Creating a Plan of Care & Patient Retention

Welcome to Pelly biz podcast. I'm Dr. Kelly Alhui. I've grown my pelvic health practice, orthopelvic physical therapy, and now I'm helping pelvic health professionals do the same. Each week I give you the knowledge you need to grow your practice. Let's get into today's episode.

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Today we're going to go over patients and how long kind of a plan of care is. What do you guys think about in plan of care? How long do you typically see your patients for? So when I talk to most therapists, most therapists, we all have egos, okay? And most of us therapists think in the shorter the period of time that I can get my patient better, then that means I must be the world's best physical therapist on this. They must mean that they are the world's best physical therapist on this earth because it only took them two visits to solve their patient's back pain.

Okay?

The reality is we know from pain science, okay? This is proven in the literature. We know from pain science it takes six weeks to solve or to help decrease someone's pain. And around six week, mark, what, what, whatever you're doing with them, it will get better. Okay? We know it takes three months for there to be a true muscular skeletal change. Based on the research, we cannot speed that up. Takes three months. So if we know this and most physical therapists and ots and whatever, you guys are all about research. So if you're about research, then why are we not developing a plan of care around the research? So adolithopelvic, we know it takes 12 weeks to have a true musculoskeletal change. So our Plans of care are going to be at least 12 weeks. Okay. So because we've got to get them through phases. That's why we have our method, the LSR method that I developed. Okay. That method allows us to communicate to the patient and show them that they're at point A and we've got to get them to point B. And my method shows them of how I'm going to bridge the gap for them and how I'm going to solve their problem. Instead of me over the phone saying, sally, we're the best in the area, we're going to help you out. That is not going to get the patient to buy in and get them to understand how you specifically had helped them. Especially for our pelvic health patients, we know they've seen the urologist, the gynecologist, the urogyne, like they've seen everyone. And they have gotten results. So why now would they would believe that we could actually help solve their problem? Why would they believe us? They would believe us. If we have a method that we've used on thousands of people that have gotten us results after results, after results, after results. They have a reason to believe us. Now they have a reason to believe us. If we have story after story after story, AKA client wind or client testimonials.

Okay.

