How This PT practice in Texas is Adding $500K in Chiropractic Revenues with Nat Christadoss

There's laws that physical therapists cannot employ chiropractors. There are ways to do it through, like, managed service organizations.

How much, how much revenue you think. You think you'll add for Cairo for 20, 24?

Easily half a million.

Okay, so, everyone, welcome to the Clink Boss show. And today we got a really good friend of mine coming on today's session. You know, we got, we have Nat. You know, Nat is the CEO. Co Founder. Not co founder. Founder. Physical therapy. Melissa, you've been in one for 13 years. And, and yeah, he's the one guy that I've known that signed for every single person's coaching program, you know, and, and more recently, he grew his business by 36. So, Nat, did I, Did I do a good job to summarize all that?

No. Yeah, you wrapped that up pretty well, Rick. Yeah. Yeah, you did.

Yeah. Yeah, I remember my. Do you remember, do you remember the first time me us meeting each other or not?

Yeah, it was, you know, I think it was in Colorado, right, Rick? At a APTA conference.

Yes.

Yeah. Yeah.

Well, was it Colorado? Yes, it was at a PPS event, right?

It was a PPS event. Yeah.

Yeah.

And you were sitting right next to me, and I think I signed up for Call Hero, and I was like, hey, you're the Call Hero founder. Right? So. And I think that was before.

Did you attend my talk or was I a participant?

No, I, I didn't attend your talk. Talk.

Cool. Check it out. I, I had this photo of me and you back then. I, I, I was looking for it. I was like, okay, let me see if I could find it.

Right?

So check this.

Thought I look a little different.

What do you think?

Yeah. Wow, that's crazy, huh?

Yeah. Look, all the hair he had back then, that.

Yeah, I know, man. It's like, yeah, obviously, you know, I was losing it, so I was like, I'm gonna make a little transition.

Wow, I remember those days, man. You know, I don't know where that was. I think you're right. I think that would have been. Yeah, that was a PPS for sure. I don't know which. It could have been anywhere. It could have been Vegas.

You know, it was pre covered. Okay, Pre covered, Right? Yeah, it definitely was.

Cool, cool. So you're just telling me before we started that, like, you know, you know, you got all this white space in your calendar, right? You know, like, like, just, let's continue that. Like, you know, you're like, oh, my God, like, tell me about your white space.

Yeah, I mean, before the Call today, You know, I was like, you know, just kind of waiting to hop on the call with you. And I was like, I had a few tasks to do. You know, I was like, man, I got some white space today. This is kind of feels good to have that. So.

Yeah.

And I, I got there, you know, from the help of you guys blocking and batching is huge. Right. Is something so simple. A lot of people, a lot of owners probably don't realize like how important that is.

Yeah. You know, it's interesting. So you were saying, did my five day time management challenge, right. You know, maybe talk about it like, you know, like, like we could, we could take all the lingo. But how has managing your calendar, how has using your calendar be able to help you like, work on like your business and also have white space so you could do like, you know, your personal, you know.

Yeah. You know, I think just having clarity of like what the hell I'm doing each day and you know, having the color blocks of, you know, what's my personal stuff, like when I can work out, you know, and, and also put puts into light like what I'm actually doing.

Yeah.

And to be able to categorize the stuff that I should be delegating and not doing myself. And that was really nice to see that like I had, you know, I think you color code yours yellow for the tasks.

Yes.

Yeah, I had a lot of yellow on my calendar. So I started slowly chipping away. Like, how can I delegate these yellow?

Yeah, yeah, because, because, you know, like when we look at, you know, like we've been, we've been looking at people's calendars and this is how I use my calendar. Looks like you do the same thing as well. Now is that like on my calendar I got three types of like colors, right. You know, you know, the one color is like, hey, blue. It's all my, it's all my personal stuff. It's all the stuff I do with my family or myself. And I want to see a lot of like, you know, I want to see a lot of like blue in there, you know, because that's the stuff that fills my bucket. Right?

Yeah.

And then I got like, you know, you know, tasks or projects I'm working on that are, I'm green, you know, and green is the stuff that makes me money. Right. You know, so these are, you know, like stuff that, like, if I put some work on this, it's going to pay like, you know, three times, ten times, you know, and then yellow, you know, on my calendar is like, okay, these are these tasks I just have to do, you know, no one else can do it.

Right.

Doesn't really make me money, but I have to do. But it's good reminder for me is like, hey, who can I hire or who can I delegate? So they could do some of this stuff, right?

Yeah. Like for a good example, like just this morning I had to like send my bookkeeper some reports. Right. And every month I send these reports, I spend, you know, 30 minutes to an hour doing this. It's not a lot of time, but hey, that adds up over time. Right. And I was like, how can I. Like, it's simple. All I had to do is give them access to the accounts. Yeah, right. And they can download it themselves and they're used to that. So just like little things like that, it makes just little tweaks here and there.

Yeah. And it's becoming disciplined to your calendar. Just like if you were a physical therapist or a chiropractor, you're following your schedule, right. You know, and so this concept of, you know, like using your schedule, like booking and like, you know, like, you know, and putting like getting rid of your to do list going on there and just putting everything that you need to do and color coding to tell you like, hey, what is stuff that you should be doing more of, what should do less of. And so. Yeah, so it's cool that you get to do that now.

