The Cash-Based Mindset & The #1 Online Marketing Mistake | CashPT Lunch Hour #21

Thank you so much for joining me. I'm super excited to be here and host the Cash PT Happy Hour. What I have in store for you guys tonight is a little PowerPoint presentation. Talk about the cash PT mindset. And we're going to talk about my number one marketing tactic. And really it's the number one marketing mistake most therapy practices make because they do not do this. It's simple and it's free. And at the very end I have a special gift for you. So stick around to the end. I've got a free gift and I've got a great presentation in store and we'll also have time for questions. So as you've already seen, we've got a little chat box on the side and if you have any questions, feel free to type them in the chat box and I'll be sure to get to them at the end of the presentation. And if you, if there's anything else you want to add or say, the chat works back and forth and everyone can see it. You can send private messages to people. Last time we had some other people answering some questions and it was really great and I read them out and so we'll get to all that at the end. Okay, let me just get my thing set up here. Okay, I've got a poll and I'm going to. It should start on your practice. I mean it should start up on your screen. And the poll is do you currently own or work in a cash based practice? Yes or no? So just kind of see how many people here are working in a practice or not working in a cash based practice. And go ahead, you can click yes or no and vote. And I've got a couple other polls that we'll be looking at today. I'm going to get over to my presentation while we do that. So the Cash PT Happy Hour, we're going to talk about cash based mindset and the number one online marketing mistake. So my gift to you if you stay through this whole presentation is I wrote a book on blogging for your therapy practice. So stick around until the end to get this great ebook. It walks you step by step on how to start and create a blog and a website using WordPress and why it's important. And a blog is important because it's a way to brand yourself and to brand your business. It's constantly changing and Internet and search engines really love new, fresh, unique content. So just a little bit about me. My name is Dr. Aaron LeBauer I own Labour Physical Therapy, which is a 100% cash based therapy practice. I provide one on one hands on treatments using myofascial release, some soft tissue mobilization and manual manual therapy. I only see one patient per hour and my average patient comes in about once a week for five to eight visits. I started my practice directly after graduating from Elon University doctor of Physical Therapy program. So I have not worked for anyone else as a physical therapist. Our Chat Today we're going to go over the cash based physical therapy mindset and the number one mistake most cash based really most physical therapy practices make marketing their practice online and then I'm going to introduce you to the Cash PT Blueprint which is my brand new online training course and at the end we're going to have time for questions. Mindset is everything. I've been saying this from day one and it was the title of one of my very first BL blog posts on my website. Mindset. Mindset. Mindset. It's the thing that you have to have in order to operate your cash based practice. It's the cash based mindset because it's very different than the in network mindset from the therapist perspective and the patient's perspective. So direct access is the key. Direct access, this ability to see patients directly and this is key for many reasons and we're going to get into that in a moment. The other part of that is providing primary care physical therapy or being a primary care physical therapist. Having a niche is very important but acting like the person that's the primary provider for your patient or having that mindset allows you to create possibility and open doors to new to new avenues and new ways of running a business that you might not have thought was possible before then. We're going to talk about the value mindset, how to create a valuable practice, how to how you value yourself and then we'll discuss the patient mindset, the mindset that patients have when they come to see you in a cash based practice. Number one, direct access is key. Having direct access is important, but it's not just having direct access, it's acting like you have direct access. It's understanding that you can go directly to patients and market directly to patients. It's like you don't even have to be able to treat them or evaluate them. But if you are operating from a place of I can help you, whether you've seen someone else or not, I'm going to evaluate you, I'm going to listen to you, you can tell me your story and and I'll let you know if I can help you or not or where you need to go after that. And you then position yourself as the power player, as the primary person that the patients go to when they have musculoskeletal problems or they're looking for other practitioners. I have patients ask me all the time, who should I go see, not just for orthopedic problems, but vascular issues, for yoga, for complementary wellness, for