June 12, 2018

6 Areas Every PT Owner Needs To Address To Be Successful with Shaun Kirk

PTO 04 | Areas Every PT Owner Needs To Address


Shaun Kirk, PT has been consulting physical therapy owners for longer than he's been a physical therapist. This episode is a must-listen and my interview with Shaun Kirk is one that should be downloaded and replayed by every PT clinic owner and reviewed on a regular basis. Shaun shares from his experience of walking into over 140 clinics across the country to consult them, and having over 2000 PT owners walk through his doors to get trained. He knows his stuff and how to make a PT clinic successful. Shaun says that every PT owner should ask these two vital questions, which is what is your purpose, and what are the six areas every PT owner needs to address in their clinic? He says diligently working on your purpose and one to two of the key areas he notes will immediately pay dividends, but being successful and efficient in all six areas is going to guarantee success with your physical therapy practice.


My guest is Shaun Kirk. Shaun has been a consultant of ours for the last few years and has been consulting physical therapy owners and business owners for over twenty years. He's been consulting physical therapy owners for longer than he's been a physical therapist. Nevertheless, he's got a ton of wisdom and insight into what it takes to be a successful physical therapy practice. Because of his insight, support, training and consulting, there has been a number of clinics on the nation that have been extremely successful because of the things that he's taught them.

I want you to dig into a couple of portions of the interview that happened about midway through or so where we talk about purpose. It’s an extremely important topic to discuss, and make sure that you frankly have one. The second part is his six areas of a physical therapy practice that need to be addressed. Working on just one of those and making sure it's running smoothly and successfully with the right people in place will immediately improve your statistics. Being successful and efficient in all six areas is going to guarantee success with your physical therapy practice. If you address those areas, I can guarantee you success.

This is an episode where you're going to want to come back to over and over again because he lays down some great wisdom and insight that is true for any outpatient physical therapy practice. Take the time to figure out those six areas in your own practice and see how you can work on the one that needs the most work first and go from there, shore it up and move onto the next one. This is going to be a valuable episode for you and I hope you get as much out of it as I did.

Listen to the podcast here:

6 Areas Every PT Owner Needs To Address To Be Successful with Shaun Kirk

Shaun, thanks for joining me and being part of the podcast, especially since it's a brand-new podcast. Thanks for testing the waters and jumping in with me. I appreciate it.

No problem. Glad to be here.

If you don't mind, you've got a great backstory that involves not only PT clinic ownership, but business ownership and a significant amount of consulting. I know you in your experience from the past, but will you share with the audience your professional path? What got you into PT and what path you've been on over the past 20 or 30 years?

From the very beginning of college, I knew I wanted to go into private practice. I've had an itch towards orthopedics from the very beginning. I liked the fast results of it and I felt I was good at it. Honestly, when I came out of school, I had mittens on my hands and I couldn't feel anything. The truth is I thought I was a legend. Maybe that ego got me somewhere, but I went into private practice two years out of school. I was running an orthopedic study group a year and a half out of college for Southwestern Ohio for the APTA. It was like, “Why shouldn't I be teaching other physical therapists how to treat patients? I'm only a year and a half out of school. That's no problem. I'm seasoned.”

I started out with that and I like being in front of a group. I wanted to be a comedian in school. I was a class clown in high school and all that. I just love standing in front of a group of people. Whether they're listening or not was really irrelevant. I just stand in front of them and talk good. I ran this study group for Southwestern Ohio and I enjoyed it. I ran an outpatient facility for a hospital and they put me on television, radio and print. I think it's all me, but it was just the marketing arm of the hospital. We beat the marketing projections five times in our first year. It was just a crazy good thing.

I met with the senior management and they said they wanted to see a 20% growth rate for the following year and I said, "I don't know if it's possible. We have therapists with offices in closets. We can't possibly add any more staff." They said, "We don't want to add any more staff." I went back to the clinic and saw this therapist and said, "Can you see 20% more patients?" She says, "Are you kidding? It's 8:30. I'm doing my notes." She said, "What are you going to do?" I said, "I'm going to go into private practice." She goes, "Do you want a partner?" I went, "What?"

That was my plan. I didn't have any more plans than that because I felt I should go on private practice. She says, "My husband is an accountant. If you don’t set up your company correctly, the IRS will shut you down." I said, "Really?" She said, "What do you know about QuickBooks?" I went, "What's that?" Anyway, we went into practice together and it was doomed from the beginning so we ended up splitting. I went around and pounded on doors just like everybody else did, trying to get referrals and got met with some occasionally unpleasant experiences.

