PTO 94 | Financial Management During COVID-19


Private practice owners need to make quick decisions in order to mitigate the negative effects of the COVID-19 pandemic. There isn’t a how-to on this disruption other than to take some logical and quick steps. In this episode, financial planner Eric Miller of Econologics (Private Practice Millionaire) talks about those steps that we need to take now and how to strategically ramp up in the future. Obviously, as the owner, your sole purpose is to keep the business going, so now is the time to take action in order to stay afloat until things turn around, no matter the time frame.


Listen to the podcast here:

Financial Management During The COVID-19 Pandemic With Eric Miller

I'm bringing back Eric Miller because we are all worried about money in the middle of the COVID-19 pandemic. I don't know a single owner that hasn't significantly slowed down or shut their doors altogether. The concern immediately goes to not only your employees but also your money and your financials and if you're going to be able to stay afloat when this thing does get back around. Eric, you've been a multiple-time guest. Thanks for joining me again. I appreciate it.

It’s my pleasure.

I've enjoyed the information that you've put out through Econologics, your webinars, the downloads and all that stuff. I figured it'd be great to have a talk with you on the show so we can work this thing out and share some valuable information with the owners.

I know a lot of practice owners have a lot of uncertainties happening. Anything we can do to make them feel a bit more stable in these unstable times.

A lot of times, some guys are more prepared than others financially for an expense like this. It's coming as a shock to all of us. What are some of the first things we need to do right off the bat as we're addressing this as owners?

The first thing you have to do is you have to look at what the condition is that your businesses and your finances are in. The best word is confusion and uncertainty. That is the condition. The way that you handle a confusion is that you have to get rid of all the uncertainties that you have. What I hear most when I'm talking with practice owners is that, “I don't know what I'm going to open. I don't know how I'm going to pay my bills. I don't know how this is going to affect the longevity of my practice.” There are many of those. That's what causes the fear and the anxiety and all the things that you don't want.

One thing I do know about the condition of confusion is that it breeds bad decision making and we don't want that. My advice is let's clear up some of the uncertainties. Get everything out of your head, get it on a piece of paper and try to figure out like, "I need one piece of certainty that I can establish. I know how much I have in my bank accounts. I know how much accounts receivable I have coming. These are my open credit lines." You're trying to get some stability that you can navigate without making bad or rash decisions in this timeframe.

If it's not uncertainty, it's fear, which also can lead to bad decision making. Once you can get your hands on some real data and information that is true, that helps you then make the decision and you've got to start making decisions. You can't wait for the next update. You can't wait for the press briefing. You’ve got to start making some of these sure financial decisions based on the true data that you have to start overcoming the uncertainty and fear and start developing a plan not only for the now but for the future as well.

The way that you handle a confusion is by getting rid of all the uncertainties that you have. Click To Tweet

Another point to that too, because there's information coming out fast, it's a mistake to start trying to look 4 or 6 months in the future. That's going to mess with your head when you do that. You have to say, "What do I have in front of me this week?" and plan out that way. Another week comes, "Here's my battle plan for this week." Because there's always going to be new information that's coming, it would be better to navigate that way. Otherwise, your attitude and your emotional tone level is the key. If you're an action and if you're like, "We're going to do this," you'll be imaginative that you can be creative. If you're in fear, anxiety and all those negative things that creep up, that doesn't spark creativity. Now more than ever, you need to be creative.

Keep your horizon to 1 to 3 weeks ahead of you and deal with it when you get there. I don't want to get too off-topic because I want to talk immediately about what things people need to do. After you've handled some of those things, think about maybe how this company to look in the future. If there are some things I want to change, do you allow time for that?

You're doing both. You study history, no great movement or organization ever made strides when everything was hunky-dory and rich and prosperous. You can make some big strides as an organization when times are in distress like this. What you would need to do would be the exact opposite of what everybody is telling you to do, which is a contract, close down, don't see anybody and don't promote. Those are the things that if you can do the exact opposite of that in some form, then you can become a beacon to your community and your patients and be like, "These guys were willing to provide good data and information and provide a safe place we can still get help." Make no mistake, the help that you provide is much needed in terms of what physical therapy can do for the human body.

It's interesting as people were considering shutting down. The information that I provide to my clients was don't stop promoting. Your message might change and probably should, but don't make your promotion and marketing budget one of the things that you cut. You still want to get the message out. You still want to keep in touch with your patients and your physicians and all your marketing vendors. Change the message if you need to. If you have some extra time, take an opportunity to redesign and rebrand a little bit or something like that but don't stop promoting and marketing. Find another way to do it.

You want to make sure that you're over-communicating not under-communicating. I'm having all my advisers, myself, I'm calling everybody, every client that I have because I want to make sure how they're doing and that they know that we're trying to figure out ways that they can navigate this situation. It's not easy for anybody. You can establish a lot of goodwill with your people and enhance that by doing that.

Another thing that came up in a mastermind group we've taken from physicians, we get referrals much from physicians. How many physicians are getting calls of, "What do you guys need? What can we do for you? Can we come over?" If you have a massage therapist on board or can hire a massage therapist to go over and one-on-one, not in a group, but provide massages to an overworked staff or something like that. What can you do for those physician groups who are having to stop all elective surgeries altogether? What are they doing and how can you help in that situation?

I'm seeing a lot of people that are giving stuff away. You have to do that at this time. We look at profits and revenue. That's important but at this point, you’ve got to be a beacon of help. That means that maybe I'm given a course away or I'm giving something away, a month off, whatever it would be. We want to help you. You have to do that.

When someone comes to you and as you're doing these interviews on shows, what's the first step now to handle things financially?

From a business point of view, the number one responsibility of the owner is to make sure that the organization can stay there. It means that financially speaking, you have to make probably some of the toughest decisions you've ever made in your life. Likely, a lot of practice owners have never been in a situation where you had to furlough and lay off 50%, 60%, 80% of your staff. Unless you have few months of business reserves, there's no way you can carry that payroll when no patient visits are coming in. You have to act fast on that one though. You can't wait because patient visits are dropping percentage-wise, 70%, 60%. They're dropping fast because people are scared. You can't carry that payroll if you don't have the patients coming in. You have to act fast on doing that. It's a tough thing to do, but you’ve got to make sure that you preserve the organization. Work on a skeleton crew. Keep your key people, keep your producers and the people that are going to help you fight your way out of this one.

PTO 94 | Financial Management During COVID-19
Financial Management During COVID-19: Make sure that you're over-communicating, not under-communicating.


Keep your billing people because that's your money lines right there. You need to keep those. Keep some good executives and some key producers that you need. Go down to a skeleton crew and try to produce the basics of what you need that you can keep the organization there. I don't know how many patients visit that is. Each practice would be different, what is the minimal amount of patients that we have to have come in here so that we can keep the organization flowing at least in that respect?

Have you recommended the owners get in touch with their CPAs and rework their break-even number? “What are my bare minimum expenses?” It's probably a good exercise for owners who don't have a lot of accounting knowledge and aren't good with QuickBooks and whatnot, but sit down with the CPA and say, "Walk me through it. What are my bare minimum expenses? What is my salary need to be? If I'm open, how many visits do I need to squeak out to break even and stay afloat?"

That's part of the getting rid of the confusion because you would need to do something like that. That is one of the smartest things you can do, it's going to put your attention on your money. In this time, you need to stay connected as far as who you have on your Rolodex, who I'm talking to you. You're talking to colleagues a lot and your associations. Like the show that you're doing, there is good data is coming out this. People in the news media, you go anywhere else I'm not certain that's necessarily good data, but the associations and your other colleagues, good data is coming from there. Your bookkeeper and your accountant because they're going to know your income and your expenses and they'll help you rework that make-break number. You want to get in touch with your banker because you may need to look at credit lines, see what you have available, see if there are different ways that you can access credit that maybe you didn't know about that you could.

Your financial advisors, if you have types of investments that you may not even realize have some liquidity features to them that you can access. They've made some changes with the Stimulus Bill that you can access qualified plans for some time if you need it. It's time to stay in communication with your financial team and your billing department. What do you have coming in? Whatever is in your business checking account, you have whatever accounts receivable that you're going to have coming in. You should know that and whenever your business credit lines would be. Let's get some certainty on what that is. I know what I'm going to have to do because your reserves and your credit lines are gold.

For me, as you're talking through that, I can see that if I knew I have this much cash available to me, even if it's in a line of credit and my accounts receivable and my checking account and then I know what my bare minimum expense level is, I know how many weeks or months I can ride this out. That's where I get some certainty and that's where I start getting more confident and less fearful because people might have more than what they think they have. They might be looking at their bank account and thinking, "This is only going to get me through two weeks." Whereas if they've done some proper planning and gotten a lot of credit ahead of time, they have access to that. Could people tap into IRAs possibly?

The Stimulus Bill came out and there were some provisions in there that if you were affected by the Coronavirus negatively in some way, shape or form, that you can get access to $100,000 of your qualified plans. Everyone's accounts got hit 40% and you're taking money out.

You don't want to sell low.

I'm not sure that's a smart thing to do. They have all the relief loans and grants that are coming out. I'm going to touch on that because my advice is that the devils are in the details on that. Be careful before you sign your name to something because when credit and free money is made accessible, it usually has titanium strings that are attached to it. I don't want people to start getting loans and grants and money and keep people because you think that you're going to get this money or you may be able to hit the stipulations that they're going to have of requirements before they forgive it. I would caution people to not do that. Get your mini make-break done. Know what your expenses are. Try to see enough patients ride this wave through so that way you don't come out the other end with $100,000, $200,000 of what you already have in debt. That's the problem that we're trying to solve. I don't want that for people.

The condition of confusion breeds bad decision-making. Click To Tweet

What have you heard about people putting in claims with their general business liability, insurance policies or anything like that? Have you heard anything on that end? Whether that it's going to work out for people's favor?

Unfortunately, I have and insurance companies aren't dumb. If you remember the SARS virus that hit, insurance companies went back and rework that business interruption policy that this thing wouldn't necessarily qualify for business interruption insurance. That doesn't mean that if you did have it, you shouldn't take it to file a claim. You should do that anyway because who knows. From what I'm hearing, most people that have that type of insurance, this necessarily wouldn't qualify because they're saying that there has to be actual property damage for something like that to occur. That's hard to quantify. I wish there was better news on that, but I don't think there is.

I like your advice though about being wary of the SBA loans and grants that are out there because you can imagine. You're working with the government and the time and effort that it's going to take for this to happen and to get those funds, I can't believe that it's going to be quick and in a timely manner.

You don't have time to wait. You have to act fast. The speed in which you make decisions and doing it with good data, which is why you want to get out of this uncertainty is paramount. Trying to carry all this expense on your back, it's going to force you to potentially have to dip into your personal reserves. A lot of people don't even have that. It's something I would be much wary against doing something like that.

Number one, get some true data. Put some money together or figure out where you're standing financially and what you have access to financially. Stay in communication with all the important people. That includes fellow professionals and peers. I don't know if you can trust Facebook groups because you could get a lot of fear out of those. You pick and choose the right one. Stay in close touch with your vendors. Don't give up the promotions and make fast decisions.

There was one more point I was going to make. A lot of people have loans and leases and such. Get in communication with them. I'm sure you can get some relief, deferral payments or something like that. Don't be afraid to call them up. Everyone's going through the same thing. Most of them are going to be open to it and say, "I may need 2 or 3 months deferral and let's work together on this." If you don't call them, then that's where you're going to get in trouble.

Look at any of your expenses and feel free to call them. I say this because I know that they're forgiving some of the student loan payments at this time and deferring interest and whatnot. As a landlord, my mindset and the other landlords I'm talking to is I'm still going to send out the invoice until you call me. If they do call me, I don't want to lose your business. I don't want you to go under. There are a couple of things I'm willing to do. If you want to decrease your rent payment and then spread that out over the next twelve months, that's fine. If you want to take this month's rent payment and add it to the end of the lease agreement, that's fine. If you want to draw down from your security deposit that you're already put in and pay that back over time. I'm open to all of those things. If you're coming up on a renegotiation of a lease, now is the time to do that renegotiation and see if you can get some of those free months. If your lease is coming due here, it's the time to call your landlord and say, "Here's my situation. I need some help. I need some relief. Let's start negotiating so I can get some immediate relief and I will pay you back if you help me through this."

It's amazing what will happen if you get in communication because nobody wants to lose tenants. As a landlord, especially if you have businesses in your building, you care what happens to them. That's your lifeblood too as a landlord. You're going to be open to any creative methods, but to your point, if no one calls you, you're like, "Rent is due. I need it." That's a good point.

Outside of salary and payroll, some of your bigger expenses are going to be exactly that. It's going to be rent. It's going to be insurance payments, debt payments that stuff. Some of those can be relieved and taken off your plate.

PTO 94 | Financial Management During COVID-19
Financial Management During COVID-19: Be careful before you sign your name to something because when credit and free money is made accessible, it usually has titanium strings attached to it.


We talked a little bit about this as far as when this thing recovers, how do you handle that point as well?

What would you recommend owners do as they're looking to the future? We've got some of this. I've got a financial plan in place. My idea to throw it in there is that, maybe start reading some books that you hadn't read before about business organization. Getting your mindset right. I'm a big proponent of Think and Grow Rich. Those first four chapters of getting your mind straight and getting an ideal scene in mind. If you've been working in a situation that you haven't truly enjoyed, start creating maybe an ideal scene of, what is this going to look like when I do revamp and how can I make it look the way I want to look in a situation I want to see?

You're getting an opportunity to reset this whole thing.

Take advantage of this pause button.

Right now, it should be, “If I had to do this all over again, what would I do differently?” You're going to have that opportunity, especially if you've had to let people go. You're going to have this opportunity to do good money management if you didn't do that. Now, you see the necessity of having organizational reserves and profits and putting that in as an actual expense. Maybe not having the percentages be out of whack where 80% of all your revenue is going toward staff and benefits. You have an opportunity right here to play the reset button on there. Put in some good business systems that maybe weren't there so that you can grow your organization and expand even more than what it was. Pay attention to that. Wear your owner and executive hat more than being a practitioner.

Our previous interview talked about how you handle things financially as a PT owner. You're talking to the points that we made in the previous show, is making your 10% profit margin and expense line and coming off of the top. Also, make sure that you're getting a decent profit. Some of these guys are working on 8% to 10% profit margins and I'm like, "You can do so much better." Now, is the time. As you started getting into this saying, "How are we going to ramp up and be more productive, profitable and financially sustainable?"

You have to do it on a gradient. You have to make sure that as you're bringing people back slowly that you're not overwhelming the organization with expenses again because that's what got you into trouble in the first place.

You don't open the doors and invite all the employees back in?

They can try to bankrupt you or make your business non-existent, but they can't take away the ability for you to create it again. Click To Tweet

I'm sorry, this is going to be wildly unpopular. I know that and I'll probably get beat up from some people, but you can't do that because, in the reimbursement game, the lag on income is 1 or 2 months. You have to make sure that as you bring people on, you work on a skeleton crew even if they're working double-time seeing patients.

Pay them overtime if you have to.

Don't bring on all the staff too quickly. That way, as your patient load increases, because it's not going to go from, you're doing 500 patients a week and then it goes down to 50. It's not going to go right back up the 500 in a matter of months. It's going to take a little bit of time. You’ve got to make sure you can navigate that. Now is a good time to hit that reset button and say, "We're going to put in 10% for reserves, 5% for a tax fund, another 5% for a business reserve account. I'm going to put these things in right now." That way as I bring people on and I'm going to stick to those percentages and I'm not going to deviate from them because I understand how important my profit is. That's going to do a couple of things. Number one, it's going to put good control of money back in. It's going to allow you to expand the organization and it's going to make the business more valuable down the line because you'll have a profit margin, which as you know when you sell your business, that's largely what it's based upon.

That's the value of your company.

You have an opportunity right here to do that. If you overwhelm the organization with expenses again and bring all your stuff back right away, then you're going to be right back in the same boat that you were.

If any owners are reading out there, if there are people that you didn't like or didn't produce in your company beforehand, take advantage of it and bring back the people that you're excited to see. Not the ones that you're like, "We’ve got to bring so-and-so back because we need to fill that hole." No. There are going to be plenty of people out there looking for work. Find the good ones. If you have an amazing employee, one of the skeleton crew that is live and die with you, ask them about their friends and their network and how you can find more and more A-players because they're going to be there. Find your A-players, let go of the ones that you weren't excited to bring back, to begin with, and you're having issues with. Take advantage of this time. It's a time to not only strategize financially, but it's also a time to strategize with your human resources as well.

This became an employer economy. It was an employee economy because everyone was demanding higher pay, time off, benefits and all of that and it flipped like that. The business owners are back in control here a little bit where they can be. This is not a competition. It's not me against them. It's finding out who is part of your team, who wants to be there and who's there to get a paycheck. To your point, that's key to do that.

This is an opportunity. There are opportunities that abound. Financially, restructuring and reorganizing your financials, but looking at the structure of your company and the people that are in it, your team members and create your dream team. It's time to create a dream team. If you're sitting on your butt and waiting this out, then you're going to be behind the curve. You need to start reaching out to people who you might've wanted to reach out to in the past that weren't available, more than likely they might've been let go at. It's time to start making those connections again. Even if they might be committed to going back to the place they were before, it is not a bad time to reach out.

You can get rid of the negative people without having to get in there and fire them.

PTO 94 | Financial Management During COVID-19
Financial Management During COVID-19: The speed in which you make decisions, and doing it with good data, is paramount to getting out of this uncertainty.


All the stuff that you've talked about, you shared a lot of this on webinars. You have those things on YouTube. You've got a PDF download for people to manage this. I hope they take advantage of the information that you're sharing because it's hugely valuable.

We're trying to put good financial data out there and if I can talk a little bit about the financial plan aspect of this thing going forward. What you're going to do going forward from this because you do have an opportunity to do something different. When there's a crisis, when there's blood in the water, there is an opportunity there for you to take advantage of. When you look at the several years, you look at the things that people have done with their money and what's happened, interest rates and checking and money market accounts have been 0% to 1%. Nobody saved any money because there was no purpose to save money. They made debt accessible and easy to get, "Buy this big house. Buy this car. You can afford the payment. That's all you need." They made the Tax Code confusing, ambiguous for practice owners because it's four million words. How can you confront that? Your accountants don't help you as well.

They made it seem like the stock market was the only place that you could put your money to earn any return against the inflation rate. We call that the default plan. If you didn't have your financial plan, that was your default plan right there. It worked well because if you look at the situation for most business owners, they don't have much liquidity. They have loads of debt. They overpay in their taxes and likely all their 401(k)s and IRAs were in the stock market where they took a 30%, 40% hit. Not only did your business value evaporate overnight, but all of your personal reserves at the same time went down 30% to 40% in value. There has got to be a better way to handle your finances than that. That's why I'm like, "Get a plan that does the exact opposite of that." It's fine having $100,000 sitting in a checking account, earning zero, as long as you have some liquidity there. It's fine to have some money in protected assets that may not make huge returns, but at least you know it is going to be there at some point. It's fine to take advantage of the Tax Code and save yourself $20,000 to $40,000 in taxes a year by being proactive and looking at it. It's time to get a plan that does that.

You're the man that can help us. If people want to get in touch with you, where do they go? 

They can go to They can hook me up on LinkedIn at Eric Miller and Facebook. They can go to our page. We do have that Financial Disaster Guide. For your readers too, if they want 15 to 30 minutes appointment or consultation, then I'll certainly extend that offer. Please take advantage of it, in any way we can help even if it's helping you navigate through this time. We'll be willing to do that to talk with you for 15 to 30 minutes with no strings attached.

It would help people for sure. Give them some certainty at least. I'm sure you'll give them a battle plan that they can go off and start working it so they can go from a place of surety and a little bit of faith.

It’s something that they can help with. Our YouTube channel is on They can go on our YouTube channel and subscribe. It would be cool.

Thanks for your time as always. It's awesome to have your information, your knowledge and wisdom. I appreciate it. 

I'm glad to help. For those owners again that are having the feeling like their businesses because some of your guys are shut down completely. I've been telling a lot of people this is that they can try to shut you down. They can try to bankrupt you, they can try to make it that your business is non-existent there, but they can't take away the ability for you to create it again. That's a key point for those guys that are shut down. They only lose something if you don't think that you can create it again.

It's going to take some work, but you know how to do it. You've done it before. If you're an entrepreneur, you've been through crises. This isn't the first time. Thanks.

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About Eric Miller

PTO 94 | Financial Management During COVID-19Eric Miller has been in the financial planning industry for over 20 years. He’s a co-owner of Econologics Financial Advisors – awarded an Inc. 5000 honoree for 2019. As the Chief Financial Advisor for the firm, Eric has had the good fortune to have over 10,000 financial conversations with private practice owners in various healthcare industry and helped guide them into a more optimum financial condition using a proven system.


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PTO 89 | Marketing Strategies


Getting patients to enter the door may seem simple but is actually one of the hardest steps PT clinics tackle. Today, Nathan Shields talks to Peter Decoteau, the marketing director at Physical Therapy & Sports Medicine Centers (PTSMC), the largest privately-owned PT group in Connecticut. Focusing on breaking down any barriers that keep new patients from coming in the door, Peter recognizes that the first barrier for a majority of people is simply knowledge - not enough people know what physical therapy is, thus your message has to recognize that. He shares aspects that make these technical such as location, insurance, and those can be further addressed after you've captured their attention. Peter believes that regardless of the steps taken, it is necessary to know what your brand is, who your ideal client is, where they get their information, and the content they need to hear all of which leads you to begin to generate marketing campaigns.


Listen to the podcast here:

Marketing Strategies To Ease The Path For New Patients With Peter Decoteau

My guest is Peter Decoteau. He is a Director of Marketing for a large physical therapy company in Connecticut. I brought him on because I want to talk a little bit about a couple of things. First, the things that we need to consider as we are advertising directly to our local community or direct to consumer marketing. Secondly, what are some of the things we need to do on the back end, which is number one, how did we get that patient who is interested to convert? Number two, how do we track the KPIs related to our marketing strategies.

Important stuff as we're considering that a lot of our marketing strategies need to spend more time and effort either direct to consumers, via mail, email, or social media and rely less on physician referrals. That's the trend that we're seeing. I'm trying to highlight physical therapy clinics that have been successful at doing it. If you do have a marketing strategy, I’d love to see how yours compares to what Peter represents. Also, if you don't have a marketing strategy, consider some of the basics during this episode that you need to do to be intentional about your marketing efforts to grow.


I've got Peter Decoteau. He is the director of marketing, Physical Therapy & Sports Medicine Centers, Connecticut's largest private practice group. I wanted to bring him on because I saw a past impact magazine article in which he talked about marketing. I'm always open to that and we need to consider marketing outside of the traditional physician relationships. Based on his article and further talking with Peter, I wanted to talk a little bit more about marketing and some of the things that we need to do and look outside of the traditional relationships or things that we're doing. Peter can give us some light and insight into how to make it easier for new patients to get in our door in general. First of all, Peter, thanks for coming on. I appreciate it. 

Nathan, thanks for having me. I'm happy to be here.

Give us a little bit of breakdown about you. You're not a physical therapist by trade, you're in marketing, but tell us how you got into this all and your experience with physical therapy.

I came into physical therapy cold. I didn't have any experience with physical therapy personally. I had not gone through physical therapy. It's an interesting experience to come in not knowing too much about the industry. I have a strictly marketing background. I started in a nonprofit in Hartford, Connecticut and then moved onto a private school up in Simsbury, Connecticut. I was an ad agency for a little bit as well. The benefit for me of having those experiences and coming into this environment is that I have a pretty broad breadth of knowledge in terms of different approaches to marketing. The different pieces of marketing like PR, digital or advertising, all those different things that you'd want someone to be doing.

A different perspective.

Working with different audiences. If anybody out there has worked with a nonprofit, they would know that you were pretty much every hat possible there. It was a good starting point for me. I was doing some multimedia marketing for them, but I was also doing some membership relations and some sponsorship relations and things like that. It gave me a good foundation for where I wanted to go next. The opportunity to come into Physical Therapy & Sports Medicine Centers came from working with someone in our leadership group. I was working with her husband at the private school and they needed someone to come in and do a little bit of consulting for some of the digital marketing and social media stuff that they were looking to expand upon and reach a broader audience with. I jumped on as a consultant in that way. I did a pretty extensive audit of their digital presence and gave them recommendations and I was doing some ongoing work with them.

