you are talking about. Again, to add tech, to add other programs. “Bringing cash programs into a network clinic that barely collects co-pays is a disaster,” because no one wants to collect the money. You just tell the front desk, "Collect the money." It is like, "Wait, where is all the money?" It is like, "That is not the way it works."

It is just the opposite with another owner that I met there. We had coached her back in the day. She went through this profit program. During the program, she got rid of her front desk. She had a great front desk person. She was getting the patients to come in. She tells me, "Yes, I have got this issue with a provider. Our average skilled units per visit is at 2.8." I am like, "You know, you are not going to make any profit at 2.8 units per visit.

You cannot complain to me about your profit margin if you know that your current skilled units per visit are 2.8. You and I both know.” She is like, "Yes, I have got to work with this provider. See what I can do to get them up, you know, maybe by March." I am like, “Maybe there is a sense of urgency here that needs to get put into place.

If I could inject you with anything, it would be just some urgency. This needs to be collected tomorrow. This needs to be figured out next week, or this person is not on board with us at the end of the month." "Why are we waiting till March to figure this out, or hope that he comes around?" That is part of our compassion that works against us in the industry.

Compassionate Under-Billing: Allowing Staff To Lose You Money 

We are a very compassionate group of people. We always want to sacrifice ourselves for someone else. We always want to be liked by others. That collective personality is something that bites us in the butt every time. She is willing to be less profitable so that this guy is more comfortable in his clinic and in her clinic. It is so interesting. It is a pain in the. It is so, it is so literally allowing someone to lose my money right in front of me.

Be okay with it when you can coach. If this person liked you, they are working there, then you can probably have a conversation with them about how to do what is best for their patients. They are already doing what is best for the patients. This is that whole thing. They are just not billing for it properly.

Again, I ran into this. Our ops person was on top of this. Probably was rotating through every person. Probably about every 60 to 90 days, we're checking this stuff out because we understand that. We put together a model where people could have their time. I was like, "If you bill for it, you can have your time." Constantly going back, questioning, "Why is this person on the schedule for this long when you are only?"

It was never, "You did it wrong." I loved it. Our ops person was not a PT, which was cool. He could manage the conversations very objectively. "Why was this person on the schedule for so long if you only billed for this amount of time?" Now you had to own something there. It was one or the other. Either one would have fixed it. It is like, "Short the visit or bill more when they are here that long."

Here is an owner who knew the four phases. She had been through the program. She knew her financials. She was collecting well at the front desk. She has probably had a good hold of her billing collections team. That fourth phase, like getting your providers to bill appropriately, is getting the maximum out of the visit that you can do ethically. If we are complaining that we are not getting paid what we are worth, we should probably be charging the maximum amount we can ethically charge for the service we provide.

If that is not happening, that fourth phase is sinking her. The three phases are going to find that fourth phase of getting the providers to bill according to AMA versus CMS guidelines. Maximized CPT code utilization. Making sure that the skilled units per visit match the amount of time that they are in the clinic. You are good. She can easily turn this around into a hyper-profitable organization if she fixes that one phase.

We are back to where we started, that you have got to understand all this before you can plug in something that is going to tell you what to bill, and I believe this is why PTs are fearful of these platforms is because they do not truly understand what you just said. Before I am going to let something tell me, I sign off on it, because remember, the key here is really what I am talking about is I sign off on it.

I have to be comfortable with understanding what the standards are, so I can catch things. You and I both know it is going to need the feedback. This is the other thing we forget. I said this already, it is learning. From the beginning, you do not teach it. It is going to continue to facilitate and build on, I do not know, we could call it erroneous information, or less inaccurate information.

If you understand everything you just said, you go into it with that. This was the thing when I was doing the QA for the voice agent very early on, we were catching things, correcting them within the first week, within the first month, within the first 60 days. That thing was catching up quickly, doing a good job. If we had let it flow, it would have just kept making the same mistakes. Doing the same process. I do not want to make mistakes. It would not have been optimized.

I got you. We can get into a default where AI is going to take care of everything.

It is interesting. We think it already knows. That is the biggest thing is the voice agent, all of it, "It knows what to do." I am like, "No, it is waiting for you to put something in there so it can start." It is like we think it is already halfway through the race. I am like, "It has not started the race. It is waiting for you to shoot the starting gun." Maybe that is a good analogy. I do not know.

You can see that as well, because if you put in the wrong prompt on anything, everybody is going to it.

It is going to. "I was so clear."

