There is constant chatter about "which EMR is the best", "what ERM do you use --- and do you like it?", and "what EMR should I use?" No PT-specific EMR has all the answers, and every EMR has pros and cons that make it seem like they're all equally average and stuck 5-10 years behind current technology. PromptEMR shows us that there are new EMRs in development that, built on better platforms, can become the ideal EMRs we desire. Based on their patient-based perspective, PromptEMR was initially built to provide better communication with patients during their therapy episodes. Since then, it is striving to bring the rest of the business cycle and PT clinic employee tasks into the ‘20s, making everyday tasks and reports easy to perform and access. In this episode, the co-founders join Nathan Shields to share their stories.
I'm talking about EMRs. Most notably, we're talking to the cofounders of a new EMR out there called Prompt EMR. I'm interested in talking to them because they're doing things differently with a different perspective and I'm hoping that they can be disruptive to the EMR space. I've interviewed Heidi Jannenga of WebPT and Jerry Henderson of Clinicient. I've used their products in the past and I've been happy with them, but there's always something missing. If you worked with different EMRs, some EMRs would be good at some things. Some EMRs will be better at different things, but you never are truly happy with your whole EMR system across the board.
That's the ideal scene to get to. Hopefully, these guys at Prompt EMR can be those people. I'm excited to hear about the time and energy they've taken to develop practice management reports to improve the patient experience and the systems that they've developed to stay in touch with patients in-between visits and post-discharge. All those things can be super valuable and add to your marketing efforts. I'm excited to bring them on and talk about what they're doing, what they're seeing, and how they're maneuvering so that they can be the best EMR system out there for physical therapy owners. Let's get to the interview.
I've got the Co-Founders of Prompt EMR Practice Management. I've got Mike Dwyer, Co-Founder, and Director of Sales and Adam Baliatico, Co-Founder and Director of Operations who are joining me. I'm excited to bring on a group that is newer coming into the EMR space for physical therapy and trying to be disruptive. Do things a little bit differently so that the EMRs that we have in physical therapy truly can be something that can be a benefit to all the owners out there. Not in terms of documentation, billing, some of the basics, but even more than that. That's why I thought it'd be cool to have the co-founders on and talk about Prompt EMR and what they’re trying to do to disrupt things. Thanks, Mike and Adam, for coming on. I appreciate it.
Thanks for the opportunity.
Mike, maybe you can share with us a little bit about the germination of Prompt EMR. What brought it about? What got you into this space?
I started this in 2017 and it came from being a good patient. Over my four years of college, I had multiple injuries, most notably a SLAP tear and then external compartment syndrome on both of my legs. At that stage in my life, I track every aspect of my life. I still do this in my sleep, my diet, my exercise, everything. One thing I couldn't do at the time was to track how it's progressing in therapy. When you're in therapy for about 2.5 years, it's draining. You're there because something's wrong and you're trying to get to your level of function. As a patient, it's tough. I was trying to create a product that essentially would tell a patient where they stood in therapy and then when they would be expected to get to where they were supposed to be beforehand. What we found with that product early on was that it was nice to have things, but it wasn't essential. The big problem we had with that was if it wasn't connected with an EMR, it was useless because as a provider, you have limited time. Documenting one system and documenting another would never happen.
That was a critical point for the company because it led us to a bigger problem. Given that we weren't able to integrate, we noticed that there were already too many pieces of software in a clinic. There were 2 to 5 generally in each setting that we were in. It wasn't the most fun years of our lives, but Adam and I spent roughly eight months as a fly on the wall in clinics to make sure that the juice was worth the squeeze. We decided it was and we tackled the big overarching problem of combining all of the software required in the clinic into one spot. That’s a long-winded answer but it should give you an idea.
That's great because you're coming at it from a different perspective. You're not a physical therapist who's saying, "This is what I would prefer to have and this is what I need." You're looking at it from a patient perspective, which is different. What might keep patients engage or even retain them and make them part of the journey when it comes to developing in the EMR. That's a different perspective.
It is also the way we structured the platform, most of these other systems can't display data to the patient. Where trying to make it similar to that original idea, to be able to have someone in tune with their care. Also, on the flip side, healthcare providers get as much information as they need. For example, going out there and take ahead of time going right to the eval and being able to book online. There are a lot of angles for the patient that was actively taking it as well.
It makes it an easier experience and a better patient experience altogether.
It's also something that's expected. For me, it was something I didn't have in therapy. Let's say class pass or something where you're booking online to get into your thing. It was something that I didn't see in therapy at the time and something I wanted to have. We went all-in on that.
It seems like many of the software EMRs that are out there live about 5 to 10 years behind the times. You would think and even patients came into our clinic like, "Why do I have to fill this out all again? Is there some way we can make this easier?” It would even be super nice if you're able to schedule online because you're able to do that with many other software programs. It would be nice and anxious to see how it goes with you to incorporate all that and put it all into one EMR. That makes the patients’ experience much better and easier.
One of the things that we noticed during that research phase was a lot of the software was built by the therapist and the focus was on the therapist. A lot of the patient experience falls more to the front desk, managing the intake, scheduling, and things like that. Since the software was built by the therapist for the therapist, they were focused on the therapist’s experience. A lot of them ignored the other users within a clinic. That was coming at this as an outsider and as a patient and not a physical therapist or a biller or the owner of a clinic. We took a unique approach that we wanted to build our software for every user in the clinic and also the patients. We were focused on optimizing each user's experience in software from patient to front desk.
Can you tell me a little bit about maybe what you’re doing to keep patients engage via the software? Are there any examples you can share?
Even though the patient engagement aspect of what got us into it, we had to do a lot of the other things first, like facilitating good patients’ engagement. We started with normal patient reminders and things like that. In the coming weeks or months, we'll be launching a home exercise program that's built right from the therapist flow sheet. They'll also be able to engage and track the progress. Patients will be able to tell the therapist while they're doing their home exercise program, “This hurts. I skipped this because my knee was sore.” Engaging in the home exercise program. Another area of friction for patients has always been having to call and pay your statement instead of being able to input your credit card information. Through our process, the patient's going to be able to pay their invoices without any friction. Little things like that seemed minor but improved the overall patient experience. The bigger vision is to use the data of their recovery to display progress to patients and let them visualize that recovery like Mike's original idea back in 2017.Disrupting the EMR industry and bringing it into the 2020's Click To Tweet
You're saying that patients from home make comments about the exercises that they're doing at home to the therapist prior to or in-between visits?
That's an enhancement to our home exercise platform that we'll be launching soon.
Do you also envision having something that can retain patients even post-discharge, whether that's email reminders or whatnot? You can use Infusionsoft but that's way above our heads as a physical therapist. I’m speaking for myself. Do you have some visions for having email marketing programs for customer retention?
To delve back on your point with the flow sheet. Once the patient is out discharged, being able to give them a plan, it's a big thing going forward with all these cuts coming in to diversify the clinic and having potential revenue screens that you didn't already think of. That's the way to do it because, through our system, you can template out exercises in the future, send it to the patient and still see how they're progressing outside of the clinic.
On the email marketing side, we're having some discussions with some of our clinics and we’re starting to work through the specs. It's a priority of ours to be able to engage with not just your active patients but also the patients that have left the clinic in a simple way. We don't want to give 500 different features to the therapist and owners who are going to use it for free. We're trying to figure out the core features in email marketing. Being able to engage with those patients is a priority of ours going forward.
We're talking to owners. They're going to have to deal with what the physical therapists or providers that are on their team have to deal with it. A lot of that seems to be what you guys do about ensuring fast documentation times, whether that's setting up templates and also how you deal with compliance. How do you attack something like that?
Our big thing during the research phase was to figure out exactly the workflow. We came to the conclusion that documenting in SOAP format doesn't make any sense. For insurance purposes, we have to report to SOAP. For documenting it wasn't following the same train of thought that the therapist goes through. For example, you're taking a pain measurement and then you're hoping to different tabs to generate that thought pattern. You're going to the assessment tab and the plan tab to finish it out. For us, we centralized everything on one screen. Also, a big thing we worked with our early clinics and billers, was building click-based documentation with compliant language. Our main use cases are on a tablet and the therapists as they're going through, they're tapping. They're not dealing with a bunch of pre-texts. Our main goal with documentation is to finish it either in session or before the therapist leaves. When I started this and I was talking to therapists, almost every single person said that was the worst part of their job. It was also something they were doing after hours. They didn't necessarily have to be. It was the software that required it. That was the bulk of our research. Adam, do you want to maybe touch on a little bit more of the compliance end?
We've worked with a lot of billers and people that have a lot of experience in dealing with audits and things like that. We make sure that all the items that need to be documented on eval, plan of care, or your normal follow-up visits are all there. Even things like making sure our electronic flow sheet that it's easy for the therapist to say which CPT code each exercise is associated with and then automatically populating that into their notes so they don't have to type it all out. Little things like that to make it easier to document compliantly. It was a big focus of ours early on to help the therapist document in a compliant way but also keep it easy so they can get their notes done fast on the same day. Many of our clinics are not finishing their notes on the same day, but since it's a seamless flow into the billing, a lot of our clinics are submitting their claims on the same day as the date of service with their documentation done as well.
You do have a built-in billing software program.
That's all built-in, all in one billing and documentation.
In my episode with Rick Gawenda, both of us shared a discouragement amongst the EMRs that are out there in their capabilities to generate quick malleable practice management reports for the small practice owner. We want to see the skilled units or CPT codes that are being built out by the provider but also in a clinic average. We want to see who's completing their full plans of care. How many times per week each patient is coming and is it the appropriate amount? What is the average furlough of the clinic? Things like that that you're not able to get a lot of from EMRs. It sounds like you’re looking at each aspect. You are also considering what you can do to provide those types of practice management reports.
We were an end-to-end solution. We're not an EMR that relies on a third-party billing software to do the billing. We're not a third-party billing software that relies on an EMR that passes the data. Also, because we’re capturing the whole patient's experience. By the time they book an appointment and they pay their final bill, we're able to generate a ton of reports in an easy to understand way with a complete data set. A system that doesn't do the end-to-end, they're going to have a hard time generating reports on tracking the entire plan of care. Making sure each therapist is billing out the right units and things like that. It all flows in one architecture. It’s an all-in-one platform that allows us to generate robust, easy to understand reports and we're unlimited on what we can do in reports. It's something we talk to our current owners about all the time, “Here are the reports we have. What else would you like to see?” Since we have all of the data, we're able to overtime generate all of the reports that owners find useful.
It's also not inundating an owner with reports. They need to be able to look at their dashboard and make decisions quickly. If you have over 100 reports, that's impossible. We spent a ton of time talking to owners, "What matters to you?" and then putting it all within one eyesight so you can make decisions immediately versus having to generate a bunch of reports and finish your thought.
If you're capable of doing it, if you can at some point, take some of those stats and graph them for us over a period of time, that would be great too.
A big objective for us will be trending statistics. We have all the data as a statistic. The goal for us in reports 2.0 will be trending statistics. Let's look at this compare to this month or last year. Let's look at the last six months or the last twelve weeks. It’s being able to get all that trending data so you can predict where your practice is going, instead of viewing a snapshot of where it is.
That gets me excited. Also, why I was excited about bringing you on because many of my coaching clients, I talk about certain reports that they need to generate. Either they need to finagle their current EMRs or they have to start tracking those statistics manually on a separate Excel spreadsheet that either they do or their front desk person is doing. As I'm talking about these reports on statistics, I want them to track because they're vitally important to increase their cashflow and their profit margin. I can feel like, "It's one more thing that I've got to do." To find an EMR that can provide those reports would be much easier to the benefit of the owner as well. One of the things I'm excited about talking to you is you're thinking somewhere in the future you might have a CRM as it pertains to marketing efforts.
