AI, EMRs, and Data Theft: The Future of Clinics with Terry Davison

What I have experienced over the last few years and I too recently are practitioners that are leaving a clinic and exporting all the patient data and trying to take them.

How to get smarter in business and in life. This is the question and I'm on a journey get you that answer. I'm going to interview the world's top entrepreneurs and deconstruct their winning secrets. Going to talk about everything from marketing money and, and living a bucket list life. I'm Rick Lau, healthcare entrepreneur. I grew and exited my 127 locations in my 30s. Welcome to the Clinic Boss show.

Everyone.

Welcome to the Clinic Boss show. So today we got a special guest, my good friend Terry. He's a CEO Giovanna, which is one of the top practice management softwares that a lot of clinics in our community use. Right, so. So Terry, welcome to the show.

Thank you. Yeah, I appreciate being here.

Cool, cool. So I've known you for a while and I'm curious, I actually personally don't know this. How did you get started with building EMRs and EHRs, the whole software space?

Sure. Well, I'm going to date myself. I've been in software for over 30 years now. I started an inventory control software and I needed to build. This was before the Internet was fast enough to do cloud based. I built a cloud based kind of CRM platform. Anyway, we went out to start selling it and a couple of our sales reps had clinic owners as friends and they went, oh my God, the system is fantastic, we can book online. And at that time it was, you know, unheard of. So that was kind of our foray into clinic software and really realized a niche there. And so we dropped a lot of the, you know, non relevant CRM features and built Giovanno and you know, added in all the insurance billing and everything else. So it's been about 15, 16 years where we've been solely focused 100 on clinic management.

Yeah, yeah, like, and it's interesting, I think you're sharing that before our show like just the business is starting to take it off now, right?

Yeah, absolutely. We've grown dramatically over the last few years.

Yeah, which is good because like as you grow that means like the software gets better, there's more, you know, there's more support, there's more like AI features. I'm sure we'll talk a bit about that as well. And so what type of practices do you typically work with? Because when I look at like the clinics in our community I see that there is kind of two types of like owners, the smaller ones gravitate to like, you know, like Jane is a little more simpler.

Right.

You know, not a lot of features and functions and then like some of the ones are running multi locations, like they seem to gravitate towards yours and then all these people stuck kind of in the middle.

Right, yeah, so that, that's exactly right. You know our, our system's really geared towards clinics that are growing. You know, they're adding more locations and as soon as you start adding more locations practitioners all of a sudden you need, you know, a higher level of security. You need better reporting tools and that's really where Giovanna kicks in. So you know we're doing, obviously we've got physio chiro. Massage is kind of our bread and butter. We're seeing a lot more on the mental health clinics. But you know, our sweet spot is really, you know, three plus clinics recently actually one of the exciting things for our company is we rolled out our newest client has 136 clinics. So we've been rolling that out.

Is this in the US or.

Yeah, no, here in Canada. Massage.

Okay. Wow, that's a big one.

Right? Yeah, so that's really exciting for us. But you know that's kind of an example like they, you know, it's, we can scale to that size easily and, and we offer the reporting and those kind of security tools that they really needed.

Yeah. And I'm curious, you know we, we work with a lot of like multi locations. Like what is typically a multi location, like looking for like in a typical emr you would say.

Well when it comes to multi location it's, I think it's really around employee management being able to. Because a lot of times with multiple location clinics you're going to have staff that might work in, in more than one location. And, and so being able to manage their schedules in multiple locations, you know, tying that to the online booking can be sometimes difficult for other software vendors. And then more importantly the security as far as you know, which patients are they allowed to see or not see and which staff members do they manage and from a high level, even admins, you know, which practitioners and clinics can administrators see and work on and that type of thing. And so that, that's where we get into really granular security level. But then more importantly it's the reporting.

Yeah, I see the reporting because I remember back in our PT health days is that it was brutal getting reporting.

Right.

You know, and I think back then we were using a software called Innocare. I Don't offer us route anymore but.

We still convert some innocares. Yeah. Okay.

So it's still around.

Yeah.

Oh, surprising. Okay. And so remember the back then the reporting was difficult so the reporting we would do is like off Google spreadsheets or Excel spreadsheets and doing that across, you know, the 127 locations rolling up and reporting was, wasn't very accurate, you know.

Right.

You know it's based on like manual entries. Right.

So. Oh yeah, no that's, that, that's a big challenge for the large organization. So we do have a large amount of reports, a lot of high level manage reporting. So you know, finding good data on how well your practitioner is doing. Drop off lists as an example.

Yeah.

You know, and then on the financial side, you know, we're integrating to things like Xero or packages. We really excel at those integrations. We've got a full open API and things like that. And that's what these large organizations are looking to do is tie all of their systems together so the data flows, you know, right from the EMR to the phone system. I'm actually working with one client right now, you know, integrating the Arrow to Japan, things like that. So because we've got these APIs available, it allows us to do that type of work.

