The Three Areas Of Provider Production with Shaun Kirk, PT

PTO 53 | Provider Production

 

Shaun Kirk, PT is back! Our last interview with Shaun has been the most listened-to episode of the podcast over the first year, and he’s got more to share! He discussed the six areas of practice that all owners need to be aware of in our first episode. In this episode, Shaun shares with us the three areas of provider production that need to be addressed. It’s easy to see when a PT in your practice is doing well with patients – the patients are getting better, they’re creating good bonds with patients, and their patients are happy. However, that’s not all they need to do. Their relationship with the patient means nothing if they’re not documenting and coding appropriately, two areas that will hurt you more than it hurts them if they fall short. Be sure to track all three of these areas as they could disrupt the integrity of your clinic and leave “holes in your bucket.”

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The Three Areas Of Provider Production with Shaun Kirk, PT

I have Shaun Kirk returning as a guest on the show. Shaun’s episode that I did has been one of my more popular episodes. I’m excited to bring him back so we can learn a little bit about what Shaun has been doing over the past year. He has met with a number of clinic directors and clinic owners across the country. He has been able to build off of the Six Key Areas that Physical Therapists Need to Address, which is what we talked about in our previous episode. He, however, also talks about how to improve productivity with your physical therapists. This is valuable information that we can get into. He brings us up to speed on what he’s been doing, why he’s doing it and also we addressed those six key areas and productivity in physical therapists. You’ll enjoy the show because he’s got a lot of wisdom to share.

I’m excited to bring Shaun Kirk back onto the episode. Shaun was one of the most listened to episodes that I have. It’s great results because he shares a lot of wisdom. Thanks again, Shaun, for coming on to the episode. I appreciate it.

Thanks for having me, Nathan.

What have you been doing? What are you up to nowadays? We’ll get into a little bit about some wisdom that you can share for us.

If you haven’t heard that episode I’ve done in the past, check it out. I get into a lot of color about where my life started and how I ended up where I am. What I had been doing for the past several years is prior to these last several years, I’ve had a consulting company, Measurable Solutions for about twenty years. We’re working to help practices grow and expand. I enjoyed that a lot. What I liked about it was working knee-to-knee with the practice owners and helping build their team, strengthen their goals and helping them achieve them. As the company began to expand and grow, we grew into three locations. My role changed to where I was much more administrative and a little more distant from all of my clients. There are some few I stayed close to but got distance because it’s a bigger organization to run. I had an opportunity years ago to take another look at what I wanted to be when I grew up. I thought, “Maybe there’s a different game where I can work closely with the practices.”

This opportunity came along with a private equity group in the mergers and acquisition area of physical therapy businesses. It was a brand-new startup. They liked me and they liked what I brought to the table. I ended up being their first employee. Now I believe they have about 1,100 employees. We have about 180-plus locations in about 26 states. It’s been a hustle. I have been busy working with these practices and traveling quite a bit. Although I enjoy it, it’s not quite the same. One of the things is as I’ve learned a tremendous amount of data I didn’t know before, even though for twenty years, I’ve been working with practice owners.

Before that, you were a practice owner yourself.

I was a practice owner before I went out and started helping other people how to practice. For me, as a consultant in the years past, one of the things that I never get a chance to see, Nathan, is your EMR. I don’t see how you’re coding things, your staff or billing in general, what their documentation looks like. None of those kinds of things do I get a chance to see. When I have this new opportunity, we own our own EMR software. I have the ability to see a lot of things and dive a lot deeper into practices from an operations point of view. Over the last years, I’ve been working with these practices on making a couple of internal adjustments. The best way you can look at it is if you have a bucket and the bucket has holes in it, you can pour a whole bunch of new patients into the bucket, but you still have holes. You’re going to have a lot of leaks. If you pour enough water in, so to speak, your bucket will fill. How economical is that?