Do whatever you can to break down the barriers for new patients to get into your clinic. Click To Tweet

When the opportunity came out for a marketing director to jump on board here, they reached out to me and things were tumultuous at the ad agency. That's a different story. Suffice to say that they don't exist anymore. It was good timing, jumped on board here. I had already been working with the team here. I knew that it was a good fit and I was interested in coming into the physical therapy world knowing that it'd be doing something that at the end of the day is helping people. Not necessarily for me doing the hands-on treatment, but getting people into the physical therapy clinics, especially clinics that we have that I believe do top-notch work. It felt like it was a good industry to jump into.

That's cool that we have you on because you bring a different perspective than the typical physical therapist that might be talking about marketing. I want to ask you, are there some false ideas that physical therapists have about marketing and how it should be done that you have to come in, break down or challenge and change their perspective about it? If so, what might some of those things be?

The number one thing that I've seen, in coming into the industry and being a part of the private practice section committee, is that physical therapists greatly overestimate how much the general public knows about physical therapy. We tend to exist in an echo chamber of our making. In an impact article that I've put together, we're the fish living in this water all day. We tend to think that everybody else sees it the way that we see it. We talk to the general public. You realize that their knowledge about the scope of services provided through physical therapy, the way that you might come to physical therapy, even where their nearest clinic would be or the difference between outpatient and inpatient.

There's not a lot of knowledge in the general republic and that is a matter of messaging for the industry. For the most part, the industry itself was mainly surviving on doctor referrals to physical clinics. Most of the messaging had to happen from the therapists or if they had marketing people, which a lot of them didn't to the doctors and to trust there and build relationships there, which is still important. Given that direct access is something nationwide that came out in Connecticut. The focus should be on pushing forward on self-referrals, direct access, teaching people even what that means and what that is, especially the scope of service that we provide.

Tell us a little bit about that because that leads to our topic as far as how to get those new patients in the door, direct consumer marketing. It’s getting the knowledge out to the broader audience because the stack gets thrown around and I don't know where it was found. I wouldn't be surprised if it's true that only 10% of those patients with musculoskeletal injuries get the physical therapy that they would need or could need to overcome their injury. That means that all of us are fighting for a pretty small pie. If we're focused on the physician referral route, there's 90% of the population out there that could use our help that isn't getting it because they don't know about us. We take for granted that everybody knows about physical therapy or at least some version of it. Maybe they don't understand how physical therapy could help for minor traumas, for simple injuries and stuff like that. Talk to us a little bit about how you work to help those new patients get in the door from the population and utilize direct access.

I love that you use that number. That's a number that our Vice President of Business Development, Mike Durand. He’s been a part of this company and he was an athletic trainer before. He throws that out all the time and says the same type of thing. It's like, "If that's true, which the study shows that's the case, that we're all fighting for that little piece of the pie instead of working together to try to make the pie bigger for everyone." If we're talking about ways that we can increase self-referrals or increase our patient volume with people who are not coming directly from the doctors, is that we first focus industry-wide on our messaging and create a little bit of consistency.

At least acknowledgment to get the messaging out there in a broader sense before we start doing more clinics specific or company-specific messaging, if we do that successfully in terms of having clear, consistent messaging, talking about the benefits of physical therapy as a whole because that percentage of the pie gets broader. Even if there are fewer people specifically knowing about our clinic at some point, all the whole thing grows. We'll be reaching maybe more of a niche audience, but that niche audience is also bigger. Our patient volume still grows.

It sounds like your marketing starts with developing the knowledge-based of the community as to what physical therapy itself is and how you can benefit those people who are having less traumatic issues. Maybe simply low back pain, you're marketing your message is a little bit more knowledge-based and then you add your tag or logo at the bottom? How do you guys go about doing that?

PTO 89 | Marketing Strategies
Marketing Strategies: Physical therapists greatly overestimate how much the general public knows about it.


We talked a little bit about this, something that David Straight had mentioned on a previous episode of yours, which I encourage everyone to go back and read it if they haven't. He talks about starting with establishing your brand identity and figuring out who your target audience is. Also, figuring out where that audience is in terms of platforms you can reach them most effectively. We always start there. Once we've gotten to that point, we know who we're talking to, we know who we are and how we're positioning ourselves and we know which platforms we're using. We get to this piece about the intellectual property that we can bring to that, the content that we can put together.

The value to the users or the audience while also educating them on this broad range of topics that we're talking about. That doesn't necessarily have to be broad with each piece of content, but that we're covering a lot of bases in the messaging that we're putting together. The more that the audience sees these messages, the more comprehensive of the picture they get and the more personality they get about our companies specifically. The pieces that I'd say differentiate us from the other clinics that are in Connecticut.

I love that you bring up David Straight's episode one of the few first episodes and you talked about marketing. The evolution of your marketing doesn't necessarily change. You've got to figure out who you are and who your ideal client is? Some people might say, "What is that avatar?" Once you have that figured out and what you do best and what patients you want to work with, then you can focus on, where did those people get their information from? Is it social media? Is it mail? Is it email? Is it postcards? Is it community events? You can focus on the content. Based on knowing who your demographic is, you can structure your content accordingly. To invite those specific people in the door, that's how you would structure your marketing program as you're going direct to the consumer.

In terms of what we're talking about with getting people into the clinic, educating the public both on an industry level and then on company or clinic specific level. What we're talking about is breaking down the barriers of entry to the general public. This piece of it that we're talking about is the barrier of knowledge. It's a general knowledge barrier that people have for physical therapy. What are the things that we can do that breakdown that knowledge barrier in a general sense of the benefits of physical therapy? That specific level of physical therapy can help with your recurrent back pain that you might not need surgery for but keeps you up at night. Here are the ways that our clinics specifically can help with that because we offer dry needling. We do hands-on therapy. We focus on the manual. We are closer to you than the other clinic. There are these other things that make us a better option for you. We can start from that broad sense and get more specific as we continue to try to reach that audience in the way, read the messages that resonate with them.

If you look at their websites and some of their content, they might focus more on the treatment they provide instead of the benefits they can provide to the patient. As we're talking to ourselves, we know the benefits of say, dry needling or some manual therapy technique but that's not what you want to highlight and advertise. You want to get down to their knowledge level and also, what's important to them, which are their functional capabilities and how you can improve those and focus there. What you provide is off to the side. This is how we do it. If you can simply get them to buy into what you're doing to improve their lives, you can talk about how we do it later on.

Our motto is improving the quality of people's lives. That's the thing that we always go back to because we do say that PT in general if you're going to a good physical therapist, that's what they're doing. They're improving the quality of your life because you can sleep throughout the night. You can pick up your grandkids. You can play rec league soccer on the weekend, which I do. I've needed to go back to physical therapy for that specifically to get me back out on the field. Those are things that provide quality to my life or somebody else's life that we're trying to get you back to. Starting at that point and then getting more specific.

I like to think about it and you talk about a marketing funnel, getting people down in the funnel and then wondering where do they go once they convert? I made up in a previous position. I tried to visualize what it looks like to me after they've converted and put a little bit of a tornado in the middle of the following, say, "If you've created the awareness and then you're getting to the point where the people exist in the middle point." Especially with physical therapy, which you want them to be aware of the fact that you exist and you have these benefits. Maybe that person doesn't need physical therapy but you want to be there for them when they do need it.

You want them to exist in this little middle part of the funnel that's like a little tornado of information that they can keep on receiving. How can we keep them engaged? How can we keep them interested? How can we get new little tidbits of information to them? That's the way that I like to think about it. The content marketing that we're doing that we are getting people to that point and then staying in front of them with all this relevant information that speaks to both the services that we provide, but also the personality and the differentiator points that we offer. When you talk about something like dry needling, you're right, we're not going out there necessarily promoting dry needling to the general public as a selling point for us.

Reach the audience by reading the messages that resonate with them. Click To Tweet

Once you're engaged with us, we'll do videos about dry needling and talk about the benefits of that and show you what it looks like. I had the barrier to entry for that would be thinking that it hurts. Can we show you in a video that we're dry needling, someone and they're not reacting to it at all? We did a video with one of our clinicians. She specializes in temporomandibular dysfunction. She dry needled two parts of one of her aide's phases. We'll first show the type of treatment that you would be offering, but also, ancillary it showed that it did not hurt her at all. The more we can bring that type of content into the fold, the better.

As you consider breaking down the knowledge barriers and providing them what they need to know about physical therapy and how it can help them? Do you have a secret sauce when it comes to getting that conversion? If they call and they want to utilize direct access and come to you without going to a physician, what can you share about how you get those people to convert and become new patients?

I wish we had all those answers because that would be fantastic. That's something that we're working on daily. I talked to our operations people and our employees as much as I can about the things that we should be doing that are consistent. I see that as two separate things. One is the functionality of getting them to convert. The other is the interface with our employees when they're interacting with them on the phone or when they come into the clinic. The functionality piece is, we try to optimize everything we have. Everything that a potential patient might be interacting in a way that again, breaks down the barriers to getting them into the clinic.

For example, if you're someone who doesn't have any relationship with PTSMC in the past, and you probably maybe even not had a relationship with physical therapy in the past or you've had a bad relationship with them, which is something that we hear sometimes. What's the information that you're looking for? How are you looking for it? How can we get it to you faster and easier and more effectively? How can we make it easy for you to book an appointment? Ideally, what's happening in the person's thinking, "I need physical therapy." The doctor said, "You need physical therapy." I'm going to tell you to find your therapist, which happens more often. They go to Google, they search for it. You come up, they go to your website, they're looking for maybe, do they take my insurance and do they offer the treatment that we're looking for?

We know that those are two things that people are looking for most often than not. Are you getting them to the right page initially? Is it easy for them to find that information? Once you've given them that information, how easy is it for them to book an appointment? The way that we have it set up for us, our organization is that we built a new website specifically with that user process in mind. It's optimized for the user flow. Also, for the SEO flow to the individual pages, search engine optimization flow. On purpose-built out landing pages for every treatment option. We've got that landing pages for every individual clinic so that if you're Googling, "Best physical therapy in Avon, Connecticut." If you do it in Connecticut, the first three things that probably show up are one, a Google Ad campaign that's running for that says best physical therapy in Avon, Connecticut, that when you click on it, it goes directly to Avon's location page.

The second thing that shows up is probably the organic result for that. The third thing that shows up is probably either the maps result or staff result for the same thing. We're trying to dominate the search results there as relevant as possible. When they get to the site, make it easy for them to find that additional information. We have, I believe, two or three conversion points for submitting a request for an appointment through the website on every single page. There are a floating button, a sidebar and a top bar that says, "Request an appointment." Everywhere on the site, it's there, it's ready to go.

Whenever you want to request an appointment, we're ready for you. 

Ideally, what would happen is that they would click on that and they'd be able to integrate with your scheduling and requested an exact date and time. We're not there yet. It's somewhere that I would hope for us to be pretty soon. Also, there's some friction in terms of what's available in someone's schedule. Maybe it's available for a reason that you know all about because I'm not in the clinic. It was a little bit of like, "How much can you do there?" You're breaking down those different barriers to book an appointment or they put them to call and they're going right to the clinic that they're trying to.

PTO 89 | Marketing Strategies
Marketing Strategies: Figure out where clients are and be really specific about what you're doing in terms of the platforms used.


It's great that not every individual practice owner is going to have a director of marketing like you to handle a lot of the Google Ads, the SEO and stuff like that. What it shows is, we put out some marketing promotional material or an ad, you name it, but in what you've done intentionally is, how can we make this as easy as possible for patients to get in the door and make an appointment and convert? That's a necessary exercise for any owner. That is to say, we put out this ad when someone calls or when we're calling out for a referral, how easy are we making it? Are we forcing them to give us all their insurance information before we answer their question? Are we making them jump through hoops and getting the date of births and that stuff?

Are we more focused on them and maybe what their name is? What their ailment is and how it's limiting their life, maybe establishing that relationship right off the bat. I'm saying there are other ways that you can go about it and it's worth the exercise for owners to sit down and say, "At this touchpoint with a potential patient, how can we break down the barriers?" Maybe they've got an understanding, a knowledge-based. What can we do to make it as easy as possible for them to make an appointment? Everything we can or in that call and I'm sure you're doing it with your calls. You're also doing it with your website. How can we make it as easy as possible for that internet traffic to translate into a visit as well? You can look at those touchpoints and say, "How can we make this as easy as possible?” 

You bring that up and that speaks to that other point that I was talking about the interface part of it. One of the things that we try to do, everything I was talking about the functionality wise is called technical side of it. At the end of the day, we always have to remember that we're dealing with people who are probably in some pain or representing someone who's in pain. Not only that, but they have to deal with the pain of going through the healthcare process, which is usually not simple. From that point, can we come to them from a perspective of empathy? Can we make that part of it easier? When they come into the clinic to treat the real pain that they're dealing with, they haven't had to jump through all these hoops beforehand?

Typically, what we do on that end is a lot of different folds to it. I would say that our operations group does a good job of onboarding people to the particular culture that we have at PTSMC. We focus a lot on the differentiator for us being one of the tenants of our mission statement is lifelong relationships. That's a key tenant of that. We want to be known as the physical therapy company that focuses on, we say that the person, not the problem. When we onboard people, we focus on that as a key element of everything that you do when you're working. You're getting people in a database and your scheduling. You're first and foremost, a representative of that philosophy that we have here.

Likewise, we do that with our clinicians too and we have to do that with the front desk people were feeling most of the phone calls. Another thing that we do that speaks more to the marketing side of it is we do a separate onboarding event process with all new clinicians’ call, "Living The Dream," which is they met our president loves to say. We've got to wrap it into that. It's focused more on that what we call the soft skills that you don't necessarily learn in PT school that are related more to that interpersonal piece. What's beneficial for me as a marketing person to be involved in that is again, not knowing that I'm not a physical therapist and I'm not having these face-to-face interactions with them. Giving them some more consistent tools to bring to those interactions that might help the growth of both their client base and the clinic more broadly has been useful for them. Sometimes it's something as simple as always have business cards on you.

When you're discharging a patient, if you think that they had a positive experience, which we think that most people do and our survey scores reflect that, give them a few. You can say, "I'm your person. I'm your PT. Hand this off to any friends or family that you think is dealing with pain and tell them about direct access because people don't know about that. Let them know that you've got a guy and I can get you in as soon as possible." That little intimate touch of saying like, "You've got a guy, here some cards, and bring other people into the fold." It both allows you to get that word of mouth out there for the referrals, but also, it puts the value into their hands that they've got a connection that they get to reveal to people who are in their circle enough to take advantage of. We do small things like that.

As you're Looking at some of these efforts that you're putting out, are there certain KPIs that you follow to see if these are being effective or not? You brought up Google Ads or SEO costs, how do you measure KPIs or ROI on some of these things?

I tell partners at all the different clinics and this is my number one byline to all of them. My job is to get people into your doors. That's the ultimate thing that I do. If all else fails, if we're getting more people into your doors from a marketing perspective, then I'm doing my job. Their job is to provide world-class physical therapy care, so that people want to spread the word and come back as return patients. Let their friends and family and colleagues know and all that stuff. We do a lot more than that in terms of supporting brand awareness within the clinic and supporting the clinicians to get out in the community. The number one KPI for me to answer that question is that if we're getting more patients into the door, either self-referred, returning patients or referred patients, then that's the number one KPI. In terms of tracking the performance of individual campaigns that we're running, it's a lot easier to create KPIs and track them when it's coming from a digital campaign. For Google ads, you can track the clicks through to the website and the conversion rate from those clicks.

PT clinics must remember that they are dealing with people who are in pain or sending someone in pain. Click To Tweet

There's direct percentage of saying, we have a little bit of an equation that we use that's like, "If we're spending $300 a month with this clinic on Google Ads and we're seeing six conversions through that ad campaign because their phone calls and requests through the website, we're going to estimate that only three of them are coming in. What are three patients worth in the life cycle of a patient coming for ten treatments?" The average is nine or ten. That return on investment might be $3,000. We can say those numbers of conversions and the percentage of click-throughs and say, "For that ad campaign, we're getting a ten-time return on investment of those numbers." You start to look at that and say, "How can we get those percentages higher? How can we tweak the campaigns?" Those are the types of KPIs that we start to focus on in terms of like, "We want to get more conversions through that, how can we do that without blowing out our whole budget?"

What's a percentage of return that you're expecting typically? What is the sweet spot for you at least this number and above?

We tend to see it. It works out well because we have the 25 clinics, soon to be 26, where I built out from the start a few ad campaigns on Google and optimize them as much as I could, knowing what our budget was going to be. I pretty much copied them and duplicated them down, changing the location information in the contact information. We're working off of these few optimized ones. We're the good month for one of them, we might see a 10% conversion rate, which is pretty good. Typically, we're probably seeing 4%, 5%, or 6%, which is still pretty high I as an industry average, which is good.

You work with a large company and you had soon to be 26 locations, what would your recommendation be for a guy that's only got one or two locations? He can't bring on a full-time person for marketing, maybe has room for part-time to find somebody or maybe as needed for a campaign. How would you recommend they go about looking for marketing help or doing it themselves?

I always say to start with the low hanging fruit. In this case, if you had to pick out two people who are your ideal client personas whether those are based on payer mix. Maybe you have enough volume, but you want to get volume from a higher payer or payout. Maybe it's volume focused specifically. What's the low hanging fruit in terms of the people that you know or in your area that need PT who aren't getting it or don't know about you? Start with the groups that you would most like to reach as the low hanging fruit, easiest people to get to. Figure out where they are and be specific about what you're doing in terms of the platforms that you're using. One of the things that I tend to see, and I saw this at the ad agency too, that we would bring on clients who wanted to do everything.

They were only working with the small budget or maybe it was a small organization we were working with. We dealt with a lot of that and nonprofit because nonprofits don't have a lot of money for marketing. You want to do a little bit of everything. You want to chase every new trend and you want to be on the TV and get the print ads and also do the social media thing and do the Google thing. It's important to focus on those audiences and focus on where are those audiences are or those audiences are and be that targeted and specific. It's better to maximize the effectiveness of something efficient in terms of your budget and your resources and time that you can put into. Rather than spread yourself thin and maybe see success at a few of those different things which are using up way too many resources. Be specific.

You've brought up a couple of things. Number one, be specific. Focus your marketing efforts on something and focus on that only instead of trying to hit every button out there. You also brought up something else that it's important to bring up in that is most small clinic owners don't necessarily have a budget. Number one might be figuring out what your budget is for marketing or this campaign, and then set that money aside and limit yourself to that budget and see what it does for you. Make sure you're measuring it appropriately. I brought it up with David Straight and I also brought up with Neil Trickett. What your budget is for marketing can vary wildly simply because if you're a startup and you're new. You're opening up a new location, while you want to put more money aside for your marketing purposes and may be up to 10% of your gross revenues if necessary.

Whereas if you're going along and you're nice and steady, you've got a reputation, you've been around a long time, maybe that number pairs down to 3% to 6% of your gross revenues for marketing. Number one, come up with a budget first. I like what you said, "Focus on what you want to do." How do you focus while you focus on where your demographics are? Who do you want to hit establishing your brand identity? Who's your typical patient, the ideal patient? Focus on those platforms with that predetermined budget. That budget can allow for maybe bringing someone on as needed to fulfill that campaign for you or doing it yourself if you have the capability of doing so. 

PTO 89 | Marketing Strategies
Marketing Strategies: Broad messaging is a good marketing technique for building good relationships.


I'm in a unique position at PTSMC because the way that the partnerships operate is at each clinic technically has its individual budget. We all have things wrapping up into a broad marketing bucket budget for us to work with for the most part. I have to have these conversations with each partner at the beginning of the year and then in the middle of the year when things are rolling out. The piece about, how much are you willing to spend to maybe test a couple of things out to see what works? How much are you willing to spend on things that we already know works? What's that breakdown look like? An important piece of it, what are you doing to drive organic results as well? Things that don't require too much of a budget and that's when we get back to this knowing the language to talk about self-referrals.

Having the knowledge and the language to use in talking to patients to tell them to talk about you're going on in the community or leave reviews on Google, leave reviews on Facebook, things that you know have a pretty high yield do anything asking for those things. I was talking about this piece of patient interaction that's called the point of delight. It's a marketing term that speaks to this point where people, I've received great service and they're looking for a way to reciprocate. Especially when it comes to physical therapy. They may not be paying too much for it. Hopefully, their insurance company's paying for it.

Maybe there was small copay, but they don't feel like in terms of the monetary interaction that's happened, that they've necessarily reciprocated for the service that they've received, especially if you're building a relationship. That is trustworthy, caring, they feel like they need to do something to make it up to you. Catching them at that point and saying, "Would you mind leaving a Google review or going on Facebook and sharing some of our staff or I would think most value telling people about us." That's free advertising for you. Having the language to do that, it doesn't require any budget, once you get that point if you're doing those things and you want to continue to grow and expand your patient volume, yes. How much are you willing to spend? Are you willing to test out a few different things?

Not spreading yourself thin, but you did the research, you looked at your analytics, you know that they needed the demographics, they're trying to reach out to you. This is where they are. Let's try a couple of different AB tests and see if we can track results there. Also, having the tracking measures in place to know if it's working or not because I've seen a lot of that too. Where it's like, "We're doing the social media stuff or the Google stuff." It's like, "How are you tracking performance on that? What does success mean to you there?" "We want to see more patients." Like, "Are you separating them and tracking them individually to see that this one's working, this one's not?" It's having all of those points in place before you start rolling things out.

It's important to ask the question, "Do you want to try new things or do you want to continue with what you're working on that will determine your budget?" You're going to spend a little bit more, but you don't want to forsake the stuff that's you've got going already. You want to continue doing what you're doing and then if you're going to do something new, make that an add on so you can see the benefit of it. You have to be intentional about that and plan those things out.

Don't be afraid to cut off the things that aren't working. We saw a lot of that when I came on board originally. We have relationships that had been going at certain clinics, whether or not they're community relationships where we pay $1,000 to be a part of this event. Also, print relationships where we have a monthly percentage of the budget going to these print ads for these smaller local publications. I'll see value in those things, but typically it's not that top-level value. I see a lot of value coming from people reading the paper and seeing the admin like, "I should go to physical therapy." For me, is there a way to leverage that relationship? Can we talk to the sales rep or the smaller publication?

Usually, it's a small staff to leverage the consistency of advertising into actual news coverage? Those things have a value that you might be able to parlay your investment into it, unlike a regular basis. For the most part, you come in and you see that we're throwing a few thousand dollars a year at this print ad stuff and we haven't done any of those relationship pieces. They're expecting it to keep on coming in and you pull the plug and talk to the clinician and say, "Do you know if you're getting any new patients out of this?" I would say, "Someone mentioned it to me one time. I don't know." We'll try to create some metric for measuring success there, but if we don't see that in the next two

Reviews are reciprocations of the services clients receive. Click To Tweet

Move that money somewhere else that's more effective. Anything else you want to share with us before we take off, Peter? 

I'll say one thing and this is a call out to all physical therapists out there, whether or not they have a marketing team or if they're small staff doing the marketing for themselves. I'll push this again because we talk about it a lot at the PPS and APTA and all this stuff. For us, a rising tide certainly lifts all boats. We as an industry, do have a great opportunity to take advantage of the huge percentage of people out there who need physical therapy but aren't receiving it. Also, for some reason aren’t getting the information about the benefits of physical therapy, the scope of services that we have. The ways that they might be able to bypass whatever healthcare system they were working within using referral direct access to come straight to your therapist in ways that that might save you time and money.

If we can be more consistent in not being necessarily self-serving on a marketing side to talk about, we're the best all the time. Let's talk about physical therapies the best because it's a part of a healthy lifestyle. If you commit to it and if you build a relationship with the physical therapist in a way that you might have a relationship with primary care doctor, attendant or anything like that then. Down the line, first off, that's a longstanding relationship that you have. Also, that person's going to have a healthier lifestyle and be able to maintain activity and stay active in the older age. For me it's more about broad messaging, getting those talking points out there, direct access, the scope of service, and then being specific about what the differentiators are for you. That speaks to your brand identity as you've outlined it.