Yeah, you bring up a good point. You know like the last thing you want to do is like your practice management software. You're, you know, you're not integrated on these like you know, core things that you need each month like your P. Ls your, your profit loss, like what's on your balance sheet of what's accounts like payable and like you just want all that just be kind of all tied in. Right. You know, so.

Yeah. Oh absolutely. I'd say the other big thing is automation too. You know, automating things like, you know, drop offs, you know, somebody comes in, they're on a treatment plan, you're expecting the 312 appointments in the future and they drop off after the third. Well, in our system you can automate some of those reminders, your admin staff, you know, the phone to contact them, things like that. So that's, that's another area that I find with the large organizations. They're really looking to automate as much as possible.

Something you brought up earlier was about safety and security. And I asked you like what is something that is controversial that it's kind of like been on your desk lately with some of your clients and you mentioned that, you know like, I guess like a practitioner stealing like The. The patient database. Right. You know, you want to talk more about that? Is that a common thing that you see quite often?

It surprisingly is. And let's face it, I'm not a lawyer. So as far as the relationship of a practitioner and the clinic and who owns the patient data, yes, agreements in place. But what I have experienced over the last few years, and I deal with two recently, are practitioners that are leaving a clinic and exporting all the patient data and trying to take that when it's technically not allowed, according to their agreements with the clinic owners. You know, one of the scenarios was, and this is tricky, you know, from a software perspective, we've had to train our support team to say, hey, look, we don't reset passwords or allow anybody to access a piece of software. You know, if a practitioner can't reset their own password or log in, they need to talk to their own owners or their admin team. Because what happens is, as a software company, you know, these practitioners might be locked out by the owner, and they'll contact us saying, hey, I can't get into the software. You know, can you give me a hand resetting our password? And, you know, if it's the. The support team isn't trained on this, they might go ahead and reset that password, let the person in to. To access the data, and then, you know, away they go.

Yeah, and I've heard this a lot. Like, you know, like, there's a lot of, like, practitioners are thinking of, like, starting a practice or they want to be a solopreneur or whatever, you know, and, and, and I always have. I always see this conversation in our community, and they're like, what do we do? Can we just, like, export are, you know, the patient database? And my gut is like, it's happening, you know, and. And whether the practice owner knows or not, you know, so.

Yeah, well, and that's. That's one of the things, like, you know, when you're talking about EMR systems, this is one thing that I always talk to owners about and say, hey, look, you should be aware of this. You know, make sure you're locking down export functions and reports where people can dump, you know, large, you know, databases of client data and stuff. You got to lock all that down, you know, don't. Don't let everybody. They shouldn't have access to that, first off. Yeah, but, you know, as far as a practitioner is concerned, you know, I'm an entrepreneur, you're an entrepreneur. You know, I love encouraging people to do entrepreneurial things like opening their Own clinics just have a discussion with your owner. You know, some owners are open to it.

Yeah, yeah, yeah. And obviously, like, there are, you know, each, each province or state, they got different rules and regulation of, like, who owns that. And there's a proper way of doing it too. So that, like, I think transparency is important for anyone that's thinking of doing that, because you're kind of your brand, your personal brands on the line as well, not only to the patient, but to all the staff that you work with.

Right. You know, and so, oh, 100%. You know, the other thing that a lot of people don't realize is you got to be careful of that patient, you know, seeing passwords in your browser and stuff. Bad idea.

It sounds like there's a lot of HIP or a PETA compliance, like, stuff in there. Right?

Absolutely.

So, Terry, like in your software, I'm just curious, like, so if, if, if, like I got 127 locations, if one of my clinicians is downloading, like, you know, say, like the patient database, you know, because I'm thinking of starting a clinic. Right, yeah. Is there like some type. Let's just say that feature was available. Like, is. Is the. Is management notified in your system right now?

Well, they're not notified. We do log the fact that it was done and who did it from the IP address, they did it. But, you know, if, if for whatever reason the organization didn't lock it down, yes, it could have access to that. So, you know, as far as, like, large organizations, though, that's right off the bat. That's one of the first things. It's like, yeah, we work with them, set up those security with your onboarding.

Like, so a good tip for everyone is that like, whoever EMR you use, whether you use Giovanna or Jane or Prompt or whatever ones that you want to use, you want to make sure that the security settings are set up properly. Would you say so, Terry?

Oh, absolutely. That's one of the very first things that we train people on how to set that up. We give them models right off the bat to use and then tweet. But you gotta, you gotta track that.

Cool. All right. So, Terry, everyone is talking about AI. You know, AI is on everyone's mind. And I'm curious because you're a technologist, you're an entrepreneur, you've been in the software industry for a long time. Where do you see AI in respect to maybe the software that like everyday clinic owners use? Like in our industry?

Right.