You are like, "I thought I put in a clear prompt, but I missed certain words." It gave me an answer that was, I do not know where it came from. I said, "That had nothing to do with what I said in the prompt. Maybe consider this." They are like, "Yes, that changes it entirely." Part of it was still stuck on that old answer. It still threw out some of that stuff. You have to coach it. You cannot just expect it.

Therefore, back to that documentation and billing, if you do not know that, you are signing off on stuff. Unfortunately, the insurance and billing side is leveraging AI there. I am like, "It is like a battle of the bots right now." I am like, "How far ahead?" You are never going to get ahead of it. They have more money, more leverage to stay ahead of you. Again, how do we make sure all these things are in alignment? How do we make sure that we are doing things?

I am like, "Let us just do the work properly. Do not have to worry about AI catching it, freaking doing this." It is like shooting for a 100% arrival rate. I am like, "That is stupid." Zero percent cancels. I am like, "Totally unacceptable." We have got to readjust a little bit. What should be the copay collection rate? What should our AR be? Again, we have to have this basic understanding before we can start shooting all this stuff, implementing all this stuff. We are back to the value of this information.

What was interesting after the talk that I gave, I have not been to a lot of PPS. Frankly, I have not sat through a lot of the presentations, the breakouts, but they said, "This was the most positive presentation that I have listened to all day." I heard that a few times. I am like, "Really? What are they talking about out there? Is it all doom and gloom, or is it just pie in the sky, weird alternative answers to how to improve your clinic?”

I was equally disappointed. I have to say this. Hopefully, it is not too much of a tangent, but I started my presentation with a question like, "I am here to talk about increasing cash flow. Does everyone want to do that?" I got some "Yes" from the audience. I was the last speaker of the day. This is like 4:30 in the afternoon. I was like, "What have you guys learned today or yesterday about increasing cash flow in your clinics?" Crickets. I was like, "What?"

I wanted to get on a soapbox at that point. I was like, "Why are you here if it is not to figure out how to make more money? If it is not in like how to improve your business so they can be more profitable, so you can grow. Is that the fault of the attendees? Is that the fault of the PPS nominating committee for presentations?" I was blown away that no one had anything to say about that particular topic on how to increase cash flow besides me. I was really upset about that.

Motivation Vs. Opportunity: Why 80% Drop-Off Os Actually A HUGE Upside 

There is a lot of good content. It is drinking from the fire hose. A lot of people need to go home and process. I really do. God is truth. My talk was about arriving, solving all business problems. Again, if people show up, you have done your due diligence, and you can get paid. Plain and simple meaning, again, you and I could argue we were given the same talk. You were just coming from a different angle, like we said, with the metrics. It is interesting because the first slide I pull up is from 2024.

There are only ten percent of people who need physical therapy who find physical therapy. The second data point I put on the same page is 80% of the people who start a plan of care drop off and do not complete their plan of care. I put that up. I said, "Look, this is the context we are going to work from." If anybody saw that as, I looked at that as motivation. It would be interesting and goes, “Is that negative? Do you take that as a negative?” You should take that as, "My upside is ginormous. Do the work."

There is a lot of opportunity out there.

That is what I said. "This should tell you there is so much opportunity. You actually do not have the capacity to even manage it. Why not just take care of what you need to take care of?" The other thing trying to get people off is to quit fighting for the ten percent, man. "My competition." I am like, "Competition, dude, you have got to look in the mirror. No competition.” I am not going to say this. I am not even going to allow you to say anything after, but the hinges and the swords are not competition, my friends. That is, I say it over and over and over.

If you are getting pissed off about that, you do not understand. If you believe the only value is hands-on, face-to-face, all that, that is your issue, too. That is for another day. I want this. You alluded to this because you were concerned about, "What did you learn about cash flow?" I was going to ask you, "What was your biggest takeaway?" I will put that as your number one without knowing I was going to go that direction. What is your biggest takeaway from PPS 2025, added to the fact that at the end of that, when you said, "What else have you heard about increasing cash flow?" Nobody responded.

I did not want to act like that. That was PPS's fault, necessarily. Maybe there is something to it.

It is the people in the room, dude. They have to take accountability.

That is exactly what I was going to say. I fall into this trap too. When you come into the conference, you need to go to a conference, and I say, "I need to learn X, Y, Z."

I do not think people do this. I probably go with the agenda more over the last 5 or 6 years than I ever did.

I have just learned that myself over the last six years or so. I was like, "I need to go to a conference. Even if I am a presenter. Just being altruistic, wanting to share this information with as many people as possible." “That is nice. What am I doing there? Why did I spend this time, money to come here? What am I going to do on Monday to change my business entirely for the better?"

