PTO 152 | Greater Impact in the Community


Making a greater impact in the community is a dream for many medical professionals. Alicia Backer, PTA has spent the past 7 years developing a culture and a clinic that is focused on doing just that. In this episode, Nathan Shields interviews Alicia as she shares what her clinic does to find team members who share their mentality and are ready to do some of the things they do to integrate themselves into the community. Alicia and her team have generated a fun culture that looks forward to working and playing together. Their patients sense that and gravitate to them as clients.


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Making A Greater Impact In The Community With Alicia Backer, PTA

I’ve got Alicia Backer, PTA, out of Thief River Falls, Minnesota. Alicia, thanks for joining me. I appreciate it.

Thank you, Nathan, for having me.

I don’t have a lot of PTAs on the program but you wrote a great article in the April IMPACT Magazine about becoming a community alliance champion and you had some good insight that I liked. It spurred some thinking on my own and thought it was worthwhile to bring you on and talk about the things that you brought up in the article and want to get into that. Before we do that, tell us a little bit about you. Where you’re coming from? What you’re doing nowadays?

I’m from Thief River Falls, Minnesota. It’s up in the Northwestern corner. We’re pretty close to Canada. It gets pretty cold up here. Most people don’t think there are humans that can survive this element but we do. I work at a private practice outpatient clinic. I live in a town that’s approximately 9,000 people. It’s pretty rural. We have a lot of outside communities that come in to see us, too. I graduated from the Physical Therapy Assistant Program in 2010. I’ve been in a physical therapy community for several years now and had some good experiences in a few different settings that gave me some of the knowledge that we’ll talk about. I have 5 kids, step kids, 2 of my own and 3 step-kids. It keeps me busy outside of all the other stuff that I do at work and for different parts of the physical therapy world.

Do you do something in your clinic that provides a lot of outreach to the community? Your article was about community alliances. What things are you doing then in terms of reaching out to the community in your setting? Your supervisor allows you to reach out. I’m assuming you have different aspects that you’re involved in the community. What do you do?

I’ll take it back a few years before I started working in private practice. I worked for a larger outpatient clinic in a hospital setting. While I was a part of that setting, I never was involved in marketing opportunities. I wasn’t involved in the process of planning it, what it meant, I didn’t care. It was much more based on productivity and seeing lots of patients. I didn’t have any knowledge at all working in private practice but once I started working here, we’re community-based. We have a high percentage of direct access patients. Instead of marketing to physicians, we spend more time marketing to the community. There’s a large employer in town that probably has about 6,000 to 8,000 employees that has a great insurance policy and they give us a high percentage of their direct access business.

We’re involved a lot with them. We partnered with them to create a work readiness program or injury prevention program for their business which was a huge step in the door for people getting to know us by coming in and being present and giving them that program. We do a number of things in the community. We put on the raises and we host chamber events. A lot of our employees are coaches in the community. There are a lot of things outside of the marketing box that we do that you don’t necessarily think are marketing. It’s not paying for marketing. It’s being present. It’s your time rather than money.

Is there an expectation in your clinic that you do some of those things that you lead out and either generate the race yourself outside of the ownership, taking responsibility for the team members in the community, certain things in the name of the clinic?

It only takes to have one person that's not coming to things or isn't fully engaged to bring down the morale. Click To Tweet

When we hire our people, the expectation is pretty much set in the interview. That is a big part of what we do and what makes our clinic successful and a part of our culture. We have a pretty unique culture. When we hire people, we make sure that they know the community events that we do. It’s not required but it is a volunteer. We look for people who are very highly engaged and high achievers that are looking to also do that type of stuff. We have a great team. There are eight people that work here. Everybody is excited when we do events. It makes it fun. It doesn’t make me worried when I delegate tasks because I know everyone’s going to follow through. I’m not great at delegating. I like to do everything myself. That also helped me learn more about the right way to go about marketing because involving your team, which are your huge stakeholders in this. It’s huge in your success.

It’s part of the interview process. It’s coming from the culture you’ve generated. I would assume if your supervisors or the owner was hiring somebody and they shied away from doing community events and weren’t that excited about it, they’re just not a fit. They’re not going to come in the first place. The fact that you bring it up in the interview process sounds like a huge part of it. You guys know who you are and you’re looking for a certain type of person.

When we hire people, I can’t say that we wouldn’t hire someone based on that solely but it does sway to us pretty heavily in one direction or the other because we have made that mistake in the past. It does end up not working out in the long run. You feel like when you have all the team members on board, everything feels good. Everybody’s enjoying it. Things are going well. It only takes to have one person that’s not coming to things or isn’t fully engaged to bring down the morale.

Those people probably self-select more than anything. They’re very, “I don’t fit in. This isn’t a fit for me.” It seems obvious, maybe like a natural party-wise, but the fact that you guys make it part of the initial process, you’re upfront about it. It sounds like there’s not necessarily an expectation that the team members are going to generate community-based events but the people need to be excited about doing so.

That’s an option, too. We can probably hear passion projects or people work on passion projects. That is what we say to them. “We want you to be involved but you’re never required to plan anything but if you want to, you’re more than welcome to do so.” We welcome all the ideas and creativity. Anyone who brings something to the table, it’s always talked about. You never shut it down because there’s always a way that you can figure out how to make it work.

The fact that you also have a culture that’s open to that because there are many scenarios where it is about productivity. “We’re talking about the members. Let’s move on. How can we improve?” It’s not as much about the culture so much.

We have a staff meeting every week that we hang out at lunch. It’s very informal. We talk about certain stats and stuff but everyone gets a chance to talk about whatever it is that they have to talk about that week. A lot of times, it’ll be about planning our next event. How we should make it better and what we should do or somebody will bring something new to the table that you’re like, “That’s crazy. I never thought of that but it’s fantastic.”

When you go out to these community events, what have you found are some must do? What mindset do you have going into these community events?

PTO 152 | Greater Impact in the Community
Smile & Move (a reminder to happily serve)

I always think about smiling and moving. It’s a book as well. Sam Parker has a book called Smile & Move. I don’t know if you’ve ever read it. It’s fantastic. I stumbled across it. It totally resonated with how I live. I thought, “This is amazing.” When you go to a community event, if you’re smiling, people are going to think that you’re approachable and likable. Moving means to serve people so be engaged. I don’t ever go to an event saying, “I work at Rehab Authority. I’m a physical therapist assistant. Have you ever been to PT?” It’s more like getting to know them then eventually it comes up, “What do you do?” You can talk about, “This is what you do. This is why you’re here. If you ever need us,” it’s more of a casual, “This is where we’re at. We’d love to help you,” but it’s never pushing yourself on.

You talk about this quite a bit in the article is having confidence in what you’re doing can help a lot of that. It makes it easy to smile and move if you have that confidence that lacks in our profession, knowing that we are the musculoskeletal experts. For some reason or other over the years, we’ve shied away from that. Some people might be afraid of saying that but if you go to these events knowing that you’re the musculoskeletal expert in town, your area, your niche, you name it, it makes it a lot easier to stand strongly in your space and be open to helping.

I know when the patient comes in our doors and has set up that visit or that free ten-minute consult. Once we get them in our doors, I know we’re going to help them. We’re going to do the best that we can. I have all the confidence in our staff to do that. It’s getting them there. We sell our culture and the type of people that we are by how we act and that we’re likable, you smile and we have fun. One of our core values is we have fun. That’s one of the top ones. If you get the patients in here, they forget why they’re here and the pain that they’re in. They are having a good time. A lot of times, they don’t even want to leave. It isn’t about selling what you do necessarily. It’s getting them in your doors.

Many people buy on what they feel. Buying is an emotional experience. Physical therapy is not exempt from that. I talked about this in an episode long time ago with Jerry Durham about improving the patient experience. Simply by focusing on them and the experience around physical therapy, not so much about the therapy itself can improve engagement, increase internal referrals, improve culture and an ability to have a greater impact in the community.

Culture is my favorite thing to talk about because I live in a great one. It’s easy in respect but first, you have to surround yourself with great people, which you talked about in hiring. You got to make sure. Just because they’re not the right fit for you doesn’t mean they’re not a good therapist. We all have a place that we are meant to be. Having expectations that we’re a high achieving, high energy makes a relationship. It’s all about building relationships with people then they’re going to keep coming back. They’re going to tell other people to come here. A lot of times, patients will come in because their friend has told them to come here. They’re like, “My friend said I need to come here because you are so much fun.” It’s never initially because, “You’re going to help my pain. You’re going to make me feel better. It’s because you guys are fun,” we love hearing that.

Tell me a little bit about that. It’s not necessarily related to your article but are there certain things that your owner has done to generate that culture? Whether it’s a routine. You talked about the weekly staff meetings and your agenda lens to that. You know your core values. Those are established and you probably talk about that quite a bit. What are some things that have generated this culture you’re talking about?

It first starts with good people. We have great people here. In the environment that we’re in, we have a pretty open clinic. We have two private treatment rooms. We solely use those for evals, anything that requires an enclosed room, exposed skin and then if anyone feels uncomfortable in that area. There’s a very small percentage of those people. We’re set up to have a great environment for not just us to communicate with each other but patients to talk to each other. We yell at everyone when they walk in the door and when they’re leaving. They relate us to Cheers, Everybody Knows Your Name. When they graduate from therapy, we announce it over a megaphone. We have a dance party. We have a graduation gown. We always do the extra. We have Fresh Cookie Fridays every Friday. We have dress-up days a lot where we’re dress ridiculous. They love that.

I bet National Physical Therapy Month is a month of a party for you.

COVID really challenges the marketing calendar because when everything's closed down for a year, you just fall off the wagon. Click To Tweet

We have a chili cook-off and a pumpkin painting contest. It’s pretty intense.

You got the patients involved and all that good stuff.

It’s fun. We do a lot of competitions, too, like sprinting and flippers or something random. These people are crazy weird but they’re fun.

The cool thing about your open gym concept, it’s one thing to have it. The other thing is to get what we called crosstalk. It’s like shouting to the therapist on the other side of the room or having a conversation over there. Inevitably, whoever’s between me and that other person is going to get involved in the conversation, too. We’d even generate that by having a whiteboard that would have the trivia of the day. If you don’t have anything to talk about, there’s something on the whiteboard to talk about.

You can think of so many things to put on a whiteboard. Fun-Fact Friday, where we talk facts about each staff or competitions. It’s great.

Culture is so huge. You talk about culture, thinking that this is what’s going to get the best-aligned employees and retain them. It carries over. The patients feel that as well. It improves the patient experience and the desire to come. They might know that so-and-so down the street provides a certain amount of physical therapy that might be equal to, maybe even better than yours. If they simply like coming to your place more than 2 to 3 times a week, they’ll probably going to come to your place.

That’s the best part. Therapists are competitive. It’s our nature. We want to be the best.

Talk to us a little bit about the marketing approach as you talked about in the article. It sounds like you know who your niche is. Your marketing strategy revolves around where those people are most of the time. In the community or on social media, you’re spending time in those spaces.

PTO 152 | Greater Impact in the Community
Greater Impact in the Community: It's all about building relationships with people. And then they're going to keep coming back and they're going to tell other people to come here.


Being so rural, we do see from 0 to 100. We see women’s health, vertigo, all the things. When we get a new therapist in our clinic or interviewing, we ask them that like, “What is it that you’re passionate about? Do you love pelvic health?” You have to cover all the niches per se if you want to maximize your success. When we go out, we have a new therapist who loves athletic rehab or sports injuries. What direction would you go to market that? If you love women’s health, where do you go to market that? How can we make that good? We take a case by case and we market to that population.

I love the wording that you use because as you bring in that person, you talk to them about where their passion is and what they want to focus on maybe but you don’t then stop the conversation. The next question is where are you going to go to find them? Many times, maybe you had this feeling as a new grad but newer grads come out thinking, “I’m going to join this clinic. Some other person’s going to provide me new patients,” and they don’t have to do any work for that.

You have to push especially if it’s a newer grad. You have to encourage them along and keep motivating them to like, “What’s the next step?” We had one here, start women’s health program. That’s an area that doesn’t have a lot of PTs are interested in that area. It’s a huge need and super rewarding. She’s working through that process. I said, “What are you going to do next?” She’s like, “I know I need to do it but I just like,” “Go. Get it done. Take action.”

