The Profit Paradox: Why Your Clinic Is Busier Than Ever But Making Less Money - Nathan Shields’ Appearance On The SPRY PT Webinar With Alex Bendersky, PT

The Profit Paradox: Why Your Clinic Is Busier Than Ever But Making Less Money - Nathan Shields’ Appearance On The SPRY PT Webinar With Alex Bendersky, PT

I have some experience to glean from. Honestly, with the show that I've done, like you said, 350 episodes. I'm learning a lot from a bunch of other people. Many times, the information that I share is not what I personally experienced, but what other people have experienced through the show and my interviews of them. I'm excited to hopefully share some great value with the readers.

There's no singular, generalizable experience. Everyone just lives in their own experience and learn from it. That's truly a privilege. Just some housekeeping, we will go through these five main points. We'll cover some other issues as well. You will notice that every slide will have a QR code. A QR code is linked to an actual document that either is an empirical piece of evidence that supports these statements.

It's a document that had been created through a blog on Nathan's website that you should go visit and hopefully explore. The first question for you, Nathan, is this paradox of busy clinics. We are busier than we have ever been as a discipline, as an organization. At the same time, we're generating less profit than ever What is behind this paradox of profitability?

The Paradox Of Busy Clinics: High Demand Vs. Low Profit

There's the obvious stuff. Declining reimbursement rates, increasing expenses via inflation, cost of living, etc. We're obviously getting squeezed and the difficulty remains in the fact that we have to change with the times. That's not easy to do for most people. We are going to continue to get busier. Like you said, point number two, patient demand remains strong in most markets.

The baby boomer, that curve of people that in that age bracket are going to continue to get older. Move up into the 65 plus years of age range and require more and more care for at least another ten, fifteen years before that starts decreasing a little bit. The demand is always going to be there. Therapist schedules are going to continue to remain full.

Yet, with declining reimbursement rates and the margin squeeze essentially that I shared. We're busy yet less profitable, maybe even busier and less profitable. It's incumbent upon us as individual business owners and as a profession. Frankly, I wish there was more done industry-wide to help us in this endeavor. It's incumbent upon us to learn how to increase our margins. We're not in the business to see single digit profit margins.

That's not the ideal American dream. It's not why we got into business. We wanted to open up clinics usually to have some freedom. When profit margins are thin and you're staying up late at night worried about covering payroll. “How am going to keep these people on the team if I can't increase their salaries?” That's not the idea of freedom. That's not what we signed up for. There is a paradox. We've got to change.

It's the dichotomy of working hard or working smart.

There's a lot of that for sure.

Even it's a domain-specific culture quality that we were so used to just rolling up our sleeves, working hard, and breaking a sweat. Instead of just looking into these things and seeing them, how can we generate a profit that affords us the lifestyle that we're looking for? With objective data and with data in general, if you can't measure it, you can't change it. What does a busy clinic measure in terms of KPIs? What does it need to measure and capture in order to support this financial health of the enterprise?

Mastering Critical Metrics And Provider Utilization

What they need to measure, there are the obvious ones. Before I learned more about my metrics, I lived and breathed my total visits, my new patients, and maybe my cancel rate. Thinking those told the whole story and I lived and breathed those. My emotions would follow along according to the roller coaster of those numbers, and unfortunately, my sleepless nights as well.

There are quite a few to measure. Too many for me to list off the top of my head. I have my spreadsheets that I cover. I can go into further detail if you wanted to reach out to me independently. It's imperative, number one, for every business owner to know their financials. Knowing what your profit and loss statement says every month.

Knowing how to read it, knowing what your profit margin is. On that sheet, maybe most importantly, what is an important KPI? I'll throw out there right away. It’s your percentage of employee compensation compared to your gross revenues. This goes to the example of where we're getting squeezed. It used to be, and I've been out of the business eight years as an owner, that my employee compensation versus my gross revenues used to be.

If we could keep it below 50% to 55%, then we knew we were profitable in the range that we wanted to be profitable. We had good profit margins. If that number isn't below 60%, then you're not doing very well. That's one KPI I can think of right off the bat. When I say employee compensation, it's not just salaries. It's also paid time off, payroll taxes.

Anything that goes into payroll, put it into the employee compensation bucket. That measured against your gross revenues on a monthly basis needs to be below 60%. There's a KPI that goes directly to your financial well-being. You need to keep it there. If it is above that, then either you need to minimize expenses or increase the production with the salaries that you have. That one right off the bat is a good measure.

