PTO 140 Avi Zinn | New PT Owner


Continuing where they left off in their last discussion, Nathan Shields sits down once again with Avi Zinn, DPT of the Druid Hills Physical Therapy in Atlanta, Georgia. Despite being a new PT owner, he already made some big changes in the last episode – changing his EMR, outsourcing his billing, changing his business coach, and was expecting his front desk to change in the near future. In this episode, they discuss the effect of those changes and how he started 2021 with a bang using a roadmap for continued growth and expansion. He's made some great decisions along the way and is headed for even greater success. Moreover, Avi also shares some strategies he follows when hiring new PTs, particularly with how online ads work in the recruitment process. 


Listen to the podcast here:

Reality Episode #5 - Making Great Progress As A New(er) PT Owner With Avi Zinn, DPT

We're doing Reality Episode #5 with Dr. Avi Zinn, physical therapist and Owner of Druid Hills PT in Atlanta. Avi, it's been a while since we started this up. 

I was looking back. We started around November of 2019. 

We're going into a few years of following your progress. You've made some awesome progress. Congratulations, by the way, especially for a young physical therapy owner like yourself. 

Thank you. 

Organizational skills are one of the main characteristics every good front desk officer must possess. Click To Tweet

Where we left last time is you had made some changes. You were in the beginning phases of making a number of changes. Number one, your front desk was about to leave. Number two, you had switched over to Prompt EMR. Number three, you’ve switched your billing company. Number four, with your consulting company, you got a new coach to work with you one-on-one. You had a lot of changes. We want to follow up on that stuff and more if that's okay during the show. Start with something that's been most dramatic for you. 

First of all, thanks for having me back. I love doing this, always. Last time, we were talking about my front desk. That's been the biggest change for us for a lot of good reasons. Our front desk, she was leaving to go to OT school. We were looking for a new patient care coordinator. We were trying to get her started before our previous one was leaving so we can do some training. 

You had some overlap and support there as they're training. 

It worked out that way. We got on our new patient care coordinator to start. She started in December 2020 with enough time to overlap for about a month. She got some good training. That was great to see how she eased herself into our office. 

What were some of the things that you were looking for in your next front desk person? Did it vary much from your new one or were there certain character traits you were looking for? Are there certain things during the interview process that you tried to vet out? 

One of the main things that I was looking for was someone with good organizational skills. Someone who was able to follow our workflows and be able to take the stuff and efficiently do whatever needed to be doneThere are so many different tasks to do at the front desk.  

You want someone at the front desk who's so high tone, great attitude, willing to go the extra mile, caring about every patient that comes in. If it's a female, you almost want that motherly type. 

Take care of the clinic and the patients. Make sure everyone gets the appointments they need. Let them know that, "We'll get you on the schedule. Don't worry. We'll make sure you get your visits." We got her on. That was a good transition because of all the extra training. What was also cool at that same time was I was focusing on the SOP and figuring out what we can do to improve on what we've already built with our previous. Part of it was using some of Prompt's reporting. The EMR software that we switched over to have some awesome reporting. They have this plan of care compliance report, which you can pull up the next week's list of patients. 

It shows exactly who is scheduled and who's not scheduled, if they're supposed to be scheduled two times a week or one time a week, whatever it is. That has been so helpful because we're able to get that report on Monday morning. By Tuesday, maybe Wednesday, we'll already know what our schedule is looking for the next week because we've already called and scheduled all of our patients. By Wednesday, we're looking at next week. We see it's full and that's good or we have a bunch of spots open. "Let's boost the ads." That's been helpful. That's been cool. 

For those people who are reading, SOP is Standard Operating Procedures or your policy and procedures. There’s some huge value that you went through your policy and procedures during this training to shore it up. 

We did. We created our patient journey. It was every step from the first call until they see the physical therapist. We created that. When our new front desk came on, we trained her with that patient journey. It was like"Step one, this is what happens when they call. Step two, you follow up with this. Step three, you do it." That was something that was cool. With that, all of a sudden, we started seeing that by managing the expectations of the patients and explaining everything with that workflow of patient journey, our patients were coming in prepared to do their physical therapy. They were already bought in. The PTs were telling them, "You get to come in twice a week for six weeks." They were coming straight up to the front after their visit and scheduling out all their appointments. 

We're seeing that because we're managing the expectations. We're setting up our patients for success. We're seeing in our cancellation rates. We're lower than we've ever been. Last time, we were at 5%. We've never been that low before. I attribute that to our front desk managing our expectations and getting our patients. The PTs are doing a great job with everything they do. Taking away some of that pressure to get them to buy in on that first visit by explaining everything to them beforehand has been wide. The front desk has been so successful and integral. 

PTO 140 Avi Zinn | New PT Owner
New PT Owner: Always let your patients know that you are caring about them at all times.


First of all, congratulations on 95% arrival rate. Secondly, it sounds like you've given some of the responsibility for the compliance to the front desk by what they're saying before they even come in for the first visit. On their phone calls, as they're talking to patients, they're telling them what to expect, what it's going to look likeand what successful physical therapy looks like. You have conversations like that. 

I was listening to Jerry Durham'show. He talks about front desk stuff a lot. One little thing he said on one of his shows was often, no one asks for the patient who's calling to talk about their story. It's always like"Let's get this information so we can put you in our chart. Let's get this so we can set you up." It's never like"Why don't you tell me a little bit about yourself and what's going on so we can learn more about you, we can know what to do to best get you to where you want to go?" That has been another part of the success. It was a different approach to talking to our patients when they're calling, show them that we do care about them, and try to get them in. When they come, they already trust us because they know we've talked to them and ask them about them. They're coming in ready to do whatever we tell them that is going to be best for them. 

You've changed the mindset at the front desk and with your providers as well to say, “It's not all about what we need. When they call, it's not just about, "What's your name? What's your date of birth? What's your insurance?" Instead of going down that checklist, one of the questions that may be if not one of the first questions is, "Tell me what's going on. Your back hurts you. Why is that hard for you? What can't you do because of that?" Are those the conversations your front desk is having at the beginning? 

That's exactly what she's doing. That is part of the reason that we're having a high arrival rate. From the beginning, they're calling us, they see that we care. We do care. Every place cares, but when it's trying to schedule, it's all just about numbers and trying to fill the schedule, it's a different mindset or approach when you let the patient know that you are caring about them. It shows. 

It goes back to conversation that I had with the guys at KeeHealth on an episode. They stress the customer experience as well. I did a show with Jerry years ago when we did our first one about the customer experience. One of the exercises is to map out the life cycle of a single patient and all of their touchpoints with you at the clinic from your website or the first call to their first visit, confirmation calls, follow-up visits, discharge then to billing and collections. Map that out and how we can improve and more fully live out our core values at each of those touchpoints. When you do that, it forces you to think differently instead of, “What do we need?” but rather, at each of those touchpoints, “What does the patient need and how can we help them have a better experience with us?” 

The guys at Keet Health swore and they said, "If you can improve that customer experience, you will triple your marketing efforts." You see that based on your improved arrival rate, your average frequency of visits, frequency per week of individual patients coming in improves, and full compliance to the complete plan of care significantly improves. They're not dropping off after the 3rd, 4th, and 5th visits. They're staying with you for longer periods of time and thus seeing results. That first domino is how we can do this differently to show that we care more in order to get their buy-in. 

Everything you said is what we're experiencing. There are plenty more that we can do to enhance the patient experience. From the few things that we have worked on, we're seeing huge improvements and success. They're all around from us and for our patients too. If we're getting them in twice a week or completed plan of care, that means they're getting better. If they're completing their plan of care, that means they've completed their physical therapy. Hopefully, that means that they're back to doing whatever they wanted to do in the first place. 

That also goes to your point where you are getting results and this is where it triples your marketing efforts. At this point and at this stage of your ownership, you're a few years in. You're starting to see some of those return patients or they're referring family and friends. When you treat people right, they're going to start referring other people or trust you enough to come back yourself. 

By hiring a CPA to coach you, you can rely on the numbers which is much easier than mere feelings. Click To Tweet

We are starting to see that. Interestingly enough, historically, a lot of our referrals have been from the direct-to-consumer Google Ads. 

You were solely built on that for the past few years. 

From the beginning when I first started, we got some good ads going and they were working. I never had to do too much relationship marketing with some of the other doctors in the community. Not that didn't try, but we found that this was so much more successful. That's the way it worked for us. As we got busier, we had to turn down the ads because we don't have room for everyone that's calling. We're looking to hire because we're so busy. What was interesting is that we've turned the ads off but we're still getting as many people calling. We're seeing that it's return patients. We're getting people who have come back every year. Every year, there's something new. This is their PT place. Whenever something comes up, they come in. We're seeing our patients who are coming in, we ask them who referred them. We're getting a higher percentage of people coming in from their referrals from past patients. We are seeing that, which is cool. 

Is that something that you set up internally or your providers coached or instructed on how to ask for referrals? 

No. I started to try to implement that at some point. It was right before Corona. It was something that we didn't implement. The plan at some point is to build that in. One of the things from the Lighthouse Leader Group, Jamey Schrier group, which you put out a show with himthey do this QA. On the fifth visit or something you have, you do, not a re-eval but a quick check-inAre you progressing well? The whole reason for that question is if they're doing well to then take it to the next step of, "You're making great progress. Do you have any friends or family that you know that could benefit from our services? We do want to help people." It's a good opportunity to take advantage when people are seeing good progress to use that, to ask for them to send their friends. 

That was a really successful action for us. It's something that PTs shy away from because they don't want to feel salesy. If you're trying to fulfill your purpose as a physical therapist, you want to help as many people as you possibly can. To make it easier or easiest in the conversation like that is when they're speaking positively and glowingly about your practice, how much they love coming to work or about their condition in general. "I made some great progressI can do this well." 

That's number one. Make sure you tell your doctors. If you have a ready-made template to have the patient, write a note and you can fax it off to the doctor. That can be a successful action. Number two, you can simply say, "That's awesome. Do you know anyone else that's having issues so we can help them like we're helping you?" It's a quick and easy way to ask for referrals but it's also a way for you to solidify. "You are getting better. We can do this for a lot more people." Hopefully, that cements it in their heads. 

You said something that I've been realizing lately. It the mindset of what you said about PTs have a hard time because they feel salesy when they're trying to convince people to send their friends. Our true purpose is to help as many people as possible. Once we recognize that's what we're here for and that's why we became PTs in the first place is to help peopleI don't know who said it, but I heard someone talk about making a sale. As a PT, we're doing it all the time. We're trying to educate our patients. We're trying to get them to comply with our plan of care. We're trying to sell them all the time. We are almost salespeople by nature of trying to get them to complete their plan of care. Realizing that and switching the mindset of it's not trying to make a sale, but we're trying to do it because we're trying to help them. 

Speaking of plans of care, your usage of Prompt EMR and some of the reports they provide. You are amazing compared to the other EMRs like business management reports. Prompt does a great job at that. 

I've been surprised that they keep developing their software and everything they put out. As far as the business management side, they're doing great stuff. 

That procedure used to be 1, 1.5-hour long procedure for us weekly. We called it the weekly walkthroughWe weekly walk through each physical file othe active patient file shelf with our fingers and walking it through with the front desk, saying"Where's this person? What are they doing? Are they scheduled? How are they doing? Are they coming back?" That was a weekly thing that we had to do every week. For you to simply be able to pull that up and save all that time, you're not even involved at that point. They are expected to pull it up and do the work. 

