Transcript
Marla: All right. Welcome everyone. Thank you so much for joining us today. We have a great webinar about redefining compensation, exploring alternative payment models. And I'm Marla Ranieri. I will be your moderator and we are really diving in about this topic because I recently did a presentation at CSM where we wanted to look at organizational strategies to help clinicians grow in patient care.
We are seeing a lot of clinicians leaving the industry completely or ending up, not even not even going back to another clinic. They're just going into some other field. And when we did a recent survey, from the clinician transition and Prompt it showed that 73 percent of clinicians who left the industry cited insufficient salary and benefits as a primary reason for leaving.
So we know there's a lot of different reasons there's burnout. But one of the key factors that we found was about payment models and payment. And so we have to start exploring how can we make this amazing field even better for our clinicians? And what can we do to explore our alternative payment models to make sure that our clinicians want to stay in the field, they want to grow with us and do exactly what they love doing.
So we have an incredible panel of experts to share their insights and their first hand experiences with these different models. We're gonna have a really dynamic and interactive conversation to hear from them how they've tackled it in their companies, and why they've done it. What they are exactly doing and finding out, pick their brains a little bit more.
So first we have Larissa Larissa Sharps. She brings a wealth of experience from both the clinical and business side of physical therapy. She earned a doctor of physical therapy degree from Creighton University in Nebraska and a master of business from Grand Canyon University in Arizona. She serves as an adjunct faculty member in the DPT program at Creighton University, contributing to the education and development of future physical therapists.
And she is the vice president of company operations, where she drives initiatives that enhance operational efficiency, streamline technology ecosystems and optimize front office performance. She spent her entire career at Spooner. And she brings energy, innovation and solutions, focused mindset to every role.
She embraces this change and challenges, and she's contributing to the company's growth and success. Larissa, such a pleasure to have you. Oh, I think you're muted.
All right. We'll figure out that mute in a second. Next we have Jason. He's a seasoned physical therapist with 25 years of experience and over two decades of leadership in the rehab industry. He co-founded OnusOne, an online employee compensation portal system currently being used in 43 states.
He is an internationally recognized expert in designing and implementing alternative compensation models. He regularly speaks at regional, state, and national conferences. He's also a frequent contributor to the ABTA, PBS Impact Magazine, and various industry podcasts. We're excited to have him share his expertise with us today.
Welcome, Jason.
Jason: Thank you, Marla. Happy to be here.
Marla: Great. And next we have Cyndi. Cyndi Hill holds a doctorate of physical therapy from Newman University. Following eight years in occupational therapy at Mainline Health, she joined Kinetic in 2007, where she played a key role in shaping the clinic's policies and procedures.
And as a treating physical therapist, she developed a pelvic health program. to support a variety of pelvic floor conditions. And she now serves as chief operations officer. She oversees clinical and management operations, and her passion is creating a supportive employee centric workplace that communities value.
Cyndi, such a pleasure to have you as well.
Cyndi: Thank you.
Marla: Great. Today's conversation is going to be really informal yet very informative. We'll be focusing on some real world applications and best practices. And we want to hear from all of you, so please feel free to engage with us in the chat. If you have any questions, we do have a Q& A button at the bottom that we'd really like you to use.
This way, we can make sure to answer your questions right in today's webinar, but if we don't get to it, we can definitely answer your questions afterwards. So with that, we're going to start a little poll and we want all of you to answer. We just want to know who's in the room. So you will see a poll pop up.
It's going to ask you if you are a clinic owner, a clinician, a biller, front desk, or other, maybe a student or faculty. So please feel free to answer that so we can get some input of who is in the room listening today. Great. Great. All right. Love to see all of you. And to get started, we're going to kick things off.
We want to know the why we want to know why you guys decided to implement alternative compensation models. And what your goals for implement this model are. So if you don't mind, would love to hear just your background and why you found this necessary. And what exactly it is to you.
Cyndi: I'm happy to start.
One of the things that we've recognized so going back quite a number of years, I would say, probably at least eight or nine years ago, we were starting to recognize the trend of decreasing reimbursement. And then the desire for a physical therapist to make more money. Every year that they're out of school, you do a review, you tell them how great they are, they've done Con Ed, they've gotten certifications, they've done all the things, to make themselves more of a skilled provider.
Yet, the insurances don't recognize that and offer us more money because they've done so. We want to give raises, we want to give people what we feel that they're worth. They've been great with us, they've treated a lot of patients, but yet the money just isn't coming in. Unfortunately, after a number of years, you're topping out on what you can offer to your physical therapist, and then they are going to go look elsewhere.
They don't have to work as hard, but they can get more money. Recognizing that, we actually presented something very small at PPS about eight or nine years ago on this exact concept. The only thing that we knew how to do was to try and figure out a way to tie visits. The productivity of visits to what we could offer to our therapist.
So if they saw more visits, ideally, they're generating more revenue. We could give them a little bump each month. And so that concept really worked for us to help us stabilize our payroll. We were really lopsided. We were spending, I would say, close to 75 percent of our revenue on payroll.
It was getting to be, we were going to be out of business soon. So the concept worked for us and help stabilize that for a number of years. And then of course I heard about Jason and Onis one, and it was the thing that we were missing. We were unable to tie revenue to what we were trying to do.
So since Jason and his crew are much smarter than we are and able to develop the software that. Ultimately what we were really looking for was how do we actually tie the revenue to what we can pay our therapist. So that was really out of necessity. Back in the day it was just for us to be able to stay open for us not to be taking very small salaries so that our PTs will stay with us and we can offer them a lot of money.
