When To Expand? “First Who, Then What,” And A Bunch Of Other Topics with Dr. Tim Thorsen, DPT

PTO 45 | Expansion

 

Dr. Tim Thorsen, DPT has had a lot of success in gradually expanding and stabilizing his physical therapy company. Although he had done that in many different ways, Tim had found how it was when he relied on the right people, who are aligned with his company, that he has been most successful. This goes back to Jim Collins’ Good to Great principle – first who, then what. Tim shares how he applied this in his company and gives great insights on topics from expansion, good and bad debt, and renting versus owning your building, to orthopedic residency and health care options for employees.

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When To Expand? “First Who, Then What,” And A Bunch Of Other Topics with Dr. Tim Thorsen, DPT

I have Tim Thorsen of Health In Motion Physical Therapy out of Wisconsin. I met Tim at Christopher Music’s Private Practice Millionaire seminar in Florida. After meeting Tim, I quickly found out that he has seven physical therapy clinics in Wisconsin and I thought I need to have this guy on my podcast to see what makes him successful. As we go through this interview, you’ll find that we cover a ton of different topics anywhere from expansion and when to expand. We talk about orthopedic residencies, renting versus owning your building and healthcare options for our employees. You can see that we covered a bunch of different topics. Hopefully, a couple of those topics are meaningful to you.

Tim is the CEO of Health In Motion. He’s also a Doctor of Physical Therapy through the University of Wisconsin-La Crosse. He’s got a few certifications. He has OCS. He is also a Certified Manual Therapist, Certified Myofascial Trigger Point Therapist and a Certified Clinical Instructor. He’s also the Orthopedic Residency Program Director at Health In Motion affiliated with University of Wisconsin, Madison Hospital and Evidence In Motion, EIM. Tim is originally from Rhinelander, Wisconsin and found a lot of success building clinics in more rural settings. There’s definitely a benefit to that as I’ve found some of my success in doing the same, but let’s get into the episode. Hopefully, Tim has plenty to share for you. I thought it was educational for me as well.

Thanks for joining me, Tim.

It’s my pleasure, Nathan. Thank you.

I know about you and your success. I met you and I’m excited to bring you on and talk about some financial stuff as that pertains to us as business owners/physical therapy clinic owners. Do you mind sharing with everybody a little bit about yourself, a little bit about your story? What got you to where you are now?

I’ve got a typical backstory for many physical therapists especially. I got hurt in my junior year in the fall playing football. A separated AC joint, second degree and pinched axillary nerve or probably traction to axillary nerve when you think of the mechanics of that. Hitting someone on the wrong side of the body, don’t do that playing football. I got hurt and got diagnosed by an orthopedic surgeon, went down, got an EMG, nerve conduction velocity test which everybody should go through at least one of those in their lives. If you’ve got a second-degree separated shoulder and you’ve got a pinched nerve, then good luck with baseball. You’re not going to be throwing a whole lot. It was not said to me but it was evident on my end of the equation. I got diagnosed. My hand was frozen.

The thought was maybe working on a dental rough, I ought to go ahead and look at something in healthcare. I jumped almost right away within a month back into school and I was going to be a nurse and then I could get my nurse anesthetist degree and discovered this thing called physical therapy in the pre-internet days up in the occupational health handbook. I was like, “This physical therapy thing sounds cool.” At that point, I transferred from Oshkosh to La Crosse, Wisconsin. I got into PT school and it’s been a great ride. Me and my family are thankful for the field of physical therapy. We had the drive to go back and put physical therapy on the map in North Central Wisconsin to be able to get out and reach athletes that maybe were being hurt like I was. My wife and I were both from that area. We moved to Atlanta. I worked there and learned how not to run a private practice so it’s a great experience.

I got called back to my hometown to Rhinelander. A system that I did an internship with kept calling, upping the ante which of course has never happened to another physical therapist either. I decided to move back there for one to two years, paid off some debt, bought a nice small home and got where we wanted to be. I looked around for a practice within the Midwest and particularly in Wisconsin. I looked far and wide at the time. I talked to many private practice owners because I was looking for a private practice that had a vision for the future. They wanted to go ahead and work, look at eventually mentoring someone and having someone come in and help them to take over and/or build their practice. Have some equity, they have some buy-in, and I looked Eau Claire, Wausau, Green Bay, all in Wisconsin, several different places. I interviewed and talked to people and nobody was able to articulate or even say they had that vision or plan.

