Stand 4 PT,OT,SLP Town Hall 1.19.23

All right, guys, welcome. We're so excited to be a part of this meeting today. You know, it's been such a fun journey the last two months having these town halls. We're in a position where, you know, we love doing what we do, we love being together as entrepreneurs, and we're facing a very serious situation regarding our industry. To be really clear, again, this. For those of you who are new and joining us for the first time, this monthly town hall that we do is really meant to make.

Movement over motion. Does that make sense? Like, there's been a lot of talk about the industry, a lot of talk about things to change, how things need to change, and so on. And I. And I love what they do at pps. I think they do a fantastic job of, like, helping identify and bring solutions. And it's not enough. Like, we have to generate way more from within the organization of physical therapy in order to make effective changes. I also think there's some powerful opportunities for us who are maybe not acting underneath an official umbrella of any sort. Like, we're.

We're.

We're organizing in a way, but we're not like a government body or a specific organization. So there's some things that we can do and talk about that we would be limited in another way. And as you guys know, there's so much talk about it, but there's very little action. Very little. And it's. We talked about this a few months ago as to why that's happening. So before I continue, let me lay some ground rules. First of all, be the first to share. This is not me or our guest speaking at you today. This is going to be a true town hall where if you want to contribute at any time, anytime, right now, you can cut me off. What you want to do in your zoom call is if you go to the bottom, there's reactions, and there's a raise hand function. Do you see that?

So if you raise your hand, it will pop up. You can also lower your hand. And so please, like, don't feel like it's rude to enter, like, to raise your hand. Michelle's gonna help moderate, and I will do a brief intro there for those of you who are new. But essentially, this is a real town hall. We just want to be able to come and go and be able to talk and get some progress here. So, again, the concept is movement over motion. What do you guys think I mean by that? I want to make sure that I'm speaking, but we're on the same page, and I want to warm you up a little bit.

For me, that means just instead of just stirring up the waters, it's like creating a. A wave in the right direction. So it's like there's movement. We're not just. We're not just creating motion and random thoughts and considerations, but we're actually targeting that in a direction that's going to create change or impact change in the right direction.

Man, I love that. So, you know, another way of saying it, too, to give it some additional color, guys, is that we're all busy, right? And we can stay busy. One of the worst things I hear is like, how you doing? Oh, I'm busy. Every human being, especially in America, is super busy. PT owners are especially busy. And I'm not just saying that to placate the group. Having been one for, you know, well over a decade and then stepping into other industries, I totally get it now. The burden of the PT business order is no small thing. And it's. I was told this once by one of my coaches. He said, will gotta get out of pt, man. It is. It is a horrible business.

And by the way, he's a medical professional who owned PT practices and hospitals. And he would just say, why are you doing this? And I just told him. I was like, man, listen, this is. This is my heart, and this is all of your heart. Like, this is why there's the one thing that unites us that's really our strength is the passion, like the commitment to wanting to make a bigger impact in this world through individualized relationships. Like, that's. That's this common thread. So the. The thing that we have to be careful of, though, is that, like, when we don't know what we don't know, we can be actively engaged in a good cause called running our business. Can never. But we don't necessarily. It doesn't mean we're going to progress. Right? That's why we're talking about movement over motion. What are the things, the actions that we can take, not just talk about it and really kind of get all rah rah about it. But, like, what can we say and do that not only inspire, but inspire to act in an organized, an efficient way? So that's what we're doing here today. So really excited to have you guys here on the call. Looks like we have a big group this time.

So that's just made a mention in the chat. So another way of putting it is action over activity, right?

So.

Two points, Seth.

Yeah, two points.

Yeah.

Also use that chat group, man. Like, like, we've got this chat group available. I see Carrie there. Good to see Carrie. And Kristen and Clay. Jamie, Katie. This is so great. So listen, if this is your first time on this call, let's practice. Raise your hand if this is your first. And if you're on a cell phone, Ross, don't worry if you can't raise your hand, buddy. Look at that. Physically raising his hand if this is your first time. All right, Katie's. It's her first call. Who else is it? Just so we can see.

Okay.

Denise. William.

William Hamilton junior. William. Do you go by William?

No worries if you can't answer. Kristen. It's her first time on this call, but definitely not her first time to talk with this guy. Very nice.

That's right. All right, so William goes by Billy.

Billy.

Billy. Very cool. Yep, Very cool. Nice to meet you, man.

Welcome, Billy.

So, so very exciting to have everyone here. So listen, I want you guys to think of a couple things. Number one, more like housekeeping items before we get into the meat of this again, number one, raise your hand and. And for those of you still have it up, see if you can lower it now. If you have it digitally up. There you go. You'll see that it stays up there pretty much indefinitely. You can also do other reactions since this is kind of one of those things where maybe you don't want to, like, interject, but you just want to give them a little love or celebrate or whatever, you know, so at the end of the day all. Also you can leverage that chat. So Michelle is going to very good sturdy. 10 points to sturdy for being. That's what happens when you see your, you know, reimbursement from United Healthcare. You see that every time. Oh, yeah, little PT humor. Only PTs would get that joke.

How do we take it down, though? Oh, there it goes.

So, yeah, if you don't. If you. If it's any other icon, it just kind of falls off on its own. And. Yeah, so leverage the chat. Like, if it's one of those things where you don't necessarily want to take stage or you've got a lot of noise in the background and you don't want to like. So please type in the chat because we want to make sure we progress this thing in the way that this group wants to do. Remember, my job isn't to provide you guys with value. This is a town hall. All I want to do is create a stage for us to stand on to discuss the core issues. And then the entrepreneurs, the only men and women on this planet who can solve this problem, are going to come together and create. So I would really appreciate that you spread the word. Go get other people on next month's call. Like, I know I'm spamming all your emails and you still showed up anyway. But I want you to tell anyone from your company this is an incredible opportunity to engage your company as well. By the way, if you're currently treating or if you have a practice where you can get your own PTS dialed in and your practice becomes the flagship of the movement, they'll understand and have more cultural connection to your company. If it feels like your company is also taking a stand in the industry. And to be really clear, there's no financial exchange around this at all. If you saw my, my YouTube videos from three months ago, I'm just literally clearly seeing where we're going and it's not good. So. And I do have some information on that. That's. That's even worse. I'm going to share that here in a little bit. Yeah, it keeps getting better.

