State of the Physical Therapy Industry: Trends and Predictions for 2020 | CashPT Lunch Hour #112

My name is Aaron LeBauer and if you don't know me, I am a physical therapist. I'm a massage therapist, I'm a yoga teacher. I'm the owner and co owner of Levour Physical Therapy with my wife here In Greensboro, a 100% cash based physical therapy practice. And I am the business coach and business consultant for Lebauer Consulting, which I started in 2013 to teach passionate physical therapists how to create success and successful businesses without relying on insurance companies. So if you're here and you're live, Comment Live Team Live. If you're here watching Team Replay, comment Team Replay below, just go to the comment box. Another thing I want you to do is tag your friends or colleagues that need to hear this or share this out with them. If you're watching the Cash Piggy Nation, you want to share it. You can't share from the Cash50 nation, but you could hop over to facebook.com Aaron LeBauer and share the stream from there as well. I want you to use the comment box comment below right now while I'm talking. I won't be able to see it because of the way I've got the whole presentation set up. If you've got questions, put them in. I can come back later or we will have time at the end for a Q and A. Also, I want you to use that thumbs up and the hearts and then even like the angry face, the happy face, all that stuff, it's down by the comments. You're just going to slide it over and you can see it and you can hit it and you can hit it a whole bunch of times. What that does is that's going to let me know that you're getting it, getting what I'm putting down and that it's going to help other people see this video. So make sure that you're speaking up, you're moving things forward and you're letting us know what's going down, what you're understanding, what your questions are so we can get your questions. So right now we're going to be talking about the state of the PT industry. A lot of things have happened in 2019 and these are my trends and predictions for 2020, how the physical therapy industry is changing and how not to get left behind. So if you're just joining us, great. Make sure that you let the Facebook know that you want to be notified when we go live in the future. Stay tuned for the end because there's going to be a Q and A as well as a special free gift for you if you're ready, just comment yes below or hit that thumbs up button a whole bunch of times. Share this out so my name is Aaron Labourer. As I said before, if you if you're just joining I as a PT student I saw 43 patients one day and that was on my first clinical rotation and that was the day that I realized that I had to do something different. You've probably had a similar experience. I don't know how many patients you've seen in one day or in one week, but now in our Cash practice we see five to eight patients a day. I have another physical therapist, massage therapist working for us as well. We've been in business here for in Greensboro for 10 years. I started my clinic the day I got out of PT school and everyone looked at me like I was crazy like and told me it wasn't going to work and we proved them wrong. And we've scaled it up and built it up and now we've put 600 plus people through my course, the Catch PD blueprint. I've helped thousands of people. There's almost 5,000 people in the Cash Pt Nation Facebook group. I don't know who the 5,000th person is going to be, but that's going to be an exciting thing and there's so much has happened in 2019 that we need to go through it and make sure that this doesn't happen again and make sure that you thrive next year. So my goal for this presentation is to help two kinds of people. There actually might be three, but really there's two kinds of people. You're just getting started, you're thinking about Cash based physical therapy and you're going to learn what's going on, what you need to know to be successful and understand where the industry is headed. And then number two is for people that are experienced, that have already been in practice for a little while, that are successful but want more. And that third type of person is probably for the students who don't know what they want after PT school, but they're considering or interested in cash based physical therapy, even becoming an entrepreneur. And I'm talking about people who want a Cash breakfast like I have, who want a business in the physical therapy industry, even an online business. Like I have people who are mobile and a lot of people don't know well I spent eight years doing mobile therapy. I've worked in the gym, I've been around, done a ton. I've helped dozens of practices move from in network clinics to out of network or all Cash. And I've helped thousands of people move into cash based practice. So if you're interested in helping people in a meaningful way and earning what you deserve and being able to pay off your student loans, this webinar, this training is for you. So if you stay until the end, we're going to have time for a live Q and A where I'm going to do my best to answer all of your questions based on the whole Facebook thing and live thing and how I can see your questions. I'm going to get to as many as I can and I've got a free gift for you, so just stay to the end. I've got something amazing that's not going to cost you anything. It's going to teach you exactly how to take your business and grow it and scale it, launch it first and then scale it. And I'm going to give you the step by step strategies on exactly how you can do it. So what makes this different? Well, I've been a physical therapist for 10 years, since 2000, December 2008, so a little bit 11 years. I started my practice in February 2009 and I've been a massage therapist for over 20 years. Since 1999. I've done a ton. I've learned a lot in my career as a massage therapist that allowed me to be successful as a pt. And there's a lot of things that I've learned outside of both professions, especially the fitness industry that I've brought in and adapted to physical therapy. And as I said, I've helped take thousands of people. I've lost track so far how many businesses I've gotten started through my courses or programs. And I'm still doing it like right across the street, like literally 20ft over is my clinic and I'm in there every day of the week. I'm not treating patients right now, but I'm in there every day of the week on the ground, growing the business, working with my staff, working with, creating relationships here in Greensboro, etc. We're doing it. There's a picture out front of our business at Lebauer Physical Therapy. We have a quiet private treatment rooms. It's not like a typical gym based clinic or even like big PT mill where they just pack a bunch of people on Clints. And our focus is on helping active people recover from pain and injuries without pain meds, injections or surgery. And my big mission over the course of the next 10 years is to help save 100 million people from unnecessary surgery. 100 million people from unnecessary surgery. And here in Greensboro, I want 20,000 people to have that opportunity to know that, hey, there is another option. It's called physical therapy. And I should probably try that first. And I should probably try it three or four times before I consider the surgery. I created the khashpdi nation about five years ago. As I said, we've got almost 5,000 people. We could have 5,000 people as of today. I haven't checked in a few days, but last I checked we were like 4947. Cash PD Nation is the largest Facebook group for cash based physical therapists. I'm the host of the Cash PD Lunch hour podcast. It's found on itunes, Stitcher, Google Play. Everywhere else you can find podcasts where I interview other successful cash based practice owners. I interview physical therapists and people outside the physical therapy industry who are experts at marketing and business and sales. And this is a podcast that's been downloaded hundreds of thousands of times to help people and help you gain insight, understanding and inspiration to know exactly how to do it. And so you can do it too. I'm the creator of multiple online courses and books. The Catch PD Blueprint. The CATCH PD Marketing system. The ultimate marketing system. Ethical Influence, PT Business University, PT Clinic Breakthrough. What else? The Cash PD Toolkit. We've got the Cash PD Blueprint book and I'm the coach of the