massage, everything. And it's great. And I get to help advise my patients on all the different paths they need to take because they know me, that I'm available and that they can trust me to help them make and help them, help guide their decisions. Some people say, hey, but we don't have direct access in my state. And I would say that's not true. But not that that's not true. It's that it doesn't matter. Because when a patient calls you, let's say you still needed a referral for an evaluation, which right now, in 50 states, according, at least according to the APTA, I haven't practiced in all 50 states. But according to APTA, we do have ability to evaluate patients without a referral or prescription. But even if you did need one, the idea is, is that you make a connection with the person that calls you on the phone. You let them know you care about them, and you can schedule them for an evaluation or you can schedule them for a consultation, but then what you do is you get that person in touch with their physician or the dentist or whoever else can write the prescription. Or you say, hey, look, you know, I know you've been, you just told me you've been to see someone about this already, and I'll give them a call and get the prescription on the way. You become kind of the orchestrator or conductor on getting them into your practice so that you don't lose them when they go in to see their physician. The physician says, oh, we, we've got physical therapy. You should come here, you need to come here. And so what that does is that gets the patients already coming to you, you're helping them. So it really doesn't matter if you don't have direct access to treatment. You can do an evaluation, you can get that person on their way to see their physician or your own network of trusted healthcare providers that you know when you send someone in for a consultation or to sign the plan of care, that generally they will agree with you because your principles and treatment practices kind of align in the same direction. Number two, be a primary care physical therapist. And this isn't just that I'm a physical Therapist and I treat everything. This is being that primary person that patients come to see when they hurt, when they have an injury, when they have a hard time working out, when something's physically missing from their life or they have a limitation or disability. You are the primary person that they see. They may come in and have a problem that's not musculoskeletal and you're the person that gets them to the right place. Even just suggest going back to see their gender, general practitioner, or which orthopedic surgeon they should go see next. Or this might be a claudication issue, so go see the vascular specialist, etc. You become the primary care physical therapist and practice primary care physical therapy. On top of that, you can have a niche. But it's really important to kind of create this mindset and belief among yourself, ourselves that we are independent practitioners and we have the ability and the knowledge and expertise to be able to help triage our patients to where they need to go if it's not under our care. And you are also the entry point into the healthcare system. So what this does is this also gives you leverage to, to start referring your patients to physicians. And the physicians say, hey, I'm getting patients from, you know, Aaron Labourer, maybe your next time I have a patient that needs physical therapy, I'll think of him and return the favor. When you give something to someone else, like a referral, a vote of confidence, they're often compelled to reciprocate and return the favor. And that's it. Refer patients to other providers. It benefits your patient. So this is about triaging people. And this is also about saying, hey, you need to go practice yoga. You should be practicing yoga five days a week. And I said this to a patient the other day, I said, hey, you need to be practicing yoga once or twice a week along with your other activities that you're doing. And I'm going on Thursday morning at 9:30. My patient showed up this morning at 9:30 and practiced yoga in the same class that I did. It was awesome. It was so great. The value mindset. This is a little different than these other two. And this is about creating value in your mind about what you are worth. So what are you worth? You know, it's like one of those things, it's hard to say, wait a minute, the patients just paid $20 to come see me in my in network practice. Are we worth only $20? What does the lawyer charge you to create an LLC? Or what is your accountant charge to file your taxes for you so that's the big thing is like what is physical therapy really worth? Is it worth what Aetna or Blue Cross says it's worth? Is it worth what we have to bill them? The $300 an hour, $250 an hour so that we get $78? Is that what we're worth? I'm going to go back to this one. So what are you worth? We are worth our education, our expertise, our knowledge and our time. And those are the things that we are worth and where our value comes from. And with this, we market directly to patients because that is the avenue where we're going to start to reach people directly to create this primary care kind of avenue and where patients are going to