I love how you set them up for that success, recognizing that they have some responsibility and accountability to develop their niche and that growth in that. This isn’t going to be handed to them. They have an active role in that. It was at the very end and there’s a lot like the last paragraph, you talked about the importance of a marketing calendar. Talk to me about that.

COVID challenges the marketing calendar because when everything’s closed down for a year, you fall off the wagon. We talk about that in our weekly staff meeting. In the year, we know in a timeframe we’re doing these things. Say around Christmas time, we always do this. We always have a Christmas dress-up week. In the summer, we always have friends and family appreciation day. We’re in the big parade in town in July. We have hosted a 5K in August. We were constantly talking about what’s next and what more do we want to do. They’re having a CrossFit challenge in town. How do we get involved in that? There are some kids that want to do a scholarship because of mental health awareness. How do we help them? You hear about something and it doesn’t always work where you can’t necessarily get involved but it’s worth giving it a try.

The cool thing is that you’re talking about on a routine basis as well and you’re looking ahead on the calendar. Say something like Halloween comes up, you start talking about it on October 27 and like, “What are we going to do in four days for Halloween?”

You don’t love it.

It sucks because we’re under the gun and there’s pressure. I’m assuming that these events don’t take you by surprise. You’re able to be fairly well prepared for them and that makes it more fun.

It really isn't about selling what you do necessarily. It's just getting people in your doors. Click To Tweet

It does. When everybody is on board, it’s pretty easy.

It makes it so much easier especially if you’ve done it before. If you have some traditional things that you’re doing, you know what we got to do and what everyone’s strengths and weaknesses are, you play to people’s roles and everyone knows what they need to do. It’s also, at that time, a lot easier to add on and make it an even better 5-star, 6-star, 7-star experience.

That’s a lot of the challenge when somebody is maybe opening their own practice or looking into starting a marketing plan is they want to do so much like, “We got to do this.” You’re better choosing the populations in the areas that you’ll receive the most return from and also knowing your payer mix, where you should focus most of your energy there and then build on it. That’s what got me a little bit more knowledgeable on this subject. When I started working here, it was just one PT and I. He opened it. We quickly needed help in the front office area. It was three of us for a long time. I’m also the clinic administrator so I take some of the buffering between the rehab director and the rest of the staff.

I was doing everything. I’m an achiever and maximizer. I feel good at the end of the day if I get all these things done. If I don’t, I feel lousy about it. I wanted to do everything and be a part of everything. I used to be bad at delegating tasks because I don’t always trust the people who are going to do them as good as I can. I got to the point where I started not enjoying them as much because I was feeling tired and burnt out. I realized that I needed to rely on people and trust that they were going to do as good of a job, if not better. It did turn out that way. I did start encouraging other people to take on more roles with these different events. I have my one area that I love. I love running so I love doing the 5K. Somebody else loves planning Halloween. Delegating those tasks so that you continue to enjoy them rather than feeling like it’s a bunch of work was huge for me.

You sound like a lot of burned out PT owners that I know. It’s the same thing with most owners and maybe your owner feels the same way or he or she doesn’t feel that way because you do all that for him or her but it’s that same thing. “I got many things on my plate. I know I can do them better if I do them myself,” but then you can only do so much. For me, it had to come down to, “Could they do 80%? Would I be happy with 80% of what I could do? If that’s okay then let’s hand it off. Let’s systematize it if possible or find someone who gets excited about that.”

For me, I’m not excited about marketing, like going to the doctor’s office to talk to the doctor who doesn’t want to see me and get past the front desk person whose job is to deflect and redirect me. I don’t want to do any of that. I had a PTA, she was awesome as a PTA but when I talked to her about marketing, she’s like, “I would love to do that.” Inevitably, there are people on your team who have strengths and get energy from things that don’t give you energy and are not your strengths. You have to rely on those people. That’s how you get a diverse marketing strategy in place and expand your presence in the community.

You’re talking about the calendar. That’s where we started with this conversation. It’s revisiting it and staying consistent. You don’t have to have 50 things on the calendar for the year. Pick something once a month, big or small and try and be consistent with that then you can always add to it.

You talked about payer mix in the article in here. We’re in a business. You don’t want to go towards the low payers all the time. If you know where the insurances are that pays better and you can find your niche within those and find out where those patients live, work and breathe then that can make things a lot easier on the business.

We have a couple of businesses in town. The one I talked about who has no medical responsibility. It’s 100% free healthcare and that’s all direct access. That’s huge for us but then you also have another large employer that has a high out-of-pocket responsibility. We market to them. We want to see them but we don’t spend a ton of our energy over there. That’s why we started the program with this business because we wanted to keep them coming through our doors.

PTO 152 | Greater Impact in the Community
Greater Impact in the Community: Get out and put in the extra effort and do more than people expect.


That’s smart in that way because every owner has to deal with that if they’re taking some insurance but even if they’re not taking some interest, they want to find their ideal client. That ideal client could be a certain athlete, a geriatric population, a certain patient within an insurance payer but knowing who that is and targeting your message towards them will generate more of those. It also has some carry-over to generate more patients from the other ones that aren’t your niche. We covered a ton of stuff. Is there anything else that you remember or recall from the article or from your personal experience that you think is valuable in reaching out to the communities and establishing good relationships?

You spend at what is it like the 80/20 Rule, 80% of your time preparing for your marketing plan and 20% is doing the work. You need to spend time thinking about these different things. Making sure you got good people and you utilizing your assets, using your people then get out there and find things to do that you enjoy. There’s nothing on our marketing calendar that I don’t look forward to. It doesn’t seem like work. It takes some energy. You usually are exhausted after the event’s over but I would do that 100 times before going and talking to a physician. It’s nothing against doctors but I literally would rather watch paint dry.

It sounds like based on your experience now and to flip that 80/20 Principle, you know what your 20% of work is that gets you 80% of the results. You’ve found a groove there. You have probably been to some community events where you’re like, “I won’t do that again.”

This is one thing I want to leave you with, 2020 has been challenging for everybody. We’re all coming out of it now. We’re feeling good here at our clinic, finally but everyone has gotten a little bit lazy. Getting out and about and putting in the extra effort and doing more than people expect like the whole Zoom meetings, get face-to-face if you can. Go and see people and start doing these things again and don’t just say, “We didn’t do it in 2020. I don’t know if we want to do the race this year.” Do it because you end up doing it. You realize, “This is why we did it in the first place.” It’s so rewarding.

Thanks so much for your time. Thank you for the article. If people want to read it, it’s in the April IMPACT Magazine. There’s a lot of good information in there. If people want to connect with you and maybe talk to you a little bit more about it, Alicia, how would they do that?

I will give you my email. It’s

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

Thank you, Nathan.

Important Links:

About Alicia Backer

PTO 152 | Greater Impact in the CommunityAlicia Backer is a Physical Therapist Assistant and Clinic Administrator at Rehab Authority in Thief River Falls, MN. She started her journey in 2010 when she graduated from Northland Community & Technical College in East Grand Forks, MN.

She has experience working in various settings since graduation but has spent the past 7 wonderful years working in the private practice community. Alicia was recognized as Rehab Authority’s Administrator of the Year in 2015 and 2016 as well as being chosen as MN APTA Outstanding PTA in 2020. She has presented at numerous national conferences including PPS and CSM as well as many local venues.

Alicia has been a co-developer of Injury Prevention and Performance Enhancement Programs and has created and implemented work readiness programs. She is an editorial board member for Impact Magazine where she has authored articles on clinic culture and building community alliances and has served on a PTA Advisory Board for Northland Community and Technical College from 2017-2021.

Outside of the physical therapy community Alicia coaches women’s basketball at a local junior college and works with young athletes as a speed and agility coach. Family also keeps her busy as she chases her 2 kids, Camdyn and Josie, to all of their activities while also finding time to run, read, and enjoy friends.

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PTO 147 | Care Plan


Treating patients isn’t just about getting them through the doorYou and your team also need to make sure their plan of care is completed. Our host, Nathan Shields, flies solo today as he talks all about making sure no patient falls through the cracks. Nathan discusses how to plan and execute a weekly walkthrough to make sure all active patients are attended to. We also hear about the benefits this brings, not just to the patients, but to your health care providers as well.  


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Nathan's Coaching Moment: The One Meeting That Has To Be Done Weekly 

I want to share with you something that Ive been working on quite a bit with my coaching clients. Something that we use to address issues regarding retention, situations in which maybe theres a busy season or youre expecting a busy season, but youre not as busy as you think you should be or just those situations when you might be thinking, “Whatever happened to that guy? Whatever happened to that girl? She came in a couple of weeks ago for her knee and now shes not here anymore. Worst of all“We had a ton of new patients and our total visits arent going up significantly this week. It seems like people have dropped off. 

That issue came up routinely for us in our clinics. There was one thing in particular that we did that helped it out and that was called the weekly walkthrough. You might be doing your version. You might even call it something different and thats great. Id love for you to share with the other owners what youre doing. Share with me and Ill let other people knowespecially if its a good idea. The issue generally comes up that patients are falling through the cracks. Youve got poor retention effortsor were not doing anything retention-wise to keep patients in the books. Theyre canceling, not rescheduling, and going on vacation and then not returning for physical therapy, you name it. 

The statistic that we want to improve with this particular action is increasing our percentage of completed plans of care. Click To Tweet

Ultimately, that leads to poor outcomes for the patients, lost patients, and revenue. That poor outcome for the patient eventually leads to a poor reputation for you because now theyre not getting the results that they want. Hopefully, but routinely, it gets back to the physician, That physical therapy clinic didnt work for me. We need to move on. That ends up being a loss of referrals for you, not in terms of the physicians, but also, theyre not going to refer to their family and friends. What is one thing at least that we did on a routine basis to help with these issues? That was called the weekly walkthrough. This is where it was simple. We got an Excel spreadsheetlisted all of the active patients and their future appointments with notes available to list any communication efforts that weve made. First onlist of active patients, next few columns the appointments that they had scheduled coming forward, and then lastly, any communication efforts that were made. 

Each patient on the list was addressed, whether theyre scheduled or not. What is their status? What are the communication efforts? If you can take it to the next level, the frequency in which they are scheduled at an appropriate level for their appropriate plan of care. Lastlywe would talk about who was formally discharged and informally discharged from that list. Formal discharge was obviously who agreed with the physical therapist that theyre not coming anymore. They popped the champagnegot the coffee mug and t-shirts, they high-fivecelebrity walkthrough, and lead them out the door. They were formally discharged versus those who simply arent returning your calls. Those are the informal discharges. Well talk about the important statistic to track that. 

Ultimately this walkthrough is focused on patient retention and that patient retention leading to happy and engaged patients meeting their goalsThe statistic that were going to try to improve with this is the percentage of completed plans of care. Thats the statistic I was talking about with the discharges. That percentage of completed plans of care is notoriously poor for our profession. Depending on who you listen tothat could be 10% to 20% of all patients that come through our doors are actually completing their full plans of care and meeting their goals, which is horrific. Its lost money, lost revenue, and poor reputations, you name it. Itall that stuff. 

The statistic that we want to improve with this particular action is increasing our percentage of completed plans of care. Another byproduct of it could be increasing the frequency per week that we see those patients. Inherently, if were only seeing them one time a week in a typical orthopedic clinic, theyre probably not getting well and not meeting their goals. Theyve got to come 2 to times a weekso you want to address that as well. What can the results be from the weekly walkthrough? The results are increased total visits, which leads to increased revenue, increased bottom lineprofits, and the patients ultimately are getting better. Theyre following through with their plans of care. The weekly walkthrough is a must and we called it the weekly walkthrough because we literally walk through each chart back in the day of each patient in our file folder in the file cabinet. Were old school. That was how it was back in the day. Now your EMRs can print out some of those sheets. Some of them arent very trustworthydepending on your EMR. It might be better for the front desk person to literally print all of the active patients and keep that active patient list going. Thatthe kicker. 

Heres the secret. This is the front desks responsibility. This is not your responsibility. Your responsibility is to make sure that this meeting happenssame day, same timeevery week. Ensure that it happens and that all the active patients are addressed. The responsibility to keep that active patient list up-to-date and fully communicated is the front deskresponsibility. They should be living in that form throughout the week, knowing where all the active patients are and exactly what efforts have been made to get those patients on the schedules. 

