Stand 4 PT,OT, SLP Town Hall

Started like, I think it started like everybody that, right, you want to start a practice, you want to get going and just trying to figure out how you go about that. And I started 18 years ago.

As an owner, and I. I use that term very, very loosely when I say owner because basically I would see patients and I would avoid any, any difficult situations or anything that came up, right. Something comes up, then I just, well, I'll just go see a patient. I could ignore that and hopefully it'll just kind of take care of everything on its own. You know, you make a decent living.

But I kind of realized that this was going to be my life in a sense that I'll make a decent living. The business isn't going to make any money, but I'll take what I can out of it. I'm going to see more patients than anybody else, work weekends, catch up from the week, whether that be documentation or whatever. And, you know, I wasn't. The further and further I got into it, I was not comfortable taking more than a day or two off because I recognized the business, at least I believed the business survived because I saw the patients and I had to see so many.

And I mentioned this on the podcast not too long ago, but I went one time, 18 months without taking a day off. And I don't say that as a badge of honor. It's. I kind of admit it because it's somewhat pathetic that I really believe that it could not survive. And I think about my young family at the time, and I just. It hurts. It hurts that I would do that. But those are the beliefs, right? If you believe that and you find evidence to support that belief, then you just, you know, you go full in. And I just realized that that was kind of an example of what my mindset was. You know, I had kind of given into the idea that. And believes that this, this was going to be my career, like I said, seeing a ton of patients, working weekends, doing the accounting paperwork, whatever it was, no freedom, short vacations, no chance of increase in salary, just because the insurance isn't going to reimburse any more than what they already are. So I just kind of came to the realization that this was going to be my. This is my career. Difficult to save for retirement. And on top of all that, you burn out, right? Everybody kind of experiences that. When you feel all of these things, eventually burnout comes. And I said, I started in 2005. So in 2020, when Covid hit, I was extremely nervous when Covid hit because no patients. April came around And I was obviously as busy. We lost about 75% of our patients, and so I wasn't as busy. We weren't working as many days. And I remember I went to my kitchen table, I opened my computer, and I just typed up this strategic plan, and I labeled it Belief Ceiling. And I. I brought it today because I wanted to kind of tell you what I typed out. And so the strategic plan, I wrote down my situation. So my situation was, hey, listen, I've been doing this for 22 years now, and treating patients is young man's game. I don't know how many more years I can continue to do what it is I'm doing just this, at this rate, just the number of patients that I see.

And I said, the problem is that financially, I struggle to make ends meet. If I back away from patient treatment and have someone else step in, I can't seem to figure out how to make more money per patient. And I feel like I'm missing the boat when it comes when this happens, because I know that other clinics are doing this, other clinics are doing this, but for some reason, I can't figure it out. And I feel like I'm stuck. I'm in a rut. And I keep doing the same thing over and over and over. And so I wrote that out, my situation, and I wrote down kind of what I wanted. I said, I want to be able to back away from treating patients, run my business, and I want to make $100 per patient. Now, that was for me to write that, actually $100 per patient. I think back to that is insane that I could imagine that I could actually make $100 a patient. I was just throwing a number out there, the biggest number I could actually think of. And then I wrote down my beliefs.

I said, financially, I can't make this work. This does not work. Secondly, I can't make more than 68 to $70 a patient. It just. This market doesn't allow it. There's no way around it. So that's what I. That's what I knew, or at least that's what I believed. I knew it wasn't true because other people were doing it. But I had all the evidence in my own life to support that, and I just never witnessed or experienced it, But I knew other people out there were doing it. So, you know, I figured I had spent the last 15 years looking for evidence to support my beliefs that I couldn't make more than I was actually doing. We want to make sure we're right. So I would Always use that narrative. Listen, the insurances, they're never going to pay us. They're never going to increase the reimbursement, and patients won't pay out of pocket because they've kind of been taught the whole insurance system that insurance should pay for physical therapy. That should be my co pay, right? So I told myself these things so that I can convince, in a sense, strengthen my beliefs, even though I didn't want those to be my beliefs. Your brain doesn't want to be wrong, so you're going to find any specific evidence to support that. So I had found that support, and these were the narratives I tell myself over and over and over again. But I knew somewhere out there, other clinics were successful and people were able to do this. I just didn't know who they were or what. So, like anything else, I stewed on that for a couple of months. I am the master of writing up strategic plans, coming up with great plans goals, and then walking away from them because I need to go treat a patient or whatever it is I need to do, right? So I stewed on that for a couple of months. And then a buddy reached out to me and he said, hey, listen, an attorney buddy of mine here in Vegas, and he said, hey, listen, my old college roommate, he has this podcast, it's called the PTO podcast. I don't know if you're interested in it. Maybe check it out. And this was in June. So that next week I was driving around, I thought, let me listen to the first couple of episodes. And the second episode spoke to me like nothing else. And Will, this is the one where you were talking about driving around, and all of your charts were on the passenger seat, and the weight of the charts set off the airbag sensor. And I was thinking that was me going back and forth between my two clinics. And I would just have a stack of my computer plus all the charts, and I'd go home at night and I do the charting.