How will it help the lies of whether it is a clinic owner or like the front desk or that clinicians, you know, and I'm sure your work on the back end is like, okay, how can we make this work within. Within our software?

Right. Well, yeah, you know, AI is such a. I'll call it black magic at the moment because a lot of people don't realize what it's actually capable of doing. And frankly, even as developers, we're learning every day that it's like, oh, my God, I didn't realize we could add that or that I could increase this functionality for us. So, you know, here what we've done, we've launched the first three AI tools and it's really been more around practitioners. So it's doing things like doing a summary of all the patients charts. So know, when a practitioner is going into an appointment with a patient, it'll. Instead of having to flip through all the pages of every chart they've ever had, it'll actually generate a summary for them.

So summarizes like, you know, like their soap notes.

Right. Of.

Of like.

Exactly. But it's instant. It gives them a, you know, a small caption. They can read it quickly and they go on, you know, then into things like AI charting, where you can just dictate while you're with a patient and it'll automatically create a soapboard for you. Yeah, really cool.

I see some, I see some people starting to using that. I don't know how effective it is or how accurate it is.

Right, but exactly. So that's the area that, you know, everybody's pushing us as a software company. Oh, we need AI. We need AI. You ask them what you want it to expect it to do, and very few people can answer that. Yeah, yeah, but it's, it's definitely coming. But where I'm seeing, you know, some more benefits, like we've got these practitioner tools and we've kind of focused on that and I think they're pretty slick and it's going to be a lot of learning over the next few years for everybody. But on the admin side, we're looking at things like, you know, AI can start doing schedule optimization. So it starts, you know, recommending where appointments should be placed and your online booking tools to optimize the schedule so you're not getting big blocks of empty time for your practitioner. So that's a good one too, I think.

And yeah, that's it. So is it optimizing the schedule, you know, based on the patients, like, history of, like, no shows and cancellations as well, and put like is it like looking at all? Because like I was, I was in Chicago last year and one of the, there's one of the softwares, they're like this is exactly what they did. Like the schedule optimization was not just like optimizing your schedule but it's also looking at past patient behavior and saying like this person has a high probability of no show and cancel and so let's put them at like a less premium spot and the premium spots is like, let's put like the high value and you know like high value clients in there, right?

Oh absolutely. And you can train it on things like you know, when the most common no show times are, you know, if these people are consistently not showing up in the afternoon but they show up for their morning appointments. Okay, well we're going to you know, give them a, feed them morning appointments. That's, that's very specific to a patient. We're looking at also on, on a bigger level of okay, let's, let's optimize this, the schedule so that you know, this clinician is booked solid from 7am till 3 and if we're going to leave empty spot, leave it at the end of the day possibly or whatever so that they can just less blocks or empty space in their schedules itself. And but that's like, it's, this AI is so powerful. Like you can train it on so many different things.

Yeah.

Wow.

And what else do you see? So the schedule optimization, you know, obviously like we talked about. Yeah. What else do you see that that will have value, you know, rolling out in 2025 and not only just your business but like maybe some of the macro trends that you, that you see with other software companies.

Yeah, absolutely. I think there's two other things. One is on the reporting side and be able to use it pointed at your data to run or develop for you. But more importantly and kind of along that line, we're working on Cross Canada outcome measures project with the Canadian chiropractor and this is, they're inviting all EMR vendors to participate in this and it's basically gathering outcome data and delivering it to this, you know, kind of a giant database in the sky where they can start both geographically gender related, treatment related. Well this is an area where I think the AI is going to come in really handy, this giant database and go okay, hey, the patient presents with right rotator cuff injury and it'll be able to tell you based on all the data that it's gathered. Very quickly, here's the best treatment modality you Know, he use this. This is the recommended number of appointments based on all this data from across.

Yeah, yeah, yeah, No, I see that. Like, yes. And then I'm just putting like the marketing hat on now, right? If you look at some of the big companies like Lifemark or CBI or some of these bigger chains in the US that have like 500 locations or USPH, right? That when they're negotiating, like when they're negotiating with like whether this insurance company or they're negotiating with employers, right. You know, to get, you know, whether employees or insurance, like, you know, like clients to book directly into their clinic. Like they're actually giving them, they're selling them based on these outcome data reports. Right.

You know, you can. And that's part of this project from the chiropractic side is they want the ability to go back to, you know, the federal government and provincial health and go, look, our treatments are helping patients. Here's the success of our outcomes. You should be funding this. Like, it manages. Chiropractors get partial coverage for the first seven or eight appointments. I think we're the only ones in Canada that actually has provincial health coverage. Well, they want to go.

And, you know, now this is powerful. You know, like, imagine like spinning some reports that actually shows outcome measures of your specific clinic by clinician. You know, now you're knocking the door of like local businesses. Like, you know, you want, you want like that Costco account or you want like this other employer and you're, you're like, hey, this is like our outcome. This is like what we could, you know, you know, we've had X amount of employees from you, from Costco in this case, and they had like this type of shoulder injury. And this is like the, this is like the outcome.

