The MobilePT Academy: Your Step by Step Roadmap to Start a Mobile Physical Therapy Cash Practice

What's up? Hey, y'. All, this is Aaron LeBauer This is the Cache PT Blueprint Master class for December. And I hope you guys are just joining us. You're in the right spot. We're just going to wait a few moments to get. Let everyone get in to the class and we'll get started. I also need to load up my PowerPoint. If you guys have any questions today, just go ahead and enter them in the chat box. If you know, like, we'll have time at the end for questions as well that Even questions that aren't related to the topic we're talking about. And if any questions come along, just post in the chat. If you're just joining us right now, just let me know if you can hear me. Okay? If. If your audio sounds good and the volume is good, and where you're calling in from, let's see. I'm just gonna upload. I just gotta get my PowerPoint open. How you guys doing today? Just give me a sign in the chat that you're here, that you're in the. You're on the webinar. You can hear me. Okay. We are. We're doing the mobile Cash PT biz today, Right? What's up, Kathryn? How you doing? Hey, Hallie, how are you? Hey, Thomas, Tanya, thanks for checking in. How are you guys doing? How's your practices coming along? You guys have anything that. Anything to share? Hey, Gia, how are you? Who else is here? People hiding. Brian, Joyce. Can you guys hear me? Okay, just check in and let me know that you. Sounds good. All right. If anything happens during the presentation today, there's a refresh button. Just reload your browser and just come back in and check us out. All right? So what I'm going to do is just get rolling. All right, Anyone have anything to share before we get started about how your practice is going? Any wins this week? Anything. Anything changing your practice big since the last time Tanya says practice is going okay? Need more clients? How many clients do you need? How many more people do you need? Sometimes it's just getting that extra one or two people or that one person that comes in and Then they refer 10 people a year so that person's right around the corner for sure. All right, let me load up my presentation. So we're going to talk about the mobile Cash PT business today. And I want to do this because this isn't necessarily what everyone's doing at the same time. It's something that a lot of people are. A lot of people are using to start out. With and it's an option even if you don't have. If your idea isn't mobile sometimes people call you and say hey can you come to my house and you know treat me because I just got out of surgery and I want you to come in etc. So let's get, get over here, let's get rolling on this one. All right, the Mobile Cash PT Biz. Here we are. The Mobile Cash PT Biz. This is the essential guide to setting up your cash based practice as a home health or mobile practice. And what I'm going to talk about today is basically taking your cash based practice, your physical therapy practice and getting you on the road. We're going to talk about a practice overview and basically what is a home health or mobile practice. We're going to talk about the pros and cons of a mobile business and what you should know if you're considering this model, setting it up right even using technology to make mobile easy and convenient. Billing and documentation, a few key differences you need to know and marketing strategies for your home based practice, promoting the benefits and maximizing social media. So what's a mobile cash PT biz? This is a cash based practice that provides services at the patient's home, patient's office or other or location other than in a primary brick and mortar location. There are a lot of different variations of this. Who here attending today has a mobile practice or is planning on building a mobile practice? Just give me a sign in the chat if you are or who has anyone done this and decided they didn't, they don't want to do anymore or that does like 5050 you just let me know, let everyone know in the, in the chat box. So Tanya does had it for a year. Awesome. Congratulations. Anyone else here? So this is something that is really popular especially in larger cities and even for people that want to really start really stripped down, super low overhead. Let's see, Thomas is planning one. Brian, that's what Brian does. Hallie is starting a mobile practice. Planning to start with a mobile practice and as part of the services even with an office space which is awesome. Paul is planning to start and Andrew says I sort of am. I have some home office and then treat some patients in the CrossFit gym. So that's great. Yeah so this is a, I mean this is even like you know people who treat in two or three different CrossFit gyms around town, you know treat it doesn't have to be just in patients homes. So this is just a really awesome way to minimize Expenses and, and maximize some value for patients. The pros and cons of a mobile, a mobile practice. Well, the pros that I've come up with are, is very low overhead. It really doesn't cost a lot to put together. You know, equipment wise, you need a. We'll go over some of the stuff again before. But you get rid of the local, you know, you don't have a landline, you don't have a rent, which can be 300 to $1,000 a month. You, you get rid of other utilities like water and gas, electric, and you know, there might be some other city licenses for your place, you know, that your brick and mortar place, you don't have to upfit it. You don't have to get chairs and waiting room, tables and rugs and lights and etc. It can be a really stripped down variation. It also provides super convenience to patients, so patients really will get a lot out of it because let's say someone's really busy and you know, they're, I don't know, they're like a court, let's say, like they're a CEO and I'm going to give two examples. But they're a CEO, right? And they have, they work downtown somewhere. They don't have time in the middle of their day to drive a half hour to see you or 15 minutes to see you. So if you can come there, they'll likely pay extra because let's say their hours worth, I don't know, let's just say 500 bucks. But it was probably like a thousand bucks. They can generate a thousand dollars which, well, it's better for them to pay an extra $50 in travel time or an extra 150 bucks for you to come to their office than for them to spend that 30 minutes of travel time back and forth or each way not producing any work. So a lot of people have done that and made a good model of that. Yeah. I'll just tell you a little story. When I was a bike messenger in San Francisco, I laughed one day I was like, I'd go pick up a lot of different things and one day the tag, which is when you have an order, it's called a tag. The tag was go to the Missing Link bike shop and pick up a rear wheel, take it to 325 Montgomery to the, you know, 43rd floor. Or actually, no, we had to go, I had to go pick up a wheel from the 34th floor. But they didn't really tell me what it was until I got There. He's like. My dispatcher's like, you're not going to believe this, Aaron. It's a bike wheel, and