Platinum Cash PD Platinum Mastermind group. So here you can see my book that we released earlier in the year. And it's a book that's taken me years to write and I finally got it out and I finally got the right combination of information and the ability to sit down. I spent about three months, every day, every morning just going through and writing out everything and making sure it was alright. And we've sold almost a thousand of them in the first few months. And it's just been, I don't know, it's been great. It's amazing to publish a book. It's a good feeling. If you get a chance, do it. Don't hesitate. As I said before, I'm on a mission to save 100 million people from unnecessary surgery. And I realized this a few years ago at the summit of greatness with Lewis Alice. I was like, all these amazing speakers, had these mission statements and ideas and goals that are bigger than themselves. What's bigger than me? And the thing that makes me so frustrated is hearing that patient come through and just say, hey, I was told by so and so I needed the surgery, but I did it. I did it anyways. Even though it didn't feel right and I should have come see you first. You know, it's just like. Or people getting surgeries for a sprained ankle because, well, we couldn't find anything on the MRI or X ray, so there must be a problem. Let's do exploratory surgery. And then that just makes things worse. And they're in another surgery six months later and another surgery three months later for the same angle sprain. It's just like, makes me want to bang my head on the wall. So that's the thing is, like, we've got to get in front of people. Physical therapists up to this point have not done a good enough job of letting people know that they can come see us first. And it's not just about yelling up and standing, how great physical therapy is. We have to get into a different conversation with people. And that's what I teach my coaching clients in our marketing programs. So onto it. 2020 trends and predictions. I think there's some big things coming. This year has been a tough year for a lot of people. This has been a tough year for you. Let me know in the comments what's tough. Did you lose your job? You know, there's a lot. Up until this year, it was like, hey, I could go get a job anytime. And all of a sudden this fall, a bunch of people lost their jobs due to some regulatory changes. Well, let's review 2019, because for a lot of people, it was a great year. For me, it was a better year than 2018. And I see in 2020 where there's some bigger opportunities and some places. When I review 2019, and we did this in my platinum Mastermind group last week on our masterclass, we went through exercises and metrics and numbers of. Here's exactly what we need to review. When I look at 2019, I see where, even though we did better this year, where I made some missteps, where there were some things that were working in 2018 that I didn't continue doing in 2019. So one thing is, you go back and review your own year. If there's something that's working, keep doing it. Don't stop doing it. If there's something that's not working, you need to look at it and see how can I do it differently. So the economy, 2019, all things aside, the economy is pretty great. Back when I started my clinic in 2009, man, the economy was tough. I don't know if you remember 2009, but it was just after the great Recession started, you know, like the dot com thing crashed in early 2000s. And then we had the whole Wall street crash thing happening. We called it, it was a depression. If you look at the stats and you're a, you know, a financial person, we call it the Great Recession. It was a tough time. It was like a lot of times I was like, God, if it only weren't for this recession, my business would grow faster. So what'd that do? At that time that pushed me to push the envelope and find more unique ways to market my business. The economy this year has been pretty good. I mean, stocks are going up, unemployment is like at a record low. Like right now. If you're trying to hire someone, they probably already have a job. If you want good people to come work for you in your business, you're probably going to go have to recruit them. I mean, it's been years since there were physical therapists actually available and looking for jobs. And in the last few months, in 2020, that's going to change. There are more people looking for jobs or different opportunities. But this year the economy has been so good that to try to find someone, they're most likely not the people without jobs that you want. Competition? Well, it depends on your view of competition, but the competition has been pretty fierce. There's some fierce competition out there. There's more people out there doing marketing. Right. And there's a lot of businesses out there that you think are your competition, but they're not. The hospital is not your competition. The physician owned practice is not your competition. The PT clinic down the street is not your competition. The cash practice owner across the street is not your competition. If, if you sell your patients what they want, okay, if you're out there trying to sell physical therapy and how great physical therapy is, everyone else who does physical therapy is your competition. You see that more people are starting to figure that out. A lot of people ask me, well, Aaron, I can't charge. Well, I can't charge more than my mentor who works down the street in a cash practice and they're charging $135 an hour. I'm like, but you want to grow in scale. And you're telling me that, you know, your business isn't doing as well as it should. You need to raise your rates. Well, I can't because my mentor. Who cares about your mentor, they're not your competition. They're not going to judge you. Do what you need to do and don't sell what they're selling. Sell what your patients want. You getting this. You getting that? It's like, sell what they want and give them what they need. What do they need? Physical therapy. What do they need? Whatever the manual hands on certifications you have. But on your website, don't go and try to, you know, distinguish yourself from your competition by listing all your credentials. That's the wrong way to go about it. You need to learn sales. And that's what I teach my sales and enrollment course. Ethical influences. How do we create a marketing message that makes it so no one is your competition? Student loan debt. Who here still has student loan debt? I do. I do. I don't know what I think. I am almost done. I've got about 6,000 left. But guess what? I'm not rushing to pay it off either. I pay it off when it's convenient and when it's easy. And when I don't have any credit card debt. If I'm leveraging some credit card debt to invest in my business, to grow my business, you know, I'm not paying off the student loan debt because my federal student loans is great debt. Because guess what, if I can't pay it this month, all I can do is call them up and say, hey, I can't pay this month. Can you put me on a hold? Yeah, sure. The bank, by the way, credit card, by the way, they're not going to do that. So, number one, yes, students are getting out of school with humongous stuff. Student loan debt, you know, not just 150,000, we're talking 200. 