One of the measures that I'll do in my audits on a regular basis and see, “Are you productive enough? Is your team productive enough?” When I say productive, here's another KPI. I'm expecting my providers to be, I use the term, utilization. I don't know if you use the same term, Alex, utilization, efficiency, billable hours, something to that. I always call it utilization. Of all the available appointment slots, how many of them are filled on a regular basis?

Given a week's period of time, if you had a hundred appointment slots. Of those, how many came in? I'm expecting that number for each individual provider to be between 80% and 85%. At least 80%. If they're down in 75%, 70%, especially below 70%, then that person isn't “productive” for me. I know they're not generating enough revenue to generate enough profit for my clinic.

I saw that in an audit recently where a number of the providers were in the 70% to 75% range. I saw that employee compensation metric that I mentioned first, but also is in the 70% range. That tells me likely their profit margins were like 8% or 7%. They're struggling to make it month to month. Those are a couple right off the bat. Are there a couple more that you think we should get into?

That's perfect. The employee compensation ratio, understanding the difference between that equilibrium, there's two ways to get the equilibrium. There's the homeostatic change. What your employees cost to what they generate in terms of profit and revenue. Unfortunately, our employees cost is kept by how many hours in a day, how productive they can be.

We have to set up these expectations for them. You're expected to see X amount of patients and then what they generate. That's based on their rivals. There's a lot of psychology to this. It's the perceived value. It has to come from a clinician to drive this value to the patient, to understand that “You need to be here. You made this commitment with me.” It's this subjective verbal commitment that, “I'm going to take care of you. You need to be here in the clinic.” That generates revenue.

If I'm very lackadaisical about cancellations, about no-shows, I am okay with it. We're already as an industry, the least productive healthcare enterprise in United States out of all the healthcare systems. That was one of the things that you have to consider as a clinician, even if you're not a business owner. You're just not generating enough revenue to support yourself. If you want to get paid more, you have to generate more revenue. It's the way it works.

Bridging The Education Gap: Business Acumen For Clinicians

Unfortunately, that goes back to their education. Honestly, I'll put the blame on the physical therapy schools on that one. They don't talk about business metrics or the financials around business enough. Those therapists that come out don't understand that they need to produce in order to justify their salaries. I would change the wording that you put in there. When you're talking to a patient, they need to come. You mentioned to generate revenue. We wouldn't say that to the patient.

We would say, “You need to come in order to achieve the goals that you want. It is in your best physical interest to come to physical therapy at this frequency for this period of time to get to this point so that you are healthy and can do the things that you want to do.” The mindset has to be, what's best for the patient is best for business. That's totally the case.

Therapists, unfortunately, don't take responsibility for their patients. I don't want to make a huge generalization. A majority of the time, they don't take responsibility for their patient caseload to come in at the frequency and for the duration that they need to get the results that the patients want, that you know is best for them. If you can teach your team how to, let's say what it is.

It’s selling a plan of care and get the patient to stay engaged with that plan of care on a visit-by-visit basis. Tell them, “This is where you are along the course of our plan of care. You're 50% of the way there. You're 75% of the way there. This is what we're going to do to get you all the way.” It's still going to take some time. We're a quick fix culture, but we have to talk to our patients. The best therapists simply know how to sell the plan of care to keep the patients engaged. When you do that, you will generate more revenue because you're doing what's in the best interest of the patients.

There is an optimal dose response as far as physical therapy encounters are concerned. General population understands it when they're prescribed medication. If you're prescribed an antibiotic, you're supposed to be compliant with the full course of care. You have a ten days’ worth of medications. You're supposed to take three times a day. That's your dose response.

Your dose response is that volume of medication that you have to intake to complete the course of care for that specific antibiotic. For physical therapy, it's a physical agent. The agency here is that you are going to comply to these activities that we have lined up for you for your specific diagnosis. That will take six weeks.

That is the optimal timeframe for your in-person care that will help you overcome whatever clinical barrier you're facing. Clinicians need to understand that the dose response comes from compliance. You have to integrate compliance into this, as you're saying, providing the plan of care. It's the story and the narrative that we have to give to patients that “You have to be here. You have to work together with me. You have to work.” It's an alignment and an alliance that we don't have.

If I can just add to that, you can do more. You can generate more revenue and more profit with the current patient load if you were willing to focus on it. That's what a lot of my audits are telling people. The people that I've talked to, you don't necessarily need to see a lot more patients. What you need to do is get your patients to come in at a greater frequency, which would benefit them.

