Transcript
Adam: Thanks everyone for coming. We're going to be doing a round table with three practice owners and managers that work with prompt and basically just having them share some of the tips and tricks that help them run a super successful practice. I'm just gonna have each of them introduce themselves and then we'll get going.
Josh: Hi, my name is Dr. Josh Funk. I'm the founder and CEO of Rehab2Perform. It's a DMV based PT company with 10 soon to be 11 offices.
Amanda: Hi, I'm Amanda Brewer with Brewer Physical Therapy. I've been a practice owner for 16 years. We have four locations in Northwest Louisiana and I'm happy to be here.
Dave: My name is Dave Manzo with Atlantic Physical Therapy Center.
We are located in New Jersey. We have 25 physical therapy offices, five hand therapy offices. And a robust FCE program for the entire company, which travels across the state of New Jersey.
Adam: Josh, why don't you start with talking about some of the most impactful decisions that you've made in the business, maybe in the past year that have helped drive your profitability, and then we'll take it from there.
Josh: So this year was largely centered around becoming a tech enabled company and putting things in place such as automation and self service for the patients. Automation helps your team taking away tedious tasks, lower level skilled tasks that maybe they are doing repetitively over and over. Allows them to stay in more cognitively fulfilling work and puts you in a position where you have repetitive tasks pretty much out of sight, out of mind.
And then other things involving self service involve putting the patient at the forefront of the experience. When they call you, when they're reaching out to schedule an appointment, how do you put them in the driver's seat? So they're handling the initial evaluation, scheduling, follow up scheduling, check in payment.
You're also putting yourself in a situation where your staff doesn't have to do those things anymore. They're not having to pick up as many phone calls. And again, they're staying in higher level work. One of the things that we've been looking at throughout the course of the year is our ratios of provider to non providers, as well as just total comp in both provider buckets, non provider buckets, and for the company overall.
And we've seen very positive trends throughout the course of the year.
Amanda: One of the things that we have recently implemented over the last year is using prediction health. And it's great because it pulls the information straight out of Prompt. It helps me to sleep better at night. It provides us with audit scores on every note.
You can't read every note that every one of your providers are writing or seeing how they're billing or documenting, despite how many audits you do. But PredictionHealth gives us really good, solid information. It also coaches our therapists and our new hires. And provides CPT coding insights immediately.
So that is one thing that our therapists are loving and their favorite thing is the auto scribe that PredictionHealth has, where it will listen to their evaluation and basically type their note for them.
Dave: One of the things that we've done in the last year is we actually came on board with prompt and in the last month or so, we I've had the opportunity to talk to Josh and I'm really excited about a lot of the automation that He's put in place for the patient to control their course of care.
So that's one thing recently that's been really exciting. One of the best things I would say that we've ever done for our organization was renegotiating insurance contracts and it, the value that's created for not only the business to operate more efficiently, but also to reward the staff that works so hard to provide care to the patient.
It's just, it's a game changer. And I know there's been a lot of talk about insurance, having those conversations with insurances in the speeches this morning. And I can tell you that you need to find out who the decision maker is at your insurance company. And have those conversations because you're providing a service that is worth more than you think.
And you should be rewarded for it. And it will change your business if you have those conversations.
Adam: Thanks guys. It would be great if you could chat about some of the metrics and the KPIs that you try and focus on from a, weekly, monthly, quarterly level to, to help drive profitability and growth.
Josh: Yeah. I think some of the things that we're talking about outside of obviously your vanity metrics as some of the leading indicators. To you ending up with revenue. So revenue is a good lagging metric. Your profitability is a good lagging metric. Lead for us largely centers around churn and net promoter score.
We want to catch things on the front end of the patient care journey. We want to make sure that we're not having individuals that thought we were the solution going elsewhere. That largely centers around having a good net promoter score early on. If we do have patients or locations with churn, what's going on at that office, we were We want to get people to a mutually agreed upon plan of care and the more that we can take care of those leading indicators that are going to put them in a position to continue to come back because they think that you're the solution for their problem.
The better off that we've been.
Amanda: I like looking at lead indicators as well. And so we're always looking ahead at the future scheduled visits for the upcoming week and making sure that it looks like it's in alignment with our plan of care reporting. So another thing that I like to look at is the plan of care compliance report.
that's available through prompt. We also analyze what percent of our caseload is coming in three times a week, two times a week versus one time a week. And then how long those plans of care are.
Dave: One of the biggest metrics we follow is productivity. And I'll go back to the insurance negotiation.