If you're considering if it's the right time to expand, think about Jim Collins' mantra in Good to Great - 'First Who, Then What' Click To Tweet

After a few years of working at the system approach, the rehab director talked to the VP at the small hospital at that time and said, “I know I’ve given you a lot of these ideas to get physical therapy more visible. I encouraged you to build an outpatient facility. I know you said those are great ideas, but it’s not where we’re going. I want to do that. I want to go out and move out and I want to be upfront with you. That’s where we’re headed.” “Congratulations, we get where you’re coming from.” The VP said, “If I were you and had your degree, I’d be doing the same thing potentially.” I said, “Thank you.”

That was probably November of 1993 and then April of 1994 we opened our doors. As they say, the rest is history other than the great people that we’ve been blessed within our organization to come work with us. That’s all the way from our front office coordinators to our providers and the executive team and the folks that are working to become part of that executive team. My minority partner, Ben Solheim as well, who does a great job and is a hard worker. It’s not what we work in. It’s the people we’re able to help bring together to work together, to bring something too successful and what the world considers a successful venture, that’s the most important.

You started off with one clinic. How quickly did you ramp up? Where are you now?

We had one clinic in 1994. In 2000, I had two of my folks that I’d worked at the hospital with for a few years that had been looking. We talked on and off. In 2000, they had joined us. We had people driving from 30 to 60 miles away to see us. I’m going to say it was the great therapist that’s why they drove there. It’s the package. What I was trying to encourage the hospitals to do, we branched out 30 miles one direction to Tomahawk, 30 miles in the direction of Eagle River within several months. That’s how we grew the practice and since then both of those partners have transitioned.

I had one other partner as well who was with us, a great guy. He’s now an instructor at UND in North Dakota, in the Orthopedics Department. He had six kids at the time and thought that was a good part of the retirement plan if you can be working for the system at UND and get them to cover your children’s education. I say that facetiously, but he’s a great guy, a great individual. They’ve been with us once. They moved back more toward home, he’s from that area and then moved back and now is a professor at UND. A great family and a lot of great people. We had that three for a while. We’re at seven now. We never had the idea that we want to be big or we want to grow.

Quantity was never the issue. We wanted to continue to do quality work and serve our people well and do a great job with every person that came in the door to see us on a one-on-one basis with our care. In 2014, I got a call through Jim Hoyme and he said, “I got this guy moved over in your area. He’s working for a corporate entity and wants to be in more of a private practice because he worked in the cities with OSI.” Ben gave me a call, it was August of probably 2013 and said, “Tim, I talked to Jim and is there any way I can work with you or work for you, anything?” I said, “Let’s have a conversation.” We sat down that August and then we were open in Wausau by 2014. With that location and since then we’ve added the fourth and then we’ve added three locations. One purchased since then and then two other de novo clinics that are the smallest clinics, but we assume we’ll follow the growth trend that we’ve seen in the others as they mature. The key when we get the right people in place.

PTO 45 | Expansion
Expansion: It’s the people we bring to work together who bring something to success.

 

You’ve been through a number of partnerships and you have some experience you can talk to about that.

We did not know it beforehand like anything else and like with the rest of our team and things that we’re developing. We’re learning from other people like yourselves and other colleagues that you draw from the peer-to-peer group. APK has been a good source of information on going through the Evidence In Motion EPPM program. Practice management has been a great learning experience, networking with colleagues and being able to bring that information. I’m not going to say any of our information is original per se, but we’re drawing together the best of the best concepts and then we’re working together with our internal team to distill down what works with and for us in our culture.

You’ve been in practice for many years. In the last few years, you’ve added three practices and brought on a minority partner. When did you feel it was time to expand? When was it appropriate? When did you think, “Now is the time to do this?” Now that you have a little bit more experience opening a few, are you finding a pattern as to when it is appropriate to add on the next location?

Yes and no. The first ingredient is people that you feel are ready for the opportunity. When Ben approached me, he was ready for the opportunity and then it wasn’t, “Is there a demographic that supports it in that area that we’re looking at?” It was like, “We have an opportunity here because of what we do with our residency program training. We worked with both UW-Madison, Meriter Hospital centers at UW Health, but we also work with Evidence In Motion as well for our baseline residency program where we do a lot of training.” We have a foundation to attract high-quality therapists. We feel we have a solid organizational background on what we do with folks clinically as practitioners.