And oh, man, like I said, I was miserable. It was a miserable experience. And I thought, okay, here's a guy who's in the exact same position I was in. But he figured it out. So, unlike you guys, I unloaded that clinic. Basically.

The person that was managing it, I just said, hey, listen, if you just want to take this over, maybe pay me for the equipment, you can have it. I'm done. And when I say managing it, managing it meant that I told him he was the manager, but I didn't train him. And secretly, I was hoping he would never come to Me with any problem whatsoever because I was too busy treating patients, both clinics too busy doing other things. I just didn't want to deal with it. And I figured if I ignored it, then I didn't have to address it. So basically just further and further and further into that rut. But after that episode, I came home, I talked to my wife, I said, hey, listen, I need to reach out for coaching because I just listen to this podcast, this is exactly where I am. They've gone through it, they figured it out. And she was on board 100%. She's like, hey, let's do it, let's do this. And she's been on board 100% with me many times throughout this, you know, through owning a clinic, I've looked for an out. And she was on board with that too. She just wanted me to approach it from a healthier mindset than just trying to escape. But so I reached out to Nathan. I knew I want to start working with him. And he said, hey, listen, so we need to meet for an hour and a half. And I thought to myself, okay, well my lunch is an hour. I don't know where I'm going to get a half an hour though. Where am I going to get a half an hour? Because I have to see patients, right? I've got to do this, there's no way. And he said to me, that hour cannot be your lunch. I want an hour and a half twice a month. That is not your lunch. And I gotta be honest with you, I kind of panicked. I didn't know what to do with that.

I look back at that now and I'm thinking, how sad that I couldn't find an hour and a half, twice a month to be able to be coached. Because in my brain I'm thinking, how can they survive without me? How can these patients survive without me? How can the business survive without me seeing all the patients to generate the revenue? And on top of that, I didn't even know how I was going to pay for it. But as we sat down, we coached, we consulted, the goal was to create more freedom for myself.

But the elephant in the room was always the financial issue and it was always the low paying insurances. And I knew that one of the major changes I was going to have to make was to drop the insurances. Now that raised huge, major concerns for me. If you go and talk to somebody who is.

Feeling that the only reason that you're staying afloat is because you're seeing more patients than anybody else, you have an 8% profit margin, you're going to drop the low paying insurance, which is $10,000 a month and eventually up to 20,000amonth. That makes no sense whatsoever. Right. I could not figure that in my brain how I was going to drop insurances and still stay alive. You know, dropping insurances meant that it was less patient visits each week. Dropping insurances meant that now I'm going to have staff sitting around and they're not going to have things to do. Dropping insurance is then overall meant less money, less revenue. So over the last year I've had. So this is from 2020 till now, what, two and a half years. So I've been working on this, trying to get it going. It didn't happen right away, but definitely big changes over the last year. I finally realized that this rut I was in there was going to be no escape whatsoever unless I could find a way to improve the dollar amount I was getting per patient.

So right there, Steve, if I can jump in for a hot second. So guys, we're getting right into the meat here. So listen, you've got this tool called a chat bar, right? And many of you already know this, but I just want to throw this out there while he's talking. This is where you want to make comments. You know, we have a large, large group. It's going to keep growing throughout the call. So this is where if you have questions, throw them out there. You don't have to wait until there's the actual like Q and A. Throw them out there. Now, Michelle and I will be aggregating those, organizing those and getting those ready. And don't be afraid to like throw out some comments in there. It's like, man, that's awesome. Or yep, I can relate to that. Like if as you're listening to him and you engage in this, you're gonna open up parts of your brain that are going to absorb what he's about to go through at a different level, which is going to directly, proportionately relate to your income and your freedom. So go ahead, Steve, take it away at this part of your story and thanks. I had no idea that you listened to my episode of the podcast that made me feel honored I had something to do with that.

It's crazy. That is what, that's what spoke to me because I was like, oh, somebody's actually accomplish this. You know, I just didn't realize every. All the baggage that I was bringing into it. So Jill just really quickly asked what the podcast was called. It's PTO Club.

So you can Pull up that podcast.

Nathan Shield said he was going to try to be on this call. So if he shows up, we'll make him like, promote his podcast. It's awesome.