If they're coming one time a week, and you're in musculoskeletal outpatient therapy. You can't tell me that seeing patient one time a week is enough. I just can't fathom that. It's not logical. They need to come in at a greater frequency. They need to come for a better duration. If you did that, if you caught the fish that are already in the barrel, you'll generate more revenue and profits simply by doing that. That's in the best interest of the patient.

We can play on this a little bit. That patient volume has been one of the dominant KPIs that we're looking at. Why don't we look into that, the stratification of specific need? In a way, if we're incentivized to look at this volume as a fundamental KPI, why don't we not look into the patients that need us? The ones that we're seeing once a week, but need to see three times a week.

We know that these are high-risk patients. We're not communicating. We're just trying to either maximize for all or maximize for none. Instead of being professionals and understanding that you need to be here three or four days a week. With your condition, if you're not, the downstream cost is going to be exponentially higher. Better to spend time here for the next six weeks than to spend time in an OR in a year or two. Why are we not having this conversation with patients?

I'll go to the lowest hanging fruit in that. We don't know how to have those conversations with patients. We weren't necessarily trained or coached in those conversations. We don't feel totally comfortable. There's plenty of therapists. If they were like me, especially if they were younger, we're still trying to get over the imposter syndrome.

We set high bars for ourselves. We're like, “I don't know if my skills can get you the results that I'm talking about.” There is little fear that we're not going to follow through on what we're committed to with this plan of care. It's a few different things. If I could add quickly, just because we started with KPIs.

Another KPI that doesn't get looked at enough is the average visit frequency per week. I ask owners all the time, what do you think it is in a musculoskeletal outpatient setting? They'll say, “It's probably between two and three.” That's what the typical protocol is. When we do the metric, count the numbers, it's closer to 1.3, 1.2.

If you made a substantial difference in that metric alone, you changed who's currently coming to getting them to come more often, which is in their best interest. It is also the best interest of the business, changing that metric from 1.3 to say, 1.7. What is that? That's a 30% interest and a 30% increase in your visits per week right there just doing that, just following that one metric. Again, it's looking at what's in the best interest of the patients and getting them to come in a way that will maximize the recovery will benefit your business.

That's understanding the margins. We can go into this slide that margins define industry. The failure of our system to educate our clinicians in a business acumen is the downfall of the business. What and how much revenue can you change when you operate your business efficiently? What are some of the things that you have seen that individuals can optimize their efficiency without changing anything else about their business?

Driving Success Through Completed Plans Of Care (POC)

That last metric that I shared is a good one. Increasing their average frequency for visit. Another one is tracking percentage of completed plans of care. We might get into this later, but since we're here. It's a metric that in the past was hard to generate. I'm hoping that our current EMRs, especially SPRY, can do it for us to an extent.

As long as you keep your active patient list set up right. Discharge the people out of the system that are discharged and keep the active patients active. That will give you a healthy metric and then measure how many of those people on the active patient list are coming on a regular basis. How many of those people are completing their full plans of care?

Tracking that metric, I will go back and say, I believe WebPT did a study. I did a full show on it around 2019-2020. Maybe that the average completed plan of care rate was 30%. That's good if you're playing baseball. A 30% success rate is horrific as an industry, if you're saying we get 30% of our patients better. I'll be generous.

Maybe some people get better sooner than the plan of care was set out to be. Maybe 50% of the time we're super successful. I probably said this a couple of times around these KPIs already. If you were able to track that metric and see how successful are we at getting our patients to complete the full plan of care, that would drive business right away without seeing any more patients.

They're already there. They're already coming, but we're just not getting them. Exactly what you were referencing, there's a lot of externalities and a lot of downstream effects that we're not even looking at. Someone who is looking into it doesn't want to burden a patient to come in. “It's your time. I understand that you can cancel this week. I'll see you next week.” What you're not understanding is that you're creating a greater burden on the same individual downstream.

If you look at all the data, all of their healthcare economic data, early access and robust access to physical therapy leads to a significant reduction in downstream healthcare costs and leads to better clinical outcomes. Your three times a week for six weeks leads to like a $5,000 reduction in overall healthcare costs on the same individual in that twelve-month period. Beyond that, it also leads to better outcomes. You feel better. It's a short-term investment and long-term investment too.

It’s in the best interest of the patient, like I said before. WebPT made a correlation between that metric alone is losing individual private practice owners approximately $150,000 a year. The success rate is at 30%. It's a significant impact on your financials, just as it is an impact on the patients that aren't coming.