250. I even heard someone had $320,000 worth of student loan debt. I'm pretty sure that's private school, undergrad and grad. That's a ton. And you cannot let that keep you from moving forward and starting your business and investing your business. You can't say, okay, I can't start a business until I get rid of my student loan debt. Because guess what? It's going to take you forever to get rid of your student loan debt working for someone else. You can grow a business and generate more revenue and income in your own business and erase your student loan debt faster. If you want to go into business, you cannot let the student loan debt stymie you and keep you back and keep you afraid of investing in your business because you've invested 150 to 300,000 in your education. But just by being a doctor of physical therapy doesn't mean you're going to be great at business. You need to go and invest. You don't even have to invest the same amount, you just got to invest maybe 5 to $50,000 in becoming a better or a good business owner so that you can, like that's just a fraction of what you spent on becoming a competent physical therapist. And you need to be a great business owner. And you can do that for as little as a couple thousand dollars to maybe $20,000 a year. Boom. $20,000 in some kind of business training, education coaching program in exchange for a multi six figure, if not seven figure business. That's a pretty great deal. Student loan debt, even though it's rising, it keeps so many people from making those decisions and seeing it clearly. Because what our industry has done a bad, you know, whose fault is it that people are willing to pay more to go to school and schools are raising their rates? You know, it's a great time to be a physical therapist. It's not a great time to go to school and just come out with a job and expect it to be like what, birds and roses and you know, like sitting on the beach all day long. Like a lot of those jobs that pay well enough, a lot of people are getting burnt out on them. So that leads me to the next thing, is that reimbursement is going to continue to fall. So while student loan debt is going up, like school, like education costs are going up, reimbursement's going to continue to fall next year. I mean, it's been falling. Like, is anyone surprised that Medicare cut physical therapy 8%? Is anyone actually surprised? If you were surprised by that, let me know. Are you actually surprised that reimbursement is going to fall? Because look, stock market trends always going up. Even if we look at all the recessions and depressions and everything. Stock market trend so far in my career, reimbursement has always gone down. Even before my career, reimbursement has gone down every year. It's not private insurance job to pay your patients. It's their job to make sure that they don't have to pay for their patients. So reimbursement's continuing to fall. I mean, it's just going to. That leads me to this whole 8% Medicare cut in 2021. It was just announced like I said. Were you surprised? Yeah, it sucks. It's stupid. There's studies out there that prove that if people go to PT first, they spend less down the road for their back surgery, their medical interventions, their medications, etceter. So it's not logical. But guess what? It happened. So we got to do something about it. What are you prepared to do about this. Let me know, comment below or let me know, like shout it out on Instagram stories. What are you prepared to do about this? Like I can tell you what, it's not going to affect me one day. It doesn't affect my practice. This is 8% Medicare cut. Doesn't even worry me. Why? Because I insulated myself in our business from falling reimbursement rates and Medicare cuts. I'm not saying we don't treat Medicare patients, but we've set up our business in a way that we don't rely on reimbursement to eat, to pay people, to pay salaries, to pay off my loans. Like it's not there. You can do this and you can do it ethically. And, and people who are Medicare patients, they know, they know that Medicare doesn't pay for everything. Medicare should pay for more. But Medicare is not even the worst. PDPM Holy cow. What happened? Alright, pdgm, this thing just happened recently too. What happened? Who was paying attention? Who was actually surprised? Here's what I'm going to tell you about these two things. This came around in September, in the last few weeks a bunch of people lost their jobs. Well, guess who, I would say, guess who probably doesn't pay attention to the regulations or think that their association membership matters. I would say that majority of people. I want the statistics. I don't actually know these statistics Rabbit. I think a majority of people who belong to the apta, our only association, they might not be the best at everything but the majority of people do that are self interested in own business or have something different. But you've got people that with an employee's employee mindset who got into PT because it was a good job and it wasn't that expensive, they just all lost their job. I would guarantee you. I would say a disproportionate people weren't members. I could be wrong, but is anyone surprised that regulations and reimbursement change and all of a sudden people are out without a job? I mean if you have that kind of job and you got cut, hell yeah, you're surprised. But the trends. No one wants to pay for other people to get the tires changed. GEICO doesn't pay to get my tires changed, the alignment done, oil change or even a new alternator. So how are we expecting these guys like Blue cross, Blue Shield, UnitedHealthcare, Edna, why are we still expecting them to do the same? Why are we still expecting them to, you know, take care of my salary? Because, right. UnitedHealthcare, was it the Profits rises as it exits healthcare exchanges. Right. And there was some other article came out recently that like the CEO had a $380 million salary last year. So how does the CEO of this company bring home a 300 million dollar bonus in that? Yet they're going to deny people for physical therapy when their back hurts because it's unusual to get three units of manual therapy in one session. That's the kind of shit that makes me crazy. And if it makes you crazy, then 2020 is time to do something about it. I mean, right now is the time to do something about it. So with those things said, if you have a salary, it's going to continue to decrease. I mean, salaries are increasing ever so slightly, but they're decreasing based on inflation. And if your salary is tied to reimbursement, which if you have a salary, it's tied to reimbursement. Because if you can't produce, you can't bill $200,000 a year for your employer. Well then how can they pay you $100,000 a year if you are a doctor and you want a six figure salary and yet it's impossible to bill $300,000 a year worth of physical therapy, how is someone going to pay you $120 a year? Because it's going to cost them an extra 30 a year in all the taxes and Con Ed and insurance and liability and all that stuff to have you on as an employee, they got to have a profit margin to run the hospital or run the home care company, run the outpatient clinic. They got to have a, the business owner has to have a profit. So salaries, even if you own a business that's an in network clinic and your salary and your whole environment is based on reimbursement and reimbursements are going down, profits are going to continue to decrease. It's unfortunate that's been happening this year and it's going to happen next year. There's just no denying it. Job opportunities now are shrinking. Like I'm sorry, but six months ago there were plenty of job opportunities. If you're a physical therapist and you having a hard time getting a job like this time last year, I don't know, there's something wrong. Maybe you just don't want to be a pt. Maybe it shows in your interview and it sure showed in some of my interviews when I was younger. Now I bet there's still an easy way to get a job. I mean, I still can't find a physical therapist to come work here. You know, I'm not looking really hard to come and do women's health. If that's you, send me a dm. But it's not that easy. So it's not. They're not scarce, but they're shrinking. You know, the home health, skilled nursing, who else? You know, those kinds of jobs, they're not as available anymore because of the pdpm, pdgm, you know, these bundled payment plans. If you have an outpatient clinic and they can't get reimbursement, they don't have the power to get as much reimbursement. We just can't hire as many people. So job opportunities, they're just not as abundant, and they won't be as abundant next year as they have been. And it's not a death sentence. There's plenty of opportunity in 2020 for you. So if you're one of these people that you've had a job and right now, like, you've lost it, or you see the writing on the wall and you're frustrated and getting burnt out and you want to do something, 2020 is your year. 2020 is the year where there's so much opportunity in physical therapy. But it may not look the same as it's always looked. So if you want to change and something's not working for you, you have to be ready to make a big change. But I can tell you what. Doctors are going to continue to image, inject and surgerize. They just don't know. I wouldn't say they don't care, but sometimes it feels that way. And they're going to continue. Impatience are going to continue. Like I slipped a dip. I mean, I was lifting weights and I got up off the commode. You know, that's what they call the toilet around here. Got off the commode and I felt