What I’ve learned more is a lot more things I didn’t have in my toolkit but how to close the holes in the bucket. I truly have enjoyed that. What I miss is that relationship, working with private practice owners. What I’ve been doing for the last several years, I thought I wanted to help clinicians and prior practice owners reach a whole new level of the game, open up other clinics underneath them and build something great. What I truly found is that I can’t knock anyone interested in doing a move such as a sale or whatever. What I can say is that I liked helping private practice owners reach their goals versus helping investors reach theirs. From that, I decided I’m stepping out of that world and back into the consulting arena again.

There could be so much more joy for you. I don’t want to put words in your mouth, but you’re going to help this guy grow his practice, whether it’s stabilizing his practice. When we say grow, we’re thinking that everything is going to get better. I love your analogy about the holes in the bucket because there are so many guys that have these ideas that they’re going to get three to five clinics. I’m like, “Your one clinic is barely getting by 10% profit margin and you’re burning yourself out. How do you think you’re going to get the three to five? You’ve got to fill the holes in the bucket.” There’s so much more joy to see that guy succeed, grow his practice and become an independent owner of something larger instead of seeing that happen for the benefit of a corporation. Is that where you’re going with it and get excited about?

It is something that gets me excited. You’ve known me for a while and to me, it’s always about relationships. You build those relationships when you have clients who genuinely know you care for them, and you’re interested in them and their life. If you happen to have the worst practice in the area, but you work 90 hours a week, is that something to be proud of? Not really. It’s making something grow, expand but that quality of life hopefully it can give you. People always think that their practice will give them freedom. They’ll go out on their own. They can call their own shots and work their own efforts. It can happen and there are ways to make that work. That to me is the key thing. I have a client in Florida I loved dearly and a good friend. I remember when he sat down in front of me and I said, “What would you like to achieve in your practice?” He said, “A lot of people talk about money. I don’t need to make a lot of money, but I would like to be comfortable. You don’t have to make a lot. I would like to be able to achieve that without having to be in the office. I’d like to live on a boat.” That was the weirdest thing.

His practice grew from maybe 120 to 250 visits. He was able to do that with not having to physically be in the clinic. He lived on the boat for about a year. He went on a long sales trip and he came back and said, “I’m done with that.” He sold his boat. He’s got a second clinic. He has a whole new set of goals. If one’s goals don’t include more than how big their wallet is or how many visits they are seeing or whatever, what’s the reason why? What’s the reason that you’re doing it? For me, when you work in this somewhat cutthroat environment, it’s never good enough. The world I’d been in the last several years has not been about you as the clinic director or prior practice owner. Create something and have some free time, some great things with your family and all that stuff. You are having these terrible conversations and it’s not about the quality of your life. That’s what I missed because that’s the relationship part of what glues me to this profession.

Tell us a little bit about what you’re going to do next. What’s your next game?

You don't need more patients if you have holes in your bucket Click To Tweet

If you ever have a chance to have a mulligan, you think about yourself and your practice. If you wanted to do it all over again, there’s probably a laundry list of things you would probably want to do differently. I don’t know exactly what those would be, but if you think it through there probably a few things you would have done differently. For me, this mulligan moment gave me an opportunity to take a business that I’ve built over a twenty-year period and look at the things that I loved about it and things that were not so great about it. Unfortunately, because that’s the way your machine runs, it’s not easy to go, “Let’s quit doing that. Let’s do something different.” Starting something new is different.

One of the things that we would do within the company is we had an introductory course called the New Patient Course. I know that you’ve been to it before. It’s a two-day course. It’s hopping on a plane and coming to one of our offices. You’re missing at least three days of work. It’s a great course. It’s helped a lot of people expand and grow their practice. It’s a big commitment. You’re losing quite a bit of time and money for something that you’re not sure if it’s going to work. Over these many years of working with practices, I have gobs and gobs of do this and don’t do that. Try this, it works 97 times more often than not, I was going to help you. What I decided to do in this new endeavor is to build things around a mastermind group.

