Strategies to Combat Low Reimbursement & the Staffing Crisis with Dr. Dimitrios Kostopoulos

We received a letter from an insurance carrier that they were cutting reimbursements for physical therapy from $140 down to 3.

And that was the letter that changed everything. They gave us at that time an ultimatum stating that, hey, if you do not, if you are not going to accept this by January 1st, that the rate change, then we drop you from the network. It was an ultimatum. So, see, many times we talk about cause versus being effect, and at the time felt that I was the effect, not cause, but we had to do something to change it.

Dimi, I'm so excited to be with you today. It's been a few months or years since I've seen you. It's been very. You're someone I've known for a very long time and man, I sure appreciate you spending some time with me today.

Likewise. It's been a long time and you have a tremendous evolution since the time that I have met you and you have, besides all the other business endeavors, you have an amazing podcast right now. And.

I'm very excited to kind of share this podcast with you now. From my podcast to your podcast, from your podcast to my podcast, and it will be awesome.

Well, and it's such a cool moment for me because you, as I was a physical therapy practice owner, as my audience knows, and maybe yours doesn't, but I was a PT owner who was really wanting to make a big difference in the industry. And that's when we found you, and we found you through a common connection in Florida. Oh, I'm forgetting which, which of our, which of our referrals it was, but he was at a measurable solutions conference.

Yeah, I think it was Dan, actually.

Dan. It was. Yeah, Dan Sage. So, Daniel, thank you so much, buddy. We wouldn't be here without you. And he was talking about this EMG thing and diagnostic ultrasound and how not only was it higher reimbursing, but more importantly, it was totally changing how patients were getting healthcare and physical therapy. And it made us diagnosticians versus being, you know, healthcare providers that get referred out to like a prescription. And so when we met back and it was 2014. I think it was 2014 or 15.

Yeah, I think 14 or 15. Yeah, you're right.

Yeah. I mean, who would have thought that we would have evolved the way that we did? I know we were the six, I think client of yours. We were in the first 10.

I know that early. The early days.

Yeah. And how, how many companies are you partnered with now? Ish.

Gosh, we have right now, I think about 65 companies, 245 locations.

Wow.

Like, I think 31 different states. So that's.

Yeah, amazing, you know, for my audience side of things. Can you share why you decided to do hands on diagnostics? Why are. Because you're a medical doctor, like, say, in my intro, and a physical therapist. You have both of these, like, combined talents. What was it about the industry that had. You want to jump into it?

Yeah, look.

I mean, definitely, first of all, I was involved in electrodiagnostics from the early days of my practice. Like, Costas and I, my business partner, we opened the first physical therapy office back in 1992.

Wow.

Very early. What. How old were you, Will?

I was. I was 16.

I had that number. I had that number in mind. Exactly. So anyway, we opened that office and we did very well. We grew rapidly. And.

Right around 1996. 95, 96, I was like, okay, I want to do something more. I want to do something different. Meanwhile, I had a bunch of friends, physicians, who were performing electrodiagnostic studies at that time. And I did see a flyer advertisement about these guys from the US Navy that they had physical therapies, that they had studied electrodiagnostics and they were teaching others. And I joined at that time, my very good friend Rick Nielsen.

And we did some training with him. And I started very, very slowly doing electrodiagnostic studies. But.

The point that pushed me and this, to develop this as a real business.

Is actually the same challenges and problems that physical therapists have right now. It was about. It was about reimbursements that, yes, on the one hand, we could see back then some clinical utility, some clinical importance, clinical significance of electrodiagnostic testing, but we could have never fathomed to take this and create a business opportunity with it. So until we started facing some of the industry challenges, you know, when I talk to people, actually Will, many times I say, you know, that we received the letter that changed everything.

What letter was that?

What letter was that? I'll tell you exactly that. It was.

Two days before Thanksgiving of 2002. Meanwhile, we had really expanded our practices. We had opened, I think at that cat, 13.

Physical therapy locations. And we received a letter from an insurance carrier that they were cutting reimbursements for physical therapy from $140 down to C.