I met my wife in PT school so we're both PTs. I was trying to figure out what to do with my practice, how to turn this thing around. I remember sitting in the kitchen and I said, "I think it I'm going to get my DPT." She instantly starts crying. She's instantly bawling and she says, "How many letters do you think you had to have after your name to have the practice of your dreams?" I went "Eleven, maybe?" The alphabet soup after my name, that will work and I'll be successful.

My wife walked away and honestly, I left dumbfounded because I thought I was doing the right thing. I'm going to go get my DPT, that would make me a better therapist and then I would be successful. Not to diss anyone who's done that or is coming out of programs with that, but at that time, that wasn't the drive years ago. I ended up having this practice and I decided to go out on my own. I realized right away it wasn't my clinical skills that was the problem; it was how to run a business that was a problem.

I don't think you're alone in that. What part of owning the business was such a headache for you at that time that made you think, "I need to go get my DPT?" In my experience, and you might have a different experience, if you're talking to a lot of new PTs that are coming out, they're so focused on, "I want to get my certification in this and I want to get better at that and then I want to do better at this and improve all my skills so much." If they're focused on owning a clinic, that's not the kind of education that you need. In your case, what led you to the point where, "I need to do something different?"

What led me to that was being broke. That's a pretty good motivation. I had a practice that had me. I had a receptionist who read magazines, my mother-in-law worked for free doing billing, and I was as broke as I could be. I realized I was a pretty good therapist but I had no clue how to build my business. Not everybody wants to be a private practitioner and there's nothing wrong with those that who don't, but those do and are failing, it's not hard for them to figure out that it's not the next con-ed course for shoulders and knees that's going to turn their business around.

Eventually, they'll realize there's a know-how that's missing on how to build a relationship. Sometimes the doctors will say, "If you open up a clinic, I'll send you a ton of patients." If they didn't qualify that definition of a ton, because they send ten 200-pound men which equals one ton, you don't get any more business than that. Then you're wondering and scratching your head, "How do I get this year and how do I build my business?" I fell into that trap and I had doctors saying, "I love you. You're amazing. I'll send you business." It just didn't happen. I knew that that skill was something that was lacking.

What was your next steps and what did you do at that point?

For me, it was an unusual situation. I was reading every self-help book that I could possibly get my hands on. I was trying to find the holy grail of solutions. It's something that was easy to do and very effective because inherently, I'm a bit lazy. I like the idea of figuring it out with the least amount of moving parts.

I got a phone call one day and I answered the phone. This guy invited me to a workshop on practice management and I thought, "What the heck?" I didn't even know what that word means? I went with my wife and we loved what we heard. There were 40 different businesses there. There were chiropractors and dentists and CPAs and physical therapists. It all made sense. I was electrified with excitement. When the seminar ended, there was a guy who walked up to us who was the same guy who gave me my name tag. He reached out his hand and he shook my hand. He says, "Mr. and Mrs. Kirk, I wish you nothing but success," and he starts walking at us so we start backing up.

The next thing you know, we're out in the hallway of the hotel. He walked back into the room and we were the only ones out in the hallway. We were absolutely the biggest losers in the room. I wasn't writing a paycheck, my mother-in-law worked for free, my receptionist read magazines. I was a loser in every way, shape and form. I wasn't qualified. I couldn't write a check for their program. I was whiny and bitchy about like, "It's all me." It's like, "It's all them." I was to blame with my lack of success.

My wife then starts walking to the car and I grabbed her arm, I go, "What are you doing?" She goes, "I'm going to go to the car." I said, "I want to talk to these guys." She goes, "Do you know that we're the only ones in the hallway? Everybody else is inside talking to salespeople and we're in the hallway." I told her, “I'm going back in.” I walked up to the guy who gave me my name tag and I said, "Is it possible that somebody can help me?" He says, "With what?" I go, "With my practice. I'm dying." He said, "Could you step back out into the hallway?" We were in the hallway like expectant parents walking back and forth pacing for the opportunity. A guy comes out twenty minutes later and he says, "Do you think you could come back tomorrow at 10:00?" I go, "Sure, I’ve got nothing going on."

I came back the next day and I sat down with this guy who I thought was a sales guy or a consultant and basically found out ten years later that everyone said, "Are you kidding? He's the biggest loser in the room. You need to broom him. We don't have time to talk to him." He said, "I don't have the heart." They go, "Then you sign him up." He sat down with me and he says, "Are you good at what you do?" "Yes." He goes, "Are you good on your business?" I said, "No." He then puts this program out in front of me that looked like Monopoly money. It was crazy expensive. I said, "You're not paying attention to the part where I said I'm not writing your paycheck." The guy says, "I'm sorry, but this is our program." My wife says, "Maybe mom and dad can help us out?" I said, "Your mom has worked for me for a year for free. I can't ask your mom and dad for money." She goes, "I can."