see us, find out about what we do and then call us directly for an appointment. And that's in that way we create a direct payer relationship. It's like own it, you know, own that is really easy to do when you put your mind to it. And not a lot of people are doing it even in direct access states. In North Carolina we've had direct access for over 25 years. It might be 30 years by now. Not a lot of people are marketing directly to patients. They're still marketing just to physicians, maybe some advertisements here or there, but they're not really marketing directly to patients. So we can own that relationship. In a cash based practice, we don't have anyone in between us and the patient. We form a contract directly with their patient. So to create a valuable service, we need to provide something that is unique and different than what everyone else is providing, as well as a service that is above and beyond our patients expectations. Patients come into our office all the time, say, wow, it's really quiet, peaceful, or it's beautiful. I didn't expect it to be this quiet or oh, this is Dr. Lebower. I didn't expect you to answer the phone. You know, I answer all my phone calls and patients don't expect that. They expect to get a administrative assistant, someone on the phone who doesn't know what they're talking about. If the patient asks a question about a problem or anything and they get me on the phone goes a long way to creating a really valuable service because my patients know that when they call or email, they are going to get me and I'm going to respond usually within a day or 24 hours. So I'm going to start another poll here and this is interesting to me. I want to see what the, what the results are. So what percentage of the patients you Currently, see, now that we've just talked about, direct access are referred by physicians. So do you guys know what, what percentage direct access patients you receive? You can tie. You select the option in the poll that best describes where you are. Type it in the chat box. I'd love to get some of that information. In my practice, over 50% of my patients find out about us online and the other 50% are word of mouth from my patients or people I know in the community. What is possible when you create a high value product? Can you create something that's so valuable that patients are going to pay cash to receive it versus $25 copay down the street at the in network clinic? Is there something that you can create that's so valuable and different and unique? What, what's possible for you in your practice? And it doesn't even have to be different. Maybe it's just that you can spend more time with the patient one on one and provide the exact same treatment, but you spend more time with them and you're available to answer more of their questions. Awesome. Paul says 60% of his patients are self referred. That's great. That's amazing. That's awesome. And Jordan says 40% of direct access. That's really great to hear. Okay, so the patient mindset. The patient mindset is one where the patients have to buy in. What's interesting with this is that patients that are generally referred from physicians aren't ready to buy in. At least in my practice. When they call, it's like they're coming from a physician's appointment where they paid their copay and then they hear they're paying at least twice and as much to come see us or just that we don't in quotes, take their insurance. So the patient mindset is really important. And when the patient seeks you out and reads what you do on your website, here's how you can help them or help their friend through word of mouth. By the time they call you, they're almost ready to come in that day or a lot of them are. And so that's what's vital about the patient mindset. And the patients that come to my practice are people that value one on one care, hands on manual physical therapy, myofascial release. And they value that I can teach them exercises and they will do them at home on their own. Okay, let's see. I got a couple other people chimed in about what the amount of referrals they get. So Bryce says 80% our clients are referred, 10% our medical professionals and 10% other Jackie says approximately 25% are self referred in her practice. Mark. About 30% of direct referrals from current or prior patients. That's great. That's really a great percentage. So that's a huge thing. So the current, oh, let me get back here. Okay. The current patients are your like bread and butter for referrals. But a lot of times they don't know that you want them to tell other people about you. They just, they don't know so we need to ask them. So the patients that are going to come see you in a cash based practice are people who value your time, your expertise, your hands on treatment and the service that you provide. Patients in a cash based practice also have skin in the game. They have an invested interest in doing the work. They're paying more, they're going above and beyond what their peers are doing for physical therapy. They have skin in the game so they're really motivated to get better. A lot of times my patients will discharge themselves, they'll call and say, hey, I'm better, I don't need to come in, I'm back to doing what I want to do. Or they'll