PTO 140 Avi Zinn | New PT Owner
New PT Owner: Past, satisfied patients are usually the main source of referrals.


It's automaticThe front desk pulls it up on Prompt. It’s two seconds to pull it up and then she shares it as a shared Google file through Google Drive, which is also amazing. Google Drive, in general, is so cool. It's shared to all the PTs and then they make a note on each one like, "That person was dropping down to once a week, make sure to call them,” or “This person is discharging this week." It happens so quickly. 

Have you been overall happy with Prompt? 

I'm happy. The part that I'm not so involved with is the actual documentation because I have not been treating since before COVID, although I jumped back into treatment. We've been busy. Our schedule is full. I'm trying to hire someone. We're also saying to our patients, "We want you to commit to twice a week." If we don't have room on the schedule, I feel like a little hypocritical not letting them have those twice a week visitsIt was important for me to jump back in to allow our patients to get on the schedule. I did one note on Prompt for it on the documentation side of things. I hadn't spent too much time doing the documentation but overall, we're happy with Prompt. They're great. They continue to develop their software. I still think that they're going to be the best, if not, getting close already. 

They're making so many changes, not knowing exactly what's happening on the documentation side and on the billing side. From what I hear, there's room for growth there. It's good to hear that they are receptive and they're trying to be reactive as possible to make changes on the fly and keep things up-to-date. 

That's also one of the cool things that I like about using them. They're a young company. Whave been working with them in their early stages. Some of the suggestions we give to them, they listen to us. Hopefully, as they grow, they'll continue to listen to people. Early on, some of the suggestions we make, they implement it and put into their software. It's cool to be a part of that also. 

Has the billing been going okay with Prompt as well? You made some changes with similar timing. That can be a big upset to have an EMR change and a billing company change about the same time. How did that all work out? 

Everything worked out well. They're starting any new software or new company. It took some time for things to work well together. It was new, not only for us but also a new software for the billing company. Everyone had to figure it all out. That was from the beginning. We had a meeting with the billing company and Prompt talking about if we're going to make this work. The billing company had a list of things that they needed Prompt to change, modify, or add into their software in order for them to be successfulWe prioritized a certain number of things. They've hit upon all of the main things at this point. There are more things that the billing company wants them to implement. For the most part, they've been able to take suggestions on the billing side as well and change them in Prompt. Things have been going well. 

Prior to this, so the audience knows, you were doing the billing yourself and then you finally switched over to a billing company. 

I stopped doing the billing when we started Back in the Black, the billing company. It was May 2020 or June 2020 in the early stages of Corona. I don't even know how I did the billing when I was doing it. 

I'm assuming your collections might have improved since then, but at least it freed up your time. 

Ifreed up my time. I know for a fact collection was for the denials. I know that I was writing things off back then when I was doing it. I didn't have time to follow up or know the best way to follow up, resubmit, and change a modifierI was not doing that stuff. The fact that I don't have to do that, I don't have to worry about it. I have a company that's not only doing my billing for me but also bringing in higher collections. It's so worth it right away. The loss that I was writing off is more than enough worth it to pay a billing company to do it. 

We might have discussed this at the last episode, but since we brought it up, what made you decide to go to a billing company instead of keeping in-house and train your own person or bring on someone with experience? 

The biggest reason was that it was COVID. It was too hard to think about bringing someone in and training at that time. It was that. The other thing was because the company is Will Humphreys. You recommended itI asked you about him. He was starting his billing companyI felt like I already could trust that they were going to do a good job whereas if I was going to have to hire someone and train themIf I was to be the one to train someone, I wasn't the best biller person. How would I even train someone to do the best billing practices? If I was going off of knowing that someone had previous billing experience, I didn't feel like it was, at that time, the right time to hire someone in-house. It made more sense to outsource it. 

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The other change that you made was to stay with the same consulting company but have a different one-on-one coach. What have you been doing differently than the previous coach? 

That's been cool. One of the reasons that I switched was wanted to get a different coach. I hadn't been in year. It was interesting to see what other coaches had to offer. The coach that I started working with was not a PT himself. I found that intriguing to work with someone who's a CPA. He's been a business consultant. I found that interesting to see what we can do. A lot of what we focused on in the beginning was the mission, values and purpose. Some of the stuff that had already worked on with my previous coach is to fine-tune that a little bit. It was the end of 2020. We worked on a budget for 2021. That was something I had never done before. It was a cool practice but it was also super helpful. 

2020 was a different year than anything ever before. We had to look at 2019I use that as a template to grow. We worked backwards because it was still Corona. We're trying to get a sense of how much space we have to grow in the practice with maintaining the distancing. We came up with an idea of how much we could use in our office and then worked backwards from there. We ended up choosing our 2021 budget as we were going to use a 30% increase from some of our best months of 2019. That was a cool exercise to do. I'd never done it before, but I was able to see the whole year in advance to say, "If we want a 30% increase, we need this many visits for this month and this month. We need to ramp up." 

We were able to dial in all the numbers and look at, "We need all these stats to work out this way." From there, we were able to break it down into quarters and that helped. It was a big mindset shift, understanding how projecting and planning works. If I look at this quarter, in order to hit our goals, we need to hit this. I have a better sense of what we need to make sure to do. If next quarter, we need to get to this number, I need to hire and start looking for someone to hire. I need to make sure that these numbers are hitting the goals. It was cool for me to do that because I hadn't done that before. 

How did you land on the 30% increase? Is that something that you had decided upon? 

The way we work backward was we chose a number that we felt comfortable as far as how many people we could fit into the space because of Corona and the capacity of our clinic. 

We never had a chance to do that. Your coach tends to be a numbers guyHe's an accountant by trade. If people who are reading would want to do something like this, by all means, get together with your CPA, have that relationship with your CPA, and you're communicating with him regularly, maybe you can ask for a sit-down and talk about the upcoming budget for 2021. It's easy for them knowing QuickBooks to input the numbers, bring it all up, how that affects the expenses, or a bookkeeper might have that same capability. 

To look at your 2021 goals and how that is going to affect us financially. If we want to get these goals, what does that look like? How does that change things? How are we going to hire? It's so important that a lot of times, as we look at our goals, we look at those goals and set them aside, but not seeing how they compare, what effect they're going to have on our financials, and when we'll need to hire. It's cool that you married the two together with this meeting. 

It was cool. The last thing you said when we need to hire was one of the things that first stood out to me. We needed to ramp up in quarter 2 or 3. We needed these many more visits based on our projection. We need to hireI realized it's February 2021We're planning on hiring by June 2021 because we need to get these numbers for the budget. I need to start looking so that we're ready to hit our number. I was able to use that and see, “This is when we need to do this. This is why we need to do that based on the numbers. 

You have some real guideposts to say, "When we hit this number, these actions need to fall into place." That's what it sounds likeYou're at that point. 

That's how it feels. We'll see if we stick to it and how it goes, but it's a great place to start for me based on the fact that I've never done it before and then allowing me to try to plan and grow. It's been great. 

I love that you looked at it for the whole year annually and then broke it down into quarterly pushes. We're coming towards the end of the first quarter. I assume you're on track. 

We are on track. We're trying to hire. I wanted to get more into the numbers. Our arrival rate is great. Our utilization is greatFebruary 2021 was our highest number of visits that we've ever had in a month. Thank you very much. In March 2021, we're already 100 more than February 2021First of all, March has 23 workdays versus 20 workdays in February. It's a little bit of a difference. It's also just been because of all the different things that we've implemented being able to look at the numbers, also with using Prompt and being able to make sure the plan of care compliance report is keeping our schedules full. We're on track with that budget as far as where we should be, if not more. 

The things that have worked out so well for you are that you have focused on numbers to guide you instead of feelings. When you look at your front desk and you're like"I know this person is going to be gone in January 2021 so we need to start the hiring process late October 2020 or early November 2020 so that we have someone in here by December 2020 to overlap and train." That allowed the front desk person to not only train but also review the policy and procedures, make sure they're up to speed, appropriate and that they're following them. 

PTO 140 Avi Zinn | New PT Owner
New PT Owner: With the front desk managing the clinic's patients accordingly and the physical therapists doing a great job, cancellation rates can be drastically reduced.


The same thing with your EMR. You're using it to track your numbers, your statistics, see the growth, and the business but also to see who's falling out and how we can recapture them. It’s the same thing with your bill where you're looking at that. Number one, you hired a great billing company because they provide you reports and communication. I know that because I know Will. They provide great reports and great communication to you. You outsource it knowing that someone else is going to be able to care for it better than you could since you're not the billing expert. 

You leaned on your coach. You returned back to the financial numbers. Looking at your overall story, you’ve reached forward and received help in terms of finding an EMR that can help you better manage, finding a biller that's outsourced that knows more than you do, finding a coach to help you see your weak spots, help you shore those up, marry those things together, and also using Google Ads to your advantage to grow your practice. You've outsourced a lot of things to your advantage. They've all paid off. 

It's funny that you say that using the numbers. The last few times that we've spoken, you've asked me questions where my answer is coach wouldn't love the reasons of why I chose this. It sometimes was based on feelings and not the numbers. Once I've had a better grasp of the numbers like I have, I can tell you that when I make those decisions, they feel so much more sure of that decision. Before, I'm like"This feels right. I think it will be good." Thank God most of the time, it's turned out that way. This time with the numbers, I'm making these decisions and I know this is the right thing to do based on the numbers. 

You’ve got some growth and expansion goals. The next step is to bring on another PT. Are you looking at another PT after that? Do you have a space for that or will you have to be looking for another space or a bigger space? 

We've done this distancing thing for a long time that we feel like comfort-wise, we can fit more than we were comfortable several months ago. We can hire another PTWe're looking to hire now. We could even hire another one after that in this space. It's also interesting that I've been talking to my landlord. I don't know that it's going to work out like we originally talked about. There was an opportunity to take over the middle floor so we would be able to double our space. It was possible that we could have expanded in our own building. 

I think it's not going to work out. He's selling one of his companies. They're going to maintain that middle floor. It's not going to be available for me anymore. It would have been great to be able to know that I could expand and not have to move or get a second location, but either way, we're looking at our space and we're realizing that we can fit a little bit more than we thought we could go earlier on in Corona when we're all being cautious. More and more people are getting vaccinated. People are comfortable. We realize we can do a little bit more with the space that we have. 

Physical therapists are almost salespeople by nature who are trying to complete the care plan of their patients. Click To Tweet

Maybe a lot of people reading have this question. What is your tipping point for hiring the next full-time PT? Is it a certain number that you have to hit that you know the numbers? How do you figure it out? 

To answer your question, at the end of 2020 around the holidays, our numbers started dropping a little bitAt the beginning of the year 2021, we were having cancellations and no one was calling. It was just the beginning of the year. Deductibles were resetting. It was still Corona. All of a sudden, we had a time where we've been jam-packed. I didn't even have that much time to see we're at 85% capacity, 90% capacity, and 95% capacityI didn't even have to look at the numbers. It was because we didn't have room to fit anyone on the schedule. I knew that it was time to hire. Also, moving forward, the number that we're trying to base it on is 85% or 90% utilization capacity for more than a few weeks. We know that's not just a 1 or 2-week thing. That's a trend that's going to stick around us. We’ve got to bring people on. 

When you can be an 85% to 95% efficiency with your schedule and then your front desk is complaining, "I don't have anywhere to put these patients," then that's a good sign that it's time to start up the interview process. I say interview process because from our perspective, you always have an ad out for a PT. You're always collecting resumes. We're always "hiring." For us, it would mean, "We're going to get serious and interview these people." Not knowing how you do things, it's like"Let's start ramping up. Let's start that cycle of action." 