The shameless plug, with a product like SPRY, where we have a business intelligence tool that are baked directly into the platform. You can visualize all of this. You can monitor and track it. You don't have to guess. There's no guesswork. There's no digging through your Excel spreadsheets. It's right here in the platform. It will tell you who's tracking, who's not tracking. That's why smart systems need to be operationalized for smart businesses.

Let's talk about the profitable and non-profitable time. That has to do with a time clinicians spend on these redundant tasks that don't generate revenue because they are not clinical. They are just redundantly administrative. What can a business owners do to reduce this administrative burden on a clinician so that the clinicians can focus on what they do best? Provide clinical care.

Optimizing Efficiency Via AI And Virtual Assistants

I just made a comment in LinkedIn because someone posted about the benefits of AI and documentation. Up until now, documentation was the physical therapist's biggest headache. All the surveys would say as much. They're concerned about reimbursement rates and salaries and whatnot. If they were surveyed back in the day, it was always documentation.

To overcome that if you're not using AI at this point to help you with your documentation, you're just a couple of years behind already. There's opportunities there because not only does it help you with your documentation. To your second bullet point here, they also have compliance guidelines within there to tell you how to be more compliant with your documentation.

Even your coding with some of these AI tools to maximize the codes that you're using for the same care that you're providing. Why not get paid more for the work that you're doing? Using the AI tools that are available to you and some of those administrative tasks. Maybe AI can't do them, but could a virtual assistant do them?

I'm a big fan of virtual assistants. I'm in the process of hiring on my own executive virtual assistant as within a couple of weeks. These administrative tasks are distracting. They're draining. They're not productive. They don't lead to revenue, but they still need to get done. They're part of the work that just has to get done.

Utilizing the AI that's available to you, utilizing virtual assistants, there's a lot of good companies that can help you with virtual assistants out there. My friend, Will Humphreys, has Virtual Rockstar and my partner, Adam Robin has Inbox Zero. There are great VA companies out there that can help you get the work done so that you can spend more time being productive. Your therapist can spend more time being productive and doing what they want to do. They don't want to be doing any of this stuff.

If you think about it, even that patient onboarding. As far as loss of time, inefficiency in patient onboarding. When the patient comes in and they still haven't filled out the paperwork, that's ten minutes of your time. That's ten minutes of billable time that you're spending in a waiting room waiting for someone. You've been able to digitize that process with such high degree of fluency and with high degree of precision.

We have our SPRY Kiosk. It's pretty much everything, outcome measures, patient demographics. It's spectacular. It's so well appreciated. Even beyond the product, patient comes in, they're ready to be seen. They don't have to go anything beyond that. The conversation can start about the patient and focus on the patient, not on administrative stuff. Let's talk about the revenue leakage.

Plugging Revenue Leaks With Modern Collection Systems

One more in terms of, as an industry, we're very comfortable about not collecting 100% of what we're owed. We are so ridiculously comfortable losing 20% of our revenue to these administrative garbage because it's part of a business. No other business can take a 20% loss of their margin and still be happy about it. What can you do to reduce some of these denials? What can you do to be in compliance with some of these payer-based contracts so that you can be profitable?

It's exactly what I'm doing when I do these audits. Looking for the revenue leaks within an organization by looking through their operational, financial, and billing collections metrics. I also presented on this at PPS, this last conference. There's four areas where I'm looking for leakage if I'm an owner. It's not on the bullet points here.

I'll tell you the fastest, easiest way to plug revenue leakage hole is over-the-counter collections at the front desk. If you aren't tracking that daily, what should be collected versus what is collected on a daily basis. You're losing cashflow. The studies show that once that patient walks out the door and doesn't pay their co-pay, co-insurance, deductive, portion of their deductible, whatever it is, you're losing 50 cents on the dollar at the time of service.

That's an immediate switch that can increase revenue if you're not doing that. Your collections of over-the-counter should be 100%. No give on that. The easiest way to get to 100% over-the-counter collections is get credit cards on file. If you don't have credit cards on file, do it. Do whatever you have to do.

Add a paragraph maybe to your financial agreement in your new patient paperwork. There's plenty of examples of what that paragraph looks like, sounds like. I'm sure SPRY is totally compliant to keep and store credit cards on file. What I'm also seeing as I was studying for that talk I gave is that patients expect some kind of digital payment process.