And that was the letter that changed everything. They gave us at that time an ultimatum stating that, hey, if you do not. If you are not gonna accept this by January 1st, that the rate change, then you drop, we drop you from the network. It was an ultimatum. So, see, many times we talk about cause versus being effect, and at the time felt that I was the effect, not, not cause. But we had to do something to change it.

It's interesting that this is a story that still exists today, that people are experiencing this, maybe even more so. But that was the same thing that you said that started this whole journey for you to go, wow, reimbursement for what we do is not representative of the value that we bring. And you were. And you had a choice. Could I be at the effect of this or could I be at cause over this situation? So it sounds like, ha. Was your way of being at cause.

Was that was a way of. Of. Of being. Of being. Yeah. But let me ask you this. Like, you, you speak people, right? You. You speak to. You have your podcast, you have your consulting clients, have your conference and events that you put around the country. What do you. What, what are the common themes that. That physical therapy puts. Especially private practice owners come to this point and complaining about or seeing as challenges. What are the common themes that you see?

You know, there's an overarching singularity and then there's the sub causes. The sub causes look like recruiting. The one thing I hear in my world, since I spend a lot of time consulting on recruiting, on how to hire physical therapists or how to develop people, they're the most overwhelmed when it comes to that initially. And that just might be how they show up to. To me directly, although I know it's an industry problem. The second thing is reimbursement. Reimbursement. Between those two things alone, they just. That becomes the singular issue of just not feeling imbalance in life. And it's. That's a horrible word, balance. Because, you know, I don't, I don't really truly believe in balance. But what the better way of saying it is that they don't feel in exchange with their own business, they feel like their business takes way more out of them than they get back in return. So, like, in terms of time and money that they invest in what they get back in terms of time and money is so skewed that we use industry, you know, common words like burnout or, you know, the, the fact that people are leaving the industry more than entering it, there's this massive exodus. And it's so interesting, Demi, because as you know, there is such a demand for what we do. Like, that's right. This is, this is the opposite environment where those events should be occurring because there is so much demand for it. But it comes down to. And those two issues of recruiting and reimbursement are so interlinked. If we had more money, we could hire more. If we could hire more, we could make more money. But it comes back to your core reason as to why you started the hands on diagnostic seminars. Because at the end of the day, what we get paid per visit by the insurance is the driving force. That's the in that has to be the first thing that's causing all this. Because if that was triple what it is now, people would be staying in the industry. We could pay people more, we'd have more profits, the whole nine yards.

And, and, and, and we see the application of this actually right now in the relationship between private practices and hospital organizations. So you are talking about recruitment. Right, right. And although the numbers change from year to year a little bit, but we are producing about 5,000 less physical therapies every year than what the industry really requires. All right, so 5,000 less up to now. Now moving forward, this is going to become even more challenging. And I care less about the political persuasion of anyone who is watching podcast, your podcast or whoever I talk to. But it is a real challenge. Private practice physical therapists who in larger metropolitan areas, they were recruiting therapists, foreign trained therapists from other countries, from India, from Philippines, from Australia, from various places like that. Now a private practice has to pay $100,000 application fee to apply for someone to come in with an H1 visa, provided.

That killed what I thought was the only viable solution because when we had, I was just in my coaching world about six months ago, we were really trying to figure out because there's already some challenge around that you've got a, the person has to take the boards in the United States. So you're flying people from the Philippines, for example to Hawaii. And so you're looking at about a 20 to $25,000 cost that has some risk already tied to it. And then the government threw a hundred thousand dollar penalty or whatever it is like feed in order to do that. So that killed the only viable solution which for me I loved, I loved bringing people in from other countries and to solve that problem for us because then it would increase our profitability.

I mean look, I came to the country initially as a student with an a sponsored visa. I didn't know that in the past. Yeah, in August of 1987 world where you. Okay, so we were both younger, that's for sure.

We, I always think of us as the same age. And for what it's worth, you look better at your age than I do at mine. I'm looking all the time, I'm like where are his wrinkles? Anyway, so yeah, I get it. You were here on a visa and that's like the whole point of this thing is, is that we're able to take the. Not just the country of America. But the idea again I'm not, I don't want to get into a political thing. People have all sorts of views about the border control. But getting people in legally through visas who want to provide health care. No, those are people we have to want to support. We want those people.