Yeah. And prior to the calendar, Rick, you know, I'll be honest, like I as an owner, because I backed away treating it post Covid and then as an owner, I didn't know what to do. Like I'd wake up in the morning, I'm like, oh, I'm gonna work on this today. Like there's like no structure. Right. And so, and then I would get so stuck in the weeds working on that project, I forget about all the other projects like finance, like looking at my piano and doing those other stuff. I would do the things like I really like to do and forget about the other stuff. That's cool.

Hey, so you said you don't treat anymore, right? You know, and so talk about that. How many years did it take you to not treat? You know, since opening up your clinic? Right.

Yeah, it took me. Let's see, I've been in practice for 13 years. It was pretty much around like the 10 year mark. Right?

Okay.

And it was, I. I should thank Covet for it, actually. So Covet happened. I had really good employees, really good therapists on staff. So I had the option of Like, I need to furlough a few of them. But I decided to furlough myself from treatment and at that point was like, okay, what do I do now to take care of the business and grow the business.

Okay.

Wow. Wow.

And then, and then, and then, and, and that's kind of where your big growth came in. From the moment that you actually took that risk, remove yourself from the business. Right. So that you could actually work on the business. Right.

Yep. Yeah, that. Yeah. Initial spike in growth definitely took place during that time. And a lot of it, you know, was going into, you know, spending time with a scoreboard. Right. And kind of seeing what, you know, what my numbers are and where the practice is at and the areas that I need to work on and areas that we're doing great in. Yeah.

Okay. Super cool. You know, and so, so, so, and, and that year, that year when you started working on the business, like, what type of numbers were you seeing? Like, growth wise, like, I think you said 30, 35, 36% or something.

Yeah, that was a growth that we were seeing probably in the first, like. And that was actually during COVID Okay. Wow. That's insane.

Yeah. And. And I'm curious because it took you 10 years to go here, you know, and, and like you said, like we said in the very beginning, you signed up for all these different, like, you know, like, coaching programs, and I think you've pretty much done them all.

Right.

You know, what would you have done differently so that it wouldn't take you the ten year mark, you know. Right. You know, to actually get here. Right. If you're to go back all over again now, like, what would you do, like, differently, you know. Right, right.

And so all those programs were great. Right, Rick? The only thing that was I wasn't held accountable. I just didn't implement the. That I learned.

Okay.

It's all in my head. It's like, I want to do this. I want to do this. I don't know where to start. Right. And so the calendar helped me to kind of create that. And then the accountability. Right.

What do you mean by accountability?

Right. You know, working with a coach. So I've been working with a coach, you know, with clinic accelerator, and that, that's helped me a lot to hold myself accountable. Like, I mean, even Michael Jordan had a coach. Right.

It's interesting, you know, it's, it's funny is that like, you know, like, as entrepreneurs and clinic owners. Right. You know, you know, I think a lot of us feel like we don't need someone to Held us accountable. But I think, you know, we're, we're suckers for learners. So we spend this time learning all this stuff. We go to this event, you go to that event, you're walking around. But at the day, is that like, how much of that stuff are you actually implementing?

Right, exactly. Yeah. And it was nothing. You know, I knew about these tools, I knew about a lot of this stuff and. But implementation is key.

Yeah. So, so, so let's, so let's talk about your coach because you have a bit of a super interesting story.

Right?

You know, you are, you are a physical therapist, you know, and your coach is a chiropractor, right, Matt?

That's correct. That's correct. My coach is a chiropractor.

Tell me more about that. And why do you choose this path? And like, doesn't, like, you know, I think this is a bit, you know, like this breaks all the, all the walls, you know, and all the belief system of like, you know, physical therapists over the years, like. Yeah, let's talk more about that. Right?

No, for sure. So, you know, I was the typical physical therapist, you know, been a physical therapist, licensed physical therapist for over 16 years. And so, you know, just like every physical therapist coming out of PT school, like, we just had this, we were butt heads with the chiropractors all the time. Right. It, it happens. It is what it is. Especially here in the US it's very common, especially in my state.

It's the same everywhere. It's the same in Canada, it's the same in the US the same in Australia. You know, it, there's this, there's this divide that, you know, that like my profession is better than yours. Right. You know, I know more and I help them than that.

Right, right. And I think, you know, actually being a, you know, hanging out with my coach and seeing the progress and like seeing what other clinics are doing differently in other. Across the world. Just being open and just like, like maybe we need to work with them and not against them. Right. And so just kind of. It was a change of mindset, Rick.

Yeah, it's a big mindset. And I'll be honest, like Kate, you know, like Kate's your coach, he's a chiropractor. Her clinics are crushing it, you know. Right. Like they're like insane, you know, and their, their clinic is not your typical type of like, you know, clinic that you'll see in Texas. Right. You know, like they are, you know, they're a multi million dollar clinic, you know, like, you know, it'll be like, you know, a million of physio, a million of Cairo, a million of, like, massage. Right. You know, and. And like, that's kind of the footprint, you know. Right. Of a typical clinic.