Tell us a little bit about your ideas with the mastermind group. It’s a concept that I pulled from Think and Grow Rich by Napoleon Hill. There are plenty of accountability groups out there that are another word for mastermind where you get a group of people in the room and you discuss the blank topic. Sometimes it’s similar industries, sometimes it’s not. Yours will be PT-specific. Tell us a little bit about your mastermind concept.

Several years ago, while at Measurable Solutions, I put together a group called The Master’s Club. In that Master’s Club were many of our top clients. What it became was a bit of a mastermind. Mostly I would present a topic, we would talk about it, how to apply that, issues related to that and those types of things. It started out with a couple of guys and then it began to grow and grow. It was something I liked about it because it was like getting down to the nitty-gritty. These guys have done a lot of training and in their own right very successful. It’s having a point of view that’s not in your practice, somewhat exterior to your practice, who’s seen a lot of clinics and can go, “Over here in Rhode Island, these guys are doing well.” I’ve seen it work and I’m like, “A light bulb goes off.” We’re very close to that. We didn’t have that one little special sauce you mentioned and we’ll put that into the practice. That was a cool thing. I know it’s buzzy and popular. Everybody’s doing it. I get all of that. There’s accountability all the way around. That’s what I wanted to build with this.

That definitely happens when you’ve got multiple guys in a room. If it’s one-on-one, sometimes you can be as that person, but when you’ve got two or three other perspectives and they’re like, “Why are you saying that? Why are you telling us this story? That’s not necessarily how it works where I’m at because I see something different.” Getting the different perspectives and the different mindsets together can be helpful and coming to the truth or even brainstorming can be beneficial.

I’ve delivered hundreds and hundreds of seminars and workshops. Every now and again, you’ll be delivering a workshop and someone will raise their hand from the audience. He’ll go on and spout on about how he does things in his practice and it works amazing. They get tons of referrals. Doctors love them and all this stuff. The rest of the audience doesn’t know that I know that practice isn’t winning. I know that practice is barely profitable. Others are writing it down like it’s the gospel. How does that work? Five morons don’t make a genius. You want to be able to earn the right to the table.

In the mastermind, you might have people with small practices. You might have people with big practices, but what we have to be able to do in this mastermind is you need to back up what you’re saying with some statistics and actual objective data. All of my mastermind members are in a statistical management program. We have a two-hour call every month and a follow-up call every month with individual practices. Let’s say we’re taking how to set up the standards of care or we’re taking up how to get internal referrals. We take that subject up. That would happen to be a tremendous amount of content in that area and there will be an implementation program with the intention that it will take a part-time basis under 30 days to get put into your practice.

Nobody wants something that’s going to take a year and a half to get into your practice. It’s bite-sized chunks, “Get the numbers up. I want to see the stats rise.” It’s all about driving the practice growth. For a couple of reasons. Who doesn’t want instant gratification? I’m afraid all of us do. If something takes a long time, it’s easier to give up on. It’s like, “In two years, you’re going to triple your practice,” forget that. How about two weeks? It’s dissecting down to a key couple of things. When you’re on their one-on-one, if you’re a big practice, you can take a bigger bite out of things so that program could get deeper. For a smaller practice, you might take a small bite. If anyone listened to my first presentation, there are only six key areas of practice, whether you’re big or you’re small. Each one of the masterminds deals with one aspect of that experience.

PTO 53 | Provider Production
Provider Production: If one’s goals don’t include more than how big their wallet is or how many visits they are seeing, it’s never good enough.

 

My little mantra is, “Reach out, step out and network.” Reaching out means to find some consultants or coaches. Stepping out means get out of full-time practicing so you can work on your business. Number three is to network and there are different ways that you can network. Entrepreneur’s Organization has an accelerator program that my partner, Will Humphreys and I used. We also are part of the Master’s Club that you talked about. Networking with other PTs, even other industries can be beneficial to get some mindset, some mind melding, brainstorming and different perspectives. This is all hugely beneficial. Can you share with us a little bit about what some of the content might be in a mastermind situation?

