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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