Oh, if you can show up to that employer and go, look, based on our treatments, number of days off because of injury has been reduced across the board. How popular valuable is that?

Oh, yeah, yeah, yeah. If this was available, it would actually rock some of these bigger networks, right? Because it's actually very. Because when I think about the bigger networks, like, they have this, like, they have like departments full time, like crunching this stuff, you know, Right?

Oh, absolutely. And now, you know, for a few bucks, you know, a small clinic has these tools.

They could go head to head, you know. Right. You know, or. Or if they want to put together an rfp, right. You know, now they could just like, okay, here's a requirement. And then like, they're using whether ChatGPT or Google Gemini. And then like, they got all this outcome measures, like you could spit out these reports very quickly versus not needing a half a million dollar department to like put together these big proposals. Right. For the company. Right?

Absolutely, absolutely. You're totally leveling the playing field with these AI tools that are available.

Yeah. There's a lot of talk about like AI agents. Like, do you see that happening as a technologist in the next couple of years?

You know what, Replacing the front desk, Terry, that's a tricky one, eh?

Or that is that, is that hard? Because fundamentally these clinics still need to come. Patients are still coming to the clinic. You know, like, so they, it's not like you. Unless like some of these Tesla robots are ready by then and they got the chat GDP brain and like they're replacing the role of the front desk. Right.

You know, well, what I think you will see though is, you know, Clinic closes at 6pm Having that AI assistant that's dealing with patients after hours. Brilliant. You know, there's, there's something that's super low cost and you can have, you know, interact with the patients. And some of them that I've seen are so good, you don't even realize it's AI anymore.

Yeah, yeah. So you do see that happening. But it'll be a little harder for practice owners to adopt that because this is a big shift, right?

Yeah, yeah, absolutely, absolutely. And I, you know, things are coming, but I, I don't know if it'll fully replace people, but definitely getting, you know, I think it's a matter of figuring out how is it going to benefit and, and you know, streamline processes. I don't know if it'll necessarily fully.

Replace people, but here's the thing, Terry. Like, I, like I think about, when I think about macro and I zoom up, is that like depending on what province or what state you're in, you know.

Right.

Whether in Canada, US or in Australia, there is a general trend of people's profit margins decreasing.

Right. 100. Right.

Whether you're paying your staff more, you know, like this, this is what I don't like about Canada's model where, like they're literally giving up, you know, like they're paying their staff so much because they're giving up a percentage.

Right.

Versus, like some of the American owners we work with, where they pay them hourly so they can protect the margin.

Right? Yeah, yeah.

And so when you start seeing profits like decrease, you know.

Right.

Percentage wise, like then you're back to a corner that there's not enough ROI as a business owner. Right.

For sure.

So you're almost like, I think it's sooner and later where like you have to make some of these big changes because you don't have a choice if you want to stay competitive or you want to like continue paying your staff more, you want to build up a leadership and you want to reinvest like with adding more locations. Like there needs to be a big change. And if you look at fast food chains, right, look how quickly that has adopted where like, you know, you go to McDonald's now, like we're just like literally like forget talking to a person on the counter, like we're just like touching screens on the kiosk.

Oh yeah, absolutely. And, and frankly that's possible now. Like we have some Giovanna clinics where the patients check themselves in, they arrive themselves, tells them, you know, the practitioner knows that they're there, they come either prepaid or, you know, it automatically charges their credit card on the way out. Like technically the ability to eliminate an admin staff exists already.

If you enjoy my content, I write a clinic owner newsletter. I share with you what's trending right now in marketing, selling your business, recruitment operations, front desk and more. Become a better clinical owner. Join over 22,000 clinical owners who get this free newsletter each week. Go to clinicowner.com to sign up today.

It's. It sort of depends on your culture.

Maybe it's not going to eliminate. Maybe like instead of you needing like three full time jobs or two full time, you just need one.

Right, exactly.

And then all of a sudden you go from making 10% or 15% to like, you can add another five points. Right?

Yeah, yeah, well, and there again, when people are scaling and adding more clinics, we're seeing a lot more work around centralizing admin functionality too. You know, maybe you don't need three admins in every clinic, you can manage one and you centralize your callback, centralize your, you know, receivables work in one clinic and they manage it all. And that's one of the nice things about cloud software too is, you know, they access it from when, wherever they need to be.

Yeah, yeah, no, I see that a lot. Like we have that like in the call hero software because we share a lot of the same clients, you know, with like some of the enterprise ones. But like it's like a buddy system. When one clinic goes down, like the phones and communication automatically forwards over to like the other clinic. You know, it might not even be centralized, but it's like, hey, when you got 10 clinics, you know, you have options.

Right.