This was a really nice opportunity for us to stabilize. But now we've actually had a chance to grow as a result of using this. This particular compensation model. That was our why, was really to stay in business. But now we're able to offer our therapists or show them a path to making the money that they really do want to make if they so choose.
If that's their why, if they want money versus, more vacation or whatever their why is. If money is that why, then we are there to show them how to do that. Great. And how long have you been doing this again for your clinic? So we are going into our third year with OnusOne. So it's been successful.
I know we're going to talk about turnover and retention and things like that. And recruitment, but it's been great for us. Going strong three years, almost three years in.
Marla: Great. Great. Jason, can you tell me a little bit about really where this came from, the alternative payment models, and your path to getting here?
Jason: Sure. So my path came out of really my own frustration as a young therapist a couple decades ago where I was working very hard and seeing a lot of patients and not really seeing any benefit associated with that.
And that just didn't seem right to me. And I actually was very strongly considering leaving the profession myself. This was about. 20 years ago, I was looking at other roles and really had a very low amount of satisfaction associated with the profession. And fast forward in my career, about 15 years later, I was in a position to actually do something about it at my own company.
And so I just started sitting down and talking with my providers. And the thing that became very evident is if we think about Vision 2020 and what's happening for us as a profession, the direction we're going, we made big strides moving forward as an autonomous health care provider, physical therapists, but we really missed a couple key components.
along the way. One of them was educating our new young therapists on what it truly means to be an autonomous health care provider, what it truly means to be a doctor of physical therapy. There are a lot of benefits that come along with that, but there are also a lot of responsibilities somewhere that got lost in translation.
So we have graduating therapists, doctors of physical therapy. Who whose mindset is very similar to an hourly time punch in punch out mentality that in and of itself was holding us back as a profession. So we decided to try to do something about it, and we started studying how other autonomous health care providers are compensated.
Doctors dentists chiropractors. Interestingly, none of them are compensated, the way we historically are with a full salary, maybe a little carrot dangled. We're the only ones in that boat. Every other autonomous healthcare industry is compensated through some different alternative approach, and it usually is tied to revenue that they're generating for the practice.
So what we decided to try to do is bridge that gap and make it easy for therapists to understand that they're actually missing out. by not being compensated the way these other autonomous health care providers are.
Marla: Great. Great. And I like Cyndi was saying back in the day, she used to just look at the visits, the number of visits.
I do love that this model explores a little bit differently. It's not just the number of visits that could be set up in different ways. And it allows those therapists who are really flourishing. to be compensated for that ability to flourish. Jason, I know when you said you started it, started out, did that piece of the number of visits and then how you molded that into more of a performance based model.
Really tell us a little bit about that.
Jason: Yeah, what we recommend today is entirely different from what we recommended 10 years ago, and we've learned a lot along the way. Not only the types of metrics that can and should be included when you're designing a compensation model, but also the industry has changed.
Post COVID, the ability to find and attract therapists, what therapists want is entirely different than it was five years ago, even more so 10 years ago. So to answer your question, Marley, yes, it really is something that needs to be relatively unique to each practice. It does not need to be a one size fits all approach.
And I think that's important as we look as a profession at moving in this direction, we need to make sure that we're introducing models that are consistent with our practice culture. Not every practice. There are certainly some fundamental truths across the board that makes sense for everyone, but there is also a lot of individuality that needs to be considered from one company to the next.
It needs to be a good culture fit.
Marla: Yeah, absolutely. Absolutely. And let's see, LaRissa, are we able to hear you now?
LaRissa: Okay. Awesome. Sorry about that. I have no idea. What was going on? To go back to explaining the why for us at Spooner similar to what Cyndi said, therapists come out, they want to earn more, but we are not getting reimbursed at the rate that we are able to compensate our providers the way they want to be compensated.
And so our why really came down to our therapist having an understanding of their professional value that came to the behaviors that set them up for the earning potential they want to achieve. And I've been with Sweenor for 15 years. We've had our traditional salary plus bonus models. We created what we call the shared success model, which was revenue sharing.
But it still didn't have all the things that we wanted that were really focused on the behaviors for our therapists to be successful in really increasing their earning potential. And we connected with Jason and During COVID, we had some time to really plan out what we wanted our shared, professional path to look like for our therapist.
And with that, it was a compensation plan that really put them in the driver's seat to be in charge of their earning potential. So we rolled this out, went live. Our first paycheck was March of 2021. And really, our main why and goal has been for our therapists to be the driver of their earning potential to make sure they understand the behaviors to be successful on this type of model whether that be understanding billing behaviors plan of care management, schedule management taking ownership of building community relationships, referring provider relationships to keep their schedules full, but it really just came down to saying yes, we will pay you more, but you've got to be able to perform at that level.
And this is what it takes.
Marla: Oh, that's great. And can you walk me through, I know there's different types of models like a 90 50 50, can you walk me through what it looks like at Spooner and the autonomy that a provider can choose what model fits for them?
LaRissa: Yeah, I'll back up. So all of our therapists, whether they're experienced or a new grad, when they come to Spooner, they go through a year onboarding program.
And that year. really onboards them onto the culture at Spooner, but also it equips them with all of the behaviors to be successful in this type of model. And so we do in depth training on schedule management, billing behaviors, plan of care management, how to build relationships within the community and with referring providers.