my disc pop in my back. And they go and they get an X ray, then they get an injection, and then they get some medications, some opioids, and then, oh, well, surgery's always there. And they go get the surgerized treatment. This routine surgery, the surgeon has to be routine to them, but it's not routine to the patient. And they end up in my office three to three months to six years later. I should have never gotten the surgery. I'm no better. It didn't work. But I can't fault Dr. God because they're God. And it's just like this is going to continue to happen until we do something about it, but it's going to continue to happen and we need to do something about it. What do we do about it? Well, you know, as much as I'd love to go slap around some physicians and be like, hey, don't you know there's experts in movement around here. They're called physical therapists. That's not the right way to do it. What we have to do is we have to go after patients where they are, where they hurt, when they hurt. We need to be in front of them. It's called marketing. Marketing directly to patients and sales. If you have a fear of marketing or being pushy or you don't want to sell physical therapy and you think it's yucky to ask for money and you don't have a good money mindset, well, 2020 is not going to be the year for you. You've got to change those things because it's absolutely your obligation and duty to learn how to market and sell physical therapy because people need it and they're not getting it. And we cannot rely on other people, physicians, private insurance, Medicare, even the APTA to do it for us. Got to do it ourselves. So as I mentioned before, in network business owners are going to continue to struggle, especially those in network businesses that are relying on the insurance reimbursement for the paycheck. If that's the top of the value ladder in your business, you're going to continue to struggle and really doing it wrong. Patients getting hands on physical therapy treatment, whether it's one on one or one on five with a bunch of aides and techs who are, you aren't even trained and that's all you got. You're going to continue to struggle. You have to think bigger. You really got to think bigger than that. What's next? When someone gets out of that, what's next? Insurance like treatment, care, care, et cetera, that should be really your loss leader. That's the reason to get people in the door. You should have programs, wellness programs, complimentary services, whether it's exercise programs or online programs, etc. That's where the bread and butter is. And keeping people around as customers is where you're going to generate the profit and grow your business. It's not in the insurance like only lane, like that's a dead end. And as I mentioned before, it's not the APTA or anyone else's job to save you. It's up to you to make the change and what do you do about it? It's not, it's not you doing it in isolation, it's you doing it with other people that can support you and Help you see your vision and not put you down. When I started doing this, people told me that's a bad idea. You can't. And when someone says that to you, it hurts. But just know this. What they're really telling you is that that's a great idea. What they're really telling you is that I can't. I would never take the risk to do that. And because I'm afraid that's what they're saying. So it's no one else's job to save you. It's no one else's job to fight for you. It's your job to stand up and fight. Starting a business, starting an online business, creating a side hustle, consulting, advising, etc. There's so much easier to take advantage of now in 2020 than it has been ever at any other time in history. Because of the technology that's available, the telehealth that's available. There's a lot of stuff. You can do it from anywhere in the world and you can generate plenty of revenue for yourself and help thousands and thousands of people. So I want to go over some new opportunities in 2020. Right. Let me just make sure I'm in the right. So new opportunities will telehealth. It's exploding. I mean, what is telehealth? There's two kinds of telehealth. There's one that's like, hey, I'm officially doing physical therapy through my computer and we're going to call it a physical therapy business. I'm going to file an insurance claim. Okay, great. Now. And then there's telehealth. The way that you've been doing it all along on your phone, talking to your friends, coaching other people. And it's not physical therapy. It's not being reimbursed by physical therapy. It's not even. I wouldn't even call this part telehealth. But people get it kind of confused. This is more like online coaching and training. It's health promotion and health improvement through something other than a telephone is more likely your computer, whether it's a web screen, a one on one call, a course, a group training, etc. You. The opportunity for growing an online business, the opportunity for helping people remotely is humongous. It's insane. That's how I've been able to help thousands of people grow their businesses. It's not by meeting with them one on one here in Greensboro. It's by helping them through online courses, online coaching programs, meeting a couple times a year and giving information and resources so they can do it for faster and more seamlessly and step by step in the way that I know how to do it. And I've done it with other people and I've done this with my friends who have hip pain out in California, friends have ankle and calf pain in New York, in New York City, actually Long Island. And I could make a business out of it. There's some amazing opportunities and there's everything that's happening in 2019 that's bad, like reimbursement going down. Guess what? And I remember I said Medicare patients know that Medicare is cutting services. Plenty of people out there and more people out there are willing to pay out of pocket for physical therapy and other rehabilitation services. Plenty of people out there are willing to forego their insurance benefits to get the service they want. And more and more people every year. And in 2020 specifically and especially, my s words are really going. The people are making conscious healthcare choices. They are better consumers of healthcare. So they go and they call and say, well, how much is the X ray going to be like, oh, we don't know. We'll get back to you in three days. Okay, well, how much is the physical therapy going to be? Oh, how much is that injection? What's the medication? Oh, can I get the medication at CVS for $25 by getting it at Walgreens for 50? Well, I better go to CVS to get it, etc. They're shopping around and it's your job not to let them price shop you. Because what we want to do is give people an opportunity to say yes to physical therapy. But we don't want them to price shop us based on the services we provide or the techniques that we know. Otherwise, if I sell them on coming to see me because of dry needling, well, I can go get dry needling cheaper somewhere else. So I'm just. I have to do that. Well, because they price shopped me on dry needling, not on the transformation change they want to make in their life. Is this making sense? Comment below or give me the little thumbs up and let me know. Look, knowledge is power. I'm not the first one to see it. But your knowledge, your expertise about the body is huge. Your knowledge that you have yet to gain about growing your business untapped and unlimited. Like, how much could you grow further if you knew just a little bit more or twice as much? Or spend as much time studying business and marketing and sales that you did getting your physical therapy degree? I don't even think yet. I'VE gotten to the point where I've spent as much time or money studying business. Let me see. I'm probably really close. Probably really close. I know I've read more books on business. Have I spent as much on business education? I'm not sure. I haven't added it up lately, but I'm getting there. I spent $100,000 in school, plus all the expenses. So 150,000 plus whatever it took three years. I've spent $120,000 in business learning, education, easy. I've read 30, 40 books. Yeah, so I'm close. But just imagine if you could get a little closer. You don't have to have as much knowledge as me. I can disseminate it down to you. What if you knew more? How much more successful would you be? What if you had not just more knowledge, but the