I love the insight and that you're willing to share some of what you guys are doing. I appreciate that. If people wanted to reach out to you and ask you questions or where you might be doing, are you willing to share some of your contact information?

Sure. I'll share my email, Always feel free to reach out to us on Facebook. You can message us on Facebook. We have one account for the whole company. We try to keep it all tight together.

If people want to check out your websites, you were talking about the Google Ads that you use and how you set things up to allow people to request a referral or request an appointment, what is the company's website?

It's easy The individual locations are available there. Hopefully, you'll see in the coming month we're rolling out. This speaks to the idea of breaking down barriers, but we're rolling out an AI chatbot on the site. The goal of that is to get people to the information they're looking for as quickly as possible. We know that people are looking for insurance location or treatment. It pops up and says, "What can we help you with?" If they don't need any things, it goes like, "Here it is." Try to get people to the stuff that they're looking for.

We'll have to check it out. Hopefully, it's already in place. 

Hopefully, it's in place and it's all working correctly. If it's not, you can email me and tell me that it's not.

Thanks for your time, Peter. I appreciate it.

Thanks for having me on, Nathan.

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About Peter Decoteau

PTO 89 | Marketing StrategiesBen has been a member of Teton Therapy since May of 2010. He graduated with a Doctorate of Physical Therapy from the University of Mary in Bismarck, ND and conducted his field work primarily in out-patient settings while in school. During his time at Teton Therapy, Ben has taken many continuing education courses on topics such as Dry Needling, Kinesiotaping, neuromuscular re-education, running analysis, and injury prevention—a topic which he immediately found a passion for and has since conducted classes to the community. Ben quickly applied this vast amount of knowledge to the practice and sharpened his therapy craft. His general interests include water sports, running, outdoor activities such as camping, competing in triathlons, and most importantly spending quality time with his wife and children.

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PTO 91 | Working With A Coach


Dr. Avi Zinn, PT, DPT, OCS, the owner of Druid Hills Physical Therapy in Atlanta, Georgia has been gradually growing his practice with the goal of giving high-quality care to his patients. Since our last episode, he has procured a PT business coach to reach the goals he has for his business. Today, Nathan Shields checks in with Avi to see how it's going so far, what he's learned, and his experiences since they last spoke. Discover what Avi has learned and the traumatic experience that challenged him as a young owner.


Listen to the podcast here:

Reality Episode, Ep. 2 - Avi Zinn, PT Begins Working With A Coach

This is episode two of my reality podcast episodes with Avi Zinn, tracking Avi's relationship that he's developed with a coach and consultant over the past few months. If you haven't read the episode, go ahead and do so. That'll give you an idea of where we're coming from because that was prior to Avi starting his coaching. In this episode, we want to focus on simply what his initial experience has been and some of the things that he's had to deal with since we spoke. He had some trauma that happened in his clinic and I hope we pay proper respect to the nature of the issue and how Avi got through it appropriately. It was a difficult situation for him and his clinic to go through. Hopefully, we handle that situation appropriately and understand that Avi had to navigate a ton of emotions while also trying to be the leader and a stalwart of his clinic on behalf of his team, patients, community and families involved. This is an interesting episode, but we got a lot out of it.


The Owner of Druid Hills PT, Avi Zinn. If you read the first episode with Avi, you'll understand that what we're doing here is simply tracking Avi's journey as he brings on a coach, a business consultant, if you will, to help him in his business. We shared a lot of his professional story and what he'd done before that point. Correct me if I'm wrong, Avi, you had hired the consultant as of our last episode but hadn't started doing anything with him formally.

Right, Nathan. I can't remember what month, it was a right around the same time. I may have hired them on, signed up with them, but hadn't gotten anything going.

I wanted to follow along with Avi maybe every quarter or so and see what his progress is like. What he's learning from his coach? What's helping, maybe what's not in some of his experiences as he's taking it on. I started asking you questions already, but thanks for coming on again. 

I'm glad to be back.

If you want to follow Avi's story and learn a little bit more about him, read the first episode. Since we talked, tell us a little bit about some of the things that you've done with your coach, some of the things you've learned and some of your experiences. 

First of all right from the get-go, things started well. Getting all of my numbers in order, taking all the analytics with WebPT. We had all these analytics but I didn't know what to do with them. We took all of our analytics, all of our metrics and put them all on a dashboard so we can objectively look at the numbers and track them and follow them. Right from the start, we were able to see an increase in efficiency, looking at better utilization. The numbers were able to be tracked. From the start of the coaching, it has been able to get me through a lot of not knowing, being able to like, "I see what that is, now I know what to do."

In relationship to the numbers, there's something to it, but there's a thing out there which is measured, improves, measured, and reported improves exponentially or something like that. What you find is as you start looking at the numbers, even if you don't put a lot of effort into improving the numbers, they start improving somehow. The universe starts pushing you in the right direction if you will. It's simply tracking the objective numbers and your KPIs in your clinic. That exercise alone seems to start improving things.

It feels that is happening by having those numbers on the dashboard and looking at them every month and comparing them, we see positive changes.

The cool thing about it is you're looking at it objectively and I'm not speaking for you, but for myself and maybe some other owners, you might feel things are getting better or you might feel things are getting worse. When you look at the numbers, you have the data right in front of you and you know if it is getting better or how worse it is getting or how much improvement you've made. It's good to have that certainty, if you will.

To get back to the question about how things are going. Having my coach that I speak to every two weeks and we talk about the numbers and see what needs to be changed, how could we change, what can we work on. Going back to the first one we did. Talking about The E-Myth originally and a lot of people read The E-Myth but they don't implement it. Having these numbers, the coach and the accountability is allowing me to stay focused and not get distracted by any of the millions of other little things that anything could happen, accomplish or try to affect and change what we're working on.

Considering you talked about accountability, do you feel a little bit of pressure? As you know that your meeting is coming up with your coach that you go, "I need to get this stuff done," whereas maybe you wouldn't have that before?  

I did.

That's why it's good to have that person. I'm assuming your coach is a physical therapy owner as well or was or something like that. They can relate to, they can talk about the same language and use the same vocabulary. You started using the metrics, started following your KPIs. You're meeting with your coach. Are you doing anything else on top of that? 

Always look at the numbers and make sure things are going as you want them to, and then go from there. Click To Tweet

The coaching program, there are also a whole bunch of modules that they have set up for let's say patient engagement or internal marketing or all these different modules. Another good thing that the coaching helps with is you're focusing on those numbers, “Let's talk about what we think can help change that.” If it's making sure that we're focusing on not having the patient drop off or making sure we're more efficient and completing plans of care. There are modules for, "This is what works and this is what you can do." There are all those things that I'm working on. At the end of each call, there's the plan of action and then by the next call, I'm like, "I finished this and I implemented that." That goes back to knowing that is coming up. I’ve got to make sure I get all those things done before the call so that I can say, "I've completed that module and let's work on the next thing."

You've got some homework to do in between. As I'm talking to people who are calling me about doing coaching, this is good to have this real conversation. Because when I tell them we're going to meet bi-weekly and discuss what's going on in their clinics, they think that it's just a call and that's it. What happens is you walk away with a ton of homework to do, sometimes even a little overwhelming if I'm not mistaken. 

There's still a lot to be done. It can be overwhelming.

There are many things to do where the coach can help you do it and maybe you've experienced this, help you prioritize what needs to get done more urgently or simply prioritize. “Let's make sure we hit this thing first and if you can get to it, that’s great, but let’s focus our energies.”  

My coach, being that he is a PT owner, it comes in handy because he can say, "This is what works for our clinic or proven in the program. These are the things that I can see based on the numbers, based on what you're saying, and based on what we're talking about, that this is what you should work on. If it's time management, then do that mount module and work on chunking your time so that you're efficiently using your time and not being all over the place and getting things done more efficiently. If it's patient engagement, then you start working on these things because that's what we ultimately need to get on to help with that.”

In your program, do you follow a step-by-step process? It’s like, “We're going to focus on number one first and we're not going to stop talking about number two until we get to number one figured out.” Are you able to work with them about things that are of a more urgent nature? Say if there's some disciplinary action that needs to take place, talk about disciplinary procedures and how to handle an employee. If you need to recruit somebody because numbers are going high. Are you able to discuss some of those other things as well in place of the program itself?  

There's flexibility within what needs to be worked on and what the priority is. There are the modules which are prerecorded videos, you can watch those at any point in time. We have our coach, we have our call, there's module one through however many, but it doesn't mean that you have to start with number one. “Let's look at what does Druid Hills PT needs?” We're looking at the numbers and visits are fine but maybe there's a poor utilization or I say, "This week, I noticed that we are having problems with cancellations still. Let's focus on that. This week, I noticed that my front desk isn't able to collect as much from the patients. How do we change that?" There's room for flexibility and working on what needs to be worked on, not just following step-by-step through the program.

What's a typical agenda for your meetings with your coach?

We get on the call and talk about some positive things that I've been able to change or implement since we talked. It could be anything, focus on starting on a positive note. It could go 1 or 2 ways but so far, I've had enough to bring up that I wanted to work on. Whereas there were 1 or 2 times where I'm like, "I need your help, what do you think should we work on?" A lot of times, I'm like, "This is what I've been focusing on. I've completed that. That's working pretty well." One of the things originally was working myself out of treatment. I got that under control for a little bit. I was like, "I've done that. How can I use my time better?" My coach says, "You can watch module whatever for time management and then talk about different strategies on what to do with the time and how to utilize it better." There's not necessarily one exact structure of the call other than trying to look at what we think needs to be done. We always look at the numbers and make sure things are going as we want them to and then go from there.

That sounds similar to what I do. It usually starts with what were the wins? What are the successes since we talked? What's top of mind that usually there's something that's happened that you want to talk to out and address? If there's not a whole lot there, then typically the coach will have something that he wants you to maybe consider or focus on as well. Maybe it's the next step or it's something that you might not have looked at, “Have you considered this?” There's some fluidity there based on my experience with coaching. Usually, you want to talk about things that are top of mind, but the coach then also can bring in things that you might not have considered at this stage of your ownership. Does that sound similar? 

I only know much and that's why I'm doing the coaching. Hopefully, a good coach can do exactly what you said.  

I'm assuming you're progressing fairly well towards the goals that you have set forth already for the year and whatnot?

Yes and no. A few things came up and it's been interesting. One tragic thing happened. One of our PTs was killed in a car accident and it's been crazy. That's what could have been a crazy, downward spiral for the business. It didn't turn out that way. It's ultimately because of the coaching and having that accountability. At first, it was certainly a shock and it was something that I never had to deal with. As a business owner, I had to make sure that the staff was okay. I had to make sure that all the PTs, the patients were okay. Some people didn't want to come back and that's completely understandable. Those are all things and dealing with the PT's family and it was overwhelming.

What a difficult experience and I didn't even think about this because you'd shared that with me but to consider what is expected out of you as the leader in this regard. You're not only responsible for your emotions and handling yourself, but you've got to consider the other team members, the patients that you see, this physical therapist's family and that's involved. Maybe any responsibility you have might have towards them that had to be overwhelming. How did you handle that? 

PTO 91 | Working With A Coach
Working With A Coach: A coach and the accountability can help in staying focused and not get distracted by any of the millions of other little things could happen.


I handled it all right. It was shocking. The first week, I was sitting in my office staring at my computer not knowing what to do. I will say going back to the coaching, you had to separate the emotion from it and then still recognize that this is still a business. Not to be insensitive, but the business needs to continue to move on. That alone that was tough to be able to put aside emotions and focus on the business. It felt insensitive, but it had to be done.

You want to honor them and you want to honor your emotions and your feelings. If you're looking at it from a logical standpoint, the business going down doesn't do anybody a service. You’ve got to keep it up and running because you've got multiple families and your community relying on you to perform still. That's got to be a hard position to be and to find the energy to move forward in that path. Sometimes some of these objective measures helped you out along the way. 

The objective measures, having the coaching, having accountability, being able to look at the numbers and at the end of the day everything that happened, I had to jump in and treat more and pick up those patients. At the end of the day, having the numbers and looking at them objectively and being able to look at them rationally and not emotionally and irrationally, allowed me to look and see. The business is not doing anything that different, maybe not growing as much as I was expecting and wanting to, but it wasn't falling apart and becoming this downward spiral. Everything was being able to stay stable. We were looking at the numbers and then having that accountability of talking through it with someone and getting a little bit more direction on what could be focused on more than other things that would be helpful had to have been what allowed me to get through that time.

I can't imagine the support that a third party like your coach provided at that time from the business perspective. The support that they could provide you because you'd laid a foundation, a framework of measurements of policies and procedures that we're able to keep you guys going so you can lean on it. It was a foundation. You could lean on this structure that you'd already built, even though it's not quite finished if you will, but you're able to lean on that and maybe give you space to work on your emotions as you were dealing through this issue.  

That's interesting that is what happened in that. Maybe we weren't getting this crazy growth I was anticipating or not even crazy growth, just moving forward. At the same time, because there was that foundation, the integrity of the business was there. Things were able to continue without having to get caught up in losing revenue and whatever. That allowed me to deal with what was going on maybe emotionally. Maybe there would be a time in the day where normally I would be super productive, but that hour I sat in my office and staring at the wall or something. That integrity and that foundation created the space to allow me to do that.

What was the therapist's name? 

His name is Tyler Wallace.

It’s a tough situation. I honestly haven't come across a lot of that in my interviews. I had to deal with the death of a longtime PTA that was part of our company. She was amazing. She was with me for fifteen years or maybe more. She was a big part of the company, a real light in our clinics every day. She almost became like a sister to me. It's something that I'm finding and it doesn't go away easily even a fellow employee is still working through their emotions in regards to that passing. It's a tough one. It can be hard because the team members become part of your family. Sometimes you see them more often than you see your family. It can be a difficult experience. I have to commend you for the work that you did ahead of time. You’re creating the foundation of policy and procedures, objective measures, and having the coach. It's hard to say what it would've been like if you didn't have those things in place? Hopefully, we can look back and say, "Some of those things we're able to carry you through."  

I believe that is completely what did it. This has been something I've been struggling with, not to be insensitive and not to honor the process. There were a lot of interesting things that happened with the business. By the nature of losing a PT, we had fewer PTs, but because we were implementing all of these different practices and trying to become more efficient and focusing on whatever we're focusing on. The numbers were improving at the same time. We were paying fewer payrolls because we had one less PT to pay and we still see the same amount of visits. The PT schedules were more full and we were becoming more efficient. We were having less drop-off because we are focusing on getting the patients to complete their plan of care. You've got two sides of the thing. This horrible thing happened, but in the end, a lot of ways the business benefited from it. It's hard to say that because of the actual situation but that ultimately goes back to the coaching and the ability to be able to objectively look at the numbers and see that these things work. By looking at the numbers, we can not only get through hard times but grow from them at the same time.

From a larger perspective, I don't want to minimize Tyler's passing, but you had gotten to a point where you weren't treating at all for the few weeks before his passing.

That's true. I was down to no treating.

Focused on business, time with your family, time for hobbies. I see it quite often, not necessarily that someone's going to pass, but obstacles come in the way. Whether that has to let go of somebody or personal issues show up as you're making these steps in progression, life is going to get in the way. It's because you have some of these structures in place that make getting through those difficulties easier. If someone does pass away, we've got these structures in place and we're watching the statistics. Someone who we thought was an integral part of our program and a rock that we couldn't let go of. Maybe they leave for greener pastures or for disciplinary procedures or whatever it might be. You come out the other end, things can improve. Whereas in the state beforehand, if you hadn't measured those things and structures weren't in place, then it would have been complete chaos with a lack of control or power or whatnot. You give yourself to whatever happens. You're simply riding the waves, but you're able to have some power if you're able to structure your business and your management appropriately.  

Having those numbers, having that accountability from the coach and having the structure, I was talking about in the last episode that we did, my PT, my first employee, she had reduced her hours. She was doing some home health. I started looking and I hired a new PT full-time and then she decided to do full-time home health. I had this new PT and she had this planned two-week vacation before hiring that we all knew about and it happened at the same time. This went from me backing myself out of treating, having three almost full-time PTs to then having one full-time PT for two weeks. One full-time PT and then me going back into full-time treating all of a sudden. After going through all of that and then looking at the numbers, seeing that at the end of the day, we were 20% more efficient with our utilization.

Our bottom line was in line with what we were even with one less PT. It came back full circle in that when you had asked me about, "How did I decide to hire someone on early?" It seemed out of the norm, usually you don't hire on that early because you want to make sure everything is more efficient, 90% full. It came back for full circle in that. At first, after all this happened, I'm like, "I need to start looking for a new PT because I need to fill that spot." That's not the biggest priority because I realize that we can become as effective as long as we're efficient. That's what the coaching and consulting are helping with is becoming more efficient. Ultimately we're doing the same with the business with fewer PTs, which is what exactly what we're trying to do.

It is ideal to build a culture and create a string foundation along with striving for business efficiency. Click To Tweet

What are some of the things that you're looking forward to now going forward? You've been through a tough experience that was his passing. What are you looking forward to as you're moving forward? Where are the things that you're working on as you progress through 2020? 

The first mastermind, the group with all the consulting, we all get together quarterly. Right after that, I came back and we had this whole meeting and talk to everyone about the company’s vision and trying to talk to the staff also to see, maybe they have some input on the vision. What do they want to see out of business? What are they looking for? How can we all get on the same page as the vision of this company? I've been thinking about that a lot. What is our vision? What is my vision? How can we include everyone that works here in that? What I am focusing on is I've got two great PTs that are working and I'm focusing on them and trying to get a great team, focus on the staff that I have. Try to get everyone to work together with the same goals in mind.

The vision as simply put is trying to help as many people as possible. We want to be there for the community. I'm telling all my staff that I'm doing the coaching and explaining to them that I'm focusing, anytime I come to the office and say, "We’ve got to do this and this is how we’ve got to change things." It's not because I'm trying to micromanage things. It's because this is what we're doing to try to get to that goal, that vision. This is what we're going to do to get there. I'm focusing in on the staff that I have to build the culture and create a strong foundation of not just the business efficiency, but also the team and the culture of our business.

You say that you're focusing on them, focusing on your physical therapists. What are some of the things that you're doing to focus on them? 

I had a meeting with the PTs. First of all, I acknowledged that I appreciate their hard work. That simple thing is probably something that doesn't happen often. Focusing on them, meaning they are my employees, but I also appreciate them and I want them to feel like they're a part of this as well. That is something that will help the business. It's not I'm doing it so that they can feel more appreciated. It's more like if we're all here doing this together, we're going to be able to make this thing work a lot better and help more people. Making it known that they're appreciated, not just tell them that you appreciate them, but asking them what they think we can do better. What is it that we're doing that they see from a different set of eyes that would be different, that would help out? I'm one person and there are a different set of eyes on the business and they see it differently. Their opinions are as valuable. Listening to them and trying to gain that and implement those ideas is going to be super helpful.

What a great way to develop your culture and also get your providers engaged and bought into the company by simply asking their opinions like, "What do you guys think? What should we do?" Recognizing that you don't have all the answers, that maybe they could do some things or have some answers that are better than yours. That's a great exercise that you started and you can continue to do with them to start developing this culture that you have in a new company like that. That's a great step. When I'm thinking about the vision, usually I see it as coming from the top down. It's an essential vision for the company but it sounds like you took them through an exercise where you wanted to see what their vision for the company was as well. Am I right? This is something that your coach has taken you through while you got it from the mastermind but your coaches had been following up with you and seeing how things are progressing

Correct, and giving ideas on how to even bring up the topic or the exercise like my coach was, "What's your vision?" I was like, "To be a good business." He's like, "You need maybe to have a little bit better vision than that." I went home and that was some homework. That was one of our coaching calls. It was like, "Next coaching call, I want you to have your vision." I spent the next two weeks, I watched some TED Talks about people, company visions. I read some stuff and created what I thought would be our vision, not just for the company's growth but also what we're trying to do for the community as well.

The effect in the community, the larger purpose, that stuff and how you want to be seen. You have some other mastermind groups that you're going to go to. You'll have your bi-weekly meetings. Are you going to any conferences then as well?

We have another mastermind coming up. We'll see what new nuggets we get from that. 

Based on your initial experience, you've only been with your coach for a few months. What would you tell somebody who's considered it or maybe even not considered? What would you tell our audience about your initial experience with having a coach?

I would say that if you haven't gotten a coach yet, you should go ahead and do it. Even if you're thinking of starting a business, I would say it’s probably better to do it even before starting so that you cannot have to fix what is broken, but start on a much better solid foundation having that. Having that accountability and those calls are helpful to have so you can be focused and committed to what you're trying to accomplish because it's easy to get distracted. There are many millions of things that you could spend your time on but are not important. If you need to get things done, you having that coach and that accountability not just to guide you but also to keep you accountable is instrumental in being able to grow the business.

What would you say your ROI so far on investing in a coach? Maybe you do not see it in sheer numbers, maybe you are, but what would you say are some of the ROIs on what you've invested in so far? 

I would say numbers are not the easiest thing to see yet, because of all the things that had happened and we're down a PT. We're at the same as far as the bottom line where we were. Everything else is more solid, more a better foundation. As far as the return, knowing that I have someone to fall back on after going through something like this and able to get through it in such a positive and productive way was more worth more than anything. There's no way that I could've gotten through that without having someone else to keep me focused, keep me rational, keep me objective instead of getting super emotional about it.

I'm glad you had that support. Condolences to you, the families and your team. It’s a horrible, horrific experience to go through. I wish you guys the best and I'm glad to hear that you've got some support and it sounds like you guys are starting to get your footing back and moving forward. I'm sure there are things to work through still, but you have some vision. You're starting to develop a culture and you're starting to get back on track.

PTO 91 | Working With A Coach
Working With A Coach: The integrity of your business can allow you to move forward even with problems tagging along.


We're getting there.

We'll stay in touch. I'll follow-up with you again. We'll see where you are at the time but expect huge changes.  

Me too.

Thanks for your time, Avi.

Thank you, Nathan.

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About Avi Zinn

PTO 91 | Working With A CoachDr. Avi Zinn, PT, DPT, OCS is the owner of Druid Hills Physical Therapy in Atlanta, Georgia. He opened his practice at the end of 2017 and has slowly built it up—transitioning from a staff of one (himself) to a team of administrative staff and treating therapists. He continues to grow the practice gradually. Avi’s main mission for Druid Hills PT is to provide high-quality, personalized care to each and every one of his patients.

Avi has his doctorate in physical therapy from Touro College, and is a Certified Orthopedic Clinical Specialist. He lives with his wife and three children in Atlanta.


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PTO 88 | Tripling Clinic Production


In 2019, Ben Larsen, PT, DPT, co-owner of the Teton Therapy Cheyenne Location, had great goals of increasing his number of total visits per week by year-end to well over 200. Little did he know that by making appropriate, time-honored decisions he would hit well over 300 visits per month come 2020! His path to success wasn't based on a new treatment technique or referral source. Rather, as Nathan Shields and Ben discuss in the interview, Ben hired people that were in alignment and he implemented what he knew he should be implementing (things he learned from his consultants and coaches in the past), and started tracking stats and training his team (future leaders). Suddenly, patients started coming in greater numbers than he had ever seen before and he wasn’t treating most the time! A great story of small and simple actions generating great results.


Listen to the podcast here:

The Path To Tripling Production in 1 Year With Ben Larsen, PT, DPT

I'm bringing on one of my friends and coaching clients. I hope it doesn't come across self-serving but I had to bring this guy on because he has made incredible gains. I wanted to talk to him about what he's done and what were some of the specific actions that he took that got him to see such significant gains. From what I recall from the discussion is that nothing new came up. We talk about hiring the right people, having the right mindset, figuring out your purpose, stepping out of patient care, taking control of your environment, all things that can be seen in Ben's growth. My guest is Ben Larsen. He's out of Cheyenne, Wyoming, and making great strides and looking to grow and expand. Hopefully, I'm along the ride with him as a coach but he's implemented many great things and made all the right choices so they can see significant growth and hopefully continue to see it going forward. Hopefully, Ben's story is an inspiration to you as well and it gives you some ideas about the next steps that you need to take to see your goals and dreams come to fruition.