And everything that you are feeling in terms of being scared, you know, Jill just mentioned that she's scared. That is. So that is. That is what I'm going to explain right now, right? Because somebody just tells me, my coach just says, hey, you just need to drop the insurances. That makes no sense. That makes no sense whatsoever to somebody who is scraping by with no profit margin. And you're going to tell me I'm going to give up $10,000 a month and realistically, maybe $20,000 a month down the road. So. So. But I came to the point where I realized there was no way I was getting out of this rut unless I was fine, unless I could improve the dollar amount. And I knew there was no way to improve the dollar amount per patient unless I dropped my biggest ins.

My insurance plan, this big one. It was paying me $36 a visit and it accounted for 25% of my patients.

And listen from outside when I say that now, right? It makes me sick, you know, but when you're stuck in the middle of it, you can't see any plausible alternative. There is no way, right? I only going to make up 25% of my patients.

So when I'm acting from that type of mindset, I can't be innovative, I can't problem solve, I can't offer solutions. And I also knew that if I didn't make a change, I was going to run into the exact same problems I'd been dealing with for the last 15 years, just over and over again, right? Not being able to hold on to staff because they burn out. I had a great PT that was with me for 10 years. I don't know how you asked it. 10 years. I really don't. Because that guy, I expected so much of him. And it was just over and over again, right? Just the cycle. So no direction for staff, no potential, no guidance. Because I just get right back into treating and hope the clinic runs itself. And I was losing eight players over and over again because I wasn't doing my job. So over the years, it's funny, I pull out my calculator and I start punching numbers on how I could get rid of this insurance company. And financially, it just didn't make any sense. And it got to the point it was kind of a joke in my office, my staff would hear me with my calculator. Just punching over and over and they're like, oh, no, here he goes again. Here he goes again. And I just couldn't figure it out. The interesting thing is it wasn't fair to the patients either because at $36 a visit, I mean, I knew I needed them there. I needed a patient full. But I resented them for being there and having me treat them for 36 bucks.

It was really odd. So anyway, could never figure out a way to financially do this. And the amount that that insurance came in was basically my salary every month. So I didn't want to give that up. Here I'm going to now work for free.

You know, all the thoughts everybody talks about. It gets scary because then you start thinking, you know, the doctors aren't going to send to me now are patients not going to come because I'm out of network. Right. All of those things that everybody.

Steve, hold on a second. Let's ask. What do you guys think? What's limiting people from. I want everyone to in. Now you can do it in the chat. Speak up. What is limiting us from dropping health care insurance contracts? So he mentioned the big one, like losing referral sources. Is that true for you guys? Some heads are bobbing. Silence is acceptance. What else, what else is causing us to resist that?

Seth says insecurity. Cindy says fear, not afraid of losing referrals. Carly mentions losing patience.

Okay, yeah, maybe it's also the noise. Yeah, let's hear it. Candace. It's Candace.

I'm walking my dog, so I can't Typhon walking. It's cold. I think one of the biggest things is that we all fear losing something. Money, referrals, you know, doctors referring to us. But honestly, we need to stop dropping these. We need to start dropping these insurance companies that pay us 36 bucks. Because first of all, everybody who's on this call might know I'm a straight shooter. That's bullshit. And second of all, the more of us that will drop these insurances, the better we can start to advocate for our professions.

Yeah, I agree. And it's one of those things where, like, inflation is affecting everything except for healthcare reimbursement. And those companies are growing United Healthcare, making billions of dollars, and we're, we're still getting paid $65 flat rate. It's ridiculous. And we keep taking it. Right. Like, yeah, I, and I love Katie's comment here about, like, I'm fearful that patients would think I was getting ready because they have no idea how little we were paid. It's, it's true. And it's hard because, you know, I had someone once tell us, tell me this, that physical therapists are the most fear based entrepreneurs that he's ever met. He was a coach that worked in multiple industries. And I have thought a lot about that as to why. I really have. I've talked before about how I think there's like reasons that we don't need to get into like the schools and like just kind of how we're formed growing up. But I do have a quick thought. I told my friend, I'm like, you know, we spend all day with worst case scenarios. All day it's people who had horrible accidents happen to them. So we see we're kind of almost subconsciously trained to think of the worst case scenario and prepare for it and think about it and it's, and that maybe have nothing to do with it. But at the end of the day we are, we are so fearful in our actions. And when I interact with entrepreneurs, I'd say more than 50% of what I do when I'm coaching people is just dealing with their fears. Like whatever group I'm in. Well, what if I do this and it doesn't work? It's like, are you happy with what you're doing? Like it's, we've got to do something radical. And that's why this group is going to make a difference is because we've got the best minds, the most courageous leaders out there who are going to punch fear in the face like Steve did. So Steve, given the fact that we're almost half an hour in, let's, I would love for it to kind of, if I don't, if you don't mind, I'd like to kind of direct you a little bit here. So let's skip to the end. What was the. Show me, show me, show me the money. Show me the outcome of what happened after you, you dropped the insurance. So you're about to talk about how you did it, but let's talk about what the impact was after you did it and then we'll get into the weeds a little bit. There's no way in an hour we can, you're going to be able to teach everyone every step that what you did. But going through your background has been really useful because they can see you as like one of us now. Tell share with them what the, what the change was in your world.