the destination is the bike shop. And so you take it to the bike shop, and it's just, the guy's got a flat tire. I take to the bike shop, and dispatcher's like, this is ridiculous. He should be able to change his own tire. So leave it at the bike shop, and you're gonna go do some other work, and we're gonna charge him waiting time. And I was like, okay. So instead of me sitting there and doing nothing, I went and picked up some more packages, got more business for myself, came back, picked up the repaired tire, which takes all of five minutes, and the $5 tube, and brought it back to this guy. And they paid. I mean, the minimum order was like, 30 bucks to do this. And I think they paid about $55 for a repaired tire, plus the bill at the bike shop. And that's all to say that the convenience of picking this up for someone in their office. And this wasn't even like, CEO person. This was just like, you know, hallway window, office person was worth it for them. So this can be a huge benefit to patients, busy people. You can have people who work in a factory who need some physical therapy, and if you show up at the factory or their place of work and can provide treatment at the end of the day, that's also huge. Or on a lunch break where they don't have to spend the time coming to you. So it can work in a lot of different ways. It's convenient. It's. There's a lot of times where I'll order something on Amazon because I don't want to take my kids two miles away to the store to order to pick up something I forgot, like, some shampoo that I can just order on Amazon, it's not going to really impact many people locally. And it's a convenience to me. So this convenience to patients can't be understated. And then you've also got a higher perceived value and even level of service, a level of care. So you've got this, like. It's like. So when it's. When it's. Positioned in a way, like, we come to you, we take care of you. It's a concierge. This is like the concierge thing. It's like. And it's minimally more expensive. We're not even selling this to our patients this way. But it's minimally more expensive than actually coming to see Me or not any more expensive or going to see your in network clinic. You know, it's like whoa. So you're providing a ton of value in this way of creating this high level of convenience, high level of value. You're providing like the ultimate service by going directly to the patients. They don't have to get in their car and drive to you. I mean that's huge. So those are some of the big pros. Anyone else have any pros they can think of who've been doing this for a while that they like? Go ahead and post that in the chat. Here's some icons. It's your travel expense and time. So you might have to travel 30 minutes to see someone or you and it's going to take you time. You can get stuck in traffic. You know, going along with that, there's a lower number of total patients you can see in a day. So let's say I can see one patient an hour, like 8am, 9am, 10am, 11am, 12am If I'm going to do a mobile business, I'm probably going to start my first person at 8:30, then we finish at 9:30, then my next person is going to be at 10:10 to 11 and then 11:30 to 12:30 and then lunch. So instead of seeing five patients in my clinic, I'm going to see three patients in the morning. In order to make the same amount of money I have to charge more. So that's a con. So there's a lower number of total people that you can serve but in the same amount of time. But that might be a pace that you really like. You know, I want to see five patients in a row and then go home for the afternoon. But you might not want to see people that packed on top of each other and then you know, be okay with seeing five patients in an eight hour day. So that's just, that's like the con for me, a lower number of total patients. And we're not talking, you know, like I do a high number of patients. I mean, you guys know I see, see 25 to 30 people a week and I don't really see 30 people a week unless it's a super packed week. Just because I don't want to see 30 people. Oops, let me go back. So the other one, another con is like no home base. And to me that's like there's no, you know, your home base is going to be your home. So there's no home base to be and you know, kind of help create some continuity to create a routine. Your routine becomes your car. The equipment maybe you carry with you your home. And. And I like having a routine in a home base. I like having an address and a storefront. But, you know, that's my con, and I don't know that that's a really strong one. One of the other. The other cons is, I think it's. And I go into this later, I didn't put it here as a con, but it's screening patients. So this might be not really pro or con. This might be more precautions. You're going into patients homes or patients offices and places that aren't yours. They're not. Maybe not. You might have a small. Like there could be some security concerns. So that's a con as well, depending on where you are, what neighborhoods you're going to, where you're driving. And that's an issue with regular home health pt, too. So just be in mind and aware of that. So one of the big things I think it's great about this and doing these things in the modern age of 2016 and beyond, or early 2010 and beyond, is using the technology. You got to have something like. This is what I would recommend getting an iPad or a Chromebook, probably I would go with a Chromebook, considering the iPad's nice and I do love Apple products. I've been using the keyboard on my iPad lately, and it's just like it loses its connection, its Bluetooth connection really quick. You know, I go to start typing and it'll type in a whole bunch of extra characters, etc. And I type pretty quickly. So I'm even thinking like, well, maybe I should get a Chromebook. The chromebooks are like 200 bucks. You just need to make sure you can get on wireless signal. The nice thing about the iPads is you can connect them to cell signal. I bet there's a Chromebook out there that does that. I just haven't actually looked at that. The other thing you can do is just use your hotspot from your phone and connect your Chromebook wirelessly or Bluetooth to your phone or even by a cable. But you get one of those. Like I said, you get your Internet access using a mobile hotspot or a network. So that would be like a cell network. And you got to have a mobile payment system. And I like Square. There's a lot of different ones you can choose from. If you're using QuickBooks online, a lot of times they'll have a mobile. They have a mobile payment. And that just might Be the easiest, most simple, streamlined thing to do. You do online scheduling, so there's a lot of things to do in a brick and mortar as well, but you don't have to. But you do online scheduling and online documentation. So using the Google Docs for emr. So if you don't have it or haven't watched it, watch the Google Docs for EMR bonus that's in the Cash PT blueprint and that will show you how to use, how to do it for low cost and, and something can be done anywhere. Works great with the Chromebook or iPad. And so in this way, basically your