I'm excited to bring on a friend of mine that I’ve known for some time and has become a coaching client, but he's had such tremendous growth. I wanted to share his story and talk about some of the things, especially the successful actions that he's done to double his growth in his clinic. First of all, the guest is Ben Larsen, Co-owner of Teton Therapy in Cheyenne, Wyoming. Ben, thanks for joining me. I appreciate it.

Thanks for having me. I’m excited to share our story and how we've grown this.

I know your story and I’ve had the opportunity to watch you from a distance. If people have checked the previous episodes where I interviewed the Co-owner of your company, Teton Therapy, Jeff McMenamy. He's got a great story starting from working in a racket ball court and starting his physical therapy clinic way back in the day, but he's grown, expanded and brought you on as co-owner in Teton Therapy in Cheyenne but you've done a lot. I want to highlight you and your story and your successful actions. Let's go back a little bit. Do you mind sharing with us a little bit about your professional path?

I went to PT school just like everybody else. I went to a school in North Dakota, the University of Mary. Jeff McMenamy who's my business partner, is an occupational therapist. He's from North Dakota. He was there at a career fair. We talked and it's a funny story. He tells it better than I do. I show up in a full suit and tie and he says, "What do you want to accomplish as being a physical therapist?" I was naive when I looked at him and said, "I want to own my own practice." This is the first time we've talked. At that point, he mentioned how impressed he was with my drive and my determination to expand as a professional. I signed up with him to go ahead and work for him.

I move my way up within two years as a clinical director and then as vice president of operations. In the meantime, I did a lot of training on business techniques and different management techniques through measurable solutions. I got trained in how to run the company from a vice president of operations standpoint. I'd been doing that for several years and he approached me. We had an option to move the clinic down to Cheyenne. He asked me what I thought about doing that and moving my family to a new area. I took my wife and kids down here and decided that this would be a good move for us. We moved down here and opened up the clinic with not knowing anyone in Cheyenne at all.

I put up a sign out by the door that says, “Please call for information and consultations,” a couple of months before we opened. We did a little basic type of stuff to tell people we are coming in town. We opened the door with zero patients on the books. When it hit the pavement hard, it all started with a Parkinson's support group. I met my first patient there. She brought her in. We did a couple of treatments with her. She told her doctor. The doctor was having some issues. She came in for me to treat her because we're getting such good results with her patient. She told her friend, who was another doctor who was having some elbow pain. She came in and I treated her. It expanded from there of initially first treating physicians and then getting the word of mouth out and then expanding the practice.

You've got a nice connection there.

Over the past several years, every year, we've had substantial growth, but 2019 has been a big growth for us. Like most practice owners, when you first start out, you make a lot of stupid decisions and you're trying to fill spots. Your hiring is okay as you're first learning it and then it gets better and better. We've had a complete staff turnover at least once. Within a couple of years, we've brought on some real key players that as we started transitioning people. We've seen significant improvement within the quality of care we're giving first off and then second off in our business growth because of that quality of care. That's been our biggest thing.

If your goal is to be completely autonomous, you got to be able to handle everything. You can't just handle the basic things. Click To Tweet

Finding the right people, hiring the right people, and then helping them to expand in their position in and what they want to accomplish as well. As I sat down with you, we looked and it was more than doubled. We almost tripled based upon having the right staff members in place, expanding the right way, following the right systems, and implementing things that have helped. The basis of my story is starting from about nothing, to where we're getting ready to hopefully get into a new space. It’s finalizing some things on that, to where we'll be able to double our space and hopefully continue to expand our practice and provide good quality care for the city of Cheyenne.

I don't want to go gloss over it too quickly. I do want to get to what some of the specific steps that you've taken that tripled your number of total visits per week. Can you share with us a couple of your bad decisions that when you look back on, you’re like, “That was bad, I should not have done that,” or “I would have done things differently?”

When I started out, I had done all this management training. When I first did the management training, it was more like, "I'm doing this for the company." Most people are going to have executives out there who they bring them on, they do the training, and those people are doing the training because they want to expand the business for that particular owner. When you become your own owner, you get this mindset of, "I’ve done that training. How do I want to do this?" You start thinking about how you'd want to do things and trying things that haven't necessarily been tried or tested.

Are you doing things differently than what you're trained to do?

Yes, because you're trying to make your own way. For me particularly, I’ve had this owner that has developed me into who he thought to be that good physical therapy owner. I had some ideas, some preconceived notions that there were some things I wanted to do differently than what we were doing at the other clinic. I stopped implementing some things that are successful in other clinics that bit me hard. I needed to get back to the basics. That was the one thing that if I could go back, I would stick with the basics of the training and implementing the statistics. The things that we use in our business to make sure we're producing and doing what we need to do. That would be the one thing that I go back on that I would stick with the training that I had and move forward with that. The second thing is sometimes we hire out of desperation instead of hiring out of what we need. Everyone's had it where they want a position filled with someone that can fog up a mirror. They walk in and they've got the proper license and you hire them, but they're not necessarily the right person for your company. There's a couple of times where I wish I would have taken the time and done better with the hiring process like we do now and found that key quality person that fits with our group, team, dream, and purpose, all those things. Those two things are the biggest things. One is sticking with the basic technology of managing the clinic. The second one is to hire based upon what we need not just to fill a position.

You looked back on some of those decisions in terms of hiring out of need and I wonder how much time did I lose by finding a person instead of waiting for the right person. We've had instances where it would have been better for us if we had simply let go of the entire team in a poisonous clinic and started from scratch all over again. It would have saved us a year of headaches if we started from scratch. Sometimes it's that distinct in my head that sometimes you have to wait for the right people. I also want to congratulate you. You said you're going to expand. You're looking at a new 6,000 square foot facility that you're going into. I misspoke. You're not only doubled, but you tripled in productivity. Of course, things didn't happen all of a sudden and I know it wasn't like one new provider started sending to you. You didn't necessarily niche out and do anything in particular. As you look back along the timeline, what started this process of growth if you look back a year and a half ago to lead you to the point where you had such dramatic changes?

Looking back, there is a key event that happened that sucked. It was the worst experience of my life. I had an employee that totally went ballistic on me. He was upset about things. It wasn't a good situation. He reported me to the board saying we were doing an insurance fraud, claims that made me decide what type of a team do I want to have and how do I want to foster this team to do what's best for patient care. It changed the way that I hired after that point because, initially, our HR person would contact them. This is particularly with physical therapists. I would say, "Once we get down to the top five, give me their names and I’ll set up some time to interview them."

This time I said, "Who's your top ten? I want to make personal phone calls to each one of them before I even bring them in and talk to them." I laid out everything on the line. I was very open within these interviews and talk to these individuals to try to find the right people for our team. We looked at is this person the right person for what we need? I got down to one particular candidate where there were two that I liked. I sat down and thought this process out. I didn't make a quick decision. I thought about it and what we needed. There was one thing in particular with the one that made me think, "This one is the one we need. She's going to take our clinic to where it needs to go based upon our conversations and what I saw."

With this particular one, I had some hard times with it because the HR person, our VPA, she was leaning towards another candidate. She's great and I totally trust her completely, but I didn't feel right about that other candidate. We were about ready to pull the cord on the other candidate when I said, "No, I feel there's something with this other candidate." I talked to my business partner. I told him what I thought and he called both of them. He felt the same way with this other candidate that we hired. We pulled the trigger on this. She's been one of our best producers because we followed that gut feeling of what's best for the business and for the clinic. That's been the biggest thing for me, looking at things in terms of what's best for the clinic. Sometimes it's not necessarily what's best for me personally, but it's what's best to expand the business and make things work for the team as a whole. When I started doing this and adding additional therapists, I was very upfront with my expectations.

PTO 88 | Tripling Clinic Production
Tripling Clinic Production: If you don't have somebody to hold you accountable, you will find yourself very scattered.


It's a funny story. I have this PTA. We were sitting down at lunch and we were super busy and I said, "I need somebody but I don't know if this is going to be a full-time position. Would you be interested in coming on part-time or coming on as a temp position and then it could go into a full-time position depending on how you do?" During the conversation, I don't remember saying this but she said, "If there is someone who doesn't fit in with this team, I'm going to straight-up fire them." She tells me that. It struck a chord with there that I'm serious about this team needs to be working hard together to get to our purpose, which is taking care of patients.

That's what we need. The biggest key to our success is finding the right team. You've probably seen this as well that when you find that right team, the patients seem to come. When you have that right flow, the patients show up because there's something about it. That's what we've got. In times when we're going to slow down, all of a sudden, we get these boom of patients coming in. It's from word of mouth and it's from people seeing what we're doing. They're happy with the results and sharing it with everybody else. It all starts from that team having that same purpose, working together and working for what is best for the clinic.

It sounds like what you did and unknowingly is try to find people who were in alignment with you. You had the best interest of the company in mind and that goes to show how important it is to have that filter. The company comes first. The owner comes second and then the employees come third. It seems like from your story that you focused on finding people who were in alignment with you. It was cool that you could call Jeff, the co-owner and have him also phone interview these people because you and Jeff are aligned. You two can find the right person who was in alignment with you and that starts creating a culture of like-minded people who share the same purpose, vision and goals. It starts to accelerate the growth process. I've seen it hundreds of times and it happens all the time with people I have on the show.

As you start finding those right people, you start developing a culture. Culture is simply the way you do things at Teton Therapy in your case. People do things the same way. They're saying the right thing, they show the same values, and they treat patients the same way. Not to say that they're the same, but the culture is similar and there's a feeling there that starts to gravitate like-minded individuals to the practice to work with you. That's a sense that patients can get when they come to your clinic. They'll start coming. They'll start returning, they'll start referring friends and telling their doctors. It's almost like you can't stop that as long as you continue to hire the right people. 

On top of that is I got to a point where we were doing well in the last part of 2019. We were getting things in but then the next step is that network out. That's when I approached you about coaching because I needed the next step, which was to help somebody get me to the next step. I'm talking about phase one versus phase two. Being an owner is phase one, you're that clinician, you're in there. You’re handling all the day-to-day stuff. Phase two, you're transitioning out and you're handling the business side of it. It comes down to as a therapist, you have to decide. With my two hands, I can only do much to help people.

I can only see many patients, but if I take my skills and my two hands and teach others how to do the same thing I'm doing, the amount of people I can help is unlimited based upon the amount of people I can train. Those people can then expand their hands to help more people. The whole goal of a therapy clinic is to help as many people as you can possibly. You can't do that if you're doing treatment all the time and you have to make that decision of, "It's time for me to transition to do a greater good." Therapist is a great good, but there's a greater good of training others to do it that you can help more individuals. You can help more people.

To go back into your story a little bit, and I don't want to gloss over this because it's important. When we talked, I was excited to work with you because you said, "I've learned all this stuff. I've learned the management technique. I've read the books. I’ve got the training. I know what I'm supposed to be doing but I need someone to hold me accountable." I remember that sticks out in our conversation that we had back then. As we started training, you recognize that you need to do less treatment on patients and get out of the full-time treating.

I hope you don't mind if I share but then you got Bell's palsy. Physically, you were not capable of seeing patients anymore. Correct me if I'm wrong, that was a turning point where you were able to step back and see what would happen if you physically weren't present and recognizing that, "Now that I’ve got my head out of treating patients because I'm forced to at this point, I can see the things that I can do." Whereas, when you were treating patients, maybe you didn't have a clear vision. It seems like you had to go through that experience to see that.

If the game's easy, it's not worth playing. You've got to have a harder game. Click To Tweet

That was a big part too because at that point, we’re almost 100 less visits than what we're doing just within that last time part of starting this process of the coaching and me stepping out. There's part of you that thinks as a therapist that if I step out, this clinic is not going to do as well. You figure you're going to lose visits. You'll never be going to hit an all-time high unless you're sitting out there treating patients. What I found out was my mindset changed of we're not going to hit an all-time high unless I don't see patients. I can't see patients or we're not going to hit it an all-time high. I have to be doing other stuff. I can't be out there on the floor.

If I am, then my time is not being used for more of that working on the business as not working in the business. That's been a big change. That's been something that's been working with you, working with Jeff. Because we all have that sense when we stop treating patients, it's that timeframe of what do I do now? How do I make this productive? How do I continue to grow the business when I'm not the one who's doing everything? It's a big mindset change and you do need somebody to hold you accountable because if you don't have somebody to hold you accountable, you do find yourself very scattered. What do I do? You find yourself gravitating towards getting back on the treatment floor again, which is not where you need to be.

That's the easiest path and that's what you know. You spent the last 30 years studying to become a physical therapist. Naturally, if you have some free time, you're going to go with what you know and treat patients, but you've got to pull yourself back. It takes a mindset shift. I see this with my coaching clients. There has to be a change in the mind and it doesn't happen immediately. It usually happens over time to the point where they recognize that, “I can do more for the business and for my team, my other providers, my front desk members by not treating patients and focusing on the business to give myself freedom, the bandwidth, the mental freedom and the energy to work on it and make it a better place for my team. Make it a better place for the patients that come in the door and be a greater influence in the community.” It's that mindset shift.

I look at this with my kids. I don't want them to be as good as me. I want them to be better. I want them to do things better. I want them to not have to deal with all the mistakes I have and had to deal with. I don't want it to stay the same. Within the physical therapy profession, I don't think we understand what physical therapy is going to be like in 10 to 15 years. It's going to be different in the way we approach things, the way we do things because we are constantly growing and improving this profession. As business owners and private practice owners, we've got to be at the forefront of training our therapists to be better than we were as therapists. Giving them our basic knowledge and then letting them expand that so that we can continue to expand this field. If our goal is to be completely autonomous, we got to be able to handle everything.

We can't just handle the basic things. We've got to be able to handle everything within the musculoskeletal system and the realm of physical therapy but always pushing those boundaries. That's why, you and I, both involved within hands-on diagnostics because that's what they're doing in Measurable Solutions and another company I'm part of because that's what they're doing. You network with those peoples who are pushing those boundaries because that's what we have to do in this profession if we want to see it succeed. That's what you have to do within your business is pushing the boundaries, not stick in that cookie-cutter box that we have been in the past. The past isn't going to get us to the future. It's the present of working and improving our goals, improving ourselves, improving what we do as professionals.

Did you find it was hard to make that mindset shift? I mentioned that it usually doesn't happen overnight but take some time. What made that switch for you? When did you recognize that, I can't keep seeing patients? I want to go back and reiterate what you said since you stepped out of treating full-time your business has increased 100 visits per week since you stepped out. It did it without you. What was the shift that helped you change your mindset? 

It's deciding where do you get the most gratification. For me initially, it was treating patients but then as I'm treating patients and as most of us know, when you've been treating patients for a long time, it becomes second nature that you're not thinking about. You're doing a good job treating the patient but you can tell that it's not challenging you. You get to a point where treating patients becomes this easy thing. Some people reading this may say, "I don't think it will ever get that way." It gets to a point where it's not the easiest. It's the easier thing to treat. The more gratifying thing for me was bringing on new therapists and watching them succeed. That's where I get my joy from. When I see my therapist totally handle a difficult case and they come out like, "I’ve got this guy better." That's what excites me.

Watching them do that and giving them tools to do that. We brought on an OT and she's got her caseload up to where she's seeing exactly what she needs to do. She's built this amazing caseload and seeing that was huge for me. That was a happy moment for me of seeing somebody push it and work hard to obtain something that a goal she had. That's where it comes from. You step out to work on a higher purpose of helping others, helping your staff see success, seeing them help people. You're in the background going, "This is amazing what these people are doing and these clinicians." Even your front desk staff and other things and other positions you have. Seeing them expand their positions and helping people, that's what's brings you greater joy for me, particularly. Anytime I’ve had treating a patient, that's a huge success.

You came to a point where simply treating patients didn't meet your purpose. My coaching clients who experienced this are people who are like, "I’ve got other things on my mind." They're stressed and torn. They're like, "I need to see patients full-time but I know there's the stuff that I'm learning from Nathan in which I need to implement in the clinic that I'm not getting to. I'm thinking about the business while I'm treating my patients." It's an internal struggle. For me, looking at it from the outside perspective, it's that internal struggle. The purpose that you had up into that point in treating patients had changed. Even without you’re knowing or you recognize, “I have a different purpose in mind now.” It's that transition from one purpose that got you to where you were to a different purpose that's going to get you further. You have to figure out what that greater purpose is like you mentioned.

PTO 88 | Tripling Clinic Production
Tripling Clinic Production: When things start slipping, we start making excuses and figuring out if the situation can be controlled or not.


For you, it's to create an environment in which other people can flourish and grow either as providers and hopefully in the future leaders within your own company. Be a greater influence not only in their lives but in their family's lives and in the community that you serve. I see that. We talk about a mindset shift, that's part of it. It's also a change in purpose that you have to come to grips with that as you grow, your purpose isn't being met by treating patients but your purpose is different. For you, it was to grow people. For other people, that greater purpose is meant by having more clinics and growing that way. It can be individual. That shift has to happen and you have to find that greater purpose to go to in order to do let yourself stop treating patients. 

It's finding your greater purpose, playing a different game. That's another concept that is part of it as well. The game gets to a point where it’s easy and you need a harder game. If the game is easy, it's not worth playing. You've got to have a harder game. You've got to challenge yourself or you don't want to get up in the morning and do what you need to do. It's constantly keeping yourself up to playing a bigger game. Maybe you add more clinics and that maybe our next step is we're adding more clinics. I've got some big goals and we've talked about some of those things. Some of them I look and go, "I don't know how I'm going to accomplish this but we're going to try other things." It seems goals that I’ve had in the past that are coming to pass and seeing greater good throughout the community. We all do this profession because we want to help people. It's not a money thing. It's a helping thing.

That's why we put all this time and energy into this. I learned this from Jeff, my business partner that I can only do so much with my two hands but when I train others, I can do so much more. I can see more good done through my company because of that. Because of me not being the one who has to touch everything, I can now step out. The nice thing too is it's a different game because you can step in whenever you want. You can help out your employees. You can help them with handling difficult situations in the clinic, but you can also step out. You're not the main guy anymore but you're that teacher. You're that leader that helps them to develop how they need to develop to be the high-quality clinicians and the high-quality people they're capable of being.

Looking back on your timeline, much of it is similar to what we see in the other physical therapy owners. The successful ones. You started hiring the right people, people who were in alignment with you. I know your timeline as well. Go over it and you can correct me if I'm wrong. You also brought on a marketing person to help you out and take that off your shoulders. You also had some consulting and training. You've also done some networking. You already did two of the three steps that I always promote in that is you already reached out and got some training because that was part of your leadership development. You were also part of networks. You reached out and network. When I started working with you, we started focusing on that third piece, the stepping out process and getting out of treating full-time.

We started working together. You brought on another front desk person and based on my experience, and you can share yours as well. Around 120 to 150 visits per week, you need a second front desk person. They can only handle so much. You're bringing on other providers. You've gone from visits that were in the hundreds per week to over 300 visits per week. You've got great goals to get even busier. It's important to note that timeline that you started hiring other people. A marketing person was beneficial and other front desk person was beneficial. You might say that I helped out a little bit as well, but you made that you made those important decisions after hiring the right people and then you exploded after that.

The biggest thing is we're constantly looking at what's the next hire we need to do because it is growing so fast. This might make some therapists, especially owners on this show a little like, “This guy's nuts, how was he able to do this?” We saw a need. I got to travel to try my caseload by having that intention, having those feelers out within recruiting, traveling agencies, to get somebody on immediately to handle those needs. We're in the process of filling that position with somebody more permanent and then adding more part-time help to offset our schedule. Our biggest issue is space. We don't have space until we get into the new building to expand what we want to. We're expanding hours and looking at other options. That takes into account of, we need to add some part-time help to help with this. It's constantly keeping that mindset of what's the next hire? What's the next step? What do we need to do before we get into this new building? How do we handle that? That's where a lot of my time is spent, being that vision of where we are taking this thing.

The time that you spend is much more intentional looking forward. Instead of fixing what was wrong in the past, you can look forward and look, "At this current growth rate, we need to hire another person. We need to find this person." Looking ahead, you can do that simply because you're not treating much if not at all. You're able to intentionally find those right people and take the time it takes to find the right people. There's so much value in that. As you were treating patients full-time, did you foresee that you could fill up your schedule with all of this administrative/executive work? Were you at the point where you're like, “I don't know what I would do with my time if I wasn't seeing patients?”

Initially, you think that the concept of “What am I going to do with my time if I'm not seeing patients?” Once you step out and you start filling it in with executive functions, you think, “How did I even run this company by treating patients because I’ve got some stuff to do?” What it comes down to is once you stop treating patients and you see all the balls that you're trying to juggle that you weren't juggling. You claimed you were juggling but you're not. You can't because you're so focused on patients or you look in your like, "That visit was okay with that particular patient but I don't feel that my quality is up to par where it needs to be." When you focus on those things, you realize that I can't do things halfway for one thing and be okay doing it halfway for another thing. I've got to be fully focused on one thing. I can't have two things that I'm trying to focus on or I'm not going to be focusing on anything.

Help patients start the process, change the things they need to change and stop the things that are preventing them from getting better. Click To Tweet

If you're focused on two, it's going to go all over the place. With that being said, since I have the time to handle the executive stuff, when there's an issue on the floor and I do need to see a patient, I'm focused on that patient. I know I have the time to handle the other stuff later. This is a part-time thing of me helping out as needed. It helps me focus more because I know I'm going to have the time on the back end to handle the business stuff, to handle the administrative stuff. I'm okay to focus on this patient. I can focus on the administrative stuff because I have that time. When you're treating full-time, you don't have that administrative time. It's always in your head, "I'm not handling this." You're swimming trying to make it and you don't. Eventually, you start drowning and you're like, "I got to handle this." It's a big mindset change but once you make it, it's so freeing. You free yourself up a lot.

One thing that the audience doesn't know also is that Ben is good about having weekly team meetings with his providers and the whole team, not just the providers of his clinic every week. One thing that sticks out to me from our past conversations that is a conversation that you had with them about control. You could see that the numbers were slipping a little bit, whether it was arrival rates, the number of billing units they were billing per visit or the efficiency of care and noticing that people were dropping off. I don't know what triggered that but as you're watching the statistics, they had dropped a little bit. You felt like the need to address the providers about control. Tell me a little bit about that story simply because it's important to give owners and leaders some of the verbiage or ideas to talk to their teams about being in control of their positions.

We get very complacent with things and we try to make ourselves okay with issues in the clinic being okay. For example, so-and-so didn't come in because they're sick or we had a downturn of visits because it was snowing. We can always find excuses for why things aren't happening. Not necessarily, my teams are good about taking control and handling things. They do a great job of taking ownership of when things happen and trying to solve issues. We all tend to do this when things start slipping, we start making excuses and we start figuring out, we can't control this and that. It came up to discuss what the term of control meant. We’re discussing with the team saying, "Let's define control as the ability to start change or stop something. Let's stick with that as our definition of control." I said, "What can we start? What can we stop? What can we change within our patients?" Define that and saying, "What we have to do is control the things we can control and then we'll deal with the other things as they come up." When you look at illness, weather, and all those things, those are minimalistic on the ability of a patient to come into treatment. Most of the time, why a patient won't come in is because there's some other internal reason they're not telling you.

They're claiming it's an illness, weather conditions, a work issue, or all these other things, but most of the time, there is something else going on. A patient is not committed to the treatment plan. The therapist doesn't have control over the treatment plan. Pushing that on the therapists of saying, "You need to control these patients. They're coming to you to be able to handle this situation. You need to be able to help them start this process, change the things they need to change and stop the things that are preventing them from getting better." That's what our focus is. If you're not able to do that, sometimes you have to have hard discussions with the patient. Maybe therapy is not the right answer for them at that time. Maybe tweak a couple of things, get them recommitted and then you've got a patient who's making progress with therapy. That was the biggest thing I talk about with them is making sure we're handling the patients. Making sure that we're getting those things done that the patients need so that they can handle their condition. My therapists do a good job. Our percent arrival rates stay above the 90%.