Okay, so just really quickly too. The thing that finally got me from operating from just that scared all, everything that everybody's listed here was this positive intelligence course. That just, that just made it so that I did not operate from fear, but I operated from a place of being able to navigate and to be able to innovate and create. Create.

Programs. It's incredible. And I can talk a bit more about that as we go. So, okay, the outcome. So, so we drop our first insurance, right? That was finally. And you know, any insurance you drop is going to take 90 days at least. So we drop our first INS October 2021. And we immediately went down 17% in our numbers, immediately. But obviously our average patient went up. So, and this was kind of my concern is, okay, great, my numbers go down, my expenses are the same. The average number per pa, the average dollar amount per patient goes up. Great. But where am I getting the revenue to support, you know, where my costs are? So anyway, down 17%. But because we had done a couple of things, we were making about the same money, some things to supplement our income. We dropped a second insurance about five months later. That insurance we weren't seeing very many patients on to begin with. That one didn't affect us one way or another. And then about a month later, July 2022, we dropped blue Cross Blue Shield that was paying us $55 a visit and they were about 20% of our business.

And let's see, we went down 11%. So we held on to 40 to 50% of those patients. So a couple of things I noticed right when we dropped the insurances.

I.

Would say we see about 20% of what we originally saw from the first insurance. Second insurance doesn't matter. We didn't see anybody from them. Third insurance, Blue Cross Blue Shield, we see about 35 to 50% of what we originally saw. And the other thing I noticed is that it opened up more schedule space for the higher paying insurance that weren't necessarily scheduling. Maybe there's too much chaos. Whatever it may be, they weren't necessarily scheduling, so they started to fill those slots as well.

But we didn't drop as much as I anticipated by dropping those two insurances, our total patient numbers. So our average went up per patient, almost $40 a patient.

One quick question, Clay is saying, what do you mean by drop insurance? Are you canceling the contracts or just not scheduling those patients anymore? Yeah.

Okay, so we are canceling the contracts and working as out of network providers.

Yep, out of network providers. So our dollar amount per patient went up, our number of patient visits decreased, our revenue increased and our profit margin increased. Now not just by dropping those insurances. Right. I had to create some other type of revenue. But if I was going to be in the rut, in that same rut, doing what I was doing over and over and over, it wouldn't give me the time or it wouldn't be. Give me the mindset to be able to come up with some alternatives to be able to create and generate better, you know, other revenue to support that. So, you know, whether that be. We took on attorney clients, you know, I marketed to a couple of workers comp things where we get contract.

Like I said, the higher insurance, scheduling more some cash. Cash pay services, wherever that may be. I don't know if I needed to get into that too much, but definitely was able to supplement it, you know, before I started dropping and going out of network.

So, Clay, did you see an impact when those pairs were secondary payers? Oh, yeah. Interesting. Right. So we'll see that with Medicare where we get the secondary, whether it be Blue Cross, Blue Shield or Cigna, and they are out of network. So I was under the impression, Clay, when I did this, I just assumed, which is a problem, that because I'm contracting Medicare, that a secondary would be automatically. I'd be automatically paid. And no, I'm not. I'm not. And the patients are paying their 20%. And occasionally with federal, the patients themselves will be reimbursed. But yeah, so there is some impact, but I'm not. It's so interesting. My mindset was patients are not going to pay for this no matter what I do. And it's so interesting they're willing to do it. And just so, you know, in my area. So right behind me, a building right behind me, I've got another physical therapist. He is entirely cash pay. He does a lot of work with professional teams. And then down the road from me are three other ones that are all in network. So somebody wanted to go down the street. They could.

So.

So I'm just gonna. Do you want me to just read these?

You know? Yeah, don't worry, you can. So my thought is this.

I'll.

I'll read through that and throw them your way, why don't you? So what is your practice numerically doing now? Like, you know that you. You. The 3 was advertising was 300 increase in profit. So could you just talk about that right now and like your time spent on your company? Because I want you guys to see the transformation. Why? What fear is holding us back from us individually and collectively is holding us back from a scene that I want you to paint of like what your world looks like now. Not that it's Perfect. But just in terms of improvement, do.