say, hey, do you think that we need any more visits? Because I'm doing great, I'm feeling really good. And this might be only after a few visits when I didn't expect that they would be better by then. And they've been doing the work, they've been doing their home exercise program twice a day, every day, doing everything that I've asked and more. And they've got skin in the game. They want it, we, which is great. Okay, so let's get to the number one mistake and it has to do with Google. Google is the most powerful Internet search engine and the number one mistake most physical therapists make, most businesses make is not claiming their listing on Google, not claiming their business listing on Google. Google is the number one search engine in the world. It's huge. The number two search engine is YouTube and YouTube is owned by Google. Can you do a Google search or maybe do this? You can do this now, you can do this later tonight. Do a Google search for your name. So Aaron LeBauer or your business name, which would be Labour physical therapy and see do you come up onto Google. If you don't show up for those first two you've got, you need to do some work because patients who want to come see you are going to type your name or your business name into Google and they want to be able to find you and you should be at Least the top, if not the top three results. If your name is Joe Smith or John Smith, you might have a lot of people show up for your name. But John Smith in Greensboro, your business Smith Physical therapy, those should show up physical therapy in your town. So physical therapy in Greensboro or physical therapist in Greensboro for me would be the ones in general. You should show up on those if you have your claims. Your Google listing harder ones are back pain in your town. Back pain in Greensboro is dominated by chiropractors with these pre populated chiropractic websites. They do a great job marketing better than physical therapists generally. And it was very hard to break into that. And I did break into that for a while. I'm not sure my current status in that I should have blog posts or videos on that first page of that search. And your specialty in your towns. Like if you do pelvic floor physical therapy or sports physical therapy or ACL rehab or neuro physical therapy in Greensboro, you should be able to show up for those types of Google searches. So Google Google and Google Maps are vital places to have your practice listed. And here you should be able to see my practice. I'm right in the middle. And when you type in physical therapy, Greensboro, North Carolina. The first thing that comes up, the listings of practices on the Google that are on Google Maps. And then below that are the organic listings. And you can see here's my practice right in the middle. I've got 17 Google reviews. No one else has any Google reviews that showed up. And I just took this screenshot about a week ago or two when I created this PowerPoint. So who are you going to choose when you when you enter in physical therapy Greensboro, most people are probably going to click on the one with the reviews. What you need to do is claim, verify and then complete your Google business listing. And by complete, what I mean is include your website, your blog pictures. So Google business listings gives you the ability to upload pictures. So you should upload as many pictures as possible. You should also link to your YouTube videos so they have a place in the business listing where you can put your YouTube videos in there or maybe now sometimes their technology changes rapidly sometimes. And you should have YouTube videos for your practice which will show up on your Google Business. Your Google plus business page. Basically go through the business listing and complete all the steps, the hours you're there, the type of payments you accept, etc. And a description about your practice. So where do I go to claim my listing? Google my business. So go to www.google.com/business. And you'll need if you don't have a Google account, you'll need to sign up and get a Google account. It's easy to do and it only takes a few minutes. If there's one thing that you get from this talk, I just want you to understand that Google is king when it comes to self referrals. Once you have a Google Local listing, a Google Maps listing, what you need to do is then ask your satisfied patients to write an online review and or a testimonial and ask them to go to your Google Business page. You can even go to the page yourself and copy the link and paste the link into an email who on your website, on your blog or in a in a message to your patient and say here's the link to our Google Business page, please. You know I would be honored if you could write us a review about your experience in our practice. What this does is this helps other people understand how they can benefit from therapy in our practice. Change gears a little bit. Let me ask you a question, a couple questions. Do you want. To spend 30 to 90 minutes with each patient to be able to treat five to six patients per day? You want to spend more time with your family, No hassles from insurance companies to be paid on time, like to be paid today or at least within a week or instead of 90 days or