And so we feel like we are very intentional with setting them up for success. And they're on a salary when they first come to Spooner salary, no bonus. And then after they transition off of our onboarding program they can choose a variable compensation model of their choice. We have three different plans.
We did choose to have all of our therapists on a variable compensation model. So we don't have salary as a choice or salary plus bonus as a choice after onboarding. But. You could call them high, medium, low risk, but really, they are plans that were designed for us that we partnered with Onis One in developing.
Marla: Great. Perfect.
I love that because you set them up for success, you give them that year and be able to then show them that there are alternative options for them to continue to make the salary they want to make and be almost like the owner of their own business.
LaRissa: Yeah, and that whole year we're collecting data in the dashboard so they can see what their pay checks would look like on the compensation model.
So if they get to maybe month 10 or month 11 and they are demonstrating the skills that they need to be in order to be a successful therapist at Spooner we'll let them transition early. If they're like, Hey, I see what I could be making on this model. Can I please go a couple of weeks or a month early?
We'll let them.
Marla: Great. And Cyndi, I'd love to find out from you. What were your goals before implementing this model? What were your kind of those key metrics that you said when we implement this is what we'd like to see out of this model.
Cyndi: So when, so certainly the, the big goal was certainly to find a compensation model that made sense based on what we were doing.
So certainly being able to offer therapists more money if it was there for them. The other thing that we struggled with was coding. We were traditionally undercoding for our visits. So despite all of the audits, all of the education that we would provide to our staff, we struggled with that with some schools that tended to have students that came out and if we hired them, they were traditionally low coders.
The things like that, that we would try to educate them on just didn't seem to click. So certainly taking a different approach with this and tying it into making them understand, what codes make sense for what they're doing, billing for their time, we're traditionally under billers making them understand all the facets that go into a visit and how to bill for that.
And so once they could see that, oh, if I. Just because the X is easy to put in, this really is a therapeutic activity, which does pay a little bit more. Making them understand the differences in reimbursement for certain codes also helped. So when we made the leap to OnusOne they had more control over that.
Oh, I, you know what, I would only ever see my patients for three codes. Or, maybe there's an opportunity here to actually, get another code in there, maybe more, maybe I'm not, I'm just not billing for my time, nor am I, Are my coding metrics really what they should be? A lot of things came, our goal going in turned out to be a little different than what we started to get out of it.
We were just looking to maintain our same revenue per visit. When I came up with the plan with Jason, we were trying to just keep that. So let's just keep that because that's what we're comfortable with. And as a result of this, we actually were able to generate more revenue per visit because we were billing for our time.
So I would say those have been some, Two big things that we ended up getting out of the plan one was a little more unexpected than the other but both very good.
Marla: Yes we are notorious PTs and OTs and SLPs for not really coding and valuing the time we spent with the patient because we are doing them such a big service and spending so much, really, care with that patient to be able to reflect that.
And then as a therapist, get a little piece of that, right?
Cyndi: I think one of the things that we tried to shelter our PTs for a number of years in the sense that we just wanted our PTs to come in and treat your patient, do your documentation. Let's You know, do what you're good at.
We'll worry about the backside. So we've never been a practice that calls attention to any contracted rates or, patients who are, self pay versus a different insurance. So we didn't, we just wanted to take that away. Certainly we're here to provide care for our patient regardless of how we're being compensated for that.
But I think when we finally decided, listen, you guys are little businesses you can control, what your paycheck is, you need to understand everything that goes into it. So we decided to bring them into the backside of it and say, it's okay that you know how much a code is worth, it can help you understand that, in your treatment, make sure you're billing the correct code for what you're doing. Don't just throw a code in there because it covers what your visit. But, and that really made a difference when they could make the connection like, oh, This revenue is where I'm, getting it from these codes and if I build differently, that's going to adjust my revenue.
So making them like little mini business owners was a nice way for them to start to get the idea overall.
Marla: Yeah, that's great. And Jason, what about you? What were some key metrics that you really like people to identify before and after implementing these different types of models?
Jason: I think the most important thing that they need to identify is why they're interested in changing their models. And that reason can be very different from owner to owner. One owner might say, I'm interested in introducing a different approach to compensation because I'm not profitable. Another owner might say, I'm interested in introducing a new approach because I'm tired of micromanaging.
I'm tired of the number of management touches. that I have to be involved with or that my team has to be involved with. I'd like to reduce that. And I'm willing to pay more in order for that to happen. Another owner might say, I can't recruit anybody. I'm throwing every dollar. I can get every size bonus that I can, and I still am getting rejection after rejection.
What size check do I need to write in order to get somebody to take my offer? In many cases, the answer is not that the check that you're writing is too small. It's that the structure of the plan may be the issue or that you're not offering multiple plans. And if you're offering choices, everyone loves choices.
And if you're offering choices that puts you at a competitive advantage. So for those practices that say I'm interested in improving my recruiting, if that's your, why, if that's why you're headed in this direction. Plan choices are really important. But to answer your question specifically, Marla, that's where we always start.
What is your ultimate goal and what is your outcome or your output that you're looking for? And then that should inform all of your decisions.
Marla: Yeah. And you mentioned recruiting and as we said earlier, retention. So we'd love to hear Larissa, how has this compensation model influenced your clinician retention rates or your ability to recruit clinicians?