The CRM side, our more core focus will probably be marketing to your existing and past patients first. Incorporating a lot of like helping you run Google Ads. We'll also potentially integrate with one of the existing CRMs because CRM is a massive product. We’ll be able to market to your existing patients and past patients that are in the system. We’re coming up with ways to help the clinics grow their marketing efforts as a whole or through potential partnerships or integrations with CRMs and things like that.
Some of the reports that I saw even had broken down some of the physician referrals and who sent you, how many patients, and how that generated such income based on the referrals that those physicians sent. That breakdown is hugely valuable if you're setting up a marketing strategy campaign.
We've also added the ability to taking the patient to say where they found you. For example, you're spending a bunch of money on Facebook Ads. It's a good way to be able to track similar to how we do the referring position of what that means dollar-wise once that patient is in the clinic.
That’s valuable because the statistics show that physician furloughs are significantly decreasing over time. Whether that’s because they're saying, "Go to any physical therapist around you or you’re going to stay on my network,” or whatever it is. Nowadays, it was different a few years ago. You have to do some social media marketing. You have to market directly to consumers. You've got to be able to track your efforts in those realms. That data is huge.
We're big on doubling down on what's working, getting rid of what's not. That's going to be able to help the owner to say what matters and what to leverage.
Are there any big exciting projects you’re working on?
There are some huge undertakings. We launched version 2.0. We'll be rolling out version 3.0 of the platform, which will include the most robust internal communications, as I've seen on the market, Scheduling 2.0, Documentation 2.0, some upgrades to hap, patient intake upgrades. Also, the patient's ability to pay their invoices without any contact with the clinic. There's going to be some massive updates that will culminate in version 3.0 of the product. It's massive improvements.
What are your greater visions beyond 2020?
A big piece of what we started this on was agile development. What that means for people that are not aware of it. We take feedback and implement it quickly. Our biggest focus is on talking to our users. What do they need? How can we make it better? Our ability to listen and act quickly is unique in this space. We're updating this every two weeks.
It sounds like your customer service response time is quick.
We don't off-source any customer service. It's a core competency of what we do. Built into the software is live chat support. If you submit a request, you're getting a response within 1 or 2 minutes. If we can't solve the issue through chat or through one of our pre-written help articles, we have this feature called smart help. Depending on what page you're on the platform. We can see that and we recommend articles that are likely to help you while you're on that page. If an article or the chat can't get it done, every one of our users has our cell phone numbers, our support numbers, and then we're happy to hop on the phone and work through solving a problem. If a user needs an additional 5-minute, 10-minute training session to remind them of the optimal workflow for doing something, we hop on with people. We are willing to do and have follow-up training to make sure at the end of the day that everyone's using the software in the most efficient way so that ultimately, the clinic operates in the most efficient way possible.
What have you found has been the biggest uphill struggle in getting this going from the get-go, Mike?
I would say convincing people that the new guys are better. It's something we deal with, but it's something we're open to showing. We always do demos that we always offer to people who are using the platform. The big piece that scares people and there has been a challenge is the fear of switching. If someone has switched in the past, it generally goes poorly for the most. For the past years, we're trying to make it a little less badly. We try to get all the data into the platform, get everyone trained and comfortable prior to going live. We're getting much better at it and it's going to be something we're going to always be tweaking to make it easier because from an owner standpoint, that is probably the biggest hurdle.
We're lucky in that regard that one of our senior engineers has many years of experience migrating data and taking sources of data from one system and putting them into another, whereas a lot of EMRs and other systems hand you a blank slate. We're able to transfer over in some cases, all of your patient demographics, case information, insurance info, all of the PDFs of your past notes, visits, no-shows. Depending on the system, we can maybe even bring in a history of all the claims you've submitted. Because we have a good data migration team, you're not tasked with the burden of bringing over all your data by yourself. With all the training we do for our clients when they start, it’s smoothening out that transition process. You're still switching the entire way you run your business. We've been able to make it as easy as it can be. Generally, by week 2 or week 3 for our clinics, they're operating in a way more efficient level than they were prior. Maybe there's a week of some back and forth of getting things moving out. It's not this big long extended process.Engaging with not just active patients but also that have left the clinic should be a priority. Click To Tweet
What makes you capable of doing all these things that the bigger companies can't do? What makes you more nimble and flexible?
We’ve built this from scratch. Some of these companies, you're dealing with legacy databases and to adjust it, fix it per se is a lot easier. It's a lot harder than saying it. Our ability of what we built it in, our frameworks have allowed us to be able to be nimble and adjust the platform quickly.
Our engineering team made sure we built it in a language and a system that is easy to upgrade and improve. We also actively seek out our customer's feedback and input because ultimately, we're building software for them, not the other way around. If we can't build it to satisfy all of their needs, then we're missing out on something. We recognize that. We seek out our customer's feedback and engage with them. Take their feedback and value it much higher than our thoughts. Our user experience team can take their feedback on what they would like to see or what they're used to and come up with solutions that are even better than what the users were hoping for and improve their efficiencies and beyond what they expected it could be.
I'm excited about having a new guy on the block, someone who’s a little bit more flexible, nimble and capable of creating more than what's out there. Is there anything else you wanted to add regarding Prompt EMR?
One other point we didn't add is their ability to integrate easily. Having companies that have existing workloads that they're trying to bridge together, we're able to do that. Another good piece of what we do to get people to spin the water to see what's different is we do a trial environment for 30 to 45 days. A clinic that can recreate all their workflows before deciding to switch over to our system. From your standpoint, it's a huge switch. You're changing your whole workflow. It's going from say G Suite to Outlook and changing everything up. We get that it's a big switch and we try to walk everyone through it to make the most informed decision on their end.
If someone wants to try you out, how would they get in touch with you?
Our website Prompt EMR and then we generally do a 10 to 15-minute demo quickly to let people see at a high level what's different about it. From there, most people will go to the trial site. There's no risk to it. You're not locked into anything. You can play with that.
If anyone wanted to reach out to one of you individually, how would they do that? Who should they contact?
They can also call (888) 855-2107 that is our direct line. The other thing I'd like to mention is that for us, we're launching version 3.0. That’s three versions of the product in a few months. The sky is the limit for us and where we're going to go from here in terms of improving the efficiencies and optimizing for every user in the clinic, from the patient to the front desk, to the biller, to the therapist and the owners. Our core focus is improving the efficiencies of every single user and we're not going to lose that focus, delivering tremendous customer experience and customer service. That will be at the core of what we do as we grow and as we continue to move the platform forward and hopefully help improve the efficiencies of the entire industry and the outcomes of patients.
I'm excited because we hit on it during the episode that you are coming at it from a different perspective. It's easy to understand what the physical therapists and what the owners know or want to know and want to have in an EMR system. It's cool that you're coming out of it from, "What can we do to engage the patient more?" Maybe not even during visits but in-between visits after their plan of care has ended. That's the highlight of something that would set you apart for sure.
It's the patient and the ability to go especially in private practice outpatient. You could go wherever you want. There are ways to differentiate yourself, especially to our platform to keep it more sticky for that patient.
One of the things I realized we didn't even touch on was the billing side. When we got into this, one of our first partners was a billing company and seeing some of the things they had to do on a day-to-day basis that was antiquated like printing out, going into the EMR and getting the notes and then stuffing all of those manually into an envelope and mailing it out to people or faxing it. We've been on the billing side, get rid of a lot of the archaic processes. You don't have to print anything and mail it. You don't have to print anything and fax it. Everything's in one system. It's electronic and human-less as possible in a lot of those things. There's no reason any more to have to go through and look at all your Medicare claims and make sure the GP modifiers there. On the billing side, we didn't touch on much, but we've solved a lot of the archaic processes that delay the cashflow coming into the door of our clinics.
You would expect that in 2020. Many of our EMRs are 5 to 10 years behind. They're not doing any of that stuff.
What got us excited 18 or 20 months ago, we were sitting in our billing partner's office. She had a mountain of paper stacked on her desk. We asked her what it was. She said, "It's all the stuff I have to mail and fax.” When you see an opportunity like that with all the bills and the existing ways to avoid that problem, that was an exciting moment for us way back when we knew there was massive room for improvement in the efficiency.
We were already in at that point with that. We put all our chips in after that.The big piece that scares people is the fear of switching. Click To Tweet
That gets me excited that you were able to be flexible and mobile enough and pivot to make significant differences in not just the patient experience, but also the experience of the billers, and making their lives easier and better than what they're used to for the past twenty years. It's exciting to talk to a company that focused on that experience all around. Thank you, guys, for coming on. I appreciate you taking the time. I know you're busy doing demos and whatnot across the country. I wish you the best. I know your focus is to disrupt the industry a little bit. I hope you were able to do it. I wish you the best.
Thanks for this. It was great to be able to tell our story and walk through everything with you. It's great.
Thanks for having us, Nathan.
Adam Baliatico - With a background in Equity Research at Canaccord Genuity Group and owner/operator of Boston College 247 Sports, Adam has a unique background of managing large teams on different tracks. At Prompt, Adam serves as Director of Operations and is a co-founder. Adam oversees Product Development and Customer Support. As product development lead, Adam focuses on incorporating customer feedback into unique solutions that improve clinic efficiency from end-to-end.
Michael Dwyer - Michael’s lengthy history as a physical therapy patient led to the founding of Prompt Therapy Solutions. As an industry outsider with a background in finance, he came to notice many inefficiencies and redundant workflows within the physical therapy clinics he attended. Mike then assembled a team of software engineers, user experience gurus, and billing experts to create a seamlessly integrated solution for the physical therapy industry. He now leads Prompt’s sales team and guides the companies with long term strategic initiatives.
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I've got Jerry Durham. I'm excited to bring Jerry on because he's well known in the industry. He has been an expert, a conference speaker and industry leader for a number of years. His focus is to help physical therapy practice owners to engage patients for great results. He has questioned why there isn't more emphasis placed on treating patients as individuals and focusing on truly developing the relationship with patients. You're increasing your arrival rate, decreasing no shows and cancellations and achieving greater results, all through improving that relationship between your clinic and your patients. He talks about the patient's journey. We've talked about the patient experience in the past, but I like how he explains it. He takes us through the life cycle of a patient and their interactions with the physical therapy clinic from the initial call through the billing cycle. At each touch point with the patient, each staff member has a responsibility to create a great experience with that patient. Developing that relationship will get us the numbers that we want. It will improve conversion rates and cancellation rates, improve collection rates and improve our physical therapy results.
I'm excited to bring Jerry on so he can share his wisdom. A little bit about him personally, he grew up in the Napa Valley. He played some sports and got turned on to physical therapy in that way. After physical therapy school, he worked in a number of different settings and eventually opened up his own practice. He partnered with Sturdy McKee and opened San Francisco Sport and Spine Physical Therapy. They've been in practice for several years. Halfway through that, they decided to go out of network with everything. Interestingly, it was a quick and easy decision for them. They've been successful ever since. Jerry is not only a partner in the clinics but also hosts a podcast, Healthcare DisruPTion. He's a nationally recognized expert and sought-after conference speaker, as well as a clinical instructor who travels across the United States. He's also on the nominating committee for the PPS of the APTA. He is thriving in teaching and consulting with physical therapy practice owners, whether they accept insurance or are strictly going out of network and cash-based. Let's get into the interview itself. Jerry has a ton of information to share.
I've got Jerry Durham, a physical therapist out of California. I'm excited to bring him on. I've seen his name for a long time. I've heard about him through different circles. I'm excited that he's finally on the podcast as a guest. First of all, thanks for coming on with me, Jerry. I appreciate it.
I appreciate you giving me your time too. The only thing we can't get back is our time. I promise to make it worthwhile for everybody reading and you.
Do you mind bringing us up to speed on what you do, where you've been, your experience with physical therapy in the past and what you're doing now?
