Start a Therapy Practice with Business Coach and PT Scott Harmon | CashPT Lunch Hour #22

All right. Hello, this is Dr. Aaron LeBauer with Labauer Consulting and the Cash PT Happy Hour. Welcome. From Snowmageddon in the south. We've got six inches of snow and ice everywhere. And so I'm over at the home office tonight doing an interview. And tonight I've got on the line Scott Harmon, who's a pediatric occupational therapist and he runs a blog called Start a Therapy Practice. Welcome, Scott. Thank you so much for being here. And I've learned a lot about you from your website and learned a lot of new things, and I'm happy to have you on the show tonight.

I'm honored to be here and I really appreciate the invite and I've learned a lot from you, too. So it's mutual learning going on here, so I appreciate the opportunity.

Awesome. Well, I just want to check in real quick with our listeners. Can you guys just type in the chat box where you're calling in from? Let us know if you can hear us. And this is a live hangout, so if your screen freezes or anything amiss happens with the technology, just refresh your browser and come right back in. So what I'm going to do is I've got a couple questions lined up for Scott and some things I want to talk about with him. But if you're listening and you have any questions for Scott, please don't hesitate to put them in the chat box and we'll get to them at the end or sometime in the middle as well. Okay? So, Scott, what I want you to do real quick is just tell me, where did you go to school, how did you get into occupational therapy and how did you get into private practice?

Well, I went to the University of Central Arkansas in Arkansas, obviously. And, and I got into OT because there was a really good looking girl who was going into ot and she became my wife down the road. So she kind of got me interested in ot, but I mean, that worked out great. She's also an OT, and for probably 12 years, 12, 13 years, I did pediatric occupational therapy and different developmental daycares and probably six or seven different ones. I was a contract pay therapist. So I was getting paid by the hour, by the unit, and not salary. I've never been a salaried therapist, so that was my mindset from the get go, was contract pay therapy, which to me is sort of a stepping stone to the private practice. You kind of get used to getting paid by the client instead of getting paid just to show up. And so for 12 years, that's what we did. And I was driving about 45 minutes one way to work. And it just occurred to me, you know, I'm wasting an hour and a half of my day every day away from my family. I wish I could work closer to home, but I didn't want to continue to do the same thing that I was doing, you know, basically, as I say, working for the man. My wife and I started throwing around the idea of opening a private practice and we kind of took the plunge. We did the market analysis. We were asking the different professionals in the area, do you think this would work? We asked our local pediatrician, is there a need? They confirmed that, yeah, there's a need for more therapy. And we had gotten wind that the local therapy places had a waiting list of probably three months long. It was just a matter of getting the word out that we're available now. I knew other therapists who had tried that route as far as having to practice throwing up their shingle, taking out some rent, taking out a loan, and it didn't work. They just thought that if I put my sign out here, you know, people are going to come to me. And that's not always necessarily the case. It might work, but it's, it's sort of a risk, especially if you're taking out loans and rent and if you

build it, they'll come.

That doesn't always work. I coach other therapists not to do that. You know, it's better to start small and build momentum. I mean, it could work, but it's kind of a crapshoot unless you, unless you have some really good connections. So we took out some rent and we started low with low overhead. And as I mentioned, since I was a contract therapist, I got to set my own hours where I was working and was able to gradually pull away from there as my practice built up. Now I had what you call unique situation. Talked about this before. If a therapist is in a unique situation of they're married to another therapist, or they have somebody close to them who's another therapist, or they have a spouse who is able to help out in the practice while you continue to work full time, that's a pretty unique situation. That's sort of how I sold that to my wife. I said, look, you're a stay at home mom right now, but you're also an ot. You speak the language. You know as much as I do about it. You could be the clinic. You could. Here's the cell phone. That's our phone number for the clinic. You could, you could answer the phone, set up any Appointments. And then once we had the brick and mortar facility, she would go up there with my kids and kind of hang out, you know, in the back office while anybody was treating. And that's. That really was how we did it. I mean, we started on a shoestring and with my wife basically being the practice and me gradually pulling away from where I was.

Wow, awesome. That sounds great. Did you have, I mean, was there any time, was there any pressure to, you know, perform or make more money in the private practice versus the contract work? I mean, where were there any challenges starting up?

You know, the. What I initially did was put the pen to the paper and say, how many clients do I need to replace my salary? Where I was, how I did it was smart. At the time, I didn't know it. I didn't really know what I was doing. But looking back on it, I was like, how did I know how to do that? But what I did was how many clients do I need that other therapists can see that will replace my salary from where I'm at now? In other words, that another therapist doing a contract rate like I was doing, but in my facility and me making a little bit off of their, off of their treatment. So I determined at the time I need 56 clients of someone else treating them to pay the rent and to pay my salary at that time. And that was the goal. You know, 56 clients and obviously I was still treating, but that was where we were going. That was the destination. As far as the minimum viable product,

as they say, was that 56 a week or a month or.

That was 56 a week.

Okay.

And you know, in pediatric, in a pediatric setting, that's usually two to three sessions per week. So that's kind of what we were shooting for.

Okay. And pediatric setting, are you typically treating the patients for a shorter duration of time or maybe. What's the duration of time that you're treating? Yes, let's start there.