Ultimately in an ideal situation, I, as the leader, would come into the meeting. The front desk would hand me the Excel spreadsheet with all the patients listedall their scheduled appointments. If they dont have any scheduled appointments in the near future, especially the next weeknotes are made as to what their communication efforts have been and where that patient is. Maybe theyre on vacation or something thats happened that they cant come in. Everything is listed and they report to me exactly what is happening with all of our active patients. 

PTO 147 | Care Plan
Care Plan: The responsibility to keep that active patient list up-to-date and fully communicated is the front desk’s responsibility. They should be living in that form throughout the week, knowing where all the active patients are and exactly what efforts have been made to get those patients on the schedules.


Recognize this is the front desk responsibility and it needs to be reported up to you. That is their job to ensure that all the patients are on the schedule and make sure all their patients who are scheduled come in. That’s why one of their main products is arrival rate, but make sure that all the patients who are on the schedule to actually come in for their visits and ultimatelyfill the schedules of the providers. That’s their job. Make sure that this one meeting happens and what will you benefit from it? You’ll see an increase in total visits. Youll see an increase in revenues, increase in patients plans of care being completed. Happy patients that are engaged in referring friends and family and doctors who are happy that the patients are getting better and thuswilling to send you more patients. This one thing can help you with all of those byproducts and increase all of those statistics, making you a happier owner. Recognize that the secret to it all is that youre not in charge of it. 

Yes, initially youll have to do some training. Youll have to show them what to do and how to do it, but then eventuallythey have to take ownership. This is their responsibility. They are supposed to lead out in this meeting and show you exactly whats happening with all the active patients that are coming through your doors, so they are not falling through the cracks and not getting better. The weekly walkthrough, I highly recommend it. It has to be done on a routine basis and if you do so, things will improve in your clinic. Thats my moment for the day. 

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PTO 128 | Patient Engagement

Much has been said about the importance of maintaining engagement with your patients in order to avoid drop-offs and comebacks after discharge.  However, how to run an extensive program like that could be a difficult hurdle for owners to overcome. Thus they either don't make the effort or the program they start loses steam. That's where an automated engagement platform like Swell can minimize the time and effort in order to maximize the results (consider the 80/20 principle - this is the 20). Plus it helps you improve Google status by obtaining more, recent Google reviews. In this episode Baylee Jensen of Swell joins Nathan Shields to share the key things to note when obtaining Google reviews and how Swell can help you stay more engaged with your patients with less effort.


Listen to the podcast here:

How To Automate Your Patient Retention, Reactivation, And Reviews Programs With Baylee Jensen Of Swell

I have Baylee Jensen from Swell, which is a company that can help physical therapists in their in-patient engagement retention and also help them get more online reviews. Thanks for joining me, Baylee.

Thanks so much for having me, Nathan.

Baylee is Business Development and Partnership Manager for Swell. Her job especially is to work in this physical therapy space as we're talking about. She works with other healthcare industries, but we're talking specifically about physical therapy because she does have some experience specific to physical therapy. We wanted to help PT owners do a little bit better with that patient engagement side, the patient retention side, minimizes drop-offs, you name it, we're going to talk a lot about that. Before we get into that, Baylee, do you mind sharing with us a little bit about your professional path and what got you to where you are now and your experience with physical therapy?

I’ll take us back to college. I studied Communications in college. I loved it but I didn't know how that would apply to the real world. I found this space within tech that was communications. I’ve been working in the healthcare industry for years now. I was in dental for a while. I switched over into the medical rehab, podiatry, physical therapy, chiropractic. I do love physical therapy. Part of the reason is no injury is the same. You go into dental and there are a few things. It's like a plug and play but I like how different PT is and I love working with that. I work with our key opinion leaders, different organizations and companies within the PT space, of course, one-offs with my offices there.

What are you working on now and how are you focused on helping physical therapy and physical therapy owners at this time to improve that patient engagement side?

There are a few ways that we can take this. What this whole platform does and what we're trying to do is help automate but personalize that communication with those patients. We're all busy and we're living in such a very changing world. It's hard to get into that flow or have your schedule down. What we're trying to do is make it easy for the office to use but also easy for those patients to engage with.

What are some of the benefits to a program like yours? I had an interview with Heather Chavin of GoGoDone and she had written an article in Impact Magazine about how to better utilize our patient emails and social media and focus on retention. She outlined even in the article seven days straight of email campaigns from when that patient first starts to help them understand, “This is what we're expecting of you but there are also these hurdles that we're willing to work through you with. Expect these things work through these things,” but we're not talking those first seven days. We're talking email campaigns for post-discharge and then follow up stuff and maybe monthly or quarterly newsletters. There's a lot that owners could put out there but how do they do that? I assume it's a platform like Swell that could help them out.

Any business but especially a physical therapy clinic, it's a very dynamic process. You’ve got to get them in, then you treat them and then there's going to be a patient care plan. There are many steps. I’ve talked to a lot of physical therapy clinics and they'll spend a lot of money going to these marketing bootcamps or they're spending time and money marketing and spending all these campaigns. Without follow up and without that next step, you're not actually going to get that business into your practice. What we want to do is come in and automate that for you so that yes, you have those things running in the background but then you have a system that's going to take care of that and follow up. Yes, there's going to be a small piece to it but there's so much to worry about that we want to take a burden off of you and take that sales piece away from you and help you engage with those patients. Whether it's getting them in the door the first time or continuing to get them in as a customer for life.

Tell us a little bit about what you recommend physical therapy owners do. Whether they use Swell or something else, what are some of the recommendations that you offer?

Let's dive into the online platform space and reviews because that's going to be vital to any business, no matter what platform they're using. It's an interesting time and it's been coming for a while, but 93% of customers will read online reviews before making a purchase. Even if somebody is like, “I have the most amazing physical therapist, you’ve got to check them out,” they're still going to go check that online review. I love the saying, “Your business is only good as Google says it is.” Whether or not that's the case, to the people that haven't been in, that's all they see.

It's a perfect example of social proofing. Making sure that your online presence is in a good spot is vital, especially in these day and ages where a lot of these are telematter. Sometimes they're not coming in the office or they're checking things out online before then. It's important. A couple of other facts that I like is 97% of consumers use online media. Rather than trying to look elsewhere, they're going to look online. It's easier for them, easier for the business. Another 31% of them are willing to spend more money if it has better reviews. Even if you're not in the most price-effective option, if you have good service and good reviews, they're willing to come to you.

If someone were to say, “Get a referral from a physician, whether that's in-person or Telemed,” I can imagine one of the first things they're going to do is check out, “Where is this place? What is it? What does their website look like?” Inevitably, they're going to punch in maybe physical therapy. Nowadays, many physician referrals are like, “Here's a prescription. Go find it. I'm sure there's a physical therapist near you.” I know many physician offices are doing that nowadays. They're leaving it up to the patient to find. They’re going to punch in physical therapy near me and you want to have good reviews and get yourself moving up that SEO ladder. It's vital that we spend a little bit of energy on making sure those reviews are good. That's not just Google. I'm assuming you're also talking about Yelp and stuff like that too.

There are a few things in Google's algorithm that they look at and one of them is diversifying. They want to make sure that you are across a lot of different websites. It’s not just your Google website that helps with boosting your search rankings there.

What are some other websites that you could be on?

Even if you're not in the most price-effective option, if you have good service and good reviews, patients will be willing to come to you. Click To Tweet

Your website is going to be important. A lot of times, this can happen there. If you get reviews on Google, you can repost them to your website. It's coming from two different sources. Facebook is good. If you have a blog, sometimes people will use those, Yelp, Healthgrades, whatever they want to there. There are services like Swell. We'll be able to push review invitations to any of those different platforms or multiple if they want. That is something to be aware of, having that across a couple of different platforms. Google is king and most people look there but you have people that maybe are from a different area.

I’ve talked to people in the Midwest and apparently Yelp is their go-to, not Google. Maybe they grew up there and they're coming here. They're still comfortable going to Yelp. We want to make sure that company is keeping aware of all of their platforms there. The other thing is that people get a little bit confused with SEO, paid ads and then Google reviews. Those get confusing or PPC. PPC is a paid ad. It's pay-per-click. I worked in 2019 in the marketing department. It was still my role is under marketing. I learned a lot. I don't know how people do marketing, but I applaud each and every one of you because it's a hard job. There's a lot to manage. PPC campaigns are good because you can reach a broader audience and you can target.

If you are looking to do a certain area or if you want to start targeting certain keywords like a sports injury, maybe you're starting to do a sports injury clinic or something along those lines, you can target those searches. You and I were talking about this. Anytime I go do a Google search, I see the little ad, I usually skip and then I want to go to those organic ones because you can pay for that. With your organic searches on Google, you can't pay for an increase in rankings. Obviously, it's supposed to be organic. There’s nothing that you can do to get that to move up. PPC is good. Most of Google's platform recommends that you do a little bit of both. Keep in mind, you're paying per click. You're not paying per customer. If they click on the ad or on your website, you're paying for that even if they don't convert. You want to make sure that you have a system in place to help get them converted. That can get complicated. You want to do like a retargeting campaign with an email based off of those clicks if you have a system reading that. That’s smart.

I haven't met a lot of physical therapists that do the PPC campaigns. Have you talked to anybody that's done much of that?

I have. Usually, it's through a marketing agency and I find where they get frustrating is the marketing agency is there to run the campaigns. The physical therapy clinic will provide the money and then they'll run the campaigns. It goes back to the physical therapist and their business to convert those patients. The problem is, is a lot of times they don't have the training or the know-how to do it. It gets tricky. It's good. More benefits will come from organic. The nice thing about organic reviews is that will also boost your SEO. Search Engine Optimization is what it stands for. There are a few things. If people are leaving comments in it, you want to make sure that you're responding to those. When they say certain words in there, it's based off of a keyword. If you're looking for back injury physical therapist or something like that, the more times that's mentioned, that will help you boost to the top.

The actual words that are in the reviews can improve your organic SEO.

It gets a little bit tricky too because when you're responding to that, we want to make sure we're HIPAA compliant. Most of those responses are going to be very general but what they say or if they say like a certain doctor's name or something that can typically help as well. When Google is looking at your local search rankings, it looks at five different things. It's going to be relevance, distance, prominence, quality and quantity. They're never going to release all of their algorithms but that's been standard. Those things are going to be ones that we want to look at. Pretty easy, quick takeaways. Relevance is how well does this match up for what people are looking for.

With that said, in your business profile, there's a spot that you can say like physical therapists in Ogden, Utah or whatever you want to say. If you're starting to treat different types of injuries or like I said, maybe sports therapy, put that in there physical therapy and sports therapy. That way, if someone's researching sports therapists, that's going to pop up under you, not just physical therapy. Make sure that you're using words that you would think that they would be searching for. That's going to help with relevance.

Where do you put that again?

In your Google My Business profile, there's a description area. Some people leave it blank. I wouldn't recommend it. You don't have to make it extra long but put it in a good description of what you guys do there.

Especially if you've got some niches or if you specialize in something, you want to make sure that's in there. As people are looking for let’s say physical therapy for runners, then you might want to add something, some descriptor like that in your Google profile.

What I would recommend for that, let's say the clinic is we target runners but maybe not a ton of runners are looking for that. Maybe like athletes because that's going to be more general and you're going to be able to get more. If you want to target runners, you can. When you're putting those things, in their thinking mind like, “What is the average person going to look for?” They're not as targeted necessarily, even though it might be. They're going to be broader. Think in a buyer's mind or some of those things. The next one is distance. You're going to want to make sure that your address is correct in there because that's one of the things that it'll look at. What does ‘near me’ look like? You want to make sure that's accurate. If you have a couple of different locations, make sure that they each have their own Google My Business page so it’s pulling in.

I’ve had that before where it's used an old address from a previous business that I was in and we had to update that or sometimes if your business is linked to your home address for some reason or other, it's going to bring up your home. You want to make sure it is the right address for sure.

I was talking to one of my physical therapy offices. They were like, “We were at our house and did physical therapy near me and our location didn't even pull up.” It's because it's using all five of these things. If it thinks that, “Even though this one is closest to you, I still found a better one. That's a little bit further away but it will fit your match better,” that's what it's going to pull. Google is built for the user's experience, not necessarily the business experience. Pretend like you're a buyer as you're getting some of these set up because that will help. The next one is prominence. This one is how well they're known online, like what I was saying.

PTO 128 | Patient Engagement
Patient Engagement: The nice thing about organic reviews is that will also boost your SEO. If people are leaving comments, you want to make sure that you're responding to them.