Yeah. Someone chime in. Someone say something.

They said, thanks, Will.

You're welcome.

This is, this is going to be a depressed. No, it's not depressing. What, what's. What's funny about it is no matter what I share, you guys already know what you already know. You know, you've seen what's happening. You see the model, you look at your profit at the end of the year, you already know where we're going. But there's so much good news on the back end of that. And that's not me trying to correct. There's literally so many positive things, but it's going to require us to all be together. So that all being said, let's go ahead and warm up a little bit. Who here has any wins? Has anyone here or really, let's start with, let's just share a couple of wins. You can put them in the chat, you can raise your hand and speak them out loud. But like in the last 30 days, what's something in your, in your practice that's been a positive change or something that you've accomplished or your team has done? It could even be personal, whatever that might be. So let's just get a couple of people to contribute.

Blaine. We've got hand raised by Blaine.

Mr. Blaine.

So I'm a little bit embarrassed to admit this, but I very much fall into the category of just being so busy that not like not paying attention to important things.

KPIs.

And so last week I finally had a meeting with our billing team and they actually figured out how much we're receiving per visits. And for two years I didn't even know that, which is kind of sad. But we have a meeting next month scheduled to try and increase that.

Give them some love. I love that. You can give it there or look, there's a little icon called the hand clap. I love that. Give them some love for that. And by the way, that's the most common way people and PT owners share their wins is like, hey, this is embarrassing to admit this win. But that's, that's how most of us share our wins. Let's do a couple more.

I've got some in the chat. We've got one from, from Denise that says we've increased our workman's comp visits and referrals.

Nice, Denise. Love that.

Yeah, that's great. And then from Katie, clearly identified great people to develop a leadership team beyond me and my practice manager. Oh, that's a big step. Big step.

And Seth set says something as well. What does he say, Michelle?

It says, got Medicare approved as a part B provider today, by the way. Still a part A provider as well, so.

Well, I know Katie will be happy to hear that. Katie, I don't know if you can jump on, but I wouldn't mind you saying having a 2 second spiel as to what you do since it might affect what they. What everyone here on the call is doing.

Would you like to jump on or is that for maybe next time?

I guess I'm not muted, am I?

No. Okay.

I'm in my car, so my son's at basketball practice. What do you mean, what do I do?

All the things.

Let's hear all the things. Just tell people what you do because you also have a company that might impact them. I just thought since you're here, we'll let you speak.

Sure.

So I own two clinics and adding a third one this year. But I also own an EMR company as well for the past, I don't know, five years called hino. So we deal, we, we work with people like me that run practices or starting practices or growing practices. So we certainly see all of the challenges across many different practices across the country, which is very enlightening.

Thank you, Katie. Sure appreciate you chiming in and thanks for being here today. So, guys, all right, now listen, here's where we are in terms of. I'll start with the bad news, then we'll go into the good news. Then we're going to turn some time over to our special guest McGee, who's here a good friend and someone I've been fortunate enough to know for a long time. Many of you probably already know him as well. There's not a lot of people in the industry who are well known, so I'm sure he's one of them. So you probably know who he is. But I'll do an intro in a minute. So here's an interesting little bit of the bad news. So I had an opportunity last week to participate in a healthcare conference that was all about biotech. So I was very fortunate to be a part of this conference. It's part of my business networking group. I really wish I brought Michelle. As a matter of fact, now that I'm saying this, so it was a YPO event. Certainty will know what that means. And so these are men and women who are CEOs up to billion dollar companies and like me and like some other smaller level entrepreneurs were invited to participate because we're in the healthcare setting. So I sat in this room with hundreds of these powerful leaders all across the range, especially in healthcare. And this, the speaker was a guy by the name of Peter Diamantes. You may not know that name, but you know, you'll know some of his companies and his partners. He's partnered with somebody named Elon Musk, he's partnered with another guy named Tony Robbins, if you're familiar with who that is. And he has eight New York Times best selling books on health. He has 12. He's a founder of 12 different companies that are all large 100 million dollar plus companies and they're all in the healthcare space. He has an MD from Harvard and then two, two PhDs from MIT. So he wanted to be an astronaut, so kind of took them down this road of improving health. And this isn't, this is actually really good news I'm about to share. But the reason I kind of frame it like the bad news is because in this climate of declining reimbursements and in this climate where PTA reimbursement's getting cut, the healthcare industry is about to pivot in a big way. More so than we've ever imagined. Like his exact wording was, in the next, we're not talking 10 years, in the next five years things are going to shift so dramatically that there'll be two types of companies that exist in healthcare. Companies that work with artificial intelligence and those that are bankrupt. And so if you're not familiar with artificial intelligence, don't feel overwhelmed by that just yet because it's just emerging. But there's chat GPT. I can put that website in there right now. You can go in there and interface with artificial intelligence at a level that will blow your mind. And so when it comes to healthcare, he was revealing how so much of this is just positive. They have artificially AI robots that are performing orthopedic surgeries, neurologic surgeries, and we're not talking about one or two robots. They're in this position now where the robots are being tested against human capabilities and they are dramatically outperforming the human surgical counterparts. Right now if you go into ChatGPT, you can, you can say I have a lumbar herniated disc, please give me an exercise protocol for that condition. And it's scary accurate. So what the AI does is that it's not like a Google search. What it does is it goes and it reads the entire Internet on everything that's ever been published, every research article, everything. And then it summarizes, it puts it together and then spits it out. And so with this type of technology, what's basically going to happen is a lot of healthcare is going to get put into the hands of patients. Peter Diamante showed this demo of a, of a cancer doctor, an oncologist who typed in the evaluation for one of his patients in the morning into this AI system that you have, all of us have access to for free through chat GPT. He put it in there and it did a full analysis of the person's condition, prognosis and treatment protocol. And the doctor is, this top renowned oncologist is like guys, I'm out of a job.

