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Now displaying: 2020
Jul 6, 2020

On this episode of the Healthy, Wealthy and Smart Podcast, I welcome Laura Rathbone on the show to discuss Acceptance and Commitment Therapy. Laura Rathbone is a Specialised Pain Coach and Advanced Physiotherapist that works exclusively with people experiencing persistent pain and conditions such as chronic back pain, pelvic pain, fibromyalgia and CRPS.  Much of her work is virtual as she coaches people all over the world in the service of their pain, but she also has a small clinic in the beautiful town of Weesp, just outside Amsterdam, the Netherlands.

In this episode, we discuss:

-What is Acceptance and Commitment Therapy (ACT)?

-How the ACT framework compliments a biopsychosocial approach to patient care

-The importance of promoting active over passive interventions for patients with persistent pain

-Why clinicians should integrate psychologically informed physical therapy into their practice

-And so much more!

 

Resources:

Laura Rathbone Website

Laura Rathbone Twitter

Laura Rathbone Instagram

Laura Rathbone Facebook

Laura Rathbone LinkedIn

The Association for Contextual Behavioural Science

 

A big thank you to Net Health for sponsoring this episode!  Learn more about Four Ways That Outpatient Therapy Providers Can Increase Patient Engagement in 2020!

 

For more information on Laura:
Laura Rathbone is a Specialised Pain Coach and Advanced Physiotherapist that works exclusively with people experiencing persistent pain and conditions such as chronic back pain, pelvic pain, fibromyalgia and CRPS.  Much of her work is virtual as she coaches people all over the world in the service of their pain, but she also has a small clinic in the beautiful town of Weesp, just outside Amsterdam, the Netherlands.

 

She understands the need to see people from a 'whole-person' perspective and integrates modern, evidence-based physiotherapeutic and psychologically-informed approaches.

 

Laura is a UK chartered Physiotherapist and has a Masters Degree in Advanced Neuromusculoskeletal Physiotherapy from Kings' College London.  She is part of the Le Pub Scientifique team which organise regular live learning sessions exploring the science of pain and produces a small podcast called “Philosophers chatting with Clinicians”.  She runs her own courses on ACT and mentos clinicians regularly.

Read the full transcript below:

Karen Litzy (00:01):

Hi, Laura, welcome to the podcast. I'm very excited to have you here and today we're going to be talking about ACT. So thank you so much for being on the podcast.

Laura Rathbone (00:12):

Well, thank you for having me. I'm excited too. I like talking about something.

Karen Litzy (00:17):

All right. So now let's talk about ACT first, two questions. What is ACT and how did your interest in ACT come about?

Laura Rathbone (00:32):

So ACT stands for acceptance and commitment therapy. I suppose, you know, sort of efficiently, the way we talk about it is that it's a third wave cognitive and behavioral therapy. So it's born out of the behavioral movement and it's a psych it's essentially, it's a psychology framework. It came out of the world of psychology. And the aim of it is to recognize that when we are experiencing, you know, difficult unpleasant and invasive stuff, there's often a lot of all the aspects to that experience that add to the struggle and add to the suffering. And what we're working with from an ACT perspective is often can we compassionately and you know, empathetically and appropriately work with some of that, all the stuff that comes with the struggle and comes with a difficult experience. And does that help us manage our present moment experience?

Laura Rathbone (01:38):

Does that help us reduce some of the suffering so that we can move forward with some of the realities that are in our lives? Like for example if you're experiencing pain, which is where I come into it, you know, in the absence of having a really good predictable, effective cure for things like persistent pain, things like fibromyalgia, CRPS even chronic low back pain, which we, what we don't have these predictable sort of treatments that's going to take that away once the pain has started to become resistant, but in the absence of that, are we able to support people with their pain so that they can thrive. They can be a person who has pain and has a career and has a committed family life and has a social function and role, and they're able to thrive with it. And that's really what we're doing with ACT there.

Karen Litzy (02:38):

And where did your interest in ACT come from? How did you get involved?

Laura Rathbone (02:45):

Yeah, there were two answers to that really. First answer I guess, is that I just sort of fell into it like so many people, right. I graduated from university. I went into my first job. I had a really difficult first job experience in a difficult company and ended up working, noticing, I suppose, and working with people that had persistent pain. And so I was constantly seeking for better solutions and trying to figure out how we can do better by these people. And then I guess I just sort of navigate it that way naturally. And yeah, so I was interested in mindfulness, mindfulness, you know, you study things like the MBSR. So the mindfulness based stress reduction start thinking about how you can incorporate bits of that into practice. And before, you know, it, you end up into accepted therapy.

Laura Rathbone (03:41):

And then I was super lucky because I managed to get this brilliant job in the national center for pain at st. Thomas' hospital in London, where I was working at input, which is the pain center. And I was working underneath professor Lance McCrackin in their embedded ACT unit. So I got this great opportunity to really further my training and understand how it functioned as a framework and how we as physiotherapists could really be maximizing our therapeutic alliances and relationships and really integrating this model to create, you know, a psychologically informed approach, if you want to call it that or a compassion focused approach so that we just do better by people who are vulnerable and in pain.

Karen Litzy (04:26):

Well, that makes a lot of sense to me. Thank you so much.

Laura Rathbone (04:31):

If I was to give you a second answer, is that, you know, pain is a bit of a personal experience. It's a personal journey for me. My mom had chronic low back pain when I was younger. And I guess I'm only just now coming to terms with the influence of that on my career. Something that I haven't talked about a lot. But I do get asked about quite a lot. And you know, it would be silly to say that those early experiences of somebody with chronic pain, you know, didn't have an influence on me and seeing her go through a biomedical approach to treatment and not be heard and seeing her struggles and thinking, well, you know, and the injustice has probably built in me as the second generation and thinking, well, how do we restore some of that justice? And then how do we acknowledge that there is an imbalance here in terms of privilege, like clinician privilege versus patient privilege, and how do we start to restore that and make sure that we listen to the people we work with and do better.

Karen Litzy (05:36):

What sort of experiences did you see your mother go through that kind of led you into where you are today, when you say so for a lot of people, they might not be familiar with the biomedical approach and what that looked like, but what did that look like for her? And then what did that look like for you as a kid growing up?

Laura Rathbone (05:58):

Yeah. Like I say, something that I'm still really coming to terms with then, and the memories of what I saw my mom go through was still quite like emotionally charged. They're still very close. And we're talking about it, me and my mama talking about this more and trying to open it up a bit more and explain that. And then what I remember, you know, being in the car and my mom being unable to sit in the chair and the sound of her voice when we went over a bump or the car stopped that, that Yelp for pain, that, that real yeah. Terrorist pain really. And I remember her spending hours in the bedroom, not being able to get out of bed but, you know, she also, she was an amazing woman, you know, incredible first role model as a strong woman, really, because, you know, she's a nurse, she was working in the pediatric units, she's done everything really she's done a and a pediatrics domiciliary, which is community-based working.

Laura Rathbone (07:04):

And like, she used to get up every day, even in pain. And she would go to work in paid and, you know, do all these and just push and push and push until she was exhausted. And when she would be like posted on the weekend and then pushing herself and through the day, and I saw her just be hopeless. That was, I think the overriding feeling, if I really reflect quite personally, was that feeling of, there is no hope there is no way out of this. This is the norm and resigning to that. And that's because, you know, she'd tried physical therapy or physiotherapy in the UK. And, you know, she'd tried like acupuncture and she'd gone around the holistic meds you've been in and out of the doctors and things like that. And just really been told there's nothing that they can do, but yet also she had this image of why she had pain. So she was told that she had back pain because her Coccyx had dislocated during labor, which was my labor. So there's a bit of personal guilt as well.

Laura Rathbone (08:07):

And really those things where, like, she always felt that that image had stayed with her forever. Even now, probably if you talked to her and ASCO, which we were working through a little bit, which is hard to do an issue, mom, I, you know, trying to figure out what, how she views her body and her back is becoming a much stronger image, but she really had to find her own way out of that. And it was years later until she found a solution that she could, she felt she could predictively start to acknowledge and manage her pain. And, you know, it's not the traditional method that she found a kind of like a kind of massage tool, which is everything we wouldn't say right now, but it worked for her and it gave her a freedom. She felt all of a sudden I have something I can do when I have pain. And that was the most important moment for her. And it wasn't, you know, acceptance and commitment therapy or mindfulness. It was, it was a tool that gave her strength. It was a kind of extended part of her own ability to self manage. And she did that and it worked for her and I don't advocate those kinds of mechanisms and those approaches, but it worked for her. And there's something in that. There's something important in that. But yeah, I remember I remember her pain and yeah, it's still very personal.

Karen Litzy (09:27):

Yeah. And not easy, but thank you for sharing that. Cause I know that sharing personal experiences from my personal experience is not an easy thing to do, and it's not easy to put that out there where the world is going to hear that. So thank you. But I'm glad that you shared it because I guarantee you, there are going to be people listening to this podcast who are going to say to themselves, that's me. That was my mom. That's my sister, that's my friend, that's my patient. And so I think it's really important to allow the listeners to understand the magnitude of hope and of finding something that works for you, even if it's not physiotherapy or it's not XYZ doctor or whatever framework you're using. Because like I said, somebody out there is going through that same exact thing. And just to kind of hear that story and to hear how, not only did it affect your mother, but it affect you and your family and growing up and I think that's a really powerful share. So thank you.

Laura Rathbone (10:35):

Welcome. And thank you to my mom who continues to be an incredible voice in my growth as a person and who went through that journey and who still goes through that journey. Although she doesn't identify now as somebody who has chronic pain and that's a great moment for her, like she's now able to do so much more and really doesn't have back pain very often anymore. So, I guess the, you know, yeah, it's hard for me to share, it's not my story.

Karen Litzy (11:11):

Yeah. Yeah. Well, and we're going to get back to pieces of that story in a little bit, but I heard you say in the beginning of this podcast, talking about ACT as a framework, I would like to kind of bust a myth because I think a lot of people look at it as a tool to put in the toolbox. So what do you say to someone who's like, Oh, ACT, this is a great tool. I put it in my toolbox. I'll take it out when I need it.

Laura Rathbone (11:45):

Yeah, this is, Oh, I'm glad, I'm glad we're talking about this. Cause this is something that this is probably my personal opinion and there's probably people out there are acceptance and commitment therapists. You may disagree with me and that's absolutely fine this space resolve, but I do not think that ACT is a tool that we pick up when we think it's appropriate. First of all, how do we know that? That's certainly another thing, isn't it? You know, we don't, you know, and what I would say that acceptance and commitment therapy is how we are. It's a way of being with your clients and the people who choose to work with you in the service of their pain. It happens. It's how we make decisions. It's how we think about and how we facilitate those decisions and how we are part of, you know, the next step in that person's journey.

Laura Rathbone (12:37):

It's not something that we say, Oh, we've exhausted the biomedical approach. Now we're going to pick up the ACT approach. And it's a bit later the biopsychosocial approach that it just doesn't work like that. This is just another way of, you know, clinicians getting out of doing the hard work, which is listening to people's stories and empathizing and putting themselves in somebody else's shoes and trying to, you know, trying to get more of their life experience as opposed to showing off what they know about a particular joint. Like this is not how we work in pain. Pain is a very personal, it's a very unique experience. It's built off of life experiences, as well as memories and, you know, learning and worries and fears and all of that plays out in our physiology.

 

Karen Litzy:

And what can a clinician who's working with someone in pain and they are taking the ACT framework into the clinic. What does that look like?

Laura Rathbone (13:41):

Good question. Yeah. I mean, I guess it depends what your setting is, doesn't it really like if you’re setting is first line, so people are coming to see you and they have never seen anyone else with that problem, then of course, we're going to be thinking, okay, where is that person in the journey from that injury or the onset of their pain? Are they two years down the line? And this is the first person they see, or are they two weeks down the line? Cause that always is going to affect your approach to assessment and monitoring really. So it would make a difference in terms of where you start, but you're always thinking about okay, so if this person is two weeks from injury, then you're going to be doing your injury based assessments, your pathoanatomical approach to assessment.

Laura Rathbone (14:34):

And we want to want to make sure that this person hasn't done any serious injury. And we want to make sure that we, you know, use the most appropriate and effective science that underpins our physiotherapy framework. Right. But you're still thinking, how is this person managing this injury? You know, even though we might be assessing the tissue in some aspects that tissue belongs to a person it's in a human it's in a much wider system. So we're always going to be thinking, okay, and how is this person dealing with the fear of an injury? Are they able to make sense of this in a helpful way, are their behaviors of management helpful or unhelpful? And if they're unhelpful, then how can we facilitate an experience that allows them to update that behavior into a more helpful way?

Laura Rathbone (15:29):

And that's what we're doing with that all the time. So I guess in my setting, when people have probably been through lots of healthcare professionals, then I'm going to that it would probably look quite different. I would use ACT maybe in a more intense way from very early on. Whereas if you're in a very acute injury setting, you're going to be using it as part of your assessment. You are still going to be satisfying, those more traditional approaches to injury assessment and management, which is not my area. So I don't want to make assumptions.

Karen Litzy (16:24):

Right, right, right. Of course. And what is, let's say a patient has come to you and they've had a long history of pain and you're sitting down, then this is the first time that you are seeing them. What are some questions? I know this is, I'm using this very broad net here. We're casting a very broad net because obviously the answer is, it depends on the person. And I want everyone to know it depends on the person, but it depends on the person, but for people listening to this and not really quite grasping, that sort of ACT framework is there. I don't want to say an outline, cause I don't think that's the right word for it. It's just escaping my head at the moment. But can you give examples of maybe how that conversation might go or what you're trying to, to get from the person in front of you using this framework? And again, we're talking about people with more persistent or longterm pain problems.

Laura Rathbone (17:11):

Yeah. So when somebody comes in and sits down and starts telling me, you know, what their lived experiences of pain and they start in their story, wherever they feel is the most important place to start. And we give space for that to grow. I guess what I'm looking for, what I'm trying to pay attention to is you know how is this person making sense and applying meaning to that pain what is it that they're coming to me for guess is the first thing, like, what is it that they're here looking for? Are they here looking for something that I can't give them, in which case I need to be really open and honest about that? Or are they coming here because they're looking for they're wanting to move towards a particular goal.

Laura Rathbone (18:07):

So it, usually people come in and they're telling me about that pain. And of course that's really, really difficult as a person. Sometimes it's really difficult to listen to, to hear somebody else's pain. So I'm mostly working with my own resistance, but also thinking well, okay, what is it that how we want to find out? What is it that would, would give this person that would help this person find more joy, more meaning, what is it, what is the value that they want to move towards? And what is the struggle that they are coming up with? So, so where are they getting stuck? Like, what are they battling all the time? And I guess that's where the idea of acceptance comes in and an acceptance here is really not resignation. It's really not just, you know, getting on with it's an opening up of the experience to accept that there are difficult and painful and hard to look at experiences happening in the present moment. And so we're opening that opener and sort of acknowledging that those things are there. And also maybe giving space for the fact that there are other experiences beyond those as well, that there's a wider spectrum of experience here. And trying to find a way to be with those experiences and also be with the important things in your life. This is what we see commonly. And what we hear with in the clinic is that people who have, you know, people who are experiencing pain are also missing out on a loss.

Laura Rathbone (19:51):

And that's really, really, I think what a lot of people find the hardest. And when I listened to it, you know, what the people who choose to work with me say, it's actually that they're just grieving that they're unable to be part of their family moments or their community or their society, or, you know, the things that they really believe in and that they really want to be part of. And it's hard because when they go into more traditionally biomedical models, the clinicians are saying, Oh, well, when we've done this surgery, your pain will go and you can do that when we've done this injection, when we've done this treatment and, you know, yeah, great. If that works, then that's an absolute lesson relief and fantastic. But what if someone's been doing that for 10 years and the clinicians are still saying, well, when we do this treatment, your pain will go when we do this treatment, you know, you starting to chip away at someone's life.

Laura Rathbone (20:53):

You know, this is a lifetime that easily limited, you know, we don't have infinite lives to live infinite moments to be part of our job and probably the most significant part of our job, especially in persistent pain is helping people and facilitating opportunities for people to be part of those moments. And to make sense of their life in a wider spectrum, rather than just, how does my life make sense in pain? It's more like, how does my life make sense in the whole bio-psychosocial sphere? Am I able to be part of that? And that's what we're looking for, or certainly what I use acceptance commitment therapy for. It's a way of creating opportunities and creating space for us to support someone as they take their pain into really, you know, meaningful moments and find that there can be joy as well as pain. And that is a really, really difficult thing to acknowledge and to allow for when you have pain, because it means that in one aspect of your pain journey, you have to allow yourself to take a step forward with it. And that's really hard if you really want to get rid of it. And of course we should always be working towards that. That has to be a big part of our approach, but it might not be the only thing we focus on.

Karen Litzy (22:27):

I'm glad that you said that because you sort of jumped the gun on what I was about to say, because when people come especially to a physical therapist or physio, one of the main reasons they're coming is because they have pain, right? And so they're coming to us to quote unquote, fix it, fix the pain. I don't, once I don't have this pain, what's your goal. Zero out of 10 pain, no more pain. And so I think from the clinician standpoint, when you have those people sitting in front of you, it's very, very difficult to have those conversations of, and you say, well, what if you still had a little bit of pain, but you can do XYZ activity, or you can still take part in all of this stuff. And you can expand those areas of your life, even though you have pain.

Karen Litzy (23:26):

Is that the wrong thing to say to someone is, should that be a goal to work toward, or should the goal to work toward if their goal is 100% no pain, what does the clinician do? What do we do with that person in front of us when maybe we may think, well, but you can X, Y, and Z, and you can have this full life. If maybe you have a little bit of pain, but the person in front of you is very adamant and their goal it's no pain or nothing, no pain or bust. So, how do we, as the therapist navigate that? Cause that's very tricky because like you said, we're working towards reducing pain, but what if that's not enough?

Laura Rathbone (24:13):

Yeah. So this is a really difficult part of the conversation, isn't it? And I guess what happens probably more often is we come up against our own reflex to save everybody in front of us and our own reflex to be sure we know we are right, right. Our own privilege that we are the experts, but we have no idea what is right for that person in front of us and what is enough for them. And, you know, in the first few sessions, when you meet someone, you’re still in the process of relationship building and trust building. So those early conversations may well be communication of, you know, I am really struggling with this pain. I am really suffering and I need you to fully acknowledge that I am really suffering with this pain. And it may be a way, you know, and that might be that that's where that person is.

Laura Rathbone (25:14):

And it might not be that we can change that. And I put that in quotes because you know, what we're doing here is where we're with a second sense and commitment therapy specifically is we're coming from a place of no judging. So, what the behavior, the thoughts, the meanings of that person's coming off of, I have no idea if it is right or wrong for that person to keep seeking, you know, a hundred percent cure. I mean, I looked to my own, my own experiences and see how far people I love and in my direct family have come in their chronic pain journey and think, well, you know, I have no idea if it's going to be a cure or if it's not, if there is such a thing, I mean, we're thinking of cure. The word cure is almost decided that we know what the cause is.

Laura Rathbone (26:00):

And we don't fully know that yet. So we don't know what the end point of that person's journey is. All we can ask is right now, is this helping you in this moment as we take a step in this part of your journey. And if that's unhelpful, because it's not helping us to take a step in the direction that we've highlighted is a good one that you've decided you want to take, then we need to work with that urge that keeps coming in to go for a curative treatment, potentially curative treatment. If we've got one.

Laura Rathbone (26:36):

But I guess what I would suggest in that moment is that we as clinicians probably need to do the most work because our urge is to jump all over that and be like, no, no, no, no, no. The science says that you're never going to get that. And that's a cruel message and it's not accurate. We have no idea. You know, our urge is to educate the shit out of that person and make them feel better. Right. But we don't know. We don't know that. So maybe we need to sit with our allergies a little bit more. Maybe we need to pull ourselves back a little bit more in that moment and just hear what that person is saying and listen and acknowledge it and bring it into our decision making, bring it into our understanding about, you know, what that person is going through.

Laura Rathbone (27:19):

What in our experience might be a helpful step. And then we have that collaborative discussion. Do you think it's going to be a helpful step? Would you like to go in this direction and see what happens? See what comes out of it? It's hard because we are trained to know the answer. That's what that biomedical model is all about. Those, you know, assessment tools. We can tell you if you've got an impingement and you know, that the idea, the whole point of that is that we had an idea that we knew what was causing pain. We knew it was the musculoskeletal system, and we knew it was the nervous system. Then now we're starting to think, well, maybe it's the neuro immune system. And, you know, it's all this idea that we know what is the cause of a human beings pain. And I'm not sure I have seen any evidence that we're much closer. And that's just my opinion on what I see. So maybe in those moments, we need to check ourselves a little bit.

Karen Litzy (28:27):

And thank you for that. That makes a lot of sense. And you know, it brings me back to this idea that are we doing the best we can for the person in front of us at this time with the knowledge that we have and that has to be enough at that moment because that's what we have.

Laura Rathbone (28:53):

Yeah. And I think that's really an important thing to remember is that we are both two humans interacting on a human issue, which is the human experience of pain. And, you know, we are healthcare clinicians, not heroes, right? We're not the saviors, we're not in the, you know, the people that come to see us, they're not victims. They are humans trying to live their lives. And we are people who have studied physiology and people who have studied rehabilitation and people who hopefully are studying sort of communication and behavior change theory and the philosophy of just like a human experience. And, we're hoping that when those two things come together, something happens and the person who is struggling to come to terms with their pain, manage pain and find ways and solutions to their pain, right. We're hoping that the combination of these two things or these two people, these two worlds and worldviews come together and we can find and facilitate a way for that or the person, the person in front of us to move forward.

Laura Rathbone (30:03):

So, you know, yeah. We have to sort of remember that we are only doing our best and that has to be recognized on both sides, right. That there is also a responsibility for the people that choose to work with us to remember that we are people, we are humans. We do sometimes get it wrong. We are able to look back and say, Oh, that was not necessarily the thing that I would do now. And were able to change and update and evolve. Yeah, I guess that's where I come, that our job, our role is to make sure that we are reading the literature, that we are going to the podcast that we are listening and learning and evolving and evaluating our messages to say, is this still the best I can do? You know?

Laura Rathbone (30:52):

And to that end, I would say, I've had this conversation a few times with sort of new graduate clinicians who say, Oh, but you know, this person, I educate, I gave them the education and they just didn't get it because education has also been one session. And I say, okay, so you gave him the education. How did you deliver it? What was your approach to education delivery? You know, what training have you done in educating? And they touched, they took a weekend course, but if they've even done that, that's the point, isn't it. I try the CBT approach. Okay. So how did you train in CBT? What is the CBT approach? Yeah. You know, Oh, I've done mindfulness. Okay. So how do you integrate mindfulness since you're into your practice? And we say that we think that we know how to do these things, but we're not putting in the time and the effort to really fully train and upscale, you know, acceptance and commitment therapy is an entire psychological framework, right?