whole office is online and mobile. You don't have any paper. So your receipts you can use I think online accounting receipts using QuickBooks Online. So you may have to generate a super bill in a little bit different way, but in that sense all you do is you just get on your little computer and you, you copy and paste it or you fill it out on the computer and you email it to the patient and you can even input your signature on there if you need that. The signature that I use on my receipts is just a photo image of the signature, billing and documentation. Before I go on, let me just see what some of the comments are. So yeah, so Tanya said people love having the convenience and she's gone to several offices now and yeah, Brian says it just opens up another demographic of people to treat and I completely agree with that. Yeah, so Tanya mentions, and this is something I'm going to mention and want to talk about is I've considered raising the cost to cover the lower number of patients since it's convenience or maybe calculating the distance. Not sure how to approach that, but that may be covered today. Yeah, so if I don't go over that, I will, I will talk about that and. Yep, so we're going to talk about your other question too Tanya, about the treating people in their homes, etc. I might get to that. So let's talk about some billing and documentation. Are there too many differences? Not really. But there's a major one that you need to be aware of on the super bills. If you are treating a patient in their home or their location, use office code 12 right now like for a brick and mortar practice. For my practice it's office code 11 and that's the, I think that's the default number that I have in the templates in the Cash PT toolkit that's on. It's even in the blog post on my website about creating receipts for cash based practice. So the Code you want to use in a home practice is 12. If you're doing a mix of both, what I Recommend is creating two different templates for the super bill, one with a 12 and one with 11. That would be the easiest or depending on how the system you use, just make sure you change that each time when you see someone at home or you see someone in the office that needs to be changed. The other thing you want to be sure to do is document where the treatment took place. So this isn't something I do on a daily basis. I don't document that the treatment took place here in our practice because it always does. But if you're out and about, document where the treatment took place and not just what time, but also put who else was around. So was there secretary outside? Was their administrative assistant around? Were you in the park? At the park and put the street names or at the gym and also put, you know, the owner was present. You know, I would document all that stuff because that's just going to give like more points of reference for what's happened during that treatment period of time. In case anything arises in the future, you know, put who the, you know, so and so was treated. So I'll do this when I see adolescents or minors, I'll say, you know, the patient was accompanied by their grandparent and put their name or patient was accompanied by their parent in the visit. Because I want, you know, I just want to kind of CYA or CMA cover my ass, you know, and just make sure that that's taken care of. So just document your location as well location and who is there. And then you just can generate an email super Biller receipt and email patients. You can create a Google Drive or a Google Doc in drive and share it with them or email them the link. There's a lot of different ways to do that. You don't need paper. You can pretty much go paperless. You don't need a home printer to then print and mail it to people or give to people. There's a lot of ways to get around all that. And like I said, use a cloud based documentation system. And right now my favorite's Google Suite. Some people are using Microsoft Office or even Dropbox. Just make sure they sign a baa. And I don't know that Dropbox does that. I know Microsoft Office Suite does. Okay, marketing strategies for a mobile business. Just write something down. And I just thought of something and I think I lost it. I'll come back to it though. You guys getting this so far? All right. So marketing strategies for a mobile practice, Facebook. I mean, just think about it like, this is the same as some of the other stuff, but what we're doing is we're going to take this stuff and we're going to use some Facebook posts. We're going to do online email marketing. You want to feature people on your blog so you can feature different locations. So feature the CrossFit gym that you treat at. So people in the CrossFit gym know that you're treating there. I have a friend and he has been a PT in a gym and you know, for like six or seven months. And this summer I got three or four people came to see me who work in that gym. And there's reasons they're coming to see me, but they had no clue that there was a PT working there. And I, you know, I didn't, to be fair, like, I didn't say, hey, did you know that John's working? You know, he's doing PT at Strive, but, you know, because they're in my office to see me, I don't know all the reasons, but I know that they just don't. People there don't know that he exists and not because he's not trying, but it's like it takes a long time to get in front of all the trainers and front of the people in the gyms and get them to pay attention. So blog features are a great way to do that. You've got to do that. I did massage at a gym before and the owners were horrible about letting people know that I was there. I had no business and I had no control over the marketing or anything either. So community workshops, these are great. So you want to do community workshops. Any of the partner locations where you're treating, even any of the businesses, let's say your patient has some kind of influence in their business, say, hey, look, what kind of workshop can I offer here for the employees that we can do? Because if you're already there and you can treat an employee downstairs or three cubicles over, that maximizes your time. Of course, email marketing, this is huge. And we go over that in some of these other modules. But I just want to know, is email marketing, these all still work. Search engine optimization, marketing and personal thank you letters and even word of mouth. So to me, word of mouth is email marketing because that's how I generate email word of mouth referrals. But I just want to make sure it's not on the list here and that you guys know that word of mouth is huge and send A personal thank you letter to everyone. But I think the word of mouth piece ties into the next screen, which should be nope. So I'll come back to the word of mouth piece. But that ties into this security issues that Tanya brought up. How do I know? Nervous about going to people's homes. And I'm going to come back to that in a couple slides. But that's great. Like so if you do all word of mouth marketing, it's harder and you don't get as much traction as fast as putting things out the public. But that's what can keep you so that