Diversifying that SEO is going to help. What I recommend, if you have a Facebook page, you don't necessarily need to direct people there. With our Swell platform, if someone leaves you a Google review, you can repost it to Facebook. You don't have to do double the work but it's helping that SEO. You'll pop up a little bit quicker as well. Next one, these ones are very self-explanatory, but quality. What we like to recommend is we want 4.7 or above stars. Typically, people don't go below that. The other thing to keep in mind and maybe this is me, but a lot of people feel like this is there's the first page. You can go to the second page and then you can go to the third page.

Majority, 90% of people will make a decision based off that first page. Even if you're like, “I have way more reviews than these top guys,” it's like, “Let's still get you to the top of the list because then you're going to be that much more seen because people don't take the time to move forward.” The last one is quantity. The way that Google looks at it is going to be the number of reviews fresh and then frequent. Even if you had 500 reviews but you didn't get a review in the last four months, it's going to be like, “We don't know if their service is still that great.” What it's going to look for is to make sure that those are coming in frequently and that those are being responded to.

You see that with a lot of physical therapists. They think, “Our goal is to get blank number of Google reviews.” They push out this program and they get a bunch of reviews. Maybe they got 40, 50 reviews in a one-month period and then it falls off. They don't come back around to it for another year or two years. You're saying that might help you for that month, but the effectiveness is lost after that.

Think about it if it was you. For instance, a couple of years ago, I went to Hawaii. I was the only single in there. I got the short end of the stick and I was sleeping on the pullout couch. I don't know if it was that or surfing or what, but I did something to my back and I had never been to a physical therapist before, but I was like, “I got to find one.” All that I could do was go online and search. Even if I saw one that had great reviews, but it had been a long time, as a consumer, I'm like, “I don't know. Maybe let's look for somebody that got a review last week that they had a great experience.”

I feel the same way. Even in product searches and Amazon or something like that, I want to see something that's a little bit fresher, not something from 2017. The more you can keep that relevant and up-to-date, that lends more credence to you for one reason or another. I don't know what it is but that recency means something to me as a consumer.

It will help within those rankings there. The other thing is to make sure you're responding to those. It doesn't have to be anything that's super detailed. It'll be HIPAA compliant. The Swell platform will let you respond right in Swell so you don't have to go check like Facebook, Google, Yelp, whatever. You can do it there. You can have templated responses. If it's a five-star, “Awesome, thanks so much for coming in. I’m glad you had a good experience,” or something. Even if the patient doesn't see it, the algorithm likes that because it will help boost.

A lot of what you're talking about has to become then like a system or an ongoing process that is built into the physical therapy experience from the administrative end. There's got to be a process to that. I'm sure you walk owners through this in developing a system to make this an ongoing thing and not a one and done project.

I was talking to someone and they invested in a new laser worth $60,000 or something like that. They were stoked on it but it's like, “That's awesome. You have a great plan in place of how to upsell that. If you don't get patients in the door, what are your opportunities to do that?” It is that full cycle of like, “Got to get them in the door. We can give him the treatment, then let's get them a review so that other people can see that.” It is that loop. We understand there's so much going on. As a physical therapist, your number one priority is patient care. You're not as worried about some of these things. That's where we want to come in as a platform and say like, “We know you have other focuses. Let us take over and automate a lot of this so you don't have to worry about it. While it's important, we can help lift some of that for you.”

That platform is definitely needed because a lot of people in my audience, they're like, “I'm treating full-time and then I'm trying to run my business on the weekends. I don't know how you expect me to do all this stuff.” The reason I bring people like you on is I'm trying to say, “There are resources out there, maybe I’ll have to look. Here's Baylee sitting here that can help you and give you an idea of let's automate these things for you.” It's part of the new patient process or discharge process, you name it. That being, “Put them into this email system. Our process means we need to get a review or at least get them an email or text that day or the following day to, “Please write a review. Here's the link.” It makes it as easy as possible for the patient to do it as well. If we're putting through them through a lot of hoops to give us a review, then it's more than likely not going to happen. That's where a program and a platform like yours are so vital to a physical therapy owner’s success and retention engagement and all these things that we're talking about.

We talked about this as well, but I got back from a trip and had great experiences and was asked to leave a review. I didn't have the link and I couldn't remember what it was. It's not even that I wasn't willing to. It was, it just wasn't easy for me. We're all very lazy and we're busy and we have a lot going on as a patient. Making it very simple for the patients but also simple for your office is going to be huge for both ends to maximize that. Anything with a system or a software, it's only as good as your training is and as your office is going to use it. That's where we want to come in. Even if you were using only 10%, so much of this as automated that you should still see a good increase even if you didn't have time to touch it.

If we can go in there and look at some things and some metrics, there's a lot that you can learn. If you’ve got a review and you want it to go down by practitioner, if you want to look at, “Who treated them or who checked them in or what was the service that they got,” you can filter that down. It’s like, “This is getting a lot of great reviews. Maybe we should do a marketing push for this. It's the end of the year. Let's run a promotion for the holidays,” or something like that. You can get as creative as you want but having that platform there to make it easy, like you said, for the patient is going to be huge.

Do you guys recommend more texts? Do you recommend more email? Which has been better responded to in the past?

Text is going to be best. Think about it. If it was you, how quickly are you to respond to an email versus a text? As a human being, we're in there a little bit more, especially as the generations are getting younger and younger, it's a quicker response. The other nice thing too is we can have it go out from their actual business member if they want. Those patients will recognize it. If not, we can do a local area code, but it will never be a short code. It's a little bit easier and quicker for them. The other thing that we recommend and we can have set up automatically is a lot of offices or systems will send it out right after or right when the patient's in the office.

Maybe you have to run back to work or you're taking your kids to soccer practice or you have things going on. You want to do it, but you don't have the time. We'll usually send it out in that evening, say between 6:30 and 7:30 PM when they're home and settled and be like, “Now I have two seconds to do this.” With that, if they don't, we can send a reminder the next day or in seven days a sequence like you were talking about. It captured that patient.

As a physical therapist, your number one priority is patient care. The other things, you can automate. Click To Tweet

Do you find that the 6:30 to 7:30 PM timeframe is a magical hour?

It's been nuts. One thing that's nice too with our platform is we're Google-sponsored. We're powered by Google, which helps. That was going to be something that helps respond with that. Also, we find that hour has increased it. The number that we say, “Keep in mind, this is going to sound low,” but for reviews and for engagement, we see about 10% of those reviews that are being sent out responded to. That seems low but keep in mind if you were at zero. If you're seeing twelve patients a day and we can get one a day, that's going to be massive for the business.

First of all, do you have to get permission to send out regular texts to a patient like that?

We're HIPAA compliant, CAN-SPAM compliant, all those things. The only thing is if they want to unsubscribe, they can click stop to subscribe to them. If they don't want to receive that, they don't have to but that's typically why we want to do some value with it like, “Thanks so much for coming in. Here's next steps for your treatment. Could you also leave us a review?” If that patient is saying like, “This has benefited my treatment plan. I don't want to unsubscribe from this thing.”

There could be a lot of value if that 1st, 2nd or 3rd text is, “Thank you for coming in. Here's a link to your home exercise program if you have that thing set up. If you don't mind, if you've had a good experience, please share your review online. Here's the link for that.” That makes it very simple and easy for them in all three phases.

We can even do more specific ones. Depending on the EMR system that you're using, if we're integrated with them, we can even pull based off of the person that was seen with them. If you want to have a certain doctor's picture or we can do the logo and then we can even pull in dynamic fields. Of course, it’s their name and a certain treatment that they were seen for. Based off of the code, it looks more personalized to them and people respond better to that. The office doesn't have to do anything with it. It's set up and good to go.

Are there some EMRs that you do work seamlessly with and others that you don't?

We have 90% of the market. The ones that don't, we can still work with what we do as a CSV upload of the patients. It's not a problem. Most of them we work with.

What are some of the other things that you might recommend owners, either email out or texts and requests? I know a lot of owners might work off of NPS scores or they might work off wanting other feedback. What are some other things that owners might be looking for with these texts and emails?

It depends on the office. Some people love data and so they want to get that feedback. We offer NPS. We can send those out as well. That's going to be like, “How highly would you recommend this thumbs up, thumbs down thing?” NPS stands for Net Promoter Score. We also have a system that's going to be like a ten-question survey. If you want to drill down a little bit more, you can do that. Keep in mind, you're going to see a higher drop-off per click that patient will do. That's why our reviews area one-click to the site thing.

If they're doing a survey, do you recommend a certain number of questions considering it does take more clicks? Is it better to have a 3 or 4 question survey versus a ten-question survey or have you found that matters?

It depends on what they're looking to find out. If it's about a certain new laser or a treatment that they got or if it's a new person in there, maybe you only need a few questions. If you're like, “I feel like we have a whole within our system, when you get some more information on it.” I probably wouldn't send that out to every patient that you see. That conversation usually is a little bit better of like in the office like, “We're learning or working on how to better our system here. Would you mind filling out a short survey?” That goes a long way. The other thing that is big as well is think about this if you were a consumer. With mine, when I booked it, I didn't even know if they accepted my insurance.

I was like, “They have great reviews. Their website looks awesome. I need help now.” On their website, if you have a webchat feature that they can communicate with you before having to make that call, as a patient, sometimes we're either at work when we don't have time to do that or don't want to be up-sold. We're just trying to do some due diligence. Having a system that they can communicate with the office without having to make that actual connection is big. We can do a web chat feature. It's nice because it goes right to the message board. You can manage any web chat feature or web chats, Facebook messages or text messages all at one place that makes it easy for the office

Does it come up into the Swell app that's on your computer or phone?

PTO 128 | Patient Engagement
Patient Engagement: People don't have time to ask around or to go to a physician and ask for referrals. Their online platform is the number one place that they're going to get business these days.


Is there anything else that you want to share in regards to value that you could provide for the audience or any other gadgets or cool things about Swell that you want to share?

There are a few other systems within there but what we want to do is not take away a front desk person per se but if we can save time so that they can focus on other things. We want to be like another person in the office but it's a lot cheaper.

That's the last thing I want to do for my front desk person because I know I was very sheepish about adding more to their plate because they're answering the phones and they're scheduling patients. They're trying to engage the person that's coming in. They might be verifying insurances, which takes forever and is a headache or dealing with a patient that's trying to reschedule. The last thing you want to do is come in and say, “Can you add this and do this more?” If this is something that is pushed over to them, they get some push notifications like, “Someone has got a question about that.” Maybe it's easier for them to type an answer because now on top of that, trying to ask them to get the review from the patient could be hard. If that's an automated process that doesn't necessarily have to go through the front desk, if instead they maybe click on that patient and it starts that campaign, that made things a lot easier

You don’t even have to click on the patient. It can be scheduled. If you're like, “I want to go the day of,” great. It starts. It's nice. It's ironic that I work for a tech company and I'm not super technical myself, but it is very simple to use. We've designed it for that because I’ve talked with tons of offices over the years and they're like, “I'm so comfortable with what I have but it scares me to switch platforms,” or, “I don't know how to use that.” Maybe they graduated from high school or whatever it is. We want it to be easy for anyone to use. The Swell system is self-explanatory that way.

Especially with the pandemic of 2020, the way we were engaging with patients in 2019 is completely different in 2020. It needs to be. It forced owners to recognize that they need to be a little bit more socially engaged and not rely on the in-person physician referrals or the community events, if you will. Let's admit it, physical therapists are usually a couple of decades behind technologically and so we got to get away from the paper. It forced us into the 21st century and that's where a platform like yours can be helpful.

You can look at it 1 of 2 ways. It's either a blessing or a curse but usually, people don't have a physical therapist on hand. It's not like they're dentists that they're seeing every six months. If they get an injury, then they're going to go look for that. If your house was flooding and you're in a panic, you're going to quickly go online to find somebody. It’s the same thing with this. They don't necessarily have time to be doing all this due diligence to ask around, to go to a normal physician and ask for referrals. Their online platform is the number one place that they're going to get business these days.

What I like about your platform is it can be text, email or both because as you've got a current patient, maybe text is more appropriate. If you're sending out information to a patient from two years ago, I don't know if text is necessarily appropriate, but you can still do the email thing and keep them engaged so that you do become their physical therapist. It’s like you have your own dentist that you go to. When you have an injury that crops up, you want to make sure that you are that physical therapist that they go to on a regular basis. I liked that you guys can use texts and email to your advantage and you can also maintain that engagement forever, especially at post-discharge to make sure you stay in their mindset when friends or family members do get injured.