Right? Yeah. No, absolutely. And, you know, I think it's like, in every clinic. So I'm going through a program right now. I'm. I'm trying to set up a chiro program in my clinic, and there's a lot of roadblocks, and that's why it's been difficult for a lot of practices to do it. In my stay in Texas, there's laws that physical therapists cannot employ chiropractors. So I just have to, you know, talk to an attorney and figure out how can I do this. And there are ways to do it through, like, managed service organizations. That's the route I'm taking. I'm currently working with an attorney to find out, let's get this done, you know, so it's doable.

Actually, let's talk more about that. Is it more because. Is it more because, like. Because, like, when I think about, like, you know, most clinics, you know, in, in Texas or in the US Most of them aren't multidisciplinary.

Right.

You know, there's still that old school physiotherapy versus Cairo, and even in massage or all these other disciplines. Right. You know. Yes. I'm just curious, like, is it like the. Is it the. The business stuff or is it still like, you know, like, you know, it. This. This mindset of, you know, not be able to, like, work together in a collaborative environment.

I think a lot of it, Rick, is like, I think with the physio side, I'll speak on both halves. I'll be devil's advocate here. On the physio side, the therapists feel that, you know, because of Cairo's, we're trained in the exercise or, you know, that's what we're skilled out with there. And. And they feel like the Kairos are not. And vice versa. The ky, because there are some physical therapists that, you know, do some manipulations as well. And so the Cairo was like, no, that's what we're good at. That's what we went to school for. So what I'm doing with. As I roll out my program, I know each clinic's different, but what I'm going to do is just kind of separate. Like, here's the divide. We're going to stay in our lane in our clinic here for the Kairos, strictly just do the manipulations. And the, you know, any modalities if they want and then the physio they're going to specialize that and they can create a cross referral system. Yeah, yeah.

It's interesting because you know if you look at, if you, if you look like all the like all the new physical therapists coming out, they're all like, want to be like kairos. Right. You know, and then if you look at all the kairos like graduating now, they're all like physios. You actually can't tell the difference anymore. You know, they're you know, like car. They do exercise based like programs, you know, they are. Then you got physios doing like you know, manual therapy or manips, like whatever you want. It's the same thing at the end of the day. Right, you know.

Right, absolutely.

But here's a kicker, you know, like from a marketing standpoint is that like, you know, like you know, like a consumer, there's a consumer looking for physical therapy.

Right.

You know, they're going to search physical therapy on Google and they're like, hey, and you know, maybe your website and your social media comes out. Right. You know.

Yep.

There's also another consumer that is actually searching, hey, I want chiropractics, you know.

Right.

You know, they're not competing like someone want searching and wanting chiropractic. They want chiropractic. They do, you know.

They do.

Or someone searching like I want massage therapy or license massage therapy. I want massage therapy. I don't want chiropractics or physiotherapy.

Right, yes.

And so you know, if you think about the modern day clinic, you know, I just, it, it, it boggles my mind where I don't see more, you know, clinics in the, in the US where they have this approach. Because your business could literally triple, right?

Oh absolutely.

You got three separate search terms. And it's not like they're competing. Right. You know. Right. But it doesn't mean like you know, like they can't cross reference, cross pollinate across like have like treatment plans that include all three, you know.

Yeah, no, absolutely. One of the things that I've noticed Rick, especially like during the recruiting, you know. Well, let's go back to marketing. So like in regards to like our patients, when I was treating patients all the time, patients asked me like hey do you know massage therapist I could go to? Or do you guys do massage therapy? Or, or they're going to another chiropractor in town that we know about and or they're calling like hey, do you guys have chiropractic care. So we hear this like from a lot of our patients anyways coming in to have that service in there. We're already paying rent, we're already paying all these utilities. Right. Why not bring another additional revenue stream coming in?

Yeah, I love it. You know, and, and, and, and, and for the. Are, are you introducing massage to. At your clinic or not?

Yeah, yeah, no. Eventually we're going to be adding massage therapy as well. And right now my focus is on the Cairo side, but. Absolutely.

But why wouldn't you like, like, you know, you could hire these licensed massage therapists, LMTs, right. You know, I, you know. And that is your best cash based practice, is it not?

No, it would be.

Yeah.

No, absolutely. Cash pay all the way. Right. And what's cool about. And that's going to be an easy route for me to take for the massage because in Texas we are allowed to hire massage therapists, so. Yeah, yeah.

But you know, like, so what would the, I, what would be the dream, you know, clinic for you now? Like, you know, would it be like, hey, I want to do like, you know, I want to have like a million of pt. I want a million of Cairo. I want a million of like, of like, you know, massage. Right. You know?

Yeah. No, I think like my old mindset was like I would, I need to, in order to grow, I gotta add more clinics. Yeah. And then I saw the opportunity. Like I have so much, you know, I need to squeeze the juice out of the current clinic I have right now. There's so many opportunities right there and I need to focus that and not focus on adding more clinics and, and that can be done later as we maximize our current. Yeah.

What's the square footage at your clinic right now, Matt?