you're one or two degrees of separation from your patient and it can take a little bit longer to build up if that's all you're relying on. But that can create a barrier of security that you know who people are and they're not like totally crazy people, etc. So let me just talk about some search engine optimization stuff. One of the, I would say one of the cons shows up here. So like your Google business page, it can't list a physical location, so it has to be a service area business. So if you're writing this down, write this down. A service area business is how Google will list you. If you do not have a permanent location and you can still get a business page, there's a while where you couldn't unless you had a physical location. So make sure you sign up for Google as service area business. When you go and get listed on Internet directories. If you don't have a physical location, it might be a little bit harder to get listed in certain places, especially even on testimonials and review sites. But you do want to get listed. So one of the ways you can get a physical address is to get a P.O. box. And I would do that. I wouldn't use your home address as your mailing address. If you're going to do a mobile business, I would get a P.O. box somewhere at the post office or the UPS store. If you use the UPS store, you get a physical address that's not a physical address that really will work for Google. Google will kick it out and still make you and maybe penalize you. But for some of the Internet directories, testimonials and review sites, you can kind of use that, but you kind of can't because if it's listing you as like, here's your location where you do business, don't list that, but you want to get but you want to use that address for correspondence, et cetera. So screening patients, this Goes into that security piece. You know, how do you double check that someone's not, like, crazy or their intentions are, you know, true and valid? And a big part of that is the questions we ask. You know, how did you hear about our practice? Like, who'd you hear about our practice from? If they say, I just found you on Google, okay, well, great. But, you know, I read your reviews, and I have these problems, and this isn't. I don't think this is really an issue in physical therapy like it is in massage therapy, and which is my background and where I come from. There's a bigger issue in massage therapy, but there is an issue that we have to talk about and just be mindful of. So if you don't know where someone's coming from and the conversation doesn't go well, or you're like, this is a little weird, refer them to someone else. Just be like, you know, call my friends over at Greensboro Physical Therapy. They'll take care of you. They treat this all day long. And this is. And you need to call them. One of the other things you can do is you can ask people to get a physician's referral or have you seen a physician? And, yeah, so. And so. Okay, well, then let me get back into. I'm going to get in touch with them first, and I'll get back in touch with you about setting things up. And you just give the physician or the PA a call and find out, you know. Yes. Is this really an issue for the people? Have you seen them, you know, recently? They called about physical therapy, and I just wanted to check in with you about it. And this can be a great opportunity to connect with someone else and get your name in front of them. And it's not about getting referrals from them as much as getting them on your team and just even saying, okay, great, thank you for the conversation. You can send them more patients. It's a great way to interact and just kind of create that environment, the team thing that doesn't always exist anywhere. One of the other things you can do. Oops. Is make sure, you know, just meet your patients at least the first couple times in there. If you don't want to go to their home, you feel uncomfortable going to their home, go to their office, their gym, or a park, some kind of public space or slash, you know, public private space. It's kind of private in their office. Or their office might have a gym. Their apartment building might have a gym, rather than going into their apartment room. You know, their apartment or their Condo, go to the gym in the building. And then, oh, yeah. So before I finish, we go to Q and A. There are a couple other thoughts. So. And from some of the questions. And I'll just put this on the Q and A piece. So part of this is, I think Tanya asked, she's considered raising the cost to cover the lower number of patients. And there are two ways to do this is to add extra. So say, okay, it costs 150 bucks to see me for physical therapy, but for me to come to your house, it costs $190. So this is for someone who maybe has a physical location and is doing some traveling or doing some home health pt. Where. Where you say this is what I would do is I'd say, okay, it's 147 to come see me in the clinic and there's a $50 travel fee. So when I come see you in your house or your office, it's 1 97. People are going to pay that. And it can be. It should be based. Basically it should be based on travel time. But I wouldn't bring it down to the minute. I would say, you know, if it takes me, if it's going to take me two hours from the time I leave my office and treat you and come back to my office, you, you really should be earning two hours worth of payment at the same time because that's two hours worth of your time. Going to see that patient at the same time, that's really hard to do because then you're charging them 300 bucks. So a $50 travel fee, I think is appropriate. It can be $25 travel fee. It depends on the travel. It takes you an hour to get there. It should be 100 bucks, but it should be based on reasonable amount of time. It doesn't need to necessarily double your cost. But if you're doing brick and mortar and travel, but if all you're doing is travel, it doesn't have to double your cost, but it should be worth it and maybe a little bit more. But also consider that if your plan is to eventually have one location, then if you get that location, are you going to lower your rate? I still wouldn't do that. I would just keep my rate the same. Be like, look, now I've got an office and it's the same price. So if you're only traveling, I wouldn't create a travel fee. I just create one fee and say, this is my price to come to you. Unless you know within a half hour of traveling and then anything outside of a half hour, 20 minutes of traveling, I charge an extra fee. That way you're still getting what you worth and what you earn. And then you don't lower your rates based on the travel fee when you get a brick and mortar. Because when you get a brick and mortar, you've got higher overhead. So I hope that covers some of those aspects. And I know there's a ton of stuff and I'm like, oh, as I'm giving this presentation, I'm like, well, I should have put a slide in about this and that. But there's a lot of different things, aspects to this and a lot of them, once you start looking at, at what it takes, it's really simple. But then there's a lot of little differences like the fees and etc. So let me go back to the next question. So, yeah, so the office code. The office code. A couple questions from Tanya and Gia about it. The office code is a code you put on the super bill. And yes, and Paula, the office codes are on the billboard, the super bill, in the cash PT toolkit. It's just, it's not a whole document. It's like, it's just one little line that says office code 11. So if you're doing a treatment in a patient's house, you put 12. 