They do a fantastic job of getting their patients in and committing them to their treatment plans to a point where we have them sign a document and that first part of their treatment is saying, "This is what our plan is. We want you to complete this plan. Please sign this if you're in agreement." Most of them are signing, they're excited, and they’re ready to make these changes. That's the biggest thing when those stats come down. It’s looking at what we can control and focus on that and not focus on the things you can't control. You can't control the weather. We'd like to. You can control how you're treating the patient and helping that patient to see the value of physical therapy. You can work with that patient to make sure that physical therapy becomes a top priority. You can also have those discussions when a patient is not doing what they need to do of it's time to have those tough discussions and physical therapy is not right for them at this point. Maybe you need to part ways. There are definitely some difficult conversations you have to have, but you also have to be willing to do that to control your situation.

As you're talking about it, I love how you defined control and you put the patient's plan of care in the provider's hand. They need to follow up but they also have to be bought into what the provider is selling. Would you go so far as to say that if those numbers are coming down, if the arrival rate is poor, the patients are dropping off and not completing their full plans of care, if they're only coming in one time a week, hit and miss that maybe the provider isn't fully in control of the patient care and they're leaving it up to chance?

That's a big thing and that's an issue that we have within our profession. We tend to get complacent and feel that way of, "I can't control this patient, so move on to the next one." That's where we have to stop and say, "What could I do to better sell this patient on treatment? What do we need to do differently? Do we need to do some more testing? Do I need to have a second therapist look at this person and see if there's something I'm missing?" It brings in that whole team approach of what could we do to make this experience good and to help that patient get better. It's funny because we've done surveys.

Most patients say the reason they liked coming here or they like coming to physical therapy, getting better is low on the list. The first ones are experience with the therapist and how much the therapists cared about me. All these things are more important to them than getting better. When you foster those two where you're focusing on the patient experience, that ultimately gets them better than any physical therapy skill you can put on them, it doesn't matter as long as you're giving them that high-quality experience. You're making the time. You're showing them your vested in this and getting them to be vested in their health, that's what gets them better.

I totally believe that's true. Many patients don't know what quality therapy looks like or feels like. They're coming into it as a blank slate. The experience you provide them is going to color so much of what they know about physical therapy and not necessarily the techniques you can provide. There are many different techniques that can get people to the same place. Your skills only add to the experience. The better they are, the faster they're going to get. Fundamentally, it comes down to developing a solid relationship with the patients. Getting that buy-in to the plan of care and providing a positive experience for them, which I would assume is focused on improving their functional capabilities.

PTO 88 | Tripling Clinic Production
Tripling Clinic Production: Focus on the things you can control and not those you can’t control.


As long as you've bought in and in control and not saying, "So and so didn't show up, he's not going to get better. Leave it at that.” A therapist that's in control is going to get on the phone and say, "What happened? We agreed to a plan of care that will get you better. I can't guarantee that you're going to get it better if you don't follow it." Instead of the therapist that forgets that so-and-so fell off and two weeks later says, "What happened to that guy?" Being in control shows up in your statistics as you're measuring them. If the therapists are in more control, then you're going to see a better arrival rate. You're going to see you more completed plans of care, etc.

It's great when a patient gives you cookies and all that stuff. That's great and you know that they liked you. One of my patient was on the final day and this particular patient turned to the front desk and said, "I feel like I'm leaving a family." That's the mentality you want in your clinic. You want them to feel like this is a place that helps them get better. This is family, this is a place they can come to if they have issues. That particular patient would have happily come back if they needed it or they're telling all their friends about it. That's what you want. You want to create that family atmosphere that's light and fun, the patient's getting results, everyone's high toned and well personally. That's what you're trying to foster in your clinic. When you can do that, the success comes.

It was cool that you recognize that based on some of the statistics that you had been tracking and recognize that this is what my providers need to hear. I know that your statistics turned around within the week or two after that in huge uptick because they started to take control. You couldn't have done that if you hadn't been tracking your statistics regularly. Ben, I know we can go on forever but I want to thank you for taking the time, especially as busy as you are. You have more free time to do an interview like this, which is cool. Thanks for sharing your insight. As I said on our coaching call, "I’ve got to have you on." I forgot you tripled your visit totals per week. I was like, "I’ve got to have more people like you on." That's why I interview people like you. It's because there are plenty of successful actions that other owners could gain from. Thanks for coming on. I appreciate it.

You're welcome, it’s a plug for you. Nathan, as a coach, has been extremely helpful for me, giving me that accountability. It's taken my mindset from where it was before is, I got be in training to catching the vision of why I need to be out of treatment. Sometimes you need that outside person looking in versus those people who are involved in the day-to-day. That outside perspective helps. A big part of the reason why we're doing this well is because of the coaching. We talked about the consultations stuff that I’ve had with other companies as well, particularly working one-on-one with you to look at the statistics and decide how do we improve this. We've seen my goals have been met. The first day we talked about getting me out of treatment and doing that over a six-month timeframe and we're already there. It's verbalizing those goals and then having someone to keep you accountable for is important. Someone outside of the business who's not caught up in the day-to-day side of things, that's key. I'll plug you every day because of that because you've helped turn around this business for sure.

I love to hear that and I appreciate it. I get so excited after all of our calls and share it with my wife like, "Ben is killing it. It's exciting to work with him." Thanks for the plug. I appreciate it. If people wanted to reach out to you for whatever reason, are you open to sharing your contact information? 

The best way is email because I'm not the best in answering the cell phone. My email is

Thanks for your time, Ben. I appreciate it.

Important Links:

About Ben Larsen

PTO 88 | TPTO 88 | Tripling Clinic Productionripling Clinic ProductionBen has been a member of Teton Therapy since May of 2010. He graduated with a Doctorate of Physical Therapy from the University of Mary in Bismarck, ND and conducted his field work primarily in out-patient settings while in school. During his time at Teton Therapy, Ben has taken many continuing education courses on topics such as Dry Needling, Kinesiotaping, neuromuscular re-education, running analysis, and injury prevention—a topic which he immediately found a passion for and has since conducted classes to the community. Ben quickly applied this vast amount of knowledge to the practice and sharpened his therapy craft. His general interests include water sports, running, outdoor activities such as camping, competing in triathlons, and most importantly spending quality time with his wife and children.

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PTO 92 | Telehealth PT

The Coronavirus pandemic has become a great test for the healthcare systems we have in place. Facing it head on, the time is here for Telehealth in Physical Therapy. In this episode, Nathan Shields speaks with Daniel Seidler, PT of TelePT Solutions about the benefits of the remote provision of healthcare through technology, especially in this time of the outbreak. A relative expert when it comes to providing TelePT services, Daniel has the answers about what you can do to adapt your PT services online. This is a great episode worth listening for any PT owner, to take advantage of the services you can provide, helping those in need in this most pressing time.


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Telehealth PT And The Coronavirus Pandemic With Daniel Seidler, PT Of TelePT Solutions

This interview is scheduled with Daniel Seidler of TelePT Solutions to talk about Telehealth PT services and how we can use it during this Coronavirus outbreak. There's plenty of information to help you get started at least in providing telehealth PT services. Daniel provides those services through his company, TelePT Solutions. I wanted to rush this episode out considering the current nature of what we're dealing with on this outbreak. Let's get to the interview.


I have Daniel Seidler, Founder, and Owner of TelePT Solutions, a consulting firm to provide telehealth services for physical therapists. He also is a telehealth Physical Therapist himself. He's got a great story that I want to share with everybody. The topic that we're going to cover is rather timely. First off, Daniel, thanks for coming on. I appreciate it.

Thank you, Nathan. I appreciate you having me. We talked and realized that we should record this podcast as soon as possible. You made it happen, so thanks for that.

Thanks for coming on. We want to talk about telehealth services in regards to PT, especially as it's going to affect our services here by the Coronavirus and what's happening. It’s considered a pandemic. Before we get into that a little bit for the benefit of the readers, if you can share a little bit of your professional story and what got you to where you're at this point.

I've been a PT since 1996. I owned a practice in the Bronx in New York for fifteen years. We were acquired by a larger group and I worked for them for three years, MOTION Physical Therapy and helped develop their telehealth practice, the division of telehealth at MOTION. I decided to go out and start my telehealth practice and help other groups to get telehealth off the ground. I never imagined this scenario would arise but either way, the time is here for telehealth for medicine and physical therapy.

I'm sure you couldn't have predicted that a flu pandemic like this would break out and soon after, the need for your services would be almost immediate. It was great to hear that you've gotten established quickly for people who want to get to your website ASAP. What is the website and how can they get in contact with you?

It's That's the best way to reach us. All the other information is on there.

Thanks for sharing your story. Tell us a little bit about Telehealth PT services. Let's start answering some of the general questions that you get from PT owners and providers on a regular basis. 

The first question I usually get is, “Can I do this on my phone? Can I FaceTime or Skype?” The answer to that is no, you need a secure platform. There are plenty of platforms out there that look a lot like Zoom or FaceTime but they secure the communication on both ends to and from the practitioner and the patient. The audio and video can't be stolen and intercepted. It's secure in both directions.

PTO 92 | Telehealth PT
Telehealth PT: People don't love change but this environment changes that a little bit.


Do providers need to find something that's going to be shown to be HIPAA-compliant?

HIPAA-compliant and the platform will require a BAA, which is a Business Associate Agreement.

Between the PT company and the software provider as well, that's pretty easy to get that at Zoom?

There are a bunch of software programs. The ones that are most adapted to PT are, BlueJay and Physitrack, and some of them have exercises built-in. A couple of them were built as home exercise programs. Some of the home exercise programs are adding telehealth to their platforms as well making it easy for PTs to do telehealth.

Do you have to have the patient sign anything different or can you use your typical intake paperwork for this?

It’s very similar. You would have them do your typical intake. Any information that you can get in advance is easiest. The answer to a lot of questions about telehealth is different from every state. Different states have different rules about consent. Consent can be verbal, digital or on a sign on paper, and every state is a little bit different. New York State requires only verbal consent. I'm not sure about Alaska and other States but that information is out there.

Do you get patient consent to do telehealth services?

That’s right.

If people wanted to find out those regulations as it pertains to their state, is there a website that has accumulated that information into one website or do you simply have to go through your own state by-laws.

That's always the best idea to go to your State Practice Act and most States at this point have some verbiage about telehealth. One central resource is CCHPCA, which is the Center for Connected Health Policy. They're based in California. They've done the research and plenty of documentation about the changing telehealth laws and they keep it up-to-date.

Telehealth is an opportunity to spread practitioners’ geographic reach so they can treat patients in other counties and states. Click To Tweet

Are there some states that simply don't allow telehealth services?

In some capacity, every state allows it, not necessarily for PT though. It's

You find the software program that you're going to use, you sign the BAA, you have the patient's consent to do telehealth services. Your treatment is like any other except you can't touch them.

That's the simplest form. If you're an independent PT and let's say you treat a patient in their home or at the gym on a regular basis and you have an ongoing relationship with them as a patient-client relationship but they can't make it to one of their visits. It's as simple as that. You have communication. Say, "I'm going to send you a ping. You click on this link, it will take us both to this conference to this BlueJay page and we'll do a telehealth session." That type of session is going to be you much like when you start most PT visits, "How are you? What's going on in your life? What's happened since the last time I saw you? What feels good and what doesn't?"

The subjective stuff, the conversational, comfortable things that you're going to talk about with a patient. That guides your visit like any other visit. If they need to, they can do a warm-up on their own. Someone who you're seeing on a regular basis via telehealth, may heat up a heating pad and sit with it for fifteen minutes before your telehealth session so that they're ready for you going in. Warm-up depending on if they have some exercise equipment at home, they might ride a bike or do whatever warm-up they might do at the beginning of the session. You can guide them through that or have them prepare to do that before you get on the phone with them or visit them.

What are some of your limitations outside of the manual when you can't get yours on them? What do you find is the most difficult thing in treating patients over the phone or through the software?

It depends on the patient and their set-up. I've found that most patients are doing their sessions with a phone. They have to have a good place to put that phone. When you're in front of somebody, you can see their whole body like three feet away from you. With a phone, it's a little bit different. Different accommodations work. You can use speakerphone with some patients in some situations. I always find that wireless earbuds are the best thing for the patient to be wearing so that they can move without a wire. They can hear you, you can hear them.

AirPods are ideal or something similar to that. That one challenge is having a visual and see the patient. The patient might think, "You have to see my arm move." You want to see their whole torso move. You might want to see how the trunk is moving well or even if they're bending their knees as they try to reach overhead or whatever it may be. That can be a challenge. Technology is always a challenge. It seems, for us, as the practitioner who's become used to using the software and it's very simple for me. On the other side, it takes some understanding from the patient.

Especially for those who are not technologically competent, I'm sure that's got to be difficult sometimes.

You've been on the phone with somebody who can't quite figure out how to use their phone. A phone conversation sometimes can be tough.

Do you usually share some of these things with them ahead of time like, “Here’s what is going to make our telehealth visits most successful? Make sure you have wireless earbuds, have your phone set up at a distance where I can see your whole body or you have a telephone stand if you're using one.” Do you list some of those things out for them?

I have a checklist for the patient and practitioners. The other complication or challenge can always be the Wi-Fi or the connection. That depends, sometimes it's perfect. Other times, it's all over the place. You do have to have a contingency plan. You have to have a backup, “If we get disconnected, we're going to reconnect like this, I'll call you, I'll ping you back,” or whatever is going to work for that situation.

You treat as much as you can over the software program. Do you bill as if you had seen them in person with the same CPT codes and time services and all that kind of stuff? 

That’s right. Typically, Medicare does not pay for telehealth services for PT.

We can't expect to get anything from our Medicare patients, unfortunately. These are the people that might be home down more than the others during this outbreak.

I have reached out to people I know who were in Washington who might have the ear of the government to get some accommodations on that. At this point, we all know someone in their 60s, 70s or 80s who is reluctant to go outside and probably is not attending PT right now even if they need it. It's important that those services get covered.

There are lobbyists out there that are pushing for it. If there was a way for physical therapists to do some footwork at the grassroots level to push a little bit, is there any way they can do that? 

I wish I had a solid answer. The best thing to do is to speak with the APTA and to your local representatives, whether it's local reps or federal government. It's the federal government because it's Medicare. I don't know if it's on their radar right now or not but I would think it has to be.

If some of these PT owners could flood the APTA who have lobbyists set already too, "We need to push Medicare somehow to continue to provide these services to the patients that are home-bound during the pandemic." That would be huge, I would imagine.

You would ask about billing and coding.

The billing and coding and then to follow up, since we're talking about Medicare, after you're talking about CPT codes and what insurances do pay for and who can we focus on?

It's different by state. I have found in New York that most of the commercial payers are paying, most Medicaid does cover all teleservices and managed Medicaid. I'm not sure that every state has the same arrangement but administrators of Medicaid.

It’s a matter of the owners simply need to sit down and start calling.

Speak with your payers and make sure you speak with the right person. Sometimes that first rep that you get on the call has no idea what telehealth is. They don't know. They don't see it right in front of them and they're not sure. A supervisor is your best bet.

With your consulting firm, have you made some of those calls on the behalf of some of your clients in different States or do you have some of that footwork already prepared?

I've only covered New York as far as that goes with the clients, but I've gotten some feedback from people in some other states that are telling me mixed things. Some payers are paying, some are not.

PTO 92 | Telehealth PT
Telehealth PT: This is another opportunity for us to speak for our profession and say we do so much more about education.


It's up to the individual PT owners to get someone to start making those calls.

As you alluded to, that is part of what we do. If someone does need assistance for that, we're definitely on board. I can be very helpful. I assisted in a lot of calls in New York so I know the conversation.

It’s good to hear that people can reach out to you. It's the person that you talked to, the verbiage that you use, don't take the first answer as the truth as these people are making the call and looking through your contracts and getting that figured out. In terms of billing and coding then, it's the same CPT codes, but there's a modifier.

Most are asking for the modified GT for telehealth and many require that you change the place of service to 02. For outpatient PT or outpatient services, typically is eleven. It's one of those things that's defaulted in most CMRs. Most practitioners have no idea that it even goes in. When you submit a claim, the number eleven goes to the payer. That field needs to be filled with a 02 to indicate that it’s telehealth.

As you've done some of the billing, are you getting denials initially and there have to appeals or are they easy and good about paying considering the modifier and the place of service?

I haven't seen any denials. I and my clients haven't taken too many chances yet. We've gone for the ones that we know will pay. I'm at that point right now where there's more and more demand. Patients want services and we’re going to give you a shot with other payers.

What do you find as you're doing some of this consulting? What are some of the hurdles that you have to prepare the owners for and those coming up against that you have to address?

Part of it is practitioner buy-in. For some PTs, it's completely something new. People don't love change but this environment changes that a little bit. It changes people's mindset a little bit. People are in survival mode and realize that they want to work, they want to reach out to their patients, that patients need the care. They're not going to get it otherwise. It's been a challenge but I suspect that might change. If a PT is sitting around with no patients, they would want to make contact with that patient.

They’ll get some buy-in pretty quick then.

It’s similar on the other side where some patients are very eager to do telehealth because it's so convenient. It's easy but others are not. I always say it's not for every patient, not for every visit but situations change things.

Can PTAs do these in calls?

It depends on the state. In New York, the best answer I've gotten is no. I'm unsure, to be honest with you. I'm hedging a little bit, but we're going with no in New York right now.

That would be up to the owners to call the insurance companies and ask that specific question, I'm assuming.

It's based on the contract. Its two different things. You do have to follow the state law and your State Practice Act and you do have to follow the reimbursement rules or laws from your insurance company if you expect to get paid. We do have clients who do all cash so they only have to follow the state law that they're in. There is no concern for what the payors at. We haven't talked about it yet but another thing to follow is a lot of practitioners now in telehealth recognize it. It's an opportunity to spread their geographic reach so they can treat patients in other counties and states. You do have to be licensed in the state that the patient lives in order to treat there.

You could live in Washington and do a telehealth call to Alaska if you have an Alaska PT license. You can't do a telehealth call to Alaska if you only have a Washington license.

To add to that, there is what's called the PT Compact. The compact is an agreement with, I believe it's eighteen states at this point where if you're licensed in one of those eighteen states, you can get the right to treat in one of the other compact states. Without getting a full-blown license, you can still treat those other states.

Do you have to go through a process in order to get that right?

Each state in the compact has its own process, whether it pays a fee or pass the jurisprudence tests or get approval from your state. Every state is different.

How can we find out about the PT compact from the states involved?


Is that PT compact only for telehealth services? 

I don't think so. I believe it's the right to treat in any state in the compact.

If you live near the border, you could cross state lines and do a home health visit in another state?

I'm sure that's how it started and telehealth got the ball rolling in further.

To back up a little bit, if someone's billing for some of these services, it's the CPT code and the GT modifier on top of the other modifiers that they're using. Whether you go 1st, 2nd or 3rd, it doesn’t matter.

I haven't heard that it matters. You're going to be billing and my experience thus far has been billing for an evaluation, if you do one or re-evaluation, it’s 97161. If you are billing for therapeutic exercise, that's 97110. Neuromuscular re-ed, it’s 97112. Therapeutic activity, that's in 97530. It's limited to that. You could get into 97535 or 97537, I believe it is. It's a functional activity like home activities. Reorient the community, that's community reorientation.

What are some of the difficulties than from the patient side? What are some of their complaints as they're going through this? Is it either they like it or they don't or do you hear some of the same concerns? 

I don't know if they can't stand the sound of my voice in their ears. They don't like how they look on camera. That is one. Some people are very uncomfortable doing video calls which I get it. You get past that quickly. The biggest thing is you're not getting that physical touch. I encourage people to use foam rollers, physio balls, get some of their own home equipment because as we know as PTs, they should be doing home exercises anyway. They should be managing their chronic pain. This is a great way to get them off on the right foot.

How is compliance? Do you have a cancel rate or a no-show rate?

I'm pretty persistent. My patient's schedule is not that packed. I'll find a time for most patients to get in on that day. That is a good thing, meaning flexibility. If someone can't do their 10:00, you don't want to make an open schedule then you'll have that. If someone can’t make their 10:00, they can see you at 2:00 and make that work because you're there and it's at their convenience. I try to make it that way.

Your documentation is no different than when you see them in-house?

That's true. You want to document that you're doing a visit by telehealth secure remote video call.

Where do you put that? Somewhere in the objective?

It doesn't matter, as long as it's on there.

You use the same EMR system. You use this software program with a BAA and it’s HIPAA-compliant. You do the same therapy that you would without the manual. Your billing is the same CPT codes with an additional modifier and a place of service is changed. Make sure you're dealing with the right insurance companies.

I like to take advantage of the fact that we work in the patient's home or at their office. There's the opportunity to do an ergonomic assessment of their desk. There's an opportunity to have them put some plates into a cabinet, do some functional activities, how difficult to open a door or go to a window or something like that. I haven't done any of these treatments of patients with vestibular issues, but I had a very long conversation with someone who does. She makes sure that the patient is in a very safe environment. For her vestibular patients, she does their sessions with them standing in a corner. Nothing else around. They put the phone on a nice platform where it can video them while they're doing their program while they're standing in the corner so that they have something to grab onto at all times.

Back pain heals because patients understand what's going on with them better. Click To Tweet

How does marketing go? Are the doctors receptive to some of this especially now, I'd assume they are more receptive? What is your response from the physicians?

The real answer is everybody's first response is how you can do physical therapy if you can't touch the person. I've always believed that that's a perception of what PT is a problem. Many people still think it's massage and hamstring stretching. That's a problem within our profession. I've addressed that forever and I continue to address it. This is another opportunity for us to speak for our profession and say we do so much more about education. Back pain heals because patients understand what's going on with them better. That's how people get better. That's a lot of it. Once that conversation happens in the right tone and manner, most people tend to be a lot more receptive.

You get referrals directly from physicians to specifically provide telehealth PT services.

I have not marketed it in that way. I haven't pushed it hard in that way but I suspect that it will start happening very soon and not just for me but across the board.

Have you marketed directly to a consumer and gotten patients? How do you get most of your patients this time? You have direct access in marketing your telehealth services directly to the consumer and they're calling you up and starting the therapy.

They either hit on the website or calling. I have some other online referral sources that refer directly to me. I have not made a big push on social media yet. There are regulations.

Advertising for pain relief and that kind of stuff.

Particularly in New York is tough about that. My methodology has always been when I had a brick and mortar practice was we'd put information out there. It's about being a source of information showing you professional knowledge, people respect that and want to learn more from you.

What is your website? How can people reach out to you?

What I'm getting from this is number one, it's not as hard as people might expect it to be. The ins and outs and intricacies are a place where someone like you could help out quite a bit as a consultant and getting this branch or this section of their PT practice off the ground. I'm thinking, not for this pandemic but also snow days. Like here in Alaska, I'm thinking it would be great if you could offer this service to people who live out in the bush that simply don't want to live near other people and don't want to drive two hours for PT three times a week. There are opportunities there for sure, for people to provide those services. It's time that you established your business to help people out like this.

Thank you and I'm looking at this. This is an impetus to get telehealth into the mainstream. I don't think it's a fad or it's something that's going to go away when this pandemic is gone. It might be the thing that makes people comfortable with it. Look at where demographics are going and how people are working now. A lot more people are working from home and recognizing that they can access stores and food via the internet right from the comfort of their homes. It's not every patient or visit, but if you have a total knee replacement and you're expected to go to physical therapy three times a week, maybe you’d go into the office twice a week and the third visit, you do via telehealth. It's convenient.

PTO 92 | Telehealth PT
Telehealth PT: There are plenty of opportunities out there and plenty of ways for us to reach out to patients and our patients to reach us.


Even more simply, what about the mother or father that has a child sick at home and they can't leave? Instead of canceling that visit to the out-patient facility, they do their services over the internet. It can be so great. If a patient cancels, no shows or if there's a drop in a provider's schedule, they can make some of those calls to people who couldn't make it and say, “Let's do it right now if you've got time.” There's an opportunity.

Different groups are looking to do exactly what you said in different ways. Some will have the same PT treat that patient later in the day. If that patient doesn't have so much flexibility in their schedule, they might have someone who only does telehealth visits. They might even outsource to a particular group or PT that never comes into their office and just does their coverage work for those next visits. There are plenty of opportunities out there and plenty of ways for us to reach out to patients and our patients to reach us. That's what this is about.