I will say that I learned from Will because I do coaching with him as well. I don't think it's his term, but stacking the bench. I learned from him to always be looking. I've had ads running. It is time to start being serious about it, but it is something that I've at least been entertaining or trying a little bit with keeping that bench stack. When it's time to hire, we'll have a few people that we can get in touch with. 

You can start calling those people that you have on resumes. You don't have to create the ad and post it on Indeed, which might delay you a few days if you're trying to wordsmith the ad correctly. We've got an ad that works. It's up and it's going. You've got some resumes already. Maybe you boost the Indeed payment to get more views on it. That's great that you're not starting from scratch. 

We've already dialed in a lot of our ad contains a lot of our purpose, vision, mission and values. A job to treat patientsbenefits, and salaries. He was wanting to be a part of a team. Hliked that we were a company that stuck to our values. He said all the things that I wanted someone to say. He's a new grad so I don't know if we're going to move forward with him or not. I have to make that decision. We've hired a new grad in the past. We were thinking it would be better to have someone with little experience if it's the right person. We're not against hiring new grads. We'll see, but he spoke about all the right things. 

You looked at your team and said, "What could we need? What could we do to round out this team of providers where it could be shored up?" You know what you're looking for, which is cool. 

It's been different this time with the interview process because of being a little bit more in tune with what you said, knowing what we need, what our team might be lacking, or what everyone could benefit from if we bring someone else in. It makes us a stronger team altogether. 

What's super exciting about you bringing somebody on is you're already 95% efficiency, utilization capacity, whatever word you want to use but your Google Ad spend has been lower. You bring that person on. If you want to fill up their schedule, you've got to boost your Google Ad spend. 

That's how it worked with our last hire. We filled her schedule quickly with the ads. We have to pay for that, but it's a way to fill up the schedule and do it faster than the normal potentially. We'll see if that works that way. We lowered our ads. They're at minimum. We're still totally full. Whenever we do hire, that's the plan. We're going to ramp up those ads, turn the budget to however much and see what happens. 

When you bring someone new like that on, do you have a conversation with them that maybe they're going to shadow somebody until their schedule gets full or we're going to do what we can to get you busyDo you also expect them to do some work on their end to market and build up their schedule? 

To the last point, no. That's something that I haven't had with any of the providers about having them be accountable to fill up their schedule. That was a conversation I had with the team when we had this to 8-week dip of us being at 80% towards the end of the year and in the beginning of the year. We had a conversation about accountability versus responsibility. No one is accountable to fill up their schedule, bring in new patients as much. That would be great but the way we have things set up, I use the ads. The way it's always been. 

I'm the one who brings in the patients with the ads, but everyone is still responsible to make sure that their schedule is full. We did have a meeting. Let's talk about when we do see a dip in the schedule. Let's have a plan for knowing. It looks like we're going down in numbers. Let's make sure we have a plan to make sure that this doesn't happen like it just did so that way we can get to it earlier on. That was to the last point, which was interesting about accountability versus responsibility. 

Everybody on your team should be marketing in some way or another where you're spending money on Google Ads. Their responsibility is to get patient compliance and ask for referrals. If they have some downtime during a slower season to make calls to past patients and follow up on them, they have some responsibility towards that as well. 

You asked when hiring on, is there an expectation when their schedule is filling up of what they should be doing? I'm glad you asked that because no, I don't have that. I know that I need to work on that. One of the things was you ask, “Are they supposed to shadow other PTs? That's a great thing to do, especially if it's a new grad because that could be a perfect opportunity for them to get a little bit of that extra mentoring and shadowing early on. That would be a way to be more comfortable with hiring someone who has a little less experience knowing that they're going to start and they're going to have time to do that mentoring in the early stages. That can make up for their lack of experience. 

It's something that I don't think we felt we were honing in on or got good at until towards the end of our ownership, that hiring training process for all positions. We started getting good at it, but it wasn't towards the latter parts of our leadership development as leaders ourselves, where we focused on what does the training look like for every new employee as they come on in each different position. There was some general stuff like"We're going to go over the employee handbook. We're going to cover these principles and what you're responsible for. We would break down into specific responsibilities. As a front desk, you're responsible for these stats and this is how we can train you. For a PT, this is what you're responsible for, these stats. This is how we're going to train you." I can see that maybe as a potential growth avenue for you is setting up. How do you establish a successful physical therapy on their post? What does it take? How long does it take? Is there a checklist of things that they need? 

The truth is I did that for the last one. We created a little bit of an onboarding process of 12, weeks in 30 to 90 days. It was more of training them. We startedI have a lot more room to start enhancing that and focusing on that. 

Are you starting to establish a leadership team as well, or is it just you at the top? 

That's another thing that I've been working on is I'm trying toI've been doing this for a while. I had talked to this one PT right before the beginning of 2020 before the pandemic hit. We put that on hold. We've been talking about developing that role. It's been interesting with her because she's been affected by COVID with her kids. Her kids have been remote learning this whole time. She said to drop her hours. It's been interesting talking about the leadership role. We're going to make her clinic director. She might not have enough time to do it. She had to drop her hours. It wasn't her fault or anything. 

What's been cool is that we've been discussing changing that role a little bit. Maybe she traditionally has clinic director do all these things. When we started doing these leadership meetings every week with her, when we talked about, "Let's look it up. Here's a list of all the things I would want a clinic director to do. Why don't you look through this list? Choose all of the high-energy things that you would want to do. Maybe we can build a role based on those few things. That way, it's not a clinic director in the traditional sense, but at least it gives you some more leadership opportunities to do." With the time that you have and the hours, you can still treat but also take on some leadership things. It's been cool to be flexible, tend to pivot with what we're working with and try to develop that leadership team. 

see that's where your path is next as you're starting to develop these policies and procedures or shore them up that you've done over the last little bit. You're starting to establish some goals. The next thing on your plate seems to be, from my perspective, the development of the leadership team, some of the day-to-day management, operations, and even some of the higher-level things can be taken off your plate. Thanks for updating us on everything. It's cool to see how things are progressing for you. You've got a golden touch. I don't know what it is you being in Atlanta. You have access to a ton of great people and a population that is receptive to Google Ads. You're doing some amazing stuff especially years out in ownership. You're already successful. We'll stay in touch for sure. 

PTO 140 Avi Zinn | New PT Owner
New PT Owner: Hiring fresh graduates provides the perfect opportunity for extra mentoring and shadowing early on.


Thank you, Nathan. I appreciate hearing that too. Sometimes I don't know where I should be compared to few years in, whatever it is. It feels like we're growing in a good way as far as what our reputation is. That's been the biggest thing. Clearly, the clinic is full. People do like coming to our place and we have a great reputation around town. That's been reassuring to know that people are valuing our service. 

You're going to see that jump in return patients here in the next few years, people that are referring family and friends such that your return patients are going to be 50% to 60% of your patient population. Simply by adding the physician relationships that you develop over time and your continued work with Google Ads, turning on that faucet, turning it down, turning it up as you need it will allow you to continue to grow. It's great to get in touch with you again. Keep us updated. Is there anything else you want to share, Avi? 

We went through a lot. Hopefully, we'll do this again in a few more monthsI'll give you an updateI love doing these updates. I always try to go over from the last episode. It's fun to be able to look at my progress or what I've gone through. These are so fun to do because of that. It lets me see where I've been and where I'm going. 

Congratulations and keep it up. We look forward to talking again. 

Thanks a lot, Nathan. 

Important links: 

About Avi Zinn

PTO 140 Avi Zinn | New PT OwnerDr. 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 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.

Important Links:

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 41 | EMR


Deciding on an EMR (electronic medical record) or switching to a different EMR is a huge undertaking, one that will take you at least six months to groove into your company, along with the associated tears, cursing, and bleary-eyed late nights screaming at your laptop. There can definitely be a love-hate relationship with them since none of them are perfect and we rely on them so much. In this episode I decided to ask four of my friends about the pros/cons of their EMRs and give you insight into the in vivo experiences of each. There are many more than four out there, and we'll be doing a Part 2 eventually. If you're wondering if "the grass is greener," listen to what these owners have to say about their software.


Listen to the podcast here:

The EMR Episode, Part I

Informal Reviews of 4 EMRs

We are talking about EMRs. I decided I'd ask a few people in my network about their experience with their EMRs. I've got four friends out of my network with four different EMRs so I'm going to ask the same set of questions, essentially trying to figure out the pros and cons of each of their EMRs. If you're like me, you have a love-hate relationship with your EMR. There're pros and cons to each one of them. As I go through this, let me lay down some groundwork. Number one, there is no perfect software program. We wish there was. We wish they were faster. We wish they were more customizable, we wish they had better reports, you name it. There're a lot of things that we wish they had but there's some give and take with all of them. It depends on what you're looking for as to whether or not any EMR is going to work well for you. Number two, this is 2019. The content of this episode is going to be limited to some months. I wouldn't push the relevance past that envelope.

Number three, there are only four EMRs represented here. We're talking with owners who are using Clinicient, TheraOffice, WebPT and Turbo PT Ultra. A few of those were the big dogs but there are also people in my network that were willing to talk to me in the interview. I have a friend that is using Raintree. I would have like to talk to him but it didn't work out. If there are any of you out there who would like to talk to me about your software that might be different than these, feel free to reach out to me, Number four, I have no skin in this game. I'm not affiliated with any of these. I've used some of them in the past and I'll share my experience. I've used their office and I mentioned in my interview with Aaron Williams, it's a reliable workhorse. It did well for me for a period of time. We moved on from that to Clinicient. I liked that, I liked the billing component of Clinicient better than their office and that's a lot of why we moved over, plus it’s a little bit more customizable when it came to documentation.

We would have maybe even considered going with OptimisPT but didn't liked their billing software, although the documentation and the reports were great. Nonetheless, that was years ago. It might not even be relevant. I figured I’d share some experiences with my network. One question I didn't ask that I wish I would have was their mobile capabilities and the ability to use iPads and phones. I know WebPT does that and that's a pretty awesome thing to do that you can actually complete a note on your phone but I don't believe Clinicient’s there yet. I'm pretty sure TheraOffice isn't and I have no clue about Turbo PT. I could be wrong about all of those but check up on the individual websites or call the customer service representatives of those particular software programs if you're considering any of them. I'm talking too much. Let's move along into the interviews and ask about EMRs.


I've got Sean Miller from Empower PT. Sean, thanks for coming back on the podcast and talking to me for a little bit.

I appreciate you reach back out to me. I'm excited.

To bring everybody up to speed, you were one of my first podcast episodes. Do you want to bring everybody up to speed on what you're doing nowadays?

When we talked last time, I can’t remember if I mentioned that we had merged our company together and we formed a new group called Empower Physical Therapy. What's exciting about it is that we got five private practice owners with the same mindset of putting the physical therapists and our patients first in our business model and how we operate. We want to create something bigger and to take it out on a larger scale of maintaining that private practice feel and that putting the therapist and the patient first in our business model. It's been exciting.

We've got 26 clinics that we started with and we finally got everything organized and structured, set up. We're starting to take it out and expand it. The cool thing is we're getting a lot of exciting feedback from other potential clinics about bringing them on our platform as well. You've talked to Jerod on one of the podcasts and he mentioned that we’ve got some clinics in Texas that we have coming on board. We’ve got probably about two or three other groups that we're also close to bringing on board that are excited as well about what we're trying to do.