Sometimes you run across people in your lives that profoundly change your life in a positive way. For me and for my wife, it's been our in-laws, my mother-in-law particularly. She believed in me when no one else would. She knew that I was way more capable than what I was doing every day. She trusted that I would do well and I would be a good investment. She paid for the program. I built up my practice, I paid her back her back pay. I bought her a car, I paid her back training. I sent them to Alaska of all places on a cruise, and I actually paid to have them come back. It's a gift that kept on giving and really realizing I’ve got my affinity towards practice management with the same affinity I had treating bumps and back conditions. Everything just took off from there.

PTO 04 | Areas Every PT Owner Needs To Address
Areas Every PT Owner Needs To Address: Physical therapy fulfills a purpose.

I love that you represented your mother-in-law that way because there are people out there that are rooting for us even though we feel like the biggest losers. They might not be saying it, but it's there in their hearts and it's just not out there. It’s good that you represented her in that way.

Sometimes people believe in you long before you believe in yourself. For me, I've been a consultant and have been in and out of about 145 or more practices over the years and definitely been to your place before. For me personally, in many situations, I believe in the client long before the client believes in themselves. That what's allowed me to have relationships like I have with you guys and with other clients over the years, it’s that we're friends. It's because I see greatness and I refuse to see anything other than that.

You might've felt like this back in the day when you had your clinic, and I felt it at times when I had my clinic, but sometimes as a physical therapy owner, you feel alone. I question the networks that are out there for physical therapists because they don't seem to be readily accessible or readily visible and supportive to the independent practitioner. What we tend to do and the guys that I interview and talk to is that they end up finally reaching out. Instead of reaching out somewhere in the beginning to learn what we didn't learn in physical therapy school regarding business management or any kind of business acumen whatsoever, we end up going through the school of hard knocks and getting some bumps and bruises along the way before we finally decide it's time to reach out.

One of my goals with the podcast is to help people understand that it's time to reach out well before you hit that point. Reach out, step out, whatever you’ve got to do, network if you need to, to get the support that you need. There are people out there that are doing it and are being successful and they're willing to help. At times, you need to make an investment in your education to learn how to run a business if you're going to be a clinic owner at some point. Go on a little bit about what happened from there. You had a successful practice for a number of years. What happened then along your professional path?

For me, I had my practice and it was growing and I was enjoying it. I wanted to be a comedian. That was my passion. I told jokes all through high school and I was a matchmaker in high school and I just love people. It wasn't Bob Smith's back condition that excited me; it was Bob Smith. It was the people that I loved. It was how many back-pain patients do you need to see before you go, “I think I’ve got this figured out.” I started to enjoy relationships and mentoring people and bringing them along.

As I started to learn more and more about practice management, I got to where I was working about eighteen hours a week. Two hours a day, I was treating patients. The other eight hours, I was running the practice the rest of the time. I was sneaking out in the afternoon and going and visiting my patients who own businesses and help them grow their business. I have a patient who's got a dry-cleaning business. I go, "How do you get clothes clean without getting wet?" He goes, "It's quite a process."

I was like, "Can I come over and help you with it?" He goes, "Do you want to see how I work my shoulder?" “No, I like to see if I can help you expand it.” I started sneaking out with patients. Every time one of my therapists was treating a guy who owned a business, I would latch onto him, "Tell me how did you get into this?" I got really intrigued. Then I started working with dentists, podiatrists and travel agencies. I started noticing that I was coming home excited about going into a guy's business and helping him with his business.

I was at this crossroads where I was looking at opening up to other clinics because that's what you're supposed to do. If you’ve got one that runs well, go and do more. I was looking at it and I had a lease on a 10,000-square foot place and another 5,000-square foot place. Another guy that I worked with, I said, "I don't know why but I'm not happy about this." He goes, "Why?" I said, "I don't know. For some reason, it doesn't feel right." He goes, "Let's take a look at it from a point of view of purpose. The purpose is something you've been doing your whole life." Physical therapy fulfills a purpose. He goes, "What is that thing you've been doing your whole life?" I thought about it for a minute and I said, "Help people."

He goes, "Great. Good. Does physical therapy help you with that?" I said, "Yes." "Any other purposes?" I said, "I like to help people so that they can help someone else." He goes, "Good, how'd you do that?" "I taught continuing ed." "Good, any other purposes?" I thought for a moment and I said, "I like to improve conditions in people's lives." He said, "Does physical therapy help you with that?" I said, "Yes, I get people back to work or sport or activity of daily living. It does fulfill that purpose." "That's good, but yet you're wondering whether this is what you want to do. What do you want to do?"