knowledge to know exactly what you need to work on now so you have more time. Not just going out and getting more things, you had more time to do. What was going to 10x your business, rather than spending hours, it was just going to add 5%. But your expertise is always growing. As I said, every day brings another round. And you can't be afraid of failure. If you want to grow a business, you want to be successful in 2020, you're going to have to try new things. You have to try something new, something you've never done before. You have to do something maybe I've never even thought I've ever done before. And you have to try it. And only by trying it do you become an expert. Only by sharing and teaching other people do you become an expert. It's always growing, your education. Even if you paid 150 or 350 for it, it's worth every penny that you paid as long as you're using it and utilizing it to its fullest extent. Okay, what's happening next year? Right now is the age of Instagram, and it's almost gone. Facebook is here. It's coming gone. It's not gone, but it's on its way up. Like new people to Facebook is like declined for the first time. Maybe even it declined the last quarter. Instagram is where everyone is right now. But what's coming next is TikTok. If you've never heard of TikTok, you don't know what TikTok is. Wait till after this to go figure it out. Because the next person, the first person that figures out TikTok for physical therapy is going to win. Right now, there's 10, 20, 50 times more people engaging with you on Instagram than on Facebook. I can go and do this Facebook Live or even any Facebook Live and get a couple handfuls of people. I can do an Instagram story and get anywhere from 150 to 350 people to watch it. It's huge. It's a huge return on my investment in time. So if you're not on Instagram, you need to be. It's going to be even easier next year in 2020 to impact millions of people and sell your products online. People are already selling products online and bringing in seven figures, eight figures. As a physical therapist online, it's going to be even easier. There's more and more technologies. There's more technologies for telehealth. There's more technologies for delivering programs and courses. There's more opportunities out there for you to do something that's between rehab and performance to fill that gap. There's even an opportunity for you to go into the performance zone as a physical therapist and fill in a need and fill a gap. It's even easier next year. As I said, telehealth's gonna explode. I mean, it's on the verge, it's on the cusp. Because I know people who are teaching telehealth who are working it and they're getting a lot of pushback. And what does that mean? When you get pushback, you're doing the right thing. So keep doing it. And if you're interested in what is telehealth, go check out my buddy Rob Vinant, because he's got it. He knows what is, he knows what he's doing, he knows what's right and he's getting some pushback. And so, you know, when we started talking about cash based physical therapy, we got a ton of pushback. It's because it's scary and if you just like being comfortable, go sit on your couch. But it's just like people with back pain. Sitting on the couch isn't going to solve the problem. You got to get up and do something about it. Telehealth is the next big opportunity for more traditional physical therapy. Like in delivering more traditional physical therapy outcomes, you just can't do it with your hands. But you can do so much with your knowledge and your expertise from your decision making that it's incredibly helpful. And it's just a wide open opportunity for people. Online information products and influencers are going to dominate. I think I've already been alluding to this, like, what is an information product? Well, it's an ebook Download, it's a training program, it's an online course, et cetera. People out there who have tens of thousands, if not hundreds of thousands of followers who are physical therapists, whether it's on Instagram, Facebook, TikTok, your blog, whatever, they're going to start to dominate once they figure all this out. Once they figure out, how do I get a dollar per follower from my Instagram account? Well, if you've got 10,000, 100,000 people on your Instagram account following you and you're not monetizing it, well, you're missing out on helping thousands of people and generating more revenue so you can do more good in the world. And it's just like I said, because of the technology and the knowledge and the opportunities out there, it's just going to be even easier to create more influence and teaching in the world. And this is exactly how we get more people to know that physical therapy is the best first place. When they hurt, when they slip a disc, when they wake up with a crick in their neck, where they throw something out, when something gets slid off, or, I don't know, their body's so much full of arthritis that they're never going to walk in, or whatever these common idioms are that people talk about their body and their pain and their injuries when their bodies are just being normal because they're afraid. People who have influence online on the right platforms are going to dominate. Consumers are going to demand a higher quality of care. They already are. Why would I go there if they're just going to teach me stuff I can do at the gym? I've been hearing that for years. Why would I go there if no one's going to talk to me? They demand a higher quality care. If I just get left to sit in the corner with the hot pack and e stim on, I can do that in the training room. Why would I go to physical therapy? Consumers are demanding higher and higher quality of care. It's just what they're going to do. And it's just, it should be expected and we have to meet it. You've got to be able to charge enough in your own business to provide the quality of care and service that your patients want and expect and even exceed their expectations. Personal relationships are going to matter more than social media. They're going to matter more than Facebook ads, Instagram ads, Google Ads. Building personal relationships still work. People out there that think, well, because of Facebook ads, Google Ads, all the online marketing, etc. That I don't have to build personal Relationships. Well, guess what? It's not as effective as building personal relationships, getting out and doing the hard legwork, getting in front of people, talking to them, hearing them say no. Until you find the person that finally says yes and send you 20 new patients. Develop personal relationships. Don't ask for something first, go out and give. Give. Well, everyone's got their head in their phone. As soon as you write someone a handwritten thank you note and you go speak to them and look at them in the eye, it means something. It means even more now than it did five, ten years ago because. Because everyone around you is distracted. So creating personal relationships is way more important than anything social media can ever do. Cash practices are going to continue to grow and thrive. There's nothing stopping. And everyone says, oh well Aaron, no one here can afford a cash practice like everyone's on Medicaid, blah blah blah. Who said a cash practice has to be one on one? Who said a cash practice has to charge $250 a person? Why couldn't you see 10 people for $29 in an hour? That's $290. That's 40 more dollars than the 250 we charge. Who says one on many has to be low quality and poor? If it's correct and what people need, then great. It doesn't mean you can't. It means you can still do hands on. It might just look a little different, but it's not. What it doesn't mean is that you're seeing four people and you're bouncing between them and you can't get your hands on them. And someone unskilled, it might mean, is working with them and people are rushed in and out. It might mean you spend an hour and a half with them and you get some hands on. You take them through some self mobility and in about two minutes for each person you can do a little mini self assessment through pattern recognition, recognize at least 80% of what's going on. Maybe you individually evaluate people and the program looks like, hey, you come in, this is the program. I'm going to give you an individual evaluation. You're going to come to this group class twice a week for the next six weeks and it costs, I don't know, 30 bucks a week and you put 20 people