No software is perfect. Consider your needs and what's important to you prior to studying all that's out there. Click To Tweet

You’re no longer an owner of your individual clinics. What's your position?

I'm the Chief Operating Officer at Empower Physical Therapy. I oversee all the operations of the clinic on a day-to-day basis and how they're operating. What's cool about Empower is all the leadership from top down are therapists. Our CEO is a therapist. I'm a therapist, people who are recruiting are therapists. It's a cool concept of what we're doing. That is exciting.

You're the person I want to talk to because we're talking about EMRs on this episode. What EMR are you using over at Empower PT?

We are using Clinicient.

You came over from Clinicient in your previous location. That's not a big transition for you. You've got some history. First of all, can you maybe skim over what are some of the pros and cons of Clinicient from your experience?

PTO 41 | EMRThere's no perfect EMR software out there in my mind. I've shopped all of them. What I love about Clinicient is from a business mind perspective and the therapist mind perspective, it offered everything across the gamut that I would want to see in an EMR. What I mean to that in terms of the business aspect is the access to data and the ability to run multiple reports and drill down to almost any piece of information I want to know in the business is readily available. That’s a huge strong point for Clinicient. The other side, a strong point was on the therapist side was some people may or may not like this, I don't know but we like it. That is the documentation aspect is very customizable. It takes some time to build out. That's probably the tedious portion of it but you can fully make the evaluation or daily notes the way you want them to have the content tender that you want.

We're able to do our notes very efficiently. It’s compliant, which is also a big piece of structure and manner. Most therapists tell you, “I love being a therapist if I don’t have to document all the time.” What we've done with Clinicient is streamline it so that the documentation process is fully compliant with all the insurance guidelines but it's also fast and efficient for our therapists. The majority of our therapists, I would say would walk out at the end of the day with all their notes done that day and they're not taking stuff home. That's one of our goals.

Have you gotten any feedback from the companies that have come on to Clinicient? I know you're early in those stages and so it can be a rough transition. Those who have transitioned from a different software to Clinicient, have you found that transition working okay?

Two of the companies were already on Clinicient and three of the ones weren't. The ones bringing them over, they’re always a little hesitant or fearful of how they're going to like it. It's been overwhelmingly positive. They've all liked the way I was telling you about the documentation, how we can streamline, it's faster, it's more efficient and they’re liking it.

What are some of the things that you've experienced? None of the software is perfect, we do have to address both the pros and the cons. What are some of the things that Clinicient could work on?

The customer service side is getting better. There are sometimes delays when you need help or you want someone to get to you in a timely fashion. There’s a ticket item where you log into a website and submit support tickets. Part is growing pains for Clinicient because they've had been growing quite a bit. That's probably been the biggest problem or issue sometimes is you'll get glitches and issues and you're like, “I need a fix now.” You've got to wait the time and the process, but I imagine most software are that way. I think most software have that difficulty of trying to figure out how to do the customer service side of when there are glitches and problems in the software.

I can speak to that a little bit as well because we were using Clinicient a few years ago. I noticed the same thing. There's not a timely customer service element when it comes to Clinicient. At least that was my experience. If there was one thing that I wish Clinicient could shore up a little bit was their customer service timeliness, their ability to react to a small glitch. Like you said, “Why can't I call somebody and work this out quickly but rather I have to put in a ticket and wait?” Compared to other EMRs that you studied in the past or that you're dealing with, that you've looked at because of the merger how does it compare cost-wise? Can you speak to that?

The cost-wise is pretty comparable to most of the top three or four that I know of that are going into it. Software has changed over the years. I used to be on a flat fixed fee every month that you would pay.

Like a per therapist rate.

Per therapist, per user rate and what most of them are switching to is they're starting to charge you a per visit note charge. Every visit you do, you get charged $0.50 to $1 per note that goes towards your software use. The way they're structuring it is the more notes you do, the lower that cost goes. They have a threshold of, “If you do 10,000 visits in a month, you pay this rate. If you do 15,000 you pay a lower rate.” That's how they're structuring things.

That’s a lot of business. You guys are pushing them out.

We're pushing up close to 4,000 or 5,000 a week.

If you want to create something bigger and take it on a larger scale, put the patient first on your business model. Click To Tweet

Even at your scale, you've been pretty happy with the reports and the ability to manage the data and all that stuff, stay on top of your KPIs.

Clinicient formed an advisory board and I was on this advisory board. What we're doing is we're helping them build out a dashboard of statistical physical data. When you log in instead of looking at numbers, it's actually going to be graphical data of your clinics. That's going to be coming out. It's going to take Clinicient in my mind to another level as far as a business owner's ability to log in. I instantly have all the data on visits, travels, referrals, conversion, my billing, my AR. It's all quick clicks. Then what's cool is you can drill down the data from say you've got five clinics, you can look out what's my total clinics. You can go from that to one clinic down to an individual therapist by a couple of clicks of the button.

That would be huge. The ability to scale down would be awesome. The power of that is if you look globally at your entire company, your company could be doing well. When you drill down to the individual clinics that could be saying that four clinics are doing great, one may be off and not doing so well. You can go into that individual clinic and maybe within that clinic, it's one or two therapists that aren't doing so well that could be bringing the whole clinic down. That's the power that you get when you can drill down on a dashboard like you're talking about.

Most owners of clinic therapy companies don't realize that piece. They’ll see their visits are down so they blast an email to the entire company, “The visits are down, we're not doing well.” Meanwhile, three of your four clinics were actually doing extremely well and now they got an email from you saying they're not doing well but they are. The ability to drill down and we call it being a sniper versus a shotgun type of boss. The sniper will find exactly who and what the cause is and the drill down data that comes from that is how you do that. We're excited to see that piece come out.

You talked a little bit about compliance and you've been happy with that. What can you say about the billing? You're doing billing in-house.

I used to have Clinicient actually doing my billing and they did a great job. A lot of the software, their billing platform wasn't integrated into their documentation platform. With Clinicient, it is integrated together. It's much nicer and much easier. You can work claims quicker and faster.

I can speak to that as well. We did billing in-house and my billing department was happy with Clinicient, with the reports that we were able to see the receipt or to create and the detail at which they were able to do their billing. They liked it a lot. It was ease of use. It was great. I can't speak to Clinicient’s billing services that they provide. I have heard people that didn't like them as much but you were happy with them at the time.

I was happy with them. Anytime you outsource, there are give and takes with it but the same thing. If you bring it in-house, you have the other issues you have to deal with. We're collecting 98% of what we build with these high standards. Most of billing is what you put in the system on an upfront basis. If you've got the right information, the right data and you have authorization, you're going to get paid.

There's a lot of pre-work that needs to be done in order for the billing company to work properly. You talked about the notes. The clinicians are able to get out of the day, if not all of their notes being done for the day. What training does Clinicient provide and as far as helping people get on their software?

They have different levels of that when you come on with them. Obviously the more you want them to do, the more you pay a bigger price for that because they’re investing more people in time. It depends on your level. When we did this merger because we had two companies already on it, we actually used the majority of our own people to do the training. The first time I got on Clinicient, part of the deal, which was a very reasonable and good price and they sent two people out. They spent three days with us, training us on the software and they spend a couple of months before you go on the software. Building the database, getting your hands into it. Taking your time, understanding how to use the software and things. They did a pretty good job and like most software, you got to start using it in my opinion, to figure out how to use it.

PTO 41 | EMR
EMR: You need something in-house so that when the internet goes down, you still have notes.


This was a number of years ago but we had weekly webinars or conference calls, where we sit down together with someone who was up in Oregon. We go over the software on a shared screen. Definitely having somebody come down and be on site can be a huge plus.

It wasn't efficient the first time but we did it for sure. I definitely recommend that if you're going to do it, get somebody to come down on site for a few days and show you how to do everything.

It's worth it for sure. Any other bells and whistles or anything extracurricular stuff regarding Clinicient that you want to share?

They had the inside tasking the process, which is nice, especially with HIPAA compliance and rules. You can talk patient information and data with the task piece, which is cool versus email or whatever.

You're talking inner-company messaging.

It's through Clinicient, so it’s actually right there on the software. That's a nice little feature with it. I'd like to see them do a little bit more with the referral tracking. Most PT companies track new patients but not tracking the referrals, which is interesting. If you get 50 referrals and only 25 become new patients you think, “We have 25 new patients. That's great,” but you missed 25 other possible new patients as well. That'd be an interesting piece if they could somehow integrate that. It's in there somewhere a little bit but it'd be nicer if it was a different, separate feature of it.

That's something that you don't see a push on EMRs. I've always felt if I was going to track something like that, I'd have to create my own spreadsheet and then train my front office staff on how to track those referrals. It would be a nice complement to any EMR.

That’s what we currently do we track it on an Excel spreadsheet. We convert them, not converting them and then entering the system it's a lot easier. The other new thing too that therapists should be aware of is with MIPS. If they have to do MIPS reporting, Clinicient acquired a software company called Keet. Keet is a patient engagement software. What's great about that software is it is a way to engage with your patients through a home exercise program. It actually also does all your outcome tools. Your Oswestry, LEFS, neck disability index, it's electronic format for your patient to do those. Keet then takes and reports those to Medicare on our behalf. With the MIPS reporting coming out, we're going to be compliant with that so that when Medicare goes back through in 2020 and says, “You should have been doing MIPS, did you report?” You're eligible for the increase in pay. If you don't do MIPS, you're not eligible for an increase in pay.

You might even get a decrease in pay.

That was a new feature that Clinicient added called Keet, which was a nice add on for us considering our size.

Thanks for your time, Sean.

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I hope it's helpful. If anyone has any questions, I'm more than happy to help out and talk to anybody.

Are you willing to share some of your contact info?

My email is If they want to call me or email me on that, I'd be happy to reach out and talk to them if they got questions on Clinicient and how it's been for us.

Thanks, Sean. I appreciate it.

It’s good talking to you. Thanks, Nathan.


I've got Jeanine McLellan, physical therapist out of New York and talk about her EMR. Thank you, Jeanine, for being with me.

You're very welcome, Nathan. It’s my pleasure.

Do you mind telling the audience a little bit about your company and where you're located, clinics that you have?

I own Northern Physical Therapy and we are located in Northern New York. We started our first practice in 1996 in our hometown of Ogdensburg. We quickly found that we needed to branch out to service the community. It's a rural setting up here. We expanded into the Clayton New York market, which services The Thousand Islands region and most recently we've expanded over towards the Fort Drum military base in Evans Mills, New York. We currently have a total of three practices and we employed twelve physical therapists.

What EMR are you using?

We are using WebPT. We’ve used WebPT since when we went electronic back in 2011. We started with WebPT, went right from paper to them and we've been with them ever since.

I thought you were new to them but you've been with them for the long haul. At the stage where they're at, they've made a ton of changes and I know they've done a lot of updating. What are some of the pros? What are some of the cons that you have in working with WebPT?

PTO 41 | EMRWhat we love about WebPT is their customer service. I find that is exceptional for them. They're very responsive to any issues that we may have and their communication is great. They'll notify us ahead of time when they're going to have any downtime, if they're going to do any software updates. If they're having some issues across their programming, they'll send out an immediate email, “We're aware of the problem. Hold tight.” That constant communication is a big help when you're sitting back wondering, “Why won't my note finalize, what is going on? Are you having this problem? I'm having this problem,” that's helpful. The communication aspect.

I’ve used a little bit of it myself. What I recall is it’s fairly easy to use.