Since adding those clinics, we’re working on developing executives and leaders to not only to take over the organization but to be able to multiply and add wherever they decide to serve in the professional physical therapy. As leaders within the profession influence not only our own but other industries and that’s our next step. I would get down to the fact that we’ve got a decent foundation. We need to share this with more people and we need to let other therapists benefit. If they benefit, what’s ultimately happening is more consumers at the grassroots level have a way to enter directly to a physical therapist. To get physical therapy care that’s less costly and a better value for them personally and for the system as a whole.

It’s where you are now, but I’m assuming it’s what’s led to your growth to this point and it’s a concept that Jim Collins shared in Good To Great about it’s first who then what. When you have the right people in place and in the right seats on the bus, then you can consider like, “What do I need to do to help this person continue to grow? What can I do to help them leverage their strengths to maximize their potential to the benefit of the organization and the community?” You sound like you’ve bought into that concept that once we find the right people, then the opportunities will present themselves or we will be in a position to create opportunities.

When we get the right people in place, we succeed. Click To Tweet

I’ve read Good to Great years ago and that’s why Jim Collins has written many books and we steal those principles and we put them into action. It’s probably one of the strengths areas that I have is converting stuff that people talk about into action.

If you follow that pattern even from the get-go, even from your first clinic, you go through a lot of trial and error with a bunch of different people and character types and personality types. Once you find out the personality type and the type of people that you want in your organization and that are aligned with you, then you can grow even when you’re a small practice. You go through a lot of mistakes before you hit the right people, but you maintain that idea that at first, it’s who then what. You mentioned creating the foundation and part of that is people.

You also then established the way you want to do business and that is written standard policies and procedures so that if you went to any Health In Motion practice in Wisconsin, they’d probably be running about the same. There might be a little bit of difference in culture because of the people there, but they’re going to do things about the same way. You’ve got a steady baseline foundational financial picture where all of them are probably running fairly strong before you open up the next one. That might be a little bit of a drag on the cashflow and stuff like that. When I’m talking about foundation, there are other things that go into that you’ve established over time that make it easier then to expand off of.

I’m not a real systems guy and probably anybody you talked to that knows me well would tell you that. We’ve had to go to that and many have come to understand and appreciate that structure. I give a lot of accolades. The EPPM program through Evidence In Motion for me, it was back in 2012, 2013 that I went through that. There’s some good framework that was put out there for me. It took more structure than that for me. We’ve worked with MEG Business Systems, Brian Gallagher. He came in 2016. If you ask our staff and it was totally against our culture, but we knew we needed to put in some structure and Brian has been integral in that and appreciate not only his work and effort in that area but our friendship. He has a good heart that way and is interested in seeing the profession and the individuals that need more of a system like myself grow.

I’ve heard good things about Brian. I had a previous interview with Rob Brown up here in Wausau and he went through Brian Gallagher’ system with MEG a number of years ago as well and he had good things to say about it. Interestingly, when he went through the system like that to incorporate structure, he came up against a lot of resistance and found out who was going to stay on the team and who wasn’t. What any structure and not to say anything bad about Brian, it’s any structure or anything that you try to put into place and hold people accountable. You could come up against some resistance. Did you notice any of that?

PTO 45 | Expansion
Good to Great: Why Some Companies Make the Leap…And Others Don’t

We did a little bit and it was unfortunate. We had some significant loss of great therapists, but at the same time they probably needed either something different or needed something different to grow. We tried to go ahead and bring it in and explain what was going on or why. Some people are going to embrace that, other people may run from it. It allows them to grow, maybe to move to a different situation or maybe they can grow more optimally. That does happen any time and we tried as best we could and yet went through the process. We’re better individually. Other individuals chose not to stay on the bus and will find their way will be in areas and situations that they can continue to get better and practice their craft and hopefully integrate situation.

It’s no fault of theirs if it doesn’t align with them. That’s fine, but sometimes going through that process can be difficult. It sounds like you agree with what Rob would say is that after going through the structuring process of their systems and putting some policy and protocol in place. They filtered out some of the people that weren’t in alignment with that. They’re in a better situation.

Hopefully, that is a win for themselves and they’re finding what they need or where they need to be and they’re being challenged to grow personally and professionally.

If there were any statistics or metrics that you followed that led you to think, “We’re in a good position as a company to expand.” Did you have any patterns that you saw financially that helped you recognize that you’re at a point to do that? Do you simply leave it to, “Do we have the right person to do this with?”

