"The CashPT Blueprint" Exclusive Audiobook Reading: The Cash-Based Mindset | CashPT Lunch Hour #91

Foreign. Hey, what's up? It's Aaron. And welcome back to the Cash PT Lunch Hour Podcast. Today's episode is a special episode where what I'm going to do is share with you the first two chapters of my brand new book, the Cash PT Blueprint. We're going to be talking about the anatomy of a cash based practice. So I'm going to give you a rundown of what we do and how we've built our clinic and as well as the Cash PT Mindset. Because there's no way to start a cash practice or even transition from an in network practice to cash based practice if you don't have the right mindset. And we're talking about an abundance mindset, the value mindset, the Give to get worth, the primary care physical therapist mindset, and the Dr. Mindset. So get ready for a great episode. We're going to this is from the first two chapters of my book, the Cash PT Blueprint. And this is the companion book to my best selling course where I've put over 550 people through the cash PT blueprint over the last few years. And if you're interested in getting more at the end of the episode, listen up because I'll let you know exactly where to go to get a free copy of my new book, the Cash PT Blueprint. So sit back, enjoy, take some notes and then when you're done, I'd love a shout out somewhere on social media and let me know your number one takeaway. The Cash PT Blueprint. Are you frustrated with insurance companies dictating your treatments and withholding payments? Overwhelmed by starting a cash based therapy practice and unsure where to turn for help? Eager to transition your current in network practice to a cash based practice? Do you want a simple system for starting a cash based therapy practice? If you said yes to any of those in the following chapters, you are going to get the step by step template to start a cash based practice from scratch that over 500 successful cash based physical therapists have used to build their own thriving physical therapy business. These important lessons are distilled down from over 20 years of trial and error in my own businesses and all you have to do is choose to believe it's possible for you too. The Anatomy of a Cash Based Practice we're going to start by covering the anatomy of my practice. Why an overview of my practice? Well, to show you what is possible for yours. You may not have or want the same type of practice that I have. You may have an idea for something completely different like a home health based mobile practice, working in pediatrics, a gym based practice, an online business, or something entirely different. Just understanding, knowing and seeing what other people are doing and can help you create the practice of your dreams and see what's possible so you can get there too. Sometimes it's hard to imagine what's possible or even believe it can become true until you've seen it for yourself. This is also important because I want to demonstrate to you how a low overhead cash based practice can operate successfully and be scaled to multiple therapists so you can earn a great income even while on vacation. Our Patients we have a low overhead practice. We maintain a small footprint, we don't use any equipment or modalities in our practice, so we don't have anything that's expensive to maintain or to buy or purchase. We generally see one patient every hour. We provide almost all hands on therapy using myoflash release, manual physical therapy, craniosacral therapy, soft tissue mobilization, deep tissue massage, trigger point therapy, trigger point dry needling, taping, and most importantly, we teach and empower our patients to treat themselves at home using a lot of the same techniques. When we see a patient for the first time, one of the biggest things that we do is to spend time talking to them. We let them tell their story. Our patients in general have chronic pain or unresolved pain. They've been around the block, been to see other therapists, chiropractors, massage therapists, physicians, surgeons, etc. They've been on pain medications, head injections and even surgery and and are still struggling with their pain symptoms and inability to return to their normal end quote lifestyle. They're looking for something else, something other than the cookie cutter treatment they've received elsewhere. They don't want hot packs, leg lifts or ultrasound. They don't want to ride a bike for 10 minutes. They don't want to do exercises they already know how to do, end quote, or can do on their own in their gym. They're looking for a new path. They want something more. Our patients are people who value their health, who are active or want to be active again, and who want to improve their current condition so they can focus on what they value most. They want to participate in their own healing process. Our clinic environment when it comes to your treatment room, keeping it simple is my best advice. Whether you're using equipment or not. Ask yourself, do I really need this to provide the best treatment possible for my patients? Do I really need 3,000 square feet of treatment space? Do I really need to lease that $75,000 ultra G anti gravity treadmill. As you plan your practice, start to consider these things overall. Just make sure you provide your patients with a comfortable therapeutic environment. We have soft music playing as well as dim lighting to make the experience more relaxing. We also provide water to them which I think is a must. It's like Mrs. Jones, have a seat, would you like some water? It's just a nice little gesture to help build rapport, break the ice and give people a nice experience. This is much different than your busy open gym treatment area or style found in many orthopedic clinics. I believe our way is more healing and supportive based on my experience as a massage therapist and what hundreds of patients have reported to me over the years. Finally, we sell self treatment tools in our waiting area. These are the tools that we use personally and which help support the manual therapy interventions which we provide in our clinic. We don't count on the revenue from these nor can we get great margins. I think this is important since our patients can walk out the door with the recommended product right away and start using it to get better. Because if I tell them hey, go to this link and buy