The learning curve is so easy. Whenever we have students or new staff come on, they're always a little bit intimidated. It's a new program but they're all very surprised at how easy it is and I think that’s because it's strictly designed for therapy clinics. What I also like is we've been able to use most of their templates with regard to body parts for evaluations. It does allow us to also upload our own, if we wanted to create our own templates, which we did have a therapist who had an interest in that. She was able to put her templates into the program as well.

I was going to go down the road. You find that it's customizable, it provides you some templates but you're also able to do some of your own and create those on your own.

You can customize.

Any cons to your usage with WebPT?

I myself don’t have any. I love WebPT. That's probably why we've never switched. We've looked at other ones because you always hear about the latest and greatest but I have no reason to switch. When Medicare was doing their PQRS reporting that they did a few years back, apparently we were reporting but for some reason, there was a glitch with WebPT that our reports never got put through to Medicare. We were not even aware of that because on our end they looked like they went through. I got a personal phone call from Heidi Jannenga to myself who said, “We identified that this was a problem and as a result, you're not going to get that 2% from Medicare. Because you're not going to get it from Medicare, we want to make it up to you. We're going to give you that 2%.” No questions asked, they figured it out yet. They sat with us and said, “This is how we figured out the lost revenue that you're going to experience as a result of this is.” They cut a check and mailed it the next week. That's pretty impressive because on our end we wouldn't even have found that out probably for another at least eight months.

That's a great testimonial. A notch for customer service that they provided. What is your cost? Do you pay on a per provider basis or on a per-note basis?

We pay on a per provider basis.

Are you willing to share with us that?

There's no perfect EMR software out there. Click To Tweet

It’s $100 per provider. A provider being your PTs because PTAs cannot bill in New York State. It has to be signed off by a PT. The other thing that's great about WebPT is that they keep track if there's anything wrong with it, it won't allow it to finalize. It will come back and it will tell you in red, “These are the issues you need to fix in order to get it finalized.”

They've got some good compliance integrated into the documentation right off the bat. How do you feel about the reports that you're able to get so you can manage with your KPIs and whatnot?

I like the reporting factors. There are a lot more reports available than what we actually use. If I sit down, I could probably find some. I'm sure they're all valuable but I use what I need immediately at the moment and I'm very pleased with what's available to me.

How far are you able to drill down in your statistics? Are you able to get to a per provider status on different KPIs?

That’s how we bonus. We look at patient visits per hour per provider. I can look at each individual therapist production each day and we put that into a stat format.

Are you billing through them or are you billing in house?

We do our own billing. We actually started Therabill, which is the WebPT program for billing that they came out with.

You're using their software to do in-house billing?

Correct. We've started that process. There's always a learning curve whenever you switch your billing program. We are in the process of that. I can't say it's been a completely 100% smooth, no glitches transition. This isn't the first time I've transitioned billing programs so it's not anything unusual in comparison with what we’ve done before.

You can't totally speak to the capability of using the Therabill and whatnot but you are doing it and there's a learning curve. I'll probably have to do another interview with you. That was the one big hang up for us in using WebPT in the past was there wasn't an integrated billing software. It's so much smoother when you can tie those two together, your documentation software with your billing software so it's all smooth.

I’m hopeful that Therabill will answer that for us. If they follow the same customer service model that they have for WebPT, I think that will be successful. It’s very new to them. We're teaching them as much as they're training us on things that we need as a clinic.

Speaking of training, do they provide you a significant amount of training when you switch over to WebPT or do updates and whatnot?

They have a very coordinated, organized, “We're going to meet on this day and go through this,” structured format that you do. They want you to use the program for a little bit before then you formulate your questions, go back and get the answers based on the experience of what you're signing.

PTO 41 | EMR
EMR: Part of the reason clinicians stick with certain EMRs is because they’re cheap.


You already talked to that it's a little bit customizable for your templates and whatnot. I know they have some extra bells and whistles with regards to the marketplace, home exercise programs and whatnot. Do you utilize any of those other extra things?

We don’t utilize that. We looked into the marketplace and we found from our own personal experience, we had a different venue that we were using that was more cost effective for us.

Anything else you want to share with us about WebPT and your usage of it?

I could probably be the little poster child for WebPT. It was a scary transition at the time we made the transition, we did it early, we did it before it was actually required. I was nervous to wait and then be caught up thinking. My thought process was that if everybody switches all at the same time, there are going to be glitches. I wanted to have all that worked out ahead of time. If I had known that this was going to be such an easy transition and so much more efficient, I would have done it even before we did it. I can't even imagine going back to paper.

Most owners of clinic therapy companies don't realize the power that you get when you can really drill down on a dashboard. Click To Tweet

What you speak to is their customer service and I think that can set somebody apart, especially when you get to these bigger companies.

I would say that it has because we've dealt with enough other companies to know when you're getting good customer service versus when you're not.

Thank you for your time, Jeanine. I appreciate it.

You're welcome anytime. Thank you.


I've got Aaron Williams with OSR Physical Therapy out of Arizona. Thanks for joining me, Aaron.

Nathan, thanks for having me. I appreciate it.

Do you mind sharing with the audience a little bit about your clinics, how many you've got? You're super successful and all that, give us the details.

We have seven offices in Phoenix. I started the practice in 2002, we'd been in business for several years. My wife and I are both PTs, we started as a small private practice and have grown our private practice, solely owned by us. We have seven locations around Phoenix. We're right in the thick of it like everybody.

You're using TheraOffice, right?


Tell me a little bit about TheraOffice, how long have you been with them and maybe some of the pros and cons that you're experiencing?

PTO 41 | EMRTheraOffice is the only EMR we've ever had. We happen to find them in about 2008. It's been a while. What prompted us was we were going to open a second office and we were literally using paper charts, before that handwritten, dictation and stuff like that. We knew that we would need to be going to an EMR of some sort someday. The idea of having a system where we can have multiple offices and started that process for us prompted us to look into EMR. At the time we shopped a handful of them and some of those aren't around anymore. There's a bunch more that are. For us, fortunately TheraOffice seemed to fit all the needs that we had. We've been able to grow with it. We're with them and we can talk more about that. That’s how we started.

Pros and cons that you're experiencing with them?

Pros, it's very user-friendly. Our therapists seemed to love the documentation side of it. People that were fired from other companies or that have been around, moved in or whatnot and have used different systems seem to think that TheraOffice is as good or better than any of the ones that they've had out there. I haven't had people say, “I wish you were on this one because it's so much better than TheraOffice or anything that.” We seem to get good feedback from the therapists that it's pretty user-friendly and they like the format of the documentation.

From that perspective, it's a pro. It's cost effective as far as, when we got on board back then it was one of the more affordable options. I'm not sure where it's priced out but it's expandable so you can have multiple clinics. The other thing we like was that it had everything in one; documentation, scheduling and billing. All components of the same software. We didn't have to use the documentation software in a separate scheduler and a separate billing platform. It was all together in one and that might have been the biggest reason we jumped on with them in the beginning as well.

I think the first EMR that I went with was TheraOffice. One of the reasons that I went with them initially was that it was all integrated. I did my billing in-house. Do you do your billing in-house?

Yes, we do.

It was a way to seamlessly work between all of those components of it. I was relatively happy with it, that's for sure. Any cons that you have?

The reporting side of things, it can be a little bit clunky. Some of the reports are not relevant to us. They do customize reports for you. If you do want certain things, they can build the report that's specific to what you want. It's not the glamorous looking dashboard product that you might find out there that spits everything back and is in some charts, graphs and everything looks perfect. As far as the management reporting side of things, we wish that was a little bit better. With the basic information we need out of it, that's good. That satisfied our needs up to this point.

You're able to get what you need as far as the KPIs and whatnot. I've asked a few of the other people, can you drill down and get some individual practitioner data in order to assess individual statistics in the clinic?

You can. It’s the data that you used to manage with. Whatever the report shows but it doesn't mean that that's what you want to see or what you use, whatever you've learned to manage with. If you didn't have anything else then it would be good to look at those things and at least manage off of that. We primarily use it to gather weekend, month-end, quarter, year-end type of data such as patient percentage arrival of our billing data and so forth.

How do you feel their customer service does?

I would say fair. Fortunately, we haven't had to use them a ton but when we do have to use them for a customizable report or something, it's nothing extraordinary. I don't want to say that they are responsive but sometimes it does take a little while.

It is telling that it's not very glitchy. The fact that you haven't had to use them a lot is probably good.

Most of billing is what you put in the system on an upfront basis. With the right information and authorization, you're going to get paid. Click To Tweet

That's a good thing and we certainly have our times and some things that we'd ran across but the reliability of the system up and running and working, it's done a pretty good job that way. We don't have major crashes or major problems with that shut us down or anything like that because of that particular software.

You pay on a per provider basis, is that right?

Yeah, that's the way it was set up in the beginning. They might have some different models but we pay basically a flat fee per provider per month. PTs were about $100 and PTAs were about $50. You can also have a part-time provider, which is I believe $50 as well. Your admin staff, you can have an unlimited number of those, but I don't know if there's a different pricing structure. They also have a more of a Cloud web-based version of the software, which I'm not sure how that's priced. I think it's a little bit different. We're on the server-based.

That's a big difference. I know they went to a Cloud option but they still provide the server option. Do you prefer that?

You can do that, I don't know that we prefer it. We're creatures of habit.

It's what you've been doing.

It’s something we started and we stuck with it. We didn't want to have the hassle of a change or whatnot but it still works and everything works fine with it. They do allow us to do that.

How do they do as far as compliance? Have there been any issues there?

No. I can't say that we've had any compliance issues. They seem to have regular updates that address any compliance type of things that are coming down that we're aware of. They do provide education, training as well, have a webcast and so forth to educate their members on the different updates and what that means, whether it be a compliance thing, billing or document page, whatever.

Do they help the therapists in the course of doing documentation to make sure that the individual notes are compliant, guide them and direct them along that path?

Yeah. There are some built-in mechanisms for billing in particular. I guess compliance might be the right word but also billing parameters so that if there are certain insurance that you want to set a parameter on, it will allow certain a number of units. You can set that parameter and it guides them so they're billing correctly, which is helpful and at least it doesn't make them bill a certain way. The therapist has to understand that and know what to do but at least it guides them in the right direction, which is helpful.

Did it do something extra to help you out with the MIPS reporting?

They do have MIPS, although we're not participating in MIPS ourselves. They had a whole update for that.

There's an option for that?

Leading up to that, yes. They built that in and they are a registry themselves. I know that was one of the questions we had when we were looking into it. Some EMRs you have to go through, a separate registry if you're going to do a registry and they did have the registry in-house.

What do your therapists think of the software? You said they're pretty happy with it but as far as the speed component, is it pretty quick for them to do their daily notes and their evaluations? Can they customize their documentation so they can put their own templates in and stuff like that?

They can do all that. I would say most haven't or don't. Early on, we probably did that a little bit as far as customized, a handful of different templates for evaluations, daily notes and so forth. They use the same ones that maybe we originally put together. As far as the speed goes, it's probably comparable to other ones that I've heard of out there. Anywhere from the pretty quick daily note to a minute or two in evaluations. When they're first learning the system could be ten, fifteen minutes but you can get them under ten minutes I would say once you're pretty proficient with it.

PTO 41 | EMR
EMR: Part of the reason clinicians stick with certain EMRs is because they’re cheap.


Do they provide some training for a new employee? Do they have webinars in place to train that person or is that on you during that person?