Laura Rathbone (31:53):

It's not a little bit that we just add in, it's an entire framework of being with the people that means you never finished learning. Right. I'm still learning. I still have people call me at my clinic and watch me. I still do peer review and make sure that people, people are listening and helping me understand how I apply ACT. And when I may say, or when I get it wrong. And so I can keep evolving, you know? And, that's the thing, isn't it, you know, we have to make sure that we are fully invested in our communication strategies, not just superficially, because otherwise we're not doing the best by the people that we work with. We're giving them a half-assed attempt at education, blaming them for not understanding what we were trying to say.

Karen Litzy (32:40):

Well, we don't even understand it. And, also being very cognizant of the fact that people communicate differently and people learn differently. So if you're giving quote unquote giving the education, well, I told them all about it. Well, maybe they're visual learners. Maybe they need to hear things in small chunks, not vomited all over with information, maybe they need follow-up. Maybe they need to watch videos. Maybe they need to take a test. Maybe I know I'm the kind of person who I like to take a test. It's a very weird thing. I took a continuing education course the other day on child abuse. And at the end, you know, they tell you to evaluate the course and I do. I'm like, well, where's the test, where's the test. How do they know? I know that I read. And my boyfriend was like, are you advocating for a test? Like you want to test?

Karen Litzy (33:32):

I'm like, yes, I want to test because I want to make sure that what I read that I understand it at least superficially right. So when you're talking, like I have had patients where I have explained things, explained pain, used a pain education approach to them. And I always try and follow that up with, you know, I'm going to send you a couple of videos. I'm going to send you some you know, and ask them like, do you understand? Can you kind of give me the highlights? What did you take away from that conversation? So you may educate them, but if you don't ask them well, what do you think? What did you understand from that? Does it matter what you said to them? If they can't understand a word that you just said?

Laura Rathbone (34:20):

Well, that, I mean, that is like one of the basic basic principles, isn't it of how do we communicate it? Does the other person even understand what we're saying? Are we using it an appropriate approach to communication? But I guess the other thing is, you know, the beauty of the ACT is that it came out of, you know, this struggle that we had in real time, behavior change, you know, like we can help people change their thoughts and they can change. They can, they can find a new narrative, but when pain comes, what do they do? What do we do when something difficult shows up, you know? And the skillset, in fact, the hex of flex, all the processes have changed at all. Within the hacks effects are there to be navigated and to be utilized in that moment, when pain comes, what do I do?

Laura Rathbone (35:19):

Is this helpful? Is this in service of something that I am working towards and not working towards, but that's, whatever the person in pain says it is, right. That's not all saying, Oh, we're in rehabilitation. Therefore we need to rehabilitate you to action. Or, yeah, I have no idea. You know, it might be that in that moment, the most important goal for that person is self care, right. That could be, I mean, and that's very legitimate and very, very valuable, you know, it's not, well, when pain comes, how do I push through it? It's what we're trying to figure out is okay, when your pain comes for you, what do you do? And is that helpful? And if it is, then all we want to do is facilitate that and to validate it. And if it's not helpful, then that's when we might say, okay, so how do we start opening this up?

Laura Rathbone (36:11):

How do we start finding a helpful thing? What do you think could be helpful? And our job is to facilitate that conversation so that the other person doesn't feel they are making all of the choices on their own. And they've all of a sudden, they've just had been dumped the responsibility of their own care on their lap. Our job is to compassionately titrate that conversation, what might be helpful, and to take our time, to explore it in a way that people feel they're able to meet in a way, not that people feel sorry, that isn't the right word in a way that people are able to make their own choices. And we are able to support them. That's it? And that's what ACT is.

Karen Litzy (36:55):

And to that end, I want to go back to the story of your mom and how you said she found this massager that really helped. And you know, you and I had a conversation the other day, and we had this conversation about the passive versus the active modalities and passive bad, bad, active, good only thing we should be doing. So let's talk about that within the ACT framework of your mom found a massager or whatever it is. And boy that really helped. So from an ACT framework, how do we make sense of that when we are supposed to be only advocating for active, active choices, not passive modalities, not a tens machine, not a massager.

Laura Rathbone (37:47):

Okay. So I would say this is probably the part of the podcast where I will, it's the most controversial part. Because if you are a person that advocates hands off therapy, then actually fit very nicely into your framework and you might be using it very X and you know, and doing great work. And if you are a hands on therapist, then you may have already decided the ACT is for the hands off people. So you're not going to go near him. And you know, my opinion on this probably changes quite often, but I would say that if a person is making an informed choice about how they, their pain that is helpful for them, that is active treatment, that is an active decision, but is that person and saying, this is helpful. So, I guess if we're going to use the way I would use ACT in that moment as somebody who typically doesn't use a lot of hands on therapy or a treatment delivery devices.

Laura Rathbone (38:58):

So we say, you know, I did my masters in sort of neuromusculoskeletal therapy. We did all the manual therapies stuff. I would say, okay, how much does it help? Let's talk about that helpfulness, because that's important because my job is not to make you feel bad about using something that helps you in your life. My job is to facilitate that and to support that and to see value in the bits that you might not be using, or the bits that you might not be doing. So if that person is able to say this right now is the only thing that is keeping me going, then we say, okay, it's helpful right now, helpful right now doesn't mean helpful forever. Right? Helpful right now means in this moment, in this context, with the knowledge that you have the skills that you have, the relationship that we are developing, this is very helpful.

Laura Rathbone (39:58):

So I'm not going to take that away because that's cruel, right? That's not nice. What we're going to do is we're going to work with that. I'm going to keep checking in and seeing, okay, is this still very helpful? If it's, and at some point it might not be, and it was, we're going to keep working on all this stuff, I would say, okay. So let's say, you know, a TENs machine, quite often, people that I work with are using tens machines, because it helps them to do something of value. That's it, that's what we're working for. But if they're saying I go to the physiotherapist or a particular physical health therapist, whatever, and they give me, let's say core exercises. That just for it, just rotate through their active therapies, right? These are hands off therapy, call exercises to strengthen my core.

Laura Rathbone (40:47):

And I do them. And I have worked with these people where they are doing them four or five times a day. And they're in pain when they do it. They're in pain after they do it, they're in pain the next day. And they've been doing it for months, some of them. And you're saying, well, actually, is that helpful? There's an active treatment. That's an active treatment in a way, that's the person doing it, but that is a passive approach to receiving therapy, right? Because they're not thinking and not enough. And don't feel like they're able to have the space for their own opinion on whether this is working for them. It hasn't been created in the therapeutic alliance. So, so that they're doing this in the hope that they get to the goal of the therapist that they're going to get, but they're not necessarily getting there, but they're still doing it cause they haven't the safety and the relationship hasn't been created. So that person can go back and say, actually, this isn't helping me. So we can say, okay, that's not helping. We can change. You don't need to do stuff that's not helping. If this is making your pain worse, then it's causing pain. Why are you doing it?

Karen Litzy (41:51):

Yeah. And it's so funny. I had that conversation a couple of weeks ago, the gentleman with chronic low back pain, it's been six months of low back pain. And the doctor said, we'll read this book and do these exercises. So he was doing press ups and press ups at an angle and press ups. And, and I said, well, how long have you been doing that? And he said, I've been doing for a couple months. I'm like, Oh, well, how does it feel? He's like really hurts when I do it. But you know, the doctor said to read the book and do what's in the book. So I'm just doing what's in the book. And I said the same thing. I'm like, well, there might be ways that we could alter this, or there might be other things that might be more helpful if you're doing this particular exercise.

Karen Litzy (42:38):

Exactly what you just said. Well, it hurts when I do it. It hurts more after I do it. And it hurts the next day more after. And I said, well, okay, let's explore this because I think there might be ways that we can make this work. And lo and behold, we found ways to make it work, but it's just, yeah, it's just that exact example of what you just said. And having the conversation was maybe a little uncomfortable at first, because this was something the doctor said to do. And so we had to do it.

Laura Rathbone (43:14):

Yeah. But I mean, that is a typical example where a clinician just has not invested in their communications strategy or their compassion for the person in front of them. They haven't even created a dialogue. They've just given somebody a book and said, your problem is so common that we've written a book on exactly how to get out of it. You just need to follow this. There is no dialogue that, and the thing is pain. Pain makes us very vulnerable, right? Pain creates a huge vulnerability in us. And we know that when we have pain, we are vulnerable and it's no different for the person in front of you. That's been living with it for years. They've just got more pain and had it longer, maybe feeling more vulnerable and more desperate to find a way out. And that's completely understandable. So shame on that clinician, because that is not okay.

Laura Rathbone (44:07):

We have got to invest in our dialogue abilities. We've got to commit to being good communicators and compassionate communicators and compassionate listeners. And, you know, really want to know about the human we're working with as opposed to dismissing their pain as something that a book can feel. And of course there are very helpful books out. There are helpful textbooks that have been written by very compassionate clinicians and some are better than others. And I'm not trying to say all self help tools are all bad because that's not, that's not the point here. The point here is that if there's no, there's no way, there's no space for the person who is living with pain to explore with you, the solutions that you're putting up, then, then it's very difficult for people to know what to do next. And it's very easy for them to feel like they're doing it wrong or that they're somehow not committed enough. So then they'll might do it twice as many times and more often and more days, and with more effort, because that's the only solution we've given them.

Karen Litzy (45:18):

Yeah. And then I think it also brings on for the patient sort of coming from my own experience is that, well, I can't even get this right? Like you failed yourself. You don't even know your own body. It takes you. I think it disembodies you even more than perhaps you already are out of protective purposes. And it just takes you further away from yourself and your person, if you will, because if you can't, you know, you read the book, you're doing it. The doctor said, you're doing what the therapist said, and you still can't get it right. Then you're just a failure. And it, again goes back to feeling hopeless. Like you said, like your mom felt like she didn't have any hope and she felt very hopeless. And I think these sort of faulty communications and inability to tune into what the patient is telling you leads to that feeling of hopelessness and failure from the patient point of view. And so I can totally see how using ACT as a framework and being able to acknowledge the person and what they're doing. And, are there some alternatives that can be used, maybe not now, but maybe in the future or where you are now and what can we do at this point? And it was working now, but let's keep in mind that there are some other things that we might be able to augment your program with.

Laura Rathbone (46:58):

Yeah. And I always say that brings me on to probably the next thing that really, I think, feel very, very passionate about. And there are many new ones to watch my Facebook page, but you know, this is, I think one of the big misunderstandings we have about integrating psychologically informed physiotherapy, right. Is that we still think that it's something we do to other people. And that's why I don't really like the term psychologically physiotherapy, because it's still, although I think it's the best one we've got right now. And I think that, you know, it's a lovely way of thinking about how we therapize people, but it still puts the workload and the part of our identity that is physiotherapists. It's still what we do when we put the uniform on or when we go into our clinical encounter.

Laura Rathbone (47:51):

And it's still something that we do as a thing to all the people. But, you know, if we think really and truly reflect on the idea of the biopsychosocial model and the hierarchy of natural systems, this idea that a human is embedded within their environment, then the clinician is a part of the external environment and the patient or the person that's chosen to work with us is a part of our external environment and has an influence on us. And we have an influence on them and we need the real richness with acceptance and commitment therapy is that it is something that we're thinking about, okay, what is happening in my present experience that I might be struggling with that might be coming up in me that might be having an influence on somebody else?

Laura Rathbone (48:45):

What is my reaction to that person's story or that person's behavior, or that person's diagnosis, right. You know, what's happening in me so that we can also remember that work with our own resistance and become aware, especially now become aware of our own privilege and how that might influence and take away from somebody else's privilege or equity or equality or justice or access. And this is something that we need to reflect on very, very deeply as clinicians working in an area like healthcare, where access is very, very important. And it's our role to make sure that we're delivering high quality care with open access. And so acceptance and commitment therapy is a way for us to also take that moment and be like, okay, well, what's going on in me here? How am I helping this person what's happening in my reactions and my emotions and my sense of self and is that always helpful? So if my goal is to deliver an open and evidence-based and compassionate approach to experiencing any resistance or challenges to doing that in this situation, and maybe I need to work with that.

Laura Rathbone (50:02):

I think that can be true. Across musculoskeletal health, when, you know, people see, you know, patients or people with pain coming in and they have persistent pain, and it's not going to get better in six sessions, three to six sessions, and we've all got those targets, right. And they're going to need more than 30 minutes. So we're going to have to explain to our manager why actually did more than 30 minutes. You know, all these sorts of things what's happening is our instinct to push them away to somewhere else, or to create departments where we, you know, where we don't accept people who have pain for more than three months, or, you know, then there are those departments out there that push the access away to somewhere else.

Laura Rathbone (50:49):

So there's a bottleneck in all the parts of our clinical approach. Actually, maybe we could just upscale a little bit and recognize that persistent pain is a very big part of our musculoskeletal population. And we all have a duty to be better at it.

 

Karen Litzy:

Yes, very well said. And like you said, especially in these times, so listen, Laura, I want to thank you for coming on, but before we wrap things up and get to a good, and now a nice announcement from you and what you're doing in regards to ACT, I'm going to ask you one more question that is knowing where you are now in your life and in your career, what advice would you give to yourself straight out of university?

Laura Rathbone (51:52):

Gosh yeah, I would say what I am learning is that I'm not always the right person at that moment. And sometimes my desire and urge to fix people quickly as well, and to do right the injustice of having pain and to really get rid of that pain as quickly as possible. Sometimes that has I think, taken away from the therapeutic potential in some environments and in some experiences. So, and also has just caused me in a lot of pain, you know, and we have to remember that we are humans in this, that we are not, clinicians are people that go home and try to, you know, keep going after hearing some very difficult stories of all the people and, you know, we're also not immune to when the people we work with don't get better in the way we want them to, you know, we take that on. Yes. One of the most important skills that I have been learning is to be more forgiving of myself.

Laura Rathbone (52:51):

And to remember that life is complicated and people are coming into our clinics with a whole lifetime of experiences that I am not aware of and not privileged to. And they are not aware of or privileged to mine and being slower, taking more time, being more gentle, not only with people who choose to work with me, but also with myself actually has brought me to a place where I am having a better relationship with my job. I'm getting better relationships with the people that I work with. And I just, yeah, I am able to sustain this work now for longer than I would have been, you know, eight years ago when I first started in particularly working with longterm pain, it was very hard for me and I went through my own version of a burnout when I was constantly finding, trying to find more information and be better and upskill, upskill, upskill. Yes. We need to upskill. Yes. We need to learn about these things, but we also need to find good supportive mentors and good environments that we can next explain and explore what we're going through and ask for help. If we're feeling very effected by what we're hearing every day, you know, good relationships with our colleagues, physiotherapists, occupational therapists, psychologists, social workers, help us to, you know, share our experiences and our load. And be more forgiving of that, I guess. I don't know if that's a good answer.

Karen Litzy (54:27):

That's an excellent answer. Are you kidding me? Fantastic. And now speaking of gaining skills in service of others, what do you have coming up? Cause I know you have like a course that you have put together. So can you talk about that and where people can find more information?

Laura Rathbone (54:52):

Yeah. So about six months ago, I started putting together and planning a two day course, right? Typical 15 hour, two day course, people would come to our room and we would do two days of ACT. And then, you know, the situation with COVID-19 and all of our lives changed, and that didn't seem like it was gonna make most sense. So it shifted into a sort of online collaborative learning and it's still, we're still figuring out how this is going to work, but instead it's going to be four sessions of three hours of contact and collaboration over four weeks. And then there's going to be like support and forums in between. And that will be going live hopefully at the end of July, if I can get the luck. But if people do want to come on a course with me, or they're interested in exploring ACT and they just got some questions, best thing they can do is go to my website for information for even better, because I'm basically always on social media, find me on Facebook or Twitter, whatever, flip me a DM.

Karen Litzy (56:03):

And now, so we'll have links to all of that under the show notes at podcast.healthywealthysmart.com, but can you just shout out your social media handles?

Laura Rathbone (56:17):

If I can remember them. @laurarathbone (twitter) @laurarathbonevanmeurs (facebook) @laura.paincoach (Insta) Yeah, that's more of a patient facing platform for me. So that's Laura.pain coach which is the title that I tend to prefer. So sort of working as a coach, as opposed to as under the strict title of physiotherapy yet. So that was, yeah, those are the three social medias I use the most.

Karen Litzy (57:02):

Awesome. Well, Laura, thank you so much. This is a great conversation. It's certainly got me thinking of the way that I work with my patients and my clients, and maybe how I need to do a little more introspective work and try and really check my biases, whether they're conscious or unconscious biases at the door and really see what I can do for the person at the moment and listen to them and see what I can facilitate for them. So thank you so much for coming on the podcast and sharing all of this information. Thank you.

Laura Rathbone (57:40):

Oh, no, you're welcome. There's lots of books and websites and patient information out there. Just want to give a shout out to Steven Hayes who really is responsible for the framework of acceptance and commitment therapy and the association for contextual and behavioral science, I think it is, but I'll make sure that you get linked with that and why there are you know, resources on there for people to learn about acceptance and commitment therapy, because you know, this work isn't being done, the research hasn't been done by me, it's been done by lots of other people. So I would like to just direct people to look that up as well.

Karen Litzy (58:21):

Awesome. Well, thank you so much for coming on and everyone, thank you so much for listening. Have a great couple of days and stay healthy, wealthy and smart.

 

Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram  and facebook to stay updated on all of the latest!  Show your support for the show by leaving a rating and review on Apple Podcasts

Jun 29, 2020

On this episode of the Healthy, Wealthy and Smart Podcast, I welcome Anne Stefanyk on the show to discuss website optimization.  As Founder and CEO of Kanopi Studios, Anne helps create clarity around project needs, and turns client conversations into actionable outcomes. She enjoys helping clients identify their problems, and then empowering the Kanopi team to execute great solutions. Anne is an advocate for open source and co-organizes the Bay Area Drupal Camp.

In this episode, we discuss:

-Why your website is one of your most important marketing tools

-The art of simplicity in branding

-How to track the customer lifecycle

-The top tools you need to upgrade your website

-And so much more!

Resources:

Anne Stefanyk Twitter

Drupal

Anne Stefanyk LinkedIn

Kanopi Website

HotJar

Google Pagespeed

Accessibility Insights

WAVE Web Accessibility

Google/Lighthouse

Use user research to get insight into audience behavior
How to make your site last 5 years (possibly more)

 

A big thank you to Net Health for sponsoring this episode!  Learn more about Four Ways That Outpatient Therapy Providers Can Increase Patient Engagement in 2020!

 

For more information on Anne:

As Founder and CEO of Kanopi Studios, Anne helps create clarity around project needs and turns client conversations into actionable outcomes. She enjoys helping clients identify their problems, and then empowering the Kanopi team to execute great solutions.

Anne fell into the Drupal community in 2007 and admired both the community’s people and the constant quest for knowledge. After holding Director-level positions at large Drupal agencies, she decided she was ready to open Kanopi Studios in 2013.

Her background is in business development, marketing, and technology, which allows her to successfully manage all facets of the business as well as provide the technical understanding to allow her to interface with engineers. She has accumulated years of professional Drupal hands-on experience, from basic websites to large Drupal applications with high-performance demands, multiple integrations, complicated migrations, and e-commerce including subscription and multi-tenancy.

Anne is an advocate for open source and co-organizes the Bay Area Drupal Camp. When she’s not contributing to the community or running her thoughtful web agency, she enjoys yoga, meditation, treehouses, dharma, cycling, paddle boarding, kayaking, and hanging with her nephew.

 

Read the full transcript below:

Karen Litzy (00:01):

Hey Anne, welcome to the podcast. I am so excited and happy to have you on.

Anne Stefanyk (00:06):

Nice to see you. Thank you so much for having me.

Karen Litzy (00:09):

So before we get into what we're going to talk about today, which is kind of how to use your website as a marketing tool, and that's putting it lightly, we're going to really dive into that, but I want to talk about kanopi. So for a lot of my listeners, they know that I'm a huge proponent of female entrepreneurs of women in physical therapy. We have a whole conference for it every year. And I love the fact that kanopi is a majority female company. So can you talk about the inception and kind of the journey that you've taken with the company over the years?

Anne Stefanyk (00:47):

Sure, I'd be happy to. So I founded kanopi kind of off the side of my desk and it actually came from meeting a need that I needed to take care of with my family. My family became quite sick and I had to stop working and as a result it forced my hand to pick up some contract work. And that contract works. Certain cuts soon kind of snowballed into, Oh my goodness, I have actual projects. I probably should hire some people and get out of my personal email to run the business. But it did come from a place where I needed some lifestyle flexibility. So I built a company that is fully distributed as well. And as a result of the business model that we created, it allowed us to really attract and retain really great talent. Outside of major cities. And I have a lot of single moms or a lot of moms and I have some single dads too, but we really are able to, with our business model, attract and retain a lot of top talent.

Anne Stefanyk (01:39):

And a lot of those are girls. So we're over 50% women and there's only really two men in our leadership, a team of nine. So there's seven girl bosses out of the nine that run the company. And we really have focused on helping people with their websites and making it really clear and simple and easy to understand. We find that there's always too much jargon out there. There's too much complexity and that we all are just craving simplicity. So building the business was twofold, was one to obviously help people with their websites. What was also to really create impactful futures for my staff and give them opportunities to kind of grow and expand in new ways. So I'm really proud that as kanopi has formed our team, I'm part of our retention plan has to really been to take care of our families and put our families first.

Anne Stefanyk (02:28):

Because if we realize that if you take care of the family, the family takes care of you. And so we've extended a lot of different benefits to be able to support the family journey as part of the business. And we find that as a female entrepreneur, really recognizing and appreciating that we need flexible lifestyles to be able to rear children or take care of elderly parents or we have a lot of demands as females on us. I mean the men do too, don't get me wrong, but as a female I'm creating a space of work where we can create that space for everybody really makes me proud. And happy.

Karen Litzy (03:03):

Yeah, I mean it's just in going through the website and reading about it, I was just like, Oh gosh, this woman's amazing. Like what a great way to go to work every day. Kind of knowing that you're staying true to what your values are and your mission is and that people really seem to like it.

Anne Stefanyk (03:22):

Yeah. Yeah. We always say it's not B to B or B to C, it's H to H it's human to human. And what do we need to get really clear to speak to our humans to help them, you know, move forward in their journey, whatever that looks like for them.

Karen Litzy (03:34):

Right. And, so now let's talk about that journey and it's kind of starts with the website. So let's talk about how you can make your website an effective marketing tool. Because not everyone, especially when you're first starting out, you don't have a lot of money to throw around to advertising and things like that. But we all have a website or maybe we all should have a website and have some sort of web presence. So how can we make that work for us?