"I like the mystery and the investigation of trying to figure out another guy's business problems." He goes, "Does it help people?" I said, "Yes, especially guys who are in helping professions. I can help people in businesses in helping professions and they can help more people." "Does it help someone so they can help someone else?" I said, "Yes, I can help a business owner, he or she becomes more successful, they help their staff, their staff comes up and they do better." "Does this improve conditions in people's lives?" "Yes. If a business does better, they're more successful and more profitable, they'll be able to take care of their personnel." Then I went, "I should be a consultant." I came home that night, I said to my wife, "I'm going to sell my practice." She goes, "Okay." "I'm going to start a consulting business." She goes, "I saw that coming." I sold the HealthSouth and started up a consulting business and never looked back. I've been doing that for over twenty years.

I love how you talked about purpose and I hope that people hone in on that because once they find their purpose and what aligns for them, then other things tend to fall into place. Decisions become a lot easier, right?

Absolutely, they do. When you know your reason why, purpose is the reason why. I talk to practice owners all the time, untold numbers. I’ll say, "What do you think is your driving purpose? What do you think you really want to accomplish?" They'll say, "I want to have five clinics." The obvious question is, “Why do you want five clinics?” “I like the number five. It’s a good number.” The purpose is the reason why. Why you want five versus one? When you ask that question and the guy goes, "I'm really impressed with what we do. We have a model that gets results with patients and I want to bring it across my city," that guy has got a chance.

The guy who goes, "I don't know, I like five. I think five is a good number. Don't you?" or something like that, it's like, "Forget it. You aren’t going to achieve it. Let it go. You're not going to be a ballerina. It's not going to work out for you." Purpose is the reason why. Those of you that are in private practice and you're looking at how things are going or what you'd like to achieve and you want to achieve something, you better have a very powerful reason why you want it or you'll never achieve it. If you say, "I want to open two clinics," you better know why. If you say you want to add interactive metronome, whatever that is, in your practice, or whatever, you better have a why.

It's one thing to say, “I want five,” and for many people it might be like, "I want to have greater numbers. I want to see growth. I like the net revenues that I'm getting now. If you'd multiply that by five, then I've reached a financial goal of some kind or another," that still doesn't answer the why. What are you going to do with the money because there's no guarantee that's going to be there? Are you going to push through the hardships that it takes to get to that point? You better have a stronger purpose than some financial goal or a number goal or something like that if you want to take the effort to do that.

In terms of my company, I've had 2,600 private practices come through our doors over the years. It's interesting, you'll have a program of how you handle and practice, it's very similar almost practice to practice. The ones that do really well and the ones that do okay is just separated by drive, command and purpose. Some people are dumb as a box of rocks and find every way to do it wrong. Those guys exist, but in general, the people who want to make something happen and whether to do or not is driven by how badly they want it. Are you willing to overcome some barriers to make that happen? If it was easy, everyone would do it. It's hard work.

You better have a strong purpose because when those trials come up and they're going to come up, you’ve got to have a reason why you're going to push through or those things will falter for sure. You're consulting now and doing a lot of training. Would you say that's one of the consistent issues that you come across in the number of clinics that you've been to or are there other things? Are there marketing programs out of whack or their financial is poor or are they not able to hold people accountable or they’re not hiring the right people? Can you nail it down to purpose or are there other aspects that you see consistently as an issue?

Purpose will give you the fire in your belly and the reason why. That's all good, but it doesn't necessarily make you competent. It gives you the reason. It's the fuel behind what you're doing. You can actually have the machine all tuned up, but it has no fuel in the engine. At least, if you have fuel in the engine, you’ve got a chance to go somewhere. No matter what practice, large or small, I always look at just six things. If you can do those six things really well, you're an amazing practitioner. If you do not, then you're not. Those six things are effective marketing that brings about new patients. You’ve got to have that.

I always think it's private practice. People who start private practice is very synonymous to getting married. What I mean by that is when two people love each other and decided they are going to get married, it's like, "Where are we getting married? Who's going to be the celebrant for our wedding? Where are we going on our honeymoon? Are we going to get an apartment?" Then you get married and you look at each other and you go, “Now what do I do for the next 50 years?” Sometimes starting a private practice, what happens is like, “Where are we going to put this practice? What's our color scheme? What's the name? Are we going to do extruded letters out front or just a big sticker on the window? What kind of equipment do we get?” All of a sudden, your doors open up and it's like crickets in the clinic. There are no patients. We dress up for the event but we don't plan for the duration of the event. Sometimes people go into private practice without confronting the estimation of effort that it takes to be successful.