They do have training modules, I'll say that. You can direct your employees to their training modules and that can lead them through them. I find that we do most of the training ourselves because we train them how we use it, not necessarily how it was written by a coder to you.

Especially since you've been with them for so long, you guys have a way of using the system that it's smooth, easy and you can predict the results.

The tips, tricks and shortcuts that help. We ended up doing a fair amount of that training with our people.

Any other bells and whistles from TheraOffice that we didn't cover?

I don't think so. I don't know the cloud-based version. They have a product called PracticeVibe, which is more their online cloud-based version, which I can't speak to as far as what that does for its users. I've heard good things about that. Overall, it's one of those good all-around platforms for either a beginning company to start up and use or if you have some size. If you have several clinics and you want a good reliable platform to utilize, I think it's a good one. It's probably not robust for the people that are looking for 20 or 30 clinics and need multiple reporting functions and so forth. We've certainly entertained and looked into other EMRs and haven't found anything yet or gone into depth on other EMRs to make a change.

Take your time and understand how to use the software and things. Click To Tweet

It seems it's a reliable workhorse. It's everything that's needed. It's got all the bases covered. It's not going to be your glitzy, glamory stuff that you're going to get everything you need out of it and you're going to run well.

That's the way we look at it. It’s one of the more affordable options that get the job done and if that's what you need, it would work well for most anybody.

Thanks for your time.

No problem. I should say that it also has speech, OT and PT involved.

The other disciplines are involved as well.

They have practice with multiple disciplines, they have that built in. I appreciate you asking me to jump on. It's fun to talk to you again.



I've got Rob Brown PTA out of Wasilla, Alaska with Wasilla Physical Therapy. Thanks for joining me, Rob.

Thanks for having me.

Share what EMR are you using?

PTO 41 | EMRWe use TurboPT Ultra.

What turned you on to TurboPT Ultra to begin with?

I had a consultant that I hired a couple of years ago and he recommended it at the time. He was able to give me a little bit of a discount on it. They had about 7% to 10% window. I initially purchased it to have it as server-based but now they’re cloud-based.

You've been on it for a few years. What are some of the pros and cons of TurboPT?

It's fairly user-friendly. There’s not a real big learning curve to it. It doesn't have as many of the options is I think some of the other bigger EMR companies have. That's probably what I like about it. Their customer service, once you get to know the guys, there are only two guys that you call and get one or the other and you get to know them by name.

They're readily available at any time at the drop of a hat to give them a call.

You give them a call. The way it works is you put your name down and then when the time comes, they call you back.

Is that pretty speedy?

Twenty, 30 minutes. It’s not super fast but not super long.

Honestly, Ron, that's pretty good compared to some of those larger ones out there. You can put in a customer service ticket and they'll say we'll get back to you in 24 hours.

These guys are faster than that.

You said it's missing some of the bells and whistles that maybe that the bigger ones have. Does anything jump out that you wish it had that they had?

If you're going to do install a system, get somebody to come down on site for a few days and show you how to do everything. Click To Tweet

Honestly, I initially purchased it because I could have it server-based because where we were at the time, we lose internet connection. I needed something that was in-house. When the internet goes down, we have notes. Two years after I paid the big lump sum of money, they switched to the cloud-based, which didn't make me very happy. In using it every time they do an update, there's a huge learning curve. They’ll move things that you like or don't like and sometimes it's a little buggy. It's with every EMR, there are things you like about it and things you don't like about it.

Seeing with all the EMRs, there's no perfect one out there. As a whole, they could do better in general. They all have their pluses and minuses.

When you come to whistles and bells, I will tell you one thing that I wish it would do. I wish it would break down per therapist statistics a little better. It lumps everything in and it will say within this given week, that person's build this many units. I would like more detail.

The more detail on the reports and data. I was going to go to that eventually. Since you're there, are you pretty happy with the data in order to manage your KPIs essentially or do you wish there was more to that?

I have adapted to what they offer versus I came in with, I needed this, this and this. It was either I didn't know how to find it. Maybe they do offer it in this huge maze of programming. I don't know how to get there but I've adapted to what I could get. It got patient visits per week so I know how many people we got coming in. I know if we're treating them, how many units they’re treating that person. I track the average, how much we bill per patient per week and then how many patients we got coming in the door. The overall charge amount for that week. It gives me how much we received that week.

It doesn't break it down into greater detail than the clinic. That's as finite as it will go. It won't go down to each provider.

It might. I don't know how to do that. From what I go, what's easily accessible and very fast for me is to break it down to those things I mentioned.

What's good to hear is it sounds like you could call one of your buddies on the other side and they'll probably walk you through it. How do you compare the cost and maybe this is a few years old since you've covered costs back then?

We pay the monthly fee. They're cloud-based and we can't have it server-based anymore. I'm on that monthly. Should I tell you that?

Some people have, some people haven't.

I pay $240, $45 a month.

Per provider?

No, that's total.

That's pretty cheap.

It's pretty cheap. You can add things onto it. We've added another $50 on to that so that it does the automated texting to all the patients. Total, I pay $270 or something. That's the reason I’m stuck with them, even though there are things I don't like. I got to be honest, I’ve taken the tutorials by WebPT and I love it. She's got a good program there but how much they cost compared to what I'm paying. It's hard to make that jump.

One of my other interviews is going to be someone who's using WebPT. You might be able to glean a little bit of information from her as well. WebPT has got some good stuff going on, that's for sure. How does it do as far as compliance, does it make sure you're maintaining compliance on that end?

It does the whole compliance thing with Medicare, it alerts you every tenth visit. It won't let you enter codes unless PT is doing a revaluation or progress notes. You have to redo G-codes.

You do your own billing in-house. Is your billing personnel pretty happy with the billing?

Not the best.

They don't provide any billing support whatsoever.

We use a separate clearinghouse, TriZetto. It would be nice to lump everything into one but again, finding someone that you're okay with the price point. You're looking at another 6% to take for billing or something that.

Everyone's got to figure that out on their own and there are gives and takes. It'd be nice to turn that over to somebody else and not have to handle the employees, the financial policies, procedures and stuff like that. At the same time, are they going to go after every dime? How were your providers with the speed, ability to do notes and evaluations, is it pretty easy to use in that regard?

It is fairly easy but it's not the fastest. They're way faster programs out there.

Is it customizable? Can you put in templates and whatnot to speed the process?

To a certain degree. For example, you don't have preset sentences that you click on this and it throws things in there. You can bring up the past note and you can cut or paste within that note. You see everything you wrote the last time, you can add to it, take away, edit, do whatever you need.

Can you customize an evaluation if you do typical shoulder protocol, can you throw that up there and not have to find and cut those all up?

You can do it to an extent.

Anything else you want to share in regards to it and its capabilities?

It's been a good program. We are considering actually switching to another program that we're hoping we're happier with. I've only been with two different programs so I don't have a real deep knowledge of all the ones out there. If I was giving it a rating on a scale of one to ten maybe around six, seven.

Hopefully by doing a podcast episode like this where I share people a little bit from each clinic owners’ experience with those EMRs, it might be helpful to you and people like you in the future. Thanks for your time, Rob.

Thanks. I appreciate it.

I appreciate it.

Important Links:

About Sean Miller

PTO 41 | EMRGrowing up Sean always felt the desire to make an impact in others life. It was in high school when a friend got hurt playing sports that Sean was introduced to the power of physical therapy and the impact it has on people’s lives. From that experience Sean has set a course in his life to be a Physical Therapist and change lives. Receiving his Bachelors of Science from Brigham Young University in 1999, Sean then pursued his dream of getting his education in Physical Therapy. In 2001 Sean graduated from Texas Woman’s University in Dallas, Texas. Moving to Arizona in 2002 working for others Sean became very proficient as a Physical Therapist. He now specializes in treating vertigo, balance, and orthopedic cases involving the shoulders, cervical (neck), and knees. After years of treating patients full time Sean realized that he was just 1 Physical Therapist and only had the ability to treat so many patients at one time; It was this realization that sparked the dream of owning his own practice. “What if we had multiple therapist all with the same skill and passion? The impact would be even bigger than just 1 therapist”. From this Sean along with his brothers opened Kinect Physical Therapy in 2012. “Opening Kinect Physical Therapy has been one of my greatest challenges, but to see the larger impact we have on the communities and in our patients is why I do this.”

Sean when not making an impact on others life’s enjoys spending his time with his wife and their 4 children. He is often found on the sporting fields coaching his boys teams, at the lake wake surfing or headed to the beach to enjoy the waves and surfing. His favorite quote that he lives by is: “We are what we repeatedly do, excellence, therefore, is not an act but a habit.” – Aristotle.


About Jeanine McLellan

PTO 41 | EMRUpon returning to the North Country to raise our family, we discovered that the availability of high-quality physical therapy care for the residents of the region was missing. We wanted to make our community a better place and decided to develop our vision of a practice that was devoted to improving the overall health of everyone in the community.

Our dream was to provide a facility that would provide the highest level of care with comprehensive one-on-one evaluations, hands-on manual therapy and advanced techniques provided by the best, highly trained physical therapists in the area. We also dedicated ourselves to our patients by providing them with exceptional customer service and in return, they have dedicated themselves to us and refer their friends and family!

We opened Northern Physical Therapy in Ogdensburg in 1996 and with your support over the past 20 years, we have expanded our community to include Clayton and Leray. Our enthusiastic team of physical therapists is as committed as we are in helping you to live your life without pain or limitation. Thank you for the trust that you put in us and we look forward to helping you to live your life to the fullest!


About Aaron Williams

PTO 41 | EMRAaron founded OSR Physical Therapy in 2002 in Anthem, AZ. He received his BS in Biology from Graceland University in 1998, while playing college basketball. He then went on to receive his doctorate in physical therapy from Northern Arizona University in 2002. From there he worked in an out-patient clinic in Sedona, AZ and at a skilled nursing facility in Mesa, AZ while developing plans for opening OSR Physical Therapy.

His professional interests are in sports medicine and orthopedics. Aaron specializes in out-patient orthopedics as well as post-surgical rehabilitation and functional training following injury.

Aaron is a member of the American Physical Therapy Association (APTA), the National Strength and Conditioning Association (NCSA), and is active in local business groups, Chambers of Commerce, church and charitable organizations. His hobbies and personal interests include: participating in sports, fishing, spending time in the mountains of Colorado, and traveling. Aaron and his wife, Kori, own OSR Physical Therapy, and together love spending time with their children, Emma, Sophie and Maci.

In 2007 Aaron was awarded the “Greater Phoenix Chamber of Commerce at Anthem Small Business Person of the Year Award” for his local support of Anthem and the surrounding communities. This strong community presence and OSR’s mission to provide “Quality Rehabilitation through Personalized Care,” has led to the expansion of OSR Physical Therapy across the greater Phoenix metropolitan area.


About Rob Brown

PTO 41 | EMRAt Wasilla Physical Therapy in Wasilla, AK, our team includes some of the top physical and injury rehabilitation therapists serving Wasilla, Palmer, and the Matanuska-Susitna Valley area. In fact, we were voted Mat-Su Valley’s Best Physical Therapist and Best Massage Therapist for 2010 by the Valley Frontiersman Newspaper. We have been in business since 1990, and have been helping people around Wasilla and Palmer for over 25 years! Trust in our experience to make you feel better, whether you need help recovering after a car accident, you require custom orthotics, you need help recovering your balance, or you just need some help getting back to an active life.

Wasilla Physical Therapy has the qualifications and experience to treat an extensive range of conditions, as well as an impeccable reputation. Plus we accept most insurance plans! Please call us today to set up a convenient appointment time.