You know, where hey, if they don't answer after two rings, like, bang, it goes to like your, one of your low underutilized clinics that has availability to still like maybe go on your software and then book online or understand enough about how to deal with that client or a new opportunity, right?

Oh yeah, absolutely. And even things like the, you know, online intakes and things like that too. Definitely reducing the amount of admin staff.

Yeah. And maybe it's a world where like there is less of a min because it's repulsed by some of this technology where it's like a kiosk model, you know, or it's like using some of these agent AI agents. You know, I know that at Culture we're working a lot on this stuff right now and maybe even like some of these robot stuff.

Right.

You know, but if you can have more profit in your business then you can pay your like office manager more.

Right.

You know, and so like I think like, and this is the thing I've, you know, I've seen over the years is that like I find that most practice owners are very resistant to change and technology. Right. You know.

Yeah, well, and sorry, this kind of goes so at Giovanna, I was mentioning earlier, we're starting to grow market as well. And that's one thing that I'm seeing is when, as we move into the US different mentalities, you know, they're.

Yes.

Much more aggressive to adopt new technology especially when they see, you know, streamlining capabilities and stuff like that.

Yeah, yeah, we should, we should talk about this because you know, like I same thing like you know, with our businesses, you know, clinica seller call here. We've been, we've been really grown in the US right now. Like that's where majority of our sales are coming from now. And, and there is a very different mindset with these practice owners in the US I don't care whether you're a chirophysio or a massage versus the one in Canada.

Right.

You know.

Right.

And it's very ROI based and I also feel like they are way more open to try new things.

Right.

You know, or adopt technology or like, like you said, like, you know, you're seeing way more people be able to like, you know, yeah, I'll change my EMR every six months, you know, until I find the right ones.

Right. Yeah, it's, it's shocking. Like you know, from our perspective the sales cycle is so much shorter with these types of clinics. Now I will qualify that by saying, you know, and Rick I'm older than you are, so I've seen a lot more of this. But when I first got into emr, the Canadian clinics, and anytime you brought up, you know, anything marketing related, it was really kind of frowned upon. And that's really changed a lot over the last few years. We're seeing, you know, Canadian clinics being far more ROI focused and market related and they're doing a lot more outbound work to, you know, drive new patients to the clinic. So, yeah, you know, there's definitely shifts going on in the industry.

I don't think they have a choice. Like, Terry, like, when you're, when you're, when you're like, when you got a flight flawed, like, compensation model in Canada for clinicians, right. Where you're, you're like, oh my gosh, instead of you working harder, we'll just give you a higher percentage. That higher percentage erodes your profit margins, which means you don't actually have enough to like, you know, make it worth your while to grow the business. And so a lot of these practice owners are forced to still treat because their business doesn't make them enough money. Right. Whereas you look at an American like, this is like, oh my gosh. Like, you know, they are like, they get into owning a practice because they don't want to work in there unless they just choose to. Like, I love practicing for that one day. I got these super fans. Sure. Right. But most of them are like, you know, that's why they're opening five, 10, 20, 50 locations, you know.

Oh, absolutely. Yeah. No abs. And it's exciting to see, like, I do like to see the growth and the changes in these. But yeah, there's a, definitely a different mentality as we move of, you know, working with different areas. And we're seeing it in Europe and stuff too. There, there's different challenges and things too.

Yeah. But I do believe that there is, you know, when, when, when you're an entrepreneur, whether a practice owner and you are, your profit margins are forcing you into the back of a wall. Right?

Yeah.

You're gonna make some of these changes. It's just whether you're gonna do it sooner, where you could control the narrative or you're forced to do it, you know.

Right.

And I just don't see light, you know, for some practice owners in certain provinces, you know, or certain states where, like this, the, the, the, the, the, the. When I look at the P L or the profit loss, I'm like, oh, why are you still in business? It doesn't make sense. Right.

Well, and you know what, A lot of these clinic owners are own the clinic with the expectation that at some point they're going to exit. And if they don't have that in line, they're far less attractive to that eventual buyout and acquisition down the road. So, you know, getting these things in line and making sure that their P L is, is profitable and exciting is important.

Yeah, yeah, 100%, you know, and, and adopting to technology or some of these bigger shifts, you know.

Right.

If a fast food chain or a grocery chain, which, you know, they're fairly resistant to change. Like you'll even like these grocery chains. Like I use self checkout all the time now.

Right.

I don't.

Oh yeah, no, me too. I. I enjoy the speed of it, to be honest. Yes.

It's a shorter line. Right. You know, so I'm curious. So you have access of a lot of data right now, Terry. You know, when I look at, you know, how many, how many practices in your community, you think.

Total clients, clinics. I think there's about 2200, 20, 300 somewhere around there.

Okay, you're at 23. So you're seeing a lot of data right now. Right. And so I'm curious, like, is there any trends that you're seeing with the data? Like, are certain types of like businesses doing better than others? Is in general, people like up or down? Like, are you seeing any macro trends between all the data of like all the users that you're seeing?