3,250.

Yeah, 3, 200 square feet. You should be able to like pump out like 3 million bucks like a year.

Right, right, right.

You know. Right. Like you're doing underutilizing day, seven days a week. You got like, you know, physical, you got physical therapy pumping out like a million bucks, you know. Right. You know. Right. You know, then you got a million dollars of cash based like massage, you know, like that's another million bucks right there. Right. You know, and then you got another million of a whole new search term, which is chiro, you know, Cairo, you know. Right. Whether that's cash or insurance or in, you know, it's, it's the same thing because it's a different search category. Right. You know.

Exactly, exactly. And like, for example, Rick, you mentioned, you know, seven days a week is like, our clinic is open Monday through Friday right now. But when do people want massages or any other services? They typically want the weekends. Right. So. And there's staff willing to work those days if they're, you know, maybe part time or there's people out there.

Yeah, yeah.

So it's a mindset change as well. Right. We were always thinking like, nobody wants to work weekends. Like, no, there are people out there that want to get paid a little extra and work the weekends.

Yeah, yeah, yeah, you could pay them more. You just gotta find the right type of person to do that. Right. You know, and yeah, one, one thing that I see is that like, you know, another reason why I like this, like multi disciplinary approach, right. Is that like clinics that do it well. And Kate's clinics is a good example. Right. You know, my last time I looked at their numbers, like, I think it's almost like 60 to 70% of every single new patient that comes into the clinic gets across referral.

Right.

To another discipline. So they use another service. Right. You know.

Right.

It was back to what you're saying, you know, like, you have patients coming to your ready saying, hey, I want what's a good massage therapist or even like, you know, what's a good chiropractor? You know, and so they already want to go there. Why not put together a care plan? So like, you know, it's, it's not only to get another search category, but if you implement, you know, you know, care plans, treatment plans that you do, like cross referrals, like, you could, you could actually blow it up very quickly.

Right, Absolutely. And then on the standpoint of recruiting, Rick. Right. There's a shortage of physios and PTs across the US and I, I believe in Canada as well. And so on the recruiting standpoint, you know, why not introduce another discipline? It could be even OT as well. Right? Yeah, there's a lot of clinics not utilizing ots as well. Yeah, yeah, I love that.

So, so let's talk about, let's talk about rolling out chiropractor, because I think that is like kind of the first thing you're looking at right now. What would you say is the biggest challenges with like rolling it out right now? You know, because we've been talking about this for a little bit, right?

We, we have, we have. And I've been, you know, working behind the scenes trying to get it done is. It's my struggle in my state is the laws. Yeah. And that's been the Struggle and kind of finding how that's going to fit with our model. This is all new to me, like the managed service organization mso. So learning about that and the nuances, because I want to protect myself as well. That way, I bring somebody on, they're not just going to up and leave and so working with attorneys. So there's a lot of legwork up front, but, you know, but let's talk about that.

So the biggest challenge is that in your state right now, like, you can't. You cannot, like, hire or employ a chiropractor to work at your clinic, right?

That's correct. That's correct.

And is that. Is that part of your college or is it at the state level, or is that the Cairo College?

It's the state level. So the chiropractors are in our state. You know, they have it to where only a physician or a chiropractor, and it may be somebody else, but I believe it's just only those two that can own a chiropractic clinic.

Yeah. So, so a physician or a chiropractor.

Right, Correct. A physician can. Yeah. Okay.

And so, and. And I think this. This is a very common regulation that I see at, like, you know, some of the other states. You know, like, you know, I think we met a chiropractor, Sarah, them in New York. You know, like, you know, they own, like, you know, like a really, you know, I think it was pinnacle chiropractor. They want to roll up physical therapy, and they got this exact same, you know, like, challenges as well. Right. You know.

Right.

And. And the way around that now. Right. Is this concept of, like, mso. Right. You know, maybe you could talk about that. And, and how does that. How does that, like, you know, in theory, you know, look like, you know, to help, like, you know, make sure that you can still play with the rules within the state regulations.

Right, yeah. And no, definitely, you know, reach out to an attorney for this. But in regards to our state, what we're doing is basically we create. I'm creating another llc, another business, and that's called the managed service organization, mso. And the future Cairo that I bring on, they have to also have their professional business.

Okay.

And so we have the two, and then in between, we create something called the msa. The Managed Service Agreement.

Yeah. Which is a contract between, you know, your MSO providing management services, you know. Right. Like at a 95 premium.

Yeah, right, exactly. Yeah. And just spelling that out in that agreement, and that's what I'm currently working on with the attorney right now, really flushing with that. And talk to Paul, too. He's helping me out, looking at.

Okay. And then, you know what? I'll bring this up. Like, you know, people say it's like, hey, it's a state problem. Like we, you know, like, you know, back when, like, you know, I'm not a physical therapist and we had the same rules, but we own clinics.

Right.

You know, I own clinics.

Yep.

And it was always working with your turn to create a legal structure around that, you know, and. And some attorneys don't know, and, you know, like, blah, blah, blah. If you find the right ones, you should be able to. And we had a very similar structure, you know, where it was these, you know, like MSOs, you know, that had, you know, management service agreements, and it flowed most of the money over, you know.