Yeah, the duration. Typically in our neck of the woods, as we say down here, we're seeing a client two times a week, 30 to an hour session for each session. And that continues where we're at. We only have to reassess every once a year. Sometimes depending on the system, you might have to reassess them every six months. But these are kids who have long term difficulties. It's not necessarily that they had a stroke and you're going to repair, you know, get them back to where they were in six weeks. It's. They have some sort of developmental delay, down syndrome Autism, they have continual problems. In our state, we have a really good Medicaid system that reimburses pretty good. So that's why we're able to do that. If a child qualifies for the services, our state Medicaid pays for those services and how long that'll last. You know, each state's different with their Medicaid reimbursement, but right now it's good.

Right. And do the school systems where you are, do they provide any therapy or services for the kids?

They do, they do, yeah. They're not. Kids aren't getting as much therapy in the school system as they could through my clinic. And actually that benefits our clinic because if a parent is aware that they can come to our clinic and receive supplemental therapy, if they qualify for it, they can get some outside therapy or they can get the school based therapy has to be academically, it has to be according to academics. Whereas in the clinic, I don't have to tie that back to their academics so I can bring them in possibly when they couldn't get the school therapy.

Gotcha. Gotcha. I did a little bit of work here and the school therapy was very limited. And I did it through one of my clinical rotations. We had just very limited in school therapy. So how, tell me, how did you go about getting a. Building a caseload and did you build it for yourself first or did you go after the contract therapist first?

You know, I knew from my experience working in the developmental daycare that more kids receive speech therapy than anything else. OT is the second and then third in the pediatric world where I'm at anyway. And so I knew that speech therapy would probably be our bread and butter. And that always has been as far as my clinic is concerned. So I'm trying to remember which came first. I think we had a speech therapy client before we had an OT client. Even though I'm ot, it was a close second anyway, so I had to go find me a speech therapist. And so I put an email alert out that I needed a speech therapist and I had one come on. And she was willing to treat just a few clients and build up a caseload. And she eventually did. And she stayed with us probably for almost seven years. She was our first speech therapist and she has since left, she's had a child. And I remember the day that my wife called me and said, we have a referral for this family who needs ot, PT and speech, all three. And in the home, this lady had adopted special needs children. She has four, four special needs children. All four. There was four kids. I'm sorry, I said three. Four kids needed ot, PT and speech. And we essentially went from one client to five clients instantly. And I was like, whoa, this might work. You know, it was sort of a validation. But the hustle then was to go out and find the speech therapist. I had the speech therapist to do it, but had to find a PT. At that point, I could do the OT and I did that. And that's been almost 10 years ago and we still treat a couple of those kids that we first saw. It's interesting. That's where we started and they're still with us, so it's pretty cool.

Your clients are almost. They're very different than mine in that their lifetime value is probably a lot different. What's the lifetime value of your patients?

You know, I've not actually figured that number, and that's sad to say I haven't. Obviously those clients right there, who we've seen for, you know, close to 10 years, we started seeing them when they were very young. That lifetime value on those particular clients is very good. I should figure that out. Now that you say that, I want

to back up real quick and tell us. So you've talked about your practice a little bit. You have two locations. Can you tell me, is that right?

That's right.

Tell us a little bit about the structure of your practice and when did you open the second location?

The first location we had probably for about four to five years before we opened the second one. And the first one was doing very well. And basically the geographical setup of that is, as I mentioned before, I wanted to work close to home. So we opened the first physical location in my hometown, which is a smaller hometown. We probably have 5,000 people. Where I live, south of me is the town where I went to college. And it's a bigger city. By no means is it huge, but I knew there was a need more rural than there was there in the larger town because they had the therapy there, although that's where they had the three month waiting list. So what we did was after about five years, we decided, hey, it's going pretty good where we're at. We've grown pretty fast. I think there's a need in the other city. Let's open a place there. It's the same doctors and that we were already working with, but we sort of overshot on that one and probably could have thought it out a little bit better. We did not. We underestimated how close these other therapy places were intertwined with the Pediatricians there. Obviously we were not much of a competition for them, you know, 10 miles away in the rural town. But once we moved in in the same town, then we were direct competition with those therapy providers. That being said, they are each a developmental day care center, which I didn't want or have a daycare and I never will have a daycare. That's a whole different ball of wax.

Right.

So the referrals were a lot slower there and they continued to build there even though we've been there for quite a while. It is just the inroads there were underestimated as far as how difficult they were going to be. But we're making a go of it.

Okay, was there anything that you did trying to market that location that didn't work? And then was there something that was like a home run in marketing that location?

You know what was interesting is we. I know we could have marketed it better as far as that location. We just thought, you know, we've been working with these doctors for four or five years. They know us. All we got to do is tell them, hey, now we're open here and there. Again, if you build it, they won't come always. So we had to rely more on people just recognizing that we were there and we had a decent location in town. It wasn't the best. We've since moved and have a better location. And this is a good tip for anyone considering building a brick and mortar practice. We first opened up that practice more in the shopping district and it was more tucked away off of a major street. And once we moved over to more of the medical district and had more of a street presence as far as signage, then people began to recognize us just as they drove by. And they recognized that. I think they recognized that, well, they're in the medical district over here, so they must be serious. Whereas before we were behind a Chinese restaurant and it kind of stank when you come in the door. So it's not good marketing right there. That was lesson learned as far as that's concerned. You know what's interesting in that location, and it's not so much in our rural location, but more in the city, is we begin to be known that we will treat Spanish speaking clients. The other facilities, since they have so many clients to treat, they can make the choice to not service those that are hard to service, which is Spanish speaking clients. I had a friend, and I still have a friend who was wanting to do some interpretation for us. And so basically I got him a phone, a cell phone, and Gave out that number as far as to some of the Hispanic community. And let the doctors know, hey, if you have any Spanish speaking clients, we use an interpreter for that. We'd be happy to treat them. And still to this day, it was funny. My wife had a baby three weeks ago, and one of the pediatricians, you know, they make their rounds and they come in, check on the baby. And I knew the doctor, although I knew him by name and I knew him by face, although he didn't know me because he's newer to that practice. And so I just introduced myself and let him know, you know, that we own therapy for kids. And he's like, oh yeah, y' all do the Spanish speaking clients. That's instantly what he knew. And I said, yeah, we do that. But it was good. It was good marketing. You know, it was a niche that it was the. That wouldn't be fulfilled.