You know what? One thing that I have been noticing, and I'm not sure, I'm assuming that clinics have been working on this actively, but I am seeing schedules far easier and more optimized than I.

Sorry, can you say that again? You just cut off there?

Yeah, oh yeah, I'm seeing the schedules are far more optimized than I traditionally have seen in the past.

Okay.

They're just full. Like practitioners seem to be scheduling more appointments, which is good. I'm seeing, you know, PVA scores are slowly increasing on the brand.

Terry, what is a PVA for someone that doesn't know? And I, I love this chat because, you know, you as a technologist, as like a software entrepreneur, like you actually ended it and most owners actually don't.

Well, it's. Yeah. So you know what, as far as we're tracking PBA scores for, you know, as most of the reports on our, our statistical side, and it's basically, you know, you're tracking how well the practitioner is doing as far as, you know, the number of appointments they're seeing with a specific patient, you know, and we want to see that number obviously, increase as much.

So on average, like, let's just talk what it is, you know, like. Like, you know, it's on for someone that comes for every single new consult, new eval, or new patient. On average, how many times do they come with, like, their care plan, you know?

Right.

And you'll see numbers from four, you know, and you see that a lot with, like, new grads or maybe some of these senior therapists. On average is 12. But. But yeah. What are you seeing? Like, actually, like you said you're seeing this go up. Is that what you're saying?

I have been seeing it go up, you know, just as sample sizes, I've been seeing, you know, kind of on an average, about a 3.7. Yeah, I know.

Okay. I'm just. Sorry.

Well, it's. Yeah.

So your average is like. Like, forget the. Forget the 0.7. Like, on average, like, four. Let's round up.

Okay. Four. Yeah. Okay.

I'm just telling you, like, I have access to seeing, like, maybe 2200, like, you know, like, practice owners like you, but I have access to, like, you know, like, almost a thousand in our community. And I've seen their PNLs, too. Like, typically, like, I would say that, like, the average PVA that I typically see for most well run clinics are kind of around like, 8 to 10. Right.

Wow, that's.

So when I see that, like, And. And your number is actually right. Like, a lot of, like, the smaller clinics. Sorry, A lot of the. I would say, like, like, mismanaged clinics typically are at 4. So, like, if you actually implement certain stuff, like, even if you went from a four to a six, which doesn't seem like a lot, adding two more into their care plans, like, that's an extra 50% increase in your revenue. So if you're doing a million bucks, that's $1.5 million. Right. You know, and even if you pay your staff, like, 50% of that, that's $250,000 left. Right.

Well, and I have to say this is something that I think. And give you guys a click here. I've been doing a lot of work with Sanjeev and your team at accelerator, and I think that's something you guys. I think clinical leaders need to be trained more on how to teach their practitioner to improve that.

Yeah, well, that's hard, you know, because there's a. Well, first of all, because there's a shortage of, like, practitioners, whether you're a physiopower, massage Right. That owners are typically scared of, like managing their staff and fear that they're quit. Right. And a lot of it is like, fundamentally, like there's leadership issues or they weren't taught how to like manage and lead teams and like. But when there's a shortage, like leadership and like recruitment and all this other stuff is so important, right?

Oh, 100%. I personally think that goes to a lot to culture though. When you have good staff that buy into your culture and understand that increasing their PVA, you know, everybody.

All right, PVF4, what else do you see?

This is good. I've really enjoyed this. Right, yeah. On, on the big data side, you know, one of the things that I personally noticed is accounts receivables been surprisingly higher than I've ever seen before as well. Okay. I gotta be honest, I haven't delved into that in any detail, but it's definitely something that I help some of our clients and try to manage and, you know.

Oh, sorry, you mean like AP of like them paying their bills or like consumer. Or the clients not paying their bills?

Clients not paying the.

Okay.

Evil is much. Okay.

So the AR in this case, right?

Ar.

Yeah, yeah, yeah. From the owner side of the ar, when you're thinking of ap, I'm like, oh my gosh, like, what do you mean?

Right.

Yeah.

Much higher. And, and this is just a kind of more of a personal thing that I've noticed across our clients in general. It's just, it's been higher than I've traditionally ever seen. And I, I don't know if that's, you know, consumer debt related or what.

The case is, but it's probably like a common. I would say it's kind of that, like, you know, it's part combination of that and, and also like all the front desk leaks, you know, like the front desk row is also very high turnover. And so if they're not a good job with managing like AR and doing the billing on time, you know, to all these different platforms, you know, like, of course it's going to be high, right?

Yeah, yeah, absolutely. So that's, that's an area that, you know, I, I kind of flagged a few of our clients that I could have happened to notice. Hey, you know. Yeah, focus on this. You might want to pay attention to it.