It's almost a burden for me to walk in and have to pull out my credit card. If I can just give it to you and then I show up the next day, they say, “We're just going to charge a card on file.” They're like, “No problem.” The agreement is also, “At the end of the month, if the insurance has processed everything and I have a balance, you're just going to charge my card on file. I'm not going to have to write a check. Mail in something to you and go to the post office or whatnot. Charge my card on file, please.”

Easy, low hanging fruit. It's a revenue leakage spot for sure. The claim denials, they go unmanaged. There are RCM systems and billing collection software's out there that leverage AI to manage those denials. They're not waiting for some human intervention that could take a few days. Whereas these claim denials could turn around and spit those back out in real-time or within a few hours. I don't know how fast the AI does it, but that's possible.

The coding inconsistencies, your providers need to know the difference between AMA and Medicare billing. Sorry, physical therapy schools are only teaching Medicare billing processes. Not all insurance companies follow Medicare guidelines. If you're with a commercial payer, leverage the AMA billing processes. You can generate more revenue that way.

Know what your CPT codes are paying individually. Know exactly what does Therex pay versus Theract. In general, therapeutic activity pays more. Make sure you're using that a lot more than therapeutic exercise and have the documentation and justification behind it to do so. It's greater skill. You should get paid more for the skill that you provide.

Knowing how to bill appropriately, code appropriately, knowing which insurances deny certain codes so your providers aren't using them. You got to know all these things. You got to be in communication with your billing collections team. If they're just okay with denials of line-item CPT codes, that's not okay with me. You need to teach me so I can teach my providers what those CPT codes are that we shouldn't be using or what we should be using instead of others. There's a whole matrix around that. It needs to be understood all the way through the providers.

It's the foundational knowledge and alignment. Every agent in your clinic should be aligned on the same source of truth.

Financial Clarity: Cost Per Visit And Workforce Coaching

If I could add one more is simply this. Know your cost per visit. I can ask almost every owner what their average reimbursement is per visit. They know it, within a range. Rarely do they know their cost per visit. If you're looking at these insurance contracts, you got to know where you're losing money and by how much. You can assume that United Healthcare is paying you $65 a visit, maybe. By the way, that hasn't changed in 25 years since I started my clinic.

They have record profits. Funny how that works. Do you collect $65 a visit? If patients haven't paid their balances, maybe that $65 a visit is less than $60 a visit because they didn't pay their balances or something like that. They got denied here and there. Maybe it's under $60 a visit and your cost per visit is still $80 to $85 a visit. You're losing $20-$25 a visit. If you're okay with that.

If you're okay about losing money, then that's the joke's on you. Let's move on to the next step, the work force attrition and work force bottleneck. We are definitely losing a lot of clinicians to non-clinical jobs. We're not getting enough clinicians to enter the PT training. We do have this bottleneck. Do you think hiring a new grad is an optimal way of boosting revenue and boosting productivity? Are there some of the other strategies that you would recommend?

There's a lot of different ways you can go with that. You would like to think that new grads would cost you less and generate the same amount of production. There's too many stories where that's not totally true. You can generally expect that your more experienced therapists are going to be more productive and thus you're willing to pay them more.

You're to have to spend more time and energy with a new grad to coach them on the way that you expect patients to be seen in your clinic. Teach them your culture, teach them what production looks like, and how we get there. That their ideas of what's ethical and not ethical might not be realistic. Based on what we can assume that the physical therapy schools are teaching them.

The pro for hiring a new grad is that they're moldable. They're not coming in with any preconceived ideas. “This is how things should be done.” Whatever you teach them is the way things are. You might be flexible. They're going to tend towards a lower salary, but you hear plenty of them. If you have a new grad, you're going to have to spend a lot of time with them to get them to that point where they are productive.

They'll culture.

You have to teach them the culture, teach them what it means to be productive, and what that looks like. This is how we're going to get you there and give them support. Once you get them there, the ones that do well and buy into the culture do great. They do wonderfully well. You just have to make sure that they're value-aligned. That they're the type that are anxious to work in that setting with you.

Whether you're hiring a new grad or someone that's experienced, a lot of it goes to the interview process, the recruiting process. Are these people value-aligned? Bringing up production as part of the interview process is imperative for either one. “We expect you to see 50 visits a week on a 40-hour schedule, are you going to have a problem with that?”

The last thing you want to do is bring up that production expectation after you've hired them. You need to be right up front. “This is how we do things. Come and shadow with us to see this is how we work. This is how we schedule. These are the patients that we see on a regular basis.” That's not a new conversation when they join the team.