So, so, so here is what I, I am going to advocate. I got actually the agreement of the HADZ group to advocate and I am asking you also if you got it agree on this to, to join me in this advocacy advocating to the American Physical Therapy association to utilize their lobbyists to advocate for an exemption of the $100,000 H1B fee for professions where there is a significant need in the United States such as physical therapy. Because let's set the this now if who is going to afford $100,000 private practitioner is not going to but the either larger national organizations or hospital organizations, perhaps they'll be able to afford the $100,000 with a contract that they'll stay with these organizations for the. The employee will stay for five years or so. So but that is a problem for the private practice small business owner. So I'm advocating that the APTA utilizes their lobbying resources to actually lobby that there is an exemption for specific professions specifically for the profession of physical therapy. For.

The H1B visas. Yeah, yeah.

I mean I, we are 100 supportive of that. I think that makes so much sense because I don't know anything outside of my narrow scope. So like if the hundred thousand dollar thing makes sense for legal or for other professions where that money is a little bit of a sting but it's not a big deal. Okay, great. That brings us more money, whatever. But for physical therapy companies, I love the HB1 visa or H1V. I'm always dyslexics, whatever that is H1B those visas are so vital because they allow us to hire overseas and it's not even a smooth process without the hundred thousand dollar thing. So if anything I would love to find ways to simplify that while and it's not the long term solution in my opinion. I would love to hear yours. I don't think that's the long term solution because we're still fighting a diminishing game with Reimbursements, but at least it provides us with some space to be able to get profitable, to organize and fight. Because we don't have time as the private practice sector is what's going to save our industry or transform our industry. And right now we just don't have time to go lobby or like if we're too busy treating crazy hours or running around trying to hire full time. What are your thoughts on that?

All right, so my thoughts on that.

First of all.

What will really create a significant difference is positive difference is parity, parity.

In reimbursement between hospital organizations and.

Private practices private practice physical therapy. So here is what happens right now when it comes to commercial insurances.

Hospital organizations, they are able to.

Retrieve significant multiples of reimbursement compared to a private practice physical therapy. And there are websites where you can go, because this is now public information where you can go and see the reimbursement precipitate code. But I'm going to give you a, a very simple example for, let's say a visit on a patient where a private practitioner receives $85. For that same visit, a hospital organization will receive more than $300. This is not only limited to.

Commercial carriers, it extends also to.

Medicaid and Medicare Advantage. Not the straight Medicaid, not the straight Medicare, because there, there is, you know, a little bit of difference, but not significant difference. But the Advantage plans, they have also three or four times greater reimbursement with hospitals. So what happens now is.

Large organizations in private practice who own 500 facilities, 600 facilities, 1000 facilities in various regions, they collaborate with hospitals. So the hospital rates extend to those private practice organizations.

And they are able to have those significant rates. And then we have competition for the small private practitioners, small business physical therapists. We have competition not only by the hospital itself, but also by those larger organizations that now their reimbursement increases significantly and they have to. And they can compete for.

The same physical therapy talent, but them a lot more because they can afford to do that.

It's interesting to me that these groups are actually getting increased reimbursement because that shows that there's, there's a battle that's being won, of course by the bigger companies, but they are winning. Like if they're increasing, it really kills. That's that individual who just dreams of hanging their shingle one day and having their own practice. But it the only positive I really hear from that is, well, at least some groups are able to get with insurance companies and fight it just Puts us in a position of like, well, how do we do that? How do we. Do you have thoughts on how we as a group?

So look, here is king, right? There are three things that somebody can do to.

Increase their bottom line. They cut expenses and they can increase revenue from their existing business and they can add additional revenue from related businesses that can be incorporated within their organizations. Now, the very first thing, cutting expenses is probably the easiest thing that somebody can do with only short term result and low yield. Because what are you going to cut? Can you cut your rent or mortgage? No, because that is what you pay. You probably have a lease, you probably have a mortgage. It is what it is, right? At the end of the day, you have to have the space to see your patients. Are you going to cut salaries? How are you going to compete in the marketplace if you got salaries? You're not going to be able to. Now, is it possible for you to try to create some, a lower.