You want me to give very specific numbers here?

Yeah, I mean I, I wasn't going to ask to pry into your financials, but whatever. Yeah, let's do it. Let's share this thing. Let's get going.

Okay. So we were averaging 68 to $70 a visit. Right. We go up to $105 a visit now is where we're at. And a big chunk of that is because I started marketing heavy to attorney liens. We were only three, we'd only see maybe three patient visits a week of attorney liens. My goal is to get that to 20%. We're about 30 or about 30 patients visits a week of attorney liens. So those reimburse substantially higher.

I'm not collecting on all 30 of those yet. I'm only collecting on maybe 75% of that. But over the next year I know that we'll get up to where we're collecting on average probably 30 patient visits a week. So initially, because my expenses were.

They were substantial before I started dropping insurance because I had to have so much staff to be able to, you know, support all of those patients.

Yes, you had to have as much team staff as an infection.

Yes, yes, yes. And a full time marketer. And when my full time marketer realized that I was going to be dropping insurances, then she saw that as you know, her bonus going down and she found another job. So I also didn't have to have a full time marketer now. So my expense became, began to go down. So I went from making on average after paying myself, I mean, what, two to three thousand dollars a month. I was hoping it was just there, nothing. Right. No money at all. And last month it was about $25,000.

And it's been that, it's been that for the last consistently since we dropped Blue Cross Blue Shield.

And how has been your work effort? Like how hard have you been? I mean for you? Do you feel like it's the same? Is it a lateral move in terms of effort that you're putting into this thing? Does it feel easier? Of course I'm hoping you'll say I don't know. But like I would like to know honestly.

So you know, I came from busy, busy clinics. That's all I'd ever known is busy clinics. And so I assumed if you're busy, you're profitable, you're successful. Yeah, I'm not seeing anywhere near the number of patients. In fact, I'm now only working half day. My goal in the Next six months is obviously to be able to get out of patient care, and we have a plan in place for that. But even my other therapists, they're not seeing near the number of patients they were seeing. The office is not chaotic. It's busy. There are patients in there, but everything runs smoothly. And I hear that from my front office more than anybody else. You know, them trying to track the numbers when you're trying to get 300 patient visits in there as opposed to now between 200 and 210 patient visits. It just gives them time to actually do the things that I keep wishing that they could have done. There's just time. There's time. It runs smoothly. It's a good feel in there.

Okay, so, Steve, I'm going to interject with some questions now. So, guys, it's time to get those questions ready for Steve. I didn't want this about the information of how to do it because you would get lost in it. This wasn't an overnight transition, as Nathan beautifully said. We were talking all about the PTO owners podcast earlier, Nate, how great you were. Everyone was talking about how handsome you were. I was telling him how you go by the nickname.

Michelle. What is. What does Fritz call him?

Grizzly Adams?

Grizzly. Grizzly Shields. He calls them Grizzly Shizzy Shields.

Yeah.

So starting off with question numero uno. Yeah. So PTO podcast. Go listen to it. It's awesome. Michelle's been on it. Steve's on it. I've been on it a little bit. Good times. And Nathan, of course, is brilliant. Clay says, are you holding the lien or using funding companies?

Yeah. So I've had funding companies come to me.

But with a funding company, you get substantially less. However, you would be able to drop an insurance sooner because those funding companies pay you monthly. I wanted to hold onto the lien because I wanted a relationship with the attorney, which means I needed to. That's why this took a little bit longer before I could start dropping because I needed to wait for those start coming through. I had a patient who just started last week. She works for an attorney's office. She found out that, you know, we hold on to the liens instead of getting a funding company. She sent us two patients today.

On Lean. And the other thing that's nice when you're out of network. So if anybody's looking at doing leans is just something we just figured out. Very few places are willing to put a copay on a lien, and this is something not to get in the nitty gritty of it. But this is something we've decided to do because we're out of network.

We'Re getting so much more. And then when the lien is paid, then we'll just get that last little bit. So it makes it more financially viable to be able to do that.

Love that. Okay, I had to quickly mention that Don earlier mentioned about how he hates the word except when we accept insurance, he says it's like synonymous with mediocre.

Yeah.

Like accepting equals tolerate, which is like the, the theme of physical therapy. We tolerate so much. Right. Next question from Amanda. Have you dropped all of your insurance contracts or only the ones that were below your cost of doing business? That's a great question.