That is funny. I did start the talk. I go, "If you do not walk out of here with something to do on Monday, you have got to come up and talk to me because my goal is to make sure you have one thing out of all this stuff. You have got to be taking one thing that you can." I constantly went back to, "This is something you could do on Monday." We know that. I do not think enough people do that, Nathan. I am going to jump on this real quick. Maybe a lot of people come in there, talk on a high level. Talk whatever. Go, "Cool. You got everything you need." I learned this at the front desk. We do a poor job of telling people what the next step is. I am just going to leave that there.

I’ve been thinking about that way, I could have definitely referenced back to like, I probably did say that a couple of times. "If you are not doing this, you need to do this now." I probably did say that a few times. What did I take away from PPS? Number one, there are a lot more EMRs out there than I ever remember being there at the conference. I do not know if that is a good or a bad thing. The competition, sharp iron sharpens iron, maybe one of those things, maybe it improves things altogether.

That is great. A lot of AI connectivity to whatever the product was, whether it is the scribes or the EMRs or the billing collections, that kind of stuff. That is a catchy thing to use if you are promoting anything is how we are going to leverage AI. I was impressed with the number of people, frankly, but even so, what are they? Jerry, maybe you know better, something like 30,000 clinics out there, PT outpatient ortho PT clinics.

There has got to be at least 30,000 plus. The majority. That men's market group is the largest by far. I just saw some stats on that, but I believed it would always be true. If you take like the four largest, you named a couple. We throw a couple more in there. They have like 25% of the market, 30% of the market max.

You have got 1400 of those owners at PPS. There is something in me that is like, something is not clicking. There needs to be more people. Why are there not more people there? This was an all-time high. This was an all-time high, from what I heard, for attendance. Yes, 1400 is really good for them. I am like, "Why aren't there any more?"

Addressing The "Why Aren't More People Here?": The Need For Year-Round Value 

Do you know what else I like and am involved with? I want to tag onto that, the admin side. I am going to throw this in there because this pertains to what you said. I am on a committee right now, revamping the admin education. It was solid. It needed updating. It needed more structure. It is getting both with steroids. This product that this committee is putting together for us to then go to the experts to create the content, I truly believe, will add membership. What I see back to everything you said, I love everything you brought up.

"Why are there not more people?" My journey has shown me that the team is right. The providers are just there to bear me out or are just part of a team. They are no valuable than anybody else on the team. I would just say you could have Jeffrey Maitland, Stanley Paris, and you know, whoever else, standing in the back room. If there are no patients on the schedule, then who cares? If there are no patients on the schedule, how are we getting paid? Again, the value of the front desk team, the value of the back office admin team that has to do with the billing and collections, as you spoke to, then tight in with the providers.

My takeaway this year was a more positive vibe above the line, asking better questions. Positive vibe, asking better questions. Instead of just complaining about lower reimbursement payments, and all the other downward pressures on business. There is more than that. People are leading with, "I got to do this. I am here to learn this." Again, tying in that no business on the face of the earth does not understand their patient's journey within their patient's journey. No business on the face of the earth does not understand its client's journey in their business, then understand the experience they want to create.

Building out the systems and processes, except for healthcare. Healthcare is so fragmented and so disjointed, including physio. I believe it is finally catching up to us. Again, that is why we see these point solutions in the exhibit hall and not solutions. I am going to go out on a limb and say, “The EMR industry has created this vibe. I am not saying they did it on purpose.” I did the same thing.

I expected a lot more from my EMR without asking the right questions on the front end. Again, back to the people there, why aren't more people there? After my experience of going to many, I believe not just PPS, if we can show more value in what we are delivering to your team, the sales team, the provider team, and the billing team in one place, attendance will grow. I believe people are ready for that.

If you had asked me that five years ago, I would have said the same thing. I would go, "No one is ready for this. They are just going to show up. Go to the billing and compliance talks and go home." I want to see this for the right reasons. My room has increased in size for the last three years in a row. I attribute it to one thing and one thing only. People know they have to do something different. I do not attribute it to me. I attribute it to people knowing what they have to do.

Come on, Jerry.

You know what I am saying.

You have got the brand. You have got the name and the brand. Look how pretty you are.

You know what I’m saying. I know it’s in my haircut and everything before I go. Do you know what I mean?

Yes, I do.

They know I was really surprised. Here is the most surprising thing. I put this talk together as a series. If you were at the first two, you were going to drive more value from this talk. The room was going to be greater than 50% people who had been in my other talks. It was like 75% first-timers. I was like, "If you had been in my other talks, you would get value.” I am like, “I have been building this stuff.