Lower amount for your ultrasound gel and your, the towels that you use in your office? Fantastic. You did it. You saved $55 a month. Great win. Let's go have a beer.

The beer by the way, costs 55. Yeah, the round of beers costs $55. But yes.

So it's, it's, it's a low yield type of activity to decrease expense. Now let's look at increasing income. Increasing income from your specific service line of physical therapy can be done by negotiating rates with insurance carriers. Okay. You may be able to join some IPA and join forces with other physical therapists and can go and try to negotiate those rates to a relative success on your region. You try go cash also in some cases where you can manage to get some reimbursements directly from patients. Or then you add the services that, where you are able to receive much higher reimbursements. And those services can be a variety. You can have some cash based services where they're unique in nature, where no other therapists offer those services around you, where you have an incredible marketing plan and approach where you are able to recruit patients who are willing to pay 150 or $200 for that. Or you add.

Reimbursable services by insurance company that have a multiple of what you pay for PT, such as diagnostic testing, EMG Ultra, pay three to 10 times more than what PTV is. And pretty much the math unfortunately will. By 2028, it is anticipated that 50% of the existing physical therapy private practices will be acquired by larger corporations.

How? What percent?

It was that again, 50%.

50% of all physical Therapy, outpatient private practice will be acquired by larger practices.

Correct? That's, that's what the number is right now. By the year 2028, the estimate.

We if we entire of physical therapy, the entire physical therapy, inpatient, outpatient, private practice, large entities, 34% of the entire PT is being delivered by private practices. So imagine that.

When larger companies take over half of that 34%, so you're going to have only 17%, the entire PT industry being served by private practices, small, private and medium.

But that scares me for so many reasons, and I think that you know this as well as I do, is that what makes any unique physical therapy practice successful is the passion and the creativity of the individuals who are giving care. And you can't find a more passionate or creative group than a private practice because they are, they are the ones who hung their shingle. They're the ones who put the risk up. They care arguably more about the patient experience in general. Now you'll get some standardized care with larger groups for sure, but I worry about that devaluing what we do to be more of this service that gets referred out to and we only focus on routine care items versus becoming doctors in our community and having those deep emotional relationships which is what drives you and I. What we care about is the body and soul of each patient. And people go into physical therapy for that, don't they, Demi? Where? Absolutely, yeah. I mean, look, the people who get into physical therapy school, they are the ones who are in a very interesting niche. They're, they're definitely intelligent enough to go to a MD type program, but they choose to go this route. Usually not all, but usually they are. And they choose to go this route because what they really care about is the connection with the individual combined with the fact that they love anatomy. In a way, they get to work with it more over time, but in exchange of that, they give up their profit. I told my wife this, Demi, I remember when I became a physical therapist the day I got my license. This was in the early 2000s. My wife and I didn't have any kids. I was in my 20s. And I remember turning to her and saying, man, honey, we, we're not going to be wealthy on any level. I just want to prepare you for that. We're never going to be wealthy, but I am going to be happy because I'll be serving people. And that is, I think, a great, you know, example of what most people feel when they become a physical therapist. They're, look, they, they, they're driven by those Same things. And I was, I was wrong on both counts, by the way. But it's one of those things where. I'm just kidding. But it's one of those things where it's, it's really, it's unfortunate that we would get our, basically our, our whole industry, the vast majority, save that 17% by 2028 is going to be standardized in these large groups. And again, I'm not going to badmouth the large groups completely, but there is this something about the heart and soul of our industry with the private practices that drives so much of what attracted me to the industry in the first place.

Look, there are large groups that are very ethical and they are, yes, that the patients and the value their therapies. Absolutely same. Well, they all have shareholders or board of directors and they, they have sometimes people who are a bit.

Further away from the delivery place and they cannot see what the frontline pts can see when they deliver the service and they are interacting with their patients. And look, I don't know if you are aware of that about this, both recently at the HAT symposium and also in my podcast, as you know, hands on or patient that Costas and I developed, it has a physical therapy component, the diagnostic testing component, as well as the.