One of the things when we take on a new client and we start working with a new client is you can’t keep doing the same thing and expect a different result. If you have a practice that has holes in their bucket, the most common thing people think is, “I need more new patients.” If you close the holes, you’ll get more patients. You could get a better outcome or word of mouth. A lot of things will happen. You’ll be more profitable. Also, your marketing dollar goes a lot further. Closing the holes is key but to do that, you have to change behaviors. It’s not always the owner. Sometimes you can get the owner to change his point of view, but he can’t change the rest of the team’s point of view.

I don’t know the ladies in this audience, but I do believe that I have a good understanding of the men in the audience. Whenever there’s something that we can’t quite face at work, some person we have to talk to and we think it’s going to go bad or ugly. When we lay in bed at night, we become Chuck Norris, Walker, Texas Ranger, you all know, hopefully you’ve heard that name before. You’re lying in bed and you’ve got this staff member who comes in late, cuts out early and doesn’t get his notes done. You’re mentally clicking off tally marks like, “Six times he’s done this. Seven times he’s done this.” Finally, you get to the point where you’re tired of not sleeping and you need to say something to him. You’re like, “Joe, it’s not okay that you’re coming in late.” This is what you’re having a conversation mentally. You’re lying in bed and you’re going, “Joe, it’s not okay that you’re coming in late.” He goes, “You can’t talk to me that way.” “As a matter of fact, I can.” He says, “You’re not the boss of me.” “Yes, I am. I am the boss of you.” He takes a swing at me. I docked and threw him on the floor, cuffed him and tossed him out the window. While we go through all this mental pain all night long, Joe is sleeping like a baby. He’s out cold. He doesn’t have any awareness that he’s this type of staff member.

You finally muster up the courage to go into work the next day and you go, “Joe, it’s not okay that you’re coming in late.” The next thing you know he’s apologizing. He says, “Ever since Mary had the baby, I’m not getting a lot of sleep. I’m so sorry.” He gives you a hug. You’re wondering how you get your karate chop. What I’m saying is you have to set the stage. In this mastermind, we talked about what are the standards of care? A staff PT has to do three things. He needs to treat people well and get great results, that’s a given. You can usually see that if you’re in the clinic. You look and you go, “Happy patient, range of motion improved. Now they can walk on their hands, all things are good.”

The next thing is they’ve got to code appropriately. It’s not lazy, not pick two codes and whatever number. They have to code correctly for what they’re doing. The third is they have to document it impeccably. They have to document it and back it up because number one if you guys are good therapists, it gets great results, he has happy patients who love him or her. They’re referring people in. It’s all good. If he doesn’t code well, the owner takes it in the shorts because they’re not getting paid as well as they could be. If he doesn’t document well, there won’t be any blowback on that therapist. It will only go back on the practice. What you see is a great therapist, what you may not see is what goes on in the EMR. That was one of the things that were significant to me that I learned when I was with this PE group is looking in under the hood and seeing there’s a lot of room for improvement in this game. In that particular mastermind about setting up the standards of care, it would be everything from how to code to how many visits, the discharge, different things that are expected on every patient and gaining agreement and cooperation from your clinical team. Once they embrace that, on other mastermind groups where you get together, there are the mechanics of the actions to take to achieve all of that.

An effective promotion will lead to new patients. Click To Tweet

Like you shared with me, you collect a lot of those statistics beforehand so you knew what they were doing and this is what you’ve been doing for the last few years. You’d look into EMRs and find those statistics. You shared with me also that a lot of these owners that you’re talking to think they know where their stats are, but they don’t know the true data. They might say, “We’re coding and fine. We’re doing great.” You look at it and they’re billing two skilled units of visit for a one-hour treatment.” You’re like, “You’re giving away 30 minutes of free therapy. That’s not right. That’s not ethical.” You’re also losing me money at the same time. I love that you get into the nitty-gritty about, “We need to code appropriately. We need to back it up with appropriate documentation because our license might be on the line, but I also get dinged because an insurance company could find out about it and pull the contract.”