It depends on their injury but you can have a system set up of like, “I treated you. We had our three-week treatment series but I want to check on you in 3 and 6 months to see how you're healing or how things are going.” A lot of times, offices don't have time for that. They're swamped and they don't have time to do that follow-up and a lot of times patients don't remember that. If we can have something set up where we're reactivating those patients and getting them back into the practice, that's going to be huge for them.

If you could share your contact information if people are interested in the program, go ahead. How can we get in touch with you?

I will share my email, You can email me there. I’ll even give you my cell phone number, (801) 708-9215 or you want to go around and peek at the website before you're communicating with someone. It's You can even schedule a demo from there if you want or you can text me. If you want to see more of the product and how it works, let me know and we can get that hooked up for you.

Thank you for taking the time to be on and sharing some information for PT owners. Hopefully, they take advantage of it and utilize something technological to get those reviews and also stay engaged with their patients.

Thanks for having me, Nathan. I had a blast.

Thank you.

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About Baylee Jensen

PTO 128 | Patient EngagementWith a degree in Communications, Baylee Jensen has always been passionate about the power of communication, and the technology that drives our interactions today. Over the last several years, her focus in the medical and PT space has been helping offices navigate through the ever-changing landscape of today’s communication trends and technologies, especially regarding the millennial disruption taking place in our digital world. She is passionate about enabling the improvement of efficiencies in practices, thus making day to day operations flow smoother. Over the last few years, she has developed a passion for speaking and educating the healthcare industry across the country, and is currently a business development executive, overseeing partnerships and professional relationships.

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PTO 107 | Improving Patient Compliance


As a PT patient, Vikram Sethuraman was surprised to receive his HEP written on a single sheet of paper, handwritten by his PT. He thought to himself, "Wow, is this the best you've got?" and decided he was going to use his entrepreneur course to help the PT industry move into the digital age when it comes to patient engagement. He founded and developed PT Wired as a tool to improve patient compliance and engagement, thus improving patient results and PT owners' bottom lines. Focusing on the patient experience will translate into a cascade of benefits for the patient and the business—that's the focus of PT Wired and the custom-branded mobile clinic apps they create. In this episode, Vikram sits down with host, Nathan Shields, to tell us more about the amazing things he is doing for the PT industry and more.


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Focus On Improving Patient Compliance And Engagement With Vikram Sethuraman Of PT Wired

In this episode, I've got Vikram Sethuraman. He is the Founder and CEO of PT Wired. Check out his business at Vikram is going to go through exactly what his company does and how it improves patient engagement and retention. I want to highlight a couple of things that came up simply because he noted and I'll share it here. If most patients are going to drop out, they're going to drop out within the first three visits. The average PT clinic loses $150,000 per year because patients don't complete plans of care. I would challenge you to do whatever you can to improve patient retention through the full plan of care because the benefits are vast and amazing and will significantly improve your business.

Vikram's app is one way to do that. I want to highlight it in this episode. Whether you use that app or whatever it might be, focus your time and effort on what you can do to improve patient retention. Track the statistic if you can because most EMR programs don't. I would recommend you do that even manually, but whatever you can do to maintain that engagement and maintain that retention is going to benefit you and the patients. They're going to come more often so make sure you do what you can to improve patient engagement. He's got a ton of great info to share here on the show, but they're on We'll go to the episode now.


I have the Founder and CEO of PT Wired, Vikram Sethuraman. It’s a new software program in the industry.

Thank you for having me, Nathan.

Thanks for coming. I appreciate you reaching out to me because I'm always open to talking with the founders and owners of those things that can make ownership easier and can improve our capabilities. I've had different owners of different products over the past years. I've always appreciated the insights that you guys provide and the passion that you have to help the industry. Tell us a little bit about you, Vikram. Where did you come from? Where did you get the idea for PT Wired? Share a little bit about how you started your journey into what you've developed.

Unlike a lot of PT software companies and organizations, a lot of these companies have been founded by physical therapists who have insider knowledge on the needs of PT clinic owners. That wasn't the case for me. I'm not a PT nor a PT clinic owner. I got into the physical therapy space through my experience as a patient. When I was in college, I was an athlete and had a hip labral tear. I had hip surgery for repair and then 1.5 years of physical therapy. It was an intense experience for me. I got the real point at which I felt healthy and 100% again that I fully credit with physical therapy. I had the surgery and then had a lot of pain that came back. It wasn't until I found a good physical therapist that worked closely with me that I overcame the injury and got back to full health.

During that experience, one of the first things I remember is going into PT, fresh out of my surgery, and getting a piece of paper with my exercises scribbled down on there. As a younger guy who was always on my phone, I quickly thought, “There could be an app that could be much more valuable if it had videos, notes and if I can message my PT.” My brain went off on a tangent there of all these different ideas. Coincidentally, I was in an entrepreneurship class at the time. Believe it or not, the origins of PT Wired were from a college class on entrepreneurship where my project was this PT Wired app. When I graduated, I had kept working on it. I enjoyed it. I saw some potential for it. I decided to keep working on it. Fast forward, here we are. It's out in the market being used by over a hundred organizations, thousands of PTs and thousands of patients.

Less Dropouts. More Discharges. Click To Tweet

Tell us a little bit about your app. What makes it unique? Is it simply a home exercise program app in and of itself or is there more to it than that?

This ties into me not being a PT. When I first went into this, it was only designed as how could this benefit me as a patient based on my experience. It was framed for the patient, but what I quickly learned is the clinic owner's side of this. Patient satisfaction and patient experience is one part of it, but it has to be in the context of the clinic owner, their needs and values. That's what we learned. That led us down this track of still building a home exercise platform, a powerful tool to engage patients more effectively. What we learned was the need for engagement to reduce patient dropout and an additional platform for marketing. It's a home exercise platform where the product has grown to. It's designed to get your patient to download the app to access their exercises, but then become a marketing platform that you can use to keep them engaged, push promotional content, ask them for reviews for Google and Facebook, ask them for feedback, and all of these other features that we can get into.

That's how we are positioned. The big difference for us is rather than them downloading a PT Wired app or some generic app from the App Store with their exercises, every single clinic gets its own app in the App Store and the Play Store, fully branded to your practice with your logo and name. If your clinic is Active Physical Therapy, it'll have your logo and your name on their phone. The entire idea is to sell to the patient the idea that your clinic, no matter how big or small, built this app from scratch yourself. They don't see our name and that creates an impressive-feeling for your patient, that you're going the extra mile to give them the best quality of care.

What I love about it is that you can create this app specific to each physical therapy clinic. I love the opportunity that you provide within that to have patient engagement. I've shared in the past that studies have shown that 10% to 15% of patients that come into physical therapy complete their full plans of care. That leads to hundreds of thousands of dollars of loss for the average outpatient PT clinic every year. The number comes out to around $150,000 per year on average that every clinic owner loses because patients aren't completing their plans of care. If you can bump that number up another 10%, 15% or 20%, you can save much money without a significant amount of effort.

If you can keep those patients to keep coming in, number one, they're going to get better results. Number two, they're going to complete their plans of care. Number three, if they're getting better results by completing their plan of care, they don't only benefit you as the owner financially, but your reputation is significantly better. They're going to say, “I achieved my goals.” That's going to turn around and go to the doctor and turn to their family and friends and be a good marketing source. It's a great opportunity as long as we can do as much as we can to stay engaged.

You're saying 90% of patients don't finish their full course of care and 30% of patients drop out within the first three visits. It is a massive opportunity for improvement. A lot of people when they're thinking about, “How can I grow my business? How can I get more revenue for my practice?” the first thing everybody thinks about is bringing new patients in the door acquisitions. What we like to focus on is that's important and that's the first step, but that shouldn't always be the main thing you're looking at. If you focus on the patients you already have, it's way easier to retain a current customer than acquire a new one or to sell more to an existing customer than to sell to a new one.

That's the idea. We are trying to do everything that we can to extend the journeys of these patients to get more people to discharge rather than drop out and learning more while all in the process. Another thing to know is if a patient drops out, it's not always a bad thing. It may mean that they reached their functional goals earlier than they were expecting to or maybe the number of visits they had allocated to them. That's important to know. For example, if we can see on our app that this patient who is not coming in anymore had been doing all of their exercises and having great results and progressing well, that's important to know because this is a fan. We can ask them for a Google and Facebook review.

PTO 107 | Improving Patient Compliance
Improving Patient Compliance: 90% of patients don't finish their full course of care. 30% of patients drop out within the first three visits.


We can check in through the messaging system on the app to see if they're still doing well and reactivate them if not. There's a lot of insight you can get from that. Whereas on the other end, if you can see clearly this patient hasn't done any exercises and has not progressed, you can detect a bit earlier when they're likely to drop out. You may intervene by sending them a message saying, “I noticed that you haven't been logging your exercises as much. Are there any questions I can answer?” Communicate that you're there and that you're more accessible than only when they're in the practice and the clinic and physically with you.

That's cool and there is that opportunity to communicate in the app itself. To have the back and forth communication from a patient to a provider.

A full HIPAA compliant messaging platform through the app. There's at the provider level and because it's a custom branded app, it opens the door to other marketing efforts. For example, when COVID-19 first hit, imagine if you could instead of sending out an email, putting something on your website or send out a push notification to everybody who has the active PT app downloaded that says, “This is what we're doing. We're sanitizing equipment and everybody's wearing masks. We're closed down for now, but we will reopen.” These are messages that you can get straight to the patients on their devices in a branded way. It creates a more connected experience when they're disengaged in between those visits.

You can send mass messages in that regard. All this is on top of the home exercise program part. You’ve got videos of each exercise and you can form templates and programs within the app itself for particular diagnoses or body parts and individualized for each patient.

We have about 5,000 exercises. We own our own video studio. We have a whole content team. We shoot 50 to 100 every other week. We’re constantly expanding the video library. We take requests free of charge. We also have the ability for users to upload their own videos if they want to. Anything that is uploaded is exclusive to that practice. It's not like you're putting out your content for other people to use. It's protected and that's all included. With regard to the exercise program creation, another important thing we know is building exercise programs quickly. A lot of PTs opts for paper because it's fast. They can write down, hand it, and then you're done. We knew that that was the baseline that people are working with. We have things like exercise, program templates, favorites, smart search system with filters and tags to make sure you can get to exactly what you need as quickly as possible.

You've had 100-plus clinics using this. What are some of the benefits and comments that are coming back to you from the owners and users of the app? What are some of the highlights that they are talking about?

From the standpoint of ease of use, that's been one thing we were proud of, knowing how important it is to be able to build something that seamlessly integrates with the workflow of the PT. We've heard a lot about how quickly it's gotten and we've improved it over the years. I'm not going to say that it was perfect right off of the get-go, but that's one thing of creating exercise programs quickly. In terms of the patients, it's all about creating super fans. Being able to get those patients and experience that gives them the wow factor.

It's way easier to retain a current customer than acquire a new one or to sell more to an existing customer than to sell to a new one. Click To Tweet

They are wowed that a clinic with maybe 1 or 2 locations and 3 or 4 physical therapists has their own custom app. It blows a lot of patients away. They don't see what's going on in the background. They don't know who PT Wired is. Being able to ask patients for feedback through popups on the app saying, “How are we doing from 1 to 10?” and being able to ask them to leave a Google and Facebook review. Those have been the big things that the clinic owners have loved, how impressive it is to their patients that they have their own app that's engaging. It shows that they're going the extra mile to deliver the best expense.

This isn't a home exercise program app to show the patients exactly what exercises you want them to do. It also can track. The patients can click and say, “I did this exercise this day. I did this exercise and these many repetitions.” They can post that and the provider can see what's been done.

On the app, they can mark exercises as complete. All the completion data is accessible to the provider. Another thing we do on the patient side is to give them awards and achievements as they do their exercises. They'll get these medals and trophies as they hit streaks and the number of exercises and routines completed. Going back to the marketing elements, some clinics have incorporated that into marketing efforts where they'll say, “If you get the 25-exercise trophy, show it to our front desk and we'll give you a free Active PT hat or shirt,” or something like that.