12 means like home health. 11 means outpatient physical therapy and you can look them up online. I think they're on the CMS website, but almost all insurances use these. And Tanya asked, do you handwrite letters? Yes, I handwrite letters. Right now my assistant is handwriting letters, but I hand wrote every one of them, every thank you letter for seven years or maybe longer because I was writing when I was doing massage therapy. So it's, I've been doing that for 18 years. So I've been doing thank you notes for a long, long time. So I write a personal thank you note to every person who refers a new patient. There's another strategy you can do of writing a personal thank you note to each patient when you discharge them, you know, and I mean this, this is a great personal touch. Andrea asked, if I have a physical therapy location and do mobile, do you have a suggestion which to choose? I would do both. It depends on what you want to do. Aaron Labourer. I don't want to do mobile because I was doing both. And then I got so busy that I didn't really have time in my week to start going out to people's homes because I was going to, you know, lose money or be able to see less Patients. But I could say to people, look, I'm going to come. I can come to your home. And I come on Tuesdays and Thursdays. I go to people's homes and I charge 185 for that. Monday, Wednesday, Friday, if you want to come to the office, it's 127. You know, it's. It's. They can be two different service to go to someone's home. So you can certainly do both. And if that's what you like, certainly do it. And will. Will a physician's office, a doctor's office really give you that info? You know, they will. I mean, all you got to do is call and say, hey, look, your patient has called us for physical therapy. And I just wanted to, you know, let you know that we're going to. You know, I'm planning on seeing them next week for a physical therapy evaluation. Do you have any, you know, this is Aaron from Labour Physical Therapy. Have you seen the patient recently? And, you know, what's their condition? They said they have back pain and they may say, oh, no, we can't. You know, we haven't seen them in years. Likely they say, yeah, we just saw them last week and referred them for physical therapy. Can we get you their notes? Or we saw them three or four months ago for back pain. We did an injection and I told them they needed surgery right away to fix their herniated disc. And they looked at me like I was crazy. And basically what you're calling is not to get information on what's wrong with the patient, but just to get a vote of confidence from the physician's office that the pa, the physician, the nurse, that this person is a competent person who's not dangerous for you to go to their home and treat them or to go to their office and treat them. That's really what the purpose of that phone call is. They may need to sign a release of personal info, but likely they have. So this is the thing. If someone's contacted you about doing physical therapy with you, they've set an intention to be your patient and they've been a patient of someone else, then as providers, it's okay. And it's not a violation of even HIPAA policy to confer together about a patient's case. Let's see. Okay, so I think Gia is asking about. About liability insurance. And Victoria asks, yeah, her policy with APA covers her wherever I go. And that's my policy with the American Professional association, covers me wherever I am as a physical therapist, no matter whether I'm treating my clinic location out in a classroom, at a gym, et cetera. As long as I'm providing a physical therapy service, doing business basically on behalf of Aaron Labourer and Labourer, Physical therapy. I'm covered. I'm even covered teaching yoga at the yoga studio because that's what we do. Our practice is physical therapy, massage and yoga. And it didn't cost me any extra. Let's see. Oh, yeah. So great questions, guys. Keep them coming. Tanya asked, would you put a minimum. I do have clients that are 10 minutes away versus people that are 45 minutes away. You mean a minimum charge. I think you maybe. I'm not clear on what you're asking. Let's see, I'm gonna. I'll come back to that. Or just rephrase it in a different way. Yeah. So Brian asks. He's got a specific. Says he's got a specific area he covers. Only depending on how light his schedule is, he'll stretch his area. But if his schedule is full, he'll stay closer to home. And. And I think that's a big thing about scheduling patients, is finding a way to. Finding a way to. What's up, y'? All? Finding a way to schedule people that's convenient. So let's say big places, you know, big areas. I'm gonna say Phoenix or even, you know, Atlanta, where you can schedule different neighborhoods on different days. That's convenient too. And that makes your job easier. Makes it so you can see people so you don't have to drive all the way across LA in one day. Or maybe you just stay in Hollywood or San Francisco is small, but it's hard to get around town all day long. So you just stay over in one little area for the day and go to a different area. You definitely have to account for traffic. You have to account for distance. And so as a mobile pt, a lot of times your patients need to know that maybe you'll be late. But you can't put. You know, it's gonna be hard to put an hour in between each person and say, okay, I'm not gonna get paid for it. See, that's where you have to adjust your prices and charges so that it makes up for not having a physical location for you. You know, that's the important. The bottom line is that you earn enough money to eat and feed your kids and drive the car. So you've got an expensive auto expense. You've got expenses of eating and living, and they have to be covered. So if you can only see three people in one day, not because you're not getting enough patients calling you, but because you're going an hour, an hour and then an hour and you're done driving. You spent more time driving than treating patients. It might be time to reconsider a strategy. So what days are you seeing? People that might be okay at first if that's all you got. But if you're busy and you have a lot of people calling, you need to start scheduling them in different places. This, this gym, basically you're saying instead of, you know, CrossFit Gym A on Mondays and B on Thursdays, you're saying neighborhood A on Mondays and neighborhood B on Thursday. So you can say I'm over there on Mondays and Wednesdays and I'm over there on Tuesday, Tuesday, Thursdays, you know what, what day works best for you, which location. And yes, you have to account for traffic. If you're billing. Hallie asked, if you're billing Medicare and the