Right? That's great. That's great foresight to see that or whether you stumble upon it or not. I mean, that's really awesome. And that's definitely something that there was a need. And you just kind of go, it's like some days it just pops in. I've had those moments, it's like, boom, oh, this is what I need to do. That's really great.

Doctor. Well, and I've told other therapists that I consult with that story and they'll usually say, because there is usually a need for a Spanish speaking therapy. And they'll tell me, but I don't know Spanish. And I tell them, look, I know five phrases in Spanish. And all those will get me in trouble. And you know, you go, you go hire somebody. And they'll say, I don't know where to find somebody. If you have a local university or even churches, a lot of times will have a Spanish ministry. We get a lot of our interpreters from the local university and, you know, they're willing to work a lot of times some PRN shifts and just come and go as you need them. And that's worked pretty well for us.

Do they come into your office or they do it remotely through a three way phone call?

You know, I've not tried the three way remote interpreter. That's a possibility. I always have them come in because it's. Our clinic is real close to the university. I mean, you can almost walk and so it's not really that hard for them to come in. What sometimes gets a little bit difficult is having the Spanish speaking interpreter call the client to set up that initial evaluation because they're Being an intermediary between the therapist and the client themselves, you know, and if the time doesn't exactly work, sometimes that gets a little bit hairy. But, you know, you work through it and do the best you can. And once they initially come in, if they qualify, then you can set up future sessions right there.

Okay. Okay, great. I went on to kind of back up in a question that popped into mind a little earlier. Because you're hiring people, can you tell me what are like your top three or top five questions you ask someone before you hire them to know? Like, are they the right person?

That's a really good question. Hopefully I'm getting better at this game as far as hiring people. I've probably, I've done a number of interviews. So I know my first few interviews were. I'm sure they were scared to work for me. And I always ask the therapist that I hire, what in the world were you thinking when you were talking to me in the interview? Because I learned from that, you know, you're like, well, you know, I figured you would be a, a good guy to work for, just, you know, vet your wife also. And that, you know, whatever the circumstance was, they, once they agreed to come on, they realized, all right, Scott's not such a bad guy. He didn't know what he was doing in the interview. But I've gotten better, hopefully. Usually what I'll ask them is what they're good at, what they like, you know, what type of child or client do you like to treat? I usually ask them, you know, I like to get down to not personal stuff, but I like to get down to what their values are. Because a lot of times it's a value match. If you have a professional in front of you that you're interviewing, if they know what they're doing, if they're competent. After that, it's sort of a character value match. Does this person have similar values or characteristics that you're going to be able to get along with and that your other therapists are going to be able to be able to get along with. We have a very family oriented atmosphere in my practice and if I brought somebody in who was partying every night, that probably wouldn't work real well. I mean, everybody's real laid back. They'd get along. But it would be easier to have someone who had similar values and similar background as far as that goes. So I was at our university here and I was speaking to one of the classes there. And These were therapists, OTs, who were going to graduate this Semester. That was one of their top questions is what type of questions are you asking in your interview? A lot of times I'll also ask, where do you see yourself in five years?

That's a great one.

Yeah, I had a PT here recently and I was interviewing him. PTs are great because they're so ambitious and you know, they get, they get this business stuff better than us OTs do. And a lot of times in speech therapists do that. I don't know, they're just kind of pre wired for that. So what he said was, you know, I said, where do you see yourself at in five years? And he said, I want to own my own practice. And I was like, awesome. You know, I had just started my, Start a therapy practice website and I was like, that's awesome. I can have a guinea pig right here. And he has since moved to a different town, but I mean, just a great guy and I know with a little bit of mentoring he'll have a great practice. One day he was on the ball. So that's what I asked, where are you going to be at in five years, maybe 10 years? One of the students there at the college, she said, well, what if I'm nervous and I just can't hardly talk? And I told her, I said, that's good, you know, that's because that means you're taking it seriously. If you come in there kind of nonchalant and you know, it's kind of a whatever deal, I'm probably not going to hire you. But if you're, you know, if not necessarily over nervous, where you're going to, you know, throw up on the table. But if you're taking it serious, that means you're a little bit nervous. So you try to pick up on some of the smaller stuff as far as the values and the character. You know, I can teach therapy. I always tell the OTs that come in and PT and speech, to a certain degree, I can show you therapy. I've been doing that for almost 20 years. I can't teach you how to be a good person. So that's what I look for a lot.

That's great. Those are great points. Is there any red flags or know that people throw up or from your past experience, you're like, oh, that's just not gonna, that doesn't work with my values or that's not part of my system. What, what have you experienced that way?