These six things, one is external marketing. How do we get new patients in the door? The second thing I look at is schedule for control. If you have weakness at your front desk, you're losing buckets of money. If you've got a receptionist that doesn't have a 92 or above arrival rate, then you need a new receptionist. You look at two things. Of all the things a receptionist does, there are two things you can write a check for. Those two things are high percentage of patients that keep an appointment and collecting all the money that's due at the front desk. If they can do those two things but they can't put a chart together to save their life, you should keep that person. You have to look at the front desk and schedule book control because reception is to receive. They are there to bringing people in, they're about filling the book, they are about looking for people who are missing in action and drawing them back in because they're passionate about the delivery of the service to better people's lives.

If you overburden your receptionist, which is too much crap, watch your stats crash. It's going to crash. Some people try to save money and they just keep dumping it on the receptionist. Eventually, you're not saving money because all of a sudden, the phone rings and they’re pissed off because they answered the phone, “That's your job. That's one thing you're supposed to do.” The phone just keeps ringing. You should be happy about that. Scheduled for control is number two.

Number three is case management. How are we managing our cases? People go, “What do you even mean by that?” This is the discharge, the frequency that you see a patient. There's a study done that showed 2.3 patient visits per patient per week had better outcomes than more than that or less than that. When you see a patient, 1.5 five times per week, your scheduling in general is less than two because you’ve got cancellations. If you schedule two times a week and you have a 10% cancellation, you're going to be at 1.8 times per week. Being above 2.0 to 2.3 is important.

You can get therapists who go soft and a patient got high out of pocket or something like that. They go, "Let's just see one day a week and then maybe someday you'll never get better." When that patient doesn't get better, they don't go, “The therapist is taking it easy on me.” They go, “Therapy didn't work.” Physical therapy is the problem, so they go up and see a crystal hugger or a massage therapist or acupuncturist or rub two pennies together and they'll hope to get better. It's because we didn't do our job and we didn't get that patient overcome the barriers to get the service that they need to get better.

PTO 04 | Areas Every PT Owner Needs To Address
Areas Every PT Owner Needs To Address: We get all wimped out about fees and yet all the patient wants to do is get better.

One thing I've always felt very strong about in case management, as you know, I'm a pretty good sales guy. I’ve become a very good sales guy and purpose has driven that. If you had a therapist who believes in what they're doing, and I'm not talking about anybody who's just a PT practice owner, I'm talking about a PT who believes strongly in what they're doing, who believes that they do change lives and improve conditions in people's lives. They need to be able to get that viewpoint into the minds of all of their patients that those patients have to do their part that's necessary to get better. That is coming at a certain frequency and a little visit. Do your home program. If you’ve got a therapist who wimps out because of costs, you're doing a disservice to every one of your patients.

It's not just your patients, you're doing a disservice to the profession. It's not overblown but you're starting the beginnings of a reputation, at least in that person's mind, and they're going to spread it to everyone else that they know that, “Physical therapy doesn't or didn't work for me,” because the therapist wasn't capable of finding their purpose and what's best for the patient and getting over their issue that the patient might have a high copay or a high deductible and work around that or help them over that issue.

You've been in practice for a number of years. I was in practice for a number of years. If you look at your patient load of patients that you've seen in the past and have had therapy elsewhere, they never say anything about the therapist was all about money. They say, “It didn't help me.” That's what they always say. If they complain about PT and they've been elsewhere, they say it didn't help. They didn't say, “They’re $20 more than you.” They never say that. They always say they didn't get help. We get all wimped out about fees and yet all the patient wants to do is get better.

As a profession, in the general sense we are pretty ethical on how we manage our patients. Sometimes I think were unethical and this is what I think. Let's say you have a great insurance plan and I assessed your condition. I think you should come in three times a week for the first two weeks, two times a week for the next couple of weeks to say. That's what I believe in my heart of hearts that that's what you need. All of a sudden, I find out you’ve got a crappy insurance plan with a high out-of-pocket expense. I go, “Why don't we just see two times a week for the first two weeks, then one time a week for the next two weeks?”

Which one’s unethical, the first one or the second one? If you think a person needs to be three and two, then suddenly you change it to two and one, which one's an unethical? Are you over-treating in the first category or are you under-treating in the second? If it's ethical, it's just the right thing to do. Instead of just looking at you are allowed to have your pain for a long time because of the high out-of-pocket. Why make a judgment for the patient? They got their cable TV, they got their cars. You can work this thing out. You’ve got to toughen up. PTs who are spineless in this area have a practice that suffers 100% of the time.