Anne Stefanyk (04:00):

Yeah, definitely. You need a website. It's like a non negotiable factor these days and it really doesn't matter. The kind of website you have, especially when you're just getting started. There's lots of great tools out there from Wix, Squarespace, even WordPress that comes with templates or pre-baked themes. And I think the most important part is to really connect with your user and figure out who your user is and what kind of website needs to support their journey. But yeah, definitely you have to have a website and you actually have to have a good website. Having a bad website is the non, like, it's really bad because it will detract people so quickly and they'll never come back. So you pretty much have that first impression. And then if you don't make it, they won't come back. I think there's a well known stamp that if your site doesn't load within four seconds or three seconds they'll leave. And if it doesn't load within four seconds, they will never come back to that URL.

Karen Litzy (04:56):

Wow. All right. That's a great stat. I'm going to be, I'm going to go onto my computer, onto my website and start my timer, you know, so there's some really cool tools.

Anne Stefanyk (05:06):

We can include them in the show notes, but the Google has a page speed test where you can actually put your website URL and see how fast it is and give recommendations on what to fix.

Karen Litzy (05:15):

Oh perfect. Yeah, and we'll put all those links in the website and we'll get to that in a little bit about those different kinds of tools. But let's talk about, you said, you know, you're human to human business. We have to know who are we putting our website out there for. So how do we do that?

Anne Stefanyk (05:34):

Yeah, that's a great question. So when you're first starting off, you probably all like if you're just starting your business, you're just trying to figure out who you serve, but you may have special things that you'd like to, you know, that you're passionate about or you specialize in. Like for example, maybe you really specialize in women's health or sports medicine or you know, one of those things. And just to kind of get clear on who is your best customer. If you've been in business for a couple of years, you probably have a pretty good idea who your ideal customer is and how they engage with you. So first off, it's really thinking about who your target audience is and what are their needs. So when we're thinking about a website and thinking about that user journey, you often identify them as certain people. So you may have like, Mmm you know, kind of creating different avatars or different personas so you can really personify these people and help understand their journey.

Anne Stefanyk (06:27):

And from there you kind of understand that if someone's coming to you for physical therapy, there's going to be different mind States that they come into you with. So when you first have your website, you're going to want to, of course, a lot of people just put up who they are. Like, you know, this is my practice, this is who I am. This is my credit, my accreditation, and my certifications. And maybe maybe here's some testimonials. And then we run and we go off to the races. And that's great to get you out the door. Once you started your business, you're going to recognize that you're people, when they call you, they're going to have a million questions and there's ways to answer those questions using your website. And as a solo entrepreneur, like I ran my business by myself for three years, which means I was everything and I wore all the hats.

Anne Stefanyk (07:09):

I was the project manager, I was the designer, I was all the things that was the marketer, was the, I know that feeling well. So it took me like three years to operationalize. And I think the first thing I did as a female entrepreneur, I hired an assistant. I would highly recommend that as being one of your first hires as an entrepreneur. And that's just someone who can do all the little itty bitty details and then move on to whatever that looks like for you. But when you're building your website, the next level you really need to take is it serving my humans? Is it serving my audience? So are they able to get the information they need? And I think this strange time that we're in, we're all, this is an opportunity for us to look at our own website and our own stuff and say, is this the best representation possible?

Anne Stefanyk (07:52):

Because no longer are they just picking up the phone and calling you because your practice is probably closed. You're at home right now, your phones, maybe you if you have them redirected, but either way they're going to your website first. So it's like having the right information there at the right time for the right person. And that really comes to the user journey and that's where you know, if someone is just broken their ankle and they're now told by their doctor, you have to go into physical therapy, that's their first stage as they now are going to Google and saying, you know, PT for San Francisco and interestingly enough as Google wants to keep you there, so here you are. You user is Googling for you or Googling for physical therapy wherever, San Francisco, San Jose, wherever, and up comes the Google listings. If you can get past that point, then they go into your website and they're going to click open a bunch of them.

Anne Stefanyk (08:43):

That's what we call, you know, your awareness phase. They're becoming aware of you. There's certain things that a user wants to see in that phase. So understanding of someone's looking for you, they're going to, Oh yeah, they specialize in ankles. And I really think you know, Oh, that's person's for me. Versus now they're in the consideration stage and now they've chose likely, but Sally over here and James and Jimmy and we're figuring out which PT to go to, then that's a different level of content and what are they looking at to compare and contrast. And then when they've actually decided to work with you, then there's another layer of content you have to consider. So, Oh, I've decided to work where they're located. How do I get there? Was there anything I need to prepare their forms I need to fill out in advance?

Anne Stefanyk (09:27):

And then you even have the persona of the user once they've actually gone through all your services as I imagine. And therapy. A lot of you folks are getting referral and word of mouth. Let's nurture that. Let's use the website to nurture the word of mouth and referral work. Let's give your patients a place to go really easily to provide feedback, which will then change, you know, getting those Google reviews up leads to a higher ranking on that Google page. So if you understand where they began and where they pop out at the end, kind of map it all together. You'll start to see your gaps.

 

Karen Litzy:

And is it possible to go through sort of a quick example of what that might look like? So if someone's there on Google, they hit Google, they click on your website, you just said if it doesn't load within a couple of seconds, they're gone.

Anne Stefanyk (10:14):

Right? So that's a good awareness phase situation, right? What else? Someone's there, they're just click, click, click trying to find someone. What is it that they're looking for in that awareness stage? Like what are they, what is going to be like, Ooh, I like this, this person. I'm moving them from the awareness bucket to the consideration bucket. Yeah, yeah. So they need to see themselves in the way that their problem gets solved. So when they look at the website, they can say, Oh yeah, that person had the same problem and they got help. And then, Oh, look at their results. Oh look, there's a picture of them, you know, back on their skateboard six months later as part of this patient follow-up log. Oh, we don't, you know. So that's the kind of stuff is that when users really want to just be able to see themselves, they crave simplicity.

Anne Stefanyk (11:01):

And so often I think that if we're too close to it, we don't actually see how complex our stuff is. And sometimes when we're really smart and we have degrees in specialized things, we use vocabulary that our users are not even aware of yet. So it's really when you're talking to getting them from that awareness into considering you, it's about using really basic common language. It's about guiding them through a bit of a story. People love to read stories. So showing them like, Oh, you know, I was really showing another patient and showing the patient journey that all, I considered multiple companies locally, but I ultimately went with Sally as a PT because this, and just showing those things helps the user kind of see the whole journey so they can say, okay, okay, if you've never broken your ankle before, have no idea what to expect. You've never gone to physical therapy, you have no idea what to expect. And just the anticipation, if you can show them what snacks they feel a sense of relief that they'll be taken care of.

Karen Litzy (12:04):

Yeah. So what I'm hearing is that your testimonial page on your website's pretty important, is that something that should be front and center on the homepage?

Anne Stefanyk (12:16):

Well, that's an interesting thing. I think the main thing you want to use that front and center is being really clear about what you do. Right? Some people like to put these big sentences up there, but getting to know your user and the problem they have and this, you know, getting to how you're going to solve the problem is the most important part of that, of that real estate upfront. I will warn everybody that please don't use carousels. They're a big fad and they're just a fad. They're from a usability standpoint. And what happens is the end user thinks that whatever you put in your carousel is what you do. So if you're promoting an event in your carousel, they'll think that you're just doing the events.

Anne Stefanyk (13:01):

They won't even know that you're a physical therapist. Really clear upfront about what you do. You know, like I help people with, you know, however it goes, and then provide supporting content. So a testimonial is wonderful if it can also be like imbedded within a bigger story. So it tells the full story. I like that video. I mean everybody has an iPhone. So, or at least access to video really easily. You could do a quick little video testimonial with one of your clients over zoom for two minutes to say, Hey, you're one of my favorite PT clients and can you get on a quick video with me and just do a video testimonial. That's great way to leverage video content on your website to help the user see themselves as what the solution's going to be.

Karen Litzy (13:47):

Yeah. Great, great, awesome. And then one stipulation I would say on that is talk to your lawyer because you'll need them to sign a release for HIPAA purposes, right? To make sure that they know exactly where this video is going to be. You have to be very clear on that. Okay, great. So we're out of the awareness phase, so we're in consideration. So let's say it's between me and one other PT in New York city. What should I be looking at on my website to get that person from consideration to yes.

Anne Stefanyk (14:20):

So one of the greatest ways to do stuff is actually a very tried and it's email marketing or text-based marketing. So if you can capture an email during that awareness phase, even if it's just like you know, Mmm. Interested in getting some tips and tricks on how to rejuvenate your bone health during, you know, it doesn't have to be like sign up for a newsletter or sign up for this. It could be just a very simple, if you know your user is coming there specifically for a thing and you can provide some type of value added content, then there might be some small way to get a snippet of data so that you can continue the conversation. Cause most people are just bombarded with information and overwhelmed. So if there's any way to connect with them so you can feed them information. But another great way to kind of pull them into that consideration content is once you've got their eyeballs hooked and you're in, there is again to kind of figure out what are the common things, questions they need to have, they have answers they need answers to.

Anne Stefanyk (15:22):

And this might be from your experience, just answering phone calls when people are starting to talk to you. But it's like the questions like you know, maybe how long does it take for me to heal, you know, will I have different types of medicine I'm going to have to take? How much homework will there be? Do I need any special equipment? That's kind of, you know, just showing that you're the expert in the field and you have the answers to questions they didn't even know they had to ask. That kind of aha moment makes them feel really trusted. They trust you because they go, Oh I didn't even think about asking that question. Oh my goodness, I'm so glad they thought about that. I feel so taken care of. And that's where I think a lot of websites drop the ball is they straight up say like this is what we do, here's some testimonials. And they don't put all that soft content and that builds the trust. Can be a little blog, a little FAQ section and this is all like non technical stuff. You don't need a developer to do any of this. It's mostly just your writing time.

Karen Litzy (16:18):

Yeah, no and it's making me go through my head of my FAQ, so I'm like, Hmm, maybe I need to revisit. That's the one page I just sort of did a revamp of my website. We were talking about this before we went on, but I actually did not go to my FAQ page cause I thought to myself, Oh, it's probably good. It's probably not. I need to go back and do a little revamp on that too, just to think about some of the questions that I've been getting from patients recently and how does this work and things like that. Especially now with COVID. You know, like what about tele-health? What about this or about that?

Anne Stefanyk (16:51):

Yeah. Google loves when you update your content. Google loves it. Google loves it so much. It is one of the biggest disservices you can do is build your website and leave it. That's just not healthy. People think you have to rebuild your website every two to three years. That's who we are. That's bananas. You have to do it. If you just take care of your website and you nurture it and you love it and you make it, you make it work and you continually work on it and maybe that's just an hour a week, maybe it's an hour every month, whatever it is. Just a little bit of attention really goes a long way and it is something that we believe a website should last for at least 10 years, but that means you got to take care of it, right. A lot of clients come to me and say, Oh well, you know we're going to have to rebuild this in three years, and I'm like, no, you shouldn't.

Anne Stefanyk (17:31):

It should be totally fine. It's just like if you get a house right, if you don't do anything with your house a hundred years later, it's probably demolished. Like you're going to tear it down versus you've got to do the roof and you've got to replace the carpets and you got to do the perimeter drain. Right. It's kind of the website stuff too. I mean, Google will throw you curve balls if you're spending a lot time on social. Unless you're getting direct business from social media, don't worry about it so much. Google has changed their algorithms, which means that social doesn't count for as much as it did. Oh, so if you're spending two or three hours a week scheduling social, unless you're directly getting benefit, like from direct users, finding one social tone that way down and spend more time writing blogs, spending more time getting you know content on your website is, that's what matters from a Google standpoint.

Karen Litzy (18:16):

Good to know. Gosh, this is great. So all right, the person has now moved from consideration. They said, yes, I'm going to go and see Karen. This is what I've decided. Awesome. So now how can I make their patient journey a little bit easier?

 

Anne Stefanyk:

So we started at Google, they got from awareness to consideration. They said yes. Now what? Yeah, now what? So it's continuing the conversation and creating kind of being ahead of them. So text messages, 99% of text messages are open and read. Okay. Yeah, I think it's like 13 to 20% of emails are open read. So it would be skillful for you to gather a phone number so then you can text them, alerts, reminders, et cetera. That's a great way. There's a wonderful book called how to, what is it? Never lose a customer again. And it's beautiful. It's a beautiful book.

Anne Stefanyk (19:11):

It applies to any business. And it really talks about like how when you're engaging with a new client, the first two stages of that are the are the sales and presales. But then you have six steps. Once a person becomes your clients on how to nurture and engage and support that client journey. And that might just be simply as like if they're deciding to work with you and they book their first appointments, there's a lot of cool video. You could just do a little video recording and say, you know, thank you so much for booking an appoint with me. I'm so excited. I really honor the personal relationship that we have together and I want to build trust. So this is a just, and then giving them like a forum to then ask the question to you. So just building that relationship. Cause even though your clients, I mean if they're coming for PT, they might just be a onetime client.

Anne Stefanyk (19:57):

But again, they also might have lots of friends and family and that works. So when their friends and family and network happened to have that, how do you also kind of leverage the website that way? But a lot of it is just clarity. And you'll notice that big way to find out what's missing is interview your last few clients that have signed up, find out what they found was easy, what was difficult, what they wish they had more information. And if they're a recent enough client, they'll still remember that experience and us humans love to help. It's in their nature, right? So you should never feel worried about asking anybody for advice or insights on this. You know, there's even a little tool that you can put on your websites. It's a tool, there's a free version called Hotjar, hot and hot jar.

Anne Stefanyk (20:47):

And it's pretty easy to install. We actually have a blog post on how to install it too. It's really, we'll put that blog posts, but what it allows you to do is it allows you to see where people are clicking and whether they're not clicking on your website. So you can actually analyze, you know it's all anonymous, right? It's all anonymously tracked, but you can do screencast and you can do with these color heatmaps, you can kind of see where people are going. You can track this and it's free, right? Three you can do up to three pages for free. So I feel like the guys looking at stuff like that, you kind of get the data that you need to figure out where your gaps are because what you don't know is what you don't know, right? So I first recommend like getting clear on who your user is, you know, if you specifically take care of a certain set, figuring out where their journey is, what kind of content you'd need for each of those and what the gaps are. And then filled out a content calendar to fill the gaps.

Karen Litzy (21:42):

Got it. And a content calendar could be like a once a month blog post. It doesn't have to be every day. And I even think that can overwhelm you're patients or potential patients, right? Cause we're just inundated. There's so much noise, but if you have like a really great blog that comes out once a month and gets a lot of feedback on it, then people will look forward to that.

Anne Stefanyk (22:11):

Exactly. Exactly. Exactly. And I mean, humans want to get clarity, they want to receive value. And right now we live in an intention economy where everything is pinging at them. So realistically, the only way to break through the noise is just to be really clear and provide what they need. Simple. It's just simple. It's actually, you just simplify it, remove the jargon, you know, make it easy. And I mean a blog post, it could be as short as 300 words. You don't need to write a massive thing. You can even do a little video blog. Yeah. You don't like writing, you can just do a little video blog and embedded YouTube video and boom, you're done. Right?

Karen Litzy (22:46):

Yeah. Yeah. I love this because everything that you're saying doesn't take up a lot of time. Cause like we said before, when you're first starting out as a new entrepreneur, you feel like you've been pulled in a million different directions. But if you can say, I'm going to take one hour, like you said, one hour a month to do a website check-in, right? One hour a month to get a blog post together or shoot a quick video. Like you said, we've all got phones embedded in every device we own these days. So it doesn't take a lot. And I love all those suggestions. Okay. So now I'm in the nurturing phase and what we've done is, because I didn't use jargon, I was simple, clear to the point, filled in the gaps for them. Now those patients that who have come to see me are referring their friends to me and we're starting it all over again. So it's sort of this never ending positive cycle.

Anne Stefanyk (23:41):

Exactly, exactly. And that's what we really frame. We call it continuous improvement, which is the methodology of that. You always need to be taking care of it, nurturing it, loving it. Because if you just let it sit, it will do you no good. Right. And that's where you know, when you're that little bit of momentum and it's about pacing yourself and choosing one goal at a time. Like if you're feeling like, Oh my gosh, where am I going to start? What am I going to do? You know, just say, okay, I just want my site to go faster. Just pick one goal. You run it through the speed test, it's scoring forward of a hundred you're like, Oh, I need to make my site faster. So then you look at that and you say, okay, I've learned, you know, big images create large page speed load. So it'll tell, you can go through and look at your images and say, Oh, I need to resize this image. Or maybe I need, if I'm using WordPress, put a plugin that automatically resizes all my images. You know, a lot of it is content driven that you can kind of make your cycle faster with an accessibility. Accessibility is so dear and near to my heart.

Karen Litzy (24:44):

When you say accessibility for a website, what exactly does that mean?

Anne Stefanyk (24:48):

I mean, yes. So that means that it is technically available for people of all types of ranges of ability from someone who is visually impaired to someone who is physically impaired, temporarily or permanently disabled. So if you think about someone who's got a broken arm and maybe it's her dominant arm. I'm doing everything with my left. Try using a screen reader on your own website and you will be shocked that if you can't type you know with your hands and you're going to dictate to it, you'll be a, is how your computer does not actually understand your words. So it's about making your website really technically accessible with consideration. Four, font size, color contrast. Yeah. Images need to have what we call alt tags, which is just a description. So if your image is like one, two, three, four, five dot JPEG, you would actually want to rename it as lady sitting in a chair reading in a book dot JPEG because that's what a screen reader reads. Oh. So it's about the technical stuff, so that if somebody needs to use a screen reader or if somebody can't use their hands from physical, they can't type, they're reading, they're listening to the website. It's about structural, putting it together correctly so the tools can output.

Karen Litzy (26:12):

Mmm. Wow. I never even thought of that. Oh my gosh, this is blowing my mind. Anyway, so there's tools out there to look, let's talk about if you want to just maybe give a name to some of those tools. So how about to check your websites?

Anne Stefanyk (26:28):

Yeah, so it's Google page speed and it's just a website that you can go in and put your URL. There's another plugin called lighthouse, and lighthouse is a plugin that you can use through Chrome. And then you just on that and it'll output a report for you. And some of it's a little nerdy, right? And some of it's, you know, some of it's very clear. I love it. They, they'll put some jargon, let's just say that they don't quite understand that not everybody understands laptop, but if you're on a tool like Shopify or Squarespace or Wix, which a lot of like first time entrepreneurs, that's a great place to start. It's really affordable. They take care of a lot of those things built in. So that's the benefit of kind of standing on the shoulders of giants when it comes to those. But lighthouse is a good tool because it checks accessibility, performance, SEO and your coding best practices.

Karen Litzy (27:28):

Oh wow. Okay. So that's a good tool. Cool, any other tools that we should know about that you can think of off the top of your head? If not, we can always put more in the show notes if people want to check them out. But if you have another one that you wanted to throw out there, I don't want to cut you off, if you've got more.

Anne Stefanyk (27:45):

Oh no worries. There's lots of different checkers and I think the big thing error is just to be able to understand the results. So I'm always a big fan of making technology really accessible. So if you do need help with that, you know, feel free to reach out and I can get more help. But generally we look at search engine optimization, which is are you being found in Google? And there's some tools like SEO. Moz is one. And then we look at accessibility, is it accessible to all people and then we look at performance, can it go fast, fast, and then we look at code quality, right? Like you want to make sure you're doing your security updates cause it's a heck of a lot cheaper to do your security updates than unpack yourself if there is.

Karen Litzy (28:27):

Oh gosh. Yeah. Yeah, absolutely. And, like you said, on some of those websites, that security part might be in like already embedded in that or is that, do you recommend doing an external security look at your website as well?

Anne Stefanyk (28:44):

Exactly. Most of the time when you're using a known platform like Shopify or if you're using WordPress or Drupal, then what you want to do is you want to work with a reliable hosting provider so they will help you provide your security updates. It's just like you would always want to lock your car when you would go out in the city. It's just like some do your security updates. So, but yeah, that's the benefit of being on some of these larger platforms is they have some of that stuff baked in. You pay a monthly fee but you don't have to worry about it.

Karen Litzy (29:14):

Right. Perfect. Perfect. And gosh, this was so much good information. Let's talk a little bit about, since we are still in the midst of this COVID pandemic and crisis and what should we be doing with our websites now specifically to sort of provide that clarity and calmness that maybe we want to project while people are still a little, I mean, I watch the news people are on edge here.

Anne Stefanyk (29:47):

Yeah. I think everybody's a little on edge, especially as things are starting to open. But nervous about it. All right. So I think the main thing that you can do is provide clear pathways. So if you haven't already put an alert on your website or something, right on your homepage, that speaks to how you're handling COVID that would be really skillful in, that could just be if you, you know, Mmm. Some people have an alert bar, they can put up, some people use a blog post and they feature it as their blog posts. Some people use a little block on their home page, but just something that helps them understand that what that is, and I'm sure most of you have already responded to that cause you had to write, it was like the first two weeks, all of our clients were like, we got to put something on our website.

Anne Stefanyk (30:26):

Right. And so, from there is I think being very mindful about how overwhelmed your peoples are and not trying to flood them with like tips and tricks on how to stay calm or how to parent or how to, you know, like that's where everybody's kind of like on overwhelm of all the information. So for right now, I would say that it's a wonderful time to put an alert up so people visit your site. If you've switched to telehealth and telemedicine, it'd be a great time to actually clarify how to do that. So if they're like, okay, I'm going to sign up for this and I want to work with you. Mmm. But how does it work? Are we gonna do it through zoom? Is it through Skype? Is it through FaceTime? Is my data secure? You know, like you said, updating all your FAQ is like, we're in this weird space where we really have almost like no excuse to not come out of this better.

Anne Stefanyk (31:16):

You know, as an entrepreneur we have this like lurking sense of like, okay, I gotta make sure I'm doing something. And the web is a great place to start because it is your first impression. And to kind of go through your content, and maybe it is if you don't have a blog set up is setting up a blog and just putting one up there or writing two or three and not publishing it until you have two or three. But it is kind of figuring out what is your user need and how do you make it really easy for them to digest.

Karen Litzy (31:41):

Perfect. And now before we kind of wrap things up, I'll just ask you is there anything that we missed? Anything that you want to make sure that the listeners walk away with from this conversation?

Anne Stefanyk (31:56):

I think the big thing is that this can all get really confusing and overwhelming very quickly. And all you need to just think about is your humans that you're servicing and like how can I make their journey easier? And even if it's like if nothing else, you're like, Hey, I'm going to get a text messaging program set up because I'm going to be able to actually communicate with them a lot faster and a lot easier. Or, Hey, I'm just going to focus on getting more five stars reviews on my Google profiles, so I show up. I'm just going to make that the focus. So I think the big thing is just a one thing at a time, and because we're in a pandemic, set your bar really low and celebrate when you barely hit it because we're all working on overwhelm and overdrive and we're all exhausted and our adrenals are depleted. Even in overdrive syndrome for like 11 weeks or something. Now I know it's kind of like, Oh my goodness, my websites maybe a hot mess. I'm going to get one thing and I'm going to give myself a lot of wiggle room to make sure that I can take care of the pressing needs and just being really like patient because it isn't a journey where you're going to have your website and your entire business.