LaRissa: That's a great question. And I have to tell the story of and remind everyone, we rolled this out March of 2021. So we committed in March 2020 that we were going to do it. And we introduced it to our teams in August, 2020. So it was in the middle of the pandemic. And during that time, we did not.
furlough, layoff or cut pay for any of our licensed providers. So we were fully staffed operating at about 50 percent volume with visits. And so we were rolling out a variable compensation model. By the time we got to the point of rolling it out, we were about 80 to 90 percent volume. And so we were close to being at our full potential as far as volume.
We knew looking at our list of therapists. that there was a potential that people were going to leave. We predicted about 10 percent turnover. We ended in about 12 percent turnover. And I would say 10 percent was due to those that were already underperforming and that a variable compensation model was just not for them.
And that was totally okay. And then there was probably another 2 percent that like, We were a year coming out of a pandemic and still in it. And so there was movement, right? They wanted to go work somewhere else. They wanted to move closer to family, whatever it might be. So I would say early on, we did anticipate a high amount of turnover.
But we knew we went into it with that mindset. I would say today as an attracting talent we are using it to be competitive in different ways. A couple to say we know we are a fast paced, high energetic, outpatient private practice in Phoenix, Arizona, and we're proud to say that and that's who we are.
So if you want to come work here, awesome. It's not going to be easy, but that's okay. And we have an awesome compensation plan for you that you can be in charge of your earning potential. If you want to be at that low risk and you want that solid base solid base, but still increase your earning potential.
We have that plan. If you want something in the middle, we have that if you really want to be in charge of your earning potential and you want to be the driver of your behaviors to be successful, by all means, if you want to make six figures, that plan is out there too. And so we have embraced that it's different.
I will say as more Practices adapt a variable compensation model. It has changed the playing field a little bit because therapists aren't just looking for that sound that solid base salary and maybe bonus potential. And so it's been as much as I want to say yeah it's helped us out a ton and we're fully staffed and it's awesome.
We still have the same issue that everyone does across the country right now, but we are getting some awesome therapists that are willing to put in the work to make our profession the way we all want it to be. Like we all love being physical therapists or occupational therapists. And so we're attracting people that are ready to be in a lively environment.
Marla: That's great. That's great. And Cyndi, what about you, with recruiting and retention, also that autonomy where providers can actually work less hours and be able to have that model for it as well, right?
Cyndi: Yeah. So we've been in a fortunate situation. We had, excuse me, we had the growing pains with a shared compensation model prior to OnusOne because of our rollout.
So the good thing was based on us transitioning into onus one, we did not lose anybody as a result of that because they were used to a version of that. So we are in a unique position where we didn't we took the leap and we did it pretty quickly without any, really nobody, nobody questioned it.
They just saw the opportunity. I will say, we have not had anybody leave because of the compensation plan in the time that we have had that. It is, I think we've gotten better at selling the compensation plan to prospective hires only because I think before with our plan we were trying to convince them how great it was and really talk them into it.
Now you can just show them, we can pull up, in fact, if I have an interview today and I'm showing them, the three plans together that says, okay, this is where you would be starting with us. What do you want? What are you looking to make? And I can map that out for them.
So rather than trying to convince them that the compensation plan is great to Larissa's point, Hey, you want to come work for us? This is a great energetic, fast paced growing company. We want you to work for us and this is how you can make money doing that. So I think our attitude towards it has definitely changed as far as how we present it.
During recruitment. We're also seeing, especially, having worked with onus one for the past several years and being at PPS and being talking, to various other owners. This is becoming more popular. So if you're not with one of the larger, private equity companies or in a hospital system, this might be what you're looking at, regardless of where you go.
Even just preparing them that, there's This is the way things are turning in the industry, so if we're not for you, you might go somewhere else, but you might also encounter this same compensation model.
Marla: Yeah. And Jason, I know when you set out to do this part of your part of it was autonomy, allowing clinicians to be able to set their own schedules.
And maybe not follow the have to see any patients X number of times per day. But you can be able to manage your schedule to do what you do best, right? So I'd love to hear your thoughts on that, Jason, as well. And retention and recruitment that you've seen in the industry with it.
Jason: Sure. So we all know when we interview a therapist, we expect that they're going to ask two questions.
If I work here, how many patients am I expected to see? And what will you pay me to do it? Those are the two questions. At the end of that, when you start talking, when you finish talking about quality care and the benefits and all that. That's where we ultimately land on. The good news with this approach is now you have a different answer.
To some degree, you can say to some degree, that's up to you. And the amount you make is also up to you. So rather than having a one size fits potentially none approach, and you're hoping that you've just landed on the right number of productivity that most therapists will be okay with, having options and choices is really a very powerful tool.
And the other thing I will say about that is, it's interesting when we're going through the recruiting process therapists very often are not comfortable negotiating. I don't know if any of you on the call have noticed that if you make an offer, they think that's the offer and it's just yes, I'll take it or no, I won't.
And you may very well lose a therapist simply because there was another offer offered elsewhere that you very well could have matched, but you're not given the opportunity to do so because this 24 year old therapist just doesn't have the experience of going through that process. They may very well never have held a professional job.
Before they might have worked through in college, but it was probably making pizzas on the college campus or something like that. And then they get this professional job and they're just not well versed in things like salary negotiation. Yet another reason why offering choices is so important and so variable.
And I want to make a quick comment too about those choices. One thing that we've noticed over the last 10 years is it's not so much the structure of the plan as it is the fact that you have multiple plans. That's even if one of those plans is, in fact, a salary, let's call it a 100 0 plan if you're offering that, but you're also offering this plan and that plan that in and of itself is attractive, and the phenomenon that we've noticed.