Right, yep.

Right.

Yeah. And then, like, you mentioned, like, finding that attorney. Right. That can. Knows about this, because this is a. This is not something all attorneys know about. And you gotta make sure you. Yeah. One that's licensed in the state as well.

Well, this is how the dental. This is how the dentists do it. Right? You know? Absolutely.

Yeah. Other healthcare.

Or the vets, you know. Right. Like in. In, you know, like now, like, you're seeing more and more companies, corporates, you know, whether it's pension funds or private equity. Right. And they're owning clinics right. Across, like, you know, different states and different countries. Right. You know. Right. And so why is it that they could open, you know, like, a good example is like. What's that? What's that? Physical therapy franchise. Physical.

Right, right, right, right. Yeah.

So physical, in theory, can't open up a clinic in New York because of all the state rules. Right. You know, just like our good friend, you know, Sarah, in or at Pinnacle, yet they are able to. Right. And I don't know if you understand the physical, like, franchise model. They're not owned by even physical therapists. They're like investors, most of them.

Is that right? I didn't even know that. Interesting.

So anyways, it's back to, like, this legal structure. Right. You know, so you're going to figure out the legal structure. It's an mso. But long story short is that it looks like, you know, like you hire these cars who have their own company, and then, you know, and then the money just flows back to the mso. Right. You know.

Right, correct. You know, they're just performing just their services and that's what you're paying them for.

Yeah, yeah. In essence, it's like, you know, you're paying and then like. And then in this mso, like what are the services that you actually provide them? Like, space. You know, you're almost like more like a, like a landlord providing these space. But it's like you're an expensive landlord, right? You know? Is that what I'm saying?

Yep. Uh huh. Yeah. And like in regards to that. Yeah, the space, utilities, you know, everything from the emr, you know, all of those things.

Okay, cool, cool.

Yeah.

So then, so then it sounds like you're getting close to figure out like the whole legal structure thing.

Right?

You know?

Yeah. And like little things that I'm learning about it. Right. So like you can even like, so they're gonna even have to like in Texas they have to have their own bank account.

Lost. You there?

Rick? You back? Rick?

Oh, I'm here. I don't know what happened. That was kind of crazy.

Right? Well, welcome back.

Welcome back. That was. Or everyone was gone.

No, it was just you. It was just you.

Oh, that was so weird. That's never happened before. Okay, so super fascinating. So it's that deeper. So the. I think you were. You're just wrapping up with the msl, right?

Yeah, I was mentioning about one thing I just learned about the mso, like even like the bank account. So they're going to have their own bank account as well. Like, money flows.

Yeah.

Basically we're controlling everything.

Yes.

Yeah, we're controlling everything.

And then if you break it down, like it just works out like how much of that money like, you know, is coming. What percent is coming back to the mso, right? On the, on the revenue build, right?

Yeah, no, absolutely. So like I was going, you know, like, that's what we're kind of playing with is like do. That's what Paul and I were kind of debating yesterday. Yeah, he was like, he was suggesting, he's like, nat, just kind of pay him like you do with your physios, right?

Yeah, like, like right now, what percent you pay your physios? Like it's 30, you know, like if you want.

Yeah, around 30. Yeah.

You do an MSO that's based on 70, you know. Right. You know, 70 of these buildings where we take care of all the management stuff. And that 70 just flows back into the MSO and the MSO flows back into your, your other company or. Right.

You know. Yeah, exactly. Okay. So we can even put them on like our payroll and everything. And then now what's going to happen? This is the beauty of it is like all my Services like payroll, marketing, it's all going to get centralized in the MSO eventually.

Yeah, yeah.

Pull that all together and it's going to be shared expenses. Yeah, cool.

That's super awesome. So the MSO and the second thing is going to be like your emr, right. You know, have you figured out the EMR issue? Or you can have two separate EMRs or you can just have the one that does like. Because I, because I, I don't know if you're on prompt right now. I don't know if prompt. Does Prompt have the ability to do some of the buildings for, for Kairos?

They do, they do. They are friendly with Kairos. So the emrs. Yeah, so that's perfect for us.

Amazing.

Yeah, yeah, yeah, yeah.

Because I think you were on webpt before you switch webptv. I don't know if they service the Kairos, but it's nice that if you could do, if you have like an EMR that could build like the both, you know.

Right, right. Yeah. I was on their office before which got bought out by I believe Net Health. Okay. And I'm not too familiar if they were gonna, if it was friendly for Cairo or not.

Okay, cool, cool. But that's it, right? You know, you got the mso, you know, the emr, the billions by the hardest part. Right. You know, but yeah, it sounds like you figure out the billing with like prompt, you know. Right.

So.

And like I said, you know, like you could jump start your business. You know. Actually, let's talk about that. How are you gonna jump start the car business now? Like have you thought about like how you're going to like jumpstart it, you know?