And he was being facetious. But the point is this is that for us, we aren't going to go away. The cool thing about what we do is that there's a hands on component that will not result in our industry being abolished. But I, with all of this change going on, the biggest thing I think we're all aware of is that if reimbursement doesn't change, that's the scary thing. And that's the main battle we still want to focus on. But it's important to be aware of what's coming down the pipeline and how these things are going to be affected. And in my opinion and many others, physical therapy will have a chance to either rise the top of the medical food chain or diminish into some watered down version of what it is today. And that's really all we have is that chance. I mean, there's really no middle ground as a profession for us to go to the Top or not, because healthcare is becoming so proactive instead of reactive, pt, OT speech has a chance to really get ahead of this curve and leverage technology and biotech to be the front leading healthcare. But it won't start unless we can start taking a stand for how we get paid. Right? As one guy told me today, this one in this one investor in PT companies was telling me, he's like, yeah, it's so great to see that a patient can go, go to a physical therapist and spend $150 a visit cash to get the treatment they need instead of spending $500 to go see a car orthopedic surgeon who's going to inject. There's just so much potential of what we have here. So that is the bad news. And the good news is that things are shifting dramatically again. We already know the worst news is that reimbursements are on a decline. And so for today's meeting, we're going to talk a little bit about one strategy in particular that all of you guys can take home today that's going to dramatically change that game for you. And any chance we can make a decision as a group that is going to like, not just increase our reimbursement and our freedom and leadership, but also promote our industry, that's where we want to start. The greatest good for the greater dynamics we want to make, those decisions are going to have the greatest impact across all of these situations. And that's where our special guest comes in today. So let me tell you about sturdy McGee for the few of you who probably don't know who he is. Sturdy McGee is a physical therapist and a private practice owner in San Francisco. But he has progressed, and he has progressed in his leadership through coaching on his own, into becoming a leader in the industry. And so what Sturdy does now is a range of things, the most impactful of which is coaching. He has helped PT practice owners and other business leaders in other industries increase their income, their impact and their freedom. He's also a very big voice of the profession as a whole to take a stand for what we do here. He has a wonderful family of three children, happily married and a great guy. So without further ado, I would like to pass the time over to Sturdy to talk about a concept that he has been working with with some of his clients that's had a huge impact. So put your hands together for Sturdy, virtual hands, whatever that might be. Dirty. It's all yours.

Thanks, Will. As he as well said, this is definitely a conversation. And you, you're Speaking my language with the entrepreneurs as problem solvers and implementation. The whole idea around action knowledge without implementation is nothing. It just doesn't, you know, it's, it isn't worth much, right? Nobody cares what you know, they care what you do. So whatever you do today, since you're spending your time here, I would urge you to think about at least one, if not two or three action items, things that you can actually do and implement in your business or for yourself so that things can, you can continue to move forward.

When you guys go and look at ChatGPT the way it is right now.

It doesn't search the Internet. It is based on a database that ended in September 21st.

It's scary crazy what it can do so far. But GPT4 is going to be coming out. They're uncertain on the timeline because the ethical implications and misinformation potential and it's complete inability to deal with emotional type things. So they're trying to figure out how they can do that safely. But GPT4 promises to be released sometime this year. It's based on a database that's 570 times larger than the database for three and it will be able to go onto the web and look at other stuff. So if you're typing in stuff right now that the cancer doctor and well, it's funny you brought this up so I wasn't even thinking about this in the whole context but I was talking to a client this morning, we were talking about that and I'm going to run all over the place a little bit. It really offends me and upsets me that you guys get paid by the hour.

And it always bothered me that as a therapist we build for our time. That always bugged me from pre PT when I was doing billing and working in a PT office.

It's a knowledge based profession so you should get paid for the value that you bring, the knowledge that you bring and a big part. So Matt and I, my co author on this book back here, we were just talking about our marketing efforts and stuff and he was looking at the Harvard Business Review journals and they have a format of problem, root cause and solution. And the root cause piece is one of the things that you guys are extremely good at, right? Think about that person with leg pain or numbness or can't raise their arm or whatever it is, right? The problem is I can't raise my arm. But there's a differential diagnosis. There's all this, there's work to be done on the root cause part of things and that's going to absolutely determine the solution. So what's happening right now though is people are typing in their symptoms, the problem, and they're getting a solution which may or may not be accurate. I think that's where the human element and your expertise and knowledge and just like what I do with the coaching and businesses, you can type in, you know, create a marketing plan or why is my cash flow low? Or whatever. And it, it can give you ideas of what to do, but it doesn't diagnose. And that diagnostic is that absolute critical thing. And I think a big, big, big, big part of your value proposition, you know, going forward.

So I agree.

That's great. I didn't realize that I must have seen when he was doing the demonstration, it must have been an earlier or more the, like the unreleased version of.

That four, because he may have access. Yeah, yeah, Peter may have access to that for demo purposes. There's got to be people waiting and stuff.

But.

So what. What do you guys want to talk about? What, what do y' all want to. What's important? I know kind of what was billed, but is that the topic? Is that what y' all are interested in?

Will, do you wanna. There's some mods that I, you know.