Is 85 percent of providers when introduced to this approach will choose whatever the most conservative plan is that you put in front of them because they tend to be risk averse. But what we also notice is if you fast forward two years, 65%. Of that, 85 will have walked themselves over to a more aggressive plan on their own time at their own speed, using their own data, making a data driven decision rather than a subjective or emotional decision.
So it's important to provide the information for your providers and then be patient, let them develop over time, their skills and their confidence, and then eventually they are most likely to settle into one of those more aggressive plans.
Marla: And those more aggressive plans are a win because as you set it up, the more they make for the company, the more they make for themselves.
Is that accurate? Yeah,
Lauren: that's right.
Marla: Awesome. And this is something that we've been doing in insurance, right? When you pick your own insurance, you've got three plans and can choose and different stages of your life. I was a young 24 year old. Oh, I didn't care about the high deductible plan. I wasn't getting sick or injured, right?
So as you said, you then have that autonomy and that option to pick the right plan for you and the right stage of your life. And would love if Larissa or Cyndi tell me a little bit about how work life balance has been able to be affected in these different plans and options as well.
LaRissa: Yeah. I can speak that a little bit.
I think Jason spoke to this before. Like we obviously have visit expectations that we still expect our therapist to achieve each week. But how they go about doing that is really on them. And so if they need to leave early on a Friday because they're taking a weekend trip and they want to flex their schedule, then they can do that.
If they're working with the local soccer team and they want to be on site and provide some coverage. They can flex their schedule and accommodate to that as well. And so it gives them a little bit of flexibility within their schedule to either choose to make up those hours or to flex them to a different day.
And so that flexibility is there for them, which I think, especially our seasoned therapists really appreciate because, previously in their career, it was, you're there either eight to five or you're there six to three, whatever your scheduled hours are, but now they have a little bit more autonomy and flexibility to be in charge of their schedule.
Cyndi: I would agree with that that same sentiment. And then the other just to add the other thing that has also helped has been snow days. So we're in the Northeast and snow days have always been, the It's always a crisis, you always get it on your busiest day, and you're always trying to figure out how are we going to manage this, and the nice thing is that, again, we put that back into the hands of the therapist, we, we drive home that, the importance of keeping the plan of care for the patients that aren't going to be able to make it in because of snow and then allowing them to open up their schedule elsewhere in the week to accommodate that.
If you don't want to come out in the snow, you don't have to. for that. Push your patients to another day. But it really takes the pressure off of us because that was always a nightmare. Nobody ever cared. It was like, oh it snowed and none of my patients are coming in. I guess I'll just catch up on some paperwork.
Now that has really changed because now it's back on them to, to really manage their schedule, make sure we're getting those patients in for, for various reasons. And so that has been a nice way to add to that work life balance is that they, they do have control over.
Everything as it involves their schedule.
Marla: That's a great example. And also again, great for them to have that autonomy and that ability to choose what's best for them in that situation. And also the working moms and parents who need to be somewhere for their child have that flexibility and that ability to do that, which I think is one of the hard parts about our field.
You watch salespeople and they're taking their They're doctor appointments in their meetings, and we just can't do that. So it's nice to have a built model where that is allowed and able, like you said, to flex and to give and take when you need to, or work really hard because your wedding's coming up and you want extra hours.
And that's what you're choosing to do, right? We'd love to hear just some advice for organizations that are thinking of implementing this model or transitioning to it. Just tell me a little bit about. what you have for organizations considering it. And what you would say you'd recommend them explore or do or think of in their company first to be able to add something like this.
LaRissa: I'll go ahead and go first. I would say definitely give yourself at least six months to 12 months of a runway to make sure that you have, You feel confident that you've prepared your therapist to be successful in this type of model. So they really do feel like they know how to bill appropriately and understand the pair mix that they're managing.
They really feel confident and schedule management plan of care management like all those behaviors that we want our therapist to do really make sure that you put in place the structure and the training for them to be successful. I think that's going to build up the confidence. that therapist, but also it's going to help them have a better mindset going into it.
Change is hard when you change someone's pay, that's even harder. And so giving yourself that runway to feel confident, to say like we have equipped you with these skills, you're ready, helps you when you deliver that message of change. I would say with that communication and messaging is key, especially for your leadership.
Our clinic directors are not on our variable compensation plan. And so it was super important that they understand the ins and outs of it because they're the ones supporting their therapist day in and day out. And so we have crafted our message. Probably every year we're looking at, like, how can we craft it both to be more attractive to those that we're recruiting, but also to make sure that our current therapist feel confident in the delivery and messaging around it.
And so communication and messaging is key, but I would say definitely give yourselves a roadmap and do a. Strong evaluation of like, where are we with the training tools to make sure our therapists are successful in this model.
Marla: Great. And Cyndi, any input there as well? Any advice? Yeah,
Cyndi: exactly what Larissa said that was exactly what we did was, to separate the two before.
We even brought on the concept of changing our our payment model was to give them, the opportunity to make sure that all the tools that were going to be necessary for this were met. So that conversation didn't even happen until we had several, rollouts of, coding and billing and time management and things like that.
The other great thing too is, if you're not sure. You can just start to, they're going to put historical data in to onus one. So you can get a snapshot and say, okay, if everybody did exactly what they've been doing for the past year, this is where they would have fell into that model.
And a lot of times you might be surprised. You might see that, oh this PT only made this much money because, salary, but look where they could have been if they had chosen a certain model. So having the historical data. And then, tracking going forward once you get the, have the plan to move on to it, I think really eased a lot of minds because they can see the three plans that we chose and say, okay, if I had done nothing different, this is where I would have fell.