My wife who has a background in accounting and business, Lisa, has been invaluable to our practice from day one. I could focus on the business, the organization growth and doing what I did first as a practitioner. As a practitioner/executive and now as an executive/owner, and a mentor within the practitioner realm and because she’s been number one who hates that. Number two, she knows her stuff with numbers well and has always liked to have money in the bank. Not that anybody else’s wife or whatever liked to have money in the bank. They feel much secure that way is my understanding.

I’ve been blessed that way because I’ve never had to think about finance. I can honestly say financial is never a big decision driver. All we knew is that we are running a large cash balance and we can go ahead and invest in things that we were believing was good. It seemed like a good alignment with the people who were there. We could get behind it because we knew that it was an investment and would grow in the future, which is good debt versus bad debt. This was a good debt because we trusted the metrics that were there. That we were seeing the people we are getting involved with, and we knew that it would be an investment and grow over time.

One of the things that I leaned on back a few years ago when it came to expansion especially when you’re going from one to two and maybe two to three clinics. It might not carry so much weight when you’re getting as large as you are because if one clinic were to falter, it’s not as big of an impact on seven or eight clinic practices as it is if you’re a one or two clinic practice. In general, some of the advice I was given was that if that one clinic is running 80% to 90% capacity, now you’re in a better situation where you could take on a second clinic. If that first clinic is only running at 50% to 60% capacity, you need to focus on building that one up before you go ahead and open up the second one. Percent capacity in my book is dependent upon the size of the clinic and how many patients you’re pushing out per week based on the size of the clinic. Is that something that you can relate to?

You go through a lot of mistakes before you hit the right people. Click To Tweet

Ironically, at the time we didn’t use those metrics because we had a cash balance. We had practitioners that were all working together within the same, but we knew that there was a lot of folks that we’re driving to see us for over 30 miles. It made sense to extend that 30-mile radius because we knew them beyond there. We could reach another 30 miles because we’re talking more of a rural area or non-urban. Those cash balances didn’t really make us in because we’ve always been frugal with running things and very good stewards of things. Do we go ahead and risk what we have here to go ahead and invest in this next opportunity? We would.

You brought up good versus bad debt. Talk to me about your thoughts on that.

We’ve been thankfully blessed we never had to worry about it from an operational standpoint with the practice. We were at our first location. We rented a fitness center and our rent was $250 a month. The size of the space was about 15×6. That was our reception area. It was wide and a small little window that we’d open to greet our patients and they’d sit down on our one or two chairs. We had access to everything in the fitness center, but then we had two little treatment rooms behind that were basically less than regulation size. They were about 8×10, about 80 square feet. We had a big gym space beyond that, but that was our humble start to keeping overhead low and looking at your cost versus what your revenues are going to be.

We’ve been able to be blessed by that model every time we stepped out of the same situation but more capital behind us. This was back in the day and you didn’t have to know nearly what you need to know in the heavily regulated and compliance required world we live in. We started out meager, modest and then we said, “We’re renting here.” I approached the owner who lived in Milwaukee and has a big fitness and racquet club. I approached him because even the people that were running the fitness center then were leasing from him. I met with him in Milwaukee and it was 1997 circa and I said, “Can we buy the building from you, work with you and do a partnership?” He said, “I’m not that interested.”

We looked at our options. We offered the current owners of the fitness center that we were in, “Come with us. We’re going to put on a second story.” We stayed with one story and we moved into about a 5,000 square foot building. That would be our first example of good debt because we chose to set up a separate LLC, go ahead and rent them ourselves instead of renting from someone else. That’s a model we’ve duplicated now in five of seven markets. That’s led to what I would call good debt because all that debt is pretty much gone and we focus on paying ourselves rather than paying someone else. I could put on my landlord hat occasionally, which isn’t bad.

Commercial real estate is always easier to handle than residential real estate. There are not as many headaches and especially if you line it up correctly. The benefit that I recognize of having a real estate holding company that I use to purchase the building and I rent to myself as the physical therapy tenant allows me to have added expenses that I could ride off and do other things like any small business could. The benefit of that is not that you can have separate liability and you should minimize your liability of owning the real estate company, but also take advantage of tax savings here and there. Use that to accumulate more wealth as a practitioner. You don’t want to have all your wealth in physical therapy. Having your finances diversified over real estate as well can only be beneficial.

PTO 45 | Expansion
Expansion: The willingness to be mentored and then to mentor is a powerful way to transfer not only information and knowledge but wisdom in our practices.

