I'm excited to have the opportunity to interview Dr. Heidi Jannenga of WebPT. If you don't know Heidi, she is the Co-founder and President of WebPT, the country's leading rehab therapy EMR platform for enhancing patient care and fueling business growth. Since the company's launched in 2008, she has guided WebPT through exponential growth. It's the fastest growing physical therapy software in the country, employing nearly 500 people and serving more than 75,000 therapy professionals at more than 12,000 clinics. WebPT is also ranked five consecutive times on the prestigious Inc. 5000 list and twice on the Inc. 500. She has been recognized as one of Health Data Management’s Most Powerful Women in healthcare IT, an entrepreneur of the year finalist by Ernst & Young, and most admired leader and tech titan by the Phoenix Business Journal among other accolades.
Prior to co-founding WebPT, Heidi practiced as a physical therapist for more than fifteen years. She regularly speaks as a subject matter expert at local and regional technology, entrepreneurship and leadership events as well at national PT industry conferences. She serves on a number of Boards and organizations including the Arizona Science Center, Support My Club, the Physical Therapy Political Action Committee, the Institute of Private Practice Physical Therapy, Conscious Capitalism, AZ Chapter, and the Arizona Community Foundation. She also dedicates time to mentorship within WebPT through her women's empowerment group, PropelHer and in the broader community through her work with physical therapy students and local entrepreneurs.
WebPT came out with their state of rehab therapy based on a survey of over 7,000 rehab professional respondents. Heidi and I are going to talk about four things that came to the forefront from their surveys. In this episode specifically, we're going to focus on one striking aspect that has to do with physical therapy ownership. That is the fact that a number of owners lack a marketing strategy. They're unaware of what they're spending on marketing and they most of the time fail to have a growth strategy in place. We are going to talk about some of the data and statistics that came from that and also look at some of the past, current and future trends for new patient acquisition. I hope you get a lot from this episode, but you can refer to the WebPT report it's on their website. Go ahead and check it out.
My guest is Heidi Jannenga, the Founder and Owner of WebPT, a leader in our industry. Thanks for coming on, Heidi.
Thanks so much for having me, Nathan. It’s an honor to be one of your guests.
I know everyone throughout the industry knows about WebPT. Do you mind going into a little bit of your backstory and sharing with the audience where you came from as a PT or even prior to that? What got you to where you are ten years into your ownership of WebPT?
My interest in physical therapy started when I was in college. I was a high school athlete. I went on to play basketball at UC Davis in Northern California and injured my knee during my junior year. I was pre-med going into college. I had a knee injury, the MRI was inconclusive, but they saw some things going on with my ACL. They said, "We're not sure. We don't want to go in for surgery. We're going to send you to physical therapy." I've been in the athletic training room as most athletes know very well but hadn't had much experience at all with physical therapy. I was sent to an amazing therapist whom within about ten weeks had me up and running and back playing again with a brace.
It intrigued me to learn more. I did a few volunteer internships and I ended up going on to PT school after I graduated from UC Davis. I went to the Institute of Physical Therapy, which I was in the inaugural class with Stanley Paris and Catherine Patla for their Master's program. They had done a lot of postgraduate work, but this is their first program. That was a unique experience. I had lots of training from two amazing gurus. Then I went on to practice sports medicine in private practice. I practiced for about fifteen years and worked my way up over time to clinics directors. In 2006, I was a clinic director over a few clinics here in Arizona. One of our biggest expenses was transcription and dictation.PT owners lack focus on marketing and growth strategy. Click To Tweet
A lot of our referring physicians had transitioned into using some digital documentation or electronic medical records. I thought there had to be something out there for therapists. I went out, found some very clunky server-based platforms that were super expensive. Even at a clinic my size which we had about 40 employees, I still didn't think it was an appropriate capital expense. I partnered up with a software engineer and we put our heads together. We built something that was originally just supposed to be for my practices. We’ve got something up and running and got very positive feedback from my therapist. It took about nine months to build. Then within the next six months after we got our clinics up and running, some of my colleagues said, "What are you doing over there? We want to try it."