At this point, the important thing is to make sure providers recognize that this is an option, that there are people like you out there that can help them. Lastly, they need to push at the federal level to make sure these telehealth services are covered. Is there anything else you want to share, Daniel?

Be safe out there. It's crazy times. We'll all get through this. Telehealth and other services like this are ways for us to be smart and handle a challenging situation. Going forward, it will be something a lot more fun for us to do.

Telehealth and other services like this are ways for us to be smart and handle a challenging situation. Click To Tweet

Out of every challenge comes an opportunity. Thanks for your time, Daniel. I appreciate you reaching out.

Thank you, Nathan.

It was timely that you did so. I'm glad that we're putting this out.

I appreciate it. I'll be in touch again soon.


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About Daniel Seidler

PTO 92 | Telehealth PT

Daniel Seidler, PT, MS
Daniel is an experienced Physical Therapist, healthcare innovator, entrepreneur and executive. He grew his practice in the Bronx, NY to three successful locations before being acquired by a regional multi-site group. Daniel  developed and launched the company's telehealth program in early 2019.

Daniel's passion for PT and desire to dramatically improve care delivery models inspired him to formalize his telehealth PT education programs and offer them through TelePT Solutions.

Daniel now treats remotely, coaches PTs to be telehealth specialists and consults owners on building successful telehealth practices.


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PTO 87 | Leaders In Your Company


As your business grows, it is important that you learn to entrust it to others as well. That is why, for this episode's returning guest, the job of a leader is to develop other leaders. CEO of Performance PT and FitnessStephen Rapposelli, PT, is back to bring tremendous value about developing a leadership team. Having written an article in Impact magazine about the qualities to look for in potential leadership, Stephen shares those with us and discusses how we can structure our own leadership development programs to assess, test, and develop our own leadership teams. This episode is very valuable for anyone looking to continue to grow their businesses because, at some point, you become the stumbling block to your progress.


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Cultivating Leaders In Your Company With Stephen Rapposelli, PT

I've got a returning guest, Stephen Rapposelli out of Delaware, who on a prior episode, discussed an Impact Magazine article which he wrote regarding creating values for your company and how to go about doing that. It's one that I've recommended to coaching clients and friends a number of times in the past. I highly recommend you go back and check that. He also turned the tables and interviewed me about my professional path. If you're interested in my history, you can go ahead and look at that. I brought him on again because I saw that he wrote another Impact Magazine article about developing leadership teams, most notably qualities to look for.

We also delve into how to develop your leadership team, find those best candidates and what to do once you find them, how to train them and how to coach them going forward. They can take the burden off you eventually and continue to grow and expand your practice, and maybe make up for some of the flaws that you have as an owner. As always, Stephen shares a lot of wisdom and even asks me some of the things that we did to develop our leadership team. We go back and forth, sharing some experience on how we develop our leadership teams to move forward.


I've got a returning guest Stephen Rapposelli, Physical Therapist, CEO of Performance PT and Fitness in Delaware. He is also the VP of the Delaware PT Association. First of all, I’d like to welcome you, Stephen.

Thank you, Nathan. It's always a pleasure to be with you.

Thanks for coming back. I appreciated and I've referred plenty of people, including coaching clients back to our previous episode where we discussed values and how to establish those and it's still vitally important. I recommend everyone to start with purpose and values as they're developing a structure to the business model. Thanks for sharing and being such a valuable part of history.

It's always fun to talk about values. On the surface, that sounds boring, but it helps guide every decision you make as an owner.

The reason I'm bringing you on is because you had an article in the Impact Magazine about developing leaders. Foundationally, we can say that before we even consider leaders in our company, we have to go back and establish the purpose and values of our company. Otherwise, how are we going to determine who's in alignment with us to become those leaders in the future? How are we going to base what kind of leaders we want and what is expected out of them if we don't have those things, to begin with?

Your job as a leader is to create other leaders. Click To Tweet

Your values are your ultimate filter for everything.

It starts with hiring but your leadership team who eventually will be your leaders of your team should be the people that are completely bought in. They live and breathe the values as you do. They are making their business decisions on your behalf or on the company's behalf according to those values like you.

If you manage by gut reaction, think about it, and spend the time to think it through, that gut reaction is an identifiable, quantifiable series of filters which are your values.

A lot of times it's based on those initial gut feelings that help us determine those values, to begin with. We eventually put words to them and we do quantify and qualify them but it's that gut feeling of, “That explains us,” or “That feels right.” That's how we know when we have the right ones and when people are in alignment with us.

All of us who think we're good clinicians, we feel that we have this special magic of why we're good. Nathan had his magic. Steve has his magic. That “magic” is something that can be identified and more importantly, it can be taught. As an owner, you should be constantly thinking of how you can transfer whatever magic you have to your staff in order to elevate them.

It's vital to transfer that same knowledge in order to grow because we can't expect everything to be on us. If we do so, we're going to be burning the candle at both ends. We don't have the energy for that and we will be the limiting factor in the growth of our company if we don't write down and set that purpose and values, and hire and fire accordingly. Other leaders can step up, develop and continue to the growth of the company.

The number one job of a leader is to make other leaders. That's it.

On the surface, talking about values sounds boring, but it helps guide every decision you make as an owner. Click To Tweet

You listed a number of things in the article about qualities that we can look for and this goes beyond values. We hire and fire accordingly. There are some people that you might consider as leaders but are simply good therapists. They have the values but maybe good at leading other people. They share the values, but they may not have that skillset. Besides that, what are some of the things that you've listed out that you think are important to acknowledge and people who could be potentially good leaders?

There's a number of them. You bring up a good point, which is, “The best leaders aren't necessarily the smartest people in the room. The best leaders of your business aren't necessarily the best physical therapists.” Those are different skillsets. They both need to be identified and groomed by you so those people are behaving up to their fullest potential. The first thing that I talk about is intellectual humility. You are never done learning. You look for people who are insatiably curious. Insatiable curiosity are those people who are asking questions and always wanting to know how something works, “I wonder what would happen if this or that.” Those are the people who are going to be constantly growing. They're going to be lifelong learners and that's one of the characteristics that not only you should have, but you should also be looking at others.

You can't expect two people to naturally know how to lead and to naturally run a business because that's essentially what you're wanting them to do. You're wanting them to run at least a portion of your business. That's something that if they've been through physical therapy school, they haven't had any business training. You would expect them to be wanting and willing to learn more. Either through working with the same coach or consultant that you work with or reading some of the same books that got you to the point where you are so they're in alignment with some of your thought processes. They need to have some of that same intellectual growth.

The thing that I look for is the people who are raising their hands. Who are the people volunteering and saying, “I'd like some help and direction. Show me this. Tell me how to do this. I'm looking for this?” There has to be that innate sense of volunteerism that demonstrates to me that they are going to be the ones that go and get it. It can be something simple. We have a road cleanup a couple of times a year where we go out to a local road and clean the trash up. Who are the people that show up? Sometimes, you need to tell people, “This demonstrates to me that you want to do a little bit above and beyond. Therefore, I'm going to give you more to go above and beyond. We're going to be limited by whatever your ability to grow is going to be.” A lot of people in this day and age don't understand those behavior traits that the leaders look for future leaders. We need to tell them. We can't assume that they know that that's what you're looking for.

It's the leader’s responsibility to develop other leaders and part of that is coaching your team. You're going to have one-on-one conversations with them. Either they express a desire to grow in a leadership path or you've talked to them about, “You might have the desire or the capabilities to do so.” You start having one-on-one conversations. It's imperative to say, “This is what a leader looks like. This is what I would expect.”

We all make assumptions that we shouldn't be about what people already know, what you think maybe basic or even intermediate level thinking. You can't be that way. You have to express it and communicate it. A key to that starts with being vulnerable and being authentic to your staff because that's how you develop trust. If they don't have trust because you haven't been authentic and vulnerable in your leadership path, they're not going to meet you halfway.

I learned that when we had our two-day Annual Leadership Conference. We spent a good part of the day trying to be vulnerable and authentic with each other because we felt that there was a certain level of trust that was missing among our leadership team. It was exhausting and it was hard. People were visibly stressed but then we had a breakthrough. I'm not saying that every interaction with your staff has to be an intervention. You do have to be able to allow yourself to be seen as a fallible human being that is trying to do the best that they can. A lot of times, leadership starts with yourself and how you are leading yourself. You become either an example to others or a warning to others based on your behavior and what people can see that you do.

PTO 87 | Leaders In Your Company
Leaders In Your Company: As an owner, you should be constantly thinking of how you can transfer whatever magic you have to your staff in order to elevate them.

That's a huge quality that you need to look for in your leadership as well. You talked about the ability to be vulnerable, not have to be right or correct in every circumstance, be willing to recognize when you've done something wrong, and ask for questions. It might expose you to someone who doesn’t know you. You talked about insatiable curiosity. That touches into that a little bit, but there are some people that get a feel. The gut reaction has to be right or they have to be seen as better than so you have to be wary of those people. Help them to understand that being vulnerable and being fallible is okay.

The bottom line with all of this is a lot of these behaviors that we see are a result of fear. It's a fear-based mindset and you have to recognize it, appreciate it, move people from that and look for other people who have that ability and that capacity. Those are the leaders of your business.

Considering you went through this exercise, did you follow any particular book or program to get you guys through that stage to expose yourselves, become vulnerable and increase the trust of your leader as well?

As it may have been said in other places that leaders are readers. My ability as a leader is directly proportional to the amount of time that I spend reading. With that said, there's a whole list of great books out there but I'll break it down to 2 or 3 books that are almost required reading for anybody on our leadership team. Some of these, you might outgrow a little bit and you might be like, “That's an old one.” I'm going to go on a tangent here. A lot of the things that we hear is a rehash of ancient wisdom that goes back a long time. The more you're in the space of leadership and the more that you read, the more you say, “I heard this before. This was somewhere else.” I'm a big fan of going sometimes 4,000 years back. Let me give you some examples.

Number one, The 7 Habits of Highly Effective People by Stephen Covey. That's the one that everybody should probably read once a year. The way not to read is to read a book once and then put it up on your shelf. You have to take that thing out, you’ve got to dog-ear and underline and you’ve got to use no cards. You’ve got to talk to somebody about any tactic you can think of to squeeze as much juice out of that book as you can. Number two, How to Win Friends & Influence People by Dale Carnegie. I read that book when I was fifteen years old. I don't know what possessed me to read that book. It was truly dumb luck and his lessons are basic but they're not done by 90% of the people. You can be exceptional. It's easy to be exceptional by following some of the things that Dale Carnegie speaks of. For example, looking people in the eye, calling people by their name, and shaking people's hands. People like to scoff at that but how many times do you go down to your local department store and nobody even looks at you or talks to you? Getting these basics down is fundamental in being a leader.

Next is Executive Toughness by Jason Selk. That is an outstanding book. I finished it twice and I'm going to be implementing it like that. Emotional Intelligence 2.0, you've heard that one before and that's a good one. Here's one that you probably haven't heard of The Art of Living by Epictetus. Epictetus was a stoic. He lived about 4,000 years ago. It is a short book and it is basically one lesson a page. It is life-changing to read that book. One of the things that Epictetus says is, “Don't take things personally.” That'll change your life when you come to the realization that not everything that comes into your world is about you. I like to think that you need to get to be about the age of 40 before you finally realize that to be true, but some people get it earlier. You get to a point and read the book, The Art of Living by Epictetus. Those are some of my required readings for leaders. The list can go on and on but the older wisdom and truce are the ones that have lasted the test of time.

I want to reiterate that this is expected reading for your leadership team. At least some of these if not all. We had the same thing. If they were a leader, they were going to be expected to read some of the same books that we thought were important. Whether it's The E-myth Revisited, Good to Great or Leadership and Self-deception and The Five Dysfunctions of a Team. I thought you were going to go with Five Dysfunctions of a Team by Lencioni in terms of developing this meeting that you have.

Your values are your ultimate filter for everything. Click To Tweet

As he says, the first level that you have is to have as an effective team is trust and ability to be vulnerable so you can get a commitment, buy-in, and conflict. That's a huge book. The first time I read it, I was like, “Okay.” Sometimes, you have to read things over and over for it to stick. Maybe it's my own simple mind but you have to keep revisiting these things. The other thing to recall is when you try any new skill, you're going to be lousy. We operate by Gino Wickman's book Traction and the first year and a half, we were lousy. We weren't hitting any of our rocks, our rocks were poorly defined, and issues were all over the place. Anything you do, you have to stick with it. You do get better with time.

I have a couple of coaching clients that are voracious readers. They've read them all. They're at a point where I'm like, “You need to focus on one. I know that you know the concepts. You need to start drilling a mile deep and an inch wide instead of an inch deep and a mile wide.” Take any of the concepts that ring true to you and start implementing them. Dedicate yourself to one thing. It's interesting that you talked about focusing on Traction by Gino Wickman because there are plenty of people that have read it but haven't implemented what he’s recommended.

There's a huge difference between planning and executing. As Mike Tyson famously says, “Everybody's got a plan until they get punched in the mouth.” He’s a great philosopher.

You have a bunch of books that you have your leadership team read. Are there any other qualities that you're looking for as people who could potentially be leaders on your team as well?

There are stages to an employee's life. The first stage of an employee is they don't know what to do. The first stage is, “What do I do?” The next stage is, “What do I do next?” The next stage moving up the ladder is, “Is it okay if I do this?” The fourth stage, which you're trying to get me to go to is, “I did this and then this happened. Now, I'm going to do this.” What you look for are people that have some initiative, willing to try things out and see what happens. I don't know how else you coach that other than giving them the opportunity to know that they're safe if they fail and there are few things that are going to be fatal in a physical therapy office. There are some things that could be, but by and large, there are few mistakes in this world that can't be understated if I can use bad English. You encourage that, give them room and latitude and make sure that they're safe in doing it. You see where it takes them and it might be something simple and it might be something big.

The area where most leaders have to remind themselves is the WAIT philosophy, which is, “Why Am I Talking?” When you are about to talk, say the word WAIT and think to yourself, “Why am I talking?” As the owner, oftentimes you say, “I know it all. I have done it all. Let's get this done. Let's move on to the next thing.” You're stunting the growth of your future leaders if you don't give them the opportunity to stumble, fumble, be inefficient, awkward and to try to find their way. I find that personally difficult to do. I literally had to write it down in front of me before a meeting to keep reminding myself, “Wait, stop talking.”

That's an effective coach to someone who lets the other person verbalize, process and come up with the solutions. To say it another way, “We're looking for people who are willing to generate solutions to the problem without you being the answer.” To give you an example, we would give some of our potential leader’s homework assignments like, “What's a problem that they see in the clinic?” Maybe there's an issue with the laundry. They're not happy with how the laundry is getting done at a particular time in an efficient manner. Pick anything and come to me with the problem like, “Check it out,” and let them find a solution for it. We'll discuss how we're going to implement it and then have them oversee that process that they recommended. It’s something simple like you said.

It changes your life when you come to the realization that not everything that comes into your world is about you. Click To Tweet

Did you find when you were in practice that as you were evolving that you had to fight against not knowing what the front line problems were in your practice? Did you feel you knew every problem and every issue?

No. I was open to saying that I don't have all the answers and I know there are plenty of issues.

Do you encourage your employees to come up with those issues and then think of a solution based on what they felt the problem was?

As I grew over time as a leader, they would come to me with problems. This patient will say such and such and instead of giving them the answer, I started saying, “What would you do?” I let them voice their opinion on what they would do and if that was okay with me, go ahead and try it. I’m like, “Are you sure you're okay with that?”

You said something golden there, which is, “What would you do?”

A lot of them have the answers but they think that this is your clinic and this is how you would want things done. You have to get over that at some point and say, “No, this is our company. You need to own your position like I need to own my position. You need to be the CEO of your own role and recognize that you can affect things for the positive. There's a lot of latitude underneath my umbrella to perform and I'll check you if you go too far.” We would give them homework assignments like, “Find a solution for a problem that you might see in the company.” We get to task them with leading out on the team meetings so that we didn't have to be the people who’d establish the topics of the agenda and all that stuff. We let them do that and let them lead out. The peers appreciate seeing that from their leadership and letting someone else step forward and lead the team instead of the leader sharing his wisdom from the top of the mountain.

Was there a difference in your business between staff meetings and leadership meetings? Were those two different mutually exclusive groups?

PTO 87 | Leaders In Your Company
Leaders In Your Company: A lot of times, leadership starts with yourself and how you are leading yourself. You become either an example to others or a warning based on your behavior and what people can see that you do.

There were team meetings at the different clinics on a weekly level where the clinic directors were responsible for getting everybody together, discussing topics at hand calendaring, and sharing statistics. The leadership team was a different 3, 4 or 5 people that would discuss what’s going on between all clinics.

When someone moved up from the staff meeting level to the leadership meeting level, was it eye-opening for those people in your business?

Yes, especially when we shared financials then they could see that there's a lot going on behind the curtains at that point.

Did you see a change in their behavior once they were able to be a part of and witness the leadership level meetings?

Yes, for sure.

How can you let everybody get a taste of that? That's a challenge.

The best you can do is to give as much authority as you can to the people that are closest to the situation. That gets down to the clinic director level at least so that they can have immediate oversight of what's going on within each clinic since I can't personally be there. We're talking about a situation where there are multiple clinics and multiple physical locations.

All good things come to you with the price of an effort. Click To Tweet

It's a moving target because I know that in the past, I've shared an abundance of data with the entire staff and the feedback was, “Why are you telling us this? Do you think we're falling asleep?” You're like, “I overshot that one.”

We would have quarterly “town halls” according to Scaling Up by Verne Harnish with everybody. In those situations, we were talking from more global perspectives. Their favorite part, honestly, was talking about the values amongst the team, in which people within the team had exemplified those values in the past quarter. We'd share larger perspective items like the organization chart of the entire company and what their responsibilities were within the chart or discussing what charity or what value we're going to focus on in that quarter. We'd look at bigger picture things. We'd share some higher-level statistics here and there, especially if we met some great goals and whatnot. We didn't get down to the nitty-gritty, which is too much as far as statistics.

One of the top parts of our meetings is when we give each other what we call attaboys. It doesn't come from the leadership team but you let the staff members stand up and give each other praise for something that they were observed dealing that adheres to our values. Once you get that started, it becomes like a ball of fire and that raises everybody's ship. James Clear in his book Atomic Habits says, “Praise others. It will bring them peace of mind. Do not expect others to praise you. It will bring you peace of mind.” You look for that leadership trait in others and that is, “Be quick to praise others to lift them up but don't do it to expect praise yourself because you don't need it.”

Our team meetings were most successful when they were able to recognize each other and how they exemplified values in the past. It can become emotional, tears, excitement and almost without fail. That was the favorite part of their meetings. In developing that, that's where you start honing the values of your company and you also start getting buy-in from your company as we start going through these processes. Of course, you're looking for the initial qualities whether that's curiosity, first to share, first to raise them or volunteer. Every person should be able to sketch a leadership progression and it's typically tied to how you grew as a leader and what those steps might take.

It's the books we read, sharing some of the wisdom we received from coaches and consultants, maybe give them a little bit of homework that a leader would do, and start sharing some of the statistics that you were looking at on a regular basis. Also, maybe delegating some of the responsibilities over to them, especially if you're going on vacation for a week, “You're in charge. This is what I do and I expect you to do the same. See your patience because that's what I had.”

The goal of the owner is that the people that are under you don't have as long of a learning curve as you had. You want to try to eliminate as many of those mistakes. It is shocking. I tell people that I was successful in spite of myself. I was ignorant of everything and it took so long. You want to try if you can shorten that for everybody else because they'll make their own share of mistakes eventually. If you can save them some of the pain that we all have to endure as we move from novice to expert, that's a valuable and admirable goal as a leader.

That's your goal. When you consider a leader being powerful, how can you get the same effect in a shorter amount of time? If you can generate that type of power from a leadership development perspective, the power that comes with your leadership team and the opportunity for growth and acceleration, then it increases for that.

The best leaders aren't necessarily the smartest people in the room. Click To Tweet

You'll agree with me. It is so much fun to watch others grow into that role, make it their own and take it to the next level. It's fun.

I had an employee and her name is Stacy Sullivan. She tragically passed away but she stayed with me for probably 15 or 16 years. She was one of the first employees that I hired. She was a PTA. She left for a period of time to work somewhere else and then came back. I brought her on with open arms because she was amazing. Without me knowing, it had bought into the values. I don't know what it was but she was all-in on whatever I did and every mistake I made. We worked through and we talked through. I asked her a couple of times, “Why are you so loyal? Why do you care so much?” It's almost like she cared more about my company than I did and I couldn't understand it.

She did it and people liked that out there that will carry the banner for your company when they know that they're in alignment with you. You've probably recognized this yourself with some of your leadership team members. They're willing to go above and beyond and they hurt when the company is hurting. They're staying up late at night when the company is facing problems like you do. They'll own their position and that company will take on part of their lives.

Face it, Nathan, it's easy to get discouraged. There are many times where you say, “Am I the only one here? No one helped me plant the wheat.” You also have to remember that there are six billion people on this planet and they don't all have to agree with me. I need 10, 15, 20 or whatever your number is, of people that share those values and that's when the magic happens. Those people magically start to develop and flourish before your eyes. You have to water the plants. That's all you have to do. These are some of the things that you look forward to making sure that you're finding the right plan to work.

That's fun when you can start developing some of those people and see them grow in a capacity that maybe they didn't see for themselves. Going back to Stacy, one time, one of our coaches showed her the org chart and said, “Where would you want to go on this?” She said, “Don't tease me like that. I want to be over here. I want to be the vice president of marketing.” She's like, “Why don't we set up a path for you?” She was almost in tears. She couldn't have imagined as a PTA that she could become an executive within a PT company. She wasn't the greatest therapist. She had such amazing kindness and exuberance of personality and light that she brought to the clinic. She became one of our better clinical directors when she was given that mantle. She was a great marketer. She did want to build relationships across the town for us and she had that path. There are those people out there that will grow with you. The fun part is to see them grow.

Nathan, that story leads to my final tip, which is, “Leaders ask.” You never would have known that about her if you did not ask. You couldn't assume that she wanted to be VP of marketing or whatever position she aspired to be. Somebody had the wisdom to ask and it is amazing what you discover when you simply ask. The converse of that is, “How many mistakes do you make when you assume that you know?” That gets me every time.

When you ask, you show that you care. That's easy for them to buy in when they know that somebody cares about their growth.

PTO 87 | Leaders In Your Company
Leaders In Your Company: You're stunting the growth of your future leaders if you don't give them the opportunity to stumble, fumble, be inefficient, awkward and to try to find their way.

That comes from getting to know your staff personally. You have to take the time and the effort to get to know them. I'm talking about easy things like, “What did you do this weekend? Where did you take your kids? What's going on with your parents?” When you ask those questions, over time, you find out those answers then you have that connection with that person. You understand that person and then that can change everything about the whole relationship. It's my truth bomb.

You dropped it well. It goes back to you have to take the time and you can't be doing that if you're treating it full-time.

All good things come to you with the price of an effort. You're constantly thinking to yourself, “Where can I best apply my limited resources of time and energy to move the ball forward for everybody's good?” That's what you wind up doing. It was in another show and maybe yours where the girl from Alaska said, “I was getting to the point where I was treating patients and I was distracted by it. I couldn't focus on the patient. I knew I had to get out of patient care because I was thinking of other things.” That was golden to hear that because people say, “How come you're not treating patients anymore?” “I only have many things I can do in a day and my number one function that cannot be delegated is I’ve got to ensure that this business keeps its doors open because people pay their mortgages because of me.” That's a pretty big responsibility. You have to guard your energy well. That's why I love your show. I learn all kinds of stuff.

Thanks for joining me, Stephen. When I saw your article in Impact Magazine, I got excited and I'm like, “I know Steve will come on.” Not only because of your willingness to come on, but the topic was great. I know you share a ton of great information.

We're all in this together and we're all stumbling and fumbling our way through. None of us are experts. We're all learning as we go along. I have found at this point in my life that the more I share, the more I get back. Thank you.

If people wanted to contact you, are you open to that?