Karen Litzy (33:00):

Yeah. We never got to turn off your website. Right. I hope not. Oh, you never will. Right. Telemedicine is going to give you a new kind of way to practice too. It's revolutionizing the way we treat patients. A hundred percent yeah, absolutely. I personally have have been having great success and results with telehealth. And so I know that this is something that will be part of my practice going forward, even as restrictions are lowered. I mean here in New York, I mean you're in San Francisco, like we're both in areas that are on pretty high alert still. But this is something that's definitely gonna be part of my practice. So if there is a silver lining to come out of this really horrible time, I think that is one of them. From a healthcare standpoint, I think it's been a game changer because you're still able to help as you put it, help your humans, you know, help those people so that they're not spinning out on their own. So I love it. Now final question and I ask everyone this, knowing where you are in your life and in your career, what advice would you give yourself as a new graduate right out of college? So it's before, even before you started.

Anne Stefanyk (34:21):

Yes, yes. Honor my downtime. I think especially as a girl boss, that's always like, I've been an entrepreneur pretty much since I was in high school. I never took weekends and evenings for myself until I became like a little older. I would've definitely done more evenings and weekends because the recharge factor is just amazing for the brain. When you actually let it rest, it figures out all the problems on its own, get out of your own way and it'll like just, you know, even this COVID stuff. I find it so interesting that you know, as a boss you feel like you want to do so much and you want to get it done and you want to help your staff and you've got to figure out how to be there for them and then it's like, wait, you gotta put on your own mask before you put it on the others.

Anne Stefanyk (35:04):

And I feel like healthcare professionals, it's like so important for you to honor that little bit of downtime that you have now. Yeah, I mean, if I knew that back then, I'd probably be way stronger way would have honored myself. And as a woman, self care seems, we put it like second to our business and our families and second, third, fourth, fifth. So it's like, you know, advice to pass out. Let's take care of you. Yeah. It will be great. You will do wonderful things. Take care of you. You'll feel great. You know, I broke my ankle because I wasn't taking care of myself. Yeah.

Karen Litzy (35:36):

Oh wow. What advice. Yeah. Honor the downtime. I think that's great. And I think it's something that a lot of people just don't do. They think that in that downtime you should be doing something else. So you're failing.

Anne Stefanyk (35:48):

Yeah. And it's just so silly. It's just this weird, you know mental game that we have to play with ourselves. I listened to one of your recent podcasts and I just loved the girl that was on there said like, you know, successes is 20% skill, 80% of mind game. And I could not agree with that. You know, having a company full of women, imposter syndrome is the number one thing that I help coach my females with. It's like, no, you know exactly what you're doing because nobody knows what they're doing. We all learn, right? There's no textbook for a lot of this stuff. Like we went to school, there was a textbook, there was structure. We got out of school and now we're like go learn. It's like okay, okay so I find the entrepreneurial journey so cool. And that means like kind of like also finding out other tribes like where can we lean into and that's why I love you have this podcast cause it really focuses on like building a tribe of entrepreneurs that are focusing on taking it to the next level. Like how can we be empowering them to do their best, be their best selves.

Karen Litzy (36:47):

Exactly. I'm going to just use that as a tagline from now on for the buck. Perfect marketing tagline. Well and thank you so much. Where can people find more about you and more about kanopi.

Anne Stefanyk (37:00):

So you can go to kanopi or you can simply just look for me just go to kanopi on the Googles and you'll find me. But if you want to reach out via LinkedIn or anywhere, I'm always just a big fan of helping people make technology really clear and easy to understand. So find me on LinkedIn or on stuff and we can chat more there.

Karen Litzy (37:23):

Awesome. Well thank you so much. And to everyone listening, we'll have all of the links that we spoke about today and I know there were a lot, but they're all going to be in the show notes at podcasts.healthywealthysmart.com under this episode. So Anne, you have given so much great information. I can't thank you enough.

Anne Stefanyk (37:39):

Well thank you so much for it. I'm really grateful for the work that you're doing. I think it's fantastic.

Karen Litzy (37:45):

Thank you. And everyone else. Thank you so much for listening. Have a great couple of days and stay healthy, wealthy, and smart.

 

 

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Jun 29, 2020

On this episode of the Healthy, Wealthy and Smart Podcast, I welcome Anne Stefanyk on the show to discuss website optimization.  As Founder and CEO of Kanopi Studios, Anne helps create clarity around project needs, and turns client conversations into actionable outcomes. She enjoys helping clients identify their problems, and then empowering the Kanopi team to execute great solutions. Anne is an advocate for open source and co-organizes the Bay Area Drupal Camp.

In this episode, we discuss:

-Why your website is one of your most important marketing tools

-The art of simplicity in branding

-How to track the customer lifecycle

-The top tools you need to upgrade your website

-And so much more!

Resources:

Anne Stefanyk Twitter

Drupal

Anne Stefanyk LinkedIn

Kanopi Website

HotJar

Google Pagespeed

Accessibility Insights

WAVE Web Accessibility

Google/Lighthouse

Use user research to get insight into audience behavior
How to make your site last 5 years (possibly more)

 

A big thank you to Net Health for sponsoring this episode!  Learn more about Four Ways That Outpatient Therapy Providers Can Increase Patient Engagement in 2020!

 

For more information on Anne:

As Founder and CEO of Kanopi Studios, Anne helps create clarity around project needs and turns client conversations into actionable outcomes. She enjoys helping clients identify their problems, and then empowering the Kanopi team to execute great solutions.

Anne fell into the Drupal community in 2007 and admired both the community’s people and the constant quest for knowledge. After holding Director-level positions at large Drupal agencies, she decided she was ready to open Kanopi Studios in 2013.

Her background is in business development, marketing, and technology, which allows her to successfully manage all facets of the business as well as provide the technical understanding to allow her to interface with engineers. She has accumulated years of professional Drupal hands-on experience, from basic websites to large Drupal applications with high-performance demands, multiple integrations, complicated migrations, and e-commerce including subscription and multi-tenancy.

Anne is an advocate for open source and co-organizes the Bay Area Drupal Camp. When she’s not contributing to the community or running her thoughtful web agency, she enjoys yoga, meditation, treehouses, dharma, cycling, paddle boarding, kayaking, and hanging with her nephew.

 

Read the full transcript below:

Karen Litzy (00:01):

Hey Anne, welcome to the podcast. I am so excited and happy to have you on.

Anne Stefanyk (00:06):

Nice to see you. Thank you so much for having me.

Karen Litzy (00:09):

So before we get into what we're going to talk about today, which is kind of how to use your website as a marketing tool, and that's putting it lightly, we're going to really dive into that, but I want to talk about kanopi. So for a lot of my listeners, they know that I'm a huge proponent of female entrepreneurs of women in physical therapy. We have a whole conference for it every year. And I love the fact that kanopi is a majority female company. So can you talk about the inception and kind of the journey that you've taken with the company over the years?

Anne Stefanyk (00:47):

Sure, I'd be happy to. So I founded kanopi kind of off the side of my desk and it actually came from meeting a need that I needed to take care of with my family. My family became quite sick and I had to stop working and as a result it forced my hand to pick up some contract work. And that contract works. Certain cuts soon kind of snowballed into, Oh my goodness, I have actual projects. I probably should hire some people and get out of my personal email to run the business. But it did come from a place where I needed some lifestyle flexibility. So I built a company that is fully distributed as well. And as a result of the business model that we created, it allowed us to really attract and retain really great talent. Outside of major cities. And I have a lot of single moms or a lot of moms and I have some single dads too, but we really are able to, with our business model, attract and retain a lot of top talent.

Anne Stefanyk (01:39):

And a lot of those are girls. So we're over 50% women and there's only really two men in our leadership, a team of nine. So there's seven girl bosses out of the nine that run the company. And we really have focused on helping people with their websites and making it really clear and simple and easy to understand. We find that there's always too much jargon out there. There's too much complexity and that we all are just craving simplicity. So building the business was twofold, was one to obviously help people with their websites. What was also to really create impactful futures for my staff and give them opportunities to kind of grow and expand in new ways. So I'm really proud that as kanopi has formed our team, I'm part of our retention plan has to really been to take care of our families and put our families first.

Anne Stefanyk (02:28):

Because if we realize that if you take care of the family, the family takes care of you. And so we've extended a lot of different benefits to be able to support the family journey as part of the business. And we find that as a female entrepreneur, really recognizing and appreciating that we need flexible lifestyles to be able to rear children or take care of elderly parents or we have a lot of demands as females on us. I mean the men do too, don't get me wrong, but as a female I'm creating a space of work where we can create that space for everybody really makes me proud. And happy.

Karen Litzy (03:03):

Yeah, I mean it's just in going through the website and reading about it, I was just like, Oh gosh, this woman's amazing. Like what a great way to go to work every day. Kind of knowing that you're staying true to what your values are and your mission is and that people really seem to like it.

Anne Stefanyk (03:22):

Yeah. Yeah. We always say it's not B to B or B to C, it's H to H it's human to human. And what do we need to get really clear to speak to our humans to help them, you know, move forward in their journey, whatever that looks like for them.

Karen Litzy (03:34):

Right. And, so now let's talk about that journey and it's kind of starts with the website. So let's talk about how you can make your website an effective marketing tool. Because not everyone, especially when you're first starting out, you don't have a lot of money to throw around to advertising and things like that. But we all have a website or maybe we all should have a website and have some sort of web presence. So how can we make that work for us?

Anne Stefanyk (04:00):

Yeah, definitely. You need a website. It's like a non negotiable factor these days and it really doesn't matter. The kind of website you have, especially when you're just getting started. There's lots of great tools out there from Wix, Squarespace, even WordPress that comes with templates or pre-baked themes. And I think the most important part is to really connect with your user and figure out who your user is and what kind of website needs to support their journey. But yeah, definitely you have to have a website and you actually have to have a good website. Having a bad website is the non, like, it's really bad because it will detract people so quickly and they'll never come back. So you pretty much have that first impression. And then if you don't make it, they won't come back. I think there's a well known stamp that if your site doesn't load within four seconds or three seconds they'll leave. And if it doesn't load within four seconds, they will never come back to that URL.

Karen Litzy (04:56):

Wow. All right. That's a great stat. I'm going to be, I'm going to go onto my computer, onto my website and start my timer, you know, so there's some really cool tools.

Anne Stefanyk (05:06):

We can include them in the show notes, but the Google has a page speed test where you can actually put your website URL and see how fast it is and give recommendations on what to fix.

Karen Litzy (05:15):

Oh perfect. Yeah, and we'll put all those links in the website and we'll get to that in a little bit about those different kinds of tools. But let's talk about, you said, you know, you're human to human business. We have to know who are we putting our website out there for. So how do we do that?

Anne Stefanyk (05:34):

Yeah, that's a great question. So when you're first starting off, you probably all like if you're just starting your business, you're just trying to figure out who you serve, but you may have special things that you'd like to, you know, that you're passionate about or you specialize in. Like for example, maybe you really specialize in women's health or sports medicine or you know, one of those things. And just to kind of get clear on who is your best customer. If you've been in business for a couple of years, you probably have a pretty good idea who your ideal customer is and how they engage with you. So first off, it's really thinking about who your target audience is and what are their needs. So when we're thinking about a website and thinking about that user journey, you often identify them as certain people. So you may have like, Mmm you know, kind of creating different avatars or different personas so you can really personify these people and help understand their journey.

Anne Stefanyk (06:27):

And from there you kind of understand that if someone's coming to you for physical therapy, there's going to be different mind States that they come into you with. So when you first have your website, you're going to want to, of course, a lot of people just put up who they are. Like, you know, this is my practice, this is who I am. This is my credit, my accreditation, and my certifications. And maybe maybe here's some testimonials. And then we run and we go off to the races. And that's great to get you out the door. Once you started your business, you're going to recognize that you're people, when they call you, they're going to have a million questions and there's ways to answer those questions using your website. And as a solo entrepreneur, like I ran my business by myself for three years, which means I was everything and I wore all the hats.

Anne Stefanyk (07:09):

I was the project manager, I was the designer, I was all the things that was the marketer, was the, I know that feeling well. So it took me like three years to operationalize. And I think the first thing I did as a female entrepreneur, I hired an assistant. I would highly recommend that as being one of your first hires as an entrepreneur. And that's just someone who can do all the little itty bitty details and then move on to whatever that looks like for you. But when you're building your website, the next level you really need to take is it serving my humans? Is it serving my audience? So are they able to get the information they need? And I think this strange time that we're in, we're all, this is an opportunity for us to look at our own website and our own stuff and say, is this the best representation possible?

Anne Stefanyk (07:52):

Because no longer are they just picking up the phone and calling you because your practice is probably closed. You're at home right now, your phones, maybe you if you have them redirected, but either way they're going to your website first. So it's like having the right information there at the right time for the right person. And that really comes to the user journey and that's where you know, if someone is just broken their ankle and they're now told by their doctor, you have to go into physical therapy, that's their first stage as they now are going to Google and saying, you know, PT for San Francisco and interestingly enough as Google wants to keep you there, so here you are. You user is Googling for you or Googling for physical therapy wherever, San Francisco, San Jose, wherever, and up comes the Google listings. If you can get past that point, then they go into your website and they're going to click open a bunch of them.

Anne Stefanyk (08:43):

That's what we call, you know, your awareness phase. They're becoming aware of you. There's certain things that a user wants to see in that phase. So understanding of someone's looking for you, they're going to, Oh yeah, they specialize in ankles. And I really think you know, Oh, that's person's for me. Versus now they're in the consideration stage and now they've chose likely, but Sally over here and James and Jimmy and we're figuring out which PT to go to, then that's a different level of content and what are they looking at to compare and contrast. And then when they've actually decided to work with you, then there's another layer of content you have to consider. So, Oh, I've decided to work where they're located. How do I get there? Was there anything I need to prepare their forms I need to fill out in advance?

Anne Stefanyk (09:27):

And then you even have the persona of the user once they've actually gone through all your services as I imagine. And therapy. A lot of you folks are getting referral and word of mouth. Let's nurture that. Let's use the website to nurture the word of mouth and referral work. Let's give your patients a place to go really easily to provide feedback, which will then change, you know, getting those Google reviews up leads to a higher ranking on that Google page. So if you understand where they began and where they pop out at the end, kind of map it all together. You'll start to see your gaps.

 

Karen Litzy:

And is it possible to go through sort of a quick example of what that might look like? So if someone's there on Google, they hit Google, they click on your website, you just said if it doesn't load within a couple of seconds, they're gone.

Anne Stefanyk (10:14):

Right? So that's a good awareness phase situation, right? What else? Someone's there, they're just click, click, click trying to find someone. What is it that they're looking for in that awareness stage? Like what are they, what is going to be like, Ooh, I like this, this person. I'm moving them from the awareness bucket to the consideration bucket. Yeah, yeah. So they need to see themselves in the way that their problem gets solved. So when they look at the website, they can say, Oh yeah, that person had the same problem and they got help. And then, Oh, look at their results. Oh look, there's a picture of them, you know, back on their skateboard six months later as part of this patient follow-up log. Oh, we don't, you know. So that's the kind of stuff is that when users really want to just be able to see themselves, they crave simplicity.

Anne Stefanyk (11:01):

And so often I think that if we're too close to it, we don't actually see how complex our stuff is. And sometimes when we're really smart and we have degrees in specialized things, we use vocabulary that our users are not even aware of yet. So it's really when you're talking to getting them from that awareness into considering you, it's about using really basic common language. It's about guiding them through a bit of a story. People love to read stories. So showing them like, Oh, you know, I was really showing another patient and showing the patient journey that all, I considered multiple companies locally, but I ultimately went with Sally as a PT because this, and just showing those things helps the user kind of see the whole journey so they can say, okay, okay, if you've never broken your ankle before, have no idea what to expect. You've never gone to physical therapy, you have no idea what to expect. And just the anticipation, if you can show them what snacks they feel a sense of relief that they'll be taken care of.

Karen Litzy (12:04):

Yeah. So what I'm hearing is that your testimonial page on your website's pretty important, is that something that should be front and center on the homepage?

Anne Stefanyk (12:16):

Well, that's an interesting thing. I think the main thing you want to use that front and center is being really clear about what you do. Right? Some people like to put these big sentences up there, but getting to know your user and the problem they have and this, you know, getting to how you're going to solve the problem is the most important part of that, of that real estate upfront. I will warn everybody that please don't use carousels. They're a big fad and they're just a fad. They're from a usability standpoint. And what happens is the end user thinks that whatever you put in your carousel is what you do. So if you're promoting an event in your carousel, they'll think that you're just doing the events.

Anne Stefanyk (13:01):

They won't even know that you're a physical therapist. Really clear upfront about what you do. You know, like I help people with, you know, however it goes, and then provide supporting content. So a testimonial is wonderful if it can also be like imbedded within a bigger story. So it tells the full story. I like that video. I mean everybody has an iPhone. So, or at least access to video really easily. You could do a quick little video testimonial with one of your clients over zoom for two minutes to say, Hey, you're one of my favorite PT clients and can you get on a quick video with me and just do a video testimonial. That's great way to leverage video content on your website to help the user see themselves as what the solution's going to be.

Karen Litzy (13:47):

Yeah. Great, great, awesome. And then one stipulation I would say on that is talk to your lawyer because you'll need them to sign a release for HIPAA purposes, right? To make sure that they know exactly where this video is going to be. You have to be very clear on that. Okay, great. So we're out of the awareness phase, so we're in consideration. So let's say it's between me and one other PT in New York city. What should I be looking at on my website to get that person from consideration to yes.

Anne Stefanyk (14:20):

So one of the greatest ways to do stuff is actually a very tried and it's email marketing or text-based marketing. So if you can capture an email during that awareness phase, even if it's just like you know, Mmm. Interested in getting some tips and tricks on how to rejuvenate your bone health during, you know, it doesn't have to be like sign up for a newsletter or sign up for this. It could be just a very simple, if you know your user is coming there specifically for a thing and you can provide some type of value added content, then there might be some small way to get a snippet of data so that you can continue the conversation. Cause most people are just bombarded with information and overwhelmed. So if there's any way to connect with them so you can feed them information. But another great way to kind of pull them into that consideration content is once you've got their eyeballs hooked and you're in, there is again to kind of figure out what are the common things, questions they need to have, they have answers they need answers to.

Anne Stefanyk (15:22):

And this might be from your experience, just answering phone calls when people are starting to talk to you. But it's like the questions like you know, maybe how long does it take for me to heal, you know, will I have different types of medicine I'm going to have to take? How much homework will there be? Do I need any special equipment? That's kind of, you know, just showing that you're the expert in the field and you have the answers to questions they didn't even know they had to ask. That kind of aha moment makes them feel really trusted. They trust you because they go, Oh I didn't even think about asking that question. Oh my goodness, I'm so glad they thought about that. I feel so taken care of. And that's where I think a lot of websites drop the ball is they straight up say like this is what we do, here's some testimonials. And they don't put all that soft content and that builds the trust. Can be a little blog, a little FAQ section and this is all like non technical stuff. You don't need a developer to do any of this. It's mostly just your writing time.

Karen Litzy (16:18):

Yeah, no and it's making me go through my head of my FAQ, so I'm like, Hmm, maybe I need to revisit. That's the one page I just sort of did a revamp of my website. We were talking about this before we went on, but I actually did not go to my FAQ page cause I thought to myself, Oh, it's probably good. It's probably not. I need to go back and do a little revamp on that too, just to think about some of the questions that I've been getting from patients recently and how does this work and things like that. Especially now with COVID. You know, like what about tele-health? What about this or about that?

Anne Stefanyk (16:51):

Yeah. Google loves when you update your content. Google loves it. Google loves it so much. It is one of the biggest disservices you can do is build your website and leave it. That's just not healthy. People think you have to rebuild your website every two to three years. That's who we are. That's bananas. You have to do it. If you just take care of your website and you nurture it and you love it and you make it, you make it work and you continually work on it and maybe that's just an hour a week, maybe it's an hour every month, whatever it is. Just a little bit of attention really goes a long way and it is something that we believe a website should last for at least 10 years, but that means you got to take care of it, right. A lot of clients come to me and say, Oh well, you know we're going to have to rebuild this in three years, and I'm like, no, you shouldn't.

Anne Stefanyk (17:31):

It should be totally fine. It's just like if you get a house right, if you don't do anything with your house a hundred years later, it's probably demolished. Like you're going to tear it down versus you've got to do the roof and you've got to replace the carpets and you got to do the perimeter drain. Right. It's kind of the website stuff too. I mean, Google will throw you curve balls if you're spending a lot time on social. Unless you're getting direct business from social media, don't worry about it so much. Google has changed their algorithms, which means that social doesn't count for as much as it did. Oh, so if you're spending two or three hours a week scheduling social, unless you're directly getting benefit, like from direct users, finding one social tone that way down and spend more time writing blogs, spending more time getting you know content on your website is, that's what matters from a Google standpoint.

Karen Litzy (18:16):

Good to know. Gosh, this is great. So all right, the person has now moved from consideration. They said, yes, I'm going to go and see Karen. This is what I've decided. Awesome. So now how can I make their patient journey a little bit easier?

 

Anne Stefanyk:

So we started at Google, they got from awareness to consideration. They said yes. Now what? Yeah, now what? So it's continuing the conversation and creating kind of being ahead of them. So text messages, 99% of text messages are open and read. Okay. Yeah, I think it's like 13 to 20% of emails are open read. So it would be skillful for you to gather a phone number so then you can text them, alerts, reminders, et cetera. That's a great way. There's a wonderful book called how to, what is it? Never lose a customer again. And it's beautiful. It's a beautiful book.

Anne Stefanyk (19:11):

It applies to any business. And it really talks about like how when you're engaging with a new client, the first two stages of that are the are the sales and presales. But then you have six steps. Once a person becomes your clients on how to nurture and engage and support that client journey. And that might just be simply as like if they're deciding to work with you and they book their first appointments, there's a lot of cool video. You could just do a little video recording and say, you know, thank you so much for booking an appoint with me. I'm so excited. I really honor the personal relationship that we have together and I want to build trust. So this is a just, and then giving them like a forum to then ask the question to you. So just building that relationship. Cause even though your clients, I mean if they're coming for PT, they might just be a onetime client.

Anne Stefanyk (19:57):

But again, they also might have lots of friends and family and that works. So when their friends and family and network happened to have that, how do you also kind of leverage the website that way? But a lot of it is just clarity. And you'll notice that big way to find out what's missing is interview your last few clients that have signed up, find out what they found was easy, what was difficult, what they wish they had more information. And if they're a recent enough client, they'll still remember that experience and us humans love to help. It's in their nature, right? So you should never feel worried about asking anybody for advice or insights on this. You know, there's even a little tool that you can put on your websites. It's a tool, there's a free version called Hotjar, hot and hot jar.