So in the last two months that we had this, the first month we had this meeting, the discussion was very much like, hey guys, let's just talk about the problem. And it went super powerful. Um, Carrie hall, who's on this call, was there for that meeting and she was a powerful contributor. Just talking about. You identified the outpoints in our industry from language usage, like the language that we use. That sets us up for the mindset that's limited down to, you know, reimbursement concerns. And so over the last two months, just so everyone gets a little bit of an update too. What I've been doing is I've met with a couple of different groups. One of them is local here in Arizona. Another one is. Is outside where we're identifying situations where PT owners have banded together to, to fight lower reimbursement. So I sent an email out at the beginning of this month regarding a couple of companies that we had found. And it's amazing because they're. We're not changing federal policy, obviously, but we are preventing the private payers who usually follow those federal policies. There are groups that are stopping them dead in their tracks. There's an OT that who's been on the call the last two times. I was really hoping she would be here today. She and like four other ots have helped block a number of different policies in Colorado, I think against lower reimbursement for PTOT and slp. So right now this is a PT specific. Not specific, it's more specific, but it's. Yeah, but really we want this to be the general discussion for all three of these groups since they get tied together and bundled. But yeah. So for this one today, I think people would like to know, I'm guessing sturdy, that the reason they're on this call is because they saw my emails about, hey, let's, let's talk about how to stand together for the profession and also increase your revenues. And you know, I'm very familiar with what you do in, in that regard.

Right.

I talk. Before you continue. I'll tell you, I, my partner in Alaska, Nathan Shields, he's like, we should create a, a hashtag that says drop uhc. And I, and I looked into it and apparently that's illegal to do something. Like, I mean it's, I don't get it. I don't know why we. There's anti collusion laws that exist out there that I don't understand.

I can do it. I don't, I, I don't own a practice anymore and my license is expired.

So can you explain real quickly why we can't do that? Do you know why we can't do that? Like, what is that?

I don't know that we can't. Okay, so one of the things, this is something for you guys, anytime you're talking about to an attorney, they will always tell you you can't or they will always give you the most conservative interpretation of whatever it is. What I learned to do both with attorneys and accountants through the 20 plus years of owning a business now, 25, 30, whatever, was ask them what happens if. Okay, so when they like to sell you something. And part of that comes from I don't remember what the, what the thing was, but I remember I was asking, oh, can we do this? And the attorney kind of freaked out. Oh, no, no, no, you can't do that. It's against the law. Like, what law? You know, I was kind of pushing back. Like, that doesn't make any sense. What law is it? And he's like, well, it was passed here. And whatever. I'm like, okay, when was it? Like, what are the penalties? But they haven't written those yet. Like, okay, so it's a new law. It's like, well, it's about five years old. Like, wait a minute. So the regulations, they haven't written the regulations of it. No, they haven't finished. It's five years old and they haven't finished them. And you're telling me I can't do it. What happens if I do it? And he was like, well, I don't know. Like, there are no regulations. What happens if I do it? Nothing could mean potentially something happened retroactively. The law was passed, but the regs weren't written. It was like. It just didn't make any sense to me at all. So what I've learned from that is with, particularly with accountants and attorneys and with a lot of other folks, bankers, you name it, they're all going to give you the most conservative interpretation. And the one answer I just absolutely won't accept is you can't, you know. Well, I can.

Right?

What happens if I do that? Well, you'll go to jail for 30 years. Okay, well, I'm not going to do that. That's an easy answer. Right. But I want to know what the consequences are. I want to be more creative. I want to figure out things. And that's one of the things you guys do. You know, your entrepreneurs, your visionaries, you literally are visionaries. Yeah. Peter Dianetis is a visionary, but the thing about that is you see things that don't yet exist. Right? You see a future that doesn't exist yet. And one of your challenges is taking that vision and painting a picture and making sure that other people can see that picture.

Regarding UHC and stuff, tell me I can't do it. One of the reasons you can't do this, because we can't afford the attorneys. UHC, right, UHC. Last year, actually. I don't know. In 22, 21. Okay, anybody here know what UHC's profit was in 2021?

Carrie, does Carrie, Take a guess.

Carrie, what is it?

I'm not going to give a number, but Rich Katz said at PPS that their profit, whatever it was last year or the year before, was greater than their total spend in ot, pt and speech.

Their net profit?

Yeah, yeah, their net profit. Their final, like, you know, profit. Profit.

Right.

Katie guess has 20 billion.

Yeah, Katie Guess.

Katie's close. Very close. Then the profit was 24 billion with a few dollars.

Again, putting that into perspective, though, because what does that mean to us?

Right?

We don't know what our industry.

Pardon?

Our industry is 50.

The entire industry is our industry.

Physical therapy.

We're a $50 billion industry.

Including. Including the hospitals. SNF outpatient is around $50 billion.

Right. And so I think what Rich was pointing out to keep the perspective is that within uhc, their net profit was greater than their total spend.

What have to be OJ Speech.

So, I mean, it's like they're. They're. Again, you know, their. Their game is to limit health care, not to provide health care.

Right, Right. Insurance. You're carrying. Oh, my gosh, you're a ringer. Right. You. Insurance companies don't make money by spending.

Right. I mean, the whole system's not set up to use the money for what premium payers think it's supposed to be used for. Right. They make their profit by not paying bills, period.

In how many ways do they not pay their bills, including delaying, you know, miss Billing, blah, blah, blah. There's so many ways. Aside from just the fact that the care seems to be restricted, sort of, you know, for no rhyme or reason at times, you know.

Oh, it's intentional, Carrie. Just to jump in.

I knew.