 

There are many advantages to opportunities. You’re talking a lot of my wife’s language with that, but the principles I definitely get. Talking tax and accounting is her world.

At your size now, how many employees do you have?

We’re probably pushing on about 35 employees’ total. Some of those are from coordinators, job sharing and part-time. We’re at about sixteen providers and we’re looking to bring on three more. Two are already coming on and we’re interviewing for another position. We’ve been blessed with the residency program, which certainly in Wisconsin if not in the country where we’ve been an affiliated program with UWHC out of Madison. It’s about a three-hour drive from us, but we started that in 2009 working with Catherine Lyons, who was a pioneer. She started one of the first residencies in the country in 1998 at UW Madison. We’ve been blessed and glad to participate as an affiliated partner with them as well as with Evidence In Motion, which has done a bang up job in a relatively short period of time out there. Their organization does impress me.

You’ve been able to then recruit through that residency program. That’s something new to me. How would you recommend another owner become an affiliate like that for residency programs? Can they create their own?

They can always create their own directly through the APGA following the guidelines and implementing their own program. You’ve got to have a considerable amount of internal impetus to go ahead and do that. If you’ve got the faculty and the folks on staff that wants to do it, go for it. That’s one great way to get directly involved in an intense but rewarding way. The way we look to do it was through residency affiliation both with UWHC and also with Evidence In Motion. They provide the didactic component. We don’t necessarily have to have all of our folks providing didactic content, not that we couldn’t do that. We ask that question sometimes. We’ve left that alone at least for now because we like our affiliations and our options that we can provide to incoming residents as well as to the rest of the folks working with us.

I see that as a great possible recruiting tool for those owners that are in areas where it’s difficult to recruit physical therapists. Do you find that it’s been a real boon to you as far as recruiting PTs, especially solid PTs?

Whatever care we get, we pay at the cash rate. Click To Tweet

We’ve grown most of our own solid PTs internally through those residency programs. We’ve got great clinic leads that are on the exact track to become leaders in our organization and/or within the profession. We’re relatively young in that process but that’s largely where they’d come from. These guys and gals are spot on. How I’ve seen each of them grow not only with the inherent skills that they brought in but what they’ve been able to access and add, technically competent, highly empathetic. I can’t say enough about their practice as practitioners and then their willingness to take that next step to be developed as leaders in the organization, in the profession as that executive moving into that executive realm. Who’s going to take it on and own it? We don’t know, but we’re offering it and seeing how they develop and how they come along.

I can imagine that the people that are part of those residency programs are A players, movers and shakers in the first place. Otherwise, that residency program application process probably filters out the dross anyways. You’re getting some solid people coming through simply because of the residency program and that leads to a special candidate that you can work with.

The willingness, whether it’s for myself or anyone, to be mentored and to mentor is a powerful way that we can transfer not only information and knowledge but wisdom. That’s in our practices. We need to be able to manage those patients. We need to be able to manage people and it all comes down to communication and relationships. As physical therapists or the practitioner we’re teaching, we have to have that connection to those people. If we have the connection, it becomes so much more valuable. It resonates with them when you can connect.

That’s a tangent that we didn’t discuss, but I’m glad we talked about the residency program and your affiliation there, and how it affected your company. It seems like it’s been a big foundational support to your growth and the number of executives that you can choose from to be part of your executive team.

It offers them an opportunity. People generally that come into residencies are looking for that lifelong development growth and opportunity. We hope to be able to provide that. Other owners can hear this and say, “I want to do that too because we need more residency offerings in the country.” That’s a be all and end all from a success standpoint, but it gets him on the track to then decide, “Do I want to stay as a practitioner? Do I want to consider this exact thing or leadership training thing maybe?” We’ll each do that differently in our own organizations, but those are the basic principles that we need to share and encourage others in.

That can be a definite recruiting tool to your practice, but one thing I’ve recognized in general from a basic level is that the benefits you provide your employees as they come on. When we’re interviewing physical therapists, they’ll ask of us, “What are the benefits? What are you providing?” One of the big ones is healthcare. What healthcare benefits are you offering? Talk to me a little bit about some of the ideas that you’re having on providing healthcare benefits to employees. I’ll share with you my thoughts as well.

PTO 45 | Expansion
Expansion: Everybody wants their rights, but no one wants to go ahead and take personal responsibility for themselves.