Within another six months, we had about ten clinics up and running, all giving us positive feedback. We continued to iterate on the process. In the middle of 2007, we decided to do a little bit of market research and found that 80% of therapists were still documenting on pen and paper. The light bulb went on and we decided to launch the company in February of 2008. We launched the Combined Sections Meeting in Nashville in 2008. We had no customers outside of those that we had in Arizona who were using our platform and one employee. We are celebrating our tenth-year anniversary, which is amazing. It's like the blink of an eye, it's gone by that fast.
That conference with one employee, I'm sure that was just like a hockey stick that went straight up.
It's been an incredible ride. We now have 500 employees. We’re not just located here in Arizona, but in eight other states and serving 12,000 practices. I stopped practicing in 2011 after my daughter was born, and that was a hard transition year of going away from your identity as a person, your career. Obviously, I still have so much pride in being a physical therapist. I maintain my license, you never know one day I might be back treating patients again.
Making that transition from patient care and even as a clinical director to owning a business had to be a huge transition. A lot of support, coaching, consulting that came into play and helped a lot to mature.
I always have used mentors along my path in my career, in general, to learn about best practices, to learn about speed bumps that I could prompt potentially avoid. What was interesting though, which finally made my transition a little bit easier, was to fully grasp and understand my clinic director leadership knowledge of running a business. We basically ran our clinics even though the ownership wasn’t my company or my clinics, but running it like you were an owner. The people leadership and the culture of our clinics were those skills and that skill set was immediately transferable into building a software business even though it was completely two very different industries. The quicker I recognized that allowed us to ramp up and allowed me to feel more confident in completely switching industries at that point in my life.
We're going to go into your report that you put out here in the last couple of months based on your surveys. What are some of the things that WebPT is focusing on and looking to in the future?
Over the last three to five years, we've expanded way beyond just being an electronic medical record. We’re much more of a portfolio platform company for rehab therapy. We've never wavered in terms of our focus on rehab therapists, which includes PT, OT and speech. Our core is the EMR but on top of that, we've added so many more digital tools for clinics to run their businesses. This includes patient retention management, which is a way for therapists to continue communicating and retaining patients within the community that they've built and worked so hard to get into their practices.
We have multiple ways of billing on behalf of your own practice, whether you like to bill on your own. We have a platform called Therabill for smaller practices that you're able to do. We made a huge acquisition with BMS with John Wallace's company who is now part of the WebPT portfolio, which we offer a revenue cycle management as well as what we call RevEquip. This is a hybrid model where you can still do some of your billing and maintain some control. We also help you to make sure those claims are getting to insurance companies in the cleanest manner that they can be. We offer a whole lot of cool functionality beyond just the electronic medical record.
One of the most important things that we always try to utilize in our clinics and recommend the same is especially as owners come around if they haven't already and they need to be, is to recognize their KPIs and having an all integrated software like yours. They need to be able to easily obtain those reports and know exactly what the health of their clinic is like. You have developed that out.
That has been our main goal over all of these years. We were the first web-based application to enter the market which is significant because all of the data is held by us as a software company versus server-based companies. The data lives in your practice. With all of that data, we have the ability and what we are doing with the analytics program is offering benchmarks. We have such a density of clinics all across the US and the platform of information and data. We're able to show a significant KPIs of what those benchmarks could look like across the country. Our ultimate goal of triangulating outcomes with clinical data along with payment data.WebPT can support owners with their internal marketing via their Patient Retention Management tool Click To Tweet
Understanding how those three worked together to hopefully influence more and more, which is our main mission. Our mission in general is to empower therapists to achieve greatness. Part of the greatness we feel is trying to conquer this 90% problem. This is the 90% of people out there who don't know that physical therapy exists. They're not getting into our car clinics across the country because either they're not getting referred in with the appropriate diagnoses that we could help them with or they just don't know who to turn to. They don't know that we as therapists have to deliver the value and help them with their ailments. We're all fighting over this 10% of people and wondering why we can't get more patients in the door, which is a great segue into why we created the industry report.