It was probably about three or four years ago. We went through a process where we called it threading the needle. Because of our ability to negotiate with insurances, we were actually able to take our productivity down for therapists. So we're trying to give the therapist more time with the patient, which is ultimately what's gonna drive your business through word of mouth, through results, through outcomes, which we other metrics that we track as well.
NPS is big, outcomes are big, and all those ultimately become tools for your negotiation with the insurance companies. So those are some metrics we look at.
Amanda: Yeah. I know you were talking about productivity. I will say another one that I found very beneficial to track in our practice is to track the number of therapeutic activity units billed per therapist per visit.
So we are educating function all the time. We are training them in function all the time, but many therapists that come on board, we're billing that as therapeutic exercise, which we all know is. Typically reimbursed at a lower level. So whenever we started focusing on tracking that TA per visit lo and behold, they were able to realize that they were addressing function.
We are actually reimbursed by some of our insurers based off of our functional outcomes and our FOTO outcomes. And so it was really important for us to be able to measure whether we are working on something functional for every visit? Now we are and now our reimbursement also went up because of that. When you talk about PlanetCare, you talk about the lifetime value of a customer, at least for their patient journey.
Josh: You could argue that they're coming back in and potentially the lifetime value's extended. Another thing that's a front end of them, even before they walk in, will be considered like your CAC. Especially if you're looking at your cost per acquisition. For the people that are coming into your company.
So if you're not looking at the conversions of the lead that you're having, you could be in a situation where you're doing things from a marketing standpoint, at least the things that you can directly monetarily look at and you potentially are spending a lot of money for very little acquisition.
If you're running into a situation where you're not taking care of looking at the leads, how they're getting converted, and then how that converted lead is turning into a plan of You're losing out on the central thing in terms of value generation in your company.
Adam: You all mentioned in different ways, but trying to align your providers to achieve the outcomes.
And obviously one of the big challenges in the industry right now is retention and recruiting. But what have you guys tried to do on the align incentives and recruiting standpoint to help get your therapist more bought in on what you're trying to do as a business?
Dave: Some of the things that we've done to try and engage the therapists is obviously compensation, right?
We have a compensation plan where the more productive you are, the more compensation you can get, right? But we've also done some things and this is credit to our CEO, my brother, Mike. He's floating around here somewhere, but he set up a mental health coach. So we just hired an outside mental health coach that does like a weekly call.
You can go, you can join if you want, if you don't want to, but anybody in the company is welcome to do that. And she'll just do like a mind, like a mindfulness session. It's probably like 20 minutes at lunch, maybe like once a month, but all employees have gotten value out of that. That's been a big thing.
And then I heard someone else talking about it, but we have a college tuition plan, like a college tuition assistance plan. So that's another nice little tool. It's no cost to the employee we contribute to help them pay down their college loans So if we can help accelerate that for them, too That's we think that's a nice tool and obviously we have health insurance and 401k But those are just some of the other little add ons that we've been able to do and then One of our big things is we do this we call a team engagement So we give out points to employees that just do anything in the community, right?
If you go to a soup kitchen and you're wearing an Atlantic PT shirt, send us a picture of it. If you're at a race and we have a, and we have a tent and you go, let us know that you're there, right? And we give out points and what you can do is accumulate points throughout the year. If you refer a patient to a local physician that supports us, you get points and we track all the points and what we do is we have an awards program where we have a store that we set up and it's all Atlantic swag, sweatshirts hoodies, t shirts, coffee mugs, and you can read, you can redeem your points for the swag.
But then what we also have is we have a party down in Atlantic City where we get a hotel room for every employee that has enough points. You cash in your points and you'll get a hotel room. And then we have an open bar party and everybody celebrates the engagement for the year. And it's pretty cool because it's become like a thing between the offices were like Amanda and I are like competing Hey, how many points you got?
So it's become a fun thing too, that everybody's engaged in. So that, that, that's been a really good tool that we have going on.
Amanda: All right. So we changed our compensation structure 100 percent a few years ago. We set out to make it different. It's weird. It is designed to pay those that are working harder more and that are working more efficiently more.
What we do is we bonus, they get a weekly bonus. It's paid out every two weeks. And they are bonused off of quality measures and also functional measures. So I brought up that TA per visit. So that is one thing that we'll add to their bonus each week. Additionally, we look at time units per visit.
We look at the NPS score and then number of patient visits per week. So taking all four of those together, they're each weighted a little differently. But those are the things that we wanted our providers to be focused on. And so we chose to incentivize those things and that has worked out extremely well for us.
There are no more conversations really about maybe someone averaging two units per visit when they're treating patients for 60 minutes. So it lets them manage themselves really. And additionally, prediction health is really good for that as well. And another thing I like to do is I like to catch people doing the right thing.