I dropped all the ones that were below my cost of doing business except I have one last one that is right at my cost of business. And we are, we are, we have a plan over the next quarter to work with them. And if they're not going to work with us, then we'll get rid of that. Beautiful. So, yeah, all the ones that were above I held onto. Just the ones that were I was losing substantial amount of money on, we dropped and went out of network.

By the way, if you guys want to. This isn't like a super formal setting. We're all just kind of doing our thing. So like if I ask your question, you just, you have like follow up questions. You can just turn on your microphone and just start digging away. Like, you know, it gets weird, I might interrupt, but otherwise go for it. Don't feel like we have to keep it all here. So the next question is from Candace Candice. What state are you in?

Dog Walker.

She's probably not listening. What is the name of the book that you read about? Mindset, she says.

So I did a course called Positive Intelligence.

And my wife is actually a Positive intelligence coach. So she would run people through it. She'd talk to me about it. I was like, yeah, yeah, yeah. And then I was like, okay, I've got to do this. And basically all it is, it just teaches your brain to be able to access the portions that's going to allow you to be a problem solver instead of a scarcity mindset.

I'm going to share screen. Is this what you're talking about? Because you and I talked about that. Is this what you're talking about?

Yeah, and there's a link on there.

I'll put the link into the chat.

Yeah, but there is a link. If somebody wants to go in, you can go take what's called just basically A saboteur test there to see which things are preventing you from being able to.

To be able to accomplish your goals. So anyway, go take the quiz on there. It's. It's fantastic.

Okay, thank you.

This is kid as well.

It's just.

It's just cold. I can't get my phone out to like.

Yeah, where are you at? I forget where you are.

I'm in Nebraska.

That's right. So, guys, we are really excited because next. Next month, at least I hope I said this to Candace, but we're gonna have Kristen Fox from South Dakota, Seth from Arkansas and Candace from Nebraska are going to be on the call. They are all part of organizations that are starting to effectively fight insurance decreasing reimbursement. They take a stand for PT in general. There's all these things that they're doing. So we're going to talk about what their organization is, how it works so that we can start getting ideas. We need something. We either need a cohort of multiple organizations across the country that's. That are organized and unified. We. Or maybe just one massive organization. But there are successful groups that are. That are winning battles that we don't hear about. Like, we just need to like. Anyway, so next month we're going to be learning more about their groups and be focused on that piece in addition to continuing our discussion on dropping insurances. So thank you very much for that, Candace. Cindy asks, does lean mean lop? Is that the same thing? Not familiar with what lop means? I know what a lien is, but what's an lop?

Lots of people.

It's a letter of protection.

Letter of protection.

It's what you. It's what you sign with the attorney that states that you won't bill the patient directly, but that it'll go through the attorney's office and that you'll be a part of the. A part of the payment when the settlement's complete.

Okay, awesome. Thank you for that, Clay. So is that from understanding that correctly, an LLP is a part of the lien, like process, right, or no?

Yeah, that's how you set it up.

Okay, so that's like a step in that painting a lean. Okay, very cool. We missed a question earlier from Blaine. Blaine, I'm sorry, man. You know I love you. Where are we at.

For the patients that had the insurances you dropped? Did you retain quite a few of them as out of network patients?

So.

No, actually, we didn't. There were certain ones. I remember my administrator and I. Like I said, I was very nervous to do this. But. So we went through every patient and we anticipated, okay, who do we think is going to continue here, who doesn't have much of a deductible, all that kind of stuff. And like everything else in the business, it never went like I thought it was going to. People that I didn't think would stay, stayed. Others didn't, but no, we didn't initially, we didn't. But within a month, it was interesting how many started to come back. So, like I said, we retained maybe 15% of that first insurance. But a lot of them understood as we went through and we talked to the patients a couple weeks prior to the month before, we gave them a letter. And then I met with every one of them. I talked to them about it. This is what's going to be going on. This is why we're doing it. They all understood. You know, one patient in particular, he's like, hey, listen, you can't take that. Yeah, you can't take that amount. There's no way you can make a living on that. So. And most people felt that way. And then they went and found a physical therapy office that took their insurance.

And we should let them.

That's right.

If people are willing to kill themselves for marginal to no profits, then, you know, eventually those are going to burn out. Inflation's going to take care of those groups or take care of us if we're not being careful. I love that. Um, all right, so let's go back to the next question here.

I think that's it for the patients. Oh, how did. Seth wants to know, how did physicians referring to you react?

Yeah. So once again, I went and visited with each physician and only one stopped referring to us. All the others said, yeah, you can't. You can't work for that amount. You can't. And our physician referrals went down. Obviously, they went down because we're in network with insurances that are a large percentage of the valley here, but those doctors still send to us, and they send us the patients with the good insurances. The other thing is, too, even the ones that are out of network, they'll go and talk to their patient. This is out of network, but I want you to go here. So it really, I mean, it's gone down, but it hasn't hurt us. It really hasn't. I was shocked by that. All these things I believe that were going to happen weren't as bad as I thought they were going to be.