So they have. A snapshot to see if they could have made more money just by doing the same thing. And then they could also see the comfort level of, okay, I know which plan to pick because I know that's where I'm going to be the most successful, but also the most comfortable. So I think giving your staff the time to look at that data and really live with it before.
Making that jump, I think was
Marla: super helpful for us. That is really nice to have the full visibility and see it when you're not on it. And then be able to know exactly what it would look like if you did jump to a different model or a different plan. So I do love that structure part of it. We have quite a few questions and also a lot of them are about financial and operational benefits.
So we'd love to know. How has this flexible payment model affected your clinic's financial performance? And if anyone could share specifics I have a question here asking, what is your, what would you feel like your revenue per visit now is and so forth as much as you could share would be welcomed.
LaRissa: Yeah, I can go ahead and speak to that. The year after rolling out our variable compensation model, our revenue per visit increased by 6 in just the first year. Being on our variable compensation model now for almost 5 years or 4 years our revenue per visit has significantly increased. In addition to that, because it's increased, it in 2003, we evaluated all of our payers and United Healthcare was well below our current revenue per visit.
And so it allowed us to go out of network with United Healthcare, which at the time I want to say was 18 percent of our volume. And so it allowed us to make a big decision. And I think the billing behaviors of our therapists had a huge impact on that, as well as our visits. per week per therapist went up by four visits, so a therapist was averaging four more visits per week than they were prior to their variable comp model.
And then our visits per new patient went up too. And so we saw significant changes in certain KPIs that allowed us to make a big decision with UnitedHealthcare. In addition, it obviously influenced our clinics and company in a positive way. That's
Marla: great. Cyndi what about you? And if you can also talk about documentation?
Absolutely.
Cyndi: We jumped pretty far the first, within the first year. We, gosh, we probably went anywhere from 15 to 20 more per visit across the house. We used to struggle just to maintain our dollar per visit. And so to see it even increase at all was shocking. And like I said, we weren't, that wasn't our why.
For switching to this model, this was, so that was a really nice benefit. But again, it was letting the PTs understand, all of the things that go into a visit, as opposed to just the treatment side. So the buy in from them and the understanding from them was huge with that.
Yeah. So we were able to really jump in the first year and we've been able to maintain that since. That's been, it's been great.
Marla: Yeah, that's a great significant increase and great to know that also was able to given back to the therapist too, right? So they got to, your company did better, but the therapist did better in the same way because they got to share some of that increase.
Jason, what about you? Any thoughts or input on that from what you've seen in the industry and your experience?
Jason: Just that is very consistent. What we see across the board, the average therapist after being enrolled in the types of models that we're talking about today tends to increase their productivity from 5 to 8%.
That's an average, some people more, some people less. But in general, what Larissa and Cyndi have reported is what we definitely see fairly consistently across the country.
Marla: That's great. We have a ton of questions coming in. I might Go through some of these since we've only got about 15 minutes left.
Some people asked if this is just for PTs or PTAs as well. If somebody wants to answer that on their end.
LaRissa: Yeah. We currently have our. Therapist, not our PTAs. So we have occupational therapists and physical therapists on our variable comp model. We originally chose not to put our PTAs on it only because again, we were coming out of COVID or still in COVID.
And so we at the time, our PTAs did have lower volume schedules. Since then we have evaluated a couple of times actually in the last two years, whether or not we were going to put our PTAs on there. And so each year we reevaluate if that's a decision that we want to do. And. As of today, they're still on a salary plus bonus, but it's a revenue share type of model as well.
Just not on the current one that we have our therapist on.
Marla: Great. And I also have a question about since you're sharing profits, have you seen the company's benchmark profit margins increase? And Cyndi, I'll ping that one over to you.
Cyndi: Oh, for sure. For sure. Seeing seeing our profits go up, has allowed us to expand to grow by a couple more points of service.
We actually have a PT sponsorship with with an MLS soccer team in Philadelphia. So we've, it's, we've been able to do things that, you know as a result of this. Not only paying our pts much, much larger salaries, but being able to grow as a result. And our profit has really skyrocketed.
We didn't think we would be in this position at all. So that's great.
Marla: And what about for new clinics opening up? Do you see that this is something that could add right from the start? Or do you need a ramp up time? And how many clinicians would you see is the right amount to be on this model?
And maybe Jason, I might ping that over to you.
Jason: Sure. Yep. And let me follow up on Larissa's point earlier about who is or is not appropriate for these models. That's a very practice specific decision. You certainly can enroll PTAs on the model. One of the things that, that we see a lot is a credit program set up where A PT refers a patient to the PTA and gets a percentage of what the PTA is generating added on top of what the PT is generating.
You can do that as well for clinic directors. That's a pretty popular approach. So just to comment on that, but with respect to de novo clinics, startup clinics, typically what you would need to do if someone, unless that person is an owner in the practice is you would need to give them a grace period, similar to what you would do if you were to hire somebody.
from the start, you would give them a grace period with a guaranteed set salary of X. And then you could still offer those same plans that everybody else has. But that person would have a runway to get the practice up and running to the point where it made sense to introduce those. As far as the number of F.
T. E. S are concerned, one is enough. As long as that one individual is actually up and running. and functioning at the practice, it would make sense to put that person on that model. And you could also set up that shared credit that I referenced for that person to be incentivized to add other FTEs as the practice builds.