It's funny. What's funny is, you know how, like, everything's really political now. Like, you can't, you know, I like glasses. Oh, you're a glass wearer. Like, everything is so intensely political now. You know, the one thing that unites us, I have. I say this all the time, man. Health insurance companies are evil. And I know that's, like, dramatic and, like, has a religious connotation, but I say that, and literally everyone I've ever said that to goes totally. And, like, we just. I don't. So, like, the thing that could bring our country together is this fight against insurance companies. And it's funny, owning a medical billing company as an owner. I knew it was intentional. I had no idea until we got our hands deep in the pot. Like, it's so funny because, like, there's this one insurance where we literally. We bill out the claim, we send all the correct information over. We wait one day. It's in our policies. We wait one day, and then we resend everything so that the rejection that comes immediately from them, not like it was evaluated. And most of the time, it's 100% of the time it's automated. This rejection comes the other way, saying that what we sent was incomplete. So all we do is we take the same documents, we send them in 24 hours, and that's how, like, it's all these stupid inefficiencies that they're very smart. Every little bit that they can do to delay things results in greater profits to them. And it's so overt, and we all accept it. And in pt, we just take it Unless you're William, who just put into the chat about 10 minutes ago that he dropped Cigna because of Ash. Let's give him some love. I think that's the kind of decisions we have to start making as individuals to, to start changing the industry for sure, is to stop taking it. Like, I don't think there's anything complex we have to do. Like, it's like, where do we begin? Stop taking it. Like just. And not like we don't have to band together and sue UHC or anything like that, but, you know, sturdy. What's your. What's been your experience around, like dropping insurances and stuff?

Yeah, it's. Well, it's market forces. Right. They're all on the lowest bidder model. In addition to denying your claims and delaying and obfuscating and everything else, they're trying to sign contracts for the lowest dollar amount. And you know, they don't care whether you can make a profit. They don't care what your education is. They don't care about any of the rest of it. They care about. Do they have enough people in their network to satisfy the insurance commissioner. You know, and Blaine is you figured out what your revenue per visit is. The next step is to figure out what your cost per visit is and then look at your profit margin and then look at. Do you have any contracts that are lower than your cost per visit? It gets really, really simple when I. Denise, I see your hands one second.

When.

Talk to people and break it down. Like if you had a hamburger stand or a lemonade stand and it cost you, let's use lemonade. It costs you a dollar a cup to make it, what would you charge? Right. The math is pretty simple. It would be over a dollar. Right. If I came along and offered you 70 cents and told you I could make that 50% of your load or I could double your business at 50 cents apiece, would you take that contract? And again, it's super straightforward and simple. No, I wouldn't. I have owners want to just emotionally debate and argue. They have to take it. They have to take it. I used to love it when my competition had to take it because they were losing money faster.

Denise. That's a good pausing point. Denise, what's your question?

Or that it was a comment on when. With the cuts that we've had in Medicare. Now then United is a better payer per unit than our Medicare is in our reimbursement. Yeah. So it's. It. We get $85 a visit. So it's 28, 45 for a unit. Well, we have units less than 20 from Medicare and the Medicare Replacement Plan. So it's like, now there's a little bit of a switch in that. And then the other comment is this, like, why do we even say the word reimbursement? I think we're just so. You know, I've been a therapist for 38 years. Just this conditioning. Why do we have to get reimbursed and fund this time? We've just accepted this reimbursement instead of just like, why is it reap. You know, pay us when we do the work like everybody else does.

We want versement. We just want burstment.

Yeah, we just want the burstment. No re.

Yeah, that's so great. Sturdy. What's that? And this is maybe for everyone and sturdy. But why. You mentioned your client who's afraid, who, like, doesn't want to. Like, why do. Why do we take insurances that are underpaying us? Like, what is it that sturdy? And everybody. Like, why do you think that is?

Yeah, go for it.

I was gonna say. I can tell you why I did. And it was to make. When I started my practice, it was to be able to take as many insurances as possible. So it was easy for my referral sources to be like, oh, I don't need to see if they take them or not. I'm just sending them there.

Perfect.

Yeah, we. We told.

We solved that problem by telling all the referral sources. We will check their benefits. We will tell them their benefits with us. And if they absolutely cannot come see us, we will tell them which of the groups, whoever in network we would go to.

So you control that. You control it either way. Like, send everything to us.

Right.

We don't take it. We'll push them to whoever else. Right.

We'll spend the extra time to do the benefits checks. We'll tell you, you know, Michelle, you come to us, it's going to be X amount of dollars insurance going to pay. This is the price. That was the other big thing about going out of network. The only thing we did differently, and I swear to God, you guys are going to go and ask me 17 questions. Everybody always does. The only thing we did differently was we set our prices, okay? We checked benefits, we did authorizations, we build the insurance, we, you know, all the other things. The only thing different was we took control of what the price point was. So if UHC is saying $85, like, nope, not taking $85, it's going to be 150 or 177 or whatever the number was, right. And UHC is going to pay what you see pays. That's why we check the benefits. They're going to pay 65. Okay. Your portion at time of service will be the difference between 65 and our price.

That's it. Okay. And yeah, we took control of that. We would give lists and we would tell the physicians, referral sources, send them to us, we'll check their benefits, we'll give it run up, you know what we just said to you? And if they're like, well, you know, hey, I lost my job and I really, I wish I could come to you guys, but I just can't, you know, fine, send us over a list of who's in network with your payer, with your insurance and we will tell you. And there where it got interesting was there were a few times where I know how this happened because the front desk, whoever would bring it over to me and say, who would you send them to? I'm like, oh, they could go here or here, you know, and sometimes it'd be like, well, they're across town. That's not convenient. Like, then come here and pay us. Right? There were other times where it's like, you're looking list and going.

Yeah, I wouldn't send my mom to any of those places. Right?