Consulting and education component. Right. The HUD component. So, you know, looking at conditions in, especially in the state of New York, where the hands on organization is, Costas and I made a decision to actually sell our physical therapy component of our organization. And we did as of as a few months ago.

Oh my goodness. I didn't know.

Yeah, yeah, we. Yeah, that's correct. So I'm breaking the news. Breaking.

Congratulations.

Thank you, thank you, thank you.

That's wonderful. Because you've had that for decades and you've grown a beautiful business there, but you've recognized the opportunity to help. You're, you're. It sounds like you're going all in on helping the industry is what I hear.

Yes. Plus we, we sold our physical therapy operation, but we did not sell our diagnostic testing operation. So.

Right.

We, we have currently In New York 35 locations where we perform electrodiagnostic testing and musculoskeletal ultrasound. So that part we kept because we believe that that is where the future lies and, and of course had where impact in the industry and, and in practices around the country and putting, putting more of attention on those two areas. I believe it will yield better not only for us, but also for all the people that we care around our, the pts and the patients in need.

You know, so that's so beautiful that you guys are doing that. And again, you know, obviously your podcast people already know this, but for me, for my end of it, you know, the electrodiagnostic journey has, was a beautiful part of our growth when we joined hods and we brought it into our four locations in Arizona that increased our reimbursement, but it also spawned a new business in Alaska that Nathan Shields took off and started and grew and then we ended up selling to a physical therapist who had become a key hand. So it was, it's a very, it's a powerful. There are things out there and you know, there's, like you said, it kind of boils down to cutting expenses, which really there are. I, until I love to see the business that shows up and says we're here to help you make money by cutting expenses. Well, I guess except for mine, which I'll talk about later. But, but in terms of like your regular expenses, like your lease and that stuff. But then increasing reimbursement is one and I'm really hoping Nathan will take that on. He's got a program I know he's been working on for a while to help people get more reimbursement just through like, you know, tactical support, through negotiating and that kind of stuff. But then there's your company that helps you get more reimbursement in a way that creates additional value that actually supports the industry in terms of autonomy and just straight up marketing. Like when patients and other MDs start seeing physical therapists as the musculoskeletal experts because we're doing diagnostic works is the day that our industry as a whole benefits because we're no longer some medication that gets referred out to. We become equals in the referral process.

And I'll give you actually if you want to put in your, in your, in your podcast podcast website.

Yes.

Please give you you a copy of a white paper that I wrote recently that compares actually physician electronic residencies with what physical therapists have in place right now. And it's like a side by side comparison. So our listeners can, can take a look at that. But tell me something from, from your viewpoint and the things that you are doing, what are some meaningful ways that you have put together that physical therapists can save money right now in their practices?

Yes. So my audience can tune out because they understand this point. But it's my journey. As you know, I had a medical billing company to help fight that piece of it and started coaching across the board. I started hiring virtual assistants for my core business back in 20, in 2001. And I had clients d me that were working with me on multiple levels. They were coaching for recruiting, they were getting their billing done, all these things. And I had a handful of really close friends say, hey, can we try that VA thing? And I said, no, leave me alone. I've got four other companies. I'm, I'm dying. And so they, they just asked, they said, please, can you help me? And so I ended up hiring virtual assistants for them. And recruiting is my favorite thing. So we started hiring virtual assistants and they came back two months later. This was years ago. And they said, this is the best thing you've ever done for me. And so very quietly we added that business line into what I do. And now it's 99% of what I do now. And it's been like that for a few years. We, we have 150 clients across the country, somewhere around four to 500 locations. We have hundreds of VAs that we work with. It's really scaled. And the reason I bring it up isn't to promote, but because whether you use me or somebody else, one thing that people can do immediately is look at supporting their non clinical team with virtual assistants. It's the second fastest growing trend next to AI.

Yeah, and I totally agree with that. And yes, you should promote it. And, and, and yes, you know, especially from someone who comes from the physical therapy industry, you can trust that will recruit individuals who really can pay more attention to the proper to a physical therapy practice. So absolutely, please promote. That's, that's.