 

It’s a challenge. Anybody in private practice is providing your own employees their own insurance and our insurance even it’s a challenge. I don’t think there’s anybody that can tell me that it’s not. If they do, please take my information and get ahold of me. We struggle with it. Over the last couple of years, we’ve looked at going self-insured. Companies as small as ten or less now can go self-insured, but we look at the feasibility at least in our area and we’re not getting the straight dope. It’s too costly and we went against that option. We drag what I would call a pre-ACA plan or a grandfathered plan through the ACA or Obamacare. We still offer that because some employees are coming on, they think they need a traditional insurance plan. We carry that and we do offer it.

A lot of my folks approach me with this thing called health share ministerial plans. They’re the one they approached me with. Initially it was this thing called Liberty HealthShare. What is that? As usual, google it and start reading about it and put my HR person Sandy on it. She talked about tons of information and she’s a great person in this position. She had her own insurance, had been on our plan and have looked the ministerial option. Her husband became a postmaster so she’s on a government plan and a pretty good one for most postmasters.

Our HR person has all the details with it, but the bottom line I’m even on the HealthShare ministerial plan. It costs me $300 a month and I’m covered for a catastrophic medical in any state and not limited to a PPO. I can go ahead and they do still WellCare checks every year. I can go in for an annual physical. I’m generally healthy. I work out regularly. I’m teaching genetic background. I’m not worried about it. I’m like, “Why do I need to go ahead and give an insurance company over $1,300 a month? I can go ahead and hedge my insurance. I’m putting $300 a month on me and saving $1,000 monthly.” It’s huge. That’s my personal experience. On HealthShare ministerial plan, we don’t expect every employee is coming in to know those exist, but we tend to educate them over time and then they choose it because they talk to their colleagues and other folks. Their peers are the ones that brought it to me initially. That’s where we’re at.

Especially the physical therapists that you’re bringing on. They’re physical therapists and they tend to be relatively healthy. They’re younger. They usually don’t have a lot of issues. Why would you want to throw as a single individual $500 to $800 a month for a high deductible plan when you can use some of this healthcare sharing accounts or health sharing?

They’re not insurance.

They do comply with ACA. You can count as coverage because of my family, same thing. We have the typical Blue Cross Blue Shield plan. The deductible was going higher every year as well as the premium. We were getting to over $10,000 a year in deductible, paying the same amount or more in premiums every year. I’ve got seven kids and my premium was going up to $1,300 a month for a high deductible plan. My wife approached me about these ministerial plans and we’re currently on one called Samaritan Ministries and there’s another one called Medi-Share that’s a popular one out there. Now we pay $500 a month. To get some specifics, the expectation on our end, now we’re in control. We’re responsible for our health that we pay the first $300 of any bill that comes across.

It's not how you feel in any situation. It's what you do after it. Click To Tweet

Whatever care we get, we pay the cash rate and they can get reimbursed and I’ve found that to be a huge saving us because we’re a young family that doesn’t tend to get too injured. We still have catastrophic care. We’re responsible for the first $300 of any episode that we encounter and that’s been a huge saving for us. We’ve been on that for the last few years. I can’t count the thousands of dollars that we’ve saved in premiums and whatnot in dealing with that and the deductible money that we would have had to pay on top of that. I’m a big proponent of the health ministry programs that are out there. It’s saved us a lot of money.

It is amazing, Nathan, and people won’t believe it. A lot of times they don’t have the information. They don’t know this is possible. The old adage is used against them, “If it looks good, it’s got to be a lie.” It is that cool and that true. I’ll hear the other one which is, “It’s not covered by any laws or insurance.” I’m like, “Who am I going to trust? Am I going to trust insurance companies that we have such a great time relating with on a regular basis in our practice who never lie? They don’t receive something you send them eight times or more. Who am I going to trust?”

I call it throwback insurance. They are a mutual organization or a collegial organization. We agree with their ideas or values. You sign on to those. They are in the business of pooling money and covering each other’s care. They’re not in the business of million-dollar CEOs that I’ve seen. They’re not in the business of building buildings not that you’ve ever seen an insurance building anywhere. They’re not in the business of generating excess cashflow to invest in the stock market and generate their own financial security through those investments. Hypothetically, not that that would be true of an insurance company.

