But I Don't Have Direct Access The Administrative Referral

Hey, what's up, y'? All? This is Aaron with Lebauer Consulting and the Cash PT Nation. What's up, Cash PT Nation? I've just had a couple questions lately. Basically the same question. And I was like, well, I got some time today. I'm not treating patients today. And I just thought I'd come in the group and answer the question. This is the question of, but I don't have direct access. How can I start a cash based practice? Or how can we market the patients? We don't have direct access. And I know in Texas there's limited direct access. One of those questions came from Michael Match the other day, and he's from Pennsylvania. And I think they don't have direct access to for like the first two years of practice, something like that. And so what you got to do is, okay, so you don't have direct access. This is the thing. You don't want to let the patient go if they've called you. So what I call it is an administrative referral. Actually, I learned this on one of my clinical rotations as a DPT student, the same place where I decided I've got to have a cash based practice. I learned about the administrative referral because this was in the state of Georgia, Bob Duvall at Sports Medicine of Atlanta. And this is the way it works, and this is the way it's adapted. So, and that was about, might be 10 years ago, maybe nine years ago. So things are different now in a lot of states, but there's still limited direct access. So what do you do? Well, just because you don't have direct access, what's up, Dave? Doesn't mean that you can't treat patients. You can't get patients coming in to see you, especially when they call you, and especially when the goal is to market directly to patients. This is how the administrative referral works. You say, hey, I'm the pt, I'm the best person to see you, and this is my mindset. So you call me, you come into my practice pretty much everywhere. You can evaluate your patient. Just because you can't treat the patient doesn't mean you can't give them some good advice and evaluate them and tell them what's going on. Because in that evaluation, you can really take care of all their fears and worries and let them know that you know what's going on and how you can help. So let's say you don't have direct access because you don't have the direct access license in some states, or you don't have like in Texas or a couple other places, you can't treat without a referral. There are creative ways not to cheat the system, but to make the system work for you without just giving up. And so what you do is you get on the phone and you get that person in and you make the referral or the script, the order part of doing business, it's just like paying for your credit cards. It's part of doing business, it's part of getting people in to your practice. And as part of like this is the thing, so what you're going to do. Alright, Ms. Smith, I'm going to get you in for an evaluation. Have you been to see a physician or dentist or whoever else in the last year or last three months for the same condition? Yes. Okay, great. What's their name and number? And I'm going to call them and just touch base with them and make sure we got everything okay, because I need a referral. Or just make sure you don't need, you might or might not need a referral. We're going to get that taken care of for you and I'll see you on Tuesday when they come in. Tuesday, before you do that, you get on the phone, hey, I'm seeing so and so. She's been in cu. Can I get a copy of the referral or can we just get your signature on our plan of care, however that works. You get Ms. Smith in and you say, Look, Ms. Smith, I've been in touch with your physician or the chiropractor or dentist, whoever, and they've sent over their referral and we're good to go. So I'm going to evaluate you. So I evaluate you and I tell you this is what I want to do. Hey, what's up Joey? How's it going? I appreciate the comment, brother. Okay, so the other scenario is you don't get that referral before the first visit and you get Ms. Smith in and you say, okay, Ms. Smith, what's going on? What's the problem? What can't you do that you'd like to do, et cetera. You know, let's take you through your evaluation. Okay? Part of the process is this is what's going to happen. I'm going to treat you for eight visits, we're going to get you back to running the 5K. And before your next visit we need to get you in to see your physician so that he can, she can, you know, sign off on our plan of care or write your referral. It's just part of, you know, Kind of the way it has to work here in Texas, Madagascar, wherever you are or you say, so that's kind of just part of doing business. Or you go the other kind of option is, all right, well, Ms. Smith, you don't have a physician you haven't seen. I know three or four people that would be. That are great. You know what? Dr. Smith, or your name is Ms. Smith. So doctor, I'm going to use that. Dr. Smith's a real osteopath here that I refer patients to. So Dr. Rigby, who's the other one I like. Dr. Rigby is great at seeing this. I'm going to send you to him just to make sure that we're in agreement on the best course of care for you. And when Dr. Rigby agrees, he then we're going to get you in for your seven visits. What that means is that what you're doing is just basically having someone else sign off on your plan of care or really agree with you that you're on the right track. It's just like this administrative referral. It's not defaulting to the physician to make the decision. It also comes with a, a nice letter from you or conversation that says, hey, look, this is what I found out in my physical therapy evaluation. This is my physical therapy diagnosis. It looks like my physical therapy diagnosis might be a lumbar extension rotation