Oh, I appreciate that. I think, you know, and I appreciate that because of course I'm growing a business, but you and I are both are pushing a movement. What we're really are. At the end of the day, what you and I are aligned in and always have been is our passion. And I, and for my audience sakes, and I don't say this often on my podcast ever, if ever, but Demi is In the top 1% of the best human beings I've ever had the privilege of working with. He can be trusted in every way if you're looking at diagnostics. So for me, what we're doing together is the same thing, just in a different way. You're trying to get increased reimbursement and more awareness from the industry of our professionalism and our expertise. I am trying. I've been trying to help the industry in some way. When this came around, it was like, oh, not only am I using a talent that I have that I love, but we're doing it in an immediately impactful way that increases profit and time. We have less than a 2% churn, meaning 98% of the people who hire us never leave us. And it's because when we can have good people supporting us, then we can make decisions like how do I hire professional help or how do I do this? And, and so they, all these pieces need to come together for the ultimate battle, which is fighting the insurance companies for reimbursement. Or as Brandon Siegel says, if you know who that is, that he's a good guy. He was telling me, he's, he's like, you know, I believe that he's not a clinician like us. So he has a different perspective. He's like, he goes, I think it's crazy that PT, OT and SLPs keep doing the same business model despite these horrible conditions versus changing the business model. And that's where HODS comes in. That's where some really cool cash pay services come in that are going to be really powerful. He's like, you guys should have created stretch labs. You guys should have, you should have owned that space and you still can. And so if we came, if we had a little bit more profit in time and if we organize better, which is where HODS does it better than any organization, in my opinion, is that we get people together to talk about how we can change the industry, then we can move the needle globally for all of us, like a rising tide. So that we all have. Because here's the funniest thing is dme, you and I both know if all the people you and I work with tripled their profits, they would use those profits to like, better the patient experience and maybe take a vacation for once in their, their lives. Like, like the selfish return on that would be so unselfish from the outside looking in and everything else would go into the industry and then we would start preventing surgeries more. We'd stop opioid addictions. Like the, the cascading effect across the human experience in terms of health would be significant. And so it's interesting because we all know that within the industry that if we just had more profits and time, we could shift healthcare globally really dramatically. But my word, we stink at marketing because we just don't have time, we don't have the business training. So yeah, I think guys like you and I just feel very called and very fortunate to be in a position where we might be able to help organize and educate a little bit.

Absolutely. And definitely the solution you have provided of a lower cost of very highly capable individuals as virtual assistants that can help in many functions in an organization is absolutely extremely valuable. I mean we are using both in HUDs and in my hands on EMG testing our local diagnostic company. We do use virtual assistants for certain things. And the best experience I personally have is my personal executive assistant. She is a virtual assistant and she is, oh my God, absolutely incredible. I don't know what I could do without her. She is very valuable.

What country is she from?

Kenya.

Kenya. Do you know? I. I leave for Kenya in two days. Deanie.

You, you, you.

I'm going to Kenya in two days.

Nairobi.

Nairobi specifically. Yeah.

Oh wow.

I'll give you the information so you can maybe meet up for some Kenyan coffee.

Yeah. Send me her, send me her. Do an introduction in WhatsApp and then I'll reach out to you. Where I'm in Kenya and I'm so excited because like I love that you've had that experience. Everyone needs to have that virtual assistant experience. And I always tell people don't go through an agency. If you'd like to try doing it yourself, you can go. If you're going to hire one or two go to through like you know there's in, in the Philippines there's online jobs. Ph Africa has its own boards as well and it just depends what you're looking for. Some people are now going more towards like Central America and South America because there on similar time zones and they like the Spanish speaking. It just depends what you're looking for. But yeah like for everyone who's listening, like don't. You don't have to go through an agency. You can go try to do this on your own. Services like mine are for people who are looking to scale or just want to help people who don't want to do it. But Dini, like, you know it's funny because Africa, one of the reasons I'm going is because we're expanding into that country and we love. I was in Mozambique a year ago with my family and this is a cute story I just want to share because it's kind of related to the humanity. I took my four boys there and you know, an American father. I don't think I really did a good job of like pushing them to challenge them and, and make them work hard because you know, I don't know, I just didn't do a good job. So we took them down to Mozambique which is one of the poorest countries in the world hands down. It's usually tied in the top. The bottom five of the poorest. And it was rough. Like we're, we're digging latrines for villages that had earned it through this organization, Care for Life, this non for profit. And my youngest son, Van was 12 and he's big hearted and, and, and not. I've never really worked him hard and he was starting, he just started sobbing and I said, oh, buddy, are you just exhausted from the work? And he said, no, I'm happier than I've ever been in my life and I never want to leave. I think that what we forget in our physical therapy worlds is that we have the power to help people with technology, globally, we can serve, we can serve people in so many ways across the borders of our country. You know, whether it's an HB1 visa or whether it's a virtual assistant or whether it's just being really passionate about helping. I mean, it's really amazing. We feel such in scarcity sometimes the industry, but we are in a position where we, we are blessed. At the end of the day, we really are abundantly blessed.