Anne Stefanyk (20:47):

And it's pretty easy to install. We actually have a blog post on how to install it too. It's really, we'll put that blog posts, but what it allows you to do is it allows you to see where people are clicking and whether they're not clicking on your website. So you can actually analyze, you know it's all anonymous, right? It's all anonymously tracked, but you can do screencast and you can do with these color heatmaps, you can kind of see where people are going. You can track this and it's free, right? Three you can do up to three pages for free. So I feel like the guys looking at stuff like that, you kind of get the data that you need to figure out where your gaps are because what you don't know is what you don't know, right? So I first recommend like getting clear on who your user is, you know, if you specifically take care of a certain set, figuring out where their journey is, what kind of content you'd need for each of those and what the gaps are. And then filled out a content calendar to fill the gaps.

Karen Litzy (21:42):

Got it. And a content calendar could be like a once a month blog post. It doesn't have to be every day. And I even think that can overwhelm you're patients or potential patients, right? Cause we're just inundated. There's so much noise, but if you have like a really great blog that comes out once a month and gets a lot of feedback on it, then people will look forward to that.

Anne Stefanyk (22:11):

Exactly. Exactly. Exactly. And I mean, humans want to get clarity, they want to receive value. And right now we live in an intention economy where everything is pinging at them. So realistically, the only way to break through the noise is just to be really clear and provide what they need. Simple. It's just simple. It's actually, you just simplify it, remove the jargon, you know, make it easy. And I mean a blog post, it could be as short as 300 words. You don't need to write a massive thing. You can even do a little video blog. Yeah. You don't like writing, you can just do a little video blog and embedded YouTube video and boom, you're done. Right?

Karen Litzy (22:46):

Yeah. Yeah. I love this because everything that you're saying doesn't take up a lot of time. Cause like we said before, when you're first starting out as a new entrepreneur, you feel like you've been pulled in a million different directions. But if you can say, I'm going to take one hour, like you said, one hour a month to do a website check-in, right? One hour a month to get a blog post together or shoot a quick video. Like you said, we've all got phones embedded in every device we own these days. So it doesn't take a lot. And I love all those suggestions. Okay. So now I'm in the nurturing phase and what we've done is, because I didn't use jargon, I was simple, clear to the point, filled in the gaps for them. Now those patients that who have come to see me are referring their friends to me and we're starting it all over again. So it's sort of this never ending positive cycle.

Anne Stefanyk (23:41):

Exactly, exactly. And that's what we really frame. We call it continuous improvement, which is the methodology of that. You always need to be taking care of it, nurturing it, loving it. Because if you just let it sit, it will do you no good. Right. And that's where you know, when you're that little bit of momentum and it's about pacing yourself and choosing one goal at a time. Like if you're feeling like, Oh my gosh, where am I going to start? What am I going to do? You know, just say, okay, I just want my site to go faster. Just pick one goal. You run it through the speed test, it's scoring forward of a hundred you're like, Oh, I need to make my site faster. So then you look at that and you say, okay, I've learned, you know, big images create large page speed load. So it'll tell, you can go through and look at your images and say, Oh, I need to resize this image. Or maybe I need, if I'm using WordPress, put a plugin that automatically resizes all my images. You know, a lot of it is content driven that you can kind of make your cycle faster with an accessibility. Accessibility is so dear and near to my heart.

Karen Litzy (24:44):

When you say accessibility for a website, what exactly does that mean?

Anne Stefanyk (24:48):

I mean, yes. So that means that it is technically available for people of all types of ranges of ability from someone who is visually impaired to someone who is physically impaired, temporarily or permanently disabled. So if you think about someone who's got a broken arm and maybe it's her dominant arm. I'm doing everything with my left. Try using a screen reader on your own website and you will be shocked that if you can't type you know with your hands and you're going to dictate to it, you'll be a, is how your computer does not actually understand your words. So it's about making your website really technically accessible with consideration. Four, font size, color contrast. Yeah. Images need to have what we call alt tags, which is just a description. So if your image is like one, two, three, four, five dot JPEG, you would actually want to rename it as lady sitting in a chair reading in a book dot JPEG because that's what a screen reader reads. Oh. So it's about the technical stuff, so that if somebody needs to use a screen reader or if somebody can't use their hands from physical, they can't type, they're reading, they're listening to the website. It's about structural, putting it together correctly so the tools can output.

Karen Litzy (26:12):

Mmm. Wow. I never even thought of that. Oh my gosh, this is blowing my mind. Anyway, so there's tools out there to look, let's talk about if you want to just maybe give a name to some of those tools. So how about to check your websites?

Anne Stefanyk (26:28):

Yeah, so it's Google page speed and it's just a website that you can go in and put your URL. There's another plugin called lighthouse, and lighthouse is a plugin that you can use through Chrome. And then you just on that and it'll output a report for you. And some of it's a little nerdy, right? And some of it's, you know, some of it's very clear. I love it. They, they'll put some jargon, let's just say that they don't quite understand that not everybody understands laptop, but if you're on a tool like Shopify or Squarespace or Wix, which a lot of like first time entrepreneurs, that's a great place to start. It's really affordable. They take care of a lot of those things built in. So that's the benefit of kind of standing on the shoulders of giants when it comes to those. But lighthouse is a good tool because it checks accessibility, performance, SEO and your coding best practices.

Karen Litzy (27:28):

Oh wow. Okay. So that's a good tool. Cool, any other tools that we should know about that you can think of off the top of your head? If not, we can always put more in the show notes if people want to check them out. But if you have another one that you wanted to throw out there, I don't want to cut you off, if you've got more.

Anne Stefanyk (27:45):

Oh no worries. There's lots of different checkers and I think the big thing error is just to be able to understand the results. So I'm always a big fan of making technology really accessible. So if you do need help with that, you know, feel free to reach out and I can get more help. But generally we look at search engine optimization, which is are you being found in Google? And there's some tools like SEO. Moz is one. And then we look at accessibility, is it accessible to all people and then we look at performance, can it go fast, fast, and then we look at code quality, right? Like you want to make sure you're doing your security updates cause it's a heck of a lot cheaper to do your security updates than unpack yourself if there is.

Karen Litzy (28:27):

Oh gosh. Yeah. Yeah, absolutely. And, like you said, on some of those websites, that security part might be in like already embedded in that or is that, do you recommend doing an external security look at your website as well?

Anne Stefanyk (28:44):

Exactly. Most of the time when you're using a known platform like Shopify or if you're using WordPress or Drupal, then what you want to do is you want to work with a reliable hosting provider so they will help you provide your security updates. It's just like you would always want to lock your car when you would go out in the city. It's just like some do your security updates. So, but yeah, that's the benefit of being on some of these larger platforms is they have some of that stuff baked in. You pay a monthly fee but you don't have to worry about it.

Karen Litzy (29:14):

Right. Perfect. Perfect. And gosh, this was so much good information. Let's talk a little bit about, since we are still in the midst of this COVID pandemic and crisis and what should we be doing with our websites now specifically to sort of provide that clarity and calmness that maybe we want to project while people are still a little, I mean, I watch the news people are on edge here.

Anne Stefanyk (29:47):

Yeah. I think everybody's a little on edge, especially as things are starting to open. But nervous about it. All right. So I think the main thing that you can do is provide clear pathways. So if you haven't already put an alert on your website or something, right on your homepage, that speaks to how you're handling COVID that would be really skillful in, that could just be if you, you know, Mmm. Some people have an alert bar, they can put up, some people use a blog post and they feature it as their blog posts. Some people use a little block on their home page, but just something that helps them understand that what that is, and I'm sure most of you have already responded to that cause you had to write, it was like the first two weeks, all of our clients were like, we got to put something on our website.

Anne Stefanyk (30:26):

Right. And so, from there is I think being very mindful about how overwhelmed your peoples are and not trying to flood them with like tips and tricks on how to stay calm or how to parent or how to, you know, like that's where everybody's kind of like on overwhelm of all the information. So for right now, I would say that it's a wonderful time to put an alert up so people visit your site. If you've switched to telehealth and telemedicine, it'd be a great time to actually clarify how to do that. So if they're like, okay, I'm going to sign up for this and I want to work with you. Mmm. But how does it work? Are we gonna do it through zoom? Is it through Skype? Is it through FaceTime? Is my data secure? You know, like you said, updating all your FAQ is like, we're in this weird space where we really have almost like no excuse to not come out of this better.

Anne Stefanyk (31:16):

You know, as an entrepreneur we have this like lurking sense of like, okay, I gotta make sure I'm doing something. And the web is a great place to start because it is your first impression. And to kind of go through your content, and maybe it is if you don't have a blog set up is setting up a blog and just putting one up there or writing two or three and not publishing it until you have two or three. But it is kind of figuring out what is your user need and how do you make it really easy for them to digest.

Karen Litzy (31:41):

Perfect. And now before we kind of wrap things up, I'll just ask you is there anything that we missed? Anything that you want to make sure that the listeners walk away with from this conversation?

Anne Stefanyk (31:56):

I think the big thing is that this can all get really confusing and overwhelming very quickly. And all you need to just think about is your humans that you're servicing and like how can I make their journey easier? And even if it's like if nothing else, you're like, Hey, I'm going to get a text messaging program set up because I'm going to be able to actually communicate with them a lot faster and a lot easier. Or, Hey, I'm just going to focus on getting more five stars reviews on my Google profiles, so I show up. I'm just going to make that the focus. So I think the big thing is just a one thing at a time, and because we're in a pandemic, set your bar really low and celebrate when you barely hit it because we're all working on overwhelm and overdrive and we're all exhausted and our adrenals are depleted. Even in overdrive syndrome for like 11 weeks or something. Now I know it's kind of like, Oh my goodness, my websites maybe a hot mess. I'm going to get one thing and I'm going to give myself a lot of wiggle room to make sure that I can take care of the pressing needs and just being really like patient because it isn't a journey where you're going to have your website and your entire business.

Karen Litzy (33:00):

Yeah. We never got to turn off your website. Right. I hope not. Oh, you never will. Right. Telemedicine is going to give you a new kind of way to practice too. It's revolutionizing the way we treat patients. A hundred percent yeah, absolutely. I personally have have been having great success and results with telehealth. And so I know that this is something that will be part of my practice going forward, even as restrictions are lowered. I mean here in New York, I mean you're in San Francisco, like we're both in areas that are on pretty high alert still. But this is something that's definitely gonna be part of my practice. So if there is a silver lining to come out of this really horrible time, I think that is one of them. From a healthcare standpoint, I think it's been a game changer because you're still able to help as you put it, help your humans, you know, help those people so that they're not spinning out on their own. So I love it. Now final question and I ask everyone this, knowing where you are in your life and in your career, what advice would you give yourself as a new graduate right out of college? So it's before, even before you started.

Anne Stefanyk (34:21):

Yes, yes. Honor my downtime. I think especially as a girl boss, that's always like, I've been an entrepreneur pretty much since I was in high school. I never took weekends and evenings for myself until I became like a little older. I would've definitely done more evenings and weekends because the recharge factor is just amazing for the brain. When you actually let it rest, it figures out all the problems on its own, get out of your own way and it'll like just, you know, even this COVID stuff. I find it so interesting that you know, as a boss you feel like you want to do so much and you want to get it done and you want to help your staff and you've got to figure out how to be there for them and then it's like, wait, you gotta put on your own mask before you put it on the others.

Anne Stefanyk (35:04):

And I feel like healthcare professionals, it's like so important for you to honor that little bit of downtime that you have now. Yeah, I mean, if I knew that back then, I'd probably be way stronger way would have honored myself. And as a woman, self care seems, we put it like second to our business and our families and second, third, fourth, fifth. So it's like, you know, advice to pass out. Let's take care of you. Yeah. It will be great. You will do wonderful things. Take care of you. You'll feel great. You know, I broke my ankle because I wasn't taking care of myself. Yeah.

Karen Litzy (35:36):

Oh wow. What advice. Yeah. Honor the downtime. I think that's great. And I think it's something that a lot of people just don't do. They think that in that downtime you should be doing something else. So you're failing.

Anne Stefanyk (35:48):

Yeah. And it's just so silly. It's just this weird, you know mental game that we have to play with ourselves. I listened to one of your recent podcasts and I just loved the girl that was on there said like, you know, successes is 20% skill, 80% of mind game. And I could not agree with that. You know, having a company full of women, imposter syndrome is the number one thing that I help coach my females with. It's like, no, you know exactly what you're doing because nobody knows what they're doing. We all learn, right? There's no textbook for a lot of this stuff. Like we went to school, there was a textbook, there was structure. We got out of school and now we're like go learn. It's like okay, okay so I find the entrepreneurial journey so cool. And that means like kind of like also finding out other tribes like where can we lean into and that's why I love you have this podcast cause it really focuses on like building a tribe of entrepreneurs that are focusing on taking it to the next level. Like how can we be empowering them to do their best, be their best selves.

Karen Litzy (36:47):

Exactly. I'm going to just use that as a tagline from now on for the buck. Perfect marketing tagline. Well and thank you so much. Where can people find more about you and more about kanopi.

Anne Stefanyk (37:00):

So you can go to kanopi or you can simply just look for me just go to kanopi on the Googles and you'll find me. But if you want to reach out via LinkedIn or anywhere, I'm always just a big fan of helping people make technology really clear and easy to understand. So find me on LinkedIn or on stuff and we can chat more there.

Karen Litzy (37:23):

Awesome. Well thank you so much. And to everyone listening, we'll have all of the links that we spoke about today and I know there were a lot, but they're all going to be in the show notes at podcasts.healthywealthysmart.com under this episode. So Anne, you have given so much great information. I can't thank you enough.

Anne Stefanyk (37:39):

Well thank you so much for it. I'm really grateful for the work that you're doing. I think it's fantastic.

Karen Litzy (37:45):

Thank you. And everyone else. Thank you so much for listening. Have a great couple of days and stay healthy, wealthy, and smart.

 

 

Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram  and facebook to stay updated on all of the latest!  Show your support for the show by leaving a rating and review on Apple Podcasts!

Jun 24, 2020

On this episode of the Healthy, Wealthy and Smart Podcast, Jenna Kantor guests hosts and interviews Gabbi Whisler on anxiety. Dr. Gabbi Whisler is no stranger to anxiety and depression. After years of struggling to find her path, she landed on physical therapy and has been combining the two worlds together, the use of physical therapy to help treat and coach patients with anxiety. No system ever works alone and when the physical, the mental, emotional and spiritual can be all addressed, then that is when true healing can be found. 

In this episode, we discuss:

-When anxiety manifests in the career cycle of a physical therapist

-3 practical steps towards mastery over your anxiety

-Why communication is important to break down the stigma surrounding mental health

-The future role for physical therapists in mental health treatment

-And so much more!

 

Resources:

Gabbi Whisler Instagram

Gabbi Whisler Facebook

Mind Health DPT Website  

 

A big thank you to Net Health for sponsoring this episode!  Learn more about the Redoc Patient Portal here.

 

                                                                    

For more information on Gabbi:

Dr. Gabbi Whisler is no stranger to anxiety and depression. After years of struggling to find her path, she landed on physical therapy and has been combining the two worlds together, the use of physical therapy to help treat and coach patients with anxiety. No system ever works alone and when the physical, the mental, emotional and spiritual can be all addressed, then that is when true healing can be found.

 

“I've shared intimately my experiences with anxiety, panic attacks, alphabetizing, fixations, and suffering. Meds failed me. Doctors failed me. Anxiety controlled my life. I was drained, exhausted and defeated. I knew something had to change and I had to do it myself. I created freedom. You can too.”

 

For more information on Jenna:

Jenna Kantor (co-founder) is a bubbly and energetic girl who was born and raised in Petaluma, California. Growing up, she trained and performed ballet throughout the United States. After earning a BA in Dance and Drama at the University of California, Irvine, she worked professionally in musical theatre for 15+ years with tours, regional theatres, & overseas (www.jennakantor.com) until she found herself ready to move onto a new chapter in her life – a career in Physical Therapy. Jenna is currently in her 3rd year at Columbia University’s Physical Therapy Program. She is also a co-founder of the podcast, “Physiotherapy Performance Perspectives,” has an evidence-based monthly youtube series titled “Injury Prevention for Dancers,” is a NY SSIG Co-Founder, NYPTA Student Conclave 2017 Development Team, works with the NYPTA Greater New York Legislative Task Force and is the NYPTA Public Policy Committee Student Liaison. Jenna aspires to be a physical therapist for amateur and professional performers to help ensure long, healthy careers. To learn more, please check out her website: www.jennafkantor.wixsite.com/jkpt

 

Read the full transcript below:

Jenna Kantor(00:03):

Hello. Hello. Hello. This is Jenna Kantor with the podcast, healthy, wealthy, and smart. I'm here with Gabbi Whisler, like give a little whistle and I'm so excited to be jumping on and talking about anxiety and if you can tell from my energy, Oh gosh, I never deal with that. What physical therapist deals with anxiety. So first of all, Gabbi, thank you so much for popping on. What got you interested in really focusing on anxiety for physical therapists? Why this passion? Why not just treating patients and focusing on the patients and their anxiety?

 

Gabbi Whisler:

Yeah, so it's kind of an ironic story because I was out in California working as a travel PT. I was maybe four or five months out from graduation from PT school and I was miserable. I was like, I cannot do this the rest of my life kill me.

Gabbi Whisler(00:59):

I just can't. It was awful. And Andrew Tran, owner of physio memes is my now roommate, but he was actually across the country, I think in North Carolina maybe. And he was one of my colleagues that do travel PT to somewhere and I called him and I was like, Andrew, I can't do this. It's miserable. And I don't know what else to do. I just racked up $180,000 in debt. Like I'm supposed to love this. It's supposed to be great. I'm helping people but I hate it. What do I do? And he was like, well, what do you want to do? What are you good at? What would you love? And I was like, I honestly have no idea. So I had to go to the drawing board and really do some digging. And I was like, what would I love? And the very first thing that popped in my head is I dealt with anxiety all my life.

Gabbi Whisler (01:38):

I'm in a much better place. I can't think of anything better than helping other people to get to that destination as well. And I was like, I can do that as a PT though, right? And I called Andrew and I was like, am I even allowed to do this? Like is this a thing? And he was like, well it is if you make it. And something just clicked. And I was like, well that's kind of cool and ever since I still don't always know what I'm doing but I'm making the path to be able to do it. So it's a lot of fun. But I still, like I said, I don't know what I'm doing most days and I still deal with anxiety myself as well. So it's kind of this ironic but fun twist because that allows me to connect with my clients now on a deeper level than as a PT.

Gabbi Whisler (02:19):

I've never dealt with a shoulder replacement or a knee replacement or anything like that to really connect with my patients in the outpatient ortho setting or I've never really had like a major fall to connect with my geriatric patient, but to connect with a 28 year old woman sitting in front of me who's had major anxiety, doesn't want to take meds and it's like, what are my other options? And to show her how to use exercise and kind of monitor what she's eating and drinking and just a mindfulness approach to feel better is incredible. And we can do that. As PTs, we learned about breathing, we learned about reflexes, we learn about exercise and movement and it's a lot of fun.

 

Jenna Kantor:

So I love that. And, why do you think there's the whole thing with anxiety and PT? I think this goes hand in hand with burnout.

Gabbi Whisler (03:07):

Yeah, it does. So from a clinician perspective or from a patient perspective, because it's on both ends actually, which is really focusing on clinician focusing on the physical therapy. Yeah, a lot of it is burnout. A lot of it is expectations that I don't think we're prepared for in PT school. Well I think going into PT school, we have this grand idea that, you know, we're a doctor of physical therapy, we have all this autonomy and we have the ability to almost do what we want. And it's really quite the opposite out there for most of them. Until we realized that we are able to kind of break out of that mold. But in the traditional setting, we're very limited in what we can do and we're dictated and governed by doctors and other clinicians and our patients and insurance, and we think we're going to have all this freedom to make this what we want.

Gabbi Whisler (03:58):

Certainly cannot always do that. And I think that leads to a lot of anxiety that that gap in expectations, expectations from other people and expectations within ourselves in there are aligned. And that's what causes burnout as well. So it goes hand in hand.

 

Jenna Kantor:

Yeah, I totally get that for forgive the sounds, the grumbling sounds, I just want to give a complete, you know, story here that's construction in the building, not me being gassy. Okay. I just want that to be clear as we are all just massive ladies here for anxiety, for anxiety. You were saying, it's interesting where you're saying, I don't know anything about this, but then you clearly have a drive to know more in order to help other people. What is it within you that's getting you to help out other people when you are dealing with it yourself?

Gabbi Whisler (05:00):

Yeah. Yeah. So I know what it's like to be at like that rock bottom and not have any outlet. Cause when I was going through all of this, you know, dealing with anxiety, depression, OCD, I knew in my heart I did not want to take medications. I knew in my heart talk therapy wasn't for me. I had given it a try and I was like, this is just, it's awkward for me. And I never felt like I left there feeling better. So I was like, I'm not going to continue wasting my money. And it was one of those things, I sat down with my primary care doctor and I was like, okay, what's next? And he had no direction for me. And I just remember what that felt like. And now as a PT, I know. So I said, I know, I said I don't know what I'm doing. And that's true. I don't necessarily know the direction my career is going. Yeah. PT, I know what I'm doing.

Gabbi Whisler (05:38):

I know how to prescribe all of these exercises. But at the same time I don't, and I think that's how we all feel in our careers. So really it's not anything I'm normal but knowing that I have tools that other people are searching for, knowing that someone out there needs what I have to offer but I'm just too afraid to put it out there sometimes is what gives me that little motivation or that little push to go ahead and do it anyway. You probably deal with that too cause your niche is so specific and so focused and so high performance. I'm sure you encounter that as well too.

 

Jenna Kantor:

Yeah, I get that. I get that. I hadn't really dealt with anxiety until after the conference. Smart success physical therapy like just this past year. And it was when I came back home and I have a best practice where I work with dancers and all of them were better, which of course it's great, but as business goes freaking out, Oh my God, I was just like, this is the worst thing in the world and we're, for some people that would be something to brag about. For me that was something to significantly freak out about.

Jenna Kantor(06:55):

Awful, awful, awful, awful. I do not recommend anxiety and stress at all. Not even a little, Oh my God, this sucks so bad. So that's my experience with anxiety and it's gone. I've gotten better with it over time and I think that has to do with really acknowledging taking action for myself. So for you, with people, what are your like big overall tips that you just, when somebody reaches out to you and they're like, Oh my God, I'm about to like, collapse my anxiety so bad right now. What are things that you give them to kind of help them out at that point? Yes. So like top five things or three or 20 I don't know what your number, I'm just saying numbers.