Marla: Great. Great. That, that helps clear that up. And then they, I still have a couple more coming in here. Do they still get PTO in our sick paid days?
LaRissa: Jason could probably speak to this. I know this can be practice dependent. At Spooner, we did choose to provide PTO. So their PTO is very similar to what we had prior to a variable compensation model.
We make their salary whole. And so their PTO is equivalent to a full salary. And then what was the other part of that question?
Yep. P time off, sick days. Yeah. So we have, they have their sick and their PTO time.
Cyndi: We actually we adopted a couple of different models with that. Originally we would give them. Credit for units that they would have seen if they had been in the clinic based on their prior three month average.
So we can see how they've been performing over the past three months and give them an average. We used to just give them credit for any time off three days or more. So if they took a week off, we would give them, an average for the week. And then the three days we did have a little bit of pushback.
With the one to two days off because what we were asking our therapists to do was to make up that time within the week. So if they were only taking one day or two days off to shift their schedule the pushback was they just felt like it wasn't a day off. And we definitely tried to explain, the what we were trying to do, but ultimately we shifted and started giving credit for any time off.
So if it's a one day, we gave them a one day average, two days and so on. So the response has been better with that, but you definitely, I definitely have been watching that only because I didn't want it to all go backwards. I didn't want it to be a. No, I don't have to worry about my patients if I take a day off or two days off.
It hasn't really happened, but I'm still watching. So it was definitely a little bit of a change as far as the PTO. Now, sick time, we definitely give them credit only because it wasn't planned. And so we do a very similar process is give them credit for a day that they would have been in if they called out sick.
Jason: Marla, that's a really important point. So maybe I'll just add on top of that quickly, the PTO concept. If we think for an example of a 9010 model and somebody that ordinarily would make an 80, 000 salary, their base would be 90 percent of 80, 000, which is 72, 000. If that person takes a week off, they would essentially have three options typically that we see across the country.
Option one would be to just pay them the weekly equivalent of 80, 000. Option two would be to just pay them their base. The weekly equivalent of 72, 000 option three would be to give them some sort of a credit, which is what Cyndi's referencing. So they've been averaging X, whether your model is based on units or visits, that's what they've been averaging.
So that is going to be their credit. That's how their performance pay is calculated while they're on vacation. So I guess the point is there are a lot of options there. It certainly does not need to be a one size fits all approach for PTO, which is definitely one of the largest considerations that your therapists will have.
If you do choose to roll this out, one of their first questions will be, how does my PTO work? So you'll want to make sure you're really dialed in on that.
Marla: Yeah. And then we've got another question coming in here saying, I have several therapists that are highly compensated already. In your experience, why would these PTs opt in for this model?
Would they, is there a concern that they would leave or would this model actually still benefit those PTs?
LaRissa: It really comes down to their actual behaviors. And are they truly maximizing their billing potential? Are they hitting all KPIs that you have put out in the plan is built around our highest performing therapists?
Originally her revenue per visit wasn't the greatest. She was still making more on the compensation model when we rolled it out. But once she understood the billing behaviors around it, Her earning potential has skyrocketed, and she's been with us for 14 years and is one of our highest earning therapists, but, we had to really dial in her understanding of billing behaviors, and so it really depends on their KPIs and how they're performing.
Cyndi: Agreed. Agreed. Yeah I feel like, certainly you can also get that snapshot if, putting in the historical data to see where they would fall based on their past performance and once you know that, then, to Larissa's point is, there is still a path, to possibly earn more than what they were making.
It just may depend. And, there is that risk that you might lose a person or two because of that. But I think overall, it's really. It's really going to tighten up all your processes across the house and then certainly make you more profitable as a result. I think it really helps to scale the salaries with your revenue, whereas, doing it the old fashioned way of just paying salaries and trying to give bonuses and trying to give pay raises where you're not even really sure if they're generating what they should be.
This really solves that problem.
Marla: Yeah, and Lucy, you mentioned that your CDs might not be on this model, so I think there's a question here about how do you deal with leadership or people who are not treating as often, so we'd love to hear that perspective as well.
LaRissa: Yeah, our clinic directors are on A shared revenue model as well.
So they're bonus off of the revenue of their clinics. And so they're incentivized just as much as our therapist to, perform at the same level with those same KPI achievements, whether it's visits or revenue per visit, or, filling their schedule. I will say with our clinic directors, they also are supporting their therapist and making sure that those behaviors are aligned.
And so really, they're all working towards the same common goal of making sure that they're taking the needs of the community, filling their schedules, and then billing appropriately.
Marla: That's great. Okay, fantastic. And I, we still have more. I'm going to keep going to the end, but I am going to put a little bit of a poll in the chat for anybody who does want to learn more about, Onis one about prompt about both or kinetic or spooner.
So please feel free to answer that as we continue to answer some of these questions in the chat. I have one from Bill saying we're using prompt as Onis one integrate with prompt. And can you tell us more about that, Jason?
Jason: Sure. Yes. So onus one is officially part of prompt as of July, and there is a two phase integration that's underway.
The first phase is being released in the first couple weeks. So the short answer is yes.
Marla: Great. Perfect. And then we have, oh, somebody asked if they can access this recording. Absolutely. We will be sending it out afterwards. So you will be able to see this in review. And then another question we have is from Doug.
We use a profit sharing model with our providers. It's a quarterly bonus that's tied to metrics that should increase revenues such as schedule efficiency, UPV, clinical efficiency, and lost opportunities. He wants to know what is different between that model and ONIS one.