It's many years in the profession. I always have to throw that out first. It's several years of my own practice of which are not public knowledge but becoming more common knowledge that I'm moving my way out of. I'm no longer in California. I moved to Philadelphia. My wife and I brought my two poodles out. We love it out here. The biggest part of the journey was opening my own practice with my partner, Sturdy McKee. We started like everybody else. We started in network practice. We did everything that everybody else was doing. To give everybody some context about where my conversation in my world comes from, ten years in with multiple clinics, we went out of network.The only thing we can't get back is our time. Click To Tweet
I'm going to say two things, not as an ego, but to set some context. We went out of network when nobody else was. We were looking for solutions from other physical therapy practice owners and couldn't find them. We had to learn something new. That's when my business education started. We had to learn something from someone to stay and exist. One of the big tipping points in my career was when I joined EO, Entrepreneurs Organization. I joined an organization with 100 other business founders all doing $1 million at the time. There are no healthcare people in there. I learned so much about what we were doing. What we needed to do was run a business, which, prior to that, we were not running a business per se. From that day forward, it's running a business. That's how I got to where I am, which is this whole patient experience, front desk training, and understanding that we, both as PTs behind our names, are not the most important people. We're part of a team. Like any other sport on the face of the earth, when you engage the whole team, it's when everybody thrives and strives, including your patients, including your employees and including your bottom line. That's what I'm helping people now with.
Back in your story, what was the tipping point for you guys to decide to go out of network?
We weren't doing business things. We were doing a handful of things in reflection. One of them was we knew our cost per visit from day one. By knowing our cost per visit, it was simple. The conversation to go out of network took about a minute and a half. We made a huge business decision in a minute and a half because we understood that part of the business at the time. We knew that we could not continue to deliver care and lose money at the same time. Two things occurred right then and there. We decided in about a minute and a half to go out of network. The third huge tipping point for me in my career was as soon as we acknowledged that we had to go out of network, I looked at my partner and said, “We're going to have to start. We're going to have to change the way we are talking to people when they first call in because we're not going to be in the network.” That's what started this whole thing. I tell everybody, “Put the patient first. Your business will be successful.” That's how most clinics fell. Even though they claim to be patient-first, they can't prove to me they're patient-first. It's that and the whole team approach. Knowing that stuff, it's baffling.
What do you tell owners when they do come at you with that typical, “We put the patients first,” or “It's all about the employees?” What do you tell them to have them think differently?
I follow that up with a business question. We put our patients first. We put our employees first.
We're there to serve. It fulfills our purpose.
My follow-up question is, “What's your cost per visit?” If you don't know your cost per visit, you can't run a business and you can't put anybody first. After that, I'm going to ask them the second question, “What is your drop off rate?” Your drop off rate will prove to me how much you know about the business. It will tell me whether you know about your customers' journey. I'm a huge Herb Kelleher fan, the Founder of Southwest Airlines. Herb Kelleher is one of the first people that I ever heard said, “Your happiest customer is only as happy as your most unhappy employee.” I took that to heart. I believe that. I have a piece of flip chart paper hanging in my office. It says, “Happy employee.” Right below, it says, “Happy patient.” I have an arrow going through a complete circle. Without your employees knowing what they're working towards, they never can create a happy patient. Once they know what they're working for, they can create a happy patient, which creates a happy employee. It becomes this virtuous cycle.
What I found after studying all these successful businesses and bringing it into the physio world is every single successful business on the face of the Earth understands one thing first. They understand their customers' journey. They understand where their customers are engaged. They understand what their customers want, rarely is it what they need. Most of iPhone people, if they needed a phone, they would have bought a $35 phone. They don't need a phone. They need something else. They know what they want. They understand their touch points. Walk into an Apple store. There's a rhyme or reason on all of it. They understand the journey on the website. They understand everything about their customer, which in turn tells their employees what the focus is.
When I get in a room and I'm going to hire someone, I say, “This is our focus. Here's our customers’ journey. At the center are happy employees. Here's your role.” Once I understand my customers' journey, I can tell you the role you play. I have never interviewed a front desk person without starting out, “Your role here is to help people get better.” That's what I tell my front desk people. Your role here is to help people get better. If you don't help them and manage their expectations and bill address on the first phone call, they're never going to get better. If they do get better, it's because you managed the relationship. You took care of them on your part of the journey. In my mapped-out customer life cycle, guess who has the most touch points with the customer in the entire life cycle? It's my front desk.
I've used the term with a few of my guests here. Customer experience, can you equate that to customer journey?
These are different. We use it separately. It's important. A customer life cycle is every single touch point and interaction, your potential customer to a customer. In our world, they complete a plan of care. They leave you. It's pretty objective. You lay it out. They came to me through my website. They call here. They arrive. They meet my PT. They complete a course of care. It's simple. That's your customer life cycle. It's objective. It allows you to do a lot of things. Understanding your customer life cycle allows you to understand who owns the interaction, what objectives and goals need to be met at that interaction, what tasks it's going to take to complete and meet those objectives and goals and what information needs to pass to the next touch point. The mapping of the customer life cycle has to be first.
There are different experiences within each touch point.Your happiest customer is only as happy as your most unhappy employee. Click To Tweet
This is the beauty in it. I had a hard time understanding this. You get to create the experience you want. Everybody says, “That's your customers' emotional journey.” I said, “I know.” The important thing is to understand what emotions you want to facilitate and which you want to get rid of. We want to facilitate trust. We want to decrease and eliminate fear, doubt, and uncertainty. At every step you're going, how are we building trust and how are we eliminating fear, doubt, and uncertainty? The experience they remember is their emotional story with your service and product. That's the difference. You must know the life cycle first.
I love that you said that you gave the front desk a purpose, which is not what you would expect the purpose of the front desk is. It is so much their job because they are a frequent touch point there. They're the face of the clinic. They're the first person they see. They're the first person they talk to. They're the person that's collecting the money. They're the person that's explaining the insurance benefits. You could be an amazing physical therapist, but if any of those four things drop out at the front desk, they might care less about the therapy that you're providing.
Here's a great story to prove that too. Everybody's sitting on the other end and they're saying, “That sounds great. How do you measure it?” You don't know it's there until it's gone. Here's how I figured this out. The part of my story I left out and part of how I came up with this process is I answered all the new patients' incoming calls from my clinic for a year. I answered close to 1,000 new patients' incoming calls. I did the cost callbacks. I was the voice of the company. I was the one giving them their cost. The way we set it up, they would walk in and meet the face of the company. I was the voice and the entry points for the company.
Here's what I learned. I made that conversation around the purpose. I didn't answer the phone as the owner or a physical therapist. I answered it as the person scheduling you. When I made it purposeful and made it about you and your story, if we were the right fit for you and what you wanted from us, when you appeared, our no show and cancel rate went down. When you appeared, our billing and collections problems disappeared. When you appeared, our copay collection rate went up to 98%. When you appeared, you stayed and you got better. It’s completed care. Here's the other thing I learned. When you didn't arrive, you still had a great experience through your life cycle with our company, which was, however, you found us until I hung the phone call up. I have had referrals from people who call on the phone and chose not to see us because it was too expensive who later referred clients to us. I followed up. The first time this happened, I was more baffled than anybody else. I sat there and said, “I’ve got to find out why. There's no way anybody should be sending patients here.” It's all about the PT. It's all about whatever it is, the chiro, the acupuncture or the physio. That's what people want. I'm like, “I'm here to tell you otherwise.”
I called this guy back. I forgot his name, so I'll make names up. “Jim, this is Jerry over San Francisco Sport and Spine. How are you?” “I'm great, Jerry.” “Jim, I've got a question for you. You sent Steve Smith over at us, right?” He said, “Yeah.” “I have another question for you. I have no idea why. I'm wondering why you sent Steve over to us.” He said, “I sent him over because I figured a clinic that was so nice and so helpful on the phone before I even arrived. It probably has the best providers in town.” I went, “It's noted. I greatly appreciate that. You're very welcome.” That was my proof of process. All my billing, collections and complaints disappeared when we changed the first phone call.
You put all that experience, the time you spent, right into that first call. It’s the first time a person talks to the face of the clinic. All focus is on that. It’s giving them their purpose. Those two things alone are huge. Did you go to the point of even making a template of, “This is what you're going to say,” or are you willing to give them some freedom and say, “As long as you meet these standards and help them build trust and decrease fear, doubt, and uncertainty, and achieve your purpose, I don't care what you say?”
If you come from a position that your front desk is task-oriented and their job is to get people scheduled, who cares what they say? If you're going to churn people out, everybody goes on the schedule and it doesn't matter if they're a fit, you waste their time, money and energy. You wasted the providers' time, money and energy. If you want to hire the right person and empower them to be successful, I have a ten-point checklist. The people I train and I work with know the front desk roles. They're two things. It’s to start to build a relationship that will last throughout this person's entire life cycle with your company. That could be the end of the phone call. Number two is to be a problem solver. I say, “That's your goal. That's your objectives with every phone call you answer.”
I split the front desk out. The phone call people are on the phone. The task people are doing tasks. I give them the checklist. I give them the services that they know we offer. Some people offer free discovery visits versus paid visits. I help them to understand where these separates, then I put it in their control. Here's the structure. It's almost like you give someone a poured foundation. You build the house, but here's the footprint for the house. We measure success by conversion rate. Success is easy to measure. Book that and MPS. You’re doing MPS front desk and conversion rate. It's theirs. You’ve got to hold them accountable. You need a recording tool, something where you can track the phone calls. Have some discussions with it, what's going well and what's going not. I want them to help me find the trends before they happen.
That's part of the problem solver thing. It's not problem-solving just for the patient, but problem-solving for their position as well. To get them to that point, you talked about a little bit of the training involved in that. What do you recommend your training to be? A lot of times, you put the ad on Craigslist. I'm speaking from personal experience. You go on Craigslist. You get the person who'll take $10 an hour. You say, “Here you answer the phone.” I shadow this person for a day and then, “Now you do it.” Is yours quite a bit more involved?
If you're going to hire for front desk, healthcare or admin, you put it in that group. Here's what I tell people they do. It's not like writing an email you want to be opened or a book you want people to read. The headline has to read differently. I had this discussion. I'm having trouble with finance. I said, “How about you do this?” Put it in the same place as this admin person. I said, “Go look at every other ad. It's going to list the tasks they have to do.” They're all going to read the same. Answer the phone and deliver great customer service. It's all going to be subjective. You're going to get 130 applicants. At the top of it, and probably in slightly smaller fonts so it stands out. It's the top of what I'm going to need you to do. We are looking for someone who is willing to make an investment in helping patients get better and stay healthy. I tell her, “51% of the reason for doing that is to get the right people to apply. 49% is to get people to opt out.” Instead of 100, you got 20. I would add some more stuff down below that. There would be some tricks like, “If you're happy with what you've read so far, please reply to this email I've written here. Do not reply to this.” Anybody who hits reply to the job posting gets filtered out.
I've done some of that myself. “When you send your resume, put an asterisk in the top right corner.” It's towards the bottom of the ad or something like that.
I want them reading down. I want someone who took the time. I want them to invest with Nathan, who's on the phone asking about their low back pain. We don't take his insurance. I have no idea what insurance he has. That's not the important question. I do secret callers. People schedule me. “Tell me it's going to be 150 hours. Schedule me.” They never tell me the name of my physical therapist.Every single successful business on the face of the Earth understands one thing first, their customers' journey. Click To Tweet
We got into the front desk right off the bat because you're focused on that. You've seen a lot of benefits in training people that way. You have Everlasting Training Academy that you've started to help people in general. Tell me about the culmination of that.