Yeah. And I think that's the thing. We're so commoditized that it looks so much. We've had this discussion every time we're on this thing, but it goes without saying that people don't try dentistry. They try, but they've tried physical therapy and all of those outlying therapy companies that aren't capable to do what you were probably able to do are getting thrown into the mix of, in consideration. So I think it's powerful to think about that. So that's a real reason. It's one of many reasons I wanted Sturdy on this call. One of the main things is that he's been coaching PT owners on how to do it. And it's so powerful. What I've seen there was a client that he and I shared in Nevada who went through this journey and it was cool talking to him after I met him, after he had worked with Sturdy. And again, it was one of those things where.

It was almost like this empowering, hey, guess what? I cut out this insurance and then here's my net margin. Now we're seeing fewer people and making more money. Like there's something about the realization of what that looks like and that. And I, and I was telling them I'm like, yeah, but what's cool about that is that, yeah, you're making more money and you're not working as hard, but that you're finally taking a stand. The biggest thing we talked about two months ago is that our industry, unlike every industry in health care, I would argue we are the most fear based industry in health care. Your license is your livelihood. We're going to get sued even though our insurance policies are like 400 a year. $400 a year for millions of coverage. Like, I mean, it's ridiculous. I remember like the first five years coming out of school convinced that if I'm not careful with the units I put down, I'm going to jail. And we're thinking like, this is not going to do well in jail. Like, I kept thinking, there's no way I want to go down that road. And it's so ridiculous, the degree and fear that we have. And so there's no judgment on any of you. I did the same thing. I never dropped in low paying insurance when I used to have my practice. Michelle and I, when we ran it, we kept everything because we knew. We knew, like in our minds, it was just easier to not confront it, even though it wasn't. Carrie.

You're muted.

No, there we go. It wasn't hitting Serdi. Can you explain again what you said.

About.

The paying, the differential? Because I think what you said was not the way I received it. Because my understanding said if you're in contract, if you're in network, you cannot accept cash from the patient beyond what that contracted rate is. I don't think that's what you meant, but that's what it sounded like to me. Can you re explain.

Your strategy when you were talking about United Healthcare or whomever it was?

Yeah, the. You don't sign the contract.

Right. So you're out of network. But you said something about you asked the patient to pay the differential something.

Well, of course, yeah. We set our own price point.

So to be clear, she's talking about. So just to be clear, so let's say give her an example. Like how much? You know, give her a physical.

Like we. Yeah, yeah, I'll give an example. But the whole point is in. When you sign a contract with Aetna, Cigna, uhc, Blue Shield, whoever, you're agreeing to their price.

Exactly.

When you. I'm not obligated or controlled by a contract I did not sign.

Right.

So I can charge whatever I want.

Correct.

But insurance company. The insurance company, 90% of the time is still going to pay something.

So can you give an example of what that could look like? Sturdy?

Sure. Yeah. Yeah. So, I mean, I'll give you a real one. Right. We were. It was 207. This is a few years ago. We were at $270 for an evaluation, 207, 207 and 177 for follow up. Okay. If when we called again, it's the same exact process you guys use. Give them our tax id, check the benefits, they tell us what they're going to pay. So sometimes. Right. Again, same exact process. Sometimes they hedge and whatever, but you figure out your best guess based on past.

Payment from that group and what they tell you and write it down and record the time and the date and the person's name and everything else in the phone call and that they cannot guarantee it because they say they can't guarantee it. So how can I guarantee it? So you hedge all your bets. You put it all down. If UHC is going to pay $20 in, your portion today is 157. So whatever the price is, minus what they said they're going to pay, which is exactly the same thing you do. The only difference is you're taking the price point that they gave you, not the one that you decided on.

Yes.

Yes. It just. When you, when you said it before, it made us. I did. It wasn't clear that you were out of network with that provider. So it sounded like you were asking.

Yeah, no, I thought that that was the premise.

That's the premise.

We're not signing the contract. Right. Or we're opting out of the contract. And, you know, for us, we started, I mean, I started in the late 90s incorporated and partnered up and stuff. 2001. We were in network with essentially everybody at that time. But that was a point in time when Cigna was paying $130. Right. And when I remember, UHC was paying 128 or 143 or something like that. Right. So, you know, in early 2001, 2002, you're getting $140 from the insurance company. Why wouldn't you accept that contract? Right. Now you have a margin. The problem was when UHC came back and said, oh, we're going to pay 67, you know, and we immediately said no. We just sent it back and said no. They came back. I don't know of anybody else in the area that immediately rejected it. Right. That people were, oh, they were torturing themselves over the decision and should I. And phone calls and all this stuff we sent, we said no. And two weeks later we got a letter back saying, okay, how about 98, right. It wasn't 67 to 72 or something. It was 67 to 98 immediately. You know, and at that point in time, we looked at our cost per visit, we looked at the math, and we said, do we want to accept it? You know, we still had a margin. Our cost wasn't $98. The question now was, is the margin big enough? Does it make us happy? So, you know, looking at it like the lemonade stand, I'm going to offer you $1.20 for the dollar cup. Are you going to sell it to me? Will you do 1,000 of those? Right? Sure, sure, why not? I'm going to offer you a 98 cents, but I'm going to bring other people. Well, if it's an intentional loss leader like the grocery stores or something like that, all right, I accept that. But what I see so much of the time is it's not intentional. It's exactly what Will said. It's out of fear. Blaine, what's up?

So, two questions. So the first one, if our clinic is already insurance in network with all the insurances in the region, would we have to go proactively, like go out of network to set our price points? And then the second question is, is that different for like, Medicare and Medicaid? How you do that?

Let's go backwards. I never dealt with Medicaid. Medical here paid because the state's administrative. So of course California rebrands it as Medi Cal, but It was like 13 bucks a visit, so there was no way we were ever going to accept it. You know, I just. I'd be losing a ton of money.