When I saw it come out, I thought, "This is such valuable information." I hope all the physical therapists are taking the time to just look over it. You have a PowerPoint presentation that breaks it down easily into graphs and simple statistics. It's a survey that includes over 70,000 respondents across the nation, across the rehab spectrum and this is your second one, right?
Yes, it's our second annual. Part of who we are is what PT is from the beginning. We wanted to build a community. It's partly why we call our customers members because we’ve built this community around WebPT. A big portion of that is around education. We offer lots of free webinars. We did an amazing one around billing, the nuances of billing. We make sure that we have the most knowledge available, pushed outward to everyone, not just people using our software. That's a huge gap that people are nose to the grindstone treating patients all the time, but there's a world around them that's changing with compliance and regulatory change, billing and knowledge and technology for that matter. To help enable them and automate some of the processes that they have been struggling with and just don't know how to use.
That's been a big part of who we are as an organization as WebPT. The data play is also big. We took on doing this survey because when we went out and asked a lot of questions to as many resources as we could think of, we couldn't get answers. In the WebPT way we decided, we're just going to go find out the answers ourselves. We put out this amazing survey and got about 5,000 respondents. We took the feedback from those who downloaded the report and had more questions. We added to the question poll. We got over 7,000 respondents and I've put together this amazing report. You can download the report if you go to WebPT.com, State of Rehab Therapy report. I think it's more than 70 pages long. Don't be intimidated by that because we break everything down into small, digestible bites of such great information about the industry. I'm so glad that we're able to do it.
It was easy to read. You say 70 pages and I don't want people to get scared off by that. If you take the time, you can skim through it. You do a good job of highlighting the important information. I recommend everyone going through it and reading it to see where we're at on this in the state of the industry. It’s valuable information and what you’re talking about also in regards to benchmarks and how people are doing across the country. It's extremely valuable for physical therapists to know what's going on outside of themselves and/or outside of their community, outside of the state, just to look outside the bubble a little bit. As you put together this report, I know that a few things stuck out to you. I'll let you talk to us a little bit about those four items that you noticed after reviewing the survey results.
We can go into each one a little bit more in depth. There were pretty much four takeaways that we wanted to make sure everybody got from this report this year. The first one is the lack of focus on marketing. With our transition, I shouldn't even say transition because we've had direct access in most states for quite a long period of time. This transition into understanding is not just about marketing to physicians, it's also about marketing to the consumer. The consumer who is potentially the patient. This is where that whole 90% comes in that we've never necessarily understood how to attack. This change in mindset requires marketing and a knowledge of marketing.
We were a little bit astounded to be honest, even from the large enterprise groups who responded to our survey. Most people don't know what they're spending on marketing and they don't know necessarily what the ROI is on what they are spending. The second one and we've written a couple blogs that had a lot of interest and a lot of feedback on is around this mounting student debt. We're not alone in terms of our students who are going through PT school. We've made this transition from masters to DPT. We have people seen value from that. Obviously, increased in price has gone up for going through to get a DPT, but that hasn't necessarily shown up in our paychecks when it comes to first jobs and what we're able to pay therapists.
Alongside that is also something as a woman and a female therapist and as a feminist, the mounting gender gaps that are better in healthcare than in most other industries. It's not bad in PT, but it still remains pretty significantly. We’re addressing that and we had some good feedback around that. The last one is high patient dropout rates. When we consider that we're only getting 10% of the overall population that could use us, then you have patients that aren't even finishing their plans of care, the number of people that we’re touching and have the ability to get great outcomes with significantly diminishes if you're not paying attention to those dropout rates.
We've always talked about retention or rival rates, cancellations and no-shows. We definitely pay attention to that. What we're talking about is the whole episode of care. If you thought that they should be there for ten visits, but they drop out at three, the outcome of that is not positive. It could be. There are lots of scenarios that you could say, "They got better in three visits. That's awesome. You're a great therapist." They walk away saying positive things, but it's a lost opportunity to leave a longer impression on what physical therapists do and how they can continue to help you and keep them in your community.Owners need to recognize what their therapists are saying. Click To Tweet
You talked about having a lack of focus on marketing and growth amongst the ownership. It's interesting that it might have been a month or two before you released your report, but the APTA also put out and showed the physician referrals are at an all-time low. From 2003 to 2014, referrals from physicians had dropped over 50%. If that's not just a red flag that the days of focusing on physician referral and putting your money and shoving your money into that space isn't going to get you very far, it's just not happening anymore.