Closing The Gap: Capturing Referrals And Online Presence

That's on cost fallacy. Let's discuss the attrition of prescription. Even though we have a direct access in all 50 states, some form of direct access, we still very much are a referral-based business and continue to be. There's a statistic in a primary care environment that 70% of physical therapy referrals written by a primary care physician or primary care practitioner go unfilled. What are some of the ways to capture these people that have an intent to come, have a prescription to come, but don't come? What are some of the best ways to do it?

A lot of it goes back to marketing and promotion of exactly what we do. I don't think we've done well enough to the general public to separate ourselves as to what we do, that we are musculoskeletal experts. I've had too many experiences where people equate us to chiropractors or massage therapists.

You would think after decades that maybe the differentiations would become clear, but they're not. That's imperative upon us to differentiate ourselves, to make ourselves the experts and set ourselves up. The other thing is I've heard plenty of times where people say, “Physical therapy didn't work for me.” That's like saying, “Dentistry doesn't work for me.”

We've been commoditized. You just find a different dentist. You find a different physical therapist and all the same right. From the marketing, the promotion, and making things as easy as possible for people. If someone's getting a prescription, there are plenty of referral coordinators at these doctor’s office that are saying, “There's plenty of physical therapists around. Find one that's in your network. Go and see them. We trust these people.”

The first thing they're going to do is look at your online presence. Maybe even your social media presence. If that's not there, if it doesn't look good, then they're just going to move on to the next place. Make it as easy as possible. Make sure “Book an appointment” button is on the top of the first page, you phone numbers at the top of the first page. Make sure your Google reviews are current and that they look good.

You've got a number of them. There's a threshold there. Algorithms may have changed, but you want to have at least 35 or 40 comments/reviews. You build up an online presence because people are going to look at that more so than the doctor's recommendation. Maybe as much as the doctor's recommendation.

This one I got from your website. It was a powerful quote. The leadership and identity. What is the way to get clinic owners and operators to rely on true objective data instead of intuition? Versus the other way. What are some of the arguments?

The CEO Mindset: Data Vs. Intuition

If you're going off of how you feel and what your bank account says, then you're going to be reactionary. It's not based on objectivity. It's imperative, I like to say, that there are many owners out there that don't know what to measure. Even though if they were measuring it, they might not know what an appropriate benchmark or expectation is for that metric.

Lastly, even if they had some of those metrics in the benchmarks, they might not know what to do about those metrics and benchmarks. Frankly, this could be self-serving, but you need to pay the tuition to learn. Coming to this is appropriate. You're well-intentioned but you need to pay the tuition to learn.

What the metrics are, where they should be, and how to improve them. You need to know your KPIs. You need to be measuring them on a weekly basis. One of them, the over-the-counter collections on a daily basis needs to be reported to you. There needs to be weekly metrics. There needs to be monthly metrics that you need to understand your financials.

You have to take it upon yourself to learn. You have to pay the tuition. That's time and money from someone who knows and can teach you. That's how I got out of it. I was in a funk. I was busy. To the point of the title of this entire presentation, I was waking up at 4:00 AM to finish my pen and paper notes.

Getting home usually around 7:00 PM, got to the clinic by 6:30 AM or so to see the first patients. That was on a routine basis. There would be days that I would go at a time where I would not see my newborn babies awake. I would only see them in the crib. I wouldn't be able to interact. There would be days I would go without that simply because I was busy.

At the time, this is around 2006, I was busy. I was doing okay financially, but my life sucked. I would go on vacation. Whenever you go on vacation as an owner, that's when all hell breaks loose. That's when I'd get the calls. The physicians are calling. They're upset or there's a problem with the so-and-so quit while I was on vacation.

Not while I was there, all that kind of stuff. That was not the lifestyle that I wanted. I finally recognized that I needed to do something. I needed to pay somebody to show me how to get out of that. Learn how to be a business owner so that I could achieve the freedom, the vision, and dreams that I wanted to as a business owner.

Let's just quickly brush up on this. What is your take on a value-based care? Are we going to continue to be the volume-based provider? Is there a future for the value-based care?

There's a path to value-based care. If you're going to take the low paying contracts, the only way you win is on volume. You just have to figure out volume if you're going to take those. Could you provide value in that situation? I'm not going to say that you can't. If I'm not mistaken, Australian therapists see their patients twenty minutes at a time.

They get results. There is a path forward, just got to be clear on what you're willing to provide. If you're totally clear on what you're going to be providing and the type of clinic that you're going to have. That means you're going to filter out things that aren't going to align with the type of value that you provide.