External marketing, schedule of control, case management. The next thing I look at is internal marketing. There’s a gold mine in internal marketing. It’s one thing. If you have patients that come back and you haven’t seen him in years and they go, "Do you remember Jimmy? He got into Stanford." You’re like, "That’s awesome. Who's Jimmy?" Physical therapists are like the hairdressers of healthcare. Generally speaking, if you think of hairdressers, people tell their hairdresser everything. Honestly, how many times have you had a patient say, “I've never told anyone this.” You want to go, "You're batting a thousand. You're doing really good. Just open that door up right now. You might regret it. Don’t close that door." I can't tell you the number of patients who told me things. I can't even get this picture out of my mind.

We care for them and they know what we do, and so they hang on every word. They come back a year or so later and they do pick up where they left off. They know about your kids. They know about your family. You’re one of the most important people in their lives. Why the heck can't we ask for referral? I was always pretty hardcore in this. I would be like, “Nathan, it looks like Friday's your last day but I'm not going to be able to let you go. I was calm and like, “We haven't replaced yourself yet.” You chuckle, I chuckle. “Do you know anyone that needs our help?” I cornered people.

Old people are fantastic referral sources. They're the most intelligent people in the healthcare world because they know. Their little black book has a lot of MDs in it. They definitely know good care from bad care, caring individuals from just next. Those older people, to be able to tell them they have a job, and their job is to find people who need our help instead of letting them suffer until somebody directs them to us. If you're confident enough of what you deliver, the results that you get, and that you are about helping as many people as possible, you will not be spineless in this area. If you are, you'll just lay them on the table. Internal marketing is number four and it's very key.

The fifth thing I look at is billing and collections. Are we coding properly? Are we collecting copays and deductibles? Simple things, but they do make a difference. That's the money side of the machine. That's the end product of doing a job well done, the billing and collections and the management of that, to follow up on accounts. The sixth thing is a very simple thing. Do you have the right people and do you have them on the right seats of the bus? If I walked into your office and there was no receptionist, I would think that was odd because there should be receptionist here. In 2,600 practices that crossed our doors, less than 5% of these practices had a staff member who had a full-time job driving in new patients. Someone should be in the practice who isn't there. The typical practice owners are like, “I wish I had more patients.” What are you doing?

Most of them spend less than five hours a week doing anything actively to drive business in the door. They go, “I don't understand why I'm not busy.” I’m like, “Probably because you're not doing anything to get busy?” That might be that. One of the things that I recognized early on with my practice is that I needed to figure out how to get business in the door and being able to do it in a way that was easy and have that right. I wanted to figure out something that didn't require a lot of technical savvy that could have some basic foundation that if followed would make a difference. I started doing that with my practice.

If I was going to walk into anybody's practice, I go, “I'm going to walk in and I want to do something to better the practice.” The very first thing I would do is I would be all over the front desk. Do we have the right people in the right seats on that bus? What is our cancellation rate? I like to invert that and call it arrival rate because when the number goes up that is a good thing. Arrival rate is better than our rising cancellation rate. I would be all over that. That's always my primary target. Truthfully in business, it's easy money. As you know by working with us, that's always the first thing we jump on, schedule book control. It's easy and it's very easy to quantify, but if you've got a weak front desk, you’re probably weak on your collections and weak on a lot of other areas. That’s always the first thing I jump on.

I'm assuming you see this, it's very common. You're able to rattle off the top six things that you go into because you've been through a number of practices. There's typically a hole in, what would you say, one or two or more of those six areas?

Sometimes you can find that case management isn't that far off. Sometimes you can find that their billing and collections practices are pretty solid, they're on top of their compliance points and stuff. You'll find where they are weak is external and internal marketing and schedule book control. The thing about the internal marketing is I haven't found too many people that see the value of that. If you looked at your stats and anybody else, usually about 50% of your patient load are patients who've been there before. What are we doing to get that? We provide excellent care.

That's not a marketing campaign, that's your job. What if we actually did a little bit of a boost? What if we offered free screens? What if we did something like, “Nathan, I'm going to be letting you go, but I want you to know that all of our follow ups are free. If your knee or your shoulder is bothering you again, I want you to feel free to give us a call and we'll take a quick look at it. If we need to see you, we’ll start seeing you. If we don't need to see you, we’ll recommend a couple of solutions. As a matter of fact, you’re such a pleasure to work with. If you have any friends or family members that have any problems, just let them call and drop your name. We’ll be happy to take a look at them for free.”

That cost you nothing other than really crafting the communication with sincerity. The first time a patient comes to PT, pay careful attention when you take in your initial eval. You listened to their story. It's like, “I hurt my back and hobbled around for a while. Then I went to my family doctor. I went on some pills. I came back two weeks later and went on some other pills. Then they sent me to an orthopedist who then did an X-ray, and then they said I go to therapy.” It's a month and a half before they walk in your door. Once they've walked in your door, they realize, “I don't need a month and a half, I'll just call Nathan.”