That happened to us by experience. It’s not all about the therapists. If they can treat, great. You can develop great relationships. If they’re not doing their part as a team member, it brings the whole boat down. That’s where the holes are that you’re talking about the buckets leaking like crazy. You’re not in a position to be stable and get the freedom that you want, that you’re talking about beforehand. Especially if you want to expand, you’ve got to shore up those procedures in that regard if you’re going to expand and make this more than a two, three-person clinic.

It is about building a team. Sometimes you have an owner with a big viewpoint, big goals and big dreams and you have a staff who doesn’t know and agree with those big goals and those big dreams, you have a disconnect that takes place. I see this a lot where clients would get the two owners in a room, there are the key execs in a room and they’d talk about world domination and all these things they’re going to do. They never talk to the staff. Those are the guys who make it happen. They are like, “How did it go with the staff meeting?” Sometimes we take too big of a bite when we’re not ready. Sometimes when we’re ready, we can take massive heights and we open a clinic. There are people who open clinics and don’t show up until it’s open. They’re not even a part of it because they have such a great leadership team. Those are good and you’re fortunate to create that, but not everybody is like that.

You bring that up, I remember I was probably five to six years into my ownership. I knew that I needed to hit about 180 visits per week for my one practice to break even and make some profit. It was in a slow season, we got down to 150. I told my main therapist, “We only got 150 visits this week.” She looked at me like, “What does that mean? Is that good or bad?” She was still going and checking log. That cued me into finally recognize that not only should I know my stats, but my staff needs to know the company stats and their individual stats if they’re going to get in on this together.

There are a lot of assumptions that are made. Some of the times we don’t do a deep dive very often and looking at how our numbers are shaking out. You talk to almost any private practice PT and you go, “How often do you see your patients?” “I see them about two to three times a week.” Do you know what I’m finding with all of these guys that I’ve been dealing with when I first started working with them? It’s about 1.5 visits per week. When you have this data and you go over this, what’s funny is that they don’t believe it. 100% of all the partners that I’ve been working with, when I go, “You’re 1.52 patient visits per patient per week,” “That’s impossible. The data is all wrong.”

It’s not wrong. It’s like, “There’s got to be a miscalculation in the system.” I go, “Why don’t you manually do it for the last week?” How can that be? It can be for any number of reasons. We can sort those out. It could be as easy as the therapist being a softie. It could be the patient has a high copay and whines about it. The receptionist is a softie. It could be the therapist wants to see you three times next week and the patient says, “I can only come once.” The receptionist says, “Okay.” It could be a million reasons. You don’t know why, but the number is not very good. The lower the frequency that you see a patient, the more attrition that you’ll have with that patient where they’ll discharge themselves.

I’ve always said if you have more pain in your wallet than pain in your back, you’re going to quit therapy. If you give a long pregnant period between treatments, it’s very easy for a patient to discharge themselves. Within the mastermind, you have to start with data. Everybody is filled with opinions, “You know what I think I should do?” It’s like, “Why are you having a conversation with me? Why haven’t you already done it if that was the solution?” We have to start with raw data. We gather some raw data and the data will point us to something. That’s what we’ll do in each of the masterminds. That’s what we’ll do with a one-on-one. We look at your data. We see where it points. What are the action steps that can be taken in a short period of time to influence things in a more positive direction?

PTO 53 | Provider Production
Provider Production: If you have more pain in your wallet than pain in your back, you’re going to quit therapy.

 

What do you tell those guys who might say, “I don’t have three hours a month, I’m treating a full patient load 50 hours a week and doing my business stuff on nights and weekends?” You’ve heard that for the last 30 years. What do you tell them?

I tell them that it’s probably always going to be that way. As long as you’re okay with it, I’m okay with it.

What if they don’t do something different?

It’s okay. If you work 50, 60 hours a week and you manage on the weekends, you don’t have a life and you keep doing that, then you’re going to work 50, 60 hours a week and not have a life. If you’re okay with not having a life, it’s not my problem either. If you want to change that, some things have to change. That’s the key. Some things simply have to change.