Or reviews, they'll believe us then. I didn't write those reviews. You've got to understand that you thinking that you can solve someone's pain in two sessions, it's just an ego boost. That's all it is. Are you truly helping that fly it out? I believe you're not. Because in two sessions, how are you changing someone's movement pattern? How are you changing someone's environment in two sessions? The pain's going to come back, guys. The pain will come back. So let's be amazing physical therapists or occupational therapists or PTAs and figure out what actual thing that they're doing in their life on the day to day task, okay, that they are doing that is causing them this issue. So in my clinic, I coach my pts, how to actually get the patient. If they want to go run that on initial evaluation, I need to take them in the parking lot and go for a run. If they want to have no more chronic pelvic pain, then I need to put them in positions that they would never even dream that they could be in to understand where they're at and where we need to take the session. Conversely, compared to like me just sitting there on initial evaluation doing manual muscle tests and range of Motion. And that's all that the insurance company wants to satisfy them. Does that help my patient out at all? It does not help my patient whatsoever. Okay. I always say you want to ride the fence. So I want to see how far I can take them before I push them over the edge. And that's how we should be evaluating our initial evaluation. And on initial evaluation, sometimes this is also another good point. Sometimes you don't have to solve the problem. You don't have to come up with the diagnoses. Sometimes it takes me four visits just to deeply understand why truly the patient is there. What is the outcome that we're trying to get. And truly, what is, what's the problem? Because sometimes patients stories are incredible and you want to listen to it. And also there's lots of things that could be done to test for certain things. And we don't have to do it all in one visit. And then the next visit you're like, I did manual and I fixed them. So I'm good now. My ego's shiny. I'm, I'm great. I'm the best PT on this earth. It's not the case. This takes time. The body takes time, no matter how much we want to see. Speed it up. So, you know, I had this question the other day is how do I keep patients, Kelly, how do I keep them so that they see the value and finish their plan of care so we actually get the results and the results stick and they say they don't come back? Well, that means you gotta get em to complete your method. Okay? You've gotta get them to the end. And here's another disconnect where I find that in the therapist world, most of us don't know higher level exercises to get people to the finish line. Most PTs, OTs, PTAs, they've only showed us like quad sets and single leg, whatever. They haven't bridged the gap between that and like some personal training stuff. And so a lot of pts are afraid to take people to the end range. For us, that's our return phase where we're getting them back to the actual exercise and we're missing the boat. We are missing the freaking boat. So I'm going to challenge you guys, if you guys are listening to this, to get your patients to three months, they come in weekly. Not every other week they have to come in weekly. You have to be consistent. It is one hour a week, one hour a week that I just need their attention to get them to move them to the next week. So that we can continue to make progress. The second you decide to start spreading out someone's plan of care to two weeks or every two weeks, that patient will go, bye, bye. It's the same thing with working out. Think about working out. If I tell my trainer, look, Eric, I'll see you in two weeks. I'm like, oh, wow, I skipped Eric for two weeks. I don't really need Eric. I'm going to call Eric on the second week, be like, eric, let's just push it back another week. I'm good. Like, I feel fine, okay? But the reality is my body is slowly starting to lose muscle because I'm not working it out. Theirs is the same way. If we're not checking in with them, that's another thing. Checking in and just seeing where we're at and trying to continue to move them. We're doing that every two weeks. That's not enough. That is not enough. And the plan of care will be longer and it'll be more painful. It'll be a more painful journey compared to the patient was just very consistent. Once a week, every single week, we're going to get in, we're going to assess where you're at, we're going to tell you where you are along the method, and then we're going to come up with a game plan of what we're going to do for the following week. Because it's very laid out, it's very clear. We know the path that we're going because we are the experts. And that's the other thing is, guys, we are the experts as doctors of physical therapy or occupational therapy, we are the experts. So we have to develop the plan for the patient with the patient's help and the patient's guidance. But we are the ones that are making the recommendation. So I hear this sometimes, too. Therapists will be like, so what do you think? You want to maybe come in next week maybe, or maybe like a couple months? What do you think the patient doesn't know? That's why they're paying you, because you're the expert. They're paying to get certainty that you're going to help solve their problem. That's why they're paying you, because you've seen cases like it, you've been there, you've done it, you've gone to school for it. So that's why they're going to pay you. So be very clear about what the plan is so that they feel, hey, I know what the plan is. This person's got my back. Instead of being wishy wash. Like maybe next week, maybe. When do you want to come in? Please do not ask these questions. Please, I'm begging you, say. All right, this is the plan. I need you in here weekly. I need you committed. And if you are sick, are you going to travel? No problem. We're just going to switch to telehealth. That's it. All you got to do and that alone will people will keep your results true results that you get to have these people's problems, not come back you. It will be a hundred. Like you'll be good. Now that will make you a great physical therapist. Not the world's best, but it will make you a great physical therapist. Okay. And here's my other thing is like, who is booking your patients out when they come in for initial evaluation? Is your admin booking it potentially? Maybe you have one. I don't know, maybe you don't have one. It is the PTS booking it out. OT is booking it out. Who's booking it out? Who has the authority? The PTs or OTs are going to have more authority than the admin. So us at Orthopelvic, we have the PTS book out because they're the ones that know the plan of care. The admins don't know the plan of care. So going back and you know, to a traditional insurance based model, all admins schedule everyone out. Well, to me it makes no sense because they don't know the plan. So if we're supposed to be the authority, why then are we letting the admin do the booking out? That's my question. Okay, that's a. It's just, it's interesting. And then another thing in the visit is like, what expectations are you setting? Are you kind of just the one that's like, hey, I'm gonna kind of when you come in, you come in. Or maybe this one. Cause this is a big one. Maybe potentially, and you may not think this, but maybe your own money beliefs may be holding you guys back from getting the patients the best care that they actually deserve. Maybe you're like, you know what? This person's a college student. I'm already gonna prejudge them. Trust me, I've done this. I'm not judging anyone for this. I've done it. First as a college student, there's no way she can afford to come see me. But by me not offering her weekly sessions, I actually sabotage what she could actually achieve and the goals that she could actually make come true. And that's my fault because I had to get out of my own way and figure out like, how am I going to get past that and give people all the options on what I truly believe is the route they need to take to get the best results and get the results the fastest now? Fastest is three months. How many people are calling your clinic? I think this is another good topic to talk about. How many people are calling your clinic? Are we tracking that? Is that something we're tracking? Do you know if I asked you today for you guys that are listening, how many patients are calling your clinic? Do you know that number? What about, do you know actually how many convert to becoming actual clients of yours? Do you know that number? And if that number is low, then how can we fix it? What are we going to do about it? Also here's the other side of it too for patients is what are the follow ups? So the people that call us, that want our help because they actually called us, how are we following up with them? What are we doing? Are you sending them emails? Are you calling them? Are you going to knock on their door, send them a letter in the mail? Like, what are we doing to follow up with them? Do you have a system for that? And if you don't have a system in that, then you're losing probably half of the business that you could be having. And that's really important. You've got to have follow up systems and even current clients that you have actively coming to you. What systems do you have in place that are going to keep those patients continue continuously to be engaged with you so that they want to continue to get to that goal that they originally called you for? Sometimes people get distracted and they lose sight. It's three months, they lose sight. They're like, oh, it's getting hard, I gotta do this little exercise over here. It's getting too hard. I don't know if I can do it. So who's, who's keeping them accountable? Is that programs you have? Is that you, is that what systems you have in place for that? All that I want you guys to think about, I think it's very important. So when it comes to, you know, bringing this back around to Planet Care and, and patience and getting them to understand what it takes that it's going to take to come in. Like, you got to set the expectation, you got to know how to communicate very well to these people and get them to see the value and what you're providing and how you're going to get them from point A to point B and the, in the gap in between and if you can do that and let your ego go and not think that you have to solve their problem by, you know, tomorrow. Because I have therapists tell me all the time, Kelly, well, I'm going to make a 90 minute eval so that I can get everything in and I can diagnose them. You know, that tells me they don't believe in themselves. Tells me they don't know if they're method actually works. It tells me that they believe that if they give more of themselves, then that's going to guarantee more of the result. And that's just not the. That's not true. That also just tells me that they need a little bit of confidence boost and that they don't understand yet. They don't have to actually solve the problem on the first visit. We just have to start to try to understand it. That's very important. And it could take up to four visits. And that's okay. That's okay. They didn't teach us this in school, but that is a hundred percent okay.

Okay.

A human is very dynamic. The likelihood of us solving a very complicated pelvic health problem in an hour is highly unlikely. So why are we putting the pressure on ourselves like that?

Why?

Makes no sense. Okay, so little thoughts of the day, I guess this podcast is about, you know, patients and are we keeping them, you know, long enough? How long are you keeping them? How are we solving their problems? But kind of like a little dabble in all the things we see in clinics. And I kind of see sometimes can be a problem. So hopefully this was helpful. Bye, guys. I consider myself a business and life coach. Are you ready to live the life of your dreams as an entrepreneur? If so, let's chat. See the episode notes below and go ahead and book a call. See you all next week.