patient is not homebound, would you still use office code 12? That's a great question that I can't answer that because I'm not a Medicare provider and never have been. Likely I would. I don't think that Medicare may not pay because they may not pay for home services. But the only reason you're going to bill Medicare is if you're a Medicare provider and your billing company people should be able to answer that. I can't answer, I can't really answer that. There might be another one or it might not be a covered service. If they're not homebound, you know, if they're, if you're non par, then that might not matter versus being a participating provider. Yeah, Brian just offered some helpful information. He says he gives himself 30 minutes between patients and that's the minimum I would do even, you know, unless they're next door to each other and you can schedule that. And he puts more flexible patients at the end of the day. So people that are like, yeah, it's okay if you show up at 4 or 4:30, it doesn't really matter. They can get end of the day appointments because you might be running late. And you know that would be the worst thing to do is have someone who's really strict, needs a 5 o', clock, it has to be somewhere at 6:15 and you're not able to show up till 5:30 and either have to cancel them or they don't get their treatment. So yeah, so Tanya, Tanya said, you know, $50 travel fee is steep for someone close by. It's not steep if you're Coming to their house and that's convenience. Saves them $50 or saves them $100. Just think you got someone who's got, you know, mom or dad who has three kids. The kids are, let's say they're you know, 9, 10 and 12 and they can kind of take care of themselves. You can go to their house, do 30, 45 minutes of PT with them, show them, do exercises, some hands on care and they can still watch their kids or they have to put their kids in daycare or take them to the stay and play, get a babysitter and come to you. $50 is a wash and they don't have to drive a half hour to get your 20 minutes to get you put 20 minutes to get the kids somewhere, 20 minutes to get you or babysitter to come in. So you know, but if you feel like that's steep, you can say, okay, look, it's x for within 30 minutes. And then above 30 minutes there's an extra fee or you can mark it to 15 and 30 minutes, or 15 miles and 30 miles. But people should know that it's not like, okay, today it took me 45 minutes in traffic. I'm charging you an extra 50 bucks. It should be more like when I was a bike messenger, we had kind of districts. Okay, here's where I live. Okay, the travel time for me from center point, from my home to you is 45 minutes. So that visit is going to cost you 165 bucks. The person that lives next door to me is going to cost them $115. I don't necessarily need to tell the person that's 165 that, hey, you know what, coming out there, you know, if you came to me it'd be 115 because they're not coming to your house for me to come there. This is what it costs. And you can say, look, you know, it's a 115 treatment fee and a $45 travel fee or $50 travel fee for the person next to you. You say, look, you know it's going to be 115 if someone's 20 minutes away and your fee within 30, you know, 30 minute drive is 115, it's okay, that's one, it's 115 to come see you. But as soon as you pass like a certain barrier or two barriers. So you can have zone one, zone two, zone three, or neighborhood versus scheduling, neighborhood A and neighborhood B, does that make sense? So you can create distance and zones and they don't have to be a perfect circle. So like in San Francisco, anything up on a hill, it was at least zone two. You had to be two blocks up a hill. And you know, it was zone two for us on bikes. Most of the offices buildings were down, were not on hills anyways. Or it was beyond a certain distance. But it wasn't the same based on the geographic area. So it might be. It might take me 10, 15 minutes to go two miles in this direction. But to go two miles northwest where there's not a highway that goes definitely, I have to go way out of my way to get there. That could take me 45 minutes and a big city because there's not a direct route. And so that might be a different, you know, fee. But don't get bogged down in fees. I would say pick one fee and stick to it. You can make it a travel fee or not. If you're only doing traveling. I would stick with one fee and then maybe like an extraordinary distance fee, you know, so make your fee high enough that you're happy to travel most within a half hour and then just be like, this is my fee. And if for some reason you live X far away, okay, this is out of my way. But to come to you, it's going to be this. And you just tell people on a case by case basis what their fee is going to be. Let's see, let's see. So Tanya said usually my patients are not urgent. I've clump people that are in the same area and they were pretty flexible about it and understood. Yeah, exactly. I mean, I think that's awesome. So that's, let's see. There was one other thing that I think I had in my mind to add to this, but it's escaped me and I'm pretty sure we've covered all the big points. Do you guys have other questions about home based or like home based? Yeah, like home health based, cash practice. I think the big points are the billing, like the office code 12, the just deciding if this is what you're going to do or not and creating a system for it, creating like this safety protocol. So when people call you if they sound strange and weird, you know, just refer them elsewhere. It's like, yeah, Martha, your other patient sent me. She's my best friend. This is like a no brainer and most of the times it's a no brainer. But the, you know, so I think those are the, those are like the biggest issues that you may have. But I think this is such an awesome model and Even that model of not necessarily traveling to people's homes and offices, but being in multiple locations in the city and not necessarily having a home base or having multiple home bases is really just a huge model because you can, you can. I'm just writing down an idea. You can, you can make it work for such a low overhead, and it can be a great jumping off point. I did an interview of a guy, Brian Campbell, on my blog. He lives here in Raleigh nearby, and he started in a couple crossfit gyms until he got patience, he got some cash flow, and then he opened his own place, which is really awesome. The idea that I think that I forgot to mention that I wanted to say is, okay, what's the equipment that you own? And you're bringing places and it doesn't have to be huge. You can have a portable massage table. So you can get in your car. You can have your needles or your hands on stuff. You can have some of your extra little bands and balls. You just have like a couple little boxes of them in the trunk. You can put a portable treatment table in there. I would still get a really nice one, but I would maybe go a little bit smaller and lighter, especially if you're going to go up and down a lot of stairs or you're not like a CrossFit athlete and you can lift £5,000, 5,000 times in two minutes. But Astrolite makes some