No one talks in one hour is going to grow your business.” Again, the fact that 75% of that room was new was a huge tell to me, Nathan, that again, everybody is coming back on, "I have got to figure this out. It is not just the billing talk. It is not just the finance talk. It is not just adding more services. You have got to figure out the systems to get people." My marketing and not just marketing talks because it was a lot of marketing talk.

I just have a question for you. You have been to enough of them. You are working with the PBS. Do you think there is room for another association if it were started?

If this association, if it does what I just said, there is no reason why I cannot do what. I am not sure of the answer to that question in the context of what I just shared.

I guess why I am asking is because I admitted I did not go to a lot of PPS at all until I sold. I remember myself as an owner being like, "What are they going to teach me? I do not understand."

Let me answer this.

Just really quickly. Let me just finish this is as I did not recognise the benefit of PPS in between the conferences. There is the magazine, like you have got to get it to me somehow. I was not necessarily reaching out either, but I did not know what was out there. I did not see the benefit to me between conferences. I guess that is where I asked the question. The PPS can be, in and of itself, a great motivator, and can provide a ton of value. Now, what is happening in the next twelve months to keep some?

That is a great question. You know what? I can speak to the administrator side way better. I can speak to the owner's side. That administrator content is going to be available to owners year-round. I am going to make the next thing up. The next thing is my idea. Nobody else is. It has not been approved for anything. What I am hoping is that the build will get to conference, get the updates, like get an AI update, get it right.

You always need billing and compliance. There will be motivation to get the practice managers, but back to your point, Nathan, the value is not going to be the conference. I said it is going to the extension. I will say this. It is funny. You said that because you got my brain spinning. I have seen more and more on LinkedIn. They need a better marketing side of it because I have seen committees.

I have seen PPS. We are doing quarterly webinars. I am very up to date with things, but I do not know the reach. I am going to give you an example. I am not going to throw anybody under the bus because I do not remember. Someone from PPS reached out to me to begin the year. "Jerry, we are starting this new program."

We reach out privately, "Would really like you to amplify this, share it wherever you can." I responded, "Sure, just tag me in the post." I am still waiting for a reply. It is like 8, 9, or 10 months ago. By the way, even though I click and as part of my algorithm, they are barely showing up. I am like, "You and I both know send one email and go, nobody is responding.” It is like marketing one time.

I agree with you, Nathan. I am going to say it is there. I am going to say it is poor marketing rather than execution because I see the web. There was a great AI webinar. Someone showed up in my comments from PPS and said, "Jerry, great posts. By the way, we are speaking to this." I was like, "Cool." I am thinking, "Why did I ever see these posts going?"

I have never seen a PPS post. I am admittedly not on a ton of social media.

I am on LinkedIn. 99% of my time is on LinkedIn. If you are going to be anywhere, that should be it.

You should be able to find me easily there.

Drive everybody there.

The other thing I thought as I was walking away, I was like, "Who is going to be the next Rick Gawenda?" Who is going to be that person?

That has got to be a draw, by the way. Rick has got it. Rick's email list is bigger than anybody else's. I know because why? It’s because it is not a conference saying, "Dude, you and I both know you want the monthly updates. You want that. To your point.” Rick has got the biggest email list, the biggest list I know of anywhere.

He should. Hopefully, he does not die. What is going to happen here? There has got to be someone in this world who is committed to reading all that paperwork, going through all the reports, reading all the bills, reading all the proposals, staying on top of all the insurance changes, and actually loves doing that. Who is going to be our next Rick Gawenda? If he were to get hit by a bus, we are in trouble.

He flies a lot. They travel a lot.

There is something there. I like your point about where the connection is. It is funny because right when you said that, I was like, "I can speak to the admin side." It is going to be interesting, but there is just I am going to go out on a limb and say it is a marketing issue, not so much an execution. I see the stuff they are doing with the webinars. They are doing that.

They have the right people on them, as far as I am concerned. It is all about a conversation. They do not have to solve problems every time, but they get it. We have to have the conversations. I always think, and you and I both know, if you do not tell people what you are doing, then we think you are doing nothing. Just give us the updates. We think you are doing nothing. If you do not tell us either.

That was good, by the way. You have got to tell us what is going on because if you do not, that is the thing where I just constantly put out the same thing a hundred times. Someone goes, I get a response on the 101st post with someone going, "I did not know you did that." I just smile. Nod.

Of course, you did not.

That is all me. Not you.

I get it.

I love your takeaways. I jumped on some of that. I have had so many conversations. I am just thinking about all this.