Well, and another question I ask them is, you know, what do you like to do on the weekends? You know, always it's It's a small place around here, and most small towns are like that, you know, if I ask them enough questions, sometimes I know people they know. Which if. If I, If I have my. If I have any options, I usually ask my therapist that I know or therapists that I know known in the past. Do you know any therapists who want to pick up some kids? Because that's the best way to get a therapist is to have a recommendation. But I've hired plenty of therapists who are just, you know, blind. Email. Somebody will email me and say, hey, I want to. I want to come work for you. And I've gotten better as far as judging character is concerned. You do that enough and you get better at judging the character. What was the question?

Oh, I can't remember. That was a good answer. Yeah, that's great. Those are great. It's more like, I think, red flags. Is there anything that someone said before you were like, oh, that's just. That was the craziest answer I've ever heard. That just can't work. I don't know.

You know what's interesting? I've told my wife this before, and I don't want to offend anybody who's listening, who might be driving a nice vehicle, but if you're coming to my private practice to work for me, nobody works full time. It's all contract pay. At the most, you're working four days a week, and that's just by therapist choice. I didn't set it up like that. But if you're able to make up, make out your own schedule, you're not gonna work on Friday, at least not on a consistent schedule. You might do an eval or makeup sessions. So none of my therapists work. I have one therapist now who works consistently on Friday, but she's cut from a different cloth. She's a go getter. But if I have a therapist who wants to come in and just treat a few clients or even build up a caseload and they drive up in a Mercedes, it might not work, or it might not work if they're just living way beyond their means. I've had therapists who come in and they're making contract pay, which is really good money, more than they can make as a salaried therapist, and they start making some bad purchases. As far as poor choices and living beyond their means, then they have to see more clients. Well, how it's set up in my clinic is I don't have a guaranteed minimum amount of clients that I'm going To give you. I will give them to you as they come in. As far. And there's ebbs and flows throughout the year as far as when we get referrals and when we don't have referrals and right now you have what, six or eight inches of snow on the ground, people are not going to show up for therapy. You're going to have a busted week and your pay is not going to be as good as it will be two months from now. And so it fluctuates. So therapists who are living beyond their means as far as their tight budget usually will opt out as far as working contract pay and go make the salary. I don't know why. As far as you can make more money. But they're not budgeting their money correctly to make it even throughout the years. That makes sense. They're spending it as they get it.

Yeah, yeah, got it. Gotcha. All right, I want to pop over to a couple other. A little bit different topic, but one of the things that I want to know about and I think a lot of people want to know about is everyone's kind of struggling with something different is when you're working with people starting a practice or when you're starting a practice, what are the things that you see most people struggling with and how do you start to address. How do you address that? Like, what are the common things that you see that people are like? I'm struggling with this, you know, X, Y or Z?

It's interesting. I was reading, I have a survey on my website and it's for therapists who are in private practice. And one of the questions is, what are you struggling with right now? And I was, I was just looking over that because I've had quite a few submissions here recently. So I was like, I want to go look at that before I talk to Aaron today and see if I can glean any nuggets of information. And one of the themes of what they were struggling with was managing their time. And that was a big one. Setting up systems in their business, marketing, and just trying to do it all. And that is. I'm still there. I mean, if you own your own business, you're always going to be. You're always going to be struggling with those things as far as keeping all the flaming hoops in the air that you're juggling. A book that I've recommended here recently for people who are really struggling with the time management, there's a couple of books and I wish I would have read them 10 years ago. One of them is called the E Myth Revisited. I don't know if you've read that book, but that's an excellent book. The. The other book is as far as struggling with time management is called the One Thing, but that E Myth Revisited. If you're. It doesn't matter where you're at in your private practice or if you're even thinking about private practice or small business, you got to read that book. It'll give you a mindset of working on your practice and not in your practice or in your business for that matter. So it's an excellent book. I got some book recommendations on the website over there. I got my. I got the top seven books that you got to read, you got to have. You got to own them. I added another one today called the Magic of Thinking Big. I got it right here.

Okay, awesome.

That's a good book. I'm gonna make my kids read this book.

Okay, great. Anything else off the top of your head? Like that's on your list? Books or places, things that we need to read and learn.

Hold on just a second.

Yep, yep. While Scott's digging that up, I just want to remind you guys. Listening. If you have any questions for Scott, please enter them in the chat box to your right. And we'll be sure to try to get. To make sure we get to all of them by the end of. The end of the show tonight.

All right? I put these books here by the computer just to show them to you. Here's. Here's one you gotta read. Guerrilla Marketing.

Oh, yeah, I read that one 15 years ago.

Gotta read that one. Yeah, you gotta own that one. It's the E Myth.

Okay?

That's the E Myth. I want us to come back to presentations, but when you start giving presentations, get that book there. Secrets to Dynamic Communication.

Wonderful.

All right. For networking work the Pond.

Oh, that one.

There's a two by Stephen Covey here. You got it. This is a pretty popular one. Get the glare off of there.

Mm.

Seven Habits. The Highly Effective people. You gotta own that one. And once you start hiring people, you got to have that one by Stephen Covey, Principal Centered Leadership.

Great recommendation. I'm gonna have to start replacing all those textbooks from PT School. More business oriented books. I saw these hundred dollar tomes, you know, that I haven't even cracked open.

Yep.

Sad thing.