Yeah.

And if we just had a little bit more time, we could see it.

Awesome. Yeah. Oh, my goodness. Let's see what is. Let's both of us answer this question. Take home message. Take home message for, for everybody.

Yes, please.

Watching or listening?

Yeah, let's do that. You know what? If it's okay too, I also do a rapid fire at the end of my podcast. I ask some questions. Would that work for you as well?

Good, do that, do that.

Okay, let's do some wrap first and.

Then we'll do that.

I like that because yours could be like, you know, our parting thoughts as we get into that, that space of it. So let me just pull up these questions really fast. Oh, there we go.

All right. Okay. So these questions, they're meant to go fast, so don't worry about getting them right. Just go as best as you can.

Oh, my God. Now I'm like, oh, okay.

Okay. So what's the insertion of the quadriceps? I'm just kidding. Rapid fire number one. What's the top book that you've read recently in the last couple years that's blown your mind?

And this is supposed to be rapid fire.

Oh, it's okay. Don't worry about it. So.

I'm going to pick in this.

Case.

You know, my spiritual journey is a little bit.

Very specific and.

I would say.

Something the 15th American ACC.

Okay.

It's very ritual and.

So the title is 15th American ACC DC okay, awesome. Love that.

Very good standing for American Clinical course.

Okay. Mind blow. Love that. Okay, next question. What's your top time saver hack?

My virtual assistant.

I hope she listens to this. Me sure love.

She'll, she'll listen to it. She'll listen to it.

Oh, I love it. Okay, number three. What's the one thing you wish you'd stop doing way sooner in your business?

Not.

Taking advice.

That or needed from statistics, but instead putting a lot more attention on how I felt about something, not about what the numbers showed.

That's powerful because it's kind of an arc.

Right.

Like we come in because of the passion and then we don't know how to track the numbers. And then we start tracking the numbers because we have to. And then we start making it about the numbers so it's a full cycle. Okay. What is the most time consuming task that you secretly enjoy?

Secretly enjoy?

It's kind of like a. Maybe like one of those where they call those. It's one of those things that you do that you know you probably shouldn't do, but you kind of love doing it, so you keep doing it.

No, you know what I enjoy?

Definitely having long.

Conversations with friends while wine tasting.

Ooh.

That'S a good one.

It's more than a couple of glasses.

More than a couple of friends and more than a couple of glasses come together.

Okay, and then what is. If you had unlimited time, what would you focus on in your life?

Training somehow Paul.

More than I do right now.

To create larger influence in society in general.

Yeah. Because your, your passion's huge for that larger dynamic.

Yeah, I mean, I, I if, See, if you can definitely you can deliver to a single individual and another individual. Another individual. But if somehow you can delay range someone who they themselves have, can influence a bunch of other people, then your effect will be much larger. Right?

Yeah, absolutely.

Like. Yeah.

Okay, well, good job. You answered those rapid fires very well.

Okay, I, I think this. I'm gonna have to go triple.

No, that will make my six shots for the day. So look, what time are we recording this? It's like almost one o'.

Clock.

I had the three. Wow. So the, the three ones are. Now we gotta go for the three afternoon ones.

So wait, how about we'll do take home message last words or something like that?

I like that. I like that. Do you want me to go? And then you'll, you'll, you can finish.

That's fine.