Medicare. I don't know that you can. I don't. You'll have to talk to a compliance person. I'm not compliance person, but there are issues around Medicare and opting out, and I'm not sure you can if you're in or. I don't know what the rules are. When you say proactive, what does that mean? Cancel the contract? Yeah, yeah, that's it. That's exactly what you do. As long as you have signed that contract and it's in effect, you're bound under the terms of the contract. Right? So, yeah, if you don't like the contract, you opt out. You know, now it's not quite. It is that simple, and it's not that simple at the same time. One of the things Will and I've talked about in the Past and I think is super important for you guys as a process. The first step is you have to. And I know there are people who are like, oh, mindset is icky, and I don't like it. Even my contract authors, like, you know, I don't do a lot of mindset, which is kind of not true. He does. But you first have to get your head around how valuable what you do is.

Okay? And then you have to get that into the heads of your team, right? Get them out of the thought of a charge per visit and a transactional interaction and all that stuff. What do you do? You guys change people's lives, right? You literally allow them to stay in their homes independently. You enable them to play soccer at a competitive level. What you do with them movement and activity and strength and flexibility. Every other way is you change their lives. You allow them to go to a Division 1 school and compete, right? Or not. Or, you know, there's so many things that you do. So you start thinking about the success stories you guys have had with your patients and the people that in lives affected. You start getting your head around that. And you look at. Okay, on average, we see them at. Pick arbitrary numbers. We see people. 12 visits, you know, right now we get $100. That's 1200 bucks. Insurance, by the way, covers 800 of it. It's $400 so that they can play tennis again or throw the ball with your grandkids or climb the stairs and stay in their home. Is that worth 400 bucks?

I mean, hands down, right? I still remember a time I went to dinner with a friend of mine who's a spine surgeon. Bobby Tag. Bobby wanted. Bobby was raised in or. His family came from Burma. And he was like, I'm going to take you to the best Burmese restaurant because you got to have it because it's awesome. We went there in his convertible Ferrari.

Okay? And we got in there, and I asked him because he hadn't. He'd stopped sending his patients, Bobby, why don't you send us patients anymore? You know? And he's like, well, you guys are too expensive. Like, dude, you just told me that the passenger handle on the door of your Ferrari cost $1,200 to fix. And then I broke down the numbers for PT I'm like, is your shoulder worth 1,200 bucks?

Yeah. We don't have a cost problem. We've got a value problem. We don't understand the value of what we do as a profession. People here more than most get that, Carrie.

Yeah, yeah, Carrie.

Ah, hold on.

There we go.

Sorry, I was just gonna answer that question. Blaine, for you regarding Medicare. I just had a conversation with this at lunch today with a colleague who's doing mobile PT service and.

Pts currently cannot opt out of Medicare. So you're either a participating or a non participating provider. The difference between the two has to do with how much you're paid by Medicare. And whether you accept assignment or not starts to get a little in the weeds there in the details. But the only way that you can see a Medicare patient and accept cash is if it is a non covered service like Wellness Fitness. But you can't see a Medicare patient and accept cash.

As a pt.

But that's a great, that's a great segue right there too, Kerry, because.

This is something I'll challenge you to do if you guys know who your target customer is, okay? And I do not mean the 40 year old female, okay, cut that stuff out. It's not a demographic. Demographics don't describe people. People are different. One mindset, you want their behaviors, you want their psychology, you want, you know, whatever that is for you. But someone who's highly motivated, who wants to take control of their health or whatever. Because what ends up happening when you, when I go and talk to therapists, right, like oh well, but it's everybody and it's all this, it's not everybody. It's the person that you're super happy. It's the last person on your schedule Friday afternoon.

Right, that you're excited to see before you leave for the weekend. It's the person on your schedule at 7:30 Monday morning that you're like, oh yes, that's going to kick ass to start my week with them. The thing, the confounding thing is in a society and in entrepreneurship we try to define people by their age, income, gender, marital status, whatever, which none of that describes who they are as a person. So break that mold and go think about the psychographic, behavioral aspects of those people that you love because they're going to be 11 years old and 17 and 83 and 47 and male and female and in between and whatever. And it doesn't, none of that other stuff matters, right? Because then once you start to figure out who they are and you can convey value and you know, really work on changing their lives, they're going to look, they're going to pay you, they're going to start to see and make that connection as well. Make it awesome for them.

I'm sorry, sorry, there was one more thought on that. Keep going, Kerry. I'll make a note.

Okay. What I was going to say is when you're in sort of a setting where you are a Medicare provider, you sort of do kind of twists and turns and back handsprings to try to make the case medically necessary. So you ask the patient, you're like, well, I want to, the patient says, hey, I want to go kayaking in Alaska. And you're like, well, that's not considered medically necessary according to the Medicare guidelines. So is there something that you can't do in your home? So then they say something like, oh, my back hurts when I take the laundry out of the dryer or whatever. And you're like, okay, we'll use that. When you're on the other side and you're not wanting, you're not a participating provider or non participating provider for Medicare, you're doing the other thing. You're saying that's not medically necessary. So I can see you and I can accept cash for care. So as long as it's not medically necessary, as long as it is a non covered service, you can accept cash from Medicare recipients, but if it's medically necessary, you cannot. So that's, that's sort of the, the differential. And Jared Carter is that kind of the PT expert or one of the PT experts in this area. And he's got a, he has his own consulting business to help. If you want more, more details on that.

Thank you, Carrie. So starting, we're getting down to the last five, six minutes. I have a couple things to go over. I would love it if you'd give your final thought for the next few minutes. I have a couple of important questions to ask the group before we close out. I'm a big time guy, so I have to start and end on time.

Sorry, sorry.

Yeah, but sturdy. If you'd like finish your final thought, that'd be great.