As you go through the masterminds, do you stick to the six areas that we talked about in the first episode that I did with you? Do you focus on those areas specifically and highlight some of those each time you visit each month?

Let me run off the six areas so that I put out lots of details, but to give you an idea. The six key areas of practice success as I see them is an effective promotion that will lead to new patients. That mastermind could be almost anything marketing. It could be several different masterminds on that subject. Whether that’s social media, whether that’s remarketing, whether that’s direct mail, whether that’s how to survey your public to find the right message to deliver. It could be on a variety of different things on a high gradient, a low gradient and a medium gradient. That would be a subject. Another is your schedule work control. Getting people to keep appointments, scheduling out into the future. It gives you many predictions of expansion and it creates growth. Schedule work control would be number two. The next is mastering patient compliance. WebPT did a study where 70% of patients discharged themselves from PT.

I did an interview with Heidi Jannenga and they did their state of therapy report. I want to say the average clinic lost $150,000 a year because patients didn’t complete their plans of care.

Don’t work with people who aren't willing to put their shoulder to the wheel. Click To Tweet

That’s a good number. If you have a patient that finishes therapy not well because you didn’t have the spine to have the conversation, they go somewhere else. You don’t lay around like, “My back is killing me.” You’re going to go find someone else whether it’s another physical therapist, whether it’s a chiropractor, a massage therapist, an acupuncturist, a crystal hooker, whatever it is, you’re going to go search out some care because the person didn’t get it done. When we look at case acceptance or patient compliance, looking at closing the patient on the value of the service and receiving it and it’s sales. A therapist who is a softie on sales never built a profound reputation in their community because most of their patients are half-baked, a little doughy in the middle.

They’re not completely crisp. You can’t build a reputation when you don’t push it through. That’s the third area. The next one is your competence in management, billing and collections. Certainly, that’s the actual process of billing and collections. Certainly, it’s those types of things. It’s also coding correctly. That would be in the category, whether we’re doing a visit-based coding such as Medicare or whether we’re doing procedure-based coding such as AMA. How are we coding our care? Our EMR will do the calculations all for you. If you are sloppy in this area, you’re losing buckets of money in practice. That’s the fourth area. The fifth area is getting referrals from your existing patients and to me, that’s the gold mine of PT. Most practices, about 50% or more of what they see are old patients or friends with patients, which is fantastic. Who doesn’t like a referral? They come in and they think you’re a god before you’ve even said anything to them because their friend, Sally, said you’re amazing. Yet, we do very little. Some therapists do this crazy thing where they say to the patient as they’re discharging and leaving the clinic, “I hope I don’t have to see you again.” If you do that and you’re reading this, stop it.

I had an interview with David Self of Keet Health. He swears that if you improve that customer experience and that includes the referral basis and developing that internal marketing, you would triple your ROI on your marketing dollar. If you focused on that, you don’t need new patients. You need to improve the customer experience, focus on internal marketing and your marketing dollar will triple.

One thing I find too in this one particular area is when you treat people in a closed environment, they become patients in more than a physical sense. You become their counselor, their priest and all these different things that go along with that. One of the things they don’t get involved in is the community of physical therapy. They are not involved in like, “Seeing this guy, he was limping before and now he’s walking better.” They’re not part of that dynamic energy that goes on generally in your gym. You look at that and you start evaluating against us, it’s normally not hard to do. I’ve definitely done some looking. When you start evaluating, not like this group therapy delivery but within reason, you don’t want unclothe people walking around and are like, “You don’t need pants here.” In more of a dynamic environment like that, it’s hard to be the depressed whiner in an environment like that. It brings you up. Whereas if you haven’t been a room, they think they’re the only patient that you ever have. They hang on to your time and you never know what’s going on. That makes a difference in terms of building internal referrals.