I started out with a gentleman by the name of Todd Wickstrom who's got a great story. He does not come from healthcare. I met him at a mastermind that Paul Gough was running. He’s not from healthcare. He's from the startup world. He's from the management world. He's from the hiring world. Todd loved this conversation I had about the front desk, putting patients first, relationships, people revenue and all these things that are his terms. We connected after the mastermind. He had known I'd want to start a front desk course. I had all the content. He was like, “Let's do this.” He had some experience doing this. Todd and I got together and created what we call the Front Desk Certification Program. We started it. We had some good success with it.
The thing I like to credit doing the most was surveying our customers, our students, and our payers frequently. We get some good feedback every time we've done it. That has grown into what I call our Everlasting Training Academy, which is our new company. How it's evolved is we're training everybody in the business. Everybody says, “You're training everybody, but this part is just my desk.” I'm like, “There is no one part.” Everybody needs to be aware. The left tackle on a football team, when a play is called, even if the play is away from him, he may not know the routes the receivers are running, but he knows where the quarterback will be. He knows where the left guard will be. He knows where the running back's going. That's what makes a successful team. He's very skilled at his position. He is aware of the team. What we found is when the team was involved, the success was far greater. By success, I mean metrics.
I'd love to help everybody on this call, but this is not a pitch. We had someone come in who was a new front desk person assigned with a brand-new clinic manager. I found this out after class. I debrief with them. These two started to work together two weeks before our course. The owner told him, “Get in the course. I opened our third practice.” I ask them some specific questions. They both acknowledged a lot of things. The biggest take home was the front desk person said, “Think about this. This is a brand-new clinic with two people.” They were now putting four more people a week on the schedule since the course started. My head is like, “That's cool. There are four weeks in a month.” Each of these people works with roughly $1,000. I'm like, “How much should we charge you?” It was because the clinic manager and the front desk person came out aligned on what needed to be done at the front desk. The clinic manager didn't have to go back and convince the front desk of any of their role and purpose. The front desk didn't have to go back and tell the clinic manager, “This is my role and purpose.” They hit the ground running and after class.
From our experience, once the whole team knew what the other people were doing, their roles and how their roles affected them and vice versa, how what I'm doing affects them as well, that's when we started to see the creation of a greater culture or family or an environment.
I used to hate the word culture. We had people come back and say, “You helped us create our culture.” I was like, “They can't be talking to me. I don't even know what you mean.”
You never said the word.
I’ve got to say, “Please, tell me what this means.” They gave me the same answer you said. It was people coming together. “Guess where this comes from, Nathan? If we could double back all the way, it's understanding your customer's life cycle.” Until you understand your customer's life cycle, you cannot show the other members of the team what everybody is doing. When you create the customer life cycle, you can hire. This is why I say, “You can't have happy employees without happy patients and vice versa.” You're coming to interview in my clinic. I show you our customer life cycle. I show you, “This is what we're trying to create.” I show you your role as the therapist here. I show you how everybody else on the team comes together for successful client experience, not so you can get your ego stroked and make $100,000 a year. If you want your ego stroked, this is not the place to be. You show up knowing it's all about the patient. You deliver to the patient. They're happy. You're happy. The owner's happy. We're making more money. Your $100,000 becomes $150,000.
I'm shooting for an office where the front desk person and the provider are both at the same salary. Think about it. Because of understanding the revenue and how they drive a practice, we can set up incentive programs for that. My goal is to have the front desk person to make as much as the provider. I understand my business. I understand their role in the patient life cycle. The no show cancel rate, nobody owns it. Everybody owns it. It's a company metric. It's not the front desk metric. If it's a front desk metric, you told your PTs they have no control over it. If it's a simple metric, you told your front desk there's no control over it. No show cancel rate is a company-wide metric. This is the stuff I love. It's that tipping point of getting into EO, being in a room with someone with one or two extra zeros behind their name, talking about how they think they're going to miss payroll in three weeks. You're like, “We've missed payroll. We might miss payroll. Their payrolls have two extra zeros on it. My problems aren't so big anymore.” My problems weren't so big. Every company was having the same problems.
You're hitting on so many of the things that I love and that I'm learning about as I interview other successful physical therapy owners. Number one is I always recommend that you step out. If you're going to be a true leader in your company, you can't be treating patients full-time.
If you treat all day long, you can't be a great businessperson.
You’ve got to reach out and find people like you. I've had a number of guests that are coaches, consultants. It's somebody to guide you. We're physical therapists. We're not business owners. You've got to invest in your business education as you invested in your physical therapy education. It takes time and money. You also have to network. I was an EO member in the past.The experience your customers remember is their emotional story with your service and product. Click To Tweet
My favorite chapter was the Arizona chapter.
Those guys are awesome down there in Arizona. I was a part of the Accelerator Program, where revenues were less than $1 million. Between my partner and me, things started shifting. My partner will attest to it. He's still an EO member in Phoenix. It's when we networked with other people. They weren't other physical therapists. They were other business owners. There are plenty of networking groups within the physical therapy industry, whether it's a mastermind, PPS, peer-to-peer or that stuff. You've got to do those things to build your business acumen. You can turn around, be the leader of your group and build something that you are proud of.
One is step up. Even mastermind groups and stuff, what's interesting when you take a look from the outside in is if you're not careful, it becomes a room of like-minded people. I get it, yet, I don't want to be in a room with like-minded people because we're only going to start to reinforce our biases and beliefs. That is probably one of the best things about EO though too, is because nobody in the forum was from the same industry. We couldn't claim, “This is what I always love.” I had this conversation. “We got to do A, B and C.” “That's not going to work for us. We're different. We're too small. We're in a rural area. We do this. We do that.” I'm like, “Are you guys treating patients?” “Yeah.” “Are those patients still people?” “Yeah.” “It's going to work. You’ve got to do it.” It's that mindset. We go get a group of PTs. This is why it's stepping out of the profession for anybody. If we look back, any great business stepped out of what they knew and found someone.
I'm growing my team around me. What I'm being cognizant about is my team doesn't need me. There is no one I'm putting on my team who needs me. This is important because I want to be able to stand up and go, “This is Nathan. This is his expertise. He's here because I need him. I believe he can serve you.” That's a lot different approach than I'm in a room full of PTs. That approach has done so well. One of the guys I remember, he owned a huge furniture moving company in Phoenix. He's one of the EO guys. These were the people I connected with. “I had nothing in common. I’ve got nothing to learn from you.” He was like, “No.”
I remember the guy. He owns Get Your Move On or something like that.
Being on the West Coast, I met a lot of the Phoenix guys.
You find a lot of physical therapists, they've built their clinic because they put up their shingle. Their name was tied to it. I had to get over this myself. Patients were coming to me and the doctors are referring to Nathan Shields. They weren't referring to Pinnacle Physical Therapy back in the day. It's hard to make that transition from referring to me, the owner and getting out of the mindset that I am the foundation of this company. It's changing from a mom and pop to an enterprise.
The next step up. I would argue truly running a business.
Otherwise, you own a job.
I did a Facebook Live. I posted, “Do you have a job or a business?” I spoke about this. I said, “God bless you, for anybody listening. I don't want people to think I'm some snob. If you wake up every day and love what you do and you're making money on it, God bless you. If you wake up every day and you're making money on it and you're going to teach other people to do it, God bless you. If it can't thrive or strive without you, it's a job. God bless you. Be happy until the day you die, but don't go tell people you own a business. Don't do business training.” It's not my ego. Nobody's stealing customers from me. What I'm worried about is people saying, “I'll help you start a business.” I'm like, “You're not helping them start a business. You're helping them create a job.” If you own that and you tell people, “I can help you do something you love every day. You just got to stay in it every day,” it's fine. Own that. I see this every day, the guy on my corner shop. I see the same guy. His whole family is in there. That's what they do. They love it. They wouldn't have it any other way. I'm okay with it. I'm not bagging on him.
They're achieving their dreams. If that's your dream, God bless. I have to give credit where credit is due. We're talking about Michael Gerber's E-Myth Revisited, a popular entrepreneurial book. If you're starting a small business, you ought to check it out. Robert Kiyosaki talks a little bit about it in Rich Dad Poor Dad, where you become an employer to an investor and different quadrants that you work with.
Also, Cashflow Quadrant. When people ask the three books that I recommend, they're all older books. I recommend Kiyosaki's books. Everybody should read it anyway. I recommend Gerber's E-Myth, Start with Why by Simon Sinek and To Sell Is Human by Daniel Pink. Those three will get everybody at least in the mindset. None of those are doer books. They're all mindset books. If your mindset's not set, you can burn 36 hours a day doing the wrong thing. Those books had the biggest influence on me. I got to meet Simon Sinek when he first rolled that book out at an EO event. I got to sit in a room with 50 other people and Simon Sinek at an EO event. Those Kiyosaki books, I don't care if you think the story is true or not. Let that go. Cashflow Quadrant will get you in the mindset.Step one is step up. Click To Tweet
That's all about mindset and assessing where you're at.
This is great stuff. I've been involved in PPS for a long time and stepped off the nominating committee. I have offered my assistance to over and over. My goal, I've offered, is to take a day at our PPS conference and not allow one speaker to be a PT. We just bring in outside people. I'm still pushing for that. I'd still like that. I'm speaking during the pre-con. I’m another PT presenting there, yet, I'll be presenting stuff that people won't hear anywhere else.
Are there any teasers on what the topic might be?
It's going to be all about training your team around the customer life cycle. We send providers off to new courses. We make them come back and teach all their providers what they learned. I'm like, “Where's the front desk people?” It's the front desk people in here knowing what the providers are doing.
Aren't they the salespeople for us?
Back to my pre-con for PPS, I worked collections. I had mapped out this customer life cycle. If you think about it, there's no zero in anything. I never knew where the ceiling is or where the floor is in this stuff. I want to know, “Where are the floor and the ceiling on people we send the collections? What percentage of customers should we plan on going to collections?” I took care of the collections. I called everybody who had one foot in the collection door and one foot still out. They had one last opportunity. It's understanding my patient's life cycle, understanding the experience we had created, understanding every script and every piece of paper that everybody ever saw before I called any of these customers. They're all past customers. Before I called any of them, I went back. The first thing I looked for is, “Did they have assigned financial policy?” Our financial policy is the bluntest thing you've ever read in your life. It says, “If any of this is an error, it was your insurance company's fault.” At the top of our financial policy is, “This is your cost.” We gave them a number. If they signed it, they saw it. We made them initial the part that said, “Your insurance company made a mistake.”The Purpose of the Front Desk is to GET PATIENTS BETTER, not just get them in the door. Click To Tweet
Did they sign the financial policy? Did they complete their plan of care? Did they pay at the time of the visit? I knew all of this before I ever picked up the phone. Like that front desk person answering the phone, I started every phone call with them. “Nathan, this is Jerry. I'm the owner of San Francisco Sport and Spine Physical Therapy. I know we're having an issue with some money that is owed to us. I am calling you to see how I can help you get this resolved. I wasn't calling to collect money. I wasn't calling to threaten you.” People get protected. They get everything. I had all this information. The most empathetic I ever was with another patient whose insurance company had screwed them. I was saying, “Nathan, I get that. I was looking through your chart, so bring me up to speed. You do understand we called the insurance company. You do understand they gave me their information. You and I both know they're looking to screw people. Unfortunately, they screwed you. You pay your premiums. You showed up here. You paid every time. Your insurance company screwed you. How can I help you get your insurance company to pay me?”
Not everybody called me back. Everybody that called me back, I collected 100% of what was owed based in that conversation. I base it on a person who understood their journey and understood, “I know the insurance company screwed you. I wasn't calling to say you owe us $1,500. Your insurance company owed us that money. How can we get this done together?” Everybody knew at that point that I was on their side. They knew their insurance company messed with them. They all paid. I took them down. This is what we're going to teach. Someone started asking me, “Should I bring my front desk or my billing people to your class?” I said, “Yes. You're going to have to prep them because they're going to wonder what they're doing in the room. You should have your billing people.” I do this whole thing. I credit Ray. Out of Pittsburgh, Pennsylvania, we are doing some work together on some technology stuff on how to systematize, how to customize and how to automate some of this stuff I'm telling you about.