Well, the. So the whole point of that target customer is what's going to benefit them, what can they use? And going back to that idea, you guys are a knowledge based profession, right? Your knowledge base, it's your expertise that you bring that's of extreme value. What else could you offer them? So you've got all these other opportunities around classes and teaching and kind of going down the road Kerry was talking about, it's quote unquote not medically necessary. So what I can help you with the kayaking and we can charge cash for that. You offer value and again, it doesn't matter what age they are. So I Just hopefully want to get you guys started thinking about the changes you make in people's lives, who you want to really work with, what you can bring to them, maybe other ways that kind of break the mold a little bit and get you outside of this transactional pay for 15 minutes of your time.

Love it, guys. Give Ster some love, please. He's done a fantastic job to really highlight the concept here and just to be really clear, there is no financial exchange between and Sturdy if you hire him to work with you on it. But the big thing that he's helped people do, and I've seen it through clients is drop their lowest paying insurance or. And it's, it's so much more than that. Like, you know, I think what we need to do as a group is think about a movement hashtag or something that would really grip, like drop UHC if that was possible. And so, you know, at the end of the day, Sturdy is one who's really helped people increase their net profits in a way that I think promotes the industry dramatically. So feel free to reach out to him. I would also just say, what, what do you guys want on the. So we have another. I'm going to do these every month until you guys don't show up. And it won't hurt my feelings, it'll depress me a little because it's like, I guess we don't care as much or maybe I didn't create it powerfully, which, whatever. The point is, is that we, I believe we can make a difference here. But what do we want to cover next? What is something that we can do? I. I will tell you right now. I think it would be very cool to continue this discussion as a group of like dropping our lowest paying insurance just as kind of like one unified action of what we can do. Talk it through, go through the problem solving, share the successes. I really wanted to pick William Hamilton, Billy's mind on what he did because he crushed it. And he also knew how much UnitedHealthcare made last quarter, which I thought was impressive. I don't have that information at my fingertips, but I just really think there's, there's stuff in there. What, is there anything else in the last few minutes? Is there any sort of specific help you'd like or any topics or any sort of actions that we could organize here that would help move our movement along?

I will, Don.

I think one of the big pieces to physical therapy and where it's going tomorrow and into the future is going to be automation, AI technology.

But just Things to have.

PT in the forefront and leading up to the technology, I think is going to be a big movement, especially maybe in 2025.

We literally talked about that the first 15 minutes in a way of not creating the answer to your solution, but just setting the stage for you to make that comment perfectly. Don, that was great. So I love that. Anything else?

My question would just be like the logistics of dropping a drop, picking insurance, because it seems like if you're the only one that dropped one but no one else in town did, then I don't know that it would send much of a message. And it seems like you'd have to like band together with the other pts in your region to make it effective.

Well, I would just say briefly that it would make a dramatic difference to your bottom line into your kids, even if it doesn't impact the region and the other pts.

Thank you.

Thank you.

Go ahead, Sternie.

Well, I said this to Mark, one of the guys, right? Put a picture. This helped me when I was deciding whether to drop them or what to do or not. I put a picture of my family next to my computer next to my desk and when I looked at my cost per visit and a payer that I was literally paying $13 a visit to see those people, right, I looked at them and asked is it fair to my kids? So I'm not trying to make a statement that's going to change the industry. They're going to be other people who take the contract. Fine. Can they do it profitably? If you're not doing it properly, what are they doing differently?

I will tell you this, that if all we did was make decisions as individuals that promote the profitability of our clinic, we promote the industry. When you win, the industry wins. Unless you're being unethical, in which case you wouldn't be on this call. So the whole point here guys, is that if we take a stand for our business, we stand demand for the industry simultaneously. So next, next month this is what we're going to do because we got to wrap this thing up. We are going to talk more in details. I want to hear case studies and stories of people who've dropped insurances. We're going to talk about how to do that logistically. It'll be worth your time in gold to be on the next call. In addition, I want to put it out there that I have recently in my coaching been training my clients teams. Last Friday I was virtually in.

Where are they? At some state and I spoke to a bunch of I've done This in Florida with Don's team. I've. I love talking to your teams about how to think about money. I think that's part of your issue too is like, how do you drop it in your. In your pts, Be like, oh, good for him. He's making more money for him. He's taking a stand for the industry. They don't think that. So I would be more than happy to do one of these town halls where it's more like a masterclass where you invite all of your team members to attend and I take a Q and A, but I'll do a little training in the front end. About 20 minutes of like, what does money mean to our industry? And I'm telling you, every time we've done this, people, their teams immediately go, oh, I get it now. They're not being about the money when they want me to hit a certain number of units per visit. So if you guys want that, I need to hear from you. I'm not going to put the work into this unless you want it. If you don't take the time to let me know you want it, I'm not going to do it it. So please reach out. That's something you'd like for me to do minimally. Next month we're going to talk more about how to drop insurance companies. You'd love to have you again, Sturdy if you'd like to come. Thank you all for being here. Super acknowledging the power of leaders in this room. Have a great rest of your night and we'll see you guys next month. I'll send out an email immediately with our next meeting time. Thank you.

See everything in the chat too for future topics. So we've got that recorded too.

So yeah, I'm like so worried about being on time. Michelle, thanks for holding me accountable. Let me quickly just read through that real fast.

So Katie dropped uhc. So much better now. Yeah. Be first to market challenge the status quo is from Donald. There's some other comments tie up around the collusion and being mindful around, you know that type of discussion when, when addressing payers that will come after us if we're coming as a unified single group. So just a thought for consideration and just love the idea. Can we access entire population of young professionals that are too busy to physically attend PT via virtual visits? I think this could be a huge increase in revenue for PT practices and.

That came from Billy, so great contribution there. Billy. Love to get to see you next time. Okay guys, so listen, just have a great rest of your day. It's been a pleasure to be with all of you. Hope you guys do well. Send us any emails if you have ideas of what you want to cover in the future. Go make lots of money, but more importantly, change lives. We'll see you guys.

Bye, everyone. Thank you.

Bye, everybody. Thanks for.