You can reach out to me but I'm not going to sell you anything. I will probably refer you anyway. You can reach me at my email address at or look me up on the internet.

Thanks. I appreciate it.

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About Stephen Rapposelli

PTO 87 | Leaders In Your CompanyStephen opened his private practice in Delaware in 1992, at the tender age of 26, because he was told by his former employer that he couldn’t afford to buy into that existing business. He has since grown to 3 clinics, and has been voted best PT business in his state for numerous years. He also serves as Vice President of the Delaware PT Association, as well as sitting on the IMPACT editorial board. Stephen plans on devoting the rest of his career to promoting independent practices across the country.

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PTO 86 | PromptEMR


There is constant chatter about "which EMR is the best", "what ERM do you use --- and do you like it?", and "what EMR should I use?" No PT-specific EMR has all the answers, and every EMR has pros and cons that make it seem like they're all equally average and stuck 5-10 years behind current technology. PromptEMR shows us that there are new EMRs in development that, built on better platforms, can become the ideal EMRs we desire. Based on their patient-based perspective, PromptEMR was initially built to provide better communication with patients during their therapy episodes. Since then, it is striving to bring the rest of the business cycle and PT clinic employee tasks into the ‘20s, making everyday tasks and reports easy to perform and access. In this episode, the co-founders join Nathan Shields to share their stories.


Listen to the podcast here:

Disrupting The EMR Industry - The Co-Founders Of PromptEMR With Michael Dwyer And Adam Baliatico

I'm talking about EMRs. Most notably, we're talking to the cofounders of a new EMR out there called Prompt EMR. I'm interested in talking to them because they're doing things differently with a different perspective and I'm hoping that they can be disruptive to the EMR space. I've interviewed Heidi Jannenga of WebPT and Jerry Henderson of Clinicient. I've used their products in the past and I've been happy with them, but there's always something missing. If you worked with different EMRs, some EMRs would be good at some things. Some EMRs will be better at different things, but you never are truly happy with your whole EMR system across the board.

That's the ideal scene to get to. Hopefully, these guys at Prompt EMR can be those people. I'm excited to hear about the time and energy they've taken to develop practice management reports to improve the patient experience and the systems that they've developed to stay in touch with patients in-between visits and post-discharge. All those things can be super valuable and add to your marketing efforts. I'm excited to bring them on and talk about what they're doing, what they're seeing, and how they're maneuvering so that they can be the best EMR system out there for physical therapy owners. Let's get to the interview.


I've got the Co-Founders of Prompt EMR Practice Management. I've got Mike Dwyer, Co-Founder, and Director of Sales and Adam Baliatico, Co-Founder and Director of Operations who are joining me. I'm excited to bring on a group that is newer coming into the EMR space for physical therapy and trying to be disruptive. Do things a little bit differently so that the EMRs that we have in physical therapy truly can be something that can be a benefit to all the owners out there. Not in terms of documentation, billing, some of the basics, but even more than that. That's why I thought it'd be cool to have the co-founders on and talk about Prompt EMR and what they’re trying to do to disrupt things. Thanks, Mike and Adam, for coming on. I appreciate it.

Thanks for the opportunity.

Mike, maybe you can share with us a little bit about the germination of Prompt EMR. What brought it about? What got you into this space?

I started this in 2017 and it came from being a good patient. Over my four years of college, I had multiple injuries, most notably a SLAP tear and then external compartment syndrome on both of my legs. At that stage in my life, I track every aspect of my life. I still do this in my sleep, my diet, my exercise, everything. One thing I couldn't do at the time was to track how it's progressing in therapy. When you're in therapy for about 2.5 years, it's draining. You're there because something's wrong and you're trying to get to your level of function. As a patient, it's tough. I was trying to create a product that essentially would tell a patient where they stood in therapy and then when they would be expected to get to where they were supposed to be beforehand. What we found with that product early on was that it was nice to have things, but it wasn't essential. The big problem we had with that was if it wasn't connected with an EMR, it was useless because as a provider, you have limited time. Documenting one system and documenting another would never happen.

That was a critical point for the company because it led us to a bigger problem. Given that we weren't able to integrate, we noticed that there were already too many pieces of software in a clinic. There were 2 to 5 generally in each setting that we were in. It wasn't the most fun years of our lives, but Adam and I spent roughly eight months as a fly on the wall in clinics to make sure that the juice was worth the squeeze. We decided it was and we tackled the big overarching problem of combining all of the software required in the clinic into one spot. That’s a long-winded answer but it should give you an idea.

PTO 86 | PromptEMR
PromptEMR: A lot of the patient experience defaults more to the front desk managing the intake.


That's great because you're coming at it from a different perspective. You're not a physical therapist who's saying, "This is what I would prefer to have and this is what I need." You're looking at it from a patient perspective, which is different. What might keep patients engage or even retain them and make them part of the journey when it comes to developing in the EMR. That's a different perspective. 

It is also the way we structured the platform, most of these other systems can't display data to the patient. Where trying to make it similar to that original idea, to be able to have someone in tune with their care. Also, on the flip side, healthcare providers get as much information as they need. For example, going out there and take ahead of time going right to the eval and being able to book online. There are a lot of angles for the patient that was actively taking it as well.

It makes it an easier experience and a better patient experience altogether. 

It's also something that's expected. For me, it was something I didn't have in therapy. Let's say class pass or something where you're booking online to get into your thing. It was something that I didn't see in therapy at the time and something I wanted to have. We went all-in on that.

It seems like many of the software EMRs that are out there live about 5 to 10 years behind the times. You would think and even patients came into our clinic like, "Why do I have to fill this out all again? Is there some way we can make this easier?” It would even be super nice if you're able to schedule online because you're able to do that with many other software programs. It would be nice and anxious to see how it goes with you to incorporate all that and put it all into one EMR. That makes the patients’ experience much better and easier.

One of the things that we noticed during that research phase was a lot of the software was built by the therapist and the focus was on the therapist. A lot of the patient experience falls more to the front desk, managing the intake, scheduling, and things like that. Since the software was built by the therapist for the therapist, they were focused on the therapist’s experience. A lot of them ignored the other users within a clinic. That was coming at this as an outsider and as a patient and not a physical therapist or a biller or the owner of a clinic. We took a unique approach that we wanted to build our software for every user in the clinic and also the patients. We were focused on optimizing each user's experience in software from patient to front desk.

Can you tell me a little bit about maybe what you’re doing to keep patients engage via the software? Are there any examples you can share?

Even though the patient engagement aspect of what got us into it, we had to do a lot of the other things first, like facilitating good patients’ engagement. We started with normal patient reminders and things like that. In the coming weeks or months, we'll be launching a home exercise program that's built right from the therapist flow sheet. They'll also be able to engage and track the progress. Patients will be able to tell the therapist while they're doing their home exercise program, “This hurts. I skipped this because my knee was sore.” Engaging in the home exercise program. Another area of friction for patients has always been having to call and pay your statement instead of being able to input your credit card information. Through our process, the patient's going to be able to pay their invoices without any friction. Little things like that seemed minor but improved the overall patient experience. The bigger vision is to use the data of their recovery to display progress to patients and let them visualize that recovery like Mike's original idea back in 2017.

Disrupting the EMR industry and bringing it into the 2020's Click To Tweet

You're saying that patients from home make comments about the exercises that they're doing at home to the therapist prior to or in-between visits? 

That's an enhancement to our home exercise platform that we'll be launching soon.

Do you also envision having something that can retain patients even post-discharge, whether that's email reminders or whatnot? You can use Infusionsoft but that's way above our heads as a physical therapist. I’m speaking for myself. Do you have some visions for having email marketing programs for customer retention? 

To delve back on your point with the flow sheet. Once the patient is out discharged, being able to give them a plan, it's a big thing going forward with all these cuts coming in to diversify the clinic and having potential revenue screens that you didn't already think of. That's the way to do it because, through our system, you can template out exercises in the future, send it to the patient and still see how they're progressing outside of the clinic.

On the email marketing side, we're having some discussions with some of our clinics and we’re starting to work through the specs. It's a priority of ours to be able to engage with not just your active patients but also the patients that have left the clinic in a simple way. We don't want to give 500 different features to the therapist and owners who are going to use it for free. We're trying to figure out the core features in email marketing. Being able to engage with those patients is a priority of ours going forward.

We're talking to owners. They're going to have to deal with what the physical therapists or providers that are on their team have to deal with it. A lot of that seems to be what you guys do about ensuring fast documentation times, whether that's setting up templates and also how you deal with compliance. How do you attack something like that?

Our big thing during the research phase was to figure out exactly the workflow. We came to the conclusion that documenting in SOAP format doesn't make any sense. For insurance purposes, we have to report to SOAP. For documenting it wasn't following the same train of thought that the therapist goes through. For example, you're taking a pain measurement and then you're hoping to different tabs to generate that thought pattern. You're going to the assessment tab and the plan tab to finish it out. For us, we centralized everything on one screen. Also, a big thing we worked with our early clinics and billers, was building click-based documentation with compliant language. Our main use cases are on a tablet and the therapists as they're going through, they're tapping. They're not dealing with a bunch of pre-texts. Our main goal with documentation is to finish it either in session or before the therapist leaves. When I started this and I was talking to therapists, almost every single person said that was the worst part of their job. It was also something they were doing after hours. They didn't necessarily have to be. It was the software that required it. That was the bulk of our research. Adam, do you want to maybe touch on a little bit more of the compliance end?

We've worked with a lot of billers and people that have a lot of experience in dealing with audits and things like that. We make sure that all the items that need to be documented on eval, plan of care, or your normal follow-up visits are all there. Even things like making sure our electronic flow sheet that it's easy for the therapist to say which CPT code each exercise is associated with and then automatically populating that into their notes so they don't have to type it all out. Little things like that to make it easier to document compliantly. It was a big focus of ours early on to help the therapist document in a compliant way but also keep it easy so they can get their notes done fast on the same day. Many of our clinics are not finishing their notes on the same day, but since it's a seamless flow into the billing, a lot of our clinics are submitting their claims on the same day as the date of service with their documentation done as well.

You do have a built-in billing software program.

That's all built-in, all in one billing and documentation.

In my episode with Rick Gawenda, both of us shared a discouragement amongst the EMRs that are out there in their capabilities to generate quick malleable practice management reports for the small practice owner. We want to see the skilled units or CPT codes that are being built out by the provider but also in a clinic average. We want to see who's completing their full plans of care. How many times per week each patient is coming and is it the appropriate amount? What is the average furlough of the clinic? Things like that that you're not able to get a lot of from EMRs. It sounds like you’re looking at each aspect. You are also considering what you can do to provide those types of practice management reports. 

We were an end-to-end solution. We're not an EMR that relies on a third-party billing software to do the billing. We're not a third-party billing software that relies on an EMR that passes the data. Also, because we’re capturing the whole patient's experience. By the time they book an appointment and they pay their final bill, we're able to generate a ton of reports in an easy to understand way with a complete data set. A system that doesn't do the end-to-end, they're going to have a hard time generating reports on tracking the entire plan of care. Making sure each therapist is billing out the right units and things like that. It all flows in one architecture. It’s an all-in-one platform that allows us to generate robust, easy to understand reports and we're unlimited on what we can do in reports. It's something we talk to our current owners about all the time, “Here are the reports we have. What else would you like to see?” Since we have all of the data, we're able to overtime generate all of the reports that owners find useful.

It's also not inundating an owner with reports. They need to be able to look at their dashboard and make decisions quickly. If you have over 100 reports, that's impossible. We spent a ton of time talking to owners, "What matters to you?" and then putting it all within one eyesight so you can make decisions immediately versus having to generate a bunch of reports and finish your thought.

If you're capable of doing it, if you can at some point, take some of those stats and graph them for us over a period of time, that would be great too.

A big objective for us will be trending statistics. We have all the data as a statistic. The goal for us in reports 2.0 will be trending statistics. Let's look at this compare to this month or last year. Let's look at the last six months or the last twelve weeks. It’s being able to get all that trending data so you can predict where your practice is going, instead of viewing a snapshot of where it is.

That gets me excited. Also, why I was excited about bringing you on because many of my coaching clients, I talk about certain reports that they need to generate. Either they need to finagle their current EMRs or they have to start tracking those statistics manually on a separate Excel spreadsheet that either they do or their front desk person is doing. As I'm talking about these reports on statistics, I want them to track because they're vitally important to increase their cashflow and their profit margin. I can feel like, "It's one more thing that I've got to do." To find an EMR that can provide those reports would be much easier to the benefit of the owner as well. One of the things I'm excited about talking to you is you're thinking somewhere in the future you might have a CRM as it pertains to marketing efforts.

The CRM side, our more core focus will probably be marketing to your existing and past patients first. Incorporating a lot of like helping you run Google Ads. We'll also potentially integrate with one of the existing CRMs because CRM is a massive product. We’ll be able to market to your existing patients and past patients that are in the system. We’re coming up with ways to help the clinics grow their marketing efforts as a whole or through potential partnerships or integrations with CRMs and things like that.

Some of the reports that I saw even had broken down some of the physician referrals and who sent you, how many patients, and how that generated such income based on the referrals that those physicians sent. That breakdown is hugely valuable if you're setting up a marketing strategy campaign.

We've also added the ability to taking the patient to say where they found you. For example, you're spending a bunch of money on Facebook Ads. It's a good way to be able to track similar to how we do the referring position of what that means dollar-wise once that patient is in the clinic.

That’s valuable because the statistics show that physician furloughs are significantly decreasing over time. Whether that’s because they're saying, "Go to any physical therapist around you or you’re going to stay on my network,” or whatever it is. Nowadays, it was different a few years ago. You have to do some social media marketing. You have to market directly to consumers. You've got to be able to track your efforts in those realms. That data is huge. 

We're big on doubling down on what's working, getting rid of what's not. That's going to be able to help the owner to say what matters and what to leverage.

Are there any big exciting projects you’re working on?

There are some huge undertakings. We launched version 2.0. We'll be rolling out version 3.0 of the platform, which will include the most robust internal communications, as I've seen on the market, Scheduling 2.0, Documentation 2.0, some upgrades to hap, patient intake upgrades. Also, the patient's ability to pay their invoices without any contact with the clinic. There's going to be some massive updates that will culminate in version 3.0 of the product. It's massive improvements.

What are your greater visions beyond 2020?

A big piece of what we started this on was agile development. What that means for people that are not aware of it. We take feedback and implement it quickly. Our biggest focus is on talking to our users. What do they need? How can we make it better? Our ability to listen and act quickly is unique in this space. We're updating this every two weeks.

It sounds like your customer service response time is quick.

We don't off-source any customer service. It's a core competency of what we do. Built into the software is live chat support. If you submit a request, you're getting a response within 1 or 2 minutes. If we can't solve the issue through chat or through one of our pre-written help articles, we have this feature called smart help. Depending on what page you're on the platform. We can see that and we recommend articles that are likely to help you while you're on that page. If an article or the chat can't get it done, every one of our users has our cell phone numbers, our support numbers, and then we're happy to hop on the phone and work through solving a problem. If a user needs an additional 5-minute, 10-minute training session to remind them of the optimal workflow for doing something, we hop on with people. We are willing to do and have follow-up training to make sure at the end of the day that everyone's using the software in the most efficient way so that ultimately, the clinic operates in the most efficient way possible.

What have you found has been the biggest uphill struggle in getting this going from the get-go, Mike?

I would say convincing people that the new guys are better. It's something we deal with, but it's something we're open to showing. We always do demos that we always offer to people who are using the platform. The big piece that scares people and there has been a challenge is the fear of switching. If someone has switched in the past, it generally goes poorly for the most. For the past years, we're trying to make it a little less badly. We try to get all the data into the platform, get everyone trained and comfortable prior to going live. We're getting much better at it and it's going to be something we're going to always be tweaking to make it easier because from an owner standpoint, that is probably the biggest hurdle.

We're lucky in that regard that one of our senior engineers has many years of experience migrating data and taking sources of data from one system and putting them into another, whereas a lot of EMRs and other systems hand you a blank slate. We're able to transfer over in some cases, all of your patient demographics, case information, insurance info, all of the PDFs of your past notes, visits, no-shows. Depending on the system, we can maybe even bring in a history of all the claims you've submitted. Because we have a good data migration team, you're not tasked with the burden of bringing over all your data by yourself. With all the training we do for our clients when they start, it’s smoothening out that transition process. You're still switching the entire way you run your business. We've been able to make it as easy as it can be. Generally, by week 2 or week 3 for our clinics, they're operating in a way more efficient level than they were prior. Maybe there's a week of some back and forth of getting things moving out. It's not this big long extended process.

Engaging with not just active patients but also that have left the clinic should be a priority. Click To Tweet

What makes you capable of doing all these things that the bigger companies can't do? What makes you more nimble and flexible?

We’ve built this from scratch. Some of these companies, you're dealing with legacy databases and to adjust it, fix it per se is a lot easier. It's a lot harder than saying it. Our ability of what we built it in, our frameworks have allowed us to be able to be nimble and adjust the platform quickly.

Our engineering team made sure we built it in a language and a system that is easy to upgrade and improve. We also actively seek out our customer's feedback and input because ultimately, we're building software for them, not the other way around. If we can't build it to satisfy all of their needs, then we're missing out on something. We recognize that. We seek out our customer's feedback and engage with them. Take their feedback and value it much higher than our thoughts. Our user experience team can take their feedback on what they would like to see or what they're used to and come up with solutions that are even better than what the users were hoping for and improve their efficiencies and beyond what they expected it could be.

I'm excited about having a new guy on the block, someone who’s a little bit more flexible, nimble and capable of creating more than what's out there. Is there anything else you wanted to add regarding Prompt EMR?

One other point we didn't add is their ability to integrate easily. Having companies that have existing workloads that they're trying to bridge together, we're able to do that. Another good piece of what we do to get people to spin the water to see what's different is we do a trial environment for 30 to 45 days. A clinic that can recreate all their workflows before deciding to switch over to our system. From your standpoint, it's a huge switch. You're changing your whole workflow. It's going from say G Suite to Outlook and changing everything up. We get that it's a big switch and we try to walk everyone through it to make the most informed decision on their end.

 If someone wants to try you out, how would they get in touch with you?

Our website Prompt EMR and then we generally do a 10 to 15-minute demo quickly to let people see at a high level what's different about it. From there, most people will go to the trial site. There's no risk to it. You're not locked into anything. You can play with that.

If anyone wanted to reach out to one of you individually, how would they do that? Who should they contact?

I do the demos and then my email is Someone could always go onto the site and book a demo directly from

They can also call (888) 855-2107 that is our direct line. The other thing I'd like to mention is that for us, we're launching version 3.0. That’s three versions of the product in a few months. The sky is the limit for us and where we're going to go from here in terms of improving the efficiencies and optimizing for every user in the clinic, from the patient to the front desk, to the biller, to the therapist and the owners. Our core focus is improving the efficiencies of every single user and we're not going to lose that focus, delivering tremendous customer experience and customer service. That will be at the core of what we do as we grow and as we continue to move the platform forward and hopefully help improve the efficiencies of the entire industry and the outcomes of patients.

PTO 86 | PromptEMR
PromptEMR: The CRM side’s core will be marketing to your existing and past patients first.


I'm excited because we hit on it during the episode that you are coming at it from a different perspective. It's easy to understand what the physical therapists and what the owners know or want to know and want to have in an EMR system. It's cool that you're coming out of it from, "What can we do to engage the patient more?" Maybe not even during visits but in-between visits after their plan of care has ended. That's the highlight of something that would set you apart for sure.

It's the patient and the ability to go especially in private practice outpatient. You could go wherever you want. There are ways to differentiate yourself, especially to our platform to keep it more sticky for that patient.

One of the things I realized we didn't even touch on was the billing side. When we got into this, one of our first partners was a billing company and seeing some of the things they had to do on a day-to-day basis that was antiquated like printing out, going into the EMR and getting the notes and then stuffing all of those manually into an envelope and mailing it out to people or faxing it. We've been on the billing side, get rid of a lot of the archaic processes. You don't have to print anything and mail it. You don't have to print anything and fax it. Everything's in one system. It's electronic and human-less as possible in a lot of those things. There's no reason any more to have to go through and look at all your Medicare claims and make sure the GP modifiers there. On the billing side, we didn't touch on much, but we've solved a lot of the archaic processes that delay the cashflow coming into the door of our clinics.

You would expect that in 2020. Many of our EMRs are 5 to 10 years behind. They're not doing any of that stuff.

What got us excited 18 or 20 months ago, we were sitting in our billing partner's office. She had a mountain of paper stacked on her desk. We asked her what it was. She said, "It's all the stuff I have to mail and fax.” When you see an opportunity like that with all the bills and the existing ways to avoid that problem, that was an exciting moment for us way back when we knew there was massive room for improvement in the efficiency.

We were already in at that point with that. We put all our chips in after that.

The big piece that scares people is the fear of switching. Click To Tweet

That gets me excited that you were able to be flexible and mobile enough and pivot to make significant differences in not just the patient experience, but also the experience of the billers, and making their lives easier and better than what they're used to for the past twenty years. It's exciting to talk to a company that focused on that experience all around. Thank you, guys, for coming on. I appreciate you taking the time. I know you're busy doing demos and whatnot across the country. I wish you the best. I know your focus is to disrupt the industry a little bit. I hope you were able to do it. I wish you the best. 

Thanks for this. It was great to be able to tell our story and walk through everything with you. It's great.

Thanks for having us, Nathan.

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About Michael Dwyer And Adam Baliatico

PTO 86 | PromptEMRAdam Baliatico - With a background in Equity Research at Canaccord Genuity Group and owner/operator of Boston College 247 Sports, Adam has a unique background of managing large teams on different tracks. At Prompt, Adam serves as Director of Operations and is a co-founder. Adam oversees Product Development and Customer Support. As product development lead, Adam focuses on incorporating customer feedback into unique solutions that improve clinic efficiency from end-to-end.


PTO 86 | PromptEMRMichael Dwyer - Michael’s lengthy history as a physical therapy patient led to the founding of Prompt Therapy Solutions. As an industry outsider with a background in finance, he came to notice many inefficiencies and redundant workflows within the physical therapy clinics he attended. Mike then assembled a team of software engineers, user experience gurus, and billing experts to create a seamlessly integrated solution for the physical therapy industry. He now leads Prompt’s sales team and guides the companies with long term strategic initiatives.


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PTO 85 | Focus On You


On today’s show, Nathan Shields talks to Mike Bills, PT, the President of Measurable Solutions and the CEO and Owner of Loudoun Sports Therapy in Sterling. Mike has seen some amazing growth in his PT clinic over the past few years, and it's not because he started a new program that generated new patients or found a physician that loved how he treated patients. Rather, Mike has seen phenomenal growth because he has been focusing on himself and improving the different aspects of his personal life - physical, intellectual, professional, financial, etc. He teaches us the importance of focusing on oneself before focusing on others. Learn more from Mike on how you, too, can be the owner of your personal freedom and enjoy the life you have envisioned!


Listen to the podcast here:

50% Growth Year Over Year By Focusing On You With Mike Bills, PT

I'm bringing back a previous guest, Mike Bills. If you haven't read his first episode or my first interview with Mike, please go back to it. It's one of the most followed episodes that I have. He had some mind-blowing statistics and marketing strategies that he provided in that episode. It is an episode that I've shared with a number of my coaching clients to show them what is possible if they're not focused on physician relationships, but rather do some focusing on internal marketing programs. I wanted to share Mike's experiences in how he has worked on himself individually and as a leader over the past years that has generated 50% year over year growth in his clinic. It’s not necessarily focusing on certain programs or working in new procedures or better marketing strategies. Mike simply focused on working on himself as the owner and leader of the clinic. By doing so, he had great results and dividends from his efforts.


I've got Mike Bills, CEO and Owner of Loudoun Sports Therapy in Sterling, Virginia. He’s also the President of Measurable Solutions, a physical therapy owner consulting business. I'm bringing Mike back after we did another episode regarding his marketing strategies and how successful he's been doing internal marketing programs in his clinic. I'm bringing him back because I have something exciting that I want to talk about with him. Mike, thanks for coming on again. 

Thanks for having me back. It was a lot of fun the last time. I know it will be this time too.