They call you, “What do I do?” Depending on your state, they can walk right in the door. Hopefully if you're in one of the states that have direct access and all, you should make sure every patient understands that because what you've done is you shortened the runway from the decision that I need care to getting care. There are so many things in the internal marketing world that doesn't necessarily show up right away, but if you keep doing it, you have people coming back calling you for advice, sending their friends, those types of things.

It goes back to your purpose. One of our successful actions in our clinics in Arizona is to push the internal marketing because there are many people who love what we do and are on our bandwagon when it comes to physical therapy. We'd get return clients for years and years. It's hard to get the providers over the feeling that they're being salespeople and reminding them what their ultimate purpose is. All your training is about helping people get better. If you're not actively promoting the fact that you can get people better and you can rehabilitate better than anybody else in the healthcare profession, then you're doing yourself a disservice and you're not following up with the purpose that you set out to do in the first place.

It's tough and I was excited to hear you get on your soapbox because I could get up there as well a little bit. There's a gold mine there. It's much easier now with email campaigns that can be automated. You just get those email addresses. Social media can work to an extent, but there are many opportunities to touch those past patients, the opportunity to do direct mailers to them and to follow up with them. That list grows while your referral list of MDs stays pretty stagnant and static. You can always follow up with current technology to access that goldmine of pot of patients.

It's a misunderstanding of sales. Sales is something where people see it as a bad thing. I hear it all the time, “I don't like to sell.” It's like, “Really? Do you like to get patients better?” “Yeah.” “Do you have to get them to do their exercise program?” “Yeah.” “Are you closing on that?” If the patient's not compliant and you're saying, “You’ve got to show up or I can't get you better,” are you not closing them for that service? I was at a workshop and this one guy said this thing and I've been using it for last twenty years. It's something I stole from him. He said sales comes from an old English word sellan, which means to give, to offer or lend a hand. Years ago I would say, “I’ll help you with a barn and you're going to pay me back with a deer.”

PTO 04 | Areas Every PT Owner Needs To Address
Areas Every PT Owner Needs To Address: True sales is a helpful option and bad sales or any odd feeling about sales is when it's not helpful.

The odd thing is you're carrying this deer on your shoulders for days trying to find me and it starts to smell bad. We figured there needs to be some other way of handling, and so as currency, gold and silver came along as a standard. The dollar’s backed by gold and dollar’s backed by silver. Now it's just dollars back by other pieces of paper. We assign a value to that. True sales is a helpful option and bad sales or any odd feeling about sales is when it's not helpful. If you believe that that patient needs that care and you're doing it from “I'm helping that individual,” then getting in their face and being straight with them is right and it's ethical. We see it so many times and you go, "It's awfully expensive." I totally understand. It's not a problem. It's like you did a disservice to the patient. It means you will not take any money because you're not going to get the patient better.

If you look at sales and help, they do fit. We’re looking at a computer screen and in that computer it's like somebody sold this computer to us. Somebody sold it to me. Does it help me? Yes, it sure does. Is it good and handy? Yes, it does. What if I walk into a place and I want to buy a computer and I go, “How much is it?” He goes, “That's $2,000.” I go, “It’s so expensive. I could only pay $100.” “We don't have a computer for you.” Sales is that. PTs who can't sell and go into private practice are broke PTs. That's who they are. If you are an executive, you are a salesman. If you're doing anything, you're selling ideas. You're getting your staff to take that hill that takes sales. If you suck at sales, you suck at private practice.

I'm pretty passionate about this profession. What I love about physical therapy, these individuals who take on this profession have taken it on for noble reasons. They want to help people. They want to change lives. They want to better people. There are a lot of things you can go to college for and you can learn, but there's nothing better than taking on a profession that helps people and that is what we do. For me, I've always loved the fact that I help people who help people. I'll never be doing anything other than that.

It's obvious that you've got so much experience in seeing how things have gone right and how things have gone wrong and how you can correct those wrong things. Also, it's so succinct. You nailed it down to the six different areas to assess. Your passion shows through in that and that's awesome. Many physical therapists are the same way. Some of them have the experience and have had some success and some haven't. That's why people like you exist because your passion is there to spread the wisdom, share the wealth.

Sometimes you have to have someone kick your butt until you can kick other people's butts. I remember, for me I had a receptionist that read magazines. She was very good at it and she could read three at one time. It's a skill. It’s not very popular but that was what she was able to do. I remember doing this training and my consultant gave me this program, a little step by step list of actions that I agreed and she agreed that I should do and it would better my practice. Step one was to have a staff meeting, go over the basics of what I had learned, get everybody on board. I was to talk to my receptionist; her name was Terry. I was to talk with Terry and let her know she needs to fly straighter or she's out of there.