That's amazing. I just want to also say that right now, the industry, the country being where it is, we have the perfect excuse to explain to doctors why we're doing this. It's like, yeah, with everything that's going on. There's an article that recently came out that Angie McGilvery sent over that talked about, from the APTA, that talked about this large number of physical therapy companies that are losing pts. There's like this exodus of pts that are occurring across the country. So retaining team members is, is becoming a trend or difficulty in retaining treat team members is becoming a trend that we can track. And it's very indicative of like everything going on with inflation and what's else occurring to us. And yet insurance companies don't change their reimbursement because we keep taking it. So as we, as we look at like the stories and how to create this, that's what I would like to do in subsequent meetings, is to build on that together, on what we can do to do that. Because you're on this call specifically to learn about this one cycle of action that has been super successful for Steve. So it's a matter of now, like, what other things and tools can, can be created. And I have been prodding Steve for the last, not literally, I've been begging him, please, man, like, create a course, like, help people do this. And he's now looking at doing that. If you're interested in taking, working with Steve again, I'm not selling nothing financially. I'm not here to sell you guys anything. But if you, but if there are services out there, I'll say, hey, that looks like a good one. Steve did it. If you're wanting to work with him, let me know. You can email me. The guy that blows up your email every week, just email me back and say, I'd like to be involved or whatever, and I'll get that group over to Steve and then he can get in contact with you to create something. But either way, on these calls, we'll do little pieces of how to do it, maybe problem solve just to help you do that. Nathan mentions another friend of his dropped United Healthcare recently and retained a third of their patients out of network and collected their payments up front. Which is like the billing and collecting piece of our industry is insane. So if we can eliminate that piece of it, which is, you know, it's, it's that, that'd be wonderful. Tyler asked the question, how do you make, how do you market to attorneys? Kind of like switching now to like this idea of, okay, you've dropped these insurances and these patients. It's created an Opening. You said you filled it with attorney liens.

Like, yeah.

How did you approach that?

So.

I knew when I wrote down that strategic plan, that belief seeing, I knew that I had to get some attorney liens in there. I was only seeing about three patient visits a week, and those were just random. Those just kind of ended up our place. I had no idea how they got there. So I networked. Now, here in Vegas, there are billboards everywhere for personal injury attorneys. Car accident, right. I mean, they're everywhere. But these attorneys only send to very, very few physical therapists. They have their people, and trying to break into that was so much harder than I anticipated it would be. So what they did, I'll just get really specific. I called a buddy of mine, another buddy, who's an attorney, and he. He occasionally has the. The personal injury come to him. And I said, hey, listen, let me buy you lunch. Let me just sit down. I want to pick your brain on what it is every personal injury attorney is looking for. How do I get in there? How do I break in so that I can get past this list that they have? So I sat down with him, and he's like. He just kind of laid it out for me. This is what you're looking for. This is what you want to do. And he gave me a list of, like, eight attorneys. He's like, here are eight attorneys. These are good friends of mine. I'm going to call and tell them that you're coming to visit them. So I called ahead. I went and visited those people. And of those eight people, none of them have ever sent to me, ever. I've never got one. So it doesn't. It has never come from where I thought it was going to be. But I just started hitting. I just started networking and hitting attorneys just over and over and over until one of them would work with me. And to be honest with you, you only need three or four attorneys that are willing to work with you to be able to do that. But I said, I've got this one lady who just came into the office as a patient, kind of saw what we were doing, how we're different, and is starting to send to me now, too. So just network, network. And I can give you more specifics as well on kind of what you say to the attorney, what you're looking for, but for the most part, it is networking and just pavement.

Got it. Very good.

All right, so we've got some more questions here. Sean, the attorneys. Oh, he's just making. Oh, it's a question. The attorneys Usually want to reduce the total billed. Do you accept a discount or do you stay firm and collect the full bill?

Yeah, so this is one of the things. When I sat down with my buddy, he said, hey, listen, attorneys are looking for relationship. And I don't know if that's the case with everybody, but here in Vegas, they're looking for relationships. So they want to be able to work with somebody that they know they're gonna. They can say, listen, can you take a 35% reduction on this and not have to worry about it? They just know it's gonna be handled. Sometimes it'll be a bad one where you. It falls through, but sometimes it'll be great ones where they're not taking much of a reduction at all. So they just want somebody that is willing to work with them. And so, yeah, we do. And that's one of the things that my, you know, the attorneys I work with, I'll go in and say, hey, listen, we're going to. We're willing to take a reduction. We bill it a certain amount. I anticipate collecting at this amount. And that's generally what we average.