It's no coincidence that the opioid epidemic has also occurred during that time.
I didn't make that connection.
It's an interesting path of one going up as one comes down. APTA was specifically focusing on PT referrals. That can be positive if you think about it the number of patients coming into practices hasn't significantly changed. There are more people who need us, physical therapists, as PT continues to grow in terms of the Baby Boomers. There's more opportunity for us to see patients. Hopefully, the direct access has improved. I know we've done a bit of a push. A lot of people are now much more available to take patients in without referrals from physicians. Insurance companies have jumped on board, the Medicare no longer requires it on their first visit. There are a lot of things that have come into play to allow that statistic not to be super negative. I'll just harp on the 90%, we're still not getting to the people that truly do need us. They're seeking other avenues or physicians are giving out medication instead of getting to the root cause of what's causing musculoskeletal pain, for example.
What we're seeing at least in our clinics is that physicians are telling our marketers nowadays we don't guide where the patient's going to go. We give them a prescription. We know you are out there all over the place. Just see who's in the network and decide for yourself. More and more physicians are doing that. I see that in Arizona and our clinics there, but also up here in Alaska as we're talking to some of the physicians. The people need to understand that trend. If we can take it positively, it's our opportunity. In one way you could say we're getting forced in this direction, but let's go after the 90%. There's a big pool of patients out there and you know as well as I do that a lot of times PT owners can get very competitive in their spaces geographically. When we recognize that, we're only fighting over the 10%, there's 90% more business out there. We need to jump into a bigger pool and make a difference.
That will do two things. Number one, it can increase our access to the number of patients. Number two, it needs to extend the awareness of physical therapy. I'm sure you saw it when you treated and I saw it as well, but patients asking me, "Do you guys treat low back pain?" "Yes, all the time." Getting that awareness out is imperative upon us and to focus and put more effort. Recognizing where our money's going, what the ROI could be and should be for marketing those people. Getting the word out that we are the rehab experts. The doctors have some good ideas, but we know how to overcome your musculoskeletal pain.
It's working together with the physicians. You never want to throw anybody under the bus. On our billing webinar, there was a question about the fact that they're starting to get primary diagnoses from physician referrals, opioid addiction and long-term drug issues. They were like, "Is that okay? Can we actually treat these patients?" They have secondary issues, a muscle weakness and abnormalities and strength problems. I was like, "Are you kidding me? Everyone on this webinar should be cheering as loud as you possibly can seize this moment." There are so many people who are having to change their medication and take them off these opioids and they're still in pain.
Having physical therapists be that alternative to these pain medications is absolutely an opportunity that we need to be seizing. That may be their primary diagnosis that we can't treat them for that, but here are all of the other problems in pain which got them to that place, which we can treat. That's the one that we should be able to be doing. When it comes back to marketing, which is exactly what you were talking about, people and even physicians are no longer necessarily referring to some specific person. I still think that relationship with physicians is very important.
It's super important they're generalizing because of the way that people are searching. There are lots of studies out there that show that patients will go online before they do anything and decide where to go regardless of what the physician said because they're looking at online reviews. They're looking at your website, they're are checking out anything that anyone's ever said about you if they referred to you specifically. They want to know about the clinic. That's an impression before they even walk in your door if you don't have a website that truly reflects what you do in your practice, the diagnoses that you treat, what it looks like, online reviews, you're missing out potentially on people that are going to be looking for that. I think that 72% of patients use online reviews as the first step in finding a new healthcare provider.
You better have your website dolled up. It's got to look good.