Gabbi Whisler (07:54):

Very first thing I tell them is give yourself grace and permission. Cause so often we can find ourselves to the notion that anxiety is this horrible thing and cause anxiety and depression are just emotions truly like their emotions and we so often label them as good or bad emotions in general and we always strive to feel happy and we strive to run away from anxiety and depression. The very first thing I told girls or guys or whoever I'm working with is let it be your anxious, like accept it and just sit with it for a minute and allow your body to feel that because your body needs it. It's very uncomfortable. It's very uncomfortable. It's like not butterflies, but it's like, Oh it's very uncomfortable. It's hard. Her own skin. That's the best word that I can think of. Like you literally want to run out of your own body.

Gabbi Whisler (08:43):

Yeah, yeah. Lots of you can have a moment. So that's what I was like, give yourself the grace to be human. The fact that you're experiencing this and then use it as an indicator. So like, so often we're controlled by our emotions and they tell us how to live our life. You know, when we were anxious we want to sit in bed but instead use as an indicator. What's this trying to tell you? Like what's going on in life? You feel this way? And beyond that, what can you do about it? So like you said, action, what action can you take to move on from this? Cause so often we let it paralyze us, but that's really when we need to take some sort of action, whether it's to talk to someone or maybe getting a medication or going to talk therapy or going for a run or lifting weights or like what needs to happen to make you feel better.

Gabbi Whisler (09:31):

And it's different for every person. So those are my top three starting points. I guess. Three is my number, but really it's giving yourself that grace, using as an indicator and then taking action.

 

Jenna Kantor:

Yeah. Yeah, that definitely makes sense. When you're saying give grace, what are ways that you can, because it's not just like, okay, I'm giving myself grace. What are things where you could actively be, you know, literally taking actions, you know, like cleaning the dishwasher, you know, what are things that you could do to help you start learning what it is to give yourself grace? Do you know what I mean?

 

Gabbi Whisler:

Yeah. So I'll just share examples of what I do in my own day cause I think that might be easier. But when I get anxious, I literally will sit with myself and say, Hey Gabbi, it's really okay that you feel this way.

Gabbi Whisler (10:18):

And I just kind of let my body off sit with it for a minute, you know, I recognize, okay, my chest is tight, my fingers are tingling, my eyes, my vision sometimes changes just a little bit. And I'm like, this is normal. It's nothing to panic over. This is my body's response. Okay. It's okay in the moment. Like it doesn't take it away, but it's like, okay, I know I'm not dying in the moment because often we do, right? Like, we're like, Oh my gosh.

Gabbi Whisler (10:55):

So I'll sit with it and then from there, a lot of times what I'll do is I like to have one person in mind for, you know, if I'm feeling angry, it might be my sister that I call if I'm feeling hurt, it's my mom that I call who's really good at helping me through whatever I'm feeling in the moment. And I always have that on the back burner and that's the first thing that I'll do is get it out because the more we hold it in ourselves, the worst off we get. And sometimes it's not even talking to the most sometimes like I'll literally sit in my room in front of a mirror and talk to myself.

Jenna Kantor(11:46):

It’s cool you can out like get it out. Like you did get it out in the universe. You know, before we started recording today, you were sharing something with me about wanting to just get out in the, because once you do that, you're more likely to follow through and take action and feel better about it. It's true. It's true. Like I'm doing this, I'm doing this. It's true. But I never thought about it in a way where you would use it as a tool with when you're like feeling it because it's like a zit that's dying to pop.

Jenna Kantor(12:26):

Yeah. So for you, where do you find in the physical therapists life with people reaching out you a common time when people, are you actually, okay, I'm going to actually separate this out. Common point in someone's career, whether it be student, new, grad or professional, where are you finding a real, like this is where it's happening a lot specifically in the physical therapy career.

 

Gabbi Whisler:

The answer's kind of funny, but all of the above. So for students I'll kind of go through each one cause I think we all do, it's just a matter of like, so each stage will have points throughout it that are very specific when that anxiety is like greatest. But for students it's typically right before the NPTE or right before an exam, like a lab practical that students are reaching out to like, Oh my gosh, I'm so anxious.

Gabbi Whisler (13:18):

I don't know how to handle this. I've never really experienced anxiety until now. Usually that's when they're noticing it is in grad school. And they're like, what can I do? And then, you know, I'll try to talk with them through that. As far as anxieties go, a lot of new grads experience it. Cause again, it's expectations. They're in school for so long and they have people guiding them and now all of a sudden they're kind of fed to the wolves and they're expected to do things that they weren't, they weren't yet in their minds, comfortable with. And also seasoned clinicians, a lot of times they're like, it's either burnout, it's not finding satisfaction in their career. It's wanting something more like, not feeling, they're not necessarily burned out, but they're also, they feel like they're doing the same thing day in and day out and they're not contributing to the world in a greater way, I guess.

Gabbi Whisler (14:08):

Or they're not seeing, yeah, just frustrating for them, but also sad from an outside perspective. Cause they're still making a huge impact, but they're just, it's routine for them now, so they're not seeing, so it's not as fulfilling. They feel like they're very separate from what they're doing.

 

Jenna Kantor:

Yup. Exactly. Exactly. Wow. That's powerful. Right. Because they're still, they're changing people's lives. Like every 20 minutes are changing someone's lives, but they're just doing it so often they don't see it. Where does shame come into all this?

 

Gabbi Whisler:

Ooh, that's a good question. I think it's very specific person to, but probably again, that mismatch in expectations so they don't feel like they're providing the care that they should be for their patients and then in front of their patient, you know, they have to continue and be professional and carry on throughout their day, but inside their brain, they're like, am I really the best person to be helping this person? You know, we tend to tell our story ourselves, stories like that. So that's true. That's insanely true.

Jenna Kantor(15:44):

Yeah. Wow. Yeah. If there was going to be, I would say one big vision you have for physical therapists regarding anxiety, what would be your big like one day Do you know what I mean?

 

Gabbi Whisler:

So this is kind of a far stretch, but I'll bring it back full circle model clinician because right now as PTs we can't treat anxiety or we can't treat mental health. It's just not like fully within our scope of practice. So myself and another PT are actively working to try to get PT into, there's a world Federation for mental health and there's other countries that are participating in and it's specific to physical therapy. So we're hoping to get PTs in that role because I think right as PTs were very uncomfortable with the idea of mental health because it doesn't get talked about in PT school. We don't really talk about it with our patients. It's one of those things we try to skate around as much as possible and there's some clinicians out there who are great at it and I think we're as a whole, we're getting better.

Gabbi Whisler (16:36):

But the more we can certainly the more we can start talking about it to our patients, the more we feel comfortable within ourselves talking about it to other people and opening up as well. Cause if we can't get other people to open up, how are we ever going to open up ourselves? So it goes both ways. If we can't open up, then we can't get other people to open up. So I think once we're able to, as PTs kind of get into this role just a little bit more, and it's not that every PT has to treat mental health specifically, but we find ways of bringing it into, because we know if someone's struggling with their mental health, their physical health suffers. And so if we're not addressing that, it's so true. And if we're not addressing that first with our patients, then we're probably not getting them the results that we need.

Gabbi Whisler (17:22):

But if we can't do that, if we don't know how, and that goes back to our own lives as well. So it all kind of comes full circle. So my big goal is to get PTs to be able to go to conferences at CSM, for example, and have a course, have a talk on the side of mental health. Cause right now there's very little out there for us. So truly but surely like nothing. And it's because we're so uncomfortable with it. So that's my dream is to be able to get us in that scope of practice and also show clinicians how to handle in our patients. And I'm hoping through that they see how they can handle it within themselves as well. And kind of tackle it from that approach.

 

Jenna Kantor:

Yeah, yeah, that makes sense to me. Oh my gosh, this is perfect. Thank you so much for coming on. I would love to ask for you to just have your mic drop moment and this could be for anyone who may be dealing with anxiety right now and I would love for you to just acknowledge that person and just give him some big picture advice if they're really feeling stuck.

Gabbi Whisler (18:46):

Yeah. So, Oh my gosh, I have so much in my head right now. Start with the word you. So if you are feeling super anxious and having a hard time handling this, especially throughout the workday, my biggest piece of advice for, I guess this is the direction I would go, so specific to clinicians who are feeling anxious throughout the day. And I actually have a couple girls who I work with right now, her PTs and their new grads and they're feeling this way too. They feel like they have to compartmentalize this and they can't talk about it at work. Talk to someone like whether it's your boss or a coworker, someone there needs to know that you're dealing with this because if you continue to try to do this on your own, it's only going to snowball and then your boss is going to come to you one day and be like, what in the hell is going on right now?

Gabbi Whisler (19:35):

You know what, what? Cause your performances is often the way you speak to patients. So the earlier you can nip it in the bud and let them know, Hey, I'm dealing with this right now. I don't want to go into details. Or you can say whatever the heck you want to, but they need to know about it. And the more comfortable you get talking to your boss, the more comfortable your boss gets talking to their employees about it as well. So you might be opening up the door for another clinician right next to you because more than likely everyone in your building is dealing with some form of anxiety.

Jenna Kantor(20:16):

That's true. It's not talking about it. That's very true. That's very, very true for clinicians. I love that. Oh my gosh. Thank you so much for coming on. How can people find you, find you and contact you. Thank you.

 

Gabbi Whisler:

First, thank you for having me on. But yeah, @mindhealthDPT, that's my Instagram and Facebook handles, so they're free.

 

Jenna Kantor:

Got it. Wonderful. Thank you so much for coming on. This was an absolute joy. I think that this is going to be extremely helpful for people who are dealing with anxiety. So you guys don't be afraid to reach out to her. She's here to help you. In fact, you're one of many.

 

 

Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram  and facebook to stay updated on all of the latest!  Show your support for the show by leaving a rating and review on Apple Podcasts!

Jun 15, 2020

On this episode of the Healthy, Wealthy and Smart Podcast, I welcome Christa Gurka on the show to discuss marketing. An orthopedic physical therapist specializing in Pilates-based fitness, rehabilitation, injury prevention and weight loss, Christa Gurka’s reputation speaks for itself. With two decades of experience training those of all ages and fitness levels, the founder/owner of Miami’s Pilates in the Grove, which serves the Coconut Grove and South Miami communities, believes in offering her clients personal attention with expert and well-rounded instruction.

 

In this episode, we discuss:

-Why you should design an ideal client avatar

-How a small marketing budget can make a big impact

-Crafting the perfect message to attract your ideal client

-The importance of continual trial and error of your message

-And so much more!

 

Resources:

Christa Gurka Instagram

Christa Gurka Facebook

Pilates in the Grove

Christa Gurka Website

FREE resources  

 

A big thank you to Net Health for sponsoring this episode! Learn more about the Redoc Patient Portal here.

 

For more information on Christa:


An orthopedic physical therapist specializing in Pilates-based fitness, rehabilitation, injury prevention and weight loss, Christa Gurka’s reputation speaks for itself. With two decades of experience training those of all ages and fitness levels, the founder/owner of Miami’s Pilates in the Grove, which serves the Coconut Grove and South Miami communities, believes in offering her clients personal attention with expert and well-rounded instruction.

 

Read the full transcript below:

Karen Litzy (00:01):

Hi Christa, welcome to the podcast. I'm happy to have you on. So today we're going to be talking about three strategies for marketing for cash based practices. And the good thing about all of these strategies is they don't cost a lot of money, right? And that's important when you're starting a business. You know, we don't want to have to take out a bunch of loans, we don't want to have to spend a lot of our own money. We want to try and start up as lean as we can. And so I'm going to throw it over to you to kick it off with. What is your first strategy for marketing for cash based practices?

Christa Gurka (00:43):

Perfect. So one of the reasons I just want to start with saying why I'm a little passionate about this marketing thing is because myself included when I first started, I really kind of, I felt like I started backwards almost like from the ends. And I think it's really so helpful for people to learn to start kind of from the beginning. Right? So my very first strategy that I think is really, really important is to have a real good idea of who your ideal customer or who your target audience is. And I get often some pushback from people saying, well, everybody can use my services. Of course everyone can use physical therapy. Absolutely. And that doesn't mean you have to single anybody out. But you know, I think Marie Forleo said it or maybe somebody said it to her, but when you speak to everyone, you really, you speak to no one and so slew thing, your who, your ideal customer is, how they feel, how they think.

Christa Gurka (01:45):

It's very, very beneficial. So if you want, I can kind of go through like a few questions that I use to kind of narrow down who that person is. So one of the things to know when we go through our ideal customer, we actually give this person a name, an age, a gender demographic, married, not married, retired, not retired, education level, median income. And when we do anything in our business now, so we are ideal customer, her name is Georgia. And so we say every time we have a meeting we say, well what will Georgia think about this? Well Georgia like this, so we're Georgia not like this. So that's the very first thing. And we refer to that person as their name. And then you want to go through like what are their biggest fears about whatever problem they're looking to solve.

Christa Gurka (02:40):

People buy based on emotion. And so get into the underlying source of that emotion is really, it can be very powerful. So what are their fears? What do they value? Right? Cause when it comes to money, people paying for those, it's not always a dollar amount. It's more in line with what do they value? And if you can show these clients that you serve, offered them a value, the money, the dollar amount kind of becomes obsolete. So things like that. What could happen, what would be the best case scenario if this problem were solved for them? What would be the worst case scenario of this problem were never solved. So in terms of physical therapy, let's say generalize orthopedics, right? Back pain. 80 million Americans suffer from back pain. Yeah. So an easy one to start with, an easy one to start with, right?

Christa Gurka (03:35):

So let's think of, you know, back pain, it's so general, right? But if you can say, what is the worst thing that can happen because of this back pain, right? So maybe the worst thing that could happen is this person loses days at work because they have such bad back pain, they can't sit at their desk or maybe they have such bad back pain that there performance drops and so that cause they can't concentrate. And so now maybe they lose their job or they get emoted because their back pain. So the worst case scenario is maybe they're not, they ended up losing their job because of back pain. So you kind of take it all the way back. And then if you could speak to them about how would it feel if we were able to give you the opportunity to sit eight hours at a desk and not think of your back pain one time and what would that mean to you? So really kind of under covering a lot, a lot, a lot about who your ideal customer is. It's my number one strategy.

Karen Litzy (04:39):

And I also find that it's a great exercise in empathy. So for those that maybe don't have that real innate sense of empathy, it's a way for you to step into their shoes. And I always think of it as a what are their possible catastrophizations? So if we put it in the terms that the PT will understand, like when I did this number of years ago, I sort of catastrophized as this person. What would happen if this pain didn't go away? I wouldn't be able to take care of my children. I wouldn't be able to go to work. It would affect my marriage. My marriage would break up, I would be a single mom. I would, you know, so you can really project out really, really far and then reel it back in, like you said, and say, well, what would happen if they did work with you? What is the best case scenario on that? So yeah, I just sort of catastrophized out like super, super far and it's really helpful because when that person who is your ideal client then comes to you and you're doing their initial evaluation, you can ask them these questions.

Christa Gurka (05:51):

Yeah. Yeah. It's very powerful. And I love how you brought in, like you empathize with them and you know, and by the way, a lot of our clients do catastrophize, right? And we have to reel them, we have to reel them back in. So that was a really great point. I also think it can be sometimes on the flip side where somebody maybe comes in and their goal is very benign. Maybe it's, I really want to be physically fit. I want to look good. Right? So you kind of think, well, what's the catastrophe if that doesn't happen? But maybe, maybe they're in a relationship where they're a partner. Aesthetics is a big part of that. And maybe they feel insecure and they feel if they don't present well to their partner, their partnership may dissolve whatever the case may be. So now you're getting to an underlying, it really is more emotional than physical, right? So now you're being able to empathize with them in that way and speak to them in those terms, give them positive things that maybe they don't even realize they need.

Karen Litzy (06:53):

Exactly. And then it also seems like once you're in those shoes or walking in their shoes, in their footsteps, however you want to put it, that’s when that person does come to you, you can have a conversation with them that's maybe not so much centered around back pain, but that’s centered around their life. And that's when people make that connection with you. Right? So when we're talking to patients who are not sure that they want to start physical therapy, if we kind of get them, they're much more likely to come and see us. So it's not about the back pain, it's not about the knee pain. It's about how are we going to make a difference in their life. And if we can make that, like harking back to what you said earlier, it's an emotional experience and people tend to buy things based on emotions and their gut feelings and how they feel. So if we can tap into that in a really authentic way, then talk about a great marketing strategy.

Christa Gurka (07:58):

Excellent. Exactly.

Karen Litzy (08:00):

And then, okay, so we've got our ideal customer, client avatar. Now what do we do?

Christa Gurka (08:10):

Great. Now what? So you've got your ideal customer, right? And so by the way, people also sometimes think like, well, I don't want to pigeonhole myself into this, right? But by the way, your ideal customer may change. It's okay first of all to change. And he doesn't have more than one. You can have more than one. Certainly we have more than one in our business. And by the way, you may start out thinking about one ideal customer, but the people that keep coming back, maybe somebody else and you're like, Oh, obviously, maybe I have to rethink this. Right? And again, it doesn't mean that you can't serve someone else. It just means that when you're thinking about marketing and stuff, you're going to go after everything should funnel into one specific thing. So then the next step in the marketing is, okay, so where do these people live?

Christa Gurka (08:59):

And I don't mean live like literally what neighborhood do they live in? Where do they live in terms of getting their news information? Where do they live in terms of being on social media? Where do they live in terms of, you know, what do they value as far as like personal or professional life? So one thing I see is, you know, people you know are like, well, I'm gonna put an ad in the newspaper, that's great. But if you live in an area where nobody reads the newspaper, then you're putting your money somewhere that you're not going to be seen. Or maybe the flip side is, well, I'm going to do a lot of stuff on Instagram. Well, if you were, your clientele is over 65 studies show that most people over 65 are not on Instagram. That doesn't mean they're nobody is, it just means, you know, or vice versa.

Christa Gurka (09:50):

If your client is 25, they're probably not on Facebook anymore, right? So, then again you can be, this is why it won't cost you a lot because you can narrow down where you are going to spend your money, right? Also, if you're running Facebook ads, which will then go on Instagram you can narrow down in your audience when you build out your audience to be very, very, very specific based on are you a brick and mortar establishment? So are you trying to get people to come in to your place? Right? So you want to say, well, if people are not, if you know that your ideal customer's not convenience as important and they're not going to travel more than five miles, you shouldn't market to people that live or work outside of a five mile radius from your studio. Right? So that's important to know as well as also maybe your customer gets their information from friends or relatives, you know, or like someone said, you know, you need to go see Karen, she's been really great for me and that's how they get to you.

Christa Gurka (11:00):

So how can you then get in front of your client's friends, right? Maybe you could do an open house, invite a friend, bring them in. Let's do one-on-one, you know, just kind of like a talk, right? Maybe you could bring them in if, say your ideal customer, let's say your ideal customer is in their sixties, what are some things that people in that age group are going through? Maybe you can have a talk about that specific thing. Not necessarily a therapy, but now you get everyone to kind of come to you. It's not even about what you actually do cause you can need them based on where they are. And most people, by the way, they say there's the numbers range, but usually they have to see you about seven times or have seven points of contact with you before they're comfortable buying from you. So these are just way to get people to know, like, and trust you and then they'll buy from you. So that's strategy number two. Once you know really who your customer is and they could take a couple years to really start to peel back all the onion of that, then the next thing is be where they are, be in front of where they are.

Karen Litzy (12:13):

Yes, absolutely. And, I love that you mentioned the different types of social media and who's on where, because like you said, this is something that isn't going to break the bank because you have narrowed down exactly where you want to spend your money. Right? So we're taking who that ideal person is, where finding out where they like to hang out, what they read, who they're with, all that kind of stuff. So that when you build out a marketing campaign for your business, you kind of know who and where to target.

Christa Gurka (12:49):

Right? Exactly. Yes. And even so, even with Facebook, yeah. When you build out your audience, right? So you can have a variety of audiences. You can create lookalike audience, which I'm sure is like a whole podcast onto itself, but you can also target people that like certain brands. So when I do my ideal customer, I'm like, well what brand do they resonate with? In other words. So I would say that our brand is a little more towards Athletica versus like Lulu lemon. And that's not to say one is better than the other. It just means that's who my generally customer is. And why, what do they value? They value that customer service. You get, you know, Athletica has like a, you can take anything back all the time, right? So when you build out a Facebook ad, you can also target, that's right. They've bought from Athletica online. Right. So now you're reaching people. So you kind of near just keep narrowing it, narrowing it, narrowing it down, which can be, you know, other interests is your client. Do you do pelvic health? So obviously women, although men do it right, if moms can you target people that like mom influencers on Facebook or on the internet. So these are all just ways that the more you know about them, then you can use that in your marketing strategies afterwards.

Karen Litzy (14:15):

Absolutely. Fabulous. Okay. So know who the person is, know where they're hanging out. What's number three?

Christa Gurka (14:23):

Okay. So number three to me is the most important, the most, most important. And that really is messaging. So when you're working with your ideal, when you're working through that ideal customer you know, workbook getting to them, to you for them to use their own language for you. So I see this very, very commonly, and I am sure you can attest to it too. When physical therapists, we love what we do. We are passionate about movement and anatomy and biomechanics but you know what, the general population has no idea what we're talking about. None. Zero. Yeah. And so oftentimes I feel like, and by the way, I'm not saying I did this for a long time too. I think that we're trying sometimes to get other practitioners to say, Oh, that's a really good therapist. So we're talking about pain science and biotech integrity and fascial planes and the general population.

Christa Gurka (15:32):

The end consumers, like I have no idea what you're talking about. So you need to speak to them at their level based on what their problem is. And kind of like how we spoke about before. It's not always the back pain, it's what the back pain is keeping them from doing. Right. it's not always, let's take pelvic health for example. Right? A lot of pelvic health issues or not necessarily painful. Okay. So say you have moms, this is super, super common stress incontinence. They leak, they leak when they jump and they go to CrossFit and they're embarrassed to start with a jump rope because they, it's not, why? Why do women go 16 years after childbirth? Because you know what? It's not really painful. So they don't consider it a problem. Like physical therapy is not going to help me with it. So, but if you say to them, Hey, that might be common, but that's not normal, and guess what?

Christa Gurka (16:25):

There's a solution to that, you know? That is something that will resonate with them. Do you like things like, do you feel, do you worry when you're out at a restaurant as it gets later and later that the line at the bathroom is going to be too long and you stop drinking because you're afraid to wait in line for the bathroom? Right. So some women will be like, Oh yeah, I totally do that. Right? Are you afraid to chaperone your child's field trip? Because the bus ride is going to be three hours and you don't think you can hold it three hours on the bus without a bathroom. That's terrible for a mom. She can't chaperone her kids field trip because she's embarrassed that she might have to go to the bathroom. So using their language. So I like to send out surveys very frequently.