Yeah. My take home message for everyone listening is the importance of recognizing that there's hope that this is the best time in the history of our profession to be a leader or owner in the physical therapy space. Because we are at this kind of. I'd compare it to being like, in the real estate industry in market around 2008. The best time in the history of real estate to get into real estate was 2008, you know, and so a lot of people who'd been through 2006 and seven wouldn't agree in 2008 if they weren't able to see the future. But when you look backwards, like, oh, no, the beginning of great things was about to occur. We have so many things pivoting. So I just want to encourage everyone who's listening to never give up, focus on. On increasing reimbursement, Be bold enough to join an event. The hands on diagnostic symposium is one that I highly, highly, highly recommend. It has. That symposium has a lot to do with why I have my own events. So if you have to choose between the two, go to that one, because I wouldn't have mine without that one. It's a. It's a networking opportunity on steroids. So just be brave enough to build that network. And that would be my parting thought. What about you, Demi?

Yeah. Well, first of all, we have to make sure that our symposiums don't conflict in terms of dates.

I scheduled mine intentionally, not to conflict with yours. I scheduled mine in March so I would never step over your. Your November October event.

Awesome. Is. Is yours coming up this month?

It is. We have. We. We made the mistake of only giving 100 seats out, and so we're almost already sold out. Awesome. Awesome.

Where are you. Where are you hosting it?

Phoenix. We have this really cool spot in Phoenix where we have a state. You know me, I need to be the center of attention. So we. We have like a live band and then me and my comedic partner get up on stage and we do comedy songs about physical therapy. But the whole event is about learning how to recruit, train, and retain talent. It's all about the people side of the business. And we have come. Most people come from out of state, ironically. So we have people from across the country. And then we do something really fun. We invite all the local university students to attend one day to get interviewed, and it turns into an actual hiring event.

Wow.

And so half of the Arizona students leave the state and want to go out of. Out of state. So it's a perfect. People usually will hire. So it's fun. It's a lot of fun.

Fantastic. And you will give us also the link. So we're going to post it also.

In our podcast and vice versa, please, all the links.

Awesome.

Okay, final thoughts.

Amy, final thoughts. I mean, I totally agree with what you talked about and hope, and I want to add to that action. Right? Yes, there is hope to do something, but we have to do it. You have to take action on it. And if nobody's gonna just give you the world, he's gonna just come and tell you, all of a sudden, we're gonna double your reimbursement just because you are cute. Oh, you gotta do something about it. You have to take some action. And many people, they're like, many times in a. In a zone of indecision. They're like, okay, should I do this or I shouldn't do this? Should I do hads or I shouldn't do hads? Should I get a virtual assistant from Will or I should not get a. Well, you know what? The worst place you can be is the zone of maybe, because indecision is actually a decision.

So just indecision is a decision.

Absolutely. Indecision is a decision. It's a decision of not doing it, actually.

Wow. Oh.

Hey. Yes. Good. You're embracing the change. You are embracing the new. You are embracing the new opportunity. If your decision is no, at least you are freeing up your mind from being stuck somewhere in the middle not knowing what to do. And. And eventually you'll be able to put those attention units to something else that you want. Never be in the middle. Never be in a state of maybe or indecision. Just make up your mind and do something.

Okay. Demi, it has been too long. I am so grateful that we got to be together. I sure appreciate you being on the show. I. And honored every time I'm with you.

Awesome. Likewise. And you know what? I guess we should get our friend Nathan and, yes. Rio with that.

Let's do it. I would do. That'd be so fun, the three of us to talk and share memories from the battlefields of me calling doctors and hanging up after introducing myself and as an electrician, like, all the things. Like, we could do all the things.

Exactly. Be awesome. Thank you, Will. Thank you everything you do and appreciate giving the opportunity also for your audience to. For me to share with your own some of my thoughts. Thank you.

Thank you.

All right, so I guess we say. Yeah.

Okay. Well, Demi, thank you so much. Let's stay in touch and please. I mean that. Let's stay in touch. I'll. I'll send out all the assets and stuff and then. Yeah, man. Great to be with you today. I sure appreciate your time.

Sounds good. Likewise.