Generally, the sixth key area of practice success is improving the productivity and efficiency of each staff member. In this area, it’s broad. How many visits do you need to see before you hire a tech or a PT? Where do you need to hit numbers-wise to justify the next hire? How do you evaluate the performance of every individual in the practice so that you can see that they’re pushing the rock up the hill and you can see by how much? You know when you don’t need somebody is when they go on a two-week vacation and nobody had to pick up anything while they were gone. When they come back, they don’t come back. How do we improve the efficiency and productivity of every staff member?

One of the things, Nathan, is we look at an efficiency statistic. We talk to every practice and you say, “How many visits would have a full-time PT in a week?” It’s a full-time schedule. They start doing the math. They’re like, “They get a double appointment for a new patient,” and they start doing all this math. Let’s say they come up with a number of 60, even number and they say it’s 60. You look and go, “Where are you?” They go, “Let’s see.” You do the math. You go, “How many PTs do you have?” “I have three PTs.” I go, “How many visits are you seeing?” They’ll say, “We see about 90.” That gives you a 50% efficiency, which means 50% of the time, they aren’t doing anything productive. If that therapist goes back from a workshop, seminar or mastermind and says, “Guys, 50% of the time we’re not doing anything,” that percentage is going to improve because someone is going to quit because they’re mad at you. That’s a management strategy, but people will not consider that they’re inefficient.

They’ll fill the time. They’re not sitting around twiddling their thumbs. They’re going to say, “I was documenting. Remember that, for our staff meeting, you wanted me to present. I was doing that and I called some patients.” They’ll fill the time that’s available to them. It just won’t be productive.

PTO 53 | Provider Production
Provider Production: Make sure you don’t over-hire unless the stats supports that you bring on a new person.

 

They won’t like to start playing Euchre or something like that. Maybe they do. They don’t and no engine can run at 100% either. You can’t be flat out all the time. There’s somewhere in between. I remember being in Maryland visiting a client about fifteen years ago and 86% of his revenue went to salary. He was paid lower than the lowest-paid PT. While I was there, three staff members reached out to the owner and said, “We need help in billing. We need another therapist for such and such.” He goes, “Let’s get an ad out.” I looked at the staff member and go, “No, don’t do that.” The staff member looked at me, looked at the owner. He goes on, “I’ll get back to you.” I go, “What are you doing?” It’s like being big, powerful and lots of staff that are inefficient is ridiculous. You can’t take care of your staff. The staff who’s working hard, you might have one working hard, you can’t take care of them because you’ve got seven of them that are doing 50%.

You’ll eventually lose that one because they’ll get burned out. For people who are wondering, we try to keep our salary as a proportion of our income. It’s less than 50% if we could. If you can do that, you’re doing well. If you’re at 45%, you’re killing it. Try to keep it around 50% on an annual basis, then you’re doing pretty good. 86% is horrific. That guy has got a lot of holes in the bucket.

In some areas of the country, if you’re upstate New York, it’s more challenge. When you reimburse at $46, $48 a visit, you’ve got to hustle. When you’re in that environment, you figure it out. If you’re in different environments in Chicago land area, Maine or whatever where you might be pulling down over $100 a visit, you can have a lot more sloppiness in your game and still survive. It is a changing environment. Rules change and people won’t be making more money if they’re funny that way. How do you do that? You can do it in a controlled and agreed upon fashion or you can cut back to where you’re not even delivering great care anymore. When we look at improving productivity and efficiency of each staff member, we’re looking at the other five things running well, good promotion, good schedule control, good patient compliance, coding appropriately, billing appropriately and getting internal referrals. If the team pulls that off, they’re generally very efficient and productive. You want to make sure we don’t over hire unless the stats support we bring on a new person.

I love that you brought up stat simply because the key to all of these things is typically statistics 90% of the time. To know if you’re doing well in any one of these key areas is to know the stat related to it. In that way, you’re not objectively saying, “We’re doing great. I’m seeing two to three times a week,” when they’re 1.5 simply because you’re going off your feeling or, “So and so is my best physical therapist and his patients love him. Meanwhile, he’s only producing two times a salary when he should be producing three and a half to four times.” You have to have the stat in order to recognize what is happening in the business and drill down on those.