really nice light tables, and you can get the ones that are just a little narrower and it takes a couple pounds off the table and. And most clients don't notice. You can also take. A great thing to take is like a couple dumbbells or kettlebells. So if you're into weight training, you're like, gosh, I don't. But I don't have a rack. I don't have all the equipment I need. I don't have the pulley thing. All you need are some bands and two or three kettlebells in the trunk of your car and you can pretty much. You get a workout taking that stuff in. And your patients can do pretty much anything with just a fat few pieces of equipment. So what's the lightest portable table I've heard of? I think there's an 18 pound portable table. It's going to be aluminum. Just don't get like the cheapy, cheap ones because I got a cheap, cheap one for traveling and it sucked. You know, it's like the vinyl's wearing out. The table fell at one point. One of the little buttons was not that great. And it's wobbly and get on it. It's like the Astrolite doesn't do that. And I think even my table with the extra Baltic birch is only 20 something pounds. If you go to Costco and get the $200 table, it's gonna be like 35, 40 pounds. But I think you can get one for like 18 pounds. The lighter you go, they might be a little bit more expensive, but it's usually thinner wood base and narrower and maybe a little shorter. You can even get like, they have like this little travel chiropractic tables which are like, yay. I don't know if you guys can see how yay thin that is. Yay thin. You know, and it's just for a couple cracks and snaps. You can certainly do some needling and some MFR on there. It might not be the most comfortable, but certainly easy to haul around. The other thing you can get is if you take a table places is a bag and, or a, like a table trolley or cart. So it's like a little folding luggage. You know those old metal things they used to carry people carry luggage on before they put wheels on everyone's luggage. You get one of those for your massage table. And that way you can get up and down stairs and in and out of buildings really easily. You just have to get it off of your. Out of your trunk. And it's probably one of the best investments you can, you can make. So. Oh, Brian, thank you for the other tip. He said the other trick is to do visits in a loop as best as possible. So I guess you're just connecting the dots in a loop rather than zigzagging. I think that's awesome. Yeah. So anything else? Do we have time for questions not related to mobile practice as well? So if you guys are having any other. Have any other questions or challenges or struggles in your practice, you know, marketing, billing, setting up, etcetera, Just put it in the chat box. Allergies getting to me this week. Okay. Yeah. So Tanya says, yeah, she's got a light massage table and it works. Has a carrying case, shoulder strap, side pocket for bolster, and then my tool bag, a travel bag that fits needles, folders, mobilization rolls, etc. That's awesome. Yeah, I mean, some days I just want to get like a little travel kit of some things and just be like, hey, you know, here's my little bag on the mobile pt. I can do whatever I want anywhere. I saw like a Jet Li movie where he was like, you guys know Jet Li is like Kung fu, martial artist guy. He was also like this acupuncturist and he had this little bag of needles. It was like this little leather bag of needles. And he'd whip it out and like throw them at people and stick them in places and paralyze them. And it was kind of weird. I'm like, oh, I want one of those. That'd be fun. Let's see. Yeah. So Tanya asks, online scheduling. This is your question, like, what's the best online scheduling or what's the one you should use? Let's see, what's the main points you give to people to help convince cache based is the way to go? Danny, great question. Okay, let's go back to mindset on this one for a moment. It's not about convincing people that cash based is the way to go. Separate cash based and payment from how do you want to treat a patient? So when you call your physician's office, do you want them to only talk to you about billing? Because most PT practices, the first thing is going to happen when you call there. They're going to say, what's your insurance? What's your date of birth? Or would you rather have someone talk to you about what the problem is? How long has it been a problem? What are you struggling with? What things are you unable to do now that you'd like to be doing? What is it that you can no longer do? Or what can you no longer do as well as you would like? And if you ask questions to get to the reason that person is calling you now versus two months ago or last week or five years ago, when you talk to them as a real person, as a caring professional, they're gonna going to see the difference between what you're providing and what they can get anywhere else. So how do you convince people, you don't convince them to use cash, you overwhelm them with like, value and awesomeness. That where they understand from the conversation with you that they're going to get a service from you that they cannot get anywhere else. You know, some people are going to go try to use their insurance, but then one of the things you can ask is, well, so is insurance the primary factor in you deciding where to get physical therapy or is the value and quality of service that you want to receive? And most people are gonna be like, I want a higher quality, higher value service. You know, I don't care about insurance. But people are. People say, oh, it's insurance, I have to use my insurance. Okay, well, is it something like, is that the Number one thing that you need to decide on or are you concerned at all with the quality of care and whether you see a physical therapist or not? Oh, of course I want to see a physical therapist. And are you concerned about how long you might see a physical therapist? You know, do you want to see someone for 15 minutes or an hour, one on one or in a group? People are like, what they don't know. And so what you have to do is say. Then you say, okay, well what's your understanding of how physical therapy can help? Or what's your understanding of physical therapy and how it can help you solve this problem? So we don't talk about insurance yet. We talk about what do people want and expect. What is their understanding? Because their understanding might be that you're just going to fix my alignment and give me some leg lifts and hot packs and I'll be fine. So I think that's a huge, I mean that's a huge piece. So. Yeah, I mean I think it's a great question. The question you asked is a question that everyone has and just kind of explore some of these other questions check out and it should. I know it's on the Facebook page and I have the intention of putting it in the membership website, but most people should have it. It's my Medicare do you take my insurance training. I did a video on do you take my insurance. I also did a Medicare video at the same time. So I did a do you take my insurance Call training, Check out that and if you don't have it, you can't find it, email