Then I had step three. I had a phone call about ten days later and I get her on the phone and she's like, "How's it going?" “It’s going great.” We’re small talking for a second. She goes, "Did you get that program I gave you?" I knew she was going to talk to me about it because I didn't do step two. She was like, “Step one, did you have your staff meeting?” I go, "It was amazing. We laughed, we cried. We held hands and sing Kumbaya. It was such a bonding moment." I keep on talking and she said, “Good. Number two, did you talk with Terry and let her know she needs to fly straighter or she's out of here?” I said, "I was so busy. I have so much going on. I honestly didn't have time to do anything." She says, "That's totally fine. How much time did you black out for me?" I said, "An hour." She goes, “Great.

We've only been on the phone for about ten minutes, so how about I hang up right now and you go ahead and talk to her. Bye." All of a sudden, it felt like I got punched in the chest. I'm pitying and I'm sweating and I'm like, "I have talked to her." My consultant is Israeli and she spent two years in compulsory military. She said she's going to kick my butt, I felt like it would happen. I was very much afraid of her more than I was afraid of my receptionist. What I did was I walked up to Terry, our receptionist and I said, "I need to talk to you." I sat her down. I said, " I'm going to have to tell you, if I catch you read magazines during work hours, I'm going to let you go.” Her jaw gapes and she goes, “Ah.” I said, “Did you hear me?" She said, "Aha." I said, "Good. Number two, if you fail to acknowledge a patient when the patient comes in the door, I’m going to let you walk out the door. Got that?” She's like, “Got it, I'm good.”

I went through eight things cool as a cucumber, then she says, "Should I be looking for another job?" I said, "Yes, I don't think you're going to make it through the week." She goes, "Could I leave now?" I go, "Sure." She gives me her key and she walked out the door. I turn around and there's my mother-in-law with a double high five. Then my PTA gives me the chest butt. I go to the phone, I call my consultant. I said "I did it." She goes, "You did it." She said, “Good. Number three.” I looked at the next step of the program and I never looked back. Any good consultant serves as a cheerleader and a coach at the same time. They validate the client who does well, “Well done, that took some courage,” and they're there to put a boot in your butt if necessary. They get you to overcome those things. It all gets easier after you do it. Thank you, Nathan, for inviting me into this. This is awesome.

It was great. You have so much experience to share. If someone didn't get something out of this then we can't help those people. If we had stopped at purpose alone, that would have been a lot for probably half the audience. Not that I know, but so many people are flying without a purpose. Your six areas to focus on in the clinic is invaluable stuff. If someone works on just one of those aspects, then things are going to change. It's not the end all be all, because holding people accountable is something you have to do as leader. Leading a team is another thing. Systematization of maybe meetings and protocols and statistics and reporting are all other things that have to be dealt with. If you just get down to some of these basic principles then you can progress and change in your business.

I've seen a lot of practices, particularly small practices, they get overwhelmed with so many things. You're right, just give me or find me one that the guy can do that's within his capability and resources available, one where he can quantifiably see the difference. Sometimes it's just like the front desk and getting a little bit better control of that. When they get that, they would feel a sense of pride, “I took that from that to that. Look at what it did to my numbers. What's next?” You overwhelm any guy. “You’re capable. You can do it.” It’s like having a baby. It’s like, “Come on, crawling’s good.” We can't be pole vaulting by year two, right?

No, step by step. Shaun, thanks for providing so much information. If people wanted to connect with you or get in touch with you and see what you're doing and where you're at, how can they contact you?

The easiest way would just be to use LinkedIn. We can connect that way. Just reach out to me on LinkedIn and if you have questions, I'll be happy to help you out.

If people have questions they want to shoot off to Shaun, they can also email me, Nathan@PTOClub.com. Maybe at later episode or something, we can bring you back to answer some individual questions that some of the audience might have. Would you be open to that?

I'm totally open to that.

Thank you, Shaun. I appreciate your time.

Thanks, Nathan.

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About Shaun Kirk

PTO 04 | Areas Every PT Owner Needs To AddressAlliance Physical Therapy Partners is supported by a very successful private equity group. Our strategy is to partner with private practice physical therapists by making a sizable investment in their practice and help them to build their brand.

We do not change the company name, owners or corporate entity. If you are curious, I would suggest that I connect you to our Director of Business Development who can assist you.

My role with Alliance Physical Therapy Partners as the VP Operations, is to work directly with our partners to assist them in expanding their practices, identifying other practices in their area that could be "tucked-into" their practice in order to build their brand. In short - help our partners reach their goals, create growth in their practice while creating a best in class experience for all their patients.

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