Ray has this great idea. You know if you're in network. You know you do billing. Everybody's going to get an EOB for about three weeks in. You know if there's a billing problem, you're going to have Jerry from billing call them. There's no better way to kill a relationship than have you be the happiest and, in two months later, you get a call from Jerry in billing at ABC Physical Therapy telling you to owe another $250. First off, you're like, “Why do I owe this money? Who are you?” Ray gave me this great idea. I train everybody to do this. You put your billing team in the video. You send me an email. It's your billing team, “Hi, I'm Jerry. Hi, I'm Becky. Hi, I'm Steve. We're the billing team here at ABC Physical Therapy. Why are you getting an email from us right now with this video? You should have received one of these. It's called an EOB. That is the biggest misnomer on the face of the Earth. We know that when you open your EOBs, you probably don't understand it. It's an explanation. If you have any questions on this document, we want you to call us. You can ask for Becky, Steve or Jerry. We will help you with that EOB.” That's it. You give them their billing phone number.
Two things occurred. You told people, “I care.” You told people, “Your insurance statements are going to start coming.” You told people you know they don't understand it. You said, “Let me be a solution for you.” My financial policy says all the mistakes of the insurance. When they call you and they don't understand their own mistakes, we will again reiterate, “Your insurance company screwed that up. Let us help you with it. Here's what you need to do.” It's going to say it too. Back to that scenario when Jerry and billing called you and you saw the video, now you know Jerry and billing are calling you to help you. “Nathan, this is Jerry Durham over at ABC Physical Therapy. I've got a bill here of yours that I'm looking at. I'm wondering if we could have a discussion about it.” I'm going to script that call-up. You already see the name and the face and you know I'm calling to help you. That is understanding your customers' life cycle in creating an experience. That could have ended disastrously. They say, “I'm so glad. I'll send that $250 over.”
What I love about it is you're thinking through the entire life cycle and not just knowing the different parts of it. You're thinking through the life cycle and, “What are they going to experience here? What's going to happen here? How can we be at the front end of that to create an experience where we can maintain communication? How can we make it better?” It's an evolving process.
It's always changing, dynamic itself.They have to believe that and create a patient experience that increases trust and eliminates fear, doubt, and uncertainty Click To Tweet
It's intentional. This is the experience we want them to have.
Everything is intentional. Here's my favorite analogy. You're thinking of your business. You describe your business as an ecosystem. What's going to happen here fourteen days later is going to have an effect on interaction. How can I manage those downstream effects?
I love the beauty of the life cycle. Laying that out and seeing how everyone's involved and what their purpose is at each point generates a powerful cycle for you. No show rates are a team experience. Those will diminish. Conversion rates on the first calls are going to go up. Your collections are going to improve. It's as long as everyone's working together as a team and knows everybody's purpose and responsibilities.
This my passion. If anybody needs us more than any other industry in the face of the Earth, it's healthcare. It's not because healthcare sucks in America. It's not because it's too expensive. It's because healthcare is about other people more than anything. We owe it to this person. I'm not going to get into evidence-based medicine. We owe it to this person to acknowledge him on the phone when they call in. I took you through my wife's journey to get some doctor's appointments and visits, it took her almost two weeks to get a live person on her phone to follow through with the referral and to get a scheduled appointment. Nobody deserves that. When you're told you need this follow-up and we make them two weeks, what's important? Is the follow-up important? Is your broken system more important? What's most important? It's me. This is healthcare. If people who I buy my shoes from can give me this, healthcare can give you this.
You shared a ton of great wisdom with us. We didn't even share that you're also a fellow podcaster. You've got the Healthcare DisruPTion podcast. You've got plenty of episodes to listen to. There's a whole section that you have specific to the front desk. If you want to check that out, you want to go to the Healthcare DisruPTion podcast. How can people find you? Share all your contact info.
JerryDurhamPt.com is my website. JerryDurhamPt.com/podcasts will take you to my podcast page. The top podcast is the last one. There is a front desk series that I started. There are seven episodes. If you listen through those, you will know everything you need to know about the mindset and the doing. Some of them are doing about how to create a customer experience, which we know goes back to understanding your customer life cycle and where to put the focus. I have an interview with an awesome person who has been a patient. I did a follow-up podcast on how could we have made this experience better for this person. There are a lot of references to this person's blog posts and something like that. The front desk series is the last seven episodes. My last one is one of my most opens. It's called, What is Customer Service? If you're training customer service, it means you don't understand someone's customer experience and you're putting out fires. Here's a quote to leave you with. “Customer service is reactive. Patient experience is proactive.”
If people want to look up Everlasting Training Academy, is that the same website?
EverlastingTrainingAcademy.com will tell you all about my team training and the front desk training around all this. PM me on Facebook. It's Jerry Durham on Facebook. I'll give you my phone number. It's (415) 509-3986. Text me there. Put like, “Nathan's podcast.” Say, “Jerry, I’ve got some questions about the front desk,” or “I want to know more about this.” I still have people pinging me from the first podcast I ever did and I love it.” I'm like, “This is awesome.” This is what I want to happen. When it's your time, it's your time to have this conversation. It's so much stuff. This is passion. Do you want more new patients? You've got to figure out your customer’s life cycle. Do you want more money in the bank? You've got to figure out your customer’s life cycle. Do you want to hire employees? You’ve got to figure out your customer’s life cycle. It's that simple.
Thanks for being on. You've been awesome. Thanks for sharing your wisdom.
I appreciate your time and energy. Thank you very much.
Dee Bills, PT, spent a year perfecting her clinic's front office procedures and now has it down to a science. Dee found Front Office Guru in 2016 and now specifically trains front offices to optimize the patient experience, the arrival rates, and, thus, the collections at the front desk. In doing so, she has been able to turn around clinics that were severely under-performing to eventually achieving more than 95% arrival rates week over week. Dee has systematized her processes and is willing to share some of them in today's episode.
We all know how important the role that the front desk plays in our clinics. In fact, we know that the front desk can have a significant positive and negative impact on our clinic’s efficiency, patient experience, revenues, and arrival rate percentages. No matter what kind of physical therapy we provide, good or bad, the front office can many times dictate the experience that the patients have and the revenues of our clinic. I decided to bring on Dee Bills, the Owner of Front Office GURU to talk about some of the things that she recommends that we do to make sure that we have a well-run front office team.
Dee has been a physical therapist for over twenty years. In 2004, her husband achieved his career-long dream of owning an outpatient physical therapy practice. In 2011, they recognized that significant changes were happening in healthcare in general, declining reimbursements being one of them. They decided to get a business consultant. I'll let her share the story as to what eventually led her to really focus on the front office, but over really perfecting and systematizing their front office procedures, she recognized that they got results of over 95% arrival rate, which is amazing. In 2016, Dee realized that she wanted to help others also obtain the same success and founded Front Office GURU. She offers front office training programs in practices across the United States and Canada. I for one am really excited to have her come on and share some of her secrets as to what it takes to have a well-run and efficient front office team.
One thing she mentioned was, “We get what we train.” That can be applied to every position that we have on our team. Specifically, I know Dee trains her front office staff for over twelve, fifteen weeks I believe. From past experiences, I think that's about eleven to fourteen weeks longer than I train my front office teams. If we really want to make a significant impact on our practice, we really have to focus on our front office teams because they can be the face of our clinic no matter what kind of physical therapy we provide. Let's see what Dee has to offer and what she recommends we do to improve our front office teams.
I have Dee Bills, a physical therapist out of Virginia, the Owner of Front Office GURU, who has made it her mission and focus on the front office and we are going to talk about that. Thanks for joining me, Dee.
Thank you, Nathan. I'm excited to be here.
Thanks for helping us focus a little bit more on the front office. We spent a lot of time focusing on management styles and owning your practice. One of the greatest effects that any of our team members can have is at the front office. Do you mind sharing a little bit of your story, where you came from and what got you to the point where you are now?
I was a physical therapist for under twenty years when my husband had recently purchased our PT practice and he was running it. One of the big things we noticed was that insurance was decreasing and declining reimbursement. We had a ton of decrease in referrals from doctors because they all had their own PT practices. We knew that if we didn't do something, we weren't going to really be there anymore. We weren't going to survive at the level we wanted to. I came away from treating patients and started working in the practice. We happened to get some consulting ourselves and the practice started to expand and we went to this financial course. The gentleman that ran the course was talking about finding areas of inefficiency in your practice. It was something that really hit me. As I started to evaluate things, I was watching us bleed money from our front desk.
I took over the front end of our practice. I worked side by side with my front desk staff. I started to learn what worked well with patients and what didn't get the result we were looking. The things that they were saying that really weren't getting good results. It was very evident that we were bleeding money with patient arrivals. We weren't capturing patients like we could. We weren't collecting what we should. I started to write policy in our practice and put in measures that worked. Lo and behold, our arrivals went to 95% every week. We are capturing 90% to 95% of the patients that we’re calling in for evals. We started to have a great machine on the frontend.You don't want to waste a month on somebody who isn't willing to do what you need them to do. Click To Tweet
You said you were bleeding at the front desk. Was it simply that maybe they weren't collecting copays, they weren't following up with patients to make sure they were following their plan of care? Is it those types of things that you're talking about when you say bleeding at the front desk?
Yes, we were bleeding visits. A patient would call and say, “I'm not going to able to make it now.” My front office would say, “No problem. We'll see you on your next visit.” What ended up happening was, “We need to get them in. We need to handle them.” One of the big things I hear a lot is, “Can you tell me your hours?” The front office will immediately jump to tell somebody their hours. What ends up happening is there's this dead air and the front office says, “Is there anything else I can help you with?” The person will go, “No,” and then we've lost a new patient. That was a big thing for me. I was in another group online and there were a lot of people that were asking me, “How do you do that? How do you get 95% arrivals? How do you get your evals to show up?” I was helping a lot of people. I realized that my practice didn't need me as much anymore as it used to. It’s running really well. I missed helping people. I wasn't treating anymore. That's how Front Office GURU was born. I decided to start helping owners have the same success that we were having.
As you were doing this and with the successes that you had, did you find that simply implementing the processes made a major difference? Did find that you had to find different people and train them appropriately?
It's a little bit of all of that. It comes down to having the right person in place, having set processes and systems that work and get results. The third thing is training your staff and putting that effort into making sure your front office staff is as skilled as your clinical staff would be in their duties.
As you went through implementing some of these systems, processes and training people, that was probably a good way for you to filter out who was going to stay on the bus and who you need to kick off?
We still go through that now. That's really important to not be agreeable to someone who's not on board with you. It's being able to handle that employee well and setting parameters. We were just talking about that in our clinic about you set a parameter, they have to do this within two weeks. If they don't, it's time to go because you don't want to waste a month on somebody who isn't willing to do what you need them to do.
Is there a way that can filter out those people ahead of time? Are there certain personality types? Is there a part in your interview process that lets you know if that front office person is going to work with you or not?
One of my biggest pieces of advice is to have a system that works for you and not alter it. We are really big on testing from day one. The testing comes from us. We don't pay for online testing any longer. You have to know what you're looking for. If you don't know what you're looking for, it's hard to find them. You’ve got to lay that out. It's one of those things that we forget. If you don't write down what you're looking for, it's a lot harder to find it. You don't have the same certainty, but when you write it down, you now have the certainty of what you're looking for. What's your ideal employee look like? It’s just like we all know what our ideal patient looks like. What is our ideal front office employee look like? Do they have previous training or don't they? Are they good at sales? Are they friendly but at the same time can they manage people? Once you know that, then you have more certainty about what you're looking for when you're interviewing people. The biggest piece of advice is to test them. Put little challenges everywhere and if they can't follow challenges in writing, it's very likely that they're not going to be able to handle a verbal challenge.