this product, they usually don't do it. I started by depositing $10,000 into my new business bank account. This covered all of my equipment, rent and marketing materials. A big chunk of it was estimated living expenses for the first few months until I had some cash flow. I know a former practice owner who started their own clinic with just $500 in the bank and years later after a lot of hard work and success sold his clinic for multiple six or even seven figure sum. He never disclosed the amount to me. When I started I already owned a portable massage table, an expense that's well worth it if you're doing any manual techniques. Budget $900 to $1,000 on a quality American made portable massage table. I have to say the quality of table makes a huge difference. The higher quality tables last a lot longer. Stay away from the cheap Costco or Amazon special. You can often find high quality used tables on Craigslist or Facebook. I have a table that's been with me for my whole massage career and it's still in use today. We bought one a little bit less expensive to have as a second table and it really only lasted four or five years before the vinyl was all rubbed off and the legs were wobbly and it even had it malfunction when a patient sat on it at one point. And spend good quality money on a good quality table. It's going to be one of the best investments you make. In our first clinic location, we were paying about $300 in rent a month, which is really inexpensive. We didn't have a very big space, just two rooms and a closet large enough for a desk. One was the waiting room office, one was the waiting room office and the other larger room was the treatment room. It was far from prime real estate and that doesn't really matter. If you have a strong value proposition, patients will come see you. We've had patients drive an hour to come see us and come as far as California to be treated in our Clinic. The Cash VT Blueprint Part 1 Chapter 2 the Cash PT Mindset One of the most important things you need to be successful in this practice model is the cash based mindset. You may already have it, but you definitely weren't taught it in PT school. If you're reading this book, you probably have it, but we just need to bring it to the surface. What is it, you may ask? The idea that we are worth much more than a copay in this chapter we're going to talk about the different mindsets you need to have in the cash based model. If you're not a physical therapist, I want you to understand that a lot of the ideas are going to apply to you and your profession or situation. Whether it's occupational therapy, massage therapy, chiropractic, acupuncture, etc. The ideas in this book are based on solid, long standing foundational business principles that we'll dive deep into in later chapters. The Worth Mindset One of the things I want you to think about right now is health. How much you paid for your degree or your training? How much is that worth? How much is it worth to you? How much is it worth to patients clients? Now think about the last patient who told you you changed my life or you gave me my life back? How about the patient you saved from back surgery or from getting a double hip replacement at 45 years old? Or having their foot amputated because of chronic pain from a possible hospital borne infection or even death on the operating table for a routine surgery? What is that worth to them? How much do you need to earn each month to sustain yourself? And how much do you need to earn to make a good living? The next step is to say to yourself in a mirror, I charge X per hour, I charge $250 per hour or I charge $249.75 per hour. Okay, you getting this? There's a lot of self doubt here, but practicing it will will help you grow confidence in your worth. I can't tell you exactly what you should charge, but if you're charging less than a typical copay, the Medicare allowable less than your dentist charges you for a teeth cleaning, or basing your rates on what your colleagues are charging, you need to rethink your pricing strategies. The likelihood is that you're afraid to charge more because it feels unethical to sell physical therapy and you're afraid of being perceived as sleazy. This is very common and completely understandable. You were never taught your worth and value to your patients. This is what a majority of my students struggle with, something I worked hard to overcome personally. Once I figured out the secret to ethically selling physical therapy, it transformed our business. You are worth so much more than just a copay, so don't settle there. This struggle is what I teach people how to overcome and why I created my course. Ethical Influence the Value mindset. You have to lead with value and provide value to your patients. You also need to value yourself. What is value? Value is what you provide your patients so that they know and understand you will help them get what they want. You give them value by asking the right questions and helping them get the transformation they deserve. Enter the conversation in their mind. Patients don't want more new range of motion or even to be pain free. They want to be able to finally complete that 5k, get a PR in CrossFit, play with their kids on the floor, dance at their daughter's wedding, and feel strong and independent so they can run away if they have to. Valuing ourselves is rather tricky because it's not something you were taught in PT school, in your clinical rotations, or even in your last job, maybe not even in your family or growing up. Your value also includes your expertise, your skills and your education. So to show your value as a business, consider what can you provide that is unique in a cash based model? We're almost always seeing one person at a time and we have the freedom to spend as much time or as little time as we need with them. So we can spend 30 minutes, but a lot of people are going to spend 45, 60, even 90 minutes with their patients one on one, just having the time to sit and listen to their story. That's valuable in and of itself. And I want you to understand that it's not the one on one that's the value. It's you being able to spend the time with people to ask the right questions, to understand what it is they want, which is where that value comes from. What other Expertise and skills do you have that can't be provided in an in network or contractual setting, or