Well, I find a lot of people don't. I find a lot of people don't read books anymore. You know, we're real. We're on the Internet all the time and reading Blog articles and, and whatnot, which is good. But you should always have a book that you're reading. I try to do that. I don't have much time to read books, but I always have one that I'm going to. And I like audiobooks too.

Yeah, audiobooks are good if you have a time and place to listen to it. Okay, awesome. Thank you, Scott. Those are great. I've got another kind of follow up question on that. So you've got this survey. What else is in the survey and where do we can, where can we find it? If someone wants to, how do we get the results or how do we participate in that?

It's a good question. If you're in private practice and you gotta be in private practice in order to take the survey, if you take that survey over at startotherapypractice.com, you will get the results for free. If you're not in private practice yet and you're like, oh man, I'd love to see the results of that survey. It's for sale over there. I think it's, I don't remember, four or five dollars. So it's super cheap. So you could, you could purchase it also. But some other stuff that's in there is, let's see if I got it on my computer here. Okay. One of the, one of the things was, one of the questions was, how much per month do you spend on marketing? Now these are therapists who have a private practice, not necessarily a brick and mortar private practice, but some of them do. 60% of the people who took this survey spent less than $100 a month on marketing. I would say I spend a little bit more than that. Depending on where you're at with your private practice, you probably want to be spending at least $100 a month. And I would spend at least $100 a month in Google Ads. I took out a Google Ad probably six or eight months ago. And it's, I mean, you know, people are not just busting down the door after that, but I have seen an uptake in referrals and you know, Google has some good analytics on that. You can, you can look at what your Google Ad money is getting for you. And it's, it's good in that you can set your budget as far as how much you want to spend. You don't have to spend $1,000 a month. So you can kind of experiment with it. You know, what's 50 bucks a month going to do for you?

Right.

Go ahead.

What is working for you in the Google Ads, I guess. Real quick, let's explain what the Google Ads are and just tell me what's working for you. Is there a certain strategy that you found that was working best?

Well, a Google Ad is simply if you search anything on Google, you'll notice at the top those are paid advertisements. And the way to know is there's a yellow square that says ad next to that search. Now, the search is relevant. It's going to be relevant for whatever you searched for. But there's some keywords that those people are paying for to come up so their website or their ad will come up. What I did was first I wanted to see what my competition was doing, were they taking out any ads? So do a search for what you're providing, whether it's physical therapy, speech therapy, occupational therapy, or any special services within those. If you're providing feeding therapy as a speech therapist or dry needling as a pt, put that search in there. Although you have to think like a potential customer. Is a potential customer going to search dry needling or you know how think like they would or, and just ask people who are not necessarily therapists, hey, if you had this problem, how would you search for that? And you can also get in the search box and dry run those different search phrases. But what I did was I searched for, like I said, speech therapy is our bread and butter. So that's where I keyed in on as far as my private practice. So the keywords that I wanted was speech therapy. And then my geographical location, my city. That's. That's what I keyed in on. And so if you do that search phrase speech therapy in my city, that's I'm number one. I'm coming up as, as that as the ad. Now, I noticed the other day that another speech therapist had come up. She's her, her niche is dyslexia, but she lives 50 miles away from me. But she came up in the search as an ad. People will travel that far for dyslexia services, by the way, in my area. So then on the same page, you want to come up on page one. On the same page, my, my clinic comes up on down along with my competition, but I'm at the top. So that's, that's pretty significant right there. If you think about the younger generation. I mean, we're treating kids in my clinic. Their parents are probably under the age of 30. What are they doing? They have a smartphone in their hand. If junior here is not talking right, they're going to do A search on speech therapy, My city. And that just. You have to think like a potential consumer would. What are they searching for? How are they searching for it? If you're seeing geriatrics, they might not be Googling stuff. They might still be using a phone book. But in my practice, they don't know what a phone book is.

I don't know what a phone book is anymore. It's this little tiny thing that gets dropped on my doorstep once a year.

Recycle it.

Yep, recycle it. Exactly. Awesome. That's great. Is there anything else that you're. That you're using, like you're spending your money marketing on? Are you doing. Are you doing any other paid advertising, like in magazines or papers or anything like that?

I got one of these. See if the camera will pick it up.

Okay, awesome.

It's a shot, but it's also a pen. It's an ink pen. So it has my clinic practice on their phone number. OT, PT, speech. And so what I did is I ordered 300 of these. This is just an example. I mean, I do different stuff. I'm always thinking about what can I use for marketing. And so I just carried these around with me for a while. And it was funny about the time I purchased those, two of my kids got sick with the flu, so we had to go to the doctor. And so I had a handful of these ink pens that look like, you know, shots. And I wanted to give some to my doctor because he'll refer kids to us sometimes. And so I had this handful, and I said, hey, I want to give these to you. Well, they look real enough. And he said, what is that? He was backing up. He didn't know what that was. But then once he realized, he thought that was pretty cool. So it's just another reminder that we exist. If you look at marketing, marketing has what they call the rule of eight. If you think about this in your own life, sometimes you have to be presented with a certain product or service a number of times before you finally say, oh, yeah, I remember whatever. Those pair of shoes. Or the plumber. Now that I need a plumber. I remember that commercial that I saw 500 times. So they call it the rule of eight. And this is from an ebook that I bought from. I think it's called George Meets the Marketing Man. I can't remember if I can find it. I'll. I'll send it to you, and maybe you can put a link on your. On your website. But basically, it's a story of how this. It was a furniture salesman. His advertising was bad. So basically the marketing guru told him, look, people need to see things so many times before it clicks. And they say, okay, I need to call Aaron, because I know he does PT because I've seen his card here and I've seen his ink pen there, and I've seen the ad in the fitness magazine over there, and then he gave a presentation over here. So it's, it's. People have to be reminded, you know, it has to be fresh in their mind.