maybe not ever. More freedom in practice. If you said yes to any of those. I've got a product. It's called the Cash PD Blueprint and this is a community of like minded physical therapists, occupational therapists, experiment, a couple massage therapists and a chiropractor. And what this is, it's a step by step program that will show you how to create, grow and market a cash based practice. This is something that I put together from my successes and mistakes to help other people create the same kind of success that I feel like I've achieved for myself and my family. The Cash PT Blueprint. It's a step by step online training course. It's a community of like minded therapists with Premium video trainings, PDF and MP3 downloads of every video training. I'm going to teach you how to market your practice and there are all kinds of downloadable resources, handouts and worksheets. In short, there's six video training modules. There's a bonus module, Facebook group live Q and A every month. There's exclusive resources and I have a no questions asked money back guarantee. And if it's not the right thing for you, just let me Know what I teach is how I successfully operate and market my practice. We go deep into the mindset necessary to start a cash based practice. I explained my blueprint for success and the steps you need to take to transition your current practice from in network to out of network or from from your in network to cash based. We talk about when you can and cannot treat a Medicare patient in your practice, how to market directly to patients who will pay cash for your services. That's a huge module and a huge part of what we need to be successful. One of the reasons, let me go back and say one of the reasons that marketing is so directly to patients is so important is because when physicians refer patients to a cash based practice, or at least in my experience, patients were never ready to buy in. And so I had to go directly to patients. And I also didn't like going to physicians and trying to offer them lunch in exchange for a time to speak with them, not just in exchange for a referral. It just didn't seem right to me and I really didn't like that. Building a relationship like that where I feel like I'm the primary care physical therapist and that just didn't, that didn't jive with me. So I started going directly after patients. So there are bonuses in this program. There's the Cash PT toolkit that dominate the first page of Google ebook, the blogging for your therapy practice ebook which teaches you how to create a blog and a website. There's a Cash PT resource guide and a bonus video training on building value for patients and cash based models. One of the things I really like about the group I've created is we've got an online community just for people in the program to help support each other, help answer each other's questions and get everyone moving forward. And so far it's been really wonderful to see everyone kind of participating in the live monthly Q&As. I'm actually doing one on Monday night. All the questions answered. It's a great place to check in and ask questions and get some direct one on one help. So now that you've seen the Cash PT blueprint real quick, I just want to tell you what is there and break it down. There's over six hours of video trainings plus all of the Q&As. At $197 per hour is the rate for my consulting, that value would be almost $1,200. We've got the live Q&As and over $270 in bonuses. So there's a total value of $1,400 in the cash PT Blueprint and the lifetime value of one new patient at five to eight visits on average is about $800. That's about two new patients. So two new patients pay for that. And there's also community support which I believe is priceless as our Facebook group. But what I'm doing is I've packed it all together and I've priced it at $497. But today you can lock in lifetime access to the cash PT blueprint for just $297. And I still have my 30 day money back guarantee, no risk. And what this is about is creating community, the Cash PT Nation, helping you create the practice of your dreams and marketing directly to patients. Join our community because you have the gift of healing others. You have the power to transform lives, yourself and your patients. You're excited to practice in your way and you want a life of freedom and fulfillment. So my special offer is available. You can go to the Cash PT blueprint. And at checkout use the code Happy hour. This is just for you. Okay? So thank you very much for being here today and your free gift that I'm giving you today is my ebook on blogging for your therapy practice. To get your ebook go to labourconsulting.com free gift. I'll also email you a link with the replay of the show. So join me next time for the cash pt lunch hour. February 11th Wednesday, February 11th at 1pm I'm interviewing Chad Madden of Breakthrough Physical Therapy Marketing. This is going to be great. We're going to drop lots of knowledge bombs on marketing. Chad is the pops killer. He had a situation in his local practice where the physicians groups all became owned by the OR conglomerated with the hospital and he could know he was no longer getting through his referral stream and he came up some awesome creative ways