That’s fine.

You are the first one to say that we need a heavier rotation, a more robust rotation of what is going on in the other eleven months.

Admittedly, I am not tagging PPS or APTA in my post and subscribing to their channels. You have got to come find me. You have got to push stuff my way if you want me to see what you are doing.

That is everybody's responsibility.

I am in a large majority there.

You are, too. I agree with you 100%. You have got to push. You and I both thought. I sat back waiting for everybody to show up. Guess how many showed up? Nobody in my business. I was the "You build it, they will come." Fortunately, I had a small space with a small rent.

That is right. Now it is time to go market, I guess.

Looking Ahead To 2026: Policy Changes And The Future Of Physical Therapy 

“Wait a minute. This is not going as planned." "Jerry, yes. He planned it poorly is why it is not going." Anything else you want to wrap up with? What about 2026? Nathan?

2026 will be an interesting year. As we speak, the big, beautiful bill is changing our classification from professional. How is that going to impact things? The ACA and the subsidies, how is that going to impact things? Are we going to continue to subsidise the ACA plans? If the government does not subsidise them, how are insurance companies going to react to us requesting more reimbursement? They are like, "Yes, we are not flush with cash anymore. Why would we increase your reimbursement rates?" There are going to be some definite changes. It will be interesting to see what happens. If you want to check out what we are doing, we are at PPOClub.com.

Hold on. PPOClub.com. I just want to make sure we got that.

Thanks for slowing me down. I appreciate it. Under resources, we have events. We are doing an in-person workshop in New Orleans in January to help people strategically plan their 2026, get clear on their priorities, and establish goals, deadlines.

This will probably be out in mid to late December. It will go out before your January event. That will be good.

We will do other events. We have our next conference plan for October 15th through 17th. We will be in San Antonio. People can look out for that. We will have 100, 150, 200 owners in a room, and get a lot of energy from that. I like doing those. Surprisingly love treating patients. I do not know about you, but I enjoy doing the presentations now. Even having the worst.

I live for that, dude.

I never saw myself as being that kind of person. I enjoy it. I really do. I provide some great value. These in-person things are really cool. We always have the podcast going out every week, whether it is or Adam Robin hosting. We have got some pretty cool stuff that we post on the show on a regular basis.

It is all on your website, PPOClub.com.

The podcast library is there with a search bar, which I think is really cool. If you are looking for a particular topic, you can search the bar. It will pull up all the podcasts related to that topic, marketing, recruiting, billing collections, excellent culture, or even particular guests. Whether it is financial stuff, "Should I own my real estate?" All that stuff. You are on there talking about the patient journey from a few years ago, and front desk stuff. It is also on iTunes, Spotify, YouTube, all that stuff. It is all there if people want to find us.

Final Takeaways: People And Process Are More Valuable Than Platform 

Great conversation. Sorry, I jumped on some of your stuff. After about now, I am realising this is like the 4th or 5th conversation. Every time it goes a little deeper. I have had more time to reflect on it. That is great because everybody is sharing something with a different perspective. All of these are going to bring great value to anybody listening and making them go, "Yes. This is cool." Again, I like where this started with talking about your talk, because here we are, November of 2025.

We could say, "It was the basics." It is what you need to move forward and grow. It was always there as the foundation for successful businesses, I like to say. Yet, all that stuff is rising to the surface again, as people are expecting tech to take over. Again, it will not. By the way, it will take over, but it may not take over the way you want. You'd better put your process on the tech that you are using to run your business. Under the QA side of it, I am growing my benefit checks and authorisations team.

We have an AI platform. My people are, I am going to say this out loud, more valuable today than they were six months ago. It has been an interesting journey to see where we. I do not believe this is going to be true until the end of time. Again, the people in the process are far more valuable than the platform. The platform is awesome, but without the people in the process, it could not deliver what it delivers.

I could see that.

Finance, billing, documentation. We talked about that documentation. Are you going to sign off on this? You do not even know the rules and the regs? You do not know what the rules the regs are around the codes. You are going to have to know all this. It is time to double down on all that. Thank you, my friend.

Thanks for having me.

PPOClub.com. It will be in the show notes. I will make sure there is a little blurb about January, also.

Thanks, man. I appreciate you having me, Jerry.

Do not hang up.

Nope.

I always saw that on the end because, like once or twice, people hung up. I am like, "Where did they go?" Cheers, my man.

Important Links

• Jerry Durham on LinkedIn
• Traction
• Private Practice Owners Club
• Private Practice Owners Club on Spotify
• Private Practice Owners Club on YouTube

About Jerry Durham