Yeah, no, absolutely. So like we already have our patient list. Right. From 13 years being in business. That's going to be the first step is introducing, you know, the chiro services that we're gonna be offering. That's gonna be probably one of the first steps. And the person that we bring on is gonna be helping quite a bit with this in regards to marketing. So there's gonna be like. So because like I'm gonna be credentialing with insurance companies. So once I get this person on it can take four to six months to get cred, but they can see cash pay in the meantime. Right? Yeah.

And a lot of the new cash already. Let's be straight up, right? Yeah. The Cairos do way better cash than physical therapists.

They do, Absolutely. They do.

Selling five thousand dollar treatment plans. I've seen ten thousand, you know. This is insane.

Yeah. Yeah, they're great at that. You know and so we could definitely start up with the cash and block out some time for them to do some marketing. That way when we bring on the insurances they'll have a full schedule. So. Yeah.

And then for the insurance like you're thinking of being like, I guess like cash like out of network. Right?

Yeah. And then you know I'll take a look at some of the in network ones.

Right.

Like currently our physio practice, physical therapy practice. We, we're a hybrid. We have cash in network and out of network and so depending on like what the rates are, you know, have.

You looked at the rates to see what the difference is? And then give me, give me the, give me, give me the most extreme and like what's.

Yeah, yeah. So what I've been seeing in regards. So I basically looked up the Medicare tool. You can look up by your region like what Medicare pays and most insurances will pay pretty much based on that.

Is it similar?

Not all insurance, but most. Right?

Most. Most is the same. Right.

Is that would be like they're trying to be comparable to Medicare.

Okay.

But some not. Right. Okay. And this is the cool thing that what I found is that so one like with the model that we're going to be building out with the kairos, they're just going to be, we call it the subby. The subluxation chiropractors. Right, the subies. Yeah, we'll bring the subies. And that's the chiropractor we're looking for. And they're going to be doing the manipulation. We're going to block them every 15 minutes on the schedule.

Okay.

I was averaging about around $60 every 15 minutes. Okay. And there is a, here's a cool thing. There's an insurance. We're out of network with. Yeah. I'm not going to drop their name but we're out of network with them because in the physio side they paid very low. Okay. And we, we do an hour treatments, we do two patients every hour on the physio side. Okay. And they pay really low for that hour spot. And so what's cool is that they're going to be paying the same rate for the Cairo for that 15 minutes.

Wow.

Okay. Which now we can see that in network and now we're seeing a lot more of that insurance in our clinic and so they will once again our walls. We can cross refer now.

Yeah, yeah. And if you're, if you could cross, cross pollinate on treatment plans where half of Your PT patients end up getting Cairo, right? You know, like bang, you know. And is there any restrict? Because, you know, I see in some states and you know, and provinces in Canada where know there's only X, there's only so much dollars available for Cairo and there's only so much dollars for PT and like, you know, and is there like when you're doing some of this insurance analysis, like, do you see that as well?

Yeah, absolutely. Some. And that's something you'll have to look into like each insurance contract because they do, you know, use Cairo and PT as like one.

One bucket.

One bucket, yeah.

Okay.

So it pulls out a bulb. So you definitely have to look into those as well.

Is majority like that or like that's just my minority?

I would say there, there's a, there's a handful of those. Yeah.

Okay. But majority is separate, right?

That's something I still have to look into. Rick, I don't know about the majority. That's something I need to find out.

Okay. My hunch is it would be separate because like, like think about, like think about someone, you know, think about another patient who goes to another clinic scene in Cairo and they'll be like, oh, sorry, you can't, you can't, we can't see. Use it all up when you went to see NAT for physical therapy. Right?

You know, so I do know for sure. Medicare, we have a cap in Medicare, but it doesn't involve Cairo. It's just PTOT and speech, I believe.

Okay, cool. That's super cool.

Wow.

So, so that's, that's good. And so so you're going to cross refer, you're going to do, I guess, some local community marketing.

Right.

You know, which is good. Right? And then, you know, and also like we talked about it earlier, like people searching for chiropractics is another Google like search term that you will not have.

Right?

You know?

Yeah, absolutely. And they're doing it already, right? Everybody. I mean, chiropractic has been a long, you know, it's actually older than physical therapy. Right. They've been around for ages.

I think there's more people knowing about chiropractics and physical therapy. I hate to say this, but like, let's be honest, right? You know, there's more people that know what a chiropractor does versus like a physical therapist, right?

Yeah, because we suck at marketing. Right? The physical therapist, you know, they're just not good at the market living and letting the world know about how awesome PT is. The chiropractors have been doing this for hundreds of years. Right. So they're, they're doing, doing it well. Yeah.

That is so funny, you know. That's so funny. And so just on this topic, like, I love, I love everything you've been talking about because you know, I've known you for years, we've been talking about this, but it's cool to see you actually implement this, you know?

Yeah.

And it's actually game changing. If you could do this right, you know, like it looks like you're getting.

Close, you know, it's so close, Rick. I'm trying to be patient with it and just trying to get the groundwork in. Right.

And you're paired up with the best coach. That's, that's kind of the reason why you're paired with a chiropractor, you know, right. Where he's running like a multi million dollar physiotherapy business. And like just, you know, it's like the same, it's the same game, you know. Right.