to work around that and he is full of awesome marketing, direct to patient marketing ideas and he has cash based programs in his clinic. So we're going to go deep and look at some of that stuff with him. Then a few weeks later for the next Cash PT Happy hour, I'm interviewing Scott Harmon of Start a therapy practice. And Scott is an occupational therapist who helps people start, create and grow their therapy practices and specifically pediatric therapy practices. And that's going to be Thursday, February 26th at 9pm I've also created a Facebook group. This is a free Facebook group, the Cash PT Nation. So you go to facebook.com groups CashPTNation would love to have you join us there. This is a great community of people who work in cash based practices and who are also interested in the cash based model. And then next time for these next programs, we're gonna have Q and A. If you have any questions, don't hesitate to ask me. Post it to the Facebook group or on my blog. If you're reading a blog post and you're inspired to ask a question or something resonates with you, please leave a comment. I would really appreciate that and so would other people. If you have a question, it's guaranteed someone else has the same question. So now let's start with some questions. There is a little bit of a delay sometimes, so go ahead and type in some questions in the chat box if you have them and I'm going to come back on the screen. All right, let's see. I'm going to go check out the polls, see if we can end the poll and see if I got any good results or if I can see them. All right, Right, here we go. One of the most common questions I get is, you know, I've heard cash based practice only works in a large city or my, my town is a little too small for, for a cash based practice. And what I'll the way I usually answer that is cash based practice is going to work where people value your service. One of the big things about health care right now, 2015, is the affordable Care Act. What's happening with all these changes is that deductibles are getting higher and co pays are getting higher. For instance, my plan next year, I've got a $2,900 deductible and an $80 copay for physical therapy. Yes, I get 30 visits, but 30 visits, I mean, at $100, I will just meet my deductible. How many patients come in for 30 visits? I mean, it's really, it's not a benefit. So what's going to happen is people are going to start going to get therapy or just consume healthcare and realize that you're spending a lot of money because their deductibles high and they're gonna look for a better value. And a lot of times the better value is gonna come in a cash based clinic because yes, it may cost $100 or more, but they don't usually go in three times a week and only see the physical therapist for 15 to 30 minutes. They'll see, get a full hour or full 45 minutes and get a lot more done in that time and be much more efficient. Okay, I'VE got a great question from Kevin. Can you briefly speak on one or two of the main issues you've encountered doing cash only? Oh yeah, Kevin, that's a great question. The main issue that I've encountered is it's the mindset issue. It's the sports medicine physician in town who told me at the farmer's market and he said, you know, Aaron, you're doing great things, but I would send you patients but you don't take their insurance. And I'm like, here's the guy that should know a lot more about what I do. I had been to see him as like a. I hand delivered an evaluation of a mutual patient and we sat down and talked for about an hour. And this instance at the farmer's market was about two years later and I told him about what I did. We had seen patients back and forth and it's like, if he doesn't understand, who's gonna, what physician is gonna understand? So that's really one of the, that's one of the main issues being cash only is having other providers and not really understand what it means or explain to patients what it means. One of the other big issues is when people call, they want you, they want to know, do you take my insurance? And it's really like, these aren't problems, but these are just kind of things that I had to overcome and learn how to speak to patients about that. So a lot of times when someone calls and says, do you take my insurance? Well, I say, hi, may ask you Speaking, this is Dr. Labour, what's going on today that you're looking for a physical therapist? And then I get to know them a little bit, find out why they're calling. The second question I ask is, how did you hear about our practice? And if they say, I just looked you up on Google, I'm about 50, 50 where I'm going with them. But if they say you're really close to my office and, and it's basically out of convenience and I looked you up online, they probably don't have an understanding about how our therapy practice works and how the cash based issue works. So conversely, the patient calls and says, my friend Joan said you fixed your shoulder. I've got the same shoulder problem, I want to come and see you, whatever. And I'm coming in tomorrow and that person's already bought in because their friend gave them the buy in. So that's how I've overcome that, is not answering that question, saying no, the way that I answer that. Do you take