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PTO 17 | Marketing And Growth Strategies


As one of the progressive leaders in our industry, Heidi Jannenga, PT, DPT, ATC, and her group at WebPT decided to get the pulse of the PT industry by surveying over 7000 rehab professionals across the country. The report, "The State of Rehab Therapy in 2018," provides some important information regarding the current PT climate and, specifically, regarding PT business ownership. We discuss the aspects of the report pertinent to PT owners, and in this episode that topic is the fact that PT owners lack marketing and growth strategies! Focusing solely on physician referrals is not a recipe for growth. There's so much more business out there!


Listen to the podcast here:

WebPT’s Heidi Jannenga, Part 1 – Current Trends in PT Business Ownership

I'm excited to have the opportunity to interview Dr. Heidi Jannenga of WebPT. If you don't know Heidi, she is the Co-founder and President of WebPT, the country's leading rehab therapy EMR platform for enhancing patient care and fueling business growth. Since the company's launched in 2008, she has guided WebPT through exponential growth. It's the fastest growing physical therapy software in the country, employing nearly 500 people and serving more than 75,000 therapy professionals at more than 12,000 clinics. WebPT is also ranked five consecutive times on the prestigious Inc. 5000 list and twice on the Inc. 500. She has been recognized as one of Health Data Management’s Most Powerful Women in healthcare IT, an entrepreneur of the year finalist by Ernst & Young, and most admired leader and tech titan by the Phoenix Business Journal among other accolades.

Prior to co-founding WebPT, Heidi practiced as a physical therapist for more than fifteen years. She regularly speaks as a subject matter expert at local and regional technology, entrepreneurship and leadership events as well at national PT industry conferences. She serves on a number of Boards and organizations including the Arizona Science Center, Support My Club, the Physical Therapy Political Action Committee, the Institute of Private Practice Physical Therapy, Conscious Capitalism, AZ Chapter, and the Arizona Community Foundation. She also dedicates time to mentorship within WebPT through her women's empowerment group, PropelHer and in the broader community through her work with physical therapy students and local entrepreneurs.

PTO 17 | Marketing And Growth StrategiesWebPT came out with their state of rehab therapy based on a survey of over 7,000 rehab professional respondents. Heidi and I are going to talk about four things that came to the forefront from their surveys. In this episode specifically, we're going to focus on one striking aspect that has to do with physical therapy ownership. That is the fact that a number of owners lack a marketing strategy. They're unaware of what they're spending on marketing and they most of the time fail to have a growth strategy in place. We are going to talk about some of the data and statistics that came from that and also look at some of the past, current and future trends for new patient acquisition. I hope you get a lot from this episode, but you can refer to the WebPT report it's on their website. Go ahead and check it out.


My guest is Heidi Jannenga, the Founder and Owner of WebPT, a leader in our industry. Thanks for coming on, Heidi.

Thanks so much for having me, Nathan. It’s an honor to be one of your guests.

I know everyone throughout the industry knows about WebPT. Do you mind going into a little bit of your backstory and sharing with the audience where you came from as a PT or even prior to that? What got you to where you are ten years into your ownership of WebPT?

My interest in physical therapy started when I was in college. I was a high school athlete. I went on to play basketball at UC Davis in Northern California and injured my knee during my junior year. I was pre-med going into college. I had a knee injury, the MRI was inconclusive, but they saw some things going on with my ACL. They said, "We're not sure. We don't want to go in for surgery. We're going to send you to physical therapy." I've been in the athletic training room as most athletes know very well but hadn't had much experience at all with physical therapy. I was sent to an amazing therapist whom within about ten weeks had me up and running and back playing again with a brace.

It intrigued me to learn more. I did a few volunteer internships and I ended up going on to PT school after I graduated from UC Davis. I went to the Institute of Physical Therapy, which I was in the inaugural class with Stanley Paris and Catherine Patla for their Master's program. They had done a lot of postgraduate work, but this is their first program. That was a unique experience. I had lots of training from two amazing gurus. Then I went on to practice sports medicine in private practice. I practiced for about fifteen years and worked my way up over time to clinics directors. In 2006, I was a clinic director over a few clinics here in Arizona. One of our biggest expenses was transcription and dictation.

PT owners lack focus on marketing and growth strategy. Click To Tweet

A lot of our referring physicians had transitioned into using some digital documentation or electronic medical records. I thought there had to be something out there for therapists. I went out, found some very clunky server-based platforms that were super expensive. Even at a clinic my size which we had about 40 employees, I still didn't think it was an appropriate capital expense. I partnered up with a software engineer and we put our heads together. We built something that was originally just supposed to be for my practices. We’ve got something up and running and got very positive feedback from my therapist. It took about nine months to build. Then within the next six months after we got our clinics up and running, some of my colleagues said, "What are you doing over there? We want to try it."

Within another six months, we had about ten clinics up and running, all giving us positive feedback. We continued to iterate on the process. In the middle of 2007, we decided to do a little bit of market research and found that 80% of therapists were still documenting on pen and paper. The light bulb went on and we decided to launch the company in February of 2008. We launched the Combined Sections Meeting in Nashville in 2008. We had no customers outside of those that we had in Arizona who were using our platform and one employee. We are celebrating our tenth-year anniversary, which is amazing. It's like the blink of an eye, it's gone by that fast.

That conference with one employee, I'm sure that was just like a hockey stick that went straight up.

It's been an incredible ride. We now have 500 employees. We’re not just located here in Arizona, but in eight other states and serving 12,000 practices. I stopped practicing in 2011 after my daughter was born, and that was a hard transition year of going away from your identity as a person, your career. Obviously, I still have so much pride in being a physical therapist. I maintain my license, you never know one day I might be back treating patients again.

Making that transition from patient care and even as a clinical director to owning a business had to be a huge transition. A lot of support, coaching, consulting that came into play and helped a lot to mature.

I always have used mentors along my path in my career, in general, to learn about best practices, to learn about speed bumps that I could prompt potentially avoid. What was interesting though, which finally made my transition a little bit easier, was to fully grasp and understand my clinic director leadership knowledge of running a business. We basically ran our clinics even though the ownership wasn’t my company or my clinics, but running it like you were an owner. The people leadership and the culture of our clinics were those skills and that skill set was immediately transferable into building a software business even though it was completely two very different industries. The quicker I recognized that allowed us to ramp up and allowed me to feel more confident in completely switching industries at that point in my life.

PTO 17 | Marketing And Growth Strategies
Marketing And Growth Strategies: Mentors guide you along the career path, helping you learn about the best practices as well as the speed bumps that you could potentially avoid.


We're going to go into your report that you put out here in the last couple of months based on your surveys. What are some of the things that WebPT is focusing on and looking to in the future?

Over the last three to five years, we've expanded way beyond just being an electronic medical record. We’re much more of a portfolio platform company for rehab therapy. We've never wavered in terms of our focus on rehab therapists, which includes PT, OT and speech. Our core is the EMR but on top of that, we've added so many more digital tools for clinics to run their businesses. This includes patient retention management, which is a way for therapists to continue communicating and retaining patients within the community that they've built and worked so hard to get into their practices.

We have multiple ways of billing on behalf of your own practice, whether you like to bill on your own. We have a platform called Therabill for smaller practices that you're able to do. We made a huge acquisition with BMS with John Wallace's company who is now part of the WebPT portfolio, which we offer a revenue cycle management as well as what we call RevEquip. This is a hybrid model where you can still do some of your billing and maintain some control. We also help you to make sure those claims are getting to insurance companies in the cleanest manner that they can be. We offer a whole lot of cool functionality beyond just the electronic medical record.

One of the most important things that we always try to utilize in our clinics and recommend the same is especially as owners come around if they haven't already and they need to be, is to recognize their KPIs and having an all integrated software like yours. They need to be able to easily obtain those reports and know exactly what the health of their clinic is like. You have developed that out.

That has been our main goal over all of these years. We were the first web-based application to enter the market which is significant because all of the data is held by us as a software company versus server-based companies. The data lives in your practice. With all of that data, we have the ability and what we are doing with the analytics program is offering benchmarks. We have such a density of clinics all across the US and the platform of information and data. We're able to show a significant KPIs of what those benchmarks could look like across the country. Our ultimate goal of triangulating outcomes with clinical data along with payment data.

WebPT can support owners with their internal marketing via their Patient Retention Management tool Click To Tweet

Understanding how those three worked together to hopefully influence more and more, which is our main mission. Our mission in general is to empower therapists to achieve greatness. Part of the greatness we feel is trying to conquer this 90% problem. This is the 90% of people out there who don't know that physical therapy exists. They're not getting into our car clinics across the country because either they're not getting referred in with the appropriate diagnoses that we could help them with or they just don't know who to turn to. They don't know that we as therapists have to deliver the value and help them with their ailments. We're all fighting over this 10% of people and wondering why we can't get more patients in the door, which is a great segue into why we created the industry report.

When I saw it come out, I thought, "This is such valuable information." I hope all the physical therapists are taking the time to just look over it. You have a PowerPoint presentation that breaks it down easily into graphs and simple statistics. It's a survey that includes over 70,000 respondents across the nation, across the rehab spectrum and this is your second one, right?

Yes, it's our second annual. Part of who we are is what PT is from the beginning. We wanted to build a community. It's partly why we call our customers members because we’ve built this community around WebPT. A big portion of that is around education. We offer lots of free webinars. We did an amazing one around billing, the nuances of billing. We make sure that we have the most knowledge available, pushed outward to everyone, not just people using our software. That's a huge gap that people are nose to the grindstone treating patients all the time, but there's a world around them that's changing with compliance and regulatory change, billing and knowledge and technology for that matter. To help enable them and automate some of the processes that they have been struggling with and just don't know how to use.

That's been a big part of who we are as an organization as WebPT. The data play is also big. We took on doing this survey because when we went out and asked a lot of questions to as many resources as we could think of, we couldn't get answers. In the WebPT way we decided, we're just going to go find out the answers ourselves. We put out this amazing survey and got about 5,000 respondents. We took the feedback from those who downloaded the report and had more questions. We added to the question poll. We got over 7,000 respondents and I've put together this amazing report. You can download the report if you go to, State of Rehab Therapy report. I think it's more than 70 pages long. Don't be intimidated by that because we break everything down into small, digestible bites of such great information about the industry. I'm so glad that we're able to do it.

PTO 17 | Marketing And Growth Strategies
Marketing And Growth Strategies: It’s extremely valuable for physical therapists to know what’s going on outside of themselves and outside the bubble a little bit.


It was easy to read. You say 70 pages and I don't want people to get scared off by that. If you take the time, you can skim through it. You do a good job of highlighting the important information. I recommend everyone going through it and reading it to see where we're at on this in the state of the industry. It’s valuable information and what you’re talking about also in regards to benchmarks and how people are doing across the country. It's extremely valuable for physical therapists to know what's going on outside of themselves and/or outside of their community, outside of the state, just to look outside the bubble a little bit. As you put together this report, I know that a few things stuck out to you. I'll let you talk to us a little bit about those four items that you noticed after reviewing the survey results.

We can go into each one a little bit more in depth. There were pretty much four takeaways that we wanted to make sure everybody got from this report this year. The first one is the lack of focus on marketing. With our transition, I shouldn't even say transition because we've had direct access in most states for quite a long period of time. This transition into understanding is not just about marketing to physicians, it's also about marketing to the consumer. The consumer who is potentially the patient. This is where that whole 90% comes in that we've never necessarily understood how to attack. This change in mindset requires marketing and a knowledge of marketing.