I was a neuro PT for a long time and we talk about single-step and multiple-step commands. Your employee is the same thing. If your employees can't follow a single-step command, they're not going to be able to follow multiple-step commands. Our whole day is multiple-step commands, “I need you to do this and then I need you to do this.” If they can't do it in writing, they're definitely not going to verbally pick up what you want. We put challenges in everything we do in our hiring process, even our PTs but our front office especially. They don't have the same previous training and skillset. The PTs go through five, six years of schooling to get where they are. Your front office hasn't necessarily done that. A lot of them fall into the job that they ended up by happenstance. They don't go, “I'm going to do that forever.” It's a big thing to look for throughout your process.
Going back to looking for that ideal person, it hit me while I was at PPS. Brian Hart has mentioned how we oftentimes put out an ad and list the basic minimum requirements, “Can you breathe and answer a phone? Can you type at least fifteen words a minute? If you can meet these criteria, then you're qualified for our job.” Instead of saying, “We've got high standards and these are the standards. Number one, here are our values and our mission. This is our purpose. You're going to be expected to handle a ton of calls. You’re going to handle a ton of patient complaints. You're going to be asking for money when people don't want to give it to you.” Instead of really laying out what our ideal candidate would look like or ideal employee is, we instead list the basic minimum requirements and put it out on Craigslist and then we're disappointed with the replies that we get.Have a system that works for you and don't alter it. Click To Tweet
Years ago when I started helping Mike in that position, I went through eight employees in a year and I was like, “Enough, this is insanity.” It was the hiring process. I posted an ad, I get 150 resumes for the position and then I'd be upset when I was wasting all this time trying to hire the right person. We have a set of challenges that we put out there in the ad. If they don't follow those criteria, we don't even respond to them. We'll have lots of them call and be like, “I didn't hear from you.” Our front office is trained to say, “If you haven't heard from us, it means that you probably didn't follow some part of our process and we wish you the best in your job search.”
You'll put a challenge in the ad itself?
Yes. Why waste my time? I don't want to read 150 resumes. I want to look for, “Did you send me a cover letter? No, okay you're done.” There are just simple things you can do. I was just working with the young lady that's taken that over for me in the practice. The more discerning you are in what you're looking for, the more you challenge them, the more likely you're going to weed out all of the people that are just looking for a job versus, “I want to work somewhere and make a difference.” That's something really important.
Another thing because this really applies and it's important, they are not your front desk, they are not your front office, they are your patient care coordinator. It applies to what you were just saying about collecting money, managing the schedule. They are not a medical receptionist. You get what you title them. It's really important to give them the title of patient care coordinator so they understand that their job is to coordinate the patient's care. It's not your PT’s job. Your PT provides the care but your frontend, your patient care coordinators, they coordinate care. It makes a big difference. I've worked with PTs and vets and it makes a huge difference what you call them because they focus on the wrong thing. If you call them a front desk they think, “I'm just here to answer the phone.” Answering the phone is such a minute part of what they really do. That's a big part of it. That's something to look at if that's not what you're doing in your practice.
We were talking about it before that it's such a huge part of the business. If there's a disconnect between the physical therapist, the owner, whoever's working at the front desk and coordinating patient care, there's a ton of money that can be lost. That lends to a bad reputation, if patients aren't getting better or if they're not happy with the collections processes. “I wasn't told this is what I had to do beforehand.” A lot of that can look bad on your clinic in spite of how good your physical therapy is.
They’re first and last point of contact that any patient will ever have with your practice. The very first contact could be the very last contact if they don't handle that patient properly. Especially for smaller practices, for owners that are treating all of the time, they don't get the opportunity to hear what's being said, what's not being said, how it's going. Before they ever see that patient, they could lose that opportunity. That's where I focus the most on is lost opportunities and how to prevent them, how to script things the right way so that the front office has that ability to handle patients, to coordinate a patient's care so that the PT can provide it and not worry if the patient's showing up or not or if they're scheduled or not. That's not in their job duty, believe it or not.
What do you tell the owner practitioner, maybe he has a little bit of support staff and he's got a front desk person that he is not totally happy with? What's your first recommendation to them? Is it to focus on your processes and showing them up or go back and find a better person who has got a little bit more fire in the belly?
In one of my blogs, I talk about the willing and able employee. The ideal employee in your practice is somebody who's both willing and able to do the job that they're hired for. There are two parts to ability. I have the ability. I can do the math, I can handle people. There's the ability that we provide them. This is a big one and this I see a lot. We hire people who say, “I have experience.” We put them on the post and we don't train them in our expectations. We don't make sure that they can handle the objections and they're not scripted. We assumed that because they have experience from somewhere else that they can do that. We get what we train. The first thing I recommend for owners is to listen. First of all, you have to listen and hear what they're saying so you know where they're out, meaning they're not following what you would want them to do or able to do that. You want to train them.
Just like with a patient, if a patient cancels the first time, I assume that we did not handle them properly and train them on our policy. It’s the same for an employee. If an employee messes up or isn't doing things, you have to go back and look at your policy first, to make sure that you have sorted out your training processes, that you retrain them. We retrain once. If I retrain you on something once and you can't do it, then we sit down with them and we really have a conversation, “Do you see yourself lasting here? Are you invested in this? What are your goals?” My husband is amazing at being able to sit down with an employee and run this with them. They'll usually say, “I don’t want to be here,” or they'll say, “I'll do whatever it takes.”
The next thing I would say is after looking at your training, lay out your expectations for the position. A PT knows exactly what they need to do. See the patient, treat the patient, and help the patient. The front office has a very extensive list. One of the things I learned when I started working in my front office is, we as PTs really didn't learn what it takes to run our front office when we were in school. When we hire people, we have a tendency to hire people thinking that they're either going to know how to do it or their experience will help us. A big part of that is laying out what you expect of them. If you don't lay out your expectations, you end up getting what you get, which is somebody who isn't necessarily directed the way you want to go.If you don't know what you're looking for, it's hard to find them. Click To Tweet
I hear that often from owners and managers that they're not doing it. I say, “Tell me what their job duties and expectations are.” A lot of times they're not very specific themselves and that breeds exactly what they're getting, which is an employee who's like, “I'm just doing what I got to do.” If you ask your front office what their job duties are, they will tell you that it's answering the phones, faxing, filing, scheduling patients. They won't say to you, “My duties are coordinating the patient's care to make sure they get in for care and that they understand that we're here to help them.” It's a huge eyeopener.
They'll usually list off a bunch of duties that they do in order to complete their tasks. That's how they'll define themselves instead of looking bigger picture and saying, “My job is to coordinate the patients care so that they achieve their physical goals and make sure our company has collected everything that is due financially on our end as well.” They don't look at a broader perspective like that. They go down their list of tasks that they needed to perform that day. Their job ends up becoming a checklist instead of really focused on getting the product that they're there for.
It's helping them understand their product. A lot of times if you go up to your front office, any of your staff and you ask them what their product is, they don't necessarily tell you or they get confused. A big thing that I work on with companies, owners and their front office is, “What is the product?” We shifted away from all the fancy words and everything because as an owner, we understand that. Even your clinical staff don't understand that. We started focusing solely on people helped as the product of the practice. If you look at all the stats that you measure, they actually in each department are a representation of how that department helps people.
When we shifted, we still have valuable final products of our practice. We teach our staff what their valuable final product is as these people helped. When we put our entire staff on it and we showed them how their stats or metrics are equivalent to people helped, they are much more focused on helping people than they are on a number. When they can equate 95% arrivals to, “95% of the patients that I worked with this week understood that they needed to get in for their care. They can't cancel at the last minute or affect somebody else.” What ends up happening is you see them winning. They look at their stats differently. They're more driven toward achieving higher. We've grown exponentially in 2018 just like we did it years ago. It really was because we hired people that wanted to focus on people helped.
We talked a little bit about and maybe you've done some of the research yourself at how that front office person or patient care coordinators, how much money they'll actually lose the clinic. You might think that the physical therapists aren't charging enough or maybe they're not seeing their patients more than two times a week, which has been shown to improve patient care. Have you found how much money can be lost at the front desk if they're not trained and working properly?
A lot of times too we focus on arrival rate. If your arrival rate is not running in the 90s, you're losing a lot of money every year. On top of arrival rate, if you look at new patients and you look at that new patient phone call, if you called in or had somebody call in, the average front office will get through that phone call. They think they have to get through it quickly but that's the most important phone call that will ever take place for your practice. Some of the things you'll hear is, “What are your hours?” The front office will say, “We're open from 7:00 to 7:00 every day.” There's this dead space and they say, “Is there anything else I can help you with?” The potential patient will say, “That's it.” Every now and then they'll say, “I'm ready to schedule.” Most of the time we're not handling that shopping around the patient or, “Do you take my insurance?” Instead of converting them right then and there. The thing to remember is anybody who calls your office that is not a current patient should be a patient. Nobody picks up the phone and calls your office to ask a question if they don't need your help. They may not be ready to confront the fact that they need your help but they need your help. That's a big part of it.
I started talking to PT owners and veterinary practice owners. They all agreed it was probably on the low side, that the average practice loses probably ten potential new patient visits a week. If you do the math, let's go with $100 reimbursement, which is a little bit high for the national average, unless you’re in Alaska. The potential loss to your practice for the full plan of care is close to $400,000 to $500,000 a year to a practice. When we started focusing on that, we were able to ramp up our ability to capture that. It's a big thing I focus on. A lot of times we focus solely on a rivalry, but we forget that we market.
For those of us that are doing a lot of internet marketing, which in our area, all of our doctors have PT practices. Our marketing is either to pass patients to the internet. One of the things that you will find is that they’re a little bit harder to convert. If a patient care coordinator does not know how important that call is and how to really convert patients on that call, you're losing them before you ever got them. It doesn't mean they're not going to try to call back again but usually by then, they are a lot worse. It's helping them handle that and training them how to handle that will be the most valuable thing to any practice.
You really do some training and even letting these candidates know that they're going to be essentially salespeople. There's got to be a part of that within them that says, “I know you're just asking about hours but you're not calling me because you really want to know our hours. What you're really calling me about is what we sound like on the phone. How do we treat people over the phone? What specialties can you sell me on that might help my particular condition?” The front desk can do a lot of that because the physical therapist can't. Do you do a lot of training on that then? You mentioned that the calls were too short. Do you tell them you need to be on the phone for a certain amount of time or these are the certain questions you should be asking to follow up?
The first thing I teach them is the importance of that call. That call is the number one most important thing. When you rush through that call, you just get my name, my phone number and you give me a time, you're not helping me to buy in. The most important thing the front office needs to understand is that these people are reaching but they're not reaching at the same level as somebody who says, “I have a script, I want to come in and I want you to fix my problem.” Those are your ideal patients. Every front office will tell you that's their dream patient, “Fix me.” They're easy, they're nice, they'll pay whatever, life is good. The average patient is reaching but they're not ready to reach in. I know you did an interview with Shaun Kirk and he's a mentor. One of the things he taught us a long time ago, and you've probably heard this too from him, is he used to do these evals with his patients. He'd say, “Do you believe you can get better?” If the patient said no, he’d be like, “I'm sorry to hear that.” He would escort them out because they were telling him they didn't believe you could help them. They don't even get to your PT if your front office doesn't handle them.The more discerning you are in what you're looking for, the more likely you're going to weed out the people that are just looking for a job. Click To Tweet
My new patient program really teaches the front office how to handle patients from day one all the way through a scheduled-out plan of care. It teaches them the right question to ask and how to ask it. I teach them that you don't answer that question until you've asked my questions, until you've run them through. I don't have any way of handling you. If I say, “We're open from 7:00 to 7:00,” and you're like, “Thank you so much.” I could say to you, “Would you like an eval at that point?” You could be like, “No.” I teach them how to handle a patient and establish a system that can be used over and over again as the practice expands. We've gone from one front office to now we're getting ready to hire our fifth in our clinic. Our patient care coordinators, they have different levels. That’s important to be able to expand and not have to remember all the things you have to teach them. Make sure that they can literally get on a call with a patient and recognize that this patient needs help. Recognize that, “The patient may not be reaching as hard as I want them to. It's my job as the patient care coordinator to get that patient reaching harder and acknowledge the fact that life is not going to be good if I don't fix my problem.”