my, do you take my insurance question is to say, well, we are out of network. A lot of patients with Blue Cross Blue Shield come to our practice. Your first visit is an evaluation which includes a postural assessment, a movement assessment, a hands on evaluation, hands on treatment, and a home self treatment program. It lasts about an hour and it costs $125. My patients come in approximately once a week on average. Five date visits and follow up visits are $110. And people might hear, oh, that's expensive, or they might hear, oh wow, well, once a week, that's different. And they start to get it and understand that what I'm doing might be different than their last experience. So that's how I handle that question. In general, when I'm asked that question, the patient's not going to come in. So I try not to make it a really long conversation. It's usually when the insurance question is like the third or fourth question because a lot of times the patients have already been to my website and read up about it or heard about it from the person that's referred them. So I've got another couple questions that have come in. Okay, how do you manage a patient who does not see results they expect in your typical five to eight visit timeframe? So Jaggi, when I say five to eight visits, really it's not that I say to patients, all right, this is five day visits and then we're done. On average, some patients come in and they need one or two visits so I can teach them how to treat themselves, teach them some therapeutic exercises and they can self manage and they get better because they're treating themselves on their own. If someone comes in and I say, this is going to take five day visits, I usually say, let's give this about once a week, four to five, four to five weeks and then let's check in. And then when we check in, I see where they are and I'll do kind of a reevaluation. But almost every, every visit I reevaluate patients verbally and visually and with my hands. A lot of times what I, what's important is setting the expectation. On day one, it's, well, if we get you 30% better, is that going to allow you to, you know, play with your kids on the floor? It's not about getting rid of all pain and saying, okay, in five visits you'll be fixed. It's my philosophy is to teach and empower my patients to help themselves so they can fix themselves. And sometimes that's difficult. But you Know, other times it's just about really kind of helping people learn to trust themselves. And sometimes that takes more than eight visits. It's rare that I see someone for 20 visits or more. Occasionally there's someone that needs that many because maybe they've got multiple areas that need more hands on, more tactile input. They're just more time. Some people aren't willing to do the work on their own and they get kind of frustrated and realize, wait a minute, I haven't been doing my own work, let me take a few weeks off to do the work myself. And I get that from quite a few people. Once they start to realize that the onus is on them to get themselves better. Okay, so I got another question that says, what do you do with post surgical patients who will need extended care? That is a great question. I typically don't see post surgical patients. The big reason is the two orthopedic surgery practices in town have huge physical therapy practices as part of their clinic. They're physician owned practices and a lot of them don't even believe in physical therapy after surgery or physical therapy before surgery. So I end up seeing those patients a year, six months, a year, two years, five years after the surgery and they're still having problems. What I suggest to people and what works for some physical therapists I know who do a lot of post surgical is they know, okay, a total knee replacement knee usually needs X amount of visits for, you know, eight weeks. And what they'll do is they'll put together a package. This is what your physical therapy rehab is going to cost. It's going to cost 2,500 bucks and you can pay 500 now or every visit you pay. And this is kind of what the total is going to be. And you might look and they have a $3,000 deductible, or shoot, they might have a $5,000 deductible. The surgery was only 2,800 and you're going to do $2,500 worth of physical therapy and they're barely going to get over their deductible. So, you know, it might still be worth it for them and they're going to get a lot of benefit out of coming to see you versus sitting on, you know, a bike by themselves when they can do that at home, especially the motivated people who want to do that type of thing. So putting together a general package I think is my best recommendation for the people that need extended care. Okay, let's see. Anyone have any other questions? I think that I think that looks like as the last question. Thank you guys so much for being here today. I've had a great time. I hope you've learned some some things from our talk today. Please join me next time, follow my blog labourconsulting.com and connect with me on Twitter LinkedIn. On Twitter I'm obaouerpt and LinkedIn you should be able to find me. Thanks for joining. I really appreciate your time being here. This is Dr. Aaron LeBauer with the Cash PT Lunch Hour. Thank you so much.