Jason: So the primary difference there would be that the models that we would typically recommend calculate compensation on a weekly basis.
rather than quarterly. In addition to that, typically a variable comp model is not a bonus model. It's simply a method of calculating someone's pay from typically two buckets, base pay and performance pay. Neither one of those buckets is a carrot dangled. They're not being incentivized to do more or penalized for doing less.
They're being compensated according to their relative contribution to the company. So that's a fundamental shift from the model that you've described.
Marla: Great. And a couple people asked just about the admin burnout, the spreadsheets, the, all of that. Will you have to maintain all of that for this model?
And I know this is a great question for you guys as it's nice to see that's not part of this model.
Jason: Yeah, I tried doing it with spreadsheets 10 years ago, which is the whole point of going to find people smarter than me to build software. So it's very labor intensive to try to do this with a bunch of spreadsheets.
I gave up on it about a decade ago.
LaRissa: And I can speak to that. Our COO Julianne Brant and myself tried the whole year of COVID to build it out ourself with spreadsheets. And then we went to Jason who has a beautiful dashboard and it's been, Really easy, just be able to upload data right into the dashboard.
And I did it with spreadsheets
Cyndi: before I met Jason, so yeah, I don't highly recommend that at all.
Marla: It's labor intensive. Perfect, thank you. And then somebody asked about cash pay clinics. Can this model also be utilized in cash pay clinics?
Jason: Yeah, there's no difference in the structure of the plans.
The only difference would be in how your EMR system handles cash based patients. So you'd have to solve for that with your EMR platform. But in terms of the structure of the plan, it doesn't matter whether the dollar is coming from an insurance company or the patient's wallet.
Marla: Great. And what about for clinician scheduling versus admin scheduling do you feel like your clinicians want to schedule and have more control or is it still a nice let's call it, ability to work together.
So tell me about that experience for you guys
Cyndi: Yeah, we have we certainly control the schedule in the sense that we just want to make sure we're available for the times that we want to be available for our community. We will make sure we're filling all of those times.
And so we'll give a schedule to the therapist. We'll work with them certainly when they start. But within that is where the flexibility is. If we find that Hey, this particular day is a slower time and we want to shift that we just have. We certainly have an an hourly expectation per week.
And then we also then fit that in with the needs of the clinic. So there is flexibility on both sides, as long as we're, fulfilling the hours we want them to work and available the times that we want to be available. Got it. But who is actually scheduling the patients? Is it so there's Oh, I'm so my apologies.
So there's a little bit of both. So certainly if someone's calling our call center, for a new evaluation, there's not much control from the PT side, we're putting them in the spots for the evaluations. But once the patient comes in, they really like to schedule their own patients for the most part, because they have the control over it.
Making sure they're coming in the number of times that they need to for that week. They're spacing them accordingly in their schedule the way that they feel comfortable. They actually prefer to schedule their patients once they're in the door but we do, we do have the flexibility if someone calls and speaks to our call center that we can schedule them for them with communication as well.
Marla: Great. And obviously if you're using a tool like prompt, there's online scheduling that really optimizes a lot of that and allows your patients to get right in per your schedule. So that's nice to have.
Lauren: And then I have a,
LaRissa: Our therapists also, after rolling it out, we'd go up to the front office and say Hey, I had to cancel.
Can you put someone on my schedule? Obviously with prompt now with self scheduling, that's going to help fix that problem. But previously when we did not have self scheduling as an option, our therapists were more engaged with our front office to say, Hey, can you put a patient in here?
Marla: Great.
And then I know we're at time here, but somebody did ask about in the past, they were cautioned against bonusing or incentivizing based on revenue because of red flags and overbilling. So we'd love to hear your perspective, Larissa and Cyndi, of what this brought to your billing and how you maintain compliance there.
Cyndi: Yeah, you definitely have to, you definitely have to keep an eye on it for that very reason because I, the, like I said before, was our challenge was under billing. And now once they understand, hey, we can build more, you definitely want to keep an eye on that as well. Rather than having the underbilling process, It's definitely, keeping your internal audit process alive and well, because you just want to make sure that we're following all the rules, we're compliant in our billing practices because it could easily get out of hand the other direction.
We definitely would recommend keeping those processes in place because before you know it, it could go the other direction.
Jason: Yeah. Oh, sorry. Go ahead, Larissa.
LaRissa: I'm sorry. We have a compliance team that will do chart audits, and they'll do just even schedule assessments to make sure that scheduling is scheduled out appropriately, and then chart audits.
And so if they have to talk to a therapist about billing behaviors, then those conversations will happen. But you definitely want to have a system in place just to, to be sure and have a safety net there.
Jason: Yeah. Underbilling is obviously as concerning as overbilling. A lot of times we focus on one and not the other.
Every practice that we typically have worked with, we first ensure before going down this road that they have a robust method of measuring quality care. And that just needs to continue post implementation of whatever your new models are.
Marla: There's still a ton of questions. I will, we will get back to all of these questions if you did leave it anonymous anonymously, maybe a little bit challenging.
So maybe put it back in there with your name. We promise to get back to you. And we just thank you all. We really appreciate Cyndi, Larissa, Jason. Thank you for your time coming on talking about this and all the engagement from the audience. Really excited to be thinking bigger about how we can help clinicians to continue to grow.
Thank you. and get what they need out of this profession and do it mutually. So we're all bettering each other. So thank you so much for time and hopefully any follow ups. We will be doing that with all of you today. Sounds good. Thank you.