Have you used a private shopper or someone who has called to assess the capabilities of your front desk in the past? Have you used one on your practice or have you done it for other clients as well?
Yes. It's actually part of our hiring process. We’ll teach somebody how to handle a patient and then we will either have them call a “patient” or it's usually one of our staff who's on a cell phone in another room. They don't know that though. We'll have a “patient” call in and have them handle it. We have secret shops. A long time ago when I was running my front office, my mother-in-law called me one day and said, “You need to call the office.” I'm like, “I'm on my way there now.” She goes, “You need to call the office.” I was like, “Okay.” I called the office and recognized that Eeyore was working at my front desk and was like, “Good morning.” I was like, “We’re in so much trouble if I don't handle this.” I find it's really good for the owner, “Why don’t we call our practice?” It's really good for the owners and managers to call your practice from time to time or have a family member do it.
I have called other practices before. Usually what I do is because I work one-on-one with most practices, we get on video conferences once a week. I will drill with them and I will be the patient care coordinator and let them be the patient first and then I will make them be the patient care coordinator and I'm the patient. We're really working off all the scripts that I've provided. It's a big part in your practice. If you don't drill with your staff, they won't ever get better. It doesn't matter what you hand them to do if you don't practice it. It's like PT school, you could not do an anterior move on a shoulder until you had drilled that with your professor 100 times and your partners are like, “That's a grade four stop.” We all laugh about it. It's the same for your front office.
Remember, they didn't go to school for this. They may come from somewhere else. Most of the time, staff come with bad habits they picked up somewhere else. They don't necessarily come with the experience that you really need in your practice. That's really important to remember if you want somebody to be successful. Remember a willing and able employee part of the ability is I make sure you're able. I'm back in my practice, training up a new team member. It's amazing to see how we drill. She is awkward because it's like, “I have to play act with you.” I walk out front and I listened to her on a call with a patient. I watched her reviewing policy with the patient or going through something with a new patient. It's just so much more on point because we took the time to drill it and really make sure she could do it before I said, “You're set free. Have a great day.”
Do you audio or video record and feedback to them to give them pointers?
Yes. Everything is video. They can record all of our calls so that they can take pieces or all of it and train future staff or current staff. I provide all of the drills. If I give you a script, I don't just give you a script, I provide the drill as well. A lot of times the owners are like, “Okay, great.” When I give a script, I'm very adamant that you shouldn't change it. I know for a fact it's tried, true and it's tried by me. It wasn't my front office to try this. I worked my front office for six months next to my Eeyore and Eeyore did not improve. He needed to leave and then I work for three more months with two women side by side. That's where a lot of these systems came from. When things didn't work or didn't go well, I went back and change them until they worked. I learned how patients speak. How to speak to somebody to get the result I'm looking for. I can tell you even in our practice when one of those stats goes down, it's always related to something not being done or said to the expectation that it was trained at.
My staff knows how to go back and fix it versus me having to, “Let's drill it again.” Usually, I will find them drilling. That's the goal. Every owner's goal is to put it in now but not have to keep putting it in over and over again. If you're constantly having to train and retrain, hire and rehire, give me a call. I don't want to see it. It's such a waste of time. I don't know about you, Nathan, I look at Mike and when he tested drop down into the organization, we all want him back out again. Go be an owner. We don't want you working down here because things don’t go very well when the owner drops down and gets involved. It's like, “Go back and be the owner. Dream for me.” That's a big thing as owners, I don't want you to keep dropping down into your organization to train and retrain staff.
You’ve reached an ideal scene there. It blows my mind to think that these patient care coordinators know what statistics they're supposed to provide and report. They also are self-correcting. That blows my mind. Every employer's dream is to have a team member that knows their stat. When that stat goes down, without talking to you about it or even before you mentioned anything about it, knows what they need to do to go back and train themselves to get their statistic back up. That's a different world.
It was my dream. It was something that I learned a long time ago and when we received our consulting. Also when I told you I went to that financial course, it was to build a machine that you can walk away from for a month and it runs itself and fixes itself. That hit home so hard for me. Mike and I at the time were working 60, 70 hours a week. That was not an ideal scene. Our kids were like, “You guys are at home and you're talking about work again.” Now our kids are like, “Did you go to work today?” We're like, “Yes, we did.” They're like, “Really?” It's a different scene for us. Don't get me wrong, when you have new staff, it is difficult to find quality front office staff. Everybody I've talked to is struggling with that and we can say, “The United States has a 3% unemployment rate.” When you look at that in reverse as a business owner, it also means, “I'm scraping the bottom of the barrel unless I get lucky and some amazing person is looking for a job.”If you don't lay out your expectations, you end up getting what you get. Click To Tweet
You want to be as discerning as possible who you hire. If your Spidey sense says no, listen to it. You have to have challenges in place and challenge them. If you don't know what to do, call me. I can help you with that too. Even larger practices go through that. I've worked with several larger practices and some of them I've known forever. We've laughed about certain things that might've fallen out or we could make better. We put our attention on it and we put some systems in place. The next thing you know, it gets better. It's when you are always coping that life doesn't get any better.
When you can finally organize and systematize, things just tend to improve. Dee, thanks for your time. If people do want to reach out to you, how can they get ahold of you?
If you go to my website, FrontOfficeGuru.com, there is a link where you can schedule a free call with me. You can sit down and talk about your front office. I do offer three different programs. One is the hiring and recruiting program for the front office. The other is front office training for both new patient program and patient arrivals, which patient-inpatient program handles everything in a new patient. You can really capture, manage, control that new patient situation. The arrivals program handles everything after that. How to build schedule efficiency? How to increase your arrivals and really manage your patients? This is for the front office, for the patient care coordinators. It's also for the owner because when you work one-on-one with me, I actually provide you a course pack which becomes your training manual. The purpose of you not having to work with me again, you take away the skills of everything they teach you in so that you could train up an employee in two to three weeks. It doesn't take us that long. It takes us much longer. It takes us roughly about fourteen or fifteen weeks because you get breaks in there to implement stuff. I give you all the implementation that you need to do. I provide all the training. I work one-on-one with the clinic so that the end result is your stats go up, and you and your team have such a better condition.
The patients are happier when they have a good front office.
Yes, they are.
Thank you much for your time and sharing some of your insight into making our front offices better. It can be such a huge boon to the clinics if they can really get a handle on what needs to happen at the front desk. I really appreciate you sharing.
Thank you so much for having me, Nathan. If you haven't figured out, I'm very passionate about what I do. I really enjoy working with a private practice, especially physical therapy because it's near and dear to my heart. The ultimate goal is the survival of private practice owners. I love working with my practices. You become part of the Front Office GURU family basically. It's important to me just like it was when I worked with patients.
Thanks for sharing. Hopefully, we'll see more of you in the future and bring you on again sometime.
Thank you so much, Nathan. I wish everybody the best and I hope to hear from some of you.
I started my career as a physical therapist and spent over 20 years working in patient care. In 2004, my husband Mike achieved his career-long dream of owning an outpatient PT practice. In 2011, we recognized that with the impending changes in healthcare, we wouldn't survive without making changes and improving our practice efficiency and expanding our reach. We began working with a business consultant and I took over the front end of our practice.
While at a financial course, the speaker talked about building a well-run machine and to look for any inefficiencies that were holding us back. I immediately realized that our front office was bleeding visits, and this was affecting expansion and revenue.
So, I took over management of the front office. Over the next year, I worked at our front desk as a Patient Care Coordinator and learned what it took to properly manage patients. I developed reproducible front office training and systems to increase efficiency, organization, and patient control. During that time, our patient arrivals rose to an average of 95%!
In 2016 I realized I missed helping others, so I founded Front Office GURU to help other practices have similar success to ours and recognized my true purpose. I now offer front office training programs to practices across the US and Canada.
This is part two of my interview with Heidi Jannenga of WebPT. In the previous episode, I shared her bio and story. We discussed some of the issues related to physical therapy ownership and our lack of marketing and growth strategies. This is all related to WebPT’s report called the State of Rehab Therapy in 2018 where they surveyed over 7,000 respondents in the rehab industry. We talked about marketing and growth strategies in the first episode. In this part, we go into three of the four topics that stood out in the report but the main one being is that we’re losing money. We’re losing hundreds of thousands of dollars in our PT clinic businesses simply because patients aren’t completing their plans of care. Heidi and I talked into that a little bit as well as a couple of the other topics that came from the WebPT report. If you want to learn more about Heidi and her story, go back to the previous episode. In this episode, we’re going to move forward into the conversation and talk about the rest of the results from their report.
I wanted to go into that part of your report as far as patients not completing their plan of care. Did you recognize through your surveys what factors were involved that might be limiting people to not completing their plan of cares? Do you have some ideas through your conversations and perspective that might play into that?
Let me give the data first and then we can talk about some of the whys after. We noted that about 70% of physical therapy patients fail to complete their course of care, which we also equated to be about $150,000 for an average PT practice. Based on 2018, it was even worse. We saw the patient dropout problem to be about one in every ten therapy patients who didn't complete their prescribed plan of care. Only 10% of everybody who walks in the door completes their plan of care. With copays and deductibles being as high as they are, if we're not having that communication from the get-go with the patient of understanding, “In order to get this kind of outcome, the expectation is you're going to come for ten visits,” for them to feel comfortable in saying, “I have a $50 deductible, $10 is not doable.” “Let’s work together to figure out how do we make sure that you still get the great outcome and maybe we can figure out how to space that out over more time that’s going to take eight or five visits. We'll figure it out if you are super diligent with your home exercise program.”
Number two, we've always gone off of maybe the prescription from the physician or referral from the physician to create our plan of care. The physician arrives two times a week for three weeks while we stay two times a week for three weeks and call it good and say, “Six visits is what we need,” versus using expertise and our knowledge. We're able to help with predictions on this too. This is what's exciting about our analytics program and reporting components within WebPT. We now have learning on, “With these comorbidities, you can expect more of this outcome and it will take eight visits.” You can have a more accurate prediction, based on data predictability of how many visits it might take so you have a more educated conversation with the patient. It’s a shot in the dark and we just maybe see the prescription so maybe we knew all along that it wouldn't take ten visits. It would only take eight, but you said ten just to make sure it covers because you don't want to have to go back and get another referral.
The tough thing is number one, we don't learn how to have those conversations in physical therapy school. If you've got a great CI, then maybe they helped you along that path, but it's valuable upon the owners to make sure that they're doing sales training. We've got to initially show them the value that we can provide. Number two, it’s worth it financially for you and your health to fulfill this plan of care. We've got to be empathetic as to the financial burden that it causes. We also have to recognize that if we're not able to complete our plan of care, we cannot guarantee their health. That turns into the patient that walks away and says, “I tried physical therapy and it didn't work for me.”
If we are able to have that conversation in the first place, then there's a cascade of events that it goes into play. It ends up being not good not only for that patient because they're going to have issues down the road if they don't finish up their plan of care. Number two, it's going to look bad on our clinic and on our profession. There's a whole cascade of issues. The training for a physical therapist to have that conversation at the very beginning, at that very initial exam is invaluable. It can benefit us financially. It benefits the patient, our profession, clinic and our reputations.