What about cancellation rates or arrive rates? Like what you guys measure cancellations or arrive? Like, it, it depends.

Right. So, yeah, cancellation rates, honestly, has been getting much, much better. I'm finding that, you know, online booking, I know a lot of Clinics have always traditionally been a bit scared about online booking and cancellations and things like that and people, you know, not showing up in that. But we're finding it's. It's. That number's dropping quite a bit. And, you know, obviously there's a lot more clinics now are actually taking credit cards as part of the booking cycle. Kind of like, you know, when you. I'm seeing a lot more restaurants do that now, too. You know, you. I love it. You know, reservation. You got to put your credit card in to hold it. I'm seeing more clinics doing that makes a lot of sense to me. That helps drop your cancellation no shows. But overall, I'm seeing, you know, multiple reminders, helping text, email cadences, things like that are really helping to reduce the no shows and cancellations.

Okay, cool, cool.

I'm seeing a better trend on that one. You know, I'm seeing it actually go down for a lot.

Yeah. Interesting. And in overall, like, are you seeing that most businesses, like, are up or down or you're saying, like, they're flat and you're seeing more new people opening up clinics? Right.

You know, definitely seen a lot more clinics opening. It's surprising. Lately I've been shocked that, you know, obviously we. I'm tracking the number of people that are requesting, and that number is dramatically going up and new names and. And I look at them as they come in, and from a cross section, I'm just seeing, you know, new clinics popping up all the time.

So, like, do you think it's because there's more business or, like, it's just like, you know, it's just kind of every single clinician. Clinician's dream to open up a practice. And like, everyone's just getting all entrepreneurial. Right, with all the Gary Vee videos going on.

Right? Exactly. Yeah. You know, that's a good question. I really don't know if it's people that just want to go on their own or if there's more training in their schools on running their own clinics. Yeah, it's a good question. I'm hoping that there's more training going on, how to run clinics. That's one of the areas that I find. You know, we run into a lot of new clinic owners that really don't understand the business side of actually managing a clinic. Yeah, great clinicians, but no business sense.

Yeah, that's. That's pretty normal. And it's like, if you go to some of the major cities, you know, I don't care what's major city in Canada. The US or Australia, like you'll see like 5, 10 CL clinics like within a very short amount of radius together.

Right, absolutely.

And a lot of them are small clinics too.

Right.

You know, and maybe it's one big clinics run by all these like small little clinics. Like, like what do you see in the future, Terry? Like, do you see, do you see like, you know, like, like do you see the rise of soul premieres, like all these small little clinks, popping ups, surrounding like one big clinic, you know, or these see like, or do you see like all these big clinics kind of popping up, you know, Like I'm.

I'm personally seeing a big consolidation going on. I'm seeing these big players buying up a lot of these small clinics. Okay. And, and even, you know, even the clinics, the three to five clinic organization are growing. You know, they're acquiring and expanding to get a. You know, personally I'd like to suggest they're getting to a critical mass where they're ready to sell. Yeah. So they're acquiring smaller clinics, building up.

That claim and what do you call a smaller clinic? A clinic that is doing like half a million. 300,000.

Yeah, yeah, I'd say half a million. This is. Okay, so I'm seeing those get bought.

Up more by some of the like larger consolidators, like the ones that already have infrastructure. Right. Like they got 10 clinics or 15, 20, you know, which we know a lot in, you know, in, in, in Ontario. Right? You know that already.

Yeah, exactly. Yeah, we're def. I'm definitely seeing more in that. And then on the.

Yeah, I would val. I would validate the hypothesis. You know, I see what ends up happening is that like there's all these clinics that open up. Like, I don't think that, I think that trend has increased over the years. Years, like, and then they get stuck within the business, whether it's $200,000, which is good enough for one person, or maybe like they hire a couple more people and they're at half a million. And I would say most clinics don't really start making. I think their break even point is around 400 to half a million dollars. Right. And so why am I owning a business and putting all this like 60, 70 hours of work and it's not making any money. I'm stuck at half a million, $400,000. Right. So it's almost, almost like, hey, give me some money, right? Pay for what I put in and then I'll be an employee of yours. Right. You know.

Right. Yeah, yeah. And I. I have to say, I. I have had a couple of really good friends of mine that are clients of Giovanna that have actually gone the other way and have scaled down and just said, you know what? I'm tired of running the whole business. And, you know, and. And they're still happy. You know, Javona works too, but, you know, that lifestyle.

Terry, do you see this? I do see the rise of solopreneurs, right? Where they're like, hey, I. I just, like, I don't need a big clinic.

Right.

Like, as I you talked about. I just want to, like, I want to open a business, a practice. Like, I'm not gonna have a lot of staff. I'm gonna leverage some of this technology. Like, some stuff you're talking about, Rick, with like, the AI agents, robots. It doesn't have to be perfect, you know, I'm gonna use some of your tech stack, Terry, from. From Giovanno, and I'm just gonna run a super lean sole preneur practice that, like, generates 150, $200,000 a year, super easy. I could work when I want to, but it's better than working for, like, you know, this big clinic across the street that, you know, that is. Is not giving me everything that I want, you know.