that no one else in your town is able to provide? What questions can you ask your patients that will help them understand what what they truly want and value and how you can help them? That's where you can really show value to your patients. A lot of times patients will call and find out how much we charge and say, okay, I need to use my in network benefits. And a few months later they'll call back because they were unsatisfied with their care elsewhere. I should have called you first or I should have just come to see you first. Money or price is never the objection. The objection is always around a lack of clarity and understanding of value. Yes, patients will pay hundreds, even thousands to see you for physical therapy if they understand and value what it is that you offer and how you can help them make the transformation they desire and get the results that they want. Yes, patients will pay for physical therapy. No, not all patients will pay. There are a lot of people who feel like they need to use their benefits, but it's not even that they need to. They just don't understand the difference between what we can offer one day a week versus what someone else maybe offers three days a week. Patients will forego their excellent insurance benefits and pay hundreds of dollars per visit if you know exactly what they want and desire and why it's so important to them to get it. The primary care physical therapy mindset. If I view myself as a primary care physical therapist, I am the person that people come to see first when they hurt or have trouble moving. We are the point of entry into healthcare. We are referring to patients, to physicians and other providers, even other physical therapists. I now have the power as the referral source and a position as the expert on movement disorders and musculoskeletal dysfunction. I am being seen as the decision maker. It's the decision making process, entrusting us as the decision maker that's important and me feeling comfortable helping patients making the decision part of this mindset. So direct access for physical therapy means that patients do not need to have a referral script or prescription for physical therapy to see a physical therapist. This is a state by state, profession by profession issue. Marketing directly to patients is part of claiming, owning and taking responsibility for direct access. The patients are our customers, not physicians or insurance companies. The patients are are the ones who will ultimately make the decision to see you or not. We need to focus our marketing directly to our potential patients needs wants, desires and get out of the mindset of oh, I need to market to physicians. I need a physician's referral to see or treat a patient. Even if your state only has direct access to an evaluation or it's limited in some other way, you can evaluate them and make a recommendation for their plan of care, or you can talk to them on the phone and make a recommendation for their plan of care. Then, based on your specific practice act, you can contact their physician or the last healthcare provider that can refer to you or write the necessary script. Sometimes it can even be a dentist or provider in another state. You make it part of the onboarding process to get what the patient needs to be seen in your clinic. There are ways to work with these limitations and stay within the law. And we physical therapists need to start operating from the place where we are the person and that this patient can see and should see first. This is who you are going to market your services to. And that's where together we are going to focus our efforts to change the profession. The Doctor Mindset I'm going to say in quotes, doctor, this is a soapbox topic for me, so get ready. I'm not going to spend a ton of time on it, but these are the important points. Who is a doctor anyways? In physical therapy we have somewhat of an identity crisis. I need a physician's referral is what people say. Patients will say, I need a physician referral. The state needs to go in the trash. Because in 50 states we do not need a physician's referral for evaluation or to even speak with a patient on the phone and ask them a few simple yet very important questions. So there's so many therapists out there still operating under you need to see the physician first. And likely a lot of them these days are just working in a model working where the physicians actually have to see the patients first based on the business model, not necessarily the law. Patients are typically not ready to buy into our physical therapy plan of care when they come to our clinic. If they're referred from a physician, patients are not really expecting anything different than what they've experienced prior. I put quotes here. So I went to see my physician, the godlike person, and I only paid $50 or even $25 to see them. Why am I going to pay you, a physical therapy technician, more money when people are told to go get the physical therapy when they're told you need physical therapy? They're treating and seeing us and perceiving us as technicians, not decision makers. If I Ask someone, well, what did your doctor say when speaking to patients then? What I'm doing is devaluing my own degree and my position of authority as a healthcare provider and an expert in musculoskeletal care. Instead, what I'll ask patients is, what did your physician say about that? Or what did your physician recommend? I'll use the term physician, not doctor or docs, when speaking to patients about other doctoring professions. So who are you? I told you who I am. Who are you? I want you to write it down, say it in the mirror. Say it a hundred times. Primary care physical therapist. I am Dr. Lebauer and I am your physical therapist. When I say that, I am positioning myself in that statement mentally, physically and emotionally as the primary point of care for people who have pain, injuries and limited motion. It is a mindset, an expectation, a way of being. This is not for people who have blood squirting out or bones sticking out of their arms, but people that are hurt, people that can't move very well, people who think that they just need an MRI to know what's going on. I am the primary point of contact with them. Our practice is. And I am the musculoskeletal expert. We are musculoskeletal experts. I am the doctor. You are the doctor. We are doctors.