Good question, good answer. Amanda is making the comment that if you have a good relationship with the doctor, you can ask them who the attorneys are that they work with and they'll give you a recommendation. Potentially. Great. Great idea.

Love it. Any other questions?

Steve, wrap this thing up, man. Like, what. What would you say to this group of entrepreneurs who are staying on for the last 10 minutes? And we're, by the way, we don't. We can end early. I'm not going to milk this thing out. But, like, what would you say that? Like, hey, before you leave, the one thing you should know is blank. Like, what would you say to them about that?

The key to this, there are a couple of keys. You've got to have somebody kind of coaching you like I had Nathan, because somebody outside looking in, they can see it completely different. I am. I was so stuck in it. There was no way I was going to be able to pull myself out. Secondly, you've got to have some type of plan just to get rid of an insurance and see your income go away and go, oh, wait a second. I thought I was going to be able to increase my revenue. You're going to have some type of plan there. Thirdly, you have to have a mindset change. There has to be a mindset change. And for me, it was that positive intelligence course. It. It changed my life. I'm not and I can. It completely took me Away from this scarcity mindset to one that allows me to be able to navigate, explore, innovate, put plans into action. My, I put my team through it as well. So my administrator, I mean she is always doing the same thing. She's on board with me. You've got to have support as well. So you've got to have support in the office and at home. If you have, you know, a partner, spouse, you've got to have support there. So I know that like as we began this process back in 2020 with Nathan, my staff is completely different. Completely different. Because as you're going through the change, things don't align with people. As we come up with our values, they didn't align with people. And that's fine, that worked. But I'll tell you, just by going through this, I don't feel like I'm in a rut. I feel like there's hope. I feel like there's a plan. I see there's freedom. I see that there is. You know, I'm excited about the industry. Instead of thinking, oh great, this is kind of what I'm stuck with forever.

Thank you so much Steve. Guys, think about what would happen if we all did this industry wide. Like we just didn't take it anymore. Like we just started doing this. It would change how everything operates. We start becoming those first line contacts for people with musculoskeletal disorders instead of a referral that gets sent out to the side out become those doctors in the community. So we have next month. Our next meeting is going to be only three weeks away. I'm announcing it now. I just decided this a few minutes ago. We're going to have our next meeting on March 8, which is a Wednesday at 4pm so we are going to ask Kristen and Candace and Seth if they will be here in attendance. Since I've got you on the phone guys or on the line, is that something you guys can make.

Just get back to me? For the rest of you guys, just remember as you go out there and you fight for your practice every day, the more we do this together, the better result. In my third year of PT school, I was suspended from PT school. First suspected terrorism in 9 11. True story. Was almost expelled. I'll tell that story another time. But let me tell you, for a year I had to defend myself and I, I had to do it with people who knew, like, trusted and stood with me. That's what we're facing right now. And I have a, I have a belief. I knew when that happened. That had something to do with my future life. Like, this is it, and I feel like this is the beginning of that, is that we need to stand together to fight what seems like an impossible fight in order to get our industry where it needs to go. I want this generation of entrepreneurs to be looked at by younger generations as the one that made everything change. And we have everything we need. We've got the intelligence, technology, the courage. We just need to do it together. Without it. Without. Together, it won't happen. So please join me next month, March 8th at 4pm Mountain Standard Time, to continue this discussion and learn from these other groups that are organizing to start fighting these suppressive forces directly and learn how to win. Thank you, Steve, for being here. Such an honor to have you on the call. I sure hope you'll be here next week or next month so that we can continue to have more of this discussion in addition. But guys, what else do you guys want to hear about? I'd love to hear from you in an email, a text message, Facebook, whatever. Like, send me ideas of what we should be talking about and be doing. Remember, it's not just about thinking about it. It's like, what can we be doing together in order for us to be able to, um, make this work? Because ultimately, when we win, our patients win. Lots of thanks and kudos, Steve, are in the chat right there. Um, let's go ahead and wrap it up early. I'd love it if we. Guys, if you don't know me, we start on time and we, we, we end early. So next call, make sure you're there at the beginning. Cause we kick it off right away. Yeah, send your love to Steve right now before we head out. Thank you, Kristen, everybody. Sure appreciate you guys taking time out of your crazy busy day to be here with us. I hope you go to bed a little bit more like proud of the fact that no matter how busy you were, you did something extra for your practice and for your.

Have a great night. You guys will see you on March 8th. We'll see you then.