Right, right. Awesome. Is there any one, like, if you were going to do one thing, which one of those things were you going to would you choose to do?

I would do one that I hadn't mentioned yet, and I would get to know how. I'd get to know as many people in my geographical area as possible that either had a business with similar clientele or I thought could have a potential refer for me. And what I would do is I wouldn't necessarily hound them. Hey, do you have any referrals for me? I would. I've done this naturally, and throughout my career. But the book that I showed here before, called the Frog and the Prince, it outlines that as far as in networking, that's a networking book. As far as you're meeting somebody, it should always be in the front of your mind. How can I help this person out? How can I make a connection with him that he might need? The other book that you must read, I don't have it because I actually make all my office workers read. It is called how to win friends and influence People. That's a must read. You must have it on your bookshelf. You must read it about every year or two. So I make all my office workers read, read that. And Michael Hyatt said one time that your front office person is the director of first impressions, and that's what you need to tell them. I tell my office workers that you are the director of first impressions. And so I make them read that book and it out, it gives them a good idea of, okay, this is how we conversate with people. This is how, this is how you're helpful to people. And so that's what I would do with influential people, potential referrers in my geographical areas, is get to know them, network with them, never be a burden on them, always be helpful to them. How are you going to help that person out? How can you take them to the next level? Because then you're just riding on coattails at that point. Everybody, you know, Rising Tide rises all the Boats.

Mm. I call that the, like it's the win, win abundance mentality. Like a give to get where you give other people something of value and they'll just. They reciprocate because they feel like they should.

Yep. And it's just a nice thing. It's the right thing to do.

Right. That's awesome. That's awesome. Let's see. I've got another question. I want to lead in to one of the questions from the audience, but as well. So I have a. I have a cash based practice and so that's a lot of my focus. But at the same time a big part of it is marketing and that's one of the reasons I have you on here. But let me ask, are you doing anything with your practice? Do you have a cash rate, like a same day payment rate or any cash programs, anything like that?

We do have some clients who pay out of pocket. It's very, very rare. Most of my clients are state funded. As I mentioned, I do have a cash rate. If you want to pay me cash, I have that rate set. I need to put. I've kind of redone my website here recently. I took it over from my web developer. So actually what I intended to do was put that cash rate on my website. Maybe not right on the front page, but I want somebody to at least be able to find. I had this conversation today with a client, a potential client. Anyway, they have insurance and I told them, look, we're early in the year, you've probably not met your deductible. Here's worst case scenario. If insurance doesn't pay anything, here it is, here's how much it's going to cost you. I always tell them that anybody who has insurance, I always tell them that because they'll say, well, my insurance will pay 80%. Well, in a pediatric world they might not because a lot of insurances are not going to cover the therapy unless it's because of an accident or stroke. And I tell them that. And so I say, well, just in case insurance doesn't pay, I want you to be aware that we will bill the insurance, but if they don't pay, here's the fee. What I've gone to here recently is I've gone out of network with all but two insurance companies and those are the big providers in our state. You kind of have to play with them. Where I'm at, as far as pediatrics is concerned, you don't have to, but you have to. Where I live in a rural, in a rural setting and still Want to eat. So when somebody comes and says, I have United Health Care, I don't play any with United Healthcare because they don't play nice. And I say, well, we're not in network with them. We can certainly treat your child, but here's the cost for that and I can give you a super bill and you can turn that into your insurance and maybe they'll pay you and maybe they won't. But I don't make that negotiation with most of the insurance companies. It's just is such a waste of time. Such a waste of time.

Well, being out of networks, basically almost being cash based, it's like nowadays with huge deductibles and copays, it's pretty crazy.

Yes.

What's the average, Let me just ask real quick, what's the average copay and deductible for your patients?

You know, I would say the average copay for the few clients that we treat who have private insurance is probably around $40. Yeah, I'd say that's probably average and that's per session. If you think about that in the pediatric world and you have a child who's going to have a year of therapy, that's a lot of money.

That is. Yeah, yeah. What's the largest copay you've seen?

You know, Blue Cross has done pretty good for us on a few clients. If they have a federal insurance Blue Cross that they can pay pretty good. I mean, I'll charge like $110 for an eval and I've had, I've had some federal insurance policies pay that.

Okay.

You know, the full rate. So that's about as good as it gets.

Awesome. Awesome. Scott, let me get to a question here. So I think we answered a little bit, but this is from Kristen and she just asked, have you used cash based practice methods for pediatrics and if so, what's your experience and advice? So I think it seems like we covered that. Is there any other advice you have for someone who would be looking into a cash based pediatric clinic?