Oh, it's been great to pick her brain. Right? Because I, I don't know anything. I've. And she even made me go to a chiropractor. She was like Matt, you need to go see what it's like because I didn't know what it's like. And, and you're like, just like it's.

Like exactly as physio.

It' it's not bad, you know. And wow. Wow.

And, and, and, and, and, and if you look at the macro side of things, you know, right now, you know, everywhere in the world like there is this like, you know, like, you know, insurance reimbursement threat, you know. Right. You know.

Right, right.

And so how does like doing this, you know, and implementing like maybe like massage as well, like help you protect yourself, you know.

Now at the end of the day like we have to look at our business as an investment. Right. We're putting so much money, time and sweat into the business and we, we need to see an ROI and, and the best investments. You got to diversify. Yeah.

100.

We're doing the same thing. Divert like you know, we diverse like the, we're seeing the rates go down with physical therapies like what's that? Cash services. Let's do some product sales. Bring on massage, be on Cairo. And that way if something happened to that industry, you're not screwed and got shut down the doors. Right. Or what we're seeing right now is like, you know, the lack of, you know, with recruiting pts. Right. So like we got to protect ourselves yeah, yeah.

Well that's why you also need like, you know, like assistance and AIDS or hire, like overseas, you know.

Right, yeah, absolutely. Start looking outside the walls, right? Outside the box and you know, go overseas. Absolutely. Yeah.

Yeah. Wow, that's cool. And so, so after Cairo, your next move is going to be like the massage, right? Because like that's just like a no brainer. That'.

Brainer.

And more clinics don't do if it's a no brainer, you know, Is it because it's not like professional?

You know, I, I don't know why, Rick.

It's like, I think it's way easier to implement like a massage cash practice than PT, right? Straight up.

Right. 100%. 100%.

People want massage, it feels good.

Right. They want that service. Right. People pay that to get that experience. And yeah, I mean everybody knows about.

Why the resistance, you know. Why? Why? Because here's the thing, like, here's the thing I struggle with. Right. You know?

Yeah.

I'm from Canada, you know, and like, you know, when I, when I look at like how clinics are run in Canada, I'm like, hey, we do this, we're, we, we got the multi discipline, like, you know, like the best clinic to see are doing like, you know, three million bucks, three, four million dollars, you know. You know, you got a million of physio, a million of Cairo, a million and massage and a million, all the other stuff, you know.

Right.

That's your ideal clinic. Right. You know, you got all the different search categories, you know. And then like, you know, like, and, and when I look at what's happened in the U.S. everyone, it just reminds me like 10 years ago, 20 years ago, everyone's like still in their solo little boxes, you know.

Yeah. And I think, you know, everyone just gets used to that model and that's what they see, that's what they're used to. And they're not exposed to a lot of clinics doing this. Right. And so this is what we need to do. But we gotta, you know, utilize a blue ocean strategy. Right. And not, you know, swim in the blue ocean and not do what everybody else is doing sometimes.

Yeah. Yeah. So this, this, this chiropractor practice. I know, you know, he, he jumpstart his. I think a third of his business is cash based massage. Right. It's insane, you know, and it's way easier hiring an like a LMT than a pt. Let's just be straight up, right? You know.

It really is. Yeah, it really is. Yeah.

So that's just like rick we have.

LMTs constantly applying for jobs at our place and we're not even, we weren't even hiring for them.

Yeah, yeah.

You know, and so the opportunities out there. Yeah.

And also from a, from a, from a marketing side, like, you know, using an LMT for Legion is amazing. Giving out free, like you know, 30 minute massages to get them.

Yeah.

You know, and then from there, like it gets it in the door. And then like if you could do that cross referral, cross painting or, or during that session you upsell them to actually have a plan of care.

Absolutely, absolutely. Like, even on the PT side too, Right. Like when they graduate, like, hey, you know, here's a graduation gift. We're gonna give you a 30 minute massage. And now that patient's gonna be in your walls forever.

Yeah.

Because now they're, they're constantly coming in and if they need PT again in the future, who are they going to go to? Yeah. Come to that same place because they already know the staff. They know everybody. Yeah.

Wow.

Geez.

I'm, I'm excited, you know, so excited about this.

Well, yeah.

So when do you think it's going to start? When's the first day you're going to build Cairo?

Yeah. So, you know, I would say, let's see. Hopefully, you know, at the end of the summer we'll have somebody in there signed up. Yeah, yeah.

And then how much more, how much, how much, how much revenue think. You think you'll add for Cairo for 2025, like revenue wise, you think if.

You start this 2025. If I can build this quickly, Rick, if, you know, if I can get two providers in there, like easily half a million, right? Yeah.

Each provider billing 250, right?

Exactly, exactly. So the goal is you eventually, you know, get to four Cairos.

Well, let's just work out the math. You're gonna bill half a million dollars of Cairo, Right. You know, two providers, right. You know, and, and then, and what are you gonna pay them?

Right.

Like, like 30%, right?

Yeah, 30.

Okay, so let's work out the math. Let's just do some math. Right? You know, so 500k, right. You know, all your costs are still the same, right? You know?

Right.

You know, you don't have any other cost, but then after 500k and your cost is.