dysfunction. I'm not saying the person has a hernia disc. I'm going to say they've got this movement dysfunction. I'm going to say to you it looks like it might be this kind of back pain, but I'm not really sure. Why don't you evaluate them and see what you think? I think they're appropriate for pt. If you agree, please sign here and send this back to me or sign a referral form and send it back to us so we can get on with the care of this patient. What this does is this positions us as physical therapists on top. We are the ones that are bringing in patients. And I'm saying, okay, now you're going to go see Dr. Rigby, you're going to go see Dr. Smith, you're going to go see Doctor so and so, and I'm going to put you in other people's places. And now I'm distributing. Yes, flip it. I'm distributing the patients to the physicians. And the ones that see that and see, you know, how powerful that is, they're going to start coming to me and asking me for patients or they're going to be like, oh wow, Dr. Labour, Mr. Physical therapist is. We're the same, he's bringing us patients and part of that's our mindset of elevating ourselves to the same level of care, you know. No, we're not medical doctors, we are physical therapists. We're doctors of physical therapy. We are top of the chain for movement dysfunction. So when we operate from that place, direct access doesn't matter. Primary care pt. That's exactly it, Lisa. Primary care physical therapist. That's what I am and that's what we are. If we're the primary care physical therapist, this is the mindset behind the administrative referral. We are the ones that make the decision and then we say, okay, look, I just need you to agree with me on paper that we're in the right place. Obviously if you see something different like a fracture or a tumor, please let me know. But I can pretty much tell. I had a 16 year old come in a couple times a few weeks ago for an ankle thing, but her knee was hurting and it was from a similar dismount. And the mom said, we're going to see the orthopedic surgeon this week. Something's just not right. I said, well, it's probably, if it's anything, it's probably a tibial stress fracture or chondral defect or whatever. Basically. I said, here's what I think the diagnosis is going to be. Don't worry about it, it heals really quickly. They went to the orthopedic surgeon, got the X ray and he was like, this is exactly what it is. And it was just what I said. So that's basically what we're doing is we're exactly, we're putting the ball in their court and saying, hey, if you see something really weird, let me know. But otherwise I think we're going in the right path. And what you're going to do is you're going to find physicians who are not going to be a black hole and you can even tell them this. You can go up to them and take them out for lunch and say, look, I've got a lot of patients that I'm going to send to you that need your services. I need somewhere that's not a black hole, that if I send you a patient and it looks like they still, you know, nothing's wrong and they still need physical therapy and that's appropriate for them. I need it to not be a black hole where they disappear to an exercise sheet and told not to go to pt because if that happens I'm not sending you any more patients. This happened to me. I mean, I said this exact thing to a physician, and we went to lunch, and first thing, he says, well, once we got over being nice to each other, he's like, well, I'll definitely send you patients. And I was like, look, I don't need your patients. I just need a place to send mine. That's not a black hole. I was like, okay. And it's not. And I send him a ton of patients. So, yeah, I mean, that's the administrative referral. It's just a paperwork thing, and we need to treat it like that and get behind the mindset of this direct access piece. A big part of it is being creative, and it's not breaking the law. Because I know from speaking to Jared Carter, he says in Texas, he can get a referral from a dentist or physician or cousin or brother or uncle from another state. It doesn't matter. You just got to call the person and he makes that part of the. The initial phone call. Do you know anyone who. In your family or in your circle of friends, who is this type of person? Because if you can get them to write a referral, that's all we need, and we're good to go. For Michael, it's like in Pennsylvania, he's got two years of experience to get a direct access license, but he can still evaluate. And he was asking these questions like, yeah, but you can still evaluate. You get that person in you, you get them on your team, they're going to go wherever you send them or to their primary care or ortho person, and they're going to want to come back and see you because you've just done what no one else has done for them, just in your evaluation. So they're going to go and say, yeah, I need this. And if they can't get in right away, well, call around and see who can get them in right away. Even an urgent care visit might only be 50 bucks. Get them on their way to coming back to see you. One of the other issues is a lot of people say, oh, well, we've got 30 days. Well, then you just make it part of that first 30 day plan. If you think, okay, I can do this in three weeks, I can get you to your goal in three weeks. No big deal. But if you're in week two or, you know, and you need to go longer or you know from the eval that this is going to take two, three months, you just make that part of the plan of care. Okay, Going to do eight visits once a week. And in that third week, you're going to need to get an appointment with your physician or you, the pt are just going to send your notes over and it might take two weeks to fax it and get it back, or snail mail it and get it back and just get their signature on the plan of care.