in there or something like that and you make even more money. It doesn't have to be limited. The cash practices are going to grow and thrive because guess what, insurance doesn't pay shit anyways. The first three months of the year before anyone's met their Deductible, it's all cash anyways. So why waste your time paying someone else to file claims for you when you don't even get half of it back, right? It's just in network clinics that think outside of the box will rise above everyone else. In network clinic owners that start seeing like the horizon and start seeing how there's something beyond it, I can see what it looks like and they start planning for it and they shoot for it and they aim for the target they might not even see are going to be more successful. Okay, Like I mentioned before, if you own an in network clinic, it's not enough anymore to say that people came in they for their 8 to 12 visits of care and I got 800 bucks from them and that's it. See you later. No, you've got to work with people in other stages of their progress. You've got to have other services. If you think outside the box and you're not relying on insurance reimbursement, but you're using it as a reason to get people in the door or as a coupon for your services, you're going to thrive and grow. If you can identify a problem that people want solved, 2020 is your time. If you're a good problem solver, you're willing to take a risk and do something different. And you see, here's a problem people want solved. No one's feeling it. This is your year because your income is only limited by you. It's only limited by you. Your income, your revenue, your ability to pay off your loans, your ability to help more people, your ability to get more time for your family is only limited by you and your willingness to do something different and to do something about it. So here's big the big four. Authenticity. Be authentic. Be yourself. Especially developing these personal relationships. Don't try to be someone else, just be yourself. Be real. People like real. And why Facebook lives are great because it's real. Like I could record this and edit it and publish it, but you go out and do it live. You go meet people in person. Be authentic. Be transparent. Not just in your personal relationships, but in your business. Transparency. We tell people all the time, come in for our free total body diagnostic, and by the end you'll know exactly what's wrong, how long it's going to take to fix, and we'll be absolutely transparent in sharing with you the effort it's going to take, the time it's going to take, and your financial commitment to solve the problem. Like transparency. That's what we do in a cash practice. Like, I know exactly what it's going to cost. I can't tell you on the phone because I don't know what's wrong with you. I'm not doing a procedure on you. I'm helping you change, saying, look, this looks like 10 visits, this looks like 20 visits. It's like three visits. This is what it's going to cost. You need to niche. You need to niche down. You cannot be afraid of niching down. Even if you live in a small town, you have to focus on something specific. Otherwise people won't know what you do and they won't come see you. If people know you're the expert at gymnastics or dancers, even though they're a baseball pitcher, you're like, well, you're the expert at working with professionals. I need to see you. I don't care what sport it is, I'm going to come see you, I'm going to send my daughter to see you, etc. You will see other people. And if there's a big enough community in your niche, you will thrive and you will grow and you will be the go to person not just for your town, but for everywhere and community. You have to build and develop community, not just with your team members, your employees, your patients, your customers. But it's important to focus on how do I improve my community? Greensboro, how do I improve? Greensboro, how do I improve the last year? I need to educate. I also need to get back out and I need to be among the people who don't know I'm a physical therapist and see what are they talking about, what do they want, what does that need? I need to be in the community. I need to serve the community and I need to build community. And if you build community and you serve your community and you get out in your community, you're going to find the problems that people want solved and you're going to grow and you're going to do something so amazing next year that you need to tell me about it. And you need to be willing to do something different if you want to make a change next year. Let's say your business was good, but you know it could be better and you want to grow it. You need to be willing to do something different if something's not working and you're expecting different results by doing the same thing, isn't that the definition of insanity? Right. It's like doing the same thing over and over again and expecting the same results. If you want different results, you need to do something different. You need to try something new. The people that try something new, was it Thomas Edison? How many light bulbs did he go through before he got the right one? Albert Einstein? The same thing. It was like, keep trying. When something doesn't work, it doesn't mean like you failed. It means it's an opportunity to say, okay, this didn't work. Let's try something different. Michael Jordan, Kobe Bryant, Wayne Gretzky, these guys were out there and they failed. Most of them. Eddie Merckx. And if you guys don't know, I race bikes. Eddie Merckx is the most prolific winner of cycling. He won less than 30% of the time, and then it's humongous. He still didn't win every time. He failed over 70% of the time. Failure is an opportunity for growth and learning. And if you're not willing to do something different, you're going to struggle. But if you can stretch and get out of your comfort zone and do something you haven't tried before, likelihood is you're going to do it a couple different times and you're going to find the right combination and boom, things are going to change drastically. So I just want you to know I'm not the only one that's doing this. And there's a lot of people out there that I've worked with, a lot of people I haven't worked with that are crushing it. I just want to share a little bit about a couple people that I have worked with, how they're crushing it. This is Derek, Derek Nielsen. He's an awesome therapist over in Durham, North Carolina. He came and he worked with me for a year, and then he went and moved to Durham and he basically took everything I gave him, everything I taught him, and he took it to a brand new town and he opened up a cash practice and he generated almost $100,000 in his first year. He didn't know a single person. He didn't know any physicians. He didn't know any. Any, you know, like whatever X, Y and Z. People he didn't have wasn't on any insurance panels. And he's crushing it. And Derek is like one of the most honest and, like, endearing therapists. He's great with people and, you know, he gets out there and he's willing to try new things and he's taught me tons of stuff and it's been great. He's crushing it. So I wish him a ton of success, but is because he's been willing to do something that no one else really wanted to do. And Just to share with you. Like, Derek shared this with me. And I'm not saying this to brag, but I want people to know, like, you can generate $21,000 in 30 days in a cash practice. You should be able to do that working with one person, working for you. A lot of people are struggling to see that and see the bigger picture. So what does that mean? Not that it means, like, it all goes in my pocket and I can go buy a Porsche or Derek can go buy a Porsche. What it means is that if you see money as energy and it goes around and it comes around and what you put out, you get back. If you go out and you help and you put your patients first, the money will be there to help you pay down your loans and pay off your debts and help you grow your business and influence and grow your community and put back in to the pot that keeps filling you up. Remember, this world is abundant. There's more than enough going around. There's plenty going around. But if you go out there and you go, oh, who's going to take away my something? Then this isn't going to happen. But if you come with an abundance mindset like Derek does, and like, who? Where is my money? Where