We were a little bit astounded to be honest, even from the large enterprise groups who responded to our survey. Most people don't know what they're spending on marketing and they don't know necessarily what the ROI is on what they are spending. The second one and we've written a couple blogs that had a lot of interest and a lot of feedback on is around this mounting student debt. We're not alone in terms of our students who are going through PT school. We've made this transition from masters to DPT. We have people seen value from that. Obviously, increased in price has gone up for going through to get a DPT, but that hasn't necessarily shown up in our paychecks when it comes to first jobs and what we're able to pay therapists.

Alongside that is also something as a woman and a female therapist and as a feminist, the mounting gender gaps that are better in healthcare than in most other industries. It's not bad in PT, but it still remains pretty significantly. We’re addressing that and we had some good feedback around that. The last one is high patient dropout rates. When we consider that we're only getting 10% of the overall population that could use us, then you have patients that aren't even finishing their plans of care, the number of people that we’re touching and have the ability to get great outcomes with significantly diminishes if you're not paying attention to those dropout rates.

We've always talked about retention or rival rates, cancellations and no-shows. We definitely pay attention to that. What we're talking about is the whole episode of care. If you thought that they should be there for ten visits, but they drop out at three, the outcome of that is not positive. It could be. There are lots of scenarios that you could say, "They got better in three visits. That's awesome. You're a great therapist." They walk away saying positive things, but it's a lost opportunity to leave a longer impression on what physical therapists do and how they can continue to help you and keep them in your community.

Owners need to recognize what their therapists are saying. Click To Tweet

You talked about having a lack of focus on marketing and growth amongst the ownership. It's interesting that it might have been a month or two before you released your report, but the APTA also put out and showed the physician referrals are at an all-time low. From 2003 to 2014, referrals from physicians had dropped over 50%. If that's not just a red flag that the days of focusing on physician referral and putting your money and shoving your money into that space isn't going to get you very far, it's just not happening anymore.

It's no coincidence that the opioid epidemic has also occurred during that time.

I didn't make that connection.

It's an interesting path of one going up as one comes down. APTA was specifically focusing on PT referrals. That can be positive if you think about it the number of patients coming into practices hasn't significantly changed. There are more people who need us, physical therapists, as PT continues to grow in terms of the Baby Boomers. There's more opportunity for us to see patients. Hopefully, the direct access has improved. I know we've done a bit of a push. A lot of people are now much more available to take patients in without referrals from physicians. Insurance companies have jumped on board, the Medicare no longer requires it on their first visit. There are a lot of things that have come into play to allow that statistic not to be super negative. I'll just harp on the 90%, we're still not getting to the people that truly do need us. They're seeking other avenues or physicians are giving out medication instead of getting to the root cause of what's causing musculoskeletal pain, for example.

What we're seeing at least in our clinics is that physicians are telling our marketers nowadays we don't guide where the patient's going to go. We give them a prescription. We know you are out there all over the place. Just see who's in the network and decide for yourself. More and more physicians are doing that. I see that in Arizona and our clinics there, but also up here in Alaska as we're talking to some of the physicians. The people need to understand that trend. If we can take it positively, it's our opportunity. In one way you could say we're getting forced in this direction, but let's go after the 90%. There's a big pool of patients out there and you know as well as I do that a lot of times PT owners can get very competitive in their spaces geographically. When we recognize that, we're only fighting over the 10%, there's 90% more business out there. We need to jump into a bigger pool and make a difference.

PTO 17 | Marketing And Growth Strategies
Marketing And Growth Strategies: Getting that awareness out there is imperative for us to focus and put more effort.


That will do two things. Number one, it can increase our access to the number of patients. Number two, it needs to extend the awareness of physical therapy. I'm sure you saw it when you treated and I saw it as well, but patients asking me, "Do you guys treat low back pain?" "Yes, all the time." Getting that awareness out is imperative upon us and to focus and put more effort. Recognizing where our money's going, what the ROI could be and should be for marketing those people. Getting the word out that we are the rehab experts. The doctors have some good ideas, but we know how to overcome your musculoskeletal pain.

It's working together with the physicians. You never want to throw anybody under the bus. On our billing webinar, there was a question about the fact that they're starting to get primary diagnoses from physician referrals, opioid addiction and long-term drug issues. They were like, "Is that okay? Can we actually treat these patients?" They have secondary issues, a muscle weakness and abnormalities and strength problems. I was like, "Are you kidding me? Everyone on this webinar should be cheering as loud as you possibly can seize this moment." There are so many people who are having to change their medication and take them off these opioids and they're still in pain.

Having physical therapists be that alternative to these pain medications is absolutely an opportunity that we need to be seizing. That may be their primary diagnosis that we can't treat them for that, but here are all of the other problems in pain which got them to that place, which we can treat. That's the one that we should be able to be doing. When it comes back to marketing, which is exactly what you were talking about, people and even physicians are no longer necessarily referring to some specific person. I still think that relationship with physicians is very important.

It's super important they're generalizing because of the way that people are searching. There are lots of studies out there that show that patients will go online before they do anything and decide where to go regardless of what the physician said because they're looking at online reviews. They're looking at your website, they're are checking out anything that anyone's ever said about you if they referred to you specifically. They want to know about the clinic. That's an impression before they even walk in your door if you don't have a website that truly reflects what you do in your practice, the diagnoses that you treat, what it looks like, online reviews, you're missing out potentially on people that are going to be looking for that. I think that 72% of patients use online reviews as the first step in finding a new healthcare provider.

You better have your website dolled up. It's got to look good.

At least you need to be present on Google Maps, on a Google Search. You have to be out to have an online presence these days. It's a no-brainer.

It’s imperative that patient experience is seamless in every business. Click To Tweet

You've got to come to understand some digital marketing. If you're not tech savvy, find someone who is. There are companies out there that will help you. I know you did a Webinar with Neil Trickett over Practice Promotions. I've interviewed him as well. I will interview more in the future like David Straight from E-rehab. These people will help you. They work specifically with PTs to get your digital marketing presence out there because to solely referring physicians, you’re behind. There are times you’ve got to pull your head out of the sand and recognize that people are looking at your digital presence more than your physical presence than anything else. Even though they get the word of mouth, what's the first thing they're going to do? "Let's check out the website. “

Once they're there, you’ve got to show value and customers service. It has to be impeccable from the time they walk into your door with your front office, which we call our first impression officers to when they leave and the how the billing goes. All of those nuances. When I was practicing, we could get great outcomes for our patients. They loved as clinically but if we messed up on their bill, we were dead to them. It's hard to part that. It was difficult sometimes if we had those building experiences, but it's about the patient’s experience from start to finish. Every piece of that becomes more and more important because people are looking for value. Especially with the higher copay amounts that suppose these days you've got to show them value. They want to know the outcome. They want time with you. They want to understand the why of what you're doing. The digital tools that are available out there, which the WebPT portfolio has a lot of them, but regardless of what tools you're using, it's imperative that patient experience is seamless but also shows value. That's part of marketing.

I like that you talked about showing value to the patients that are already with you because that could be huge. Getting a return patient is huge. It's a part of marketing that I call it internal marketing. I know other people call it the same thing or something else. That internal marketing part of it is extremely valuable because these people are going to be spreading the word of mouth. They're going to be providing you referrals via word of mouth. Are there some things that are within WebPT that help the clinic owners and the practitioners improve their internal marketing?

Yes. We acquired Strive Labs, which we call WebPT Reach, which is a patient retention management platform. In which you can put out newsletters, texts messages, keeping contact with communication through a mobile app with a patient's digital home exercise programs in which you can provide feedback through. It's this patient connection that we have emphasized over the last couple of years. It is so important and it's a differentiator because they want you. They may not be able to come in to see you as for as many hands-on visits as previously we were able to do. Evolving our practice in how we think about things has to happen. We're providing those tools to do that. We have the patient call reminders to make sure that you are minimizing those cancellations and no-shows and making it easy and seamless from the beginning of a digital intake to capture a lot of information from the patient, so you can get some of your preliminary insurance verifications done. When they come in it's like, "We're happy to see you. Here's what we've already done for you." That patient experience is just stellar from the beginning.

That's cool that you've incorporated all of that into the EMR, so someone doesn't have to click out of your website or out of the app to find what they need. They can only do within there and see all the notes pertaining to that patient and send individual emails or mass emails if that's what you need to do like you said with the newsletters.

The internal marketing piece, I always think about it from an educational perspective. Having our outcomes platform built-in and integrated to where you can share that information with the patient in terms of how they're progressing along their path. What are some of the things you’re specifically going to work on and getting that feedback from the patient and what they still can't do? Collaboratively working with your patient on goals. It makes them part of the process. That engagement helps to make sure they are going to be completing their entire plan of care per your expertise in what you've given to them.

PTO 17 | Marketing And Growth Strategies
Marketing And Growth Strategies: You’ve got to pull your head out of the sand and recognize that people are looking at your digital presence more than you actual physical presence.


I know it’s abrupt and I’m sorry to interrupt the interview with Heidi. We talked about a ton of stuff in our interview. I broke it up into two parts. The next few topics we’ll be going into, we’ll be able to delve into quite a bit. I’m breaking it up into two episodes, so stay with me. In the meantime, Heidi made it known to me during the course of the interview that she is offering a special promotion for the WebPT Ascend 2018 Conference coming up this September 27th through 29th in Phoenix for my Physical Therapy Owner Club audience. She has setup a special promotional code so that when you register, in the promo code box, type in PTOWNERSCLUB and you’ll get a special discount for your registration for Ascend 2018. A select conference for PT business owners and their staff. Make sure you recognize that, it’s not just for the owners but also for your admin staff and your billing staff. Stay tuned and join me for the second episode of my interview with Heidi Jannenga. Be sure to register for her conference. Also, please subscribe to the podcast and leave a review. It’s huge for podcasts to have a number of subscriptions or subscribers and reviews on the podcast. It helps in growth and attraction to other podcast listeners. As a favor, please do that as well. Stay tuned.

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About Dr. Heidi Jannenga

PTO 17 | Marketing And Growth Strategies

Dr. Heidi Jannenga, PT, DPT, ATC, is the co-founder and president of WebPT, the country’s leading rehab therapy EMR platform for enhancing patient care and fueling business growth. Since the company’s launch in 2008, Heidi has guided WebPT through exponential growth. Today, it’s the fastest-growing physical therapy software in the country, employing nearly 500 people and serving more than 75,000 therapy professionals at more than 12,000 clinics. WebPT has also ranked five consecutive times on the prestigious Inc. 5000 list and twice on the Inc. 500. Heidi has been recognized as one of Health Data Management’s Most Powerful Women in Healthcare IT, an Entrepreneur of the Year finalist by Ernst & Young, a Most Admired Leader and Tech Titan by the Phoenix Business Journal, among other accolades.
Prior to co-founding WebPT, Heidi practiced as a physical therapist for more than 15 years. Today, she regularly speaks as a subject-matter expert at local and regional technology, entrepreneurship, and leadership events, as well as at national PT industry conferences.

Heidi serves on the boards of numerous organizations, including the Arizona Science Center, Support My Club, the Physical Therapy Political Action Committee (PT-PAC), the Institute for Private Practice Physical Therapy, Conscious Capitalism AZ Chapter, and the Arizona Community Foundation. She also dedicates time to mentorship within WebPT (through her women’s empowerment group PropelHer) and in the broader community (through her work with physical therapy students and local entrepreneurs).

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