The reason I reached out is because I have a coaching client who went to a Measurable Solutions Conference and he shared with me something that affected him and I've been thinking about it since because it's affecting me as well. In one of your presentations, you said, "My business has grown significantly more over the past years simply because I haven't necessarily been working on my business, but I've been working on myself. Because I've been working on myself, my business has grown at a greater pace than what I've seen in the past.” Maybe you can talk to me a little bit about that. That struck a chord with me that your business is improving significantly, not because of your immediate focus on the business but upon you specifically. Maybe you can share with me a little bit about what you said more clearly and we can get into that. 

It was a talk that I was doing at an Owner's Conference for Measurable Solutions. We were in nice and sunny Cabo San Lucas, which is on the Western side of Mexico when it was snowing at home for me in Virginia. In preparing for that talk, I was trying to figure out what it was that had made a couple of years of my practice to be so much more successful. I've been an owner of private practice for many years. Since 2012, I've grown considerably every year, but a couple of years have been this exceptional growth. I started searching and trying to figure out what it was that led to that.

When you're talking about exceptional growth, is there any numbers that you can share? 

Leading from 2012, I was a client of Measurable Solutions and I started learning how to be a business owner, something that none of us ever learned how to do in PT school. I started learning and I always had nice growth, 28%, 32%, 30%, etc. every year. Until a couple of years ago, I had 49% growth. I'm talking 49% growth in new patients, collections and production, what we're billing, patient visits, etc. In 2019, I had a 53% growth in the same thing. I was happy with 21%, 28%, 30% now. I looked at these two years and I was like, "What is different?" As I looked at it and I started to focus, I realized that I was concentrating a lot more on myself than I was the years before that.

The years before that, I was concentrating on building this business. I was the guy that was doing everything. I was making everything go right. Being able to look back, what I realized was that I started paying attention to what I needed as an individual. What did I need to be the face of the organization? What did I need to empower my staff to be better at dealing with patients, treating patients, handling processes at the front desk, whatever it might be? I looked at improving myself whether it was reading more about how to be a business owner and a team leader, listening to podcasts, listening to things on TED Talks, taking time to exercise, etc.

To give you an example, a few years ago, I weighed about 85 pounds more than I weigh now. I was spending all this time working because that's what I thought I needed to do. I was being successful but in retrospect, my health was going downhill. I was approaching 50. There was no way I was going to continue to be able to be the face of the organization. When I stopped and took a step back and started working on myself, all of a sudden I was able to be a better leader. I was able to give better guidance to people. Here's a good example, I'm driving into work and I'm listening to a book. I don't read. That hasn't happened since PT school. I listened to all of my books on tape. I do it through Audible. When I say read, what I mean is I'm listening to a book.

I'm reading or I'm listening to this book and I'm like, "My staff would benefit from hearing this." I bookmark it, get into the office, play it, record it and send it out to everybody in a text. I was doing it to listen for myself but then I'm like, "The information is pertinent to something we were talking about the other day.” In the process of helping myself to be a better person, better read, etc., I'm able to pass that on to many other people. That's where I feel I've made myself a better person. I've taken time to concentrate on myself and it allows me to empower and strengthen the people around me to be even better, which is what's helped us to have so much great growth.

Be the change you wish to see in the world. - Mahatma Gandhi Click To Tweet

That brings to mind the quote, "In order to see a change in others, you have to change yourself." It's important to recognize that if you're going to make an effect for change within your company and with your clinic, if you want to see the change in your relationships with family members and friends, but we're talking professional network, if you want to see a change in your business, it starts with you. It's not expecting more out of other people. It's simply changing yourself and maybe tightening up aspects of your life that you let go a little bit.

Whether it be losing weight, how can I be the owner of a business that professes people need to be active if I myself am not active? How can I profess to my managers and the people that I'm asking to help me to run this business to do their job if I'm not in a good position to be able to do it myself? Taking the time and looking at my personal finances. How can I expect my staff to get patients to pay their bill if I'm not working on my personal side to make sure that all of my accounts are in good standing? When you improve yourself, you automatically empower all of those around you. That's where I believe my exceptional growth has come from is that I've made myself a better person, which in a sense rubs off on everybody else. My attitude and demeanor is better. My tone and my happiness scale, I'm much higher on that scale and therefore that rubs off on all of these people. I don't get reactive about that patient that canceled or things that go wrong because I'm much more in control of myself. That doesn't become the way that they react as well.

A couple of years ago, you became more intentional about working on yourself. Looking back, you're seeing that working on yourself had a significant influence on the other things around you. You didn't go about trying to make that change in others around you first. You simply focused on yourself.

I had to add to maybe shift my mindset for a moment. I had this mindset that I'm the owner, everybody else should come first, take care of my employees, etc. What I realized was who was going to take care of them if I wasn't able to take care of myself? I had to set that example whether it takes a huge health scare for somebody or whatever it might be. When you're in a better state of mind and better frame of mind, whether it's because you get to leave every day and go home and sit in the bubble bath if that's what you want to do, go for a run, when you're able to be in a better place, then you bring that better place in with you. What I realize is that everybody then follows that. You're the one that they're looking up to.

Everybody is always looking for somebody to look up to, whether it's your kids or employees. If you become that example that they look up to, they're striving to be like you and to improve themselves. Before you know it, they're all reading or listening to books on tape or they're all going home to exercise and have dinner with their family. It starts with me changing my mindset to not feel like I'm less important than everybody else. I had that realization a couple of years ago. I was the most important thing. Without me, this clinic wasn't going to exist. It wasn't going to be what it had become. I had to be able to survive and be a good person and set that example for it to move forward.

“Be the change that you want to see in others,” is the phrase or something like that. To someone who's saying, "I'm looking at these different aspects of my life," you've seen a lot of growth and success on the intellectual side, physical side, emotional and psychological side, financial side. I'm assuming that you also put some focus on your schedule and prioritizing your time. If you look at those 5 to 6 aspects of your life, someone who's maybe not where they want to be individually and looking at that, that can seem a little bit overwhelming. Did you take a step-by-step approach or how did you approach these things so you could see an influence throughout the whole scope of your life?

It became a matter of I'm a schedule-oriented person. When I say 10:00, I'm ready to go at 9:50. As PTs, we all ended up being that way unless we're letting patients walk in the door whenever they want. We run by a schedule. I had to make things become part of the schedule. Initially, that meant a few years ago, I've got to create this time for whatever it might be. I've got to create time to be able to go for a run. At the time, I wasn't even taking a lunch break. Lunch was, "Let me shovel something down." Somebody bought a Chick-fil-A or Panera Bread or whatever for me and that was it. I had to make sure, "I'm going to take 30 minutes." That means the patients that would have been in during that 30 minutes had to be either before or after that.

Get everybody to understand that's sacred time and you can't take that away. That 30 minutes then became an hour and then that hour became leaving at 3:00. It built from there. Scheduling was the most important thing. I had to also change my mindset. For example, to watch the last three innings of the baseball game at night and do something else for the rest of that time. As much as I felt like I was productive sitting on the couch from 10:00 at night until 1:00 in the morning doing work, I had to recognize that, change that and schedule that differently. It came down to scheduling it is what made the difference.

PTO 85 | Focus On You

Do you schedule your sleep between 10:00 and 1:00?

I scheduled going to bed at 10:00 instead of going to bed at 1:00. I had to make other people help me to be accountable, like my wife to come and close the lid to the laptop that I was working on at 10:30 at night. She had to help me do that. It's like at work, I would have my staff be like, "Mr. Smith is upfront." They're there to remind me to be accountable. I had to have that in place and ask people for help to do that and stop thinking that I was the one that needed to be in control and doing everything. I needed to have people be able to help me ask people to help me with that. I needed to get those around me to understand why I was doing it and what it was that I was trying to accomplish.

I love that you bring up the concept of control and schedule because as therapists, we follow a schedule, but we don't necessarily take control of our schedules. We defer when the patients are available. We'll adjust our schedule accordingly. If an employee needs something from us, we'll adjust our schedule accordingly. Instead of what it should be ideally is that our time, especially as the owners and leaders of the clinic, is sacred. We dictate when we see patients. We dictate when our door is open to have meetings with our employees. It’s not the other way around. We default as therapists to do whatever we need to do to get the patient in, to get the patient better, to see the patient, to maximize our "productivity" instead of being in control and having power over our schedule and saying, "My sleep is vital. I need to go to bed at 10:00. Honey, help me get to bed at 10:00 and let's start getting ready at 9:30."

I don't see patients over the lunch break, even if it's an emergency situation. Maybe that's one of your rules. I only see patients over the lunch break if it's an emergency situation, but none else. That lunch break could be two hours long instead of one hour long so you can get your jog in if that's what you need. Being in control over our schedule and saying, "I'm going to block a time to work on the business two half-days a week. I can't see patients. I'm not going to take on any meetings unless they're scheduled ahead of time. No knock on the doors, 'Do you got a minute?’ That’s sacred time for me to work on the business.” Once you start establishing that control is when you start having greater control over your life and you start seeing progress like you did.

It is about control and it's about understanding that my mindset needed to change and realizing that I wasn't in control. Everybody else was in control of being. Everything else around me was in control of me. I was the result of this situation and this environment that I had created, which was a business that was growing and thriving and doing well, but I wasn't in control of anything. I was the guy that was being controlled by everything that was happening, the patient that was on the phone, the patient that was upfront, the person that needed a signature for this, "Can we talk about that? I want to buy this." That kind of thing and being able to set some rules and some standards.

I had it in my mind that if I did that, my employees were going to look at me differently. They weren't going to respect me. They weren't going to follow me. I had to realize that if that was the case, if they were going to respect me less because I wasn't working on my computer, on my couch from 10:00 at night until 1:00 in the morning, they weren't the people that I wanted on board with me anyway. They wouldn't do that. That wasn't what I would expect them to do. I had to get that control back on my side. A lot of it is changing my mindset and changing my viewpoint on things. I had to accept the fact that people weren't going to look at me differently. In the end, it was to improve the whole situation of things and make that be the strict policy that I was going to operate towards. Amazingly, when I set an example, they all follow and they all start making themselves better whether it's because I keep sending them these things to read or listen to or not. Ultimately, it's helped to make them all better people as well.

That's something that comes up quite often. I went through a little bit of that as well. When I shifted out of treating full-time and into working more on the business during the course of the week, there's this fear that if I take time for myself to work on the business or heaven forbid I go home early, the team is going to look at me like, "You're not pulling your weight." Maybe they're going to look at me differently questioning, "What are you doing with your time if you're not treating patients?" It's different from the status quo that they were used to. The fear that some of the coaching clients I have is that, "If I take away this time, what is my team going to think of me?" It sounded like you got over that mentally, but did you have any of that blow back or did you have to talk to yourself through that continually?

Yeah, I did. It was a challenging thing for me. All of us as practice owners, whether we came out of school and opened our practice or we were out of school for 8 or 10 years before we ended up in private practice, we all are about doing something. To us, we've been trained to treat this patient and that's where things are going to go well. People are going to respect you and that's where your skills are. What I had to recognize was that's not where my skill was best suited. I could find people that even though they couldn't necessarily treat a patient maybe as well as I could or as quickly as I could, it would take them 2 or 3 visits longer to get the same effect. I was going to be way better off in the long run.

If you don't have data, you start making things up. Click To Tweet

If I could get five people doing what I as only one person could do, I would be much more productive as an overall group. I had to change my mind on the fact that, what are these people going to think if I stopped treating patients? To the extent that I had to help them to understand. “Here's my reason behind wanting to do this. I want us to be able to help more people in the community.” You hear it all the time, patients come from this doctor's office across the street where they have physical therapy and they're like, "It's different here." We can't do that if I'm not here to lead seven of you because I have to constantly be one of the people out on the floor. Don't you want to be able to help more people and taking that approach with them?

I realized that was all in my head. They were all like, "Yeah, sure. That's great. You mean somebody's going to approve our vacation time as opposed to we have to keep asking you all the time? Do you mean somebody's going to be able to make that order for the equipment that we wanted to get and make sure that there's enough money in the bank account?" I'm like, "You guys have been wanting this for a while." Yet, it was me having this fixed idea that they were going to be all upset and jump ship if I made this change. To tie into that, we have this joke. We have a large number of staff but barely 10% of them remember me out there treating patients. I'll come up every now and then like, "I do have a PT license. I still remember how to treat."

Here's a short story. I was treating one of our PTA. She had a neck problem. Everybody was busy. I'm like, "Lay down, let me take care of it." She's like, "I feel a lot better." She was one of the ones who worked here when I was treating patients, but we realize there are six people standing around going, "He knows how to treat patients." They haven't seen that. My point to that is, they hadn't seen it, but yet they see the value that I bring by the other things that I do and they accept it. I had to change my mind that they were going to respect me less.

When you made that change to your schedule, did you sit them down in a team meeting and tell them, "This is what I'm doing and this is why I'm doing it?" 

I was scared about doing that. I didn't sit everybody down when I made this change. If I was going to do anything differently, I would sit everybody down. I made this change and the only person I told was my front desk manager. I said, "At noon, I'm leaving and I'll be back at 1:00." She's like, "Why?" She hadn't realized that I had moved all of the patients. I said, "I moved all the patients. I'll be back at 1:00." I walk out, it's late spring, I've got shorts on. I'm going to go for a run around where our office is. She's like, "Where are you going?" I was like, "Remember I said I'll be back at 1:00." I came back in at about 12:50, so I had time to take a shower. Everybody was all worried about where I was or what had happened. To answer your question, if I was going to do it again, I would help everybody to understand because then it was like, "What's wrong?"

They all thought that they had done something wrong, that I was pissed off that I had to go for this run. It was something that they hadn't seen. My belief is if you don't have data, you start making things up. I had seven employees at the time, all of which had all these cockamamie ideas in their head of, "What had gone wrong. Where did Mike go? Why was he this way?" If I were to do it over again, I would sit everybody down and I would say, "This is what I'm going to do. This is why I'm going to do it. Let's see how it goes.” We'll have some open dialogue about it. Over the course of that first week, I had all these people coming into my office and checking on me, "Are you okay? Is everything all right?" I'm like, "Yeah, everything's fine. What's the problem?" It dawned on me why that was the concern.

That's interesting because one of my clients, he pulled himself out and he's explained it to the team, "This is why I'm doing it." This is 1 or 2 months down the road since he pulled himself out of treating full-time. He still does it a couple of days. If they see him on the floor outside of those times, they get mad at him. The question I have for you is, as you've respected your time and set up some boundaries and whatnot, have you found that the team is also protecting your time? 

Very much so. It's funny you say that. We have a need for two PTs. The two that we've hired can't start immediately. We've had this need for about six weeks. We're running at super high capacity. Every now and then, I'll be like, "I'll come out and help you." There will be a problem. "What are we going to do? How are we going to handle this?" I'm like, "I'll come out on the floor and help you guys." They're like, "No, we do not want your help. We've got everything under control. You stay and do what you're supposed to be doing. We don't want you out there." Part of that is because they know I'll come out and I'll be like, "How about we change all this around?" At the same time, they recognize the disadvantage that would create because we'd be back to the days where things aren't happening because the guy that's supposed to make them happen fell back into patient care.

What a great position to be in that they know if you step back into the business, you're going to "mess things up." You stay behind the drapes and keep pulling the levers like the Wizard of Oz. 

I was in our front office and the phone was ringing and all five of our front office people were on the phone. I reached to pick up the second phone that's next to one of them. She slapped my hand and I'm like, "Okay, good. I'm going to walk away." She doesn't want me doing that because she knows I might screw something up and because there's something that you should be doing instead. Don't get drawn into whatever's on the other end of that phone.

PTO 85 | Focus On You
Focus On You: Personal growth is about changing your mindset and viewpoint on things.


That's someone who's taken ownership of their position, "That call is mine. It's not yours."

That brings it back to where as I was helping myself, I've helped all of these other people to take control of their position and not be reliant on me coming along and going, "Let me do it for you,” or "This is how I would do it." They're much more in control. That carries over into their lives, which is part of that talk that I was doing at that owner's conference. How me being in control of myself has spread into everybody else. How as I lifted myself, they've all followed, and so their home lives, income, spending habits, taking care of themselves are better. Why we all became PTs was that we wanted to help people.

As the owners, we have to look at it from the perspective of, "I can help patients but there's this whole other group of people that I can help to have a good working environment that they enjoy coming to.” If I make myself better, how much better am I going to make not only the care that my patients get but the family feeling, the experience, the culture that my employees have so that their lives are better? Their kids are being brought up better. Their marriage, relationship, weekends are better. It becomes this exponential thing.

One of the books that I've listened/read over the last couple of years is called Multipliers. It talks about that exponential piece. If you do something, it affects anywhere between 10 and 24 other people. They do something and think about, especially in this day and age and not to go off on too much of a tangent, sometimes how poorly ethical society is. By making ourselves better and by making 48 employees having a good working environment. They go home and they create better environments that they live in for their families, their kids and it becomes that exponential or that multiplier piece to it.

I was thinking about that as you were sharing your stories. You can treat a patient and do well. If you could get five therapists to treat patients 80% or 90% of what you could do, that influence alone is much greater. It's multiplied.

That allows us to get all these patients that are coming from all these other places where they're not getting good care, whether it be from a big corporation or a hospital or physician's office. Even many other private practices where they're being run through as a mill. If I can get five people to do even part of a good job as I would have done, it's all of those patients that are having good experiences. It's part of that multiplier piece that keeps on going.

It’s such a great influence that you've exemplified here in the last couple of years. For some reason, control comes back to me. You've simply taken control. You're not at the effect of whatever the business is doing and what your employees are doing to you. Someone's quitting and you don't know what you're going to do because you’ve got to treat this patient. You simply reassessed your life and you stepped back and decided, "I'm going to take control of these things." You've been intentional about the change that you wanted to see in yourself first. The results that you wanted to create in your life you've taken that control over. You become more powerful in that regard. That's landed to 50% growth year over year for a couple of years. That's astounding. To give people some social context, if they haven't heard your story, feel free to read the first episode with Mike. You've got sixteen providers under one roof. It sound like it might be more.

From an actual clinician perspective, I have nineteen with two more coming. By the time they get here, we'll need at least one more beyond that. If I go back, it was me and a PTA. Think about how many more people I'm able to help because it's not me that's doing it. It's nineteen people that are able to provide that. That's the piece that I realized was not necessary. There's no way I could help nineteen people. We have more than nineteen staff numbers, but nineteen clinicians, do that without somebody being on that host or wearing that hat all the time. You talk about intention. There's a difference between putting my attention on growing the business. That's what I was doing before the last couple of years. I put my intention, which is no matter what is going to happen, I'm going to be the leader but I'm not going to be the one that does it. To me, that's the difference between attention and intention is that I'm not going to be the one that's going to do it. I'm going to be the leader that's going to direct where that card is going and I'm going to be able to make sure that it gets there. I have to be in a good position myself for that to happen.

When you're in the process of helping yourself to be a better person, you're able to pass that on to many other people. Click To Tweet

I love the differentiation because as the owner, you feel like you are also the doer of all of these things when you're better suited to delegate, oversee, follow up, hold accountable and that stuff to free your time. 

By doing so, it helps us as the owner to be able to live the experience of being the owner, which is why we wanted to do it in the first place. Who got into this to be an owner because they wanted to work 80 hours a week? Nobody's like, "Yeah, that's what I'm signing up for." We got into it because we want to be able to be home with our families more. We want to be able to have four-day workweeks or whatever it might be. That ties everything we've talked about so far together up to this point. I had to accept the fact that it was okay for me to not be in the office. I've gone for periods of time where I haven't been in the office for a whole month. I had to accept that that was okay. It was because my reason for wanting to be a business owner was I wanted to see my kids. I wanted to do things. I'd go visit my son in Atlanta. I do whatever it might be. I travel wherever it is. I had to accept that that was improving things. That was why I got into being an owner was to help people. It didn't mean I had to work 80 hours a week treating 100 patients myself.

At this point, you’re a great example of enjoying the ownership experience. You're leading a great team. You're in control of your schedule and your life. That's exactly what I want other PT owners to understand. That's a possibility. That freedom and growth can happen. You can fulfill your dreams as a PT owner in that regard.

I had this realization in August, September 2019 when I was preparing for a different talk. I opened up a Measurable Solutions course book that I had done. One of the things that they had me do early on was writing out what my ideal scene was. I had written down seven things. I wanted to have X number of visits per week. I wanted to be treating patients X number of hours per week. It was my first time realizing that all seven things I had put on that piece of paper, every single one of them had come true. That to me is intention. I had the intention that it was going to happen and I made it go right. What I realized the number one reason why it went right was I'm the one controlling everything and the others were the people that were doing it.

I'm the guy in the Wizard of Oz behind the curtain pulling the strings. I had to empower those people to do that. That's where all of that successful growth came from. In the end, I became what I would view to be the biggest winner because everything on my ideal scene had come true. Between you and me and everybody else out there, number seven on that list was I wanted to be able to go back to Measurable Solutions. It’s a consulting company that had taught me how to be a business owner. It’s something that we had never learned in school. I wanted to be able to go back to Measurable Solutions and give back to the company that had significantly changed my life. In July 2019, I assumed the role of being the President of Measurable Solutions. That was the seventh thing that was on that list. That was something I had written out years ago. Had I not taken the direction to work on myself, I never would have achieved half of those.

I love talking to you about this because many PTO owners look passively at what their business is doing instead of taking control and being intentional about it. The results speak for themselves. Every person that I interview, you included, once they've decided to take control of their business, then things improve. I love sharing the story. 

It's scary how many of us are in private practice without being in control and the practice is controlling us. We have to look at, is that where we want to be 5, 10, 20, 30 years from now? I missed parts of my oldest son growing up. He now lives in Seattle. I'm going to Seattle quite frequently not because I'm making up for it, but because I finally created what I truly wanted. I got out of my way and I stopped telling myself that something was impossible. It comes back to I worked on myself to make it so, I believe that it could be so, and I made it to be so. Everybody else around me is happier as a result.

Thank you so much for taking the time and sharing your experience with me. If people wanted to reach out to you and learn more about you or Measurable Solutions, how do they do that?

PTO 85 | Focus On You
Focus On You: Success and growth comes from empowering others.


Before I forget, Multipliers is the name of the book. It's written by Liz Wiseman and John Meagher. It’s a very good book. I could give you a list of any number of other books. If anybody wants to get in touch with me, I give out my cell phone number. I love having conversations with people. My whole goal is protecting the whole business of private practice. Feel free to reach out to me anytime you want. My cell phone number is (703) 470-5995. I love it when I get calls from Wyoming, Montana, Utah and Florida. I love chatting with people. I'm happy to discuss things with anybody. You can also email me if you like. My email address is the best way to always get in touch with me is that Measurable Solutions, Feel free to email, call or text me. Anybody reach out, please.

Thanks for coming on, Mike. I appreciate you sharing your story and taking the time. 

I appreciate you having me on. It's fun as always. Thanks.

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About Mike Bills

PTO 85 | Focus On YouMike Bills is the Owner and CEO of Loudoun Sports Therapy Center in Sterling VA. He started his practice in 2005 and did everything: answered the phone, treated patients, billed the insurance, etc. Since that time he has grown his practice by over 10 times. He now has a staff of well over 20 people, including 14 clinicians and a facility size of over 10,000 square feet. It was always Mike’s goal to have the time and ability to manage his business and not work in it and he has fulfilled that goal as he is the true CEO and no longer treats patients.

Another goal Mike had was to be able to help other PT’s have the Freedom they deserved from their practice. Mike was a client of Measurable Solutions where he learned how to truly manage a private practice and where he learned how to truly be the CEO. This is where he learned the basis for all of the systems that he uses in his practice that have helped him to be so successful. Recently Mike was named the President of Measurable Solutions and is now able to fulfill that goal of helping other private practice PT’s have the same success as him.

If it weren’t for the perseverance and drive over the years to build a successful business this never would have been a reality for him.
Marketing is one of the most important pillars of a private practice and I have worked hard to develop systems that continuously help my practice to grow and thrive despite the time of year or whatever else is happening in my community. I am happy to be invited onto the podcast to share just a fraction of what has helped us be so successful. For more information, feel free to reach out to me either via cell: 703-470-5995, or email:

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