They can use it for games and that tracks their progress, especially as it pertains to home exercise programs. We used to do games for coming to all your visits in a certain week or during the month, you come to all your scheduled visits. That puts another spin on it and the opportunity to gamify if you love the experience and say, “If you keep up with your home exercises, we can track you on our app.” That forces them to the app and it rewards them if they do. It not only rewards them if they go to the app, but it also rewards them if they do their home exercises, which ultimately benefits them.

We went through a Behavioral Economics focused accelerator here in Durham, North Carolina run by Duke University. We were working with these people who have PhDs in Behavioral Economics. We're focused on that and working to make these small adjustments and feature changes to the app to maximize the impact on behavior. One of the things we did was the trophy and gamification. We'll have patients email our tech support saying, “I forgot to mark back exercises, but I did them and I'm going to lose my streak. Can you help us out?” Another thing is for the patients. At the beginning is an educational tool. They're looking at the app because they want to see the videos, the instructions, the list, but after they do it a couple of times, they'll learn the exercises.

The trophies and the metals keep them still documenting everything on these. Once they learn it, if they say, “I don't need the app until I get new exercises,” we'll then miss out on that data. If we have them hooked to working towards a medal, a trophy or a t-shirt from the front desk, that keeps them on the app which then allows you to put promotional content saying, “We've got a free back pain workshop. Refer a friend to physical therapy.” All these other things that you could put on the app that they'll still be exposed to because they're continuing to open it to mark their exercises.

What a great opportunity to back up what you're already doing. They're giving out home exercise programs, but you can back that up by having a game or a reward system behind it. It automatically does, but you can tie that back to the clinic by getting something physical. I like what you're saying about rewarding the referral system. Every physical therapy clinic that I know that's super successful has a robust internal referral program, where patients are bringing their family and friends in for physical therapy because the team is asking for those. To be able to do that through the app, it gives you another avenue and reminder. It backs up the program that you're already doing.

Improving Patient Compliance: If a patient drops out, it's not always a bad thing. It may mean that they reached their functional goals earlier than they were expecting.


To do it in a way that is more selective and automated, we can see all the patients who are having the best experience based on the data that we're collecting. Being able to identify those patients and then ask them for the referrals and reviews, that's going to be the best impact for your practice.

What makes PT Wired different than other companies that are doing the same thing? There are other companies in your space. What makes you guys more unique?

It’s our branded element. You don't go to a generic app or some different brand. It's all under your own name. That’s the root big differentiator and that makes all the other marketing elements more impactful. For example, we've got a partnership with a company, Practice Promotion. I know you've had Neil on. They do websites, but they also put the blogs on the websites. One of the things we do with them is the blog that you get on your website is accessible on the app. You get a blog button. You can read all the articles. Even though the patient may go on there for their exercise program, then they'll see all this other content.

That's a big idea. You're not going to get a patient to download an app if you say, “You'll see our blog and any updates.” If you say, “You'll have your home exercise program and you'll be able to message me directly,” then they'll download it because it's a lot more valuable to them. Once you have it on their phone, that's when you can do all these other things like asking for reviews, push promotional, content, give updates, these other things because they already have it on their phone as an HCP tool.

Can patients also book appointments or request appointments through the app as well?

They can request an appointment. How that works is they pick a preferred provider and the time and location. That comes through as an email to the front desk. We don't have an integration with a scheduling platform at this time. It's not a seamless book and appointment updated all that stuff though. That's a goal. That's what we want to do in the future that they can request appointments.

You're a small business owner and you've dealt with a ton of other small business owners as far as the physical therapy space and talking to PT owners across the country. What are some things that you're surprised to see that we're not doing in the PT space or things that you utilize that you think PT owners would benefit from using if they were to come into the 21st century? A few of us are a little bit not as tech-savvy. Maybe it would benefit us to do things up to date.

The number one indicator for a patient that is likely to drop out is when they're not doing their exercise programs. Click To Tweet

I think project management tools are helpful for small teams, especially in a situation we're in where you may not be as physically with your team as much. My team uses one called ClickUp. It's a lesser-known project management software, but an up and coming one. It's very customizable. I would highly recommend that. In terms of more general small business marketing, people would be surprised how easy it is to do something like setting up Google Ads for their practice. Something that says dry needling and rally or whatever, get a Google Ad for that. There may be much less competition than you would expect. I think to learn something that would be helpful, but those are two that we use.

Most owners either might not know the space well or not feel comfortable with some of the technology behind it. I had Jamey Schrier on where we talked about his huge recommendation during the slowdown. It is to bring things into the 21st century. He recommended a few project management apps as well to communicate with your team a little bit better. It's not posted some paper and simply email, but tracking projects that you have, whether it's regarded to policy and procedures, compliance, audits, you name it. Use some of these software programs to track your progress. It's not all pen and paper. That's essentially what you did with your home exercise program platform. Anything else you want to share with us, Vikram?

Focusing on dropout is a big thing that will help a lot of people. The number one indicator for a patient that is likely to drop out is when they're not doing their exercise programs. It is low adherence to them. A lot of people have the mindset that they can only do much. They can only give the patient the exercises and then it's out of their hands. I would encourage people to rethink that a little bit. There are a lot of other ways you can still engage patients. We can't do the exercises for them, but there are a lot of small things. On our website, we've got a free e-book on how to optimize your home exercise program experiences. Things you can do for adherence to make patients more adherent and make them less likely to drop out. Small things like wording, cues, engagement, and tracking to create that type of experience. I would highly recommend that people pay attention to those metrics of adherence and dropout. If you work on those a lot, you may never need new patients to focus on that. They’re maybe good to go.

As I'm working with my coaching clients, I purposefully steer away from marketing efforts initially because I look at it like holes in a bucket. If you have these holes in a bucket, as far as retention and maximizing the care that you provide for each patient. If you've got a ton of holes, you could add more patients to the bucket but they're going to fall out through the holes. As you start plugging in some of these holes, then you recognize that, “Maybe I can still improve and grow without much more marketing. When I do marketing, it's going to accelerate even greater because I'm retaining those patients better.”

You’ve got to fill the holes in the bucket using something that you can retain those patients because those are the low-hanging fruit. They're already in your clinic. You don't have to spend a lot more money to retain them. You have to spend a little bit more time and energy on doing. I also like what you said about a lot of times we think that we can only take the patients far and then it's out of our hands. I believe the same thing. That is the case when you're using a pen and paper. All you can do is hand over the piece of paper with their home exercise program, saying “Here, go do these two to three times a day. Keep stretching and let me know how it goes.” I love how the app keeps you engaged with them and gives them something to go to. It's much more than the home exercise program, which is cool. Thanks for your time. I appreciate you coming on, Vikram.

Thank you much for having me, Nathan.

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About Vikram Sethuraman

 Vikram is the founder of PT Wired, the only 100% custom-branded mobile app service for physical therapy practices. Vikram founded PT Wired in 2016 after his experience in physical therapy as a patient. Today, PT Wired powers over 120 physical therapy practices as #1 highest-rated Physical Therapy Software company on Capterra, winning 2020 awards for Best Value and Best Ease of Use.


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PTO 50 | Patient Experience


Some businesses struggle with connecting and keeping patients, especially in the PT industry. The secret to this is always being able to create an excellent customer experience. David Self, the Director of Product Strategy for the software company, Keet Health, shares what he learned from the internet software realm and how it can be incorporated into the physical therapy business. Focusing on making the treatment experience for provider and patient more comfortable, basic, and easy, David uncovers the top hacks in achieving more exceptional results for your business and maintaining personalization without destroying efficiency. Discover how technology is positioned in the PT industry and learn why it is crucial to market your brand assets.


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Triple Your Marketing Efforts By Improving Your Patient Experience with David Self, PT of Keet Health

On this episode, I have David Self of Keet Health, which is a PRM that is used to improve the relationships and the interactions between physical therapists and their patients. You'll be interested to follow David's story. He recognized the dichotomy between the relationship and the experience that he had in working with some of his fitness patients versus some of the patients he was working with in his clinical internships in PT school. Thus, evolved the software program that he developed with another founder of the company. He works as the Director of Product Strategy for Keet Health.

We're focused on how Keet Health helps the customer experience for patients in their physical therapy settings. How that can help the physical therapist maintain the relationship and improve the customer experience of that patient so that they continue to be returning patients and customers of theirs. The great insight that he shares comes from not only his experience in the physical therapy realm but also the experience and things that he has learned from the internet software realm and how that can be incorporated into our physical therapy businesses. I’m excited to bring in his fresh perspective. Hopefully, it can inspire you to do more in terms of improving the customer experience in your clinics.


We have David Self of Keet Health. He is Director of Product Strategy. First of all, thanks for coming on with me David.

It’s my pleasure. I'm happy to be here.

If you don't mind sharing with everybody your professional story and I’m sure that's going to incorporate the development and growth of Keet Health. Do you mind going back and tell us a little bit about how you got to where you are?

I am a PT by trade though I’ve never actually worked at a PT practice. I’ll start from the beginning.

You’ve never been into practice? You've been business-minded the entire time.

Focus on the customer experience and your 'marketing' efforts will triple in potency Click To Tweet

I had my own while I was in school, which is a misnomer. I had it the first few years at Keet. I practiced PT and got paid for it, but I’ve never been paid.

I’m excited to hear your story.

I went to school at the University of Texas. When I was there, I worked with the basketball team. That was a great experience for me because I was heavily influenced by a PT named Gary Gray who became a close friend and mentor of mine. That's where I first got exposed to thinking about doing therapy for a living. I was going to do strength and conditioning. It’s funny because I weighed ten pounds. That’s where I got started with. Todd Wright was the strength coach there. He’s now with the 76ers. It was an amazing experience at a young age. I went from there. I went to a PT school at Texas State University right outside of Austin.

Right before I started that, I started my first business, which was called Austin Integrative Fitness. It was essentially aftercare, functional fitness therapy business. The niche was I’m going to be the smart trainer that knows how to deal with people in pain that the other people don't want to work with. I’m not actually into therapy. That was my first route in the entrepreneur game and it was successful. That was a fun thing. You can imagine being a PT student trying to market for PT practices within a square mile of that studio.

I can't imagine going to school and having business at the same time. That had to be a lot of work.

PTO 50 | Patient Experience
Patient Experience: Quality care has two components - getting great results and great customer experience.


I don't recommend it, but I was able to come out with not a lot of debt. It's primarily because of that. That part worked out. I was a founding member of the Austin Health Tech Meet Up and for those who don't know, Austin is a technology hub. I was a member there in my second year in PT school. In the first meeting, I was sitting at a table with about eight people. It was six venture capitalists and the Founder of MapMyFitness and some other big company. I introduced myself, “I’m David. I make no money. I’m into the ankle joint and that's about it.” I met a person there named Jason Bornhorst, who was doing this thing called Patient IO, which was a patient engagement startup. He was getting started. I was one of the first customers. I started introducing them to a lot of people that I knew in the fitness world, like some big box gyms.

I had a lot of connections from my time in Texas. That was my first taste of Neon technology, opportunities big. It's fun. It's exciting. That got my whistle wet if you will. My last semester of PT clinicals, I was at Texas Physical Therapy Specialists, which is now a customer of ours. I met my Cofounder at the time named Jon Read and we both collectively thought that there were so many things that we had to do as either a patient and/or a therapist that was not actually related to us spending time together and working on the recovery. I recall I had my fitness studio. I’d wake up and have a session at 6:00 in the morning, one-on-one, no documentation and no bureaucracy. I was texting patients. I was sending them YouTube videos. I was super close. I went to PT practice, which I thought would be much more advanced than that. In reality, because it's what everyone knows, it felt like I was going back in time.

I felt very disconnected. There was a particular day that I was driving home from my clinicals. I was seeing twenty patients, which like Armageddon when you're a student. I stayed on top of all my paperwork. I was like Johnny non-stop. I got out at 5:00. I was going to a happy hour at 6:00. I remember driving away from the clinic, I was at a stop light and I thought to myself, “I know half the names of the patients I saw and everything that I did was primarily to expediate the amount of documentation I have to do. I said, “I don't want to do this. I’m not making great money. I got to wear Dr. Scholl’s. It's not very motivating and I feel way more disconnected than I do in the mornings when I’m the studio. We decided to go for it. That's how we started Keet. That obviously has scaled and was successful and we were acquired by Clinicient, an EMR company in Portland. Now, I’m in the tech world.