Yeah, if I was to go more cash based in a pediatric clinic and this really, you could, it would be advice even if you're not doing cash based, but especially if you're doing cash based. I would probably have more programs. As far as a pediatrician, a pediatric practice, I would have some handwriting programs, some pragmatic programs. As far as speech therapy, I would have, I would do some like sports programs, I would do some exercise programs. And I've thrown these ideas around before. We actually did a. What we call a fit kids camp. And it was for special needs kids and it was the most work I've ever done and I only did it once but it was pretty cool. It was pretty cool what we did. We had a pretty good showing of special needs kids. I brought in the local university, the OT class there. So they volunteered and helped. That was a big help. And we did it at one of the colleges here who have nice facilities, a huge rock climbing wall, a swimming pool. So we had a one day of activities and it was good marketing. It was a train load of work. But. But I would do more stuff like that. Maybe on a lower scale, you know, I might have a group of whatever, six kids doing a handwriting course once a week or you know, an exercise course. I've thrown around the idea and one of the PTs and I were going to do a speed camp for kids in the local area at the community center up here, which we have a nice community center right across the road from one of our clinics. And so we were going to do a speed camp for. And we were gonna. This was not gonna be special needs kids. These were gonna be, you know, teenagers who were serious athletes. We wanted to provide a like a two week speed camp in right when school got out and take some initial measurements, give them some input on their shoes, their running style stuff. I'm not the pt so I was gonna defer that to the mt but give them a two week, you know, basic training speed camp and you know, charge them 100 bucks for that for that two weeks and just see how it went. I would do more stuff like that.

Mm, awesome. Awesome. Just real quick follow up question. Let me get back to my. I was looking up something for someone. There we are. Okay. When you're. Kristen also added a follow up question. When you. How did you determine your cash rate compared to Medicaid or private reimbursement? Is there, is there a limit to what you can do being a Medicaid and Medicare provider? And how did you determine that rate?

I put it just a little bit above the Medicaid rate for a while. I had it pretty far past it and I was like, you know what, that's not realistic. I need to bump that down. So it's actually not very. I mean it's a few dollars more than the Medicaid rate and then we just take what Medicaid pays us, which is fine. And I've thrown around the idea of alright, I'll just take the Medicaid rate. But it's, you know, I think Most cash based therapists can appreciate that. I don't want to be dictated to by the man.

Right.

So I'm gonna, I'm gonna charge what I want to charge kind of deal. I think, I think you cash based therapists are probably free market people, so you can appreciate that, right?

Totally. I think it's. But still at the same time, you know, the rates are all over everyone, they're all over the board and people don't know what to charge. And that's a big thing, is that we need to recreate our own value across the board.

I want to recommend a podcast that I came. Actually my wife listened to it the other day and this is not directly related to therapy. It, it's not even directly related to healthcare. But it is if you listen to it and I'll send you the link to it. But it's@tomwoods.com and he has a bunch of podcast episodes. Podcast episode number 340 fouromwoods.com he's talking about the market in that. And if you listen to that and keep in mind and relate that to health care, I think you'll get a lot out of that. I just want to throw that out. As far as it sort of pertains to pricing in there, it directly pertains to that. So I'm going to throw that out there.

Okay, awesome. And I'll put that link up and some of these links up into the show notes when I post this to the blog and everything. Scott, that's great. There's one other thing I wanted to touch on that I have written down and you've created a great client tracking spreadsheet that I've seen on your site. Tell me about it and why did you do that and how does that help you in your practice?

Yeah, from the beginning I needed a way to track clients and I did not want to have a paid EMR that I was paying monthly for when I only had just a few clients. It didn't make sense to me. So I really bootstrapped that and just I learned how to use Microsoft Excel well and slowly developed a tracking spreadsheet for my clients. And it's just, it's developed over the years as far as what I've added onto it. And essentially it has all the client information on there, you know, date of birth, address, phone number, that sort of stuff. But then I also needed a mechanism to track when prescriptions came due because prescriptions come due for my clinic every six months. So I needed a way after I had more than Two clients. I couldn't keep up with that mentally. I needed a way for me to be alerted before the script ran out so I could request the next script for continued treatment if we needed it. So that's what I first added that on the spreadsheet. And then I also added, well, re evaluations are due every year so I need to be alerted every 11 months so I can have a month to to do the evaluation. When that evaluation is due. Well then I needed a heads up of, okay, I sent this prescription to the doctor. Did I get it back? Once you have multiple clients, how are you going to track that? It tells me that also I can put that information in there and have it give me a heads up. Hey, it was seven days ago that I sent this to Dr. So and so did we get it back? And then also on this spreadsheet started putting some marketing stuff on there. How did they hear about us? Where is this client treated? In which clinic is it treated in a school, in a daycare and home? It tracks that where, like I said, where the referral came from. Was it the doctor, another professional, a friend. And I'm trying to think what else is on there.

Awesome. It sounds like a lot, a lot of good stuff. So that's great. I put a link to it up for everyone. I think, Scott, you've got it for free on your website.

It's a freebie. Yeah. And if you use it, I would like to know your thoughts on it. What do you think about it?

Awesome, awesome. That would be great. I don't have anything that detailed that I track. I use a system for creating receipts and I just track my referrals and some things there. Well, did you have a question that you had emailed to you, did you want to.