Christa Gurka (17:09):

Google doc is super easy. Survey monkey and ask them things like, what are your fears about whatever it is you're trying to sell. Right. what are your fears about exercise? What are your fears about back pain? How does it really make you feel? Okay. what are your, like maybe even if you could pay and if money was not an issue and you could pay anything, what would that look like for you? How would that make you feel and starting to, then you start to use that language. We've all seen marketing campaigns where you're like, yes, exactly. Totally. That's how you need to get into them. Right? And so maybe maybe as a physical therapist, it's tough for us because we're like, well, no, their hamstrings are not tight. It's not hamstring tightness. It's neural tension and it's the brain and the nervous system, but they don't, they don't understand.

Christa Gurka (18:06):

So you got to get them in. What they feel is that they have hamstring tightness. So you got to tell them that you can fix their hamstring tightness. And then little by little you explained to them that it's neural tension, right? But if you start off with neural tension, they're going to go somewhere else. And so I kind of like, I use this example a lot if you, cause I think we can all relate to this. We're on tech right now, right? Okay. So if you have, I have a Mac, I have an Apple. If I go to the Apple store, cause my computer crashes or my phone won't turn on and I go talk to what are they, what are the genius bar, the genius bar. And the guy's like, you know, so what I see here is the motherboard has this month and this software program, you only have so many gigabytes.

Christa Gurka (18:50):

I'm like, can you fix my computer? That's all I want to know. And if he says yes, I'm like, I don't care how you do it. So whether you use taping or I use myofascial release or somebody uses Pilates or somebody uses craniosacral therapy, it doesn't matter to them. So the end consumer, they just want to know that you can solve their problem. People have problems and they want to know that you have the answer to solve their problem. And that's it. So messaging is really, I think, crucial. It's the crucial point of the puzzle.

Karen Litzy (19:28):

And now let's talk about messaging. Let's dive into this a little bit further. So I think we've all seen different websites of healthcare practitioners, physical therapists and otherwise that kind of make us go like,

Karen Litzy (19:43):

Oh boy cause it's in cringeworthy in that it comes off as a little too salesy, a little too slick, a little too icky. So how can we compose our messaging to avoid that? Unless maybe that's what their ideal patient wants. I don't know. But yeah, how can we craft our messages that are going to hit those pain points, get that emotion going without being like a salesy, weird gross

Christa Gurka (20:18):

So the other thing I think that's important to understand is people's buying patterns. And when people say no to you, maybe they're not saying no to you, they're just saying this. It's not a value to me at this time. So one of the phrases, one of the things that I've really restructured, cause I used it, take it very personally, if someone will be like, no, I know and I'd be like, what you mean I could totally help you? And now I'm like, you know what? It's basically I look at it like if I'm at a party or I'm having a dinner party and I serve or Durham and I'm like picking a blanket and be like, no thanks. I'm like, okay, walk away. So I say therapy with Krista. No thank you. No problem. Let me know if I can help you in the future.

Christa Gurka (21:04):

Right? So the way that I say it is if you just speak honestly to your customer, honestly, to your customers. Nobody can be you at being you. So be your authentic self, whatever that brand is for you. And whether it's your company or you yourself, and let that come through in your messaging. Right? So in other words, like if your messaging is also about mindfulness and positivity and looking past the pain and what is your relationship with your pain or dysfunction that should maybe come through in your messaging that you're more holistic, that you're not going to be a treat them and street them type thing. But maybe if your messaging is, Hey, we're going to treat you and street you and you'll be out of here in 15 minutes, you're going to attract that type of customer. So either one is fine, but I just say really be authentic.

Christa Gurka (21:59):

And the other thing is, I would say send your website. I don't put a lot, a huge amount of stock in my website to be perfectly honest. I do love my website. I'm a very like, analytical person. So the colors and where everything sits is important. But I don't think as, I'm not a big believer that as much selling goes on your website as a lot of people may think, I think it's a place where yes, people are going to Google, someone gives you a reference at a cocktail party, they're going to Google your website, but they're basically going to look like, does this resonate with me? So what you want to hear is, you know, that tagline at the very beginning, you know, is does that tagline, the first thing that they see, does that resonate with that person? Right. So we use, because we're Pilates and physical therapy, we will, right now our website's a mess because it's got coven.

Christa Gurka (22:47):

We're close, we're not close. But helping people heal with love, every twist, every turn and every teaser. Teaser is a plot. He's exercise. So we stuck that with love in there because that is part of who we are. We are a community. We care about our clients. So you're not just going to come in here for like two things. We want to help you where you are. So that's, so if someone's like, yeah, that's cheesy for me, then it's okay, they can go down the street. Right. and we don't, I used, by the way, this has come with like 10 years of testing. You just got to test it. You got to test it and you got to see like who does it resonate with? Send it to a bunch of people and ask people for their honest feedback. Give me, you're not going to hurt my feelings. I need to know like, what do you see when you see this? What, how does it make you feel? So ask people their opinions and not physical.

Karen Litzy (23:45):

Yes. Yes. And you know, I just redid a lot of the messaging on my website and I sent my website from what it was and I'm in a group of female entrepreneurs, none of whom are physical therapists. I sent it to them, they gave me some feedback, I changed a little things. I sent it again, they gave more feedback, I changed some more things and now I feel now they're like, Oh see this sounds more like you. So before what I had in my website is what I thought was me. But then once I really got like had other people take a look at it, they're like, Oh, no this sounds more like you. And yeah, I love that tagline on the front. Like the tagline on the top of my website is world-class physical therapy delivered straight to your door,

Christa Gurka (24:28):

Which is short and concise and what you do. And it's what I do. Very easy. Perfect people. Oftentimes I see these like tat and they're like, you know, they had their elevator pitch. I'm like, what's your elevator pitch? You know, people talk about, Oh, what's the elevator pitch? I'm like, if you cannot describe what you do and like two sentences or 10 words or less, how do you think other people are gonna if you can't understand it for yourself, how are other people gonna right, right. Like you said, that takes time though. It does. It does take time. I struggled with this for a while, but me always, yes, but I think as physical therapist, one of the reasons we struggle is for a number of reasons. One. If we're business owners, we tend to be overachievers, right? We tend to have weak temp. We're bred from a certain mold.

Christa Gurka (25:18):

Right? the other thing I think is physical therapist, we're very analytical. We're very left brains, right? We are, I mean I think it's what makes me a really great physical therapist. But then the flip side of that is we're perfectionist. Everything has to be analyzed. And so we get so caught up in like the details of analysis and we went to PT school. So we have to show how smart we are. But being smart also means understanding what your customer's going to understand. And so you kind of have to swivel out of that. So sometimes even in groups when I'm like, when we see people like, Hey, what do you guys think of my website? I'm like, don't ask us, we are not your customer. Go ask your customers like what they think of your website. And so when I was in a group, you know, my coach challenged me to narrow things down as well. And they used to say things like, if you were running through a desert and you like and you were selling water, what would your tagline be like what would you, what would your board say? And you know, people will be like ice cold, dah dah dah. And he was like, just say water. If someone's running through a desert, all they need is water, water will suffice. Water will suffice. Clean water less is more free water. Even less. Yeah.

Karen Litzy (26:42):

And I remember, this is even years ago, I was doing like a one sheet, like a speaker one sheet. This is a lot off topic but talking about how we need to tailor our message to our ideal audience. So I had, you know Karen, let's see PT and I remember the person was like, does that mean like part time personal trainer? And I was like no physical therapist. Like you need to write that out then because the average person like PT. Okay. Does that mean part time personal? Like what does that even mean? So it just goes down to or sorry, it goes back to kind of what you said of like we have to speak the language of the people who we want to come to see us. Right? And the best way to do that is on our websites is we just have to simplify things and it doesn't mean dumb it down. It just means like simplify. And I'm going to give a plug to a book. It's called simple by Alan Siegel and it's all about how to simplify your language, your graphics, and how everything comes together to create a site that people, number one are attracted to and number two want to hang out at.

Christa Gurka (27:53):

Right? Exactly. And there's a lot of testing and I'm a big thing like testing. It's just testing, testing, testing. We test our sales page, we test even now with like some of my coaching stuff, working with other female business owners, testing, sometimes going in and testing, switching a graphic, have what you have above the fold. So the fold for those of you that don't know is like when you're on a website, it's you don't have to scroll. So everything is above where you have to scroll. I'll call to action a CTA right at the top. Changing phrases, you know, not using broad language like confidence, like what does confidence actually mean, but maybe making it more specific using language so that that's a really good thing. Helping or like, you know, reading yourself a back pain so that you can live the life you desire and deserve.

Christa Gurka (28:57):

Right? So changing little, and you can change that by the way, mid campaign, mid launch daily. You could change it if your Facebook ads are so one of the things, if you're, if people are clicking on your ad, but when they're not converting on your sales page, that usually means that either the messaging and your ad is really off and they're, once they get to your sales page, they're not understood. There was a disconnect between what you're offering or your messaging is great, but your sales page sucks. Or vice versa. Maybe nobody's clicking on your ad. Then whatever you're trying to sell them there does not resonate with them, right? So there has to be a connection. And usually when people don't buy, there's either a, with your offer or a problem with your messaging.

Christa Gurka (29:49):

So test means put it out there, see what kind of feedback you get, and then it's think of it as, okay, what we do in therapy, right? So this, what do we do when we get a patient in, we assess, we treat, and then we reassess, right? So what's going on? Let's try a treatment in here. Let's reassess. Is it better? If it's not better, what do we do? We go back, assess again, and then do another treatment and then assess, right? Reassess. So in marketing it's the same. So let's say you wanted to do, let's say you're working on like a sales page on your website, right? A sales page. I know it sounds salesy, but it's basically your offer, right? If people are getting there, so you see people you can track. By the way, with Google analytics, like people coming to your site, if a lot of people are coming to your site but they're not clicking on the call to action or they're not following through to check out some, there is some disconnect there.

Christa Gurka (30:56):

So maybe it's the messaging. So then maybe try to change the messaging, tweak the messaging, and then watch the outcome again, maybe people get all the way to the checkout and then abandoned cart. Maybe it means that something they got confused with something at the end. Maybe there's the customer journey wasn't right. They got to the end because they put something in the cart and then maybe your checkout structure is off or something like that. So test it and then just retest until your numbers are like, now we hit it. And by the way, it's taken me. I mean I'm still testing. Hmm. It seems like it's a constant reinvention. Constant, constant. Because the market keeps changing. Especially now. By the way, by the way, right now I don't know why there are. So at the time of this recording, we are in the middle of COVID. So when people come back, your messaging, okay. Is going to have to change, right? So we need to be aware of that.

Karen Litzy (31:49):

Yes, Absolutely. All right. So as we start to wrap things up here, let's just review those three strategies again. So who is your target market is number one, where are they hanging out? Where are they living? Not physically their address, but you know, where, what are they reading? Where are they hanging out, what are they doing online, what are they doing offline? And then lastly is making sure that your messaging clearly conveys part one and part two. And how you can solve their problem. Awesome. So now if you were to leave the audience with you know, a quick Pearl of wisdom from this conversation, let's say this might be someone who's never even thought about any of this stuff before. What did they do?

Christa Gurka (32:40):

So in terms of like, never even thought about marketing before or going into brand new, brand new out of PT school are, or brand new, like they want to kind of dive in and start doing their own thing, but they want to do it in a way that's efficient and that doesn't break the bank, right? So I would definitely say,

Christa Gurka (33:17):

Start with the end in mind. So that's from a great book, right? So so start with the end in mind meaning, but don't start at the end. I think a lot of people confuse that with, they start with the end in mind, but then they go right to the end and they go to marketing, right? So I like to equate everything back to physical therapy, right? So when we learn about developmental patterns, we all know, like we start with rolling and then Quadruped high kneeling, right? So if you take a patient that's injured and has a neuro, you know, and motor control problem and start them in standing off with multiple planes, you've missed a bunch of it, right? So you start marketing without understanding who your ideal customer is and finding out what they think and how they feel.

Christa Gurka (34:01):

You're going to spend a lot of money and you're not going to know why it's not working. You're just going to think Facebook ads doesn't work or I'm not good enough, which is a very common thing, right? So take the time to do the work. The ground work. Nobody loves to learn rolling patterns. But why is it important? Because if you work from the ground up, you take the time to instill these good patterns underneath. So take the time to do that. And the other thing I would say is just decide, you know, don't go through analysis paralysis. Decide and move. And the only way you're going to know is you got to put it out there. So you know, Facebook lives, Instagram lives. That's, you know, we didn't maybe start when social media was big, but which, so by the way, I have to make a point that I think that's why it's harder for us.

Christa Gurka (34:52):

So our generation did not, we didn't have, so I didn't even have a computer when I went to college. Nope. Like, so we didn't start with, I didn't have a cell phone like, so it's very different for us because this next generation coming up, they're comfortable on social media. We may not be, but the truth is, it's like everything else, just do it. The more you do it, the easier it becomes. So, and you know, if no one's what, well, I'm afraid no one's going to watch it. But who's watching it now, if you're not putting it out nobody. So you're no worse off. Right? So just do, create an action step. Like, you know there's a book and now I forget who the author is. It's called the one thing, right? And you just focus on thing. Focus on one thing that you can do today to improve on understanding your ideal customer. If you're already past that, what can you do today to understand more about your messaging?

Karen Litzy (35:50):

Easy. The one thing you could just, just choose one doesn't have to be a million things you don't have, it doesn't have to be perfect. No, and it doesn't have to be perfect. Just one thing. Just one thing. Awesome. And now last question is the one that I ask everyone, and that is knowing where you are now in your life and in your business and your practice, what advice would you give to yourself as a brand new physical therapist straight out of PT school?

Christa Gurka (36:19):

Woof. Mmm. I would probably say be open to the possibility. Yeah. Yeah. Just be open to possibility of what's possible. Yeah.

Karen Litzy (36:35):

Excellent advice. Now Christa, where can people find you if they have questions they want to know more about you and your practice and everything that you're doing? What the deal?

Christa Gurka (36:44):

So my business is Pilates in the groves, so they can always find Pilates in the Grove. All has everything about our business. But they can find more about me at christagurka.com.  I have some freebies up there. So that's like Christa Gurka is more really about kind of business strategy. Okay, great. Like launch you know, mindset, that kind of stuff. And then the Pilates and the Grove website really if you want to look at what we do, brick and mortar wise, do it. But like I said, the websites kind of a mess. Right?

Karen Litzy (37:21):

We understand it's exceptional times. And, I know that you have some free resources and some freebies for our listeners, so where can they find that?

Christa Gurka (37:33):

Yep. So there is a link which we can either link up in your show notes, right? Or we can, so there's a marketing quiz that I created that basically will put people at, it'll kind of just give you an idea of where you are. Are you like a novice or are you a pro? Have you got this stuff down? And I could probably be calling you for advice. And then based on where you are, it kind of tells you kind of what you should focus on as well as then we have that lead you into. I have a social media and a Facebook live checklist. It kinda just gives you kind of a little bit of, I find structure helps me. So learning how to batch content, learning to say that like, okay, every Monday I'm going to do a motivational Monday post. Every Tuesday I'm going to do a Tuesday tutorial post. I think it just helps me map things out. And so I think it helps business owners also feel less overwhelmed when they can have a calendar. And we have national days. It has like a bunch of national days that pertain to our industry already built out for you, which is easy.

Karen Litzy (38:35):

Awesome. That sounds great. And I'm sure the listeners will really appreciate that. So thank you so much. This was great. And again, the thing that I love about all these strategies is it takes very little money to accomplish them. Just some time, which right now I think a lot of people have a lot of time. So thank you so much for taking the time out of your day and coming on. Thank you. And everyone, thanks so much for listening. Have a great couple of days and stay healthy, wealthy, and smart.

 

Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram  and facebook to stay updated on all of the latest!  Show your support for the show by leaving a rating and review on Apple Podcasts

Jun 10, 2020

On this episode of the Healthy, Wealthy and Smart Podcast, Jenna Kantor guests hosts and interviews Javier Carlin on the art of listening.  Javier A. Carlin is the Clinic Director at Renewal Rehab in Largo, Florida. He is originally from Miami, he graduated with his Doctoral Degree in Physical Therapy at Florida International University and is a Certified Strength & Conditioning Specialist through the National Strength & Conditioning Association.

In this episode, we discuss:

-The difference between nosy curiosity and coaching curiosity

-How to frame questions to dive deeper into conversations

-Verbal and nonverbal signals to watch for during client interviews

-How your clinic environment can help develop deeper client relationships

-And so much more!

Resources:

Javier Carlin Facebook

Javier Carlin Instagram 

Life Coaching Academy for Healthcare Professionals

Phone number: (305) 323-0427

 

A big thank you to Net Health for sponsoring this episode! Learn more about the Redoc Patient Portal here.

 

For more information on Javier:

Javier A. Carlin is the Clinic Director at Renewal Rehab in Largo, Florida. He is originally from Miami, he graduated with his Doctoral Degree in Physical Therapy at Florida International University and is a Certified Strength & Conditioning Specialist through the National Strength & Conditioning Association.

Javier has always had a passion for health and fitness and his mission in life is to help you get back to doing the things that you love to do, pain-free. His goal is to inspire people to live a healthier, happier, more fulfilling live through simple and effective wellness principles; proper nutrition coupled with a great exercise routine and good sleeping habits works wonders in how you feel inside and out!

Javier enjoys spending time with his family, he loves being by the water either soaking up the sun on the beach or on a boat! He is an avid traveler, enjoys exploring new places and experiencing different cultures. He also has an adventurous side; bungee jumping, skydiving, rollercoasters, cliff diving!

For more information on Jenna:

Jenna Kantor (co-founder) is a bubbly and energetic girl who was born and raised in Petaluma, California. Growing up, she trained and performed ballet throughout the United States. After earning a BA in Dance and Drama at the University of California, Irvine, she worked professionally in musical theatre for 15+ years with tours, regional theatres, & overseas (www.jennakantor.com) until she found herself ready to move onto a new chapter in her life – a career in Physical Therapy. Jenna is currently in her 3rd year at Columbia University’s Physical Therapy Program. She is also a co-founder of the podcast, “Physiotherapy Performance Perspectives,” has an evidence-based monthly youtube series titled “Injury Prevention for Dancers,” is a NY SSIG Co-Founder, NYPTA Student Conclave 2017 Development Team, works with the NYPTA Greater New York Legislative Task Force and is the NYPTA Public Policy Committee Student Liaison. Jenna aspires to be a physical therapist for amateur and professional performers to help ensure long, healthy careers. To learn more, please check out her website: www.jennafkantor.wixsite.com/jkpt

Read the full transcript below:

Jenna Kantor (00:04):

Hello. Hello. Hello. This is Jenna Kantor with healthy, wealthy and smart. I am here with Javier Carlin, thank you so much for coming on. It is an absolute joy Javier. As a physical therapist. He runs a clinic. What is the name of your clinic that you run?

Javier Carlin (00:21):

It's renewal rehab.

Jenna Kantor (00:23):

Renewal. Rehab. In what area though? In Florida. Cause you're part of a chain.

Javier Carlin (00:27):

Yeah, it's in Largo, Florida. So close to Clearwater.

Jenna Kantor (00:30):

Yes. I feel like the key Largo, Montego baby. What are we going to make it? I feel like that's part of a song. Right? Well thank you so much for coming on. You also, Oh, you also do have an online course. What's your online course?

Javier Carlin (00:45):

Yeah. Yeah, so it's a life coaching Academy for health care professionals where I teach healthcare professionals how to become life coaches and get their first clients.

Jenna Kantor (00:54):

Freaking awesome and perfect timing for that right now with everything. Corona. Thank you so much for coming on during this time and giving us both something to do. I wanted to bring Javier in because he has a skill, a magic skill that if you don't know him or you do know him now, you know, he is a Supreme listener. The first thing we did when we got on this call is, he goes, he just asked me questions just to listen what's going on. And I don't, of course I try to emulate it, but I'm not as good at him. You know, like I asked a few questions and I didn't deep dive as well as he does. So I want to dive into his brain and with this pen that I have holding and I'm going to part the hairs, get through the skull into the cerebrum. And so we can really deep dive into how your brain works when you are learning more about others, the art of listening. So first of all, thank you for having that skill.

Javier Carlin (02:08):

Yeah, no, absolutely. I honestly had no idea I had it until someone brought it up. And then looking into, it's kind of one of those things where, you know, I guess you have a skill. But you don't really know it. And then you try to dissect, okay, what exactly am I doing? Right? So, you know, leading up to this interview, I'm like, okay, let me actually think about this and reflect on what it is that I do. And what is it that I don't do? So that I can actually, you know, hopefully provide some value throughout the next few minutes.

Jenna Kantor (02:40):

Yeah, I would love to know. I think I want to just go into our conversation even before hitting the record button. What was in your brain when you first came on? Was it, Oh, I want to know what's going on. I'm just honestly like what was in that led you to start the conversation that way?

Javier Carlin (02:58):

That's a great question. So to be honest, I mean, I haven't seen you in a long time. We haven't spoken in a while. And so, I really, you know, did want to know what's been going on in your life? I've seen your, you know, posts on Facebook, but really had no idea what it is that you've been working on. And I always know you're up to something. So I really had a deep desire to really find out exactly what you've been working on and the people that you've been impacting. Just to know. I don't know. It's like, it's just natural for me. So, yeah.

Jenna Kantor (03:38):

You're like a curious George.

Javier Carlin (03:40):

Exactly. Yes.

Jenna Kantor (03:42):

Do you think that is a big base of it? It's just true curiosity.

Javier Carlin (03:47):

Yes. I think it's a curiosity and definitely curiosity. I'm always you know, really in tune with what people are doing. Cause I feel like it just, you know, looking deeper at it. I feel like there's, it just, I come from a place of always wanting to learn more about someone, deeply understand what they're doing and why they're doing it. Cause I think there's a lot to say about that. And it's very similar with you know, health care professionals in the sense that we're working with patients all day and we are truly, really trying to figure out you know, what's going on and where they want to get to and understanding really what they truly want the outcome to be when it comes to us helping them throughout, you know, our physical therapy and other rehab professions. And it's no different. Like that's the same, the same curiosity that I have when I, you know I'm serving patients I have with people in general. So I do believe that curiosity is a big thing and having the curiosity that's a, not in a nosy curiosity but more of like a coaching curiosity and really figuring out what's behind the words that someone is saying.

Jenna Kantor (05:02):

What do you mean by nosy versus coaching? Would you mind going into more depth on that?

Javier Carlin (05:09):

So, yeah, absolutely. So I believe, and this is, you know, there's a clear you know, when you're having a conversation with a friend, you're not really thinking about all these things. And then I think deeper into the coaching side of things, you start to think about the specific things. So when it comes to a nosy curiosity, there's always a story that someone's telling you and sometimes the story isn't even related to what the person is actually dealing with. So people use the story to kind of, let's see how I can put this to separate themselves from the interaction that you're having. Cause it's sometimes it's stuff for us to have conversations with people and really get deep down into our own emotions. So the story around it as you know, as someone who's dove into life coaching the story is actually at times something to distract people from that. And sometimes what I mean by nosy curiosity is that we actually get involved in that story, which has nothing to do with why the person is talking to you in the first place.