Based on your experience, I’m sure you can see where a lot of frustration, even what you'd call burnout can occur for owners and for longtime therapists. The focus is so much less on patients and so much more on everything else, honestly.

It's spot on and it's not the provider's fault. Sometimes these days it can be a little bit their fault if they're not willing to adopt it to the new wave of healthcare delivery. By and large, it's by necessity and unfortunately, that necessity can decrease the passion of why you got in that in the first place. I’ve been at PT school for three years and about 50% of my class has either got out of PT or they went to home health. It's a big problem and it's tough.

If you can't implement it, then it's useless. Click To Tweet

Your main focus then with Keet, tell me a little bit about that. When you initially started, tell me about what your purpose was and if that's evolved over the past few years.

It certainly evolved in terms of what we ended up building and pivoting to like any startup company. Essentially Keet’s always for me had the same vision. The vision can be characterized as we wanted to try to reimagine recovery. We wanted to reimagine that primarily as a movement of being excited again, of being able to break a lot of historically, super outdated processes to the modern world. We want to rediscover that human connection in healthcare, which fundamentally was connecting the provider and the patient. The second part of that vision is that we want to be able to do that in a way that was scalable for practice owners and not just a call center for them. The margins are insanely low compared to other businesses in therapy. We didn't want to build the super cool thing, but then it was cool but there wasn't ROI to pay for it.

It's largely remained the same. We've always had two eyes focused on value-based care. We've always believed that the most fundamental level that quality care has two components. It’s getting great results, which isn't just relevant in value-based care, but in fee-for-service or any other type of payment model we ever come up with. You've got to give a great service to customers, but you can get great results and not have a great experience doing so. Particularly not have a great experience doing so beyond the walls of the clinic. Those are the two prongs of any business.

We wanted to be able to measure both of those things. You’ve got to be able to measure that you're getting great results and mention your experience. That continues to be our fundamental hypothesis that outcomes in patient engagement should never be separate from each other because they're intimately related. Most importantly, as healthcare changes to alternative payment models, they only become more and more important, those two things. That's primarily remained the same and still is what we are now.

For the person who maybe this is the first time they've ever heard about Keet, in a snapshot, what do you provide? What do you do for an individual clinician or an individual practice owner that helps obtain improved results and greater customer experience?

PTO 50 | Patient Experience
Patient Experience: When you get so wrapped up into putting out fires everyday into your to-do list, you slack on strategy and innovation.


I can talk about it in three buckets. One bucket is clinical engagement, to not get too detailed and you can visualize our Keet Patient App and then there's everything related to the patient's care. Home care plan, education, messaging and filling out their outcome measures. Generally speaking, it’s a connection to their provider when they're not there. We have a second component that is our basic automated marketing. We send out targeted emails and measure your patient’s experience via the Net Promoter Score. That doesn't require an account and that's bringing your practice in the modern age at the most, not table stakes level. We have a third component of outcomes registry. It's a qualified clinical data registry. It measures your outcomes via the engagement app if you're inside the clinic and then we report on that.

Going back to that same pillar, we're helping you get great results because we're connecting with your patients beyond the walls of the clinic. We also measure that so you can participate in other payment programs. We're making sure that we help you build a loyal following of patients. Sometimes, patient engagements become critical. It means a lot of things to a lot of different people. Sometimes it's like an excuse for marketing or email marketing. You go somewhere else and that's nowhere to be found.

It's important to sometimes transcend the label and to think about the problems that you need solve, but also how do you uniquely solve those problems there? Sometimes therapy is unique and so you can't do everything like any other business. Sometimes it's not unique and you can't do things like any other business. We've tried to focus on things that are unique because the things that aren't unique, those are commodities. It's better to use the best software for that than a “physical therapy software.” It's a pet peeve of mine when we started trying not to commoditize terms for physical therapy. The software’s such an odd tangent and we don't want to get on that.

You've recognized the benefit of not only improving results. This isn't necessarily about improving our technical skills but improving the customer experience and the interaction between the physical therapist and even the physical therapist's experience in that relationship. Developing, growing, maintaining and perpetuating the relationship between the patient and the physical therapist.

That's a huge component of what we do and we can focus on. There's obviously the other arm of the benefit of measuring your outcomes, improving your words and how that's absent sometimes in the patient experience. That's an accepted pillar, but that's all wrapped into the actual customer experience. I might sum it up even more simply and say that we're trying to scale and what you have to do with any business is a key. Any business, regardless of therapy, it's hard to scale personalization. It's in the word. Most businesses start very hand-crafted, everything hand-crafted, meaning you do it all manual. Even when Airbnb started, everything was hand-crafted. You hit a certain stage of scale where you can no longer maintain that.

You have to be clear on what you're great at. Click To Tweet

You come to this difficult challenge of, “How do I maintain personalization without destroying my efficiency?” If you’re seeing 1,000 patients a month or something, you can't text those patients every day. You can't write personalized emails every day. You can't do all that type of stuff, but you don't want to lose that part of it. You have to have systems in place to maintain your magic sauce that got you there in the first place. That's where the provider part comes in is to be able to help give great experiences to patients in a way that keeps them loyal and helps them get varied results. Also in a way that it's not just “another thing” that the therapist has to deal with or a provider has to deal with because you can never implement that. If you can't implement it, then it's useless.

As you've been through this journey the last few years, focused on the customer experience, improving that and improving the relationship between therapists and patients, what are some of the things that you've come across that helped the physical therapy owners and the physical therapist themselves improve that customer experience? Are there some tips and guidelines? What are some of the secrets you've come across?

I’m a big fan of Brian Chesky. He is the CEO of Airbnb. He had a statement, which I agree with. I’ve had some fortunate opportunities to know some early people there. Fundamentally, it's tough to get inspired by your own industry because you get capped into the group thing. I would say that the number one thing is to try to learn from consumer internet companies. They're such an amazing example for us. They're also very salient. We all have them on our phones and we all can observe it. We all go home and watch Netflix with our kids or whatever. I would say number one is thinking about the best experience that you've always had and try to learn from those people. How has that particularly influenced us? A few things that I think that we've seen been successful by providers. It goes without saying, we learned a ton from PT owners. One is access personalization is the way that it is now and the way of the future.

You have to adopt the simple truth that that's the way it is and that's the way it's going to be. Taking that example, if a bank didn't offer mobile deposit or even have an app on their phone, again, it's not about the app, it's about the personalization. Maybe you’d go out of business because consumers have a reference point now. The banks are the ones that adopted that early, even though the majority of their customer base didn't use it very much in the first couple of years. That's what it means to be on the bleeding edge of innovation. When you implement something or you want something, it doesn't have to be super high adoption rate off the bat, but you get to escape velocity from your competitors when they're trying to freak out and catch up five years later.

Do you find that it's hard for physical therapy owners to see that far in the future when it comes to technological stuff like you're talking about? You're talking about stuff in modern day, but you and I both know that the physical therapy industry is probably years behind. Is it hard to talk to them about what the next things are coming down the pipe, either because they're busy or they can't see it? Do you have a hard time coming across?

PTO 50 | Patient Experience
Patient Experience: It's impossible to reverse any mistakes you make in culture after you'd get over it.


For anyone that’s ever owned a small business or a big business, you don't have a lot of time. At the same time, you have to prioritize what matters. I do think that it's difficult for owners sometimes because you get so wrapped up into putting out fires every day in your to-do list that you can slack on strategy and innovation. You can't afford to not do it because then you'd become lackluster. The second thing is it is admittedly difficult because beforehand you didn't think so much about technology, so you've got to focus a lot more on other parts of innovation and strategy. Whether that was treatment, whether that was how you work with someone doing customer service things or barking at physicians, how your space is laid out and how to get great leases on your spots that type of thing. That's true with any business, but now we live in the information age and that has to be something that you prioritize. There's a firm in California and Andreessen Horowitz has a phrase that I love, “Software is eating the world and if you don't make it a part of your DNA,” and I don't mean software or a particular type of software. I mean the realization that it's when you went paper to computers. You're not going to back to paper and it's no different for many other technological innovations.

I think we can see some of the growth of physical therapy in that direction, whether it's through apps or software programs like yours or even Telehealth. Some of this is inevitable. We've got to learn a way to utilize it in our own practices or we're going to fall behind when people come to expect it.

That type of stuff is at the forefront of everyone's consciousness. One of the things I think is worth pointing out is primarily a posture of thinking and a posture of strategy that often includes technology, but it's not exclusive to technology. What I mean by that is when you walk into a spa, what is a spa characterized by? Aromas. Every little detail is thought through. What they say when they first see you and all that experience. That's why they have such loyal customers. Even for people that are going there when they should be going to therapy because, “I might not be getting better, but I feel so cared for. It's a great experience and in it talks to the other parts of my humanity that is my brain, my smell, my feelings and all that sort of stuff.” That's part of the reason that we make decisions. We don't do the thing that's best for us, we do it because we said so. Those are things that don't cost money. You can start thinking about that as a practice owner. Think about your music, lighting, carpet, layout and what people wear. There are so many stuffs that we can always constantly be thinking about of establishing that great experience because that's what's happening. This is how it is.

I love where you're going with that because I never thought about smells, but honestly, what does your gym smell like? It could be a big deterrent whether people want to come back two or three times a week for that.

You'd also be shocked if you ever studied the hospitality industry, the multimillion dollars they spent testing out the aromas and the people that they bring in and the studies that they do. All of those things as a consumer, you don't even think about it. It's subconscious. All of that stuff has been taken seriously. That could sum up largely. What I’m saying is that you have a choice to either make the things that you might historically use as commodities in your business. You can either choose to make them commodities or you could choose to make them brand assets. That's the difference between outstanding customer experience and a really cool.

People pay tons of money to stay at something, not because of the result, but because of the experience. Click To Tweet

A lot of time when we talk about niche practices and stuff like that, we think about how we're going to treat patients differently or how we're going to market ourselves differently. Thinking about what you were saying there, a lot of your niche can simply be the personal experience related to your brand. It could be the smell that you use. It could be the words that the front desk uses. It could be a streamlined paperwork system for new patients. It could be comfy chairs in the front office with lights and stuff like that. A lot of things can be done to become unique and niche that doesn't require you to change a lot of what you're doing on the physical therapy side. That's something that I’m thinking about as you're going through that. From my experience, I always found some of my greatest success with physical therapists who the patients enjoyed being with, not necessarily because of their technical skill, but because they enjoyed being with them.

My business partner back in the day has stories about guys who he would have work for him that were much better clinicians than he was, but patients would come back to him. He'd ask them why? They'd say, “I like working with you. I like seeing you. I like hanging out with you and find out what you're doing.” That was a testament to me that sometimes the patients aren't all about the best care. A lot of times, it's about the experience that you provide them. I like how you're talking about there are some ways we can differentiate ourselves beside becoming the back expert or becoming the ankle expert or the knee expert, even going to women's health or vestibular. Sometimes we can make the experience unique simply by improving what we already have.

A lot of that thought matrix as to what you decide to be great on and what you decide to let fall. Particularly when you're starting out, this is different as you get bigger, but if you're relatively smaller, you're still trying to hit one particular stage of scale. You always have limited resources and that includes people, time and money. You have to be clear to yourself, “This is what we're going to compete on, this is what we're going to let go.” Part of that thought matrix is that and then also taking a sober judgment of, “What's the situation around me? Is it a saturated market or is it a blue ocean? Maybe there are the people down the street that they're killing it on getting amazing outcomes. They have the smartest people, they are off our list and you respect whatever the reason is. Maybe that should have formed this, “I can compete on outcomes, but that might be harder. Maybe if I compete on experience, time or compete on anything that's not just that, maybe that's my strategy in my market or vice versa.

I think that's what we're getting at is you have to be clear on what you're great at. It's more fun to focus on and to have the experience be something that makes you different. For a long time, Walmart was not that. Their competitive strategy was they’re the cheapest. That's obviously been successful. With the factors, the consumerization of healthcare, the more choice that patients have than ever before, that I know we are fighting for attention. It's something that we don't want to neglect anymore. The good news for everyone is that once you get to a certain stage or scale, you can reasonably compete on both. Look at Airbnb or Uber, it's the most affordable, it's the best result and it's the best experience. It's not impossible, but usually it's because you're first to market. When you’re second, third, fourth to sixth in the market, you usually can't say, “I’m going to beat the person in front of me.” You’ve got to be very strategic about it.