are my patients? Who has my patients? How do I go and find them and bring them in and help them? This stuff happens, and it's going to happen over and over and over again. I want to share with you a little bit about Alexis. Alexis is one of my mastermind students, and she was struggling doing like a cash practice on the side while she worked in her home health gig. And her home health gig was really comfortable. She was earning six figures in home health. I think it was like 120, probably out in Phoenix and just too comfortable. And she was like, Erin, you know, X, Y and Z. What do I do? And she came to the mastermind meeting, and then within three months, she grew her business 253%. So she quit her job. She went full time in her business. She did $4,000 in September, almost 6,000 in October, and a little over 9,000 in November. It's just, you know, she raised her rates and she got more people in and she grew her business. She was able to start traveling where she was teaching out of town, teaching dance instructors and doing workshops at dance studios and doing private almost like at least once a month, probably, probably 25 weekends, something like that. Last year, if I'm correct, Victoria, she's a cash practice owner over in the East Bay in California, and she sent Me this message, like, Aaron, I'm shocked this actually happened. The patient booked me for a $400 eval tomorrow. Like that's dope. And what I'm saying is people are willing to pay it if they get the right care and they know you can solve their problem. They're not paying her or Alexis or Derek for the same thing that the PT Mill is providing down the street. They're just not. There's so much opportunity out there that people are willing to. People are willing to pay for a transformation that they know you can give them. And if you are a therapist, just like these guys who are willing to put yourself out there and work really hard at growing your business, you're going to be successful too. You just got to remember when we talk about these numbers, these numbers are small in comparison to what the physician owned practice. The PT Mill home health care company is billing, charging and running through their systems. You just don't know about it. You weren't aware of it, you weren't taught it and you, you just weren't exposed to it coming through school and coming through your jobs. And that's what seems, it might seem a little weird to some of you. And I just want you to know you've got to be able to generate these kinds of numbers so that you can help thousands of people. Like, it's our duty to help as many people as possible, not just helping the 25 people a week that I can touch with my hands or even the 35. It's my duty to help more people. And as a business owner, myself and these guys included, we have to grow our businesses so that we can hire other physical therapists and trainers and dance instructors and massage therapists so that we can help even more people get the kind of care that we know they need. So I wrote a book, like I said, the Cash PD blueprint book. It took me a while to write it. I put a lot of stuff in there. Before I move from this screen, I wanted to share with you what's on my shirt. 80% is good enough, right? That's how the book ends. 80% is good enough. Remember, you were trained all the way up until about right now, until you took the licensure exam that you had to get 100. Well, actually with the licensure exam, you just had to pass. But prior to that, everything was about getting an a and going 100%. But in business, trying to get an A in business is going to drown your business. It's going to kill you. It's Going to stifle things. 80% is good enough. If you've got something that's good enough to put out there, it might not be perfect. Just do it. If it's good enough at work, if it actually just runs and does what it's supposed to do, maybe not perfectly, you've got to put it out there and do it. And so that's what we did with the book. And there's a special prize for anyone that finds all the spelling mistakes in the book. So to get that special prize, you gotta get the book and send me a message. Let me tell you what's in the book. Just a few of the things that are in here is the anatomy of a cash practice. It's like, what does my practice look like? What does a cash based practice look like? And remember, if you have an in network practice or maybe even you're out of network, you can do just even some of the marketing that we're doing. You're going to grow even faster in cash practice. It's a much higher friction business. We have to work even harder at marketing. If you just adopt some of the mindset and strategies and tactics that we're using, your business is going to grow and thrive and flourish. I also go over the Cash PT mindset because mindset is everything. It's the number one thing that's going to make or break your business other than you actually taking action. But having the right mindset, we go through that, we go through the practice blueprint. So in this book you can get the blueprint for how do I start my cash practice. Whether you've already got a business or you're just starting, you want to do a side hustle, you're going to learn how you put it together. Because maybe you just need to see some cash practice, cash patients on the side. Maybe you want to full on go 100% cash practice. I'm going to teach you how to transition your practice. So if you've got an in network business, you can learn exactly how to transition your practice. You're going to get access to the Cash PD marketing system. So a good half of this book is the marketing. Let me show you Chapter 6, the USP. If you don't have your unique surveying or selling proposition nailed down and you're doing Facebook ads, you're wasting money hands down. If you don't have that nailed down, you don't have your message nailed down. You don't know who your target audience is nailed down, you don't know that, then do not Spend any money on ads, you're gonna get access to the entrepreneur mindset. I mean, there's so much more in here. We've got a good 11 chapters and tons of scripts and everything in here, but these are some of the highlights. So the entrepreneur mindset. The mindset is what you didn't learn in PD school, what you haven't learned just owning your business. Like how do I think about investing and spending money the right way? And so when I invest in my business, I don't actually spend money. I make decisions where I put money on, let's say a credit card or I buy something that I know is going to give me at least a 2x return on my investment, usually a 5 to 10x, not more. And there's so much more in here, like exclusive resources, downloads, templates, etc. And I want to give this to you for free. Because what it's going to do is if you're just starting a practice, it's going to give you a great head start. If you've already got a practice, you're going to find just one thing in here that's missing that you can change or do or implement that's going to generate thousands and thousands of dollars for your business. And the book is free. So right now you can claim your free copy. All you gotta do is cover the shipping and handling. Even when you just pay shipping and handling, the book still cost me more money to send to you. And you can get it right now. Go to cashpdbluebook.com and grab your copy and the whole idea. Here, let me just show you. Read from you one piece. There's a thank you notes script in the back. And if you think thank you notes have gone out of style, if you want to make an impression on people, if you want to make a, if you want to build community, make that personal connection I was talking to, talking about earlier, you need to write handwritten thank you notes. This is a thank you note script. Dear patient name. Dear Mr. Jones, welcome to the Levower family. It was great working with you during your visit to our clinic today. Thank you for giving us the opportunity to help you stay fit, healthy and mobile without pain meds, injections and surgery. We are committed to doing everything to help you, whatever their goal is, get back to CrossFit, return to walking, be able to pick up your grandchild. You're in good hands. Hands. Sincerely, Dr. Aaron Lavauer. Boom. You know, so we send one of those to every patient and one of those to every person that refers Someone to us. There's a call script in here on how to answer the question do you take my insurance? So