At least you need to be present on Google Maps, on a Google Search. You have to be out to have an online presence these days. It's a no-brainer.It’s imperative that patient experience is seamless in every business. Click To Tweet
You've got to come to understand some digital marketing. If you're not tech savvy, find someone who is. There are companies out there that will help you. I know you did a Webinar with Neil Trickett over Practice Promotions. I've interviewed him as well. I will interview more in the future like David Straight from E-rehab. These people will help you. They work specifically with PTs to get your digital marketing presence out there because to solely referring physicians, you’re behind. There are times you’ve got to pull your head out of the sand and recognize that people are looking at your digital presence more than your physical presence than anything else. Even though they get the word of mouth, what's the first thing they're going to do? "Let's check out the website. “
Once they're there, you’ve got to show value and customers service. It has to be impeccable from the time they walk into your door with your front office, which we call our first impression officers to when they leave and the how the billing goes. All of those nuances. When I was practicing, we could get great outcomes for our patients. They loved as clinically but if we messed up on their bill, we were dead to them. It's hard to part that. It was difficult sometimes if we had those building experiences, but it's about the patient’s experience from start to finish. Every piece of that becomes more and more important because people are looking for value. Especially with the higher copay amounts that suppose these days you've got to show them value. They want to know the outcome. They want time with you. They want to understand the why of what you're doing. The digital tools that are available out there, which the WebPT portfolio has a lot of them, but regardless of what tools you're using, it's imperative that patient experience is seamless but also shows value. That's part of marketing.
I like that you talked about showing value to the patients that are already with you because that could be huge. Getting a return patient is huge. It's a part of marketing that I call it internal marketing. I know other people call it the same thing or something else. That internal marketing part of it is extremely valuable because these people are going to be spreading the word of mouth. They're going to be providing you referrals via word of mouth. Are there some things that are within WebPT that help the clinic owners and the practitioners improve their internal marketing?
Yes. We acquired Strive Labs, which we call WebPT Reach, which is a patient retention management platform. In which you can put out newsletters, texts messages, keeping contact with communication through a mobile app with a patient's digital home exercise programs in which you can provide feedback through. It's this patient connection that we have emphasized over the last couple of years. It is so important and it's a differentiator because they want you. They may not be able to come in to see you as for as many hands-on visits as previously we were able to do. Evolving our practice in how we think about things has to happen. We're providing those tools to do that. We have the patient call reminders to make sure that you are minimizing those cancellations and no-shows and making it easy and seamless from the beginning of a digital intake to capture a lot of information from the patient, so you can get some of your preliminary insurance verifications done. When they come in it's like, "We're happy to see you. Here's what we've already done for you." That patient experience is just stellar from the beginning.
That's cool that you've incorporated all of that into the EMR, so someone doesn't have to click out of your website or out of the app to find what they need. They can only do within there and see all the notes pertaining to that patient and send individual emails or mass emails if that's what you need to do like you said with the newsletters.
The internal marketing piece, I always think about it from an educational perspective. Having our outcomes platform built-in and integrated to where you can share that information with the patient in terms of how they're progressing along their path. What are some of the things you’re specifically going to work on and getting that feedback from the patient and what they still can't do? Collaboratively working with your patient on goals. It makes them part of the process. That engagement helps to make sure they are going to be completing their entire plan of care per your expertise in what you've given to them.
I know it’s abrupt and I’m sorry to interrupt the interview with Heidi. We talked about a ton of stuff in our interview. I broke it up into two parts. The next few topics we’ll be going into, we’ll be able to delve into quite a bit. I’m breaking it up into two episodes, so stay with me. In the meantime, Heidi made it known to me during the course of the interview that she is offering a special promotion for the WebPT Ascend 2018 Conference coming up this September 27th through 29th in Phoenix for my Physical Therapy Owner Club audience. She has setup a special promotional code so that when you register, in the promo code box, type in PTOWNERSCLUB and you’ll get a special discount for your registration for Ascend 2018. A select conference for PT business owners and their staff. Make sure you recognize that, it’s not just for the owners but also for your admin staff and your billing staff. Stay tuned and join me for the second episode of my interview with Heidi Jannenga. Be sure to register for her conference. Also, please subscribe to the podcast and leave a review. It’s huge for podcasts to have a number of subscriptions or subscribers and reviews on the podcast. It helps in growth and attraction to other podcast listeners. As a favor, please do that as well. Stay tuned.