I did. Look at that. Let's see. And the other thing I was going to mention is I use QuickBooks for some invoicing. QuickBooks is very handy and I use this. If you're cash based, you don't need it. But I use Office Ally as a clearinghouse. Let's see the question. Here it is. This is from a therapist that I know who lives not in the United States and she was asking about low cost marketing. We went over that pretty good. I think the other thing that she was coming, she came in, had a difficulty with is that in social networking forums people will post and say they need to, they need a therapist. And so she'll say, well, I'm a therapist, you know, you could, you can come see me. But these people apparently, that she's corresponding with will not come and see her unless they know somebody who came to see her. And so she's asking, you know, how do I get around that somewhat? I think that might be a cultural issue as far as different cultures. They want to know. They want the direct referral from a friend and be assured that, okay, this is. This is a good therapist. This is a good doctor, whatever. But my point here, I wanted to bring up is that not every potential client is or should be an actual client. Some people will not fit with you or your practice. And it took me a while to learn this, and I still have problems with this. You know, I want to please everybody. I want to treat everybody. I want to heal everybody, but that's simply not the case. And honestly, we've had some clients, and it wasn't a good fit. And it. And it didn't. It was not a good thing sometimes. You know, thankfully, this has only happened a couple times. But they left not satisfied just because it was not a good situation for them. As far as a good fit. Now, what's interesting is each of those clients, we were their first type of therapy. We were their first therapist as far as initiation into the system. Now, they don't know what they don't know. So once they left us and they went to another facility, it took a while, but all of them have called me back and said, can we come back? Because the situation wasn't quite as bad as they thought it was once they went somewhere else. But my point here that I want to make for this question is that not every client is going to be a good client. So make sure the fit is good. And sometimes you got to send them down the road and say, you know what? We. We might not be a good fit. You might want to go down here and see so and so I think they can help you out. You want to be helpful and you want to be cordial, but, you know, don't. Don't force the brown peg into the square hole.

Right. Right. That's one thing I've learned over the years, is that I can't heal everybody. I can't help everyone. And it's okay for people to not need to come into my practice, and it's just kind of okay. And it was really hard at first because I was hungry for new patients as well. Why isn't that person calling me back? But it has nothing to do with us as therapists. And a lot of it's the other person. The patient recognizes that it's Not a good fit. A lot of times we just don't know.

Yes. I want to mention one marketing idea that I think a lot of therapists are intimidated to do and maybe might not know how to do. But if you have a website, which you must have a website. I have on my survey There was about 20% of the respondents who didn't have a website. And I don't understand that. You got to have a website, people got to know how to find you because they're trying to Google search you. But on your website you must have some video and I know you have some good video over on your website and you don't have to overthink this as far as the video is concerned. But people have to see your face, they have to hear your voice, they have to get to know you and realize, oh, there's Aaron. I see him and he's a good guy, you know, he's working on this person and I can go see him. I've created a video here recently on my website for my clinic. It's just a walkthrough. Here's what to expect when you come in. Here's the paperwork we're going to work on. Here's the room we're going to go sit in. Here's the therapist that you might work with. And here's the owner. I'm Scott, the owner. Video is so powerful. And when you put that on your website, also put it on YouTube because YouTube is a searchable index and keyword that for your geographical location and what you're providing, speech therapy, PT or OT and your city, because that will come up in search engines as far as when they're Googling. Google owns YouTube. That's some marketing that people are missing, I think.

Yep. One other trick for that, for YouTube is in your YouTube video at the bottom in the comments section, you can put a hyperlink to your website there, but you must put the. And then therapyforkids.net after that or labour physical therapy after that. And that makes it clickable. That's one thing that gives you good Internet juice from YouTube.

Excellent. See, I didn't know that. I got to go back to my YouTube videos.

Put your practice and make it the very first line and then below that put a description of the video with some keywords in there. And that makes YouTube videos just kind of explosive. And they show up on Google searches.

Yeah. And just don't overthink it. Use your smartphone, shoot two minutes worth of video. And I did my last podcast, I did a segment on it was marketing and I did a segment on video and I put some kind of explained how I did that and how easy it is really, and how to make the sound good and the light good and. Yeah, it's underused.

That's awesome, Scott. We're just about out of time and it's been awesome talking to you. And I feel like we've got another couple hours of things we can talk about, so we'll have to do this again. But can you let us know where can we find you online? Tell us about where do we find your podcast, where do we find your website and more information about you if we want to. Someone wants to contact you.

Yeah, you can contact me through the website@startotherapypractice.com or my email is scottartatherapypractice.com and you can follow me on Twitter. It's Scott harmon, the number seven. I got a Google Plus. I got a YouTube. I have Pinterest, but probably don't do too much on that. So that's the places to find me. And if you have a question, want to email me, feel free. Okay.

And what about your podcast? If someone's a. Yeah,

the podcast is named the same. Start a therapy practice. It's in itunes and Stitcher where you can listen right there on the website. There's a little tab at the top. It says podcast. I got a blog over there. I recently put a blog post over there that therapists need to check out if you have a practice. It's how I set up systems in my practice to show my office workers how to do things or show the other therapists how to do things. You want to check that out because it's free tools. If you own a private practice, you need to be implementing systems in order to make your practice run smoother so you don't have to do all the work.

Right. That's about working on your practice, not in your practice.

Exactly. Yes.

Awesome. Thank you so much, Scott. This has been really great, and I really appreciate the time you took to come talk to us and share knowledge. Thank you so much. It's been a pleasure.

You're welcome. I do want to tell people that you are on my podcast number 15, so they need to go listen to that.

Awesome. Awesome. Thank you so much. Thank you all for joining us. I've got some great guests lined up for the next Cash BET lunch hour. We're doing one in March and one in April, so stay tuned for those. And if you have any questions,

if

we didn't cover your question. Sorry we didn't get there, but send us an email and either of us will be happy to get there. And thank you for joining us and have a great evening. From Snowmageddon in North Carolina, this is Aaron LeBauer with Labour Consulting and Scott Harmon, start of Therapy Practice. Thank you very much.

Thank you.