What you're saying about Australian-based therapists, I did my fellowship with NIAAMT. One of the instructors was a British-born, Canadian-trained therapist that was seeing 60 to 70 patients a day. These patients had full expectation of what exactly what was going to happen. They knew that the intervention had a specific system. That's having a systems design. There was a full transparency and understanding. That's what you're getting. What is a system design that you would recommend? What are just one way you can even assess your own system, best improvement to your existing system?

The setting up a system usually starts with person who is running the system super well. They know the system, they do it well, and they create the product that is expected at a high level. That has to be in place in order for the system to be generated. Once that is done, we have a system that generates X product at a great level. We need to write it down.

It's the whole premise behind E-Myth Revisited, a famous book by Michael Gerber for entrepreneurs. You need to write down your systems, generate systems so that is no longer person-dependent, but system dependent. It can be replicated over and over and get the same product. It used to be you had to write that down.

Now, you have things like Loom.ai where you can take a video and screenshot if you need to of what you're actively doing on your screen to follow the process or talk out the process. When you're done, it will write out the SOP for you, the standard operating procedure of that system for you. You copy and paste that. Turn it over to someone else so they can replicate it and generate the same product.

Let's then talk about measuring the right matrix. If you had to give someone, and I know we're short on time.

I'm talking a lot, Alex.

This is the best. This is something that we should have done a three-part series because you honestly do it. You have so much to give. This is such a good, elaborate thinker. This is great. In retrospect, we should have booked the next week. We'll have like a little boot camp.

I can always come back.

The Rubik's Cube, I like this graphic because to create a graphic that is putting it all together, standardizing a practice, standardizing a structure. Do you think that there is a specific structured standardization that all private practice owners in USS can follow? That this creates a better efficiency? Or is it still going to be a one-by-one case where each individual practice owner needs to follow each individual path?

Standardizing The Patient And Employee Life Cycle

There is a pretty common path that allows for some customization according to the culture and values of your organization. The patient life cycle is common throughout. I would build my systems. I'd start with my systems built off of the patient life cycle. You can do this also with the employee journey. What is the life cycle?

Let's start with the patient first, the patient life cycle. Let's think about each step from that first call and interaction with your clinic to their balance going to zero. Let's talk about the 13 steps, 14 steps, 15 steps in between, a follow-up call. What does it look like when they come in for their initial evaluation? What does that look like when they come in for their follow-up visit?

What does that look like when they come up for a progress note? What does that look like for a discharge visit? What does that look like when they get their first bill? All those things. Let's line out systems for each of those interactions with the patient. Let's do the same for our team members. What does that initial recruiting system look like?

What does the interview system look like? What does the onboarding process look like? Is there a path to progression? These are systems we can build off of that life cycle. What does off-boarding look like for a team member? We can build systems all around those life cycles that are pretty uniform, but that can be individualized by each clinic.

Smart clinics require smart technology. These systems require accountability. A system needs a system. These systems need to be present. That's where going into the ideal conversion of passive, non-revenue producing time into an active time requires this optimized system in each domain, in an onboarding domain, in a patient management domain, in a human resource domain.

There has to be a structure. What can a clinic owner do as a first step to build a stronger, sustainable practice? Loaded question, right? This is like a four-hour question. What is the best way to go into the clinic? It’s Thursday. Starting Monday, you go into the clinic. You're like, “I'm just going to do something different. I'm going to do this A, B and C.” This one thing that you do differently. What would it be if you had to give one thing?

There's a trait that is necessary for a good CEO/owner of their business. That's observation. If I'm going to go in on Monday, I'm probably going to start observing interactions at the front desk and see how well those are going. If they are following the processes that I'm expecting right and how those interactions go.

We're people business. A lot of those patients are going to decide whether or not they're coming back based on that interaction at front desk. If it's a solid interaction, that could make up for some poor therapy in the back. If it's a bad interaction, you could be a miracle worker, they aren’t coming back. Starting there, but then putting me on the spot, what am going to do Monday?

It’s probably start observing that, then going on to observe my providers. How they're working and whatnot and see where there's some inefficiencies. If you could start looking at your metrics, that would be great. For someone who doesn't know where to start with their metrics, it's hard to say that. If they say, “Look at your metrics,” they're like, “Where do I go? Which matrix?”

To build on what you're saying that that's spot on. We see the system as a bipolar system. It's either you are struggling or you are flourishing like you are. There's something in between which is languishing. How many practice owners just flow by? They just go into the clinic on Monday. It's the same redundant Groundhog Day. Go into the clinic and observe and be vigilant to what you're doing.