So if we catch someone doing the right thing, we have gift cards stashed around and we'll just go up and, issue a gift card right then because we want to incentivize those images of our value, our core values that are being exemplified. We want to pay them for that and have it reproduced.
Josh: I'm going to try to just go a slightly separate direction. They said some really good things. Some things that we do are some of some things that I would like to adopt personally, but trying to find ways to match marketing efforts with some kind of reward, whether or not you're a single location practice and you can create competition amongst your PTs or a multi location practice and create competition amongst your locations.
We've done monthly rewards for Google reviews. We've done monthly rewards for graduation boards where, you know, we, as somebody who has a mutually agreed upon discharge, we have a performance for life graduation board at the end. So the more photos they get with a patient, they'll help their location win.
We've done a warm leads challenge. And that forces the people to have conversations with their patient beyond just patient care. Where are they connected in the community? Use sports, schools, gyms, some kind of a person that runs the police or fire department that they're at.
But trying to come up with some of these like marketing incentives because it's going to help you. It's going to help their schedule, if they're busier, they're going to get raises and bonuses. So again, thinking a little bit before the plan of care, a little bit before the patient might interact with you and try to find a way to reward them.
And then something that we do that's just like a big culture champion award for us is we have something called the Green Team Award. At our kickoff every January, we vote on the traits of an ideal teammate. It's usually five or six traits every year. We have a quarterly award where you vote on the person that was the most green on your team.
And they get something that I'll credit. I don't know if Rick Louse here with Clinic Accelerator with regards to a bucket list item. But it's typically something in the same monetary amount as a free round trip flight. But we've had people do concert tickets. Football games, guitars, snowboards, just a wide variety of different things that are meaningful to them and attach them being a good teammate with something that's very valuable to them.
The way that we micro dose that as we do high five every Friday before the clinic opens myself and my counterpart over here. Jen, you can put your hand up, you can put your hand. I know she's a little bit shy. She pretends she's shy. She's not really shy. But we are typically the first two people that are giving people shout outs.
What you reinforce will continue to get done. So your low performer that just did something for the first time that you would love to see more of rewarded your high performer. That's killing it, reward it. But this is a way for everybody to get involved in the pat on the back that you want to continue to create this positive cascade of actions across your company.
Adam: Awesome. That was great. I know earlier you mentioned, I know all three of you implement some sort of patient self scheduling, check in things like that. And obviously the industry's moved more towards that, but there's still a lot of fear and hesitation from clinics and from the patients as well. But how did you guys approach implementing all the patient facing functionality?
And what types of strategies did you use to try and get over those hurdles, both internal with staff and potentially with patients as well?
Amanda: Okay. So recently over the last two months, I believe we have rolled out the kiosk check in for our patients and at some of our clinics that has gone over very well.
They have 100 percent actually pre check in at some of the clinics where the patients are checking in via their phone email text before they get to the clinic. And that lets us know that they're on their way. So that's fantastic. They can schedule remaining appointments that need to be scheduled if there's a hole like if they're not compliant with their point of care and they can also pay whenever they're doing the check in as well.
So at another clinic, we actually were presented with a petition. No one had even used the kiosk. They just saw it on the stand. They just saw the kiosk stand and said we're making a petition. We don't want this in here and so we educated them. We had the staff work with them. They are checking in on the kiosk.
It's okay now they're not afraid of it. It was just interesting because no one had actually used it at that point and so we're really heavily focusing on tracking the number of future scheduled appointments scheduled via the kiosk. We can also track our Just online scheduling appointments as well.
So we've had patients doing that for years now at this point, but the kiosk is new and it will really help our staff be available to answer other patient phone calls, to schedule new evaluations to do some more care coordination, maybe with the physician's office if we're missing some documentation that we need.
So we want our patients to be as independent as possible with the self check in and I love the pre check in even more. So I hope. Hopefully, maybe next year, I can come back and tell you that we have fully adopted it at every clinic and are doing as wonderful as Josh's are.
Josh: I have a graphic on my phone that shows the amount of administrators in hospital systems, and that sticks out for me when it comes to this topic.
If we grow, and we continue to add non billable providers, And it takes away from our billable providers in terms of total comp. That's a loss. Why are we growing at that point? So when I think of tech and stuff like this, it's how do I decrease the need for non-billable providers in the ecosystem? Front office and back office and make sure that as we grow, we can actually shift total comp more towards the providers because we are a provider service business.