even just that call script can save you one new patient and thousands of dollars. All you gotta do, claim your free copy. Just cover shipping and handling. Go to cashptblueprintbook.com I will enter it below the video. It's not there right now because I'm running the show. Unless. Brenna, you're on here listening. Cashptblueprint book.com you can go grab yours right now. Open it in a new window and grab one. Grab a copy. We'll send it out to you right away. If you guys have any questions, comment below. I'm going to just swap around my screen so I can see the questions. I'm happy to stay. If you've got questions, whether it's about what we talked about tonight about growing your business or starting your business or marketing question, sales question, etc. Let me know. The only stupid question is the one that you're afraid to ask. So make sure you put your questions in there while you got me. Let me see if I can. Let me just kind of. Oh, here we go. I'll do that. Like that. And then I can go over here and look at some questions. All right, Let me see if this works. That's on my Aaron Bower page. This is the Cash PT Nation page. Hey, Amy. What? You're welcome. Thank you very much. Appreciate it. What's up, Nick? All right, let me see if I can expand this and see some of the live questions. Boom. What's up, Matt Villegas? Let's see if I can turn that off. All right. What's up, Lyle? Thank you so much. Yeah. Personal relationships 1000%. Yeah. TikTok ish. Patience day is definitely trending. Yeah, Matt. Okay. Amy made her first TikTok video. That's awesome. All right, let me see if I can find any questions. If you guys have any questions. If I can't find them, no worries. If you're watching this on team replay, comment below, tag me and I'll try to come back later. See, see if I can. What's up, Kayla? What's up, Calvin? What's up, Michael? Thank you very much. Awesome. Michael ordered the book. Appreciate it, Michael. Let's see. Let me go grab your free. I just type in the link. Alright. Boom. And then we go over to the Aaron Labourer page and see because I'm running this on two different places. Good. Nope, I don't see any. I don't see any Questions over there, but let me redo it. That'll show up. Alright, y', all, here we go. I don't see any questions because I can't tell because I'm not looking at my phone which ones are coming in when. But here's the number one question. I'm going to give you the two questions, the number two questions people ask and then if I don't see any, we'll take off and then you can just tag me or something like that comment in there. The number one question people ask is, are people going to actually pay? Will people actually pay for physical therapy? If you've been listening, you should know the answer to this. Yes, they will pay cash for physical therapy. They'll pay whatever you ask them for. If you're providing a solution to a problem and a solution is a solution that they can't get anywhere else or maybe nowhere else, maybe I can get over here, but I really like you guys. If I connect with you, if they can't get that, that's part of the experience. If they can't get that anywhere else, they're going to pay. And it doesn't have to be extortion. 200 something dollars a visit isn't extorting someone. I would say that recommending surgery for someone that's going to end up costing them tens of thousands of dollars even because they spend a night in the hospital when we know that it's likely not to work, that's even more unethical than charging someone $300 a visit. Wouldn't you agree? So think about these kinds of things. Here's the other thing that I think people struggle with and I don't know if it's a question as much as a mindset and ability. It's like one just like Alexis, you've been too comfortable. So going out on a limb, trying something new and sacrificing your great paying job, or sacrificing your steady job, your knowing thing, the thing that you know, like this paycheck, even though it's not great and I'm getting burned out and I've seen too many people sacrificing that to do something bigger. That's what people struggle with. People struggle knowing that if they take a risk, am I going to be successful? Well, look, I can't guarantee it. The only thing I can guarantee is that there are other people like you doing it and who are successful. If you try and you become relentless and you don't stop and you don't say, you don't take no for an answer. And you're passionate about helping people, you will find a way to be successful. So if that sounds like you and you're struggling and you want to figure out like, how do I make this work? How do I get out of this job and grow a business, then you need this book. Cash PD Blueprint Book. Go to Cash PD Blueprint book dot com. Go there right now and grab your copy. It's free. I'm going to send it to you as soon as I can. When you're there, you get an opportunity to get the audiobook. If you do get the audiobook, we'll send you a free ebook. And there's some other opportunities to get some courses after that, if that's what you're looking for. You need something to grow. You can get the information that you need to grow yourself as an entrepreneur and a business owner before you even get started. And if you already have a business and you're doing great, but you want it to be better, and you know it can be better, then the marketing strategies and the sales strategies in this book are going to help you tweak your systems enough that just one little tweak can make a 10, 20, even $50,000 difference in change in your business in 2020. And let's say you're like, I don't want to own a business. I don't want to treat patients. I've got 20,000 people following me on Instagram. I want to try to create this online business. Well, no, this book isn't on how to build an online business, but this book is going to teach you the sales and marketing strategies that we use to sell to people online because they're the same. The only difference is the way I serve people in our clinic is with my hands or with my therapist's hands. But the sales and marketing strategies and business building strategies are all the same. So you can learn a ton in there. And then if you're like, Aaron, I want to learn how to sell on webinars, I want to learn how to start a podcast, I want to learn how to write email copy, sales copy, etc. Then send me a DM and I'll make sure you have access to that kind of training material. So promoted. Catchpgblueprintbook.com right now. Grab a copy and we'll send it out to you as soon as possible. Let's see. Cindy says, I struggle with the fear of leaving my full time job for months. And I just told my boss Friday I'm taking a Leave. Congratulations, Cindy. Whoo. That's awesome. That's really great. And that's one of those things. It's like, how do you make that change when you've got to the pain almost has to get bad enough. Like how do you do that? And you need to be sure that if you're feeling that, you do it on your terms. Don't wait for them to let you go or find out that you've started this business until you have to close down your business or lose your job. Like, do it on your terms. That's really awesome, Cindy. Congratulations. I think I'm trying to see if any questions came through, but I don't think I'm able to see the questions because I'm broadcasting on the phone and looking in lag time on the computer. So I will have to answer your guys questions later. If you have them, make sure you comment questions and tag me. I'll come back in and answer them later because you were watching this. If you got anything out of this state of the industry trends and predictions for 2020, please comment below. Let me know what your big takeaway is. Go out, screenshot this and share it on Instagram Stories. Share it in the Cash PD Nation. Go like, share something on your profile. Let other people know about it because there are tens of thousands of physical therapists out there that are not on this call. They don't know what to expect next year and they're going to lose out. You know what? They're not my competition either. We need to bring our whole profession up. So let them know. And when you teach it, you own it. When you share your goals, you're held accountable. So go share. Go do it. And if you don't have a copy of the book, go grab one. If you already have a copy, you can go grab another one and send it to a friend. Catchpdblueprint book.com I'll see you guys next time. Thanks. It.