Your recommendation is pretty excellent. I want to leave just a couple of minutes for people to ask questions. I hope people are going to have questions here. Before the questions, can you give a little bit of an insight for our audience, both live audience and audience who are going to see this. How can they contact you? What can they do to get your help on a deeper level than just this one-hour webinar?

I didn't even put my email on there, Dan. I should have considered that. You can email me Nathan@PPOClub.com. PPO Club stands for Private Practice Owners Club. Me and my partner, Adam Robin are active on our Facebook group. Go to the Facebook group, Private Practice Owners Club. I've got a LinkedIn. Look for Nathan Shields PT on my LinkedIn profile. You can DM me there as well. It's not hard to find me.

I hope everyone who is here going to take an opportunity, to come and find you, and use your services. Everyone needs a coach. A basketball team without a coach is just a group of guys throwing, shooting the basket. You need to have that structure. You are the ideal person to guide people to a better, more thriving business.

Thanks. I also have to plug the show, Private Practice Owners Club. Find it on all the media. There's a ton of value there.

A little plug for us, we have another webinar coming up here where we're going to discuss a new AI system, an advancement in our AI scribe system. That's going to be in April. I hope people are going to come and join us. Hopefully, Nathan, you are going to come and join us on April 8th, too. We can use this as a point of discussion. What have you seen in terms of private practice owner, responsiveness and relationship with these smart systems? What is the word on the street and what can we do to get more people to start optimizing and utilizing these smart systems?

The Future Of Practice: AI Agents And Hard Decisions

It's like any typical technology advancement. There's going to be early adopters, people who come along a little wise, and then people who are the late adopters. It's more imperative now than ever to implement AI into your business. If you're considering AI and don't have anything to do with it, you're a couple of years behind the curve.

You need to ramp up because AI is changing a lot of things. What is happening six months from now is not what's happening now. If you're doing business the same way now that you were doing five years from now, it's going to be hard. I don't have a lot of optimism behind. You've got to learn how to implement it into your business because frankly it's in your best interest.

It's not technology or human. It's human using technology.

Leverage it. It makes life easier. You might not be technologically-savvy. There's plenty of providers out there that aren't that say they're not. It's a great opportunity. Frankly, I'd be surprised if most therapy graduates aren't expecting some kind of AI to be used in your organization.

It's the young ones that are coming in that can be used as resources to teach people in practice for a long time. The seasoned clinicians, as I would call us, to teach us the inside of this emerging technology. It's here, it's evolving. What we're going to discuss on April 8th is we're going beyond basic AI into these agents and this agentic AI.

Which is cool advanced technology that is just so far ahead of anything that's even been here. People see AI now as just more of a chat bot, but this stuff is a rule-based engine. These rules are wonderful. One last question for you before we wrap up. What is on your roadmap? What do you see for yourself as well as for our industry ahead for the next 5 or 10 years?

For the industry, that's hard to say. If owners aren't making significant changes in their organization, then it's just going to get harder and harder to stay as a private practice owner. You got to start making some hard decisions and dropping some contracts. You have to start with knowing your numbers, if you're going to do that. How to negotiate, or just simply dropping them.

For me, personally, I've been doing the coaching consulting. We have workshops. We have conferences. You can go to our website PPOClub.com and look under events to see what's coming up next. I'm excited about these audits that I'm doing to find, you mentioned in the bio, tens of thousands of dollars. I'm surprised at what I'm finding that's available there for owners to generate without seeing more patients, without being busier. It might take a little bit more effort on the administrative side, but you can capture so much more money with the business that you have.

Work smart. You're the coach for it. You're going to coach people to work smart. Nathan, I absolutely appreciate your time for being here and your guidance in our industry. I'm a long-time PT. There's a few voices out there like yourself that have clarity and understanding of what is needed to be done. Thank you for your time. Thank you for being part of this experience. I hope you the best of your future.

Thanks for having me. It was fun.

It was great. Thank you.

Important Links

• SPRY
• Alex Bendersky on LinkedIn
• Nathan Shields on LinkedIn
• Will Humphreys on LinkedIn
• Virtual Rockstar
• Adam Robin on LinkedIn
• Inbox Zero
• E-Myth Revisited
• Loom.ai
• Nathan@PPOClub.com
• Private Practice Owners Club on Facebook
• Private Practice Owners Club on Apple Podcast
• POClub.com

About Alex Bendersky