Oh, 100% like this. That affords somebody a fantastic lifestyle. Yeah. You know, you make a good income. You can spend your own hours. I kind of like it. You know, not everybody needs millions and millions of dollars to be happy, you know, if they can run the soulpreneur clinic.

Yeah, no HR headache. It's just you maybe hire an assistant, you know, like, to help you. Like, if you're a chiro, hire another assistant. Just do more volume, you know, Right. Patient care, blah, blah, blah. And like, just. But no HR headaches. You make a lot. You. The whole goal is just to make your life easy. So it's a lifestyle business, right?

100%. I'm a huge fan of that as well. Yeah. I encourage people to do that, you know, the odd time I'll have a practitioner with their scenario, and it's like, hey, you know what? Let's help you out. You know, we'll get you started and work with you and get you set up on your own, you know, once they can. There's a lot of concern sometimes or stress around starting out on your own, but frankly, I can't say I know too many people that have taken the leap and not been grateful they did.

Yeah, yeah, yeah, yeah. It's a hard shift for sure, right, yeah, from. But yeah, but there's programs that help there with that. That's what we do at clinic seller. So Terry, we'll wrap up with this. What would you say is just top three biggest mistakes most practice owners are making that is costing thousands of dollars each month that they're not using on their software, you know?

Sure. I'd say the first one is not managing drop offs properly.

Okay.

You know, that's a huge area where there's a lot of opportunity for people to increase the number of appointments that they just manage their drop off.

And just so we're clear, you're calling a drop off like or fall call offs is someone who's an active patient doesn't have their next appointment booked.

Right, Exactly. Okay. These are active patients, maybe an active treatment plan and you know, they come in two, three times and they haven't booked their fourth appointment.

Okay.

And you know, there's automation that can help that, but it's also training your admin, staff training, everybody should be focused on that.

And also look in the reporting and look in the reporting each week saying, hey, this is your list of like full fall offs. And like let's like call, text, email, whatever you need to do to get them back in, you know. Right. So they don't drop off and become a self discharge.

Right? Yeah, yeah, exactly.

Okay, cool. What's another one not managing fall offs?

Yeah, charting. Okay. You still see a lot of people that are a. Not doing their charting or not doing their charting. Well, you know, you get into a college that comes out to audit you on your chart. Insurance company and boy, if it's a mess, that'll.

Oh my gosh, I seen a couple of those in the last couple of quarters. Right. You know, where like there's a Blue Cross audit. Right. You know, or Sun Life, you know.

Right, exactly. And you know, goes to the AI tools. One of the big focuses that we had on implementing AI for charting is making sure that the output would always pass an audit. So we worked, you know, exclusively with some of these auditors and show them the output and stuff like that. So that's, that's an area that I think AI can help. But getting clinics and practitioners specifically focus on making sure they're doing good charting.

This has been a struggle like now, but also 20 years ago when I was running clinics here. It hasn't changed, you know, so I actually do like if there's some type of thing that you could do where like the accuracy of the charting, like done through AI and voice and stuff. Like, if that could solve that, that'll be great. Because it's hard to change human behavior when, like, they're just so used to it. Like, you know, like all these patients are booked back to back and you kind of try to end the day, but your brain's so fried. Like, bring it home.

Right.

Has it changed? I don't think so.

No, no, that's another area. And then the last one, like I was saying earlier, I think is cash flow. Managing your cash flow, making sure your accounts receivable get out of whack. That can impact your ability to operate.

Okay, cool. Amazing. And Terry, how do people find out more about you? You know, if they want to learn more about Javano?

Well, obviously you can come to our website, Javano.com and, you know, anybody ever wants to discuss any aspects of their clinic, I'm always available. So, Terry, T e r r yavanna.com you can send me an email. I'm more than happy to meet or chat. And I, I try to get out to as many the trade shows and things as possible. But yeah, I'm always open to any questions. And you know, it doesn't have to be about buying Giovanno. If you've got questions about running your clinic. I, I love listening to that because it, it helps us software better too.

Yeah, I really enjoyed our talk. Just, you know, you're sitting on so much data and I'm like, oh my gosh. I would love just to like, be a flyer. Want to look at all your data, you know, and just like, oh, my God. So what's trendy?

So cool.

Awesome. Well, thanks for coming to the show, Terry.

Yeah, thanks, Rick. I really appreciate it. A lot of fun.

All right. Good job. That was good. If you found this helpful and want some free resources to help you be an even better clinic owner, head over to clinicbosstools.com we've got tons of free stuff on getting new patients, bone scripts, selling your clinic, managing clinical teams, and much more. And over to clinicbosstools.com.