We're a service provider business. So that's what I'm thinking about as a macro when I think of the implementation of this stuff and I think of communicating to your team. Hey, we have this provider bucket. Okay in terms of expenses We have this non provider bucket and we're looking to add tech to cut into the non provider Bucket and ideally we can decrease the combination of a plus B to have more in our C bucket So that was something we've been very transparent throughout the course of the year with So what we've been able to see is we've been able to see that we need less front desk staff We went from years ago where we had two front desk for four to five FTEs from a clinical standpoint to now where and I'm not saying that this is the norm in our company, but we have one front desk person at an office and there are six FTEs and it is rocking and rolling.
Now, Stacey's crushing it, our one office, Jen can shake her head over there and say, great. And I know you had a lot to do with that as well. But I would say at least a one to four and one to five ratio that I think a lot of people would be. Very happy with. And I think a big part of that is self service and pulling tasks off at the front and it allows them to, again, stay in more cognitively fulfilling tasks.
A little bit of a humble brag, but yeah, we're at a point where we have 35. 6%, almost 4, 000 visits a month are scheduled entirely without the use of a person. It is online scheduling. We have a target of 45 percent by the end of the year. It is not easy, but you have to think about an ecosystem.
How much automation can you send to people's phones or their emails? We have two QR codes in the provider area and at the front desk of every office that allow people to be scheduled every single PT during the course of their eval has to remind and ideally get people to scan those QR codes so that it's on their phone.
But we want full adoption, which for us, looks like closer and closer to a majority, and then we'll see what it looks like next year, especially as now we're three and a half weeks into initial evaluation scheduling we have not allowed our previous patients to do IE scheduling we will allow them at some point this year, just as we roll this out in phases, but It leaves me very optimistic that eventually you have this self service world.
It allows your front desk or non-billable staff to stay in cognitively fulfilling or cognitively nuanced tasks, which is probably a win and ideally shifts more and more money to our providers.
Adam: It's always interesting to focus on maybe some challenges you had or maybe something you tried that didn't work and maybe what you learned from it.
Or, obviously everyone's always getting pitched in a million different directions, but is there anything you can think of that you've tried recently or in the past few years that maybe didn't work and maybe why it didn't work or what you learned from it.
Josh: I could go a ton of different directions on this one.
I will just say that it is an absolute blessing to know that at this stage of the game going a mile deep is a tremendous thing to do from a business standpoint. I have been very guilty of shiny car syndrome or for any Alex Hermosi people out there, lady in the red dress where you're just getting, following stuff that you should not be following in terms of your time, energy and efforts.
And also taking your staff there, potentially creating situations where it's affecting them on a mental and emotional level. So know what you do well. Focus on what you do well, pour into it. Just because somebody else is doing it doesn't mean it's necessarily valuable for you, your ecosystem and your team.
And I think the more that you can dive deep and just keep hammering it, the better off you'll be.
Amanda: When I think about your question, it reminds me of when we used to outsource our billing. And that was probably one of my biggest mistakes. Not just outsourcing my billing, but outsourcing my billing and not having an understanding or very clear transparent view of what was going on in my billing.
So I would strongly encourage any practice owner to know everything that they can about their revenue cycle management and how that works and where your money is. We, it takes a lot for us to get paid. And so we want to make sure that you're actually getting paid what you're billing.
There are all sorts of things that could be going on. So if you don't have that really good understanding, I would recommend some billing courses. PPS often has some really good resources here and I would highly encourage that.
Dave: When I think about a mistake, I guess we've made, we've made a ton, right?
That's why we're here because we've learned from a lot of them. But one of the things that we talked about, was we had a clinic, I don't know, this is probably going back to when we started in 2001. So it was probably like 2007 or 2008. We had a clinic that was just, it just never was performing.
And we just held on to it and held on to it and held on to it. And we finally just cut the cord. I don't know if it was pride or what it was that it just wasn't working. And we finally cut the cord. We took all the equipment that was in that clinic and relocated to a new clinic. And that clinic took off and it was a big changing moment in our business.
Cause at that point I think we were maybe five, five or six clinics. And we went from having five or six clinics with this one that was just a loser, right? And we had to make the decision because it hurt our pride or whatever. And we closed it, relocated. opened up a new one and it became a winner and it just changed the entire company.
So I would say just try not to hold on. If something's not working, you have to get rid of it. Like you got to make the, it's going to be, it may be a tough decision. If it's the employee, that's just sucking the life out of you. You got to get rid of them. If it's the office that's not working, you have to get rid of it.
Don't hang on to losers is what I would say.
Adam: We are out of time, but thank you everyone for coming and thanks Josh Amanda and Dave for taking the time We'll be around to catch up if anyone has any more questions