I got this line from one of the gentlemen that I work with the PE group and I love it. I have to give him some ownership to it. When you’re keeping statistics, it’s like reporting the news or are you creating the news? If I’m talking to you and I’m like, “Keep the statistics on. That doesn’t do me or whatever.” Are you just reporting the statistics? Are you reporting the news or are you creating the news? Creating the news takes skill as easy to spit out a bunch of numbers or software and give it to you. It’s like, “How do we create the news?” and each staff member creates the news for his respective or her respective area. It’s not, “I just turned in the numbers for the week. There are my numbers and they stink bad but those are my numbers. I got turn them in. I got them in on time.” It’s like no. You have to be accountable to create the news. That’s what we make a shift for. A lot of practice owners and myself included at one time, you spend a lot of time when you’re trying to implement something into your practice. You don’t even realize you’re doing it, but you spend this time with them mentally or with your partner hashing it out. It’s basically, “How do I close my staff to do this? What are we going to say in a staff meeting that’s going to get people excited about this?” Did you really go through that, Nathan?

All the time. We know these stats, we know these things and we have these programs. How are we going to get the practitioners or the front office staff to buy in? It’s getting the water down to the end of the row if you’re a farmer.

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You had an owner who wants to take big bites and big bites fast but the staff doesn’t want to take any bite at all. That’s part of where the mastermind comes into play. We take a bite that’s easily digestible across the hole. We get that in place operational consistently there versus, “Do this,” and it’s huge. The guy who gets all excited. He hangs up the phone and goes, “How in the world am I going to get this motley crew to do that?” What one or two or three little things can be taken at a time where we’re beating the elephant one bite at a time and we’re growing something that you can look back and be proud of?

In the mastermind, the way I have my mastermind is you can quit at any time. I’m not locking you down to pay all up front, all of this kind of weird stuff. I’m not doing any of that because if it’s not for you, it’s not for you. On the other side of that coin, I don’t want to work with people who aren’t willing to put their shoulder to the wheel. There are always those guys who will sign up for something because they got more money to burn incense and they get involved in it. They say, “That’s some good information,” yet when it comes to application, they don’t apply it. It’s like those bizarre patients who never missed an appointment. They never get better and never do their exercise program. They won’t run it with a gun in your hand. They keep coming in. They suck the life out of you.

Unfortunately, you can occasionally have clients like that. Within the mastermind that we have, you come in and we interview you. If it’s going to fit and you want to do it, we sign you up. If we don’t think we can help you, we’re not going do it because this is already capturing attention and growing. What I loved about what I did before was I love working with people who wanted to change things. It was exhausting to work with people who were mostly unable to face their staff, situations at the office and they’re mostly whiners. I don’t want any whiners, I don’t want any spectators. Instead of locking them down like, “I paid for a whole year so I better show up to this thing,” they’re coming in like Eeyore in Winnie the Pooh. It’s like “It’s not working out. I’ll fill your seat with somebody else who wants to play ball.” I’m interested in creating 5,000 award-winning clients. You don’t get there when you got a lot of hangers-on.

Shaun, thanks so much for your time. I appreciate it. If people want to get a hold of you, find out more about the mastermind that you’re doing or just asking more questions regarding what you’re up to nowadays, how can they get in touch with you?

Probably the easiest way would be email. Just email me at ShaunK@PTPracticeSuccess.com. You can also give us a call at 866-220-0386.

I hope a lot of people will reach out to find out exactly what you’re doing and also find out more about the programs that you’re offering nowadays. That’s going to be a huge value to anyone who reaches out.

I think it’s going to be great. It’s going great already. It’s nice particularly in this web world where you can actually look at somebody and say something and the light bulb goes off and you get to see it. You can’t see that over the telephone but you sure can see it in a web environment on a Zoom meeting or whatever.

That’s the beauty of technology. Thanks again for your time. I really appreciate it.

You’re welcome. Thank you.

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About Shaun Kirk, PT

PTO 53 | Provider ProductionAlliance 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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