I like what you said about as you're starting off you can become unique by differentiating your customer experience. The thing that comes to mind, I don't have any experience with it, if you do, go ahead and speak to it. I would imagine as you get bigger, it might get to a point that it will be hard to maintain that customer experience. It has to evolve at least, if you're increasing in square footage, number of team members, physical therapy providers and then multiple locations. You've got to work even harder at maintaining a customer experience for your company.

Without a doubt and it’s why companies fail. It's not unique to therapy. It's true for any business, whether you're a software company like us or you're an airline, a hotel or restaurant. When you're going from one employee to a hundred, that's where the biggest risk always happens because you have to be a culture warrior. The CEO of Workday, he's quite fond of saying that it's basically impossible to reverse any mistakes you make in culture after you get over a hundred. It's not like you can't, it's just so much harder work because there's so much tribal knowledge, habits and expectations. That's where technology can help. This is what we say a lot to our customers and it resonates a lot with people. When you're the practice owner or you’ve got two or three of four people under you, you know everything that's going on.

PTO 50 | Patient Experience
Patient Experience: It's a lot more meaningful to a patient when they have convenient access to their care.


You know what you're saying to the patient. You know how you're talking about pain. You know how you're paying attention to them. You know the results that you're getting with them. You know everything and you know those first few employees. When you have 100 therapists or even ten therapists, you can't control that. You don't know what the new grad’s saying to them. You don't know how often they're on the computer. You don't know that stuff. That is where thinking about as practice owners always think, “How do I establish the floor of the quality, the clinical care that I deliver?” Most people will mechanize that by saying, “Everyone in our practice is going to go to this particular education, this residency or this fellowship. This is what we do with new grads.” You've established that floor of clinical care, meaning that worst case scenario at least someone's not going to get killed.

At least everyone will do the treatment-based classification for back pain. They'll at least get someone there. You have to take that same approach to customer experience. You don't know if the new grad’s butchering something. If you can make sure that when the patient is beyond the walls of the clinic between visits and interacting with your brand digitally. That you're getting the message to them that you need to get at a floor level that can compensate for whatever things might be going on elsewhere. There's a real benefit to the technology because it can scale that part of your practice. You don't have to worry about that part. You can focus on coaching your staff members to ensure that you can sleep at night not having to worry about that.

That's where I see where Keet can be a backbone to creating that fundamental structure or fundamental customer experience for the patients that come into your practice. That's what you're going for.

We certainly hope so. That’s a big part of this idea to go back to our story, that's our vision. I would say one thing I’d like to comment on. There are some things that are unique to therapy and some things that are not. An easy way to think about that, if someone said, “We're an accounting software for coffee shops.” If it's a software, it doesn't matter. You'd say, “You're an accounting software?” There's nothing unique enough about a coffee shop and how they do their books. They shouldn’t think about what they could do that as the way anyone else does. They can also emphasize the same things in any other business. There are some common characteristics between a coffee shop customer and a PT customer. They come inside, they talk to someone, they paid for a service, they get the said service and they leave. You want to keep in touch with them, maybe you want to measure their experience and you want to remarket to them, that type of thing. That's the same.

What's different about therapy is that this is unique to therapy. You have this whole concept of the episode where you’re like, “Nathan is going to see me for eight visits, nine visits or ten visits.” Also, the difference is, “Nathan's locking in.” It’s like a mini-tragedy, if not a real tragedy. He has a particular goal in mind, which is his pain and his discomfort or his goal. You have to say, “That is unique about therapy.” Consequently, being a therapy customer is a lot more like being a hotel guest. I have this snapshot and that specifically on experience to blow their socks off. You're not coming here perpetually. You’re coming here as needed, as you go to a hotel as needed. You don't go to a coffee shop as you'd go perpetually. My perspective on that is that the most effective form of marketing to that patient of establishing a groundwork for remarketing later is actually the clinical experience. In other words, “Think less about marketing and more about giving a great experience and your marketing efforts will be tripled in potency.”

When you can't possibly do it by hand anymore, that's when you worry about how to scale your business. Click To Tweet

That's why we take the approach. If someone might see our apps for instance, and again, this isn't a key fit. This is a way of thinking about it. “We already have an AGP software. We use this for outcomes. We already educate our patients and people can email our therapist.” Those are commodities. They don't hurt you, but they definitely don't help you. It's a lot more meaningful to a patient when they have convenient access to their care. When you've reinforced, maybe I explained to you how pain works. By the way, I wake up in the morning and it's like, “I have a piece of education from Nathan and it's a video of him re-explaining what you already told me. I can click something to know a little more and maybe you send me a thank you note in the morning.” That is way more impactful than thinking, “Here you go, AGP to go.” I don't mean to slam those guys. I shouldn't say that, but I think you get my point in that. What your patients care about, is that when I send them a checking email six months later asking them, “Would you like to come in again?” You're building on top of the foundation that is amazing and much more potent than if you didn't do that at all.

I love the ability that you have to work with patients between visits because it's not easy to go away and make a phone call or sending a personalized email. If you can say, “How are you doing this morning? Make sure you don't do this. Make sure you do this.” Those things can go a long way for a patient and guess what they're going to do? As they see this experience that differentiates you from other healthcare providers, they're going to say, “These guys really care about me,” and share that with their friends at lunch or over coffee. “This is what my physical therapist told me to do. This is what you guys should do as well.”

The difference between getting great results and those results are making you a fan. I could stay at Motel 6 and it gets the job done. I get to sleep, I get to take a shower and everything's fine. I’m in, I’m out, that’s it. When someone says, “I’m going to go to Austin,” I’m not like, “You’ve got to go stay at Motel 6.” I don't say that just to have the job done. I went to the W Hotel here in Austin or Four Seasons or some cool boutique thing. Think about the difference that makes you. We all have those companies in our lives that some are like, “I’m going on a business trip.” “You know where you need to go? You need to go here.” Take a step back and see, “What is it that makes you say that?”

When you listen to people start raving about they need a thing, it's not like, “They had a bed. I can sleep on it.” It's about all the little details. “It was so nice and this and that. The decor was amazing. They called me to make sure every day was going well.” Here's the amazing part about that reality, then you say, “How much is it?” They’re like, “A lot of money, but it's so worth it, I’ve got to tell you.” People pay tons of money to stay at something, not because of the result, but because of the experience. Imagine when you send that person to ask you for social review, the commodity part is asking them for a social review. You don't need some type of crazy software to do that. You need to be able to help create that person’s need to begin with.

I’ve heard many podcasts where they talk about or interview Brian Chesky of Airbnb and that's all what they're all about. It’s that customer experience. Back in the day, I remember the stories about them actually visiting some of the people who were posting on Airbnb and seeing what the experience was like to go to these places.

PTO 50 | Patient Experience
Patient Experience: What gets in the way of getting inspired and feeling you’re doing meaningful work is when the ordinary things feel like mundane things and you feel like you have no purpose.


It's a great experience. There’s another podcast, it’s called Masters of Scale by Reid Hoffman and listen to the very first episode. You'll hear an amazing story, which I’m going to sum up. It's something that we should all adopt as business owners. Brian's very inspired by Walt Disney and so he was reading the biography and he was thinking, “What can we give outside of homes?” For those that know Airbnb, they have Airbnb Experiences. I’m actually doing this with my dad. I’m taking my dad on his bucket list trip to Europe and I’m booking all these Airbnb Experiences by locals, take us to the Pantheon, to the Vatican, show us the underground or new cool restaurant.

How that came up was he didn't study and go visit cool hotels. He didn't go to tourist companies. Do you know what he did? He hired someone from Pixar who had no product management experience of technology ever. He said, “Tell me how you write a great story.” The guy got up there to say, “This is the formula. There's always the super grand entrance. They think they know what they expect, then there's this moment where they re-discover themselves because they do something uncomfortable that they would've never done by themselves. They become this new person, there is something about it.” He was like, “Great. We're going to do that for one customer.”

They had a customer, go out of San Francisco by himself and said, “We're going to take your weekend, but we're not going to go with you the first time. Do whatever you want.” That's where he came back and said, “I'm pretty miserable. I’m not that enthusiastic of a guide. I went to some bars by myself. It was really expensive. I didn't know if it was okay.” They said, “Come back the next weekend and we're going to show you around.” They flew him in a private jet. They picked him up in a limo. There was a parade in the street that he was staying at the Airbnb. They welcome him in and he got an underground bike tour. He got on all these restaurants. He got announced on stage. He got on all this crazy stuff and sent him off on a private jet.

When he was leaving, the guy was crying, “It's the best weekend of my life.” What Airbnb says, “We can't scale that, but that is the ideal experience. That's what we're shooting for. What from that can we actually scale?” That is how Airbnb Experiences started. That's been a great lesson to how often do you hear that someone's in your company or you hear some great idea and the first thing you say is, “I don't know how that would work. I don't know.” It's the wrong way to do it. You don't ever start there. Start with an imagination. Whatever your reference Pixar person is, think about that. Remove all your constraints, then do that with somebody and then you will get so inspired to get out of your box and then say, “How can I fit those types of things into our business?”

What a great exercise you can do with your executive teams, even by yourself, with someone that you work with or even by yourself. On a scale of one to five-star experience ratings, what would a twelve-star experience look like for a physical therapy clinic or for a patient to come to a physical therapy clinic? It might include a parade and having them picked up by a limo from their home and whatnot. Some of those things aren't doable, they're not scalable, but of those things that make a twelve-star experience, what could we do? What could we implement? To brush that story off as, “It's cool for Airbnb.” I think it's something that we could definitely learn from if we took it back and said, “I can't do all that stuff, but of a twelve-star experience, what could we implement now? What could we implement in a month that makes the customer experience that much better?

Sometimes, prioritize that over efficiency. It’s something we get caught up in. “I don't know what’s going on with our EMR,” like all that type of stuff. Sometimes it's worth taking it on the chin as an owner for the sake of your patient, particularly when you need to compete. The biggest lesson here is that I’m a big fan in any process in your business, you do it by hand until it hurts. When you can't possibly do it by hand anymore, that's when you worry about how to scale it. Don't not do it because you don't know how it's going to scale when you open your next site locations. You’re never going to be able to take to innovate if you constantly obsess around operations.

I really appreciate you taking the time. It's been a great conversation.

It's been a blast. As you can tell, I am very inspired and passionate about it largely because we used to have a phrase early on in Keet. We got to an interesting crew of people and a lot of us are pretty big thinkers when it comes to the big questions of life. We had this phrase early on which was a vocation as an implication. What that meant is the word vocation has largely been a lost word in our culture, replaced by job or career. Vocation, historically, is a sense of calling. It's a sense of purpose as to what you're doing and it's beyond your job. It includes your job. As implication means you're implicated in the way that the world turns out and you’re implicated the way that your business turns out.

What gets in the way of getting inspired and feeling you’re doing meaningful work is when the ordinary things feel like mundane things and when you feel like you have no purpose in things. Think about it, no one likes to do the dishes or doing laundry. It always feels it's getting in their way of something. If you could somehow make that something that is inspiring to you, it would be amazing. That's what we're passionate about at Keet as people. That's what all business owners want too. You want to be able to feel every aspect of your business is something that you're excited about. If you focus on that, then it's the same thing for your customers. I appreciate you let me rail off and getting on some tangents. I think that's always the best way to get inspired. It’s the same thing with this show. You read and it's overwhelming, just start with the one thing you can do. Take it from there and go from there.

Thanks for taking the time and sharing with us. Is there any way people can reach out to you or contact Keet if they have questions?

In terms of the actual software, if you want to learn more, You can go there. In terms of me personally, my Twitter is my last name @SelfDM. My email is I will try to get back to you, to every person, but I can't guarantee how quickly. We’re always trying to make it a point that I can. I’m also on LinkedIn. When you’re at a conference or anything and you’re around, come and say hello. I love to meet and learn from everyone else. I certainly don't know everything.

Thanks for your time, David. I appreciate it.

Thanks, Nathan.

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About David Self

PTO 50 | Patient ExperienceDavid Self, PT, DPT is the Director of Product Strategy for Keet Health - a PRM for PT companies. He began his work in the healthcare industry as a strength and conditioning assistant while attending the University of Texas. He eventually opened his own fitness facility just outside of Austin, TX while also going through PT school at Texas State University. Upon graduation he and a partner founded Keet Health in order to improve the PT experience for both provider and patient, and eventually sold the company to Clinicient.


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