me, I'll send it to you. I have it up on my screen and my intention is to add it into the membership website if I haven't. And I know I've posted it in the Facebook group so you can search the Facebook group for that. Watch that video. Definitely. Okay. Andrea, any thoughts on getting around the dry needling laws in Washington? It currently isn't allowed for cash pay patients. Wonder if I can come up with some sort of loophole. You know what, I know it's a big issue and I've talked to Austin and Paul of what's their business called myotech Dry needles. And they've got a practice in Seattle called I think Doctors of physical therapy or Doctors of pt. You might check in with them and see what they're doing because that's their business model is dry needling. And I've talked to them about it and they're like, we don't know what we're going to do. But I think they're still, I think when I talked to Paul in October, and I know things are changing rapidly, they were still needling patients in October. And it's a gray area. And I think part of that's similar to Medicare. It's like in a state where it's not, where it's a gray area, there's risk tolerance that you have to say, okay, what's best for my patients and what's best for me and fall on the side of that. I don't know any ways to get around it because it's a scope of practice limitation rather than a billing limitation. And when your scope of practice is limited, that's tough. In North Carolina, my scope of practice is limited to pretty much I can't manipulate the spine without a physician's referral put in there by the chiropractors 25, 30 years ago. However, I can mobilize the spine. It doesn't prohibit a cavitation. So I can put people in position, have them breathe in and out and get a cavitation with immobilization. So I don't do high velocity thrust. I don't really need, if I could, I don't really need to do a high velocity thrust 85, 90% of the time anyways to get the result that I, that I need. Now I'm not sure exactly if that is, that is something that there's a workaround for you guys, but you know, I doubt it. Seems like the slide is, every time I talk to them, the slide is going down, down, down to no dry needling, which kind of stinks. The other way to get around it is to do some other training and trigger point therapy, myoflash release, other hands on training techniques, even instrument assisted soft tissue mobilization, etc. There are other ways to get the tissue to react the way that you get it with a needle. Maybe not always in the same way, but not much less effective. I mean, there's not a lot of things that I want to work on where I'm like, if I had a needle, if I had a needle, it might not let go either. So Tanya says for Catch Base, she's got a little, some resource on her website. Awesome, thank you. And yeah, so Andrea says they can't really manipulate there either, so they do quick stretches. Yeah, it's like grade five mobe versus high velocity. So I think Tanya asked something about online scheduling and I didn't see a clarification. I think like online scheduling, there's a lot of different ways to do it. If you're using Google emr, you can use Google Drive. I mean, not Google Drive, Google Calendar. You can incorporate that with IntakeQ. So I would do IntakeQ for the intake forms. Use their scheduling. I use Square. You can use Square to schedule. You can straight up use Google Google Calendar to schedule. You can use something like setmore. You know, there's a lot of different things that will integrate with Google Calendar and they'll get on your phone. What you want is a way to pick up your cell phone and type in and schedule a patient on your cell phone. Like mindbody Online. So, yeah, so, Tanya, mindbody Online is great, but it's a huge hunk. It's like a freight train compared to like a little Porsche 911 mindbody online, which, like calendly would be the Porsche 911. You know, the stripped down, easy to use, quick version of online scheduling. Whereas mindbody Online is great if you're going to do group classes and you want to track other teachers teaching stuff. But it's a really big program to use if you're just doing online scheduling. It's got a lot of other features to it that make it great for practices with multiple therapists and group classes and packages and memberships, etc. Yeah, so a lot of these other programs also allow patients to log in online and schedule. So intakeq does that. Calendly does that. A lot of these online programs can do that. There's a way to even do it in Google. It's not Google Calendar directly. It's not that easy. Okay, any last questions before we go? I've got patience this afternoon and I know you guys have work to get done. This has been awesome and great participation, great questions today. So, yeah, so, you know, just leave any last thoughts or chats and questions in the chat box. Tanya said she wasn't. You're not sure if it's going to work in your model because you have multiple locations, no set schedule. I would say you might find that it helps to have a set schedule at a certain point, especially when you get busy enough and at least know a week or two out so you can tell people, hey, here's my set schedule. Or maybe it's the first person that schedules there on that Tuesday. You just try to clump them together and then you find like a system that works. And at a certain point, even in my practice, you know, I had to set a bound. I got so busy I was having patients come in the morning, in the afternoon, and it like I didn't have a boundary for when I saw patients and when I didn't. And that's one thing that they can lead to burnout, is if you don't set boundaries around scheduling. So just make sure that as you grow your practice, as things get busier, all of you guys, you start creating boundaries. And these are time boundaries, distance boundaries. It might be that, you know what, I really want to work with that patient, but they're so far away and takes me away from so many other people that I have to set a boundary and say, look, I'm not going to travel there. I had to do that in California. I was treating a couple over in Oakland and I was living in San Francisco and I started getting busy enough and I was like, look, I just, I can't come to Oakland one day, you know, one day a week just to treat the two of you or just to treat, you know, one of you. Um, you know, it's just, it's not right now. I've got a, I've got a location now and I just have to make this decision decision. And it basically meant that they were no longer going to be my patient, but I had to make that decision for the health of my business. Awesome. Thank you guys so much for being here. If you have any follow up questions, start a post in the Facebook group and just post your question, post your thoughts, post some pictures of your business, of your practice, location of, and post some of your successes and wins. I'd love to hear back from you guys in the Facebook group For the Cash BT Blueprint and Lever Consulting, this is Aaron. Thank you guys so much for being here. I'm so stoked to be working with you and helping you achieve success in your practice. Have a great Wednesday.