So it be 250k per, per Cairo, right?

Yeah, yeah. Well, like what's your physios right now bill? Like 200?

Yeah, like 225.

Yeah. So use the same numbers. You know, if you, if your Reimbursements are roughly the same, you know. Right.

Yeah.

Do 225. Let's just say 200. Be. Play conservative. You got two, 400K. Right. So 400K and you. And then your cost is like, you know, so let's just say Your cost is 30, you know. Right. Same. You got your same space, you know, so then that's an extra, like 280, you know, of EBITDA or profit, you know.

Yeah, right, Absolutely.

Yeah. And reoccurring, you know.

Right, yeah, yeah, yeah. That's on the conservative side, too. Yeah, yeah.

And yes, you could do that on the physio side, but, like, once again, this is a. This business. You wouldn't have had this business. Right. This is a completely different business. Right. They're not competing with each other. As long as we acknowledge that we're not competing.

Yeah.

That there's like, these are people searching for chiropractics and they want chiropractics, you know.

Right.

And maybe, you know, they might get physiotherapy when they come in. There's also, you know, like, 50, like, of those cars that come in, you know, likely will get, you know, either PT or massage therapy, like, you know, within that year.

Right, Absolutely. And then also just making sure your staff's aligned, too. Right. And so that was like, one of the things I was also working with, Rick, is, like, my staff, they've been knowing about this for a long time. I talk about it and they're like, let's do this. You know, and so. But, yeah, getting them, like, especially our therapists, you know, and showing the benefits and how it would actually benefit them to bring on this other provider as a.

And has that been difficult or.

No, in the beginning, maybe in the very beginning, there was a little bit of pushback, but, you know, now they're all. They're all on board and they're. They do realize the benefits that they're going to see. Yeah.

And what's the benefit? The cross referrals or, like, referrals.

They can keep their schedules full. Right. And. And keeping the clinic busy at all times. Because pt, we have ebbs and flows where it's very seasonal. Yeah. And with these other services, people are getting massage all the time. It doesn't matter if it's snowing outside, they're gonna come to the massage. Right. But they'll bail out on pt, but. And same with Cairo. Right. So it can really fill your schedule during those off seasons, too.

Keep it. Yeah. So now we talk about what we talked about the best way to protect these, like, you know, declining reimbursements that's happening right now with like most states, you know, unless you live in, you know, unless you're fortunate to live in some of these west coast states, is to diversify the different lines, you know, and to add cash, like cash based pt. Let's be honest. Like, that's difficult. Right? You know, Right. Cash based massage. Oh, my gosh. Way, like, way, way higher conversion rate, right, you know. Right.

Absolutely, Absolutely. And yeah, just so much easier. We don't have, like all the laws, like with the Medicare laws of massage when you do cash, something like that. It's. It's a lot easier.

Yeah. Cool.

You already have a front office that can schedule, right? You already have all these tools. Yeah.

Wow, that's awesome. Okay, so last question. That if you had a thousand bucks, okay. I asked everyone on the show if you had $1,000 to spend this month, you know, that will, that will make you money next month. Okay. You can spend on anything. Right. What would you do?

Right.

That's going to actually get you, like, new patients or, you know.

Yeah, okay. I, I think maybe talking to the staff and looking at the empty schedule and using that as a bonus, something.

Okay, what do you mean?

And so just like, let's look at your schedule today. What can we do to get it to this point and have this. We set together that target. Okay. And I'm going to give you guys extra thousand bucks. Okay. However we're going to do it, whether you're doing it with a therapist or maybe the front office, maybe they're not booking patients in. Find that area of your business that you're leaking and use that thousand bucks for an incentive.

I love this because a lot of times when I ask someone, you know, who's not into our community, they'll be like, trying to chase like some type of, like, gimmicky, like, marketing tactic, like to pull, you know, but you're like, hey, you know what? I'm just going to like, if, like, I'm just going to pay. I'm going to use $1,000 to actually, like, you know, unplug some of the leaks in my business. I'm going to pay my staff a bonus to be able to do that, to make my schedule even fuller. Whether it's like doing like, reactivations or like, you know, making sure every single patient, like sending specific goals to make sure that, you know, the, you know, the plan of cares are booked within the schedule, right?

Yeah, absolutely. Like, you know, even like new assessments, right? Or new evaluations if, you know, if you can't get your. That conversion rate, that initial conversion rate up a few percentage and get them to like, you know, like 90 or whatever, you. You name it. Right? Yeah. Yeah. And one plan of care, you know, will pay for that thousand bucks easily. So if you can get like five additional ones, it's a good ROI right there.

Yeah, I love it.

Cool.

Awesome. So Nat, awesome catching up with you. How do people find out more about you or get a hold of you, you know?

Yeah, no, they can, they can reach out to me. Ptofmelissa.com My email is nchrisadas my first initial Last name@ptmolissa.com so cool, cool.

And you're pretty active on social as well, right?

Yeah, LinkedIn. I'm on LinkedIn so you can connect with me there as well.

Cool. Awesome, dude, that was awesome. So, yeah, we'll see everyone next week on the show.