There are options out there. You talked about the ministering programs. Our company also provided some telehealth services, those are relatively inexpensive, you can cover an employee for $50 to $100 a month. The one we used was Redirect Health where it gives our employees and their families access to an on-call physician 24/7. This company will also go out and negotiate cash rates at physician’s offices and specialties and diagnostics and give you coupons for your pharmaceutical needs. The telehealth services have been huge in saving time, money and energy that it takes to go and see these doctors where we can sit on the phone and either talk or sometimes we FaceTime. I had a kid that had an acne problem and he would FaceTime with the physician from Alaska to Arizona and she said, “I’m going to send in this prescription for you. You have to go to the pharmacy and pick it up and here’s the coupon code for your prescription.” There are other options out there besides your strict conventional health insurance. That’s what we’re trying to drive.

It’s phenomenal what’s out there. I didn’t know about Redirect at all until you mentioned it. I was explaining the situation to my wife that she got a little strep throat thing when we’ve been down here. I think it was dryer than Arizona. She did a telehealth call. Everybody’s got smartphones. She was able to show her throat over the phone or FaceTime or whatever version you want to use of audio-visual. She talked with an internal med physician back up north and it was $60 or $70. They called in a prescription of amoxicillin down here good to go.

We did poke around the area first. We thought, “It would be good to go in.” I even look through the FMMA which is a Free Market Medical Association website for a direct primary care physician in this area and there weren’t any listed. She got on the phone and called a few. She called her buddy, David Bird with FMMA. Maybe he doesn’t know they exist, but she should be listed on their website. She called around and made three or four or five calls and they were nice enough to refer her to someone else. Bottom line, she didn’t find anybody in and we called back home and did that thing. It’s inexpensive. She was able to get treated and is feeling great.

We’ve covered a ton of topics. We’ve been all over the board, but a lot of cool topics as it relates to your ownership and your expansion in general. Anything else that you want to cover?

We need to really bring everyone. Physical therapists are generally great examples of this of personal responsibility and everybody talks about rights so much. Everybody wants their rights but no one wants to go ahead and take personal responsibility for themselves. Stuff’s going to happen, this is planet Earth. Whether it’s my separated shoulder and a pinched nerve and football as a junior and I was a lot better baseball player than I was football. Everybody has gone through that head trauma. It’s not what you do or how you feel in any situation. It’s what you do after the fact. Do you pick yourself up? Do you get back up? What can I do about this? Are you going to say, “Woe is me?” Making those personal individual choices and we as physical therapists empower every people every day to make those choices, to focus, and we can through motivational interviewing.

It’s cool listening to your podcast with John Woolf. He needs to get hooked up with the FMMA and look at all the Health Rosetta concepts that are out there too with Chase and Schwartzman. The Free Market Medical Association is onto something because we are their movement and musculoskeletal experts. It’s like ACA is carved out, pediatricians tend to practice internal med and practice on monthly membership models. We are their cohorts to help with movement in the trenches. We are the doctors of physical therapy, the doctors of movement, and they readily admit that they don’t know a lot about movement or musculoskeletal. The World Health Organization told them in 2004 and 2014 that their education is wholly inadequate and it will not change.

If people wanted to learn more about the Free Market Medical Association, how do you access information about it?

FMMA.org. They’re doing some great work there at Oklahoma City so real to the central in the country and the principles are there and the organization they’re putting together are solid. They’ve got a good internet-based presence even though their website. When you’re not a member isn’t the most laden with information, but they do have a conference coming up here in April. It’s April 11th through 13th, Thursday evening through Saturday at noon. That’s in Dallas coming up. I know I’ll be at that and cool stuff going on in that realm of things to change healthcare.

Is that an organization that physical therapists can become a part of and tap into?

Yes, I’m a member and they wholly embraced it. Not enough of our colleagues are yet. Membership is nominal and they don’t understand yet. I haven’t articulated clearly enough how we can work together to change things because of the direct contact we have with many people one-on-one for the time that we have whether it’s traditional therapy or other innovative models that we’re working on to work directly with employers.

If people wanted to reach out to you, maybe ask you questions about your residency program or the Samaritan Ministries that you’re talking about or FMMA, are you available?

The easiest way is through my email and that’s simply TThorsen@HIMWI.com or Health In Motion, HIMWI.com is probably the best way to get a hold of me.

Thank you so much for your time, Tim. I appreciate it.

Nathan, I’ve enjoyed it. I sound a little bit confusing on the number of topics that we’ve covered. I look forward to sharing at any point in time on any topic you’d like. That’s one of my favorite things to do.

I appreciate it. Have a good day.

Thanks.

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