There are many things that can help with that. I get excited about it sometimes because I remember listening to a podcast by a Paul Gough and one of his first episodes talked about it. Paul’s in London or England and there's a nationalized healthcare, but he doesn't participate in that install cash-based. He's busier than he ever needs to be because he’s really focused. He trains on that initial conversation and so it's imperative. I want to make the point that owners need to recognize what their therapists are saying in that first conversation to get buy-in. What are they doing to educate? What are they doing to work together with the patient? What does that conversation consist of so they complete their plan of cares?If you don't have a website that truly reflects what you do in your practice, you’re missing out. Click To Tweet
When I was a director and I had therapists, it was hard to have some of those conversations unless you sat in with the patient visit and you understood what was happening because you didn't have any objective data to go on. Now, you do have more opportunities for objective data. For example, with our outcomes platform, you're able to see therapist’s utilization for specific diagnoses and what outcome they're getting. If you have people who are outliers and are getting the same outcomes, but it's taking them fifteen visits versus on average while every other therapist is taking ten or if you have dropout rates for a specific therapist where their cancellation and no-show rate is significantly higher than anyone else in your practice, there's very clear education that can be done with that particular therapist.
Having those guys close to you and in a dashboard form, you can run your business through software like, “That’s what a lot of other people do in every other industry, why aren’t we doing it in healthcare?” At the end of the day, what we're trying to accomplish with WebPT is to have that tangible objective data where you can have a very pointed conversation based on objective data-driven decision-making versus just subjective like, “I’ve got a patient complaint, is this true?” We had to do it that way in the past because we didn't have access to this data, but now you do. It's important as owners to take advantage of that.
I noticed in your report that the compliance to plan of care was worse in the bigger organizations. Those PT clinics that average between $1 million and $5 million in gross revenues had some of the best averages, but those who were in the bigger organizations had the worst compliance.
There are a lot of complaints sometimes about the cool “corporate healthcare” and how it's turn and burn situation and all they want is revenue. I don't believe that because I know that every clinic is different and it's about the people in the organizations. Just like any organization or company, you have a culture and if that's your culture, then you're not going to get the best outcomes. It is interesting that there were significantly greater dropout rates as the clinics got larger. It's also a function of numbers too. You have a lot more patients running through these larger businesses, so those numbers may drop a little bit more.
I’ll make a point so that owners, specifically those who focus on growth, recognize that that can slip away. There's a crack in the ship there that could be a loss of finance, revenue and reputation. It’s important to note the $1 million to $5 million gross revenue mark. As you get bigger and as you take on more clinics, you can start losing sight of that initial contact with each patient. That training is probably something you want to nail down and clean up with all of your therapists.
It's imperative for those executives in those organizations to understand how important it is for those completions of care. When it comes to their outcomes, there's this cascade that happens. You have this unique opportunity to do some education on the forefront. That could create a lot of dividends as we showed with the amount of dollars based on the number of visits that you're losing.
One of the other things that you said that was important to you was the discrepancies with the gender pay gap. Talk to me a little bit about that and some of the factors that might play into that.
We had more than half of our respondents and we asked them about their salary ranges, most of them fell within the range of $50,000 to $90,000. The average PT right now is getting paid about $70,000. If you look at the census data, it all correlated well. Males were more heavily represented in the $70,000 and over salary segments whereas females were much more heavily represented in the lower than $70,000 range. The biggest piece that I wanted people to take away from this is the expectations from the get-go. We’re not unique and the whole salary gap conversation. We will definitely do more in our next survey because there are lots of people that work part-time. It's not just women that work part-time, but there are lots of people that work part-time.
To make sure that we have some of the nuances behind the lower paying wage information is going to be important in the future. Even for that first job, what the expectation was for male therapist versus a female therapist was significantly less for females than it was for males, going into their first job or even going to any job. Coming into it, there's already a gap, which was frustrating to me because, “Why does that exist? Why does a female therapist think that she's less valuable than a male therapist?” You can pile on top of the gap that in general, females tend to negotiate less when it comes to salary grade.Most people don't know what they're spending on marketing. Click To Tweet
All of those things come back to education right from the get-go in PT school and talking about how important it is in some of these negotiation tactics, but also realistic conversations. What we also hear is the reality of what an average PT will make coming out of school versus what they've been told sometimes academically does not necessarily match up. Knowing regionally what the average pay is because that regionally changes as well. It all comes down to knowing the business of PT. Knowing how reimbursement rates, payment rates, all of that has to affect how much you're able to get paid, “If I don't get reimbursed, if I don't get paid for my services, I can't pay you what you want to get paid. You’ve got to have money coming in to have money going out.” We’re also remising this in PT education on the business side of physical therapy of how the whole process works from the time you treat to the CPT code that you bill for, to the judication of your claim to coming back in. It’s knowing how much it costs to run a business and the liability insurance.
All of those nuances are important for people to understand. You ran a business for a long time, you understand P&Ls but you don’t even know how to read a P&L. It is basic business knowledge. That’s why we did our second event, which is Ascend Conference that WebPT puts on. It's an annual conference and it is specifically focused on business and how to run a business. We run two tracks, we run a small business and new owner track and then we also run an enterprise track of those that have been in business a long time running with much larger practices. There are two tracks running simultaneously and some amazing speakers who will come in. We're all together as a group, but we have had a tremendous response over the years. This particular year, it’s coming up on September 27th to 29th. It is WebPT’s 10th year anniversary. If you are in Phoenix, Arizona, feel free to go to AscendEvent.com or search WebPT Ascend and get your tickets because they’re going fast.
I'm impressed that you're doing it because I don't think there is enough of that out there in our industry that is separate from the APTA. I have nothing against the APTA, they're working hard. It's imperative that some of the more grassroots events take place so that we can get together and network. Also step out and see what's happening outside of our bubble.
If anyone wants to buy a ticket, you’re going to have a PT code and it’s PT Owners Club. If you put that in, you’ll get a discount on your ticket.
I invite everyone to go there as well. Take the time. From my experience, taking a week or a day coming away from patient care and attending some of these events can be hard to do, but it's imperative. Honestly, if you're a business owner, you've got to wear your business owner hat first and know what's going on in the industry. You've got to know what best practices are and it's out there for you. You've got masters and experts in PT business that will share the secrets. They'll show the blueprints and you'll come in contact with other therapists who are going through the same issues. Some of them have overcome what you're going through or you've overcome what they're going through and you can share.
We love taking extra time to provide for networking. After every session, there's an elongated period of time where you can digest and talk about it amongst other people. We have found that one of the most valuable parts of our conference is to make sure there is ample time for that networking and sharing of ideas from what you learned and how you're going to implement that immediately when you get back to your practices. We also do have some folks from outside of the industry coming in and sharing. With us continuing to tell ourselves what we're doing right, not doing right, sometimes it’s important to get ideas outside of our own industry and the best practices that have worked elsewhere that we have found like, “This can be applied to PT.” It’s going to be a great time.Having a therapist be the alternative to pain medications is an opportunity that we need to be seizing. Click To Tweet
Thanks for sharing that information. I'm sure there are not a lot of students that are reading this, you alluded to this at the mounting student debt issue. If there is a student out there in the audience, what's your advice to overcome that debt and schooling issue?
I would say press on, know the reality of what it is to be in the PT industry, and know why you got into it from the beginning. Most of it was to help people. We're on the cusp of blowing out much more of that 90%, especially if we're able to attack this with the grave issue and be a strong part of that as another provider that can help those folks. There's a lot of evolution that's going to happen hopefully over the next few years that opens the opportunity for more PT. This isn't just a conversation for students. This is a big conversation that needs to be had from owners because they're the ones that are hiring these new grads.
The cost of what they're coming into or the debt that they're coming into your business with is high. The burnout of having to not only work a 40-plus hour work week that you're going to ask them to do, but most of them will probably also be working on weekends and everything else. It's not anything different than I did when I came out of PT school. I also worked for DM on the weekends to help finance my pre-med out as well. It's a much larger amount of debt they're coming out with. They have over $70,000 in debt that they're coming out with graduation and more than a third are coming out with more than $100,000 in debt. That's not including any debt that they accumulated through undergrad.
That can be a big stressor. As owners, we need to be cognizant of that.
Having a frank conversation with academia to understand the reality of our business and our industry to hopefully disrupting the education process of how we continue to attract the best people into our profession. What was disheartening to me was when we put out this blog about student debt, the conversation was around how therapists are discouraging people from coming into the profession because of how hard it is. You're limiting the best of the best that you want in our profession, and you're saying, “I'm not sure if you want to think about PT, it's been hard. This is what you’re only going to make.” Rather than the benefits and all the pride you have in who you are, it's the starting to become a more negative conversation.Regardless of what tools you're using, it's imperative that patient experience is seamless but also shows value. Click To Tweet
We heard from students too who are saying, “I love being a therapist, but after a couple of years of knowing how long it's going to take me to get out of debt, I'm going to go to some other industry that I can use my expertise in. I can't keep doing this.” It was disheartening too because now we're losing some potentially best people out of our business into another practices and industry into another industry. That's not sustainable. If we’re going to continue to push our outcomes and value, we have to have the best in our industry that want to be here for the right reasons. We have to start some frank conversations about how we can disrupt our thinking about education. John Tiles with EIM, their group is doing a lot of amazing things with the two-year program versus the three-year program. There are a lot of opportunities. It always takes the pain and pushes back to make change happen. We're on the cusp of having more pointed conversations and making some changes here quickly.
We need more PTs with the number of people turning 65 every day here for the next 25, 30 years. 10,000 people a day are turning 65. The demand for physical therapy's not going away. It's only going to increase.
It's still one of the top ten jobs that people always say that people want. When your pay is not commensurate with your debt that you're coming out with, if you can make an annual salary of $70,000 and you come out with $100,000 debt that has a 5% interest rate on it, if you’re paying a minimum it’s going to take you 45 years to pay that back. It doesn't sound appealing to a lot of people.
What is your vision? What are some of the exciting stuff coming up that you see in the PT industry or WebPT itself?
Despite all of that negative stuff, my faith in the industry is unwavering. The future is bright where there are so many people that are needing our services and our expertise. It’s about how we reach them and how we get our profession more well-known in the mainstream as the go-to for any kind of musculoskeletal injury. Also to work collaboratively with others that are getting those patients to understand what our expertise is, how we work together in a referral sharing way to make sure that we have access to them, but also that we can share. It's not just only our expertise that's going to help them.A lot of people are now much more available to take patients in without referrals from physicians. Click To Tweet
For the WebPT side, there are many exciting things but right now we're working a lot with making our whole platform much more integrated. Efficiency is the word on all of our developers and product managers. A mindset of no longer having the oxymoron of EMR documentation efficiency happening, we want that to truly be a thing. We have some innovative changes we're doing to our documentation portion, the heart of our platform to make that a lot more streamlined for therapist student to get through their documentation portion. We're also looking at integrating more of the billing process to get those claims out as clean as possible and get that payment back into the clinics as fast as possible. Just enabling and empowering our therapists to run their businesses better.
Thanks again for taking the time and sharing your information and perspective from the report. Your personal perspective is extremely valuable. If people want to know what's going on with Heidi Jannenga or WebPT or how to get on webinars that you're posting, how can people get in touch with you?
If you go to WebPT.com and click on our blog posts, you can get those sent to you on a regular basis. I am on social media, my Twitter handle is @HeidiJannenga, so feel free to reach out that way. I'm on LinkedIn as well. There are lots of different places you can get in touch with us.
Thanks for your time, Heidi. I appreciate it.
You're welcome. Congratulations on this awesome venture into the podcast and with all your businesses. Thank you.
Thank you very much.