Jenna Kantor (06:09):

So it's like this superficial, superficial kind of thing, superficial thing, right?

Javier Carlin (06:13):

So instead of being nosy and it's the actual story and talking about the people that were in their story, we want to, you know, kind of separate that from the actual person and have a conversation about them and why that situation affected them as a person, not, you know, bringing everyone else. So that's what I mean by nosy. And he knows he's trying to get involved in their story and you know, getting involved in not just their emotions but everyone else's emotions and why they hate their boss and why this and why that. So it's really separating that from what they're telling you.

Jenna Kantor (06:45):

Hmm. I like that. Yeah. Yeah. Could you just keep talking cause I don't even know what question to ask next just because I'm really taking that in right now. Just tell me something else more about listening. Cause I know you came prepared just because when you're going into this, you just opened up a world of how much, I don't know, just from even that concept. So I feel a bit of the, honestly a lot of loss of words for it because just even that concept of the superficial versus diving deep down in, I guess my next question would be then when you deep dive in and you're getting, doing those investigative questions to really find out what really is the core of what's going on, how do you phrase your questions too? Because you're probably going to get to some real personal stuff. How do you do it delicately with them? So that way as you are deepening, deepening your listening, you're not invading their space.

Javier Carlin (07:54):

That's a beautiful question. So, I think a lot of it comes before you know, before you dive into that. So you know, you've heard of obviously you're building rapport, building trust, and at the end of the day, if someone's coming for help it typically comes with an idea that, okay, I'm going to have to, if I want someone to help me, then I have to open up to them. Otherwise, you can't really help someone. So I think, you know, it comes with that understanding and I think a lot of it also comes from coming from a place of neutrality. So not tying your emotions and your ideas and your thoughts and your beliefs and your opinions to what the person is telling you.

Jenna Kantor (08:37):

That's hard. That's hard. Yes. Very hard. Yeah.

Javier Carlin (08:41):

It really is. And, that's where, you know, that's when someone can actually feel that you're trying to either push them in a direction that they don't want to go, or that's where that nosy type of know feeling comes in, where they're like, Oh, like why are you, why are you asking me that? But I think the second thing is whenever you make an opposite, whenever you make a statement that's more of an observation or a fact

Javier Carlin (09:08):

As opposed to, you know, something that's a bit more emotional, you want to always end with a question. So as an example, a question. So after every statement you want to end with a question saying, Hey, you know, what's true about that? Or what comes to your mind when you hear that? Those, two questions allow you to kind of pull yourself from Hey, listen, what comes to your mind when I say that? As opposed to I'm saying this because Hey, you should do this or you should do that. Or you know, that came out like pretty that that came out as if, you know, instead of saying, Hey, you sound angry. Right? It's saying, okay, like what, you know, when I heard that it sounded like you, you know, there was some anger and what's true about that and now you're giving them the ability to respond back to that.

Javier Carlin (09:57):

So now it's more of an observation as opposed to kind of like telling them, or you know, letting them know, Hey, you sound angry. Right? There's more emotion to that. It's more of like, Hey, you're coming at me now. That's when someone can get a bit defensive or feel like their space has been invaded. But when you just state a fact and then ask them a question, it makes it a lot easier to have that conversation moving forward. I hope that, does that make sense?

Jenna Kantor (10:25):

Yeah, that does. That does big time. It actually connects, it brings it back to a conversation I had with my brother. I'm going to go a little deep on my own thing. I remember my older brother and I don't have a good relationship, but this is back in high school and there's a point to this that's not just about me, even though if anyone knows me, I love talking about myself, but he, I remember there was one evening where he was more of a night elephant, and we started talking. It was a rare time, was a rare opportunity when you just get into a deep conversation about life and anything and we were already at least an hour or something in and I'm just feeling my eyes shut on me. And I remember going through this like I have two options to continue this conversation to continue this conversation with him.

Jenna Kantor (11:29):

So I remember I had this opportunity to continue the conversation and force myself to stay awake and I felt like it was a very vital conversation. There was this little thing that was like, if I cut this off, it will be cutting off something big in our relationship. Me not being here to be part and present when he's open and being open to talking to me, for me to be able to hear what he has to say. Do you think that and it has over time now we don't have more. We have more solidly not a strong relationship. Do think there are conversations like that that exists that if you are not present and listening and you push it away too soon, it could actually cause damage to that relationship long term.

Javier Carlin (12:33):

Oh, 150%. Yeah, absolutely. Absolutely. Yeah. Yeah. and you know, it's tough. You know, diving back into exactly, you know, what you were feeling and how you're feeling and why perhaps that conversation was maybe at that time of interest or something that, like you were saying, you know, you felt like maybe falling asleep.

Javier Carlin (13:03):

So, you know, there's a lot to it that we could dissect really. But yes, I do agree with that. I think what happens in many conversations especially, you know, looking into it even deeper, it's, you know, when people have make offhand comments you know, short little statements in between the conversation that you're having. Most people are quick to kind of just let that pass. But that's what the person truly deep, deep inside is actually feeling and really wants to talk about. Everything else is just surface level. So, you know, exploring those offhand comments goes a very long way. And that's when people really know that you're truly focusing on them. And listening to them and that's where you get into those deeper conversations now. Again, back to the story that you just shared. There's so many different factors when it comes to that, but I definitely do believe that that can have a massive impact on, you know, the relationship moving forward and with anyone with, you know, your patients, your clients, people remember how you made them feel and that really, really sticks.

Jenna Kantor (14:19):

Yeah, you guys can't see me, but I'm like, yes. Hey man, I feel like I just went to church on that. But it's how you made them feel. So then, back to the clinic, you could have say a busy time, a lot of people, a lot of patients and everything and your time is running short. How do you cater to these conversations? If you see that there needs to be more time or if you do need to cut it shorter, how do you continue to feed that relationship, that trust? So you can have find an opportunity maybe later to spend more time listening to them. If you don't have it right then.

Javier Carlin (14:52):

That's a great question. I think there's several different ways to do it. I'll speak to more cause there's a tactical way of doing it and that's, you know, with I guess you can call it, you know, nature and the relationship through other methods with text messaging, emails and all those things. Right. Where you feel that connection with someone and continue to develop that relationship over time through sometimes automated, you know, systems and or where you're actually just sending a mass email, you know, once a week where it can still actually help to build a relationship. Right. But on the other front, you know, with our clinic specifically the way that we do that, because we do work as a team cause we are, you know, we do have insurance based model.

Javier Carlin (15:40):

So we do see several patients an hour. Because of the team that we have where for us specifically, it's a PT, two PTAs and two techs. Once we have a fully established clinic and got into that point that is where the PTA is that we have actually step in to treat the other patients that are there. And if I noticed, cause there's a lot of so when it comes to listening, there's, you know, when people say active listening, active listening really is it's not just listening to the words that are coming out of someone else, someone else's mouth, but also painted with everything else that's going on the unsaid, right? You really want to explore the unsaid. And that comes with a body language. You know, a visual cue is a body posture. You know, the way someone says something, their tone, their pace, right?

Javier Carlin (16:28):

And obviously as you get to know someone, you really get to feel how they feel when they're having a great day and when they're having a not so good day. So, you know, not letting, again, kind of like not letting offhand comments go. You don't want to let those, the visual kind of feedback that you're getting you don't want to let that go either. So, when you do see someone that's in that specific state where they might be disappointed, angry, upset, frustrated, you want to make sure that you address that right there. And then, and the way that we do that specifically at the clinic is we take them into the evaluation room and we can do that because of the fact that we work as a team, everyone on the team knows exactly what every single patient should be doing and knows them at a deep level so I could actually step out and have that deeper conversation with whoever needs it at that time.

Javier Carlin (17:20):

We'll sit for, you know, five, 10, 15 minutes, however long we need, really to explore what is going on at a deeper level so that we can ensure that they don't drop off. Cause typically what happens is that when you don't, when you just kind of let that go, that's where you get a patient call in to cancel and then it happens not just once, but twice, three times, four times, and then they ghost you. So that's how we handle that situation.

Jenna Kantor (17:50):

Absolutely. Absolutely. I think that's a really important thing to put into place. So for clinics alone, how would you, if they don't have something set up and say they're a busy clinic and they don't have something set up where people can have the time to necessarily sit and listen, how could they start implementing that in order to improve the relationships with their patients and then they're showing up?

Javier Carlin (18:13):

Yeah, that's a great question. And I think there's so many variables depending on how the clinic is set up and ran. I believe that, you know, I think as you know, obviously as physical therapists ourselves, I think our first instinct is to always like go to like the physical, right? Like, you're feeling this way today. Okay, don't worry. Like, we're going to make you feel better after this. It's like, wait a second. Well maybe the person, maybe for those initial 30 minutes, they don't even need, you know, therapeutic exercises or whatever it is that we're prescribing them for that day. Maybe they just need to have a conversation, right, for 20, 30 minutes and just to let it all out. And those 30 minutes of actually just talking to them just because we can't bill for that time technically. That's going to be the difference maker between them actually seeing the results longterm and dropping off. So it's making that clear distinction and deciding, okay, what this person needs at this point in time is not, you know, to do a core exercises or to get manual therapy. What they need is to just have a conversation about what's going on in their world. Cause ultimately that's what matters the most event.

Jenna Kantor (19:28):

So yeah, true question. I think that was great. That was good. I just want you to know, okay. So then during this time, the Corona virus, what has your clinic been exploring on a listening standpoint with the switch to virtual to try to fit those needs? Like, I don't know, it's kind of an open ended question for you to interpret this however you'd like.

Javier Carlin (19:58):

Yes. So I think, you know, it's been, to be honest, it's been a challenge. And the biggest reason why is, you know, knowing that tele-health existed for, you know, the last year, two years, et cetera. And, has been existing, we didn't really make a push to have that as an additional service. So what's happening now is that it's like physical therapy, right? A lot of people still don't know what physical therapy is and it's not something that they necessarily want. It's just something that they need. Right? So, same thing with telehealth. It's something that, you know, now we're adding to things that people don't know, which is physical therapy and telehealth. And now we're, you know, most people are now trying to figure out, okay, how can we push tele-health without, you know, having any like, previous conversation about this.

Javier Carlin (20:53):

So that's where the challenge lies is that you have people who are, you know, the ones who do know what physical therapy is. We're coming in and you know, when they think of PT, they have this, you know, they have this picture in their mind because it's what they've been doing for the past, you know, X amount of weeks and now you're trying to get them to jump on to a different type of platform to, you know, provide a service that in their minds can only be done in person. So what we've seen started to do is we've started to offer complimentary telehealth visits. So the first visit is completely free 15 to 20 minutes in length. And offering that first, you know, giving the patient an opportunity to experience what it's like and showing them how valuable it can be.

Javier Carlin (21:39):

And then from there deciding to make an offer for them to actually purchase, you know, X amount of business. And typically, you know, your time is your time, so you want to typically charge the same that you would an actual in person session. But because this is so new, we have decided to offer it at a very, very low rate. So that barrier to entry is a lot less, especially in this time where you know, people's finances might not be at their all time high, or at least, they're not going to say, they're a little bit more reserved with what they're spending their money on. People are still spending money, but with what they're spending their money on. So that's how we're handling that now. A lot of, you know, constant communication through text messages, emails and just listening.

Jenna Kantor (22:34):

Yeah, yeah, yeah. Yeah. That's amazing. Thank you so much for coming on. Is there anything else you want to add in regards to the art of listening that you think is a key point for people to take home with them?

Javier Carlin (22:47):

Yeah, so I think the last thing, and this is actually a quote from Stephen Covey and I have it here cause I didn't want to butcher it, but basically he says most people do not listen with the intent to learn and understand. They listen with the intent to reply. They are either speaking or preparing to speak. So that's it.

Jenna Kantor (23:09):

That's great. That's a really good quote. Sums it up. Yeah. Well thank you so much for coming on Javier. How can people find you on social media? What are your addresses on Facebook, Instagram, all the above?

Javier Carlin (23:32):

Sure. So I'm on Instagram. I'm at @drJavierCarlin. So dr Javier Carlin on Facebook have your Carlin's so you can just look me up there and friend request me. I do have life coaching Academy for healthcare professionals a Facebook community. So you can always jump into that as well with a podcast coming out soon. And I think that's it. If you want to send me a, you know, text message and just link up my phone number is (305) 323-0427 to have a conversation.

Jenna Kantor (24:05):

I love that. I love that so much and if you guys want to see or hear him in action, if you're in the group or even in his future podcast, you'll see from the way he interviews and speaks with people how he really uses his curiosity and deep dives and learns more and listens so well. Just watching him in action alone, aside from just even experiencing it yourself, you'd be like, Oh wow, he's good at this. I feel very listened to, thank you so much for coming on. Everyone jumping in, thank you for joining and have a great day.

 

Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram  and facebook to stay updated on all of the latest!  Show your support for the show by leaving a rating and review on Apple Podcasts!

Jun 1, 2020

On this episode of the Healthy, Wealthy and Smart Podcast, I welcome Tracy Blake on the show to discuss the evolving role of physical therapy in sport. Tracy’s desire to contribute to sport beyond the field of play motivated her clinical work with athletes from over 25 sports at the local, provincial, national, and international levels, as well as doctoral research focusing on pediatric sport-related concussion and physical activity. It remains the driving force behind her current work as a clinician, researcher, educator, editor, and author.

In this episode, we discuss:

-The preventative and reactionary roles of physical therapists in sport

-How to optimize the healthcare team’s strengths to amplify the organizational mission

-Equity and shifting power dynamics between the athlete and clinician

-COVID-19 and ethical considerations in sport

-And so much more!

 

Resources:

WCPT statement of diversity and inclusion

WCPT symposium on diversity and inclusion

2016 consensus on return to sport

Introducing patient voices

Coin model of privilege and critical allyship

Tracy Blake Twitter

 

For more information on Tracy:

The only daughter of Trinidadian immigrants, Tracy Blake and her youngest brother were raised in the multi-cultural, multi-ethnic, multi-faith, working class Toronto (Canada) neighbourhood of Rexdale on the traditional territory of many nations, including the Mississaugas of the Credit, as well as the Anishinabeg, Chippewa, Haudenosaunee, and Wendat peoples. Sport was a power source of connection and vehicle for connection throughout Tracy’s upbringing. Tracy’s desire to contribute to sport beyond the field of play motivated her clinical work with athletes from over 25 sports at the local, provincial, national, and international levels, as well as doctoral research focusing on pediatric sport-related concussion and physical activity. It remains the driving force behind her current work as a clinician, researcher, educator, editor, and author.

 

Read the full transcript below:

Karen Litzy (00:01):

Hi Tracy, welcome to the podcast. I am happy to have you on. And I'm so excited to get to speak with you one on one. I heard you speak at WCPT in Geneva last year and I think I've told you this. It was one of my favorite sessions and we can talk a little bit about that session later. We'll probably sort of weave it in as we go along here, but it was a great session at WCPT and I'm really excited to have you on the podcast today to talk about the evolving role of physical therapy or physiotherapy in sport. So I'm just going to hand it off to you and if you can kind of let us know what that role kind of maybe where we were and how you see it evolving and how it has evolved up to this point.

Tracy Blake (00:53):

Yeah, so I think historically, physiotherapy or physical therapy, I'm Canadian, so I tend to use both. Historically in sport was seen as reactionary. So injury happens, enter physiotherapist from stage 1 right. And I think over time what has happened is that both from a clinician standpoint and an organization standpoint in sport there has been a change in perspective with an increasing level of focus on primary injury prevention. And so what that has meant is physiotherapists are not only responsible for there reactionary role, the rehabilitation, the remediation of injury, but also there has been a serious investment both in their time and an organization's resources around preventing injuries from occurring at all. I think the other part of this is that part of the evolution has been in the team around the team. So historically speaking, there may have been a physical therapist and athletic trainer, a doc, and that would sort of be the primary set of your team.

Tracy Blake (02:14):

Now, more and more organizations are having maybe multiple therapists, strength and conditioning, nutrition, dietician, sports psychology, other disciplines are involved in the team, which both alters the way in which we gather information, gather experience, the way we develop as practitioners, and also the way in which we engage in our role and in our competencies. Within a sport context. And I think that there's sort of three arcs in which I see physiotherapy in sport, which is consultant. So in a consultant role, you may not be actually involved with front-facing athlete care at all. You might be making recommendations or talking to ownership or be brought in special cases for example. As a concept, then you have external service providers. They might have more regular athlete contacts, but they're not embedded in the daily training environment, which is the third aspect. Each one of those rules has a role to play in today's modern sport, particularly as you get into more resource abundance levels, your high performance or Olympic level or professional level. But the arc of change for each of them is going to be different. The arc of evolution is different. And what that means for the practitioner and the profession will also be different.

Karen Litzy (03:47):

And so when we talk about those tiers, so let's say you sort of outlined consultant the external service provider and those people who are really embedded with the team on a day to day basis. And before we went on, you sort of use the example of the NBA example. So can you talk about that just to make that a little bit clearer?

Tracy Blake (04:10):

Yeah. So there was a time where like if you were, the internet still existed, but maybe like online rosters and Google's worth weren't quite as prevalent, I know, usage, but you wouldn't have been able to just go on and find a physical therapist listed on an NBA team. There might've been one a decade ago, maybe two. And now in today's days and times, every NBA team has at least one and sometimes multiple that are working in various specialties within physical therapy. And so I think that that is also something to consider it, right? So what exactly is your contribution to the team in the context of both your profession, which is a healthcare paradigm and your occupation, which is in a performance paradigm in your sector. And so how do you reconcile those two in a way that allows you to contribute and to be of service?

Tracy Blake (05:11):

And I think we were, I mentioned this to you as well, that I think that the only way to reconcile that in a way that is grounded and sustainable is to be really clear about what your specific mission is as a physical therapist. And then making sure that whatever role you're in, whatever tier you're in, in the incredibly fast paced moving world of physio and in the fast, fast moving world of sport that you're grounded to that regardless, it makes you more responsive and adoptive, particularly in these days and times where on top of the unpredictability of sports and the fast paced moving to sports, we now overlay a global pandemic into that. And so you lose your footing. It's real easy to lose your footing in sport these days. And so if you are not grounded in something that is separate from your job professionally, it is very easy to lose your way.

Karen Litzy (06:10):

And especially now that there is no sport happening. Correct. While we're in the midst of this global pandemic, there is no sport happening. And so I guess being very clear on what your mission is, does that then allow you to find other ways you can contribute to the team aside from direct we'll say patient care, athlete care or direct overview of strength and conditioning programs and things like that.

Tracy Blake (06:41):

Yeah. So, then the question becomes is how is a team still a team when they're not playing? So when the technical has been removed from you, what makes you a team? And then in that context, what is your role in maintaining that team in contributing to that team? So I think when we were at WCPT when I had mentioned the idea of what is your mission, I had told people to think about it and you're not allowed to use the words rehabilitation, remediation, illness or injury in whatever your mission statement is. The purpose of that at the time was that you were having conversations with people in sport who do not come from your health care background. So if you only use language that relates to health care remediatory way or inaction reactionary way, you're undervaluing what you do. And you also run the risk if that's not understood in the same way you intended.

Tracy Blake (07:52):

It turns out that that actually works out in this case as well because now we've taken all of the trappings or all of the preconceptions that come with our role have now been wiped away. Right. So what are you contributing to the team in this context? Are you, for example, as it's somebody who is usually in the daily training environment? Having a team that is sometimes centralized and sometimes decentralized. I made sure that I continue to talk to my team and do check-ins even when they're decentralized. So now we're decentralized longer than we would have been because the Olympics aren't happening. Right. But their communication with me isn't somehow new.

Karen Litzy (08:42):

Smart.

Tracy Blake (08:44):

So that's not everybody's option. But that is for me, a way in which the relationships we've had, we're not based on strictly what was on court in the team context. So therefore the relationships are able to be sustainable when an earth shifting history shifting thing is occurring.

 

Karen Litzy:

And, I have a question for you. What is your mission statement? Without using remediation, rehab, et cetera, et cetera.

 

Tracy Blake:

So my mission in sports specifically is the optimization of health function and performance, whatever your age, stage or field of play.

 

Karen Litzy:

Excellent. I love it when people are prepared. That was great. And I think it's very clear. I think that's very clear. It's short and sweet and to the point and people get an idea of what your mission is and what your function is within that team setting. And now let's talk about the team, but not so much the team that's on the court or on the field. But let's talk about the team around the team. So you had mentioned you've got maybe a couple of physical therapists the MD, the ATC, a sports psychologist, nutritionist, but let's talk about how the team around the team functions for the good of the team that's performing on the field, on the slope, on the court, et cetera.

Tracy Blake (10:15):

Yeah, I think that there is, so my circumstances were particularly interesting in my current situation with volleyball Canada in that I was brought in with the strength and conditioning coach halfway through a quad. Like going into Olympic qualifiers, which is highly unusual. Well we were very lucky was that we had our conversation right out of the gate and we were of a mind so to speak philosophically in this way. So we had our first conversation, I say lucky, I think our director of sports science, sports medicine and innovation would say that he planted this way cause he hired both of us. But we were lucky that we were philosophically aligned in both what we thought our jobs could be for the team in this setting and in this circumstance. And then turns out how we work together also worked quite well that way. So that becomes, I think one of the first things is what's your mission? Does it align with the people who you work with? That's the first thing. And then from that spot, how do you use your strengths of each of those team members to amplify what that organizational or team goal is.

Tracy Blake (11:33):

And then how can you also identify gaps in each other and fill those in. Because that's the thing, like people love to talk about their strengths. To a team and what they can contribute with their strengths. They're less comfortable, particularly in sports, particularly an environment that is bred on competition and winning. And there can only be one. It is much harder to feel comfortable with vulnerability and opening up something that feels like a gap or a weakness or an area that you're not as confident in and trust that somebody else will fill it without exploiting it. So I think both parts of those need to happen for a team to be both functional and that function to be sustainable for anyone for time.

Karen Litzy (12:20):

Yeah. And I think that's also where the learning happens, right? When you have that team of professionals around the team, I would think me as a physiotherapist or as a physical therapist can learn so much from those other partners.

Tracy Blake (12:38):

Yeah, I agree. And I'm a nerd. There's no getting around it. I love a learning moment. I love them all the time. I want to know everything. And so for me, I feed on that, but that is not everyone's experience. And so what I've had to learn is timing and approach and repetition. Frankly, being not just clear on my mission once, but clear on it over and over and over again. How do I express my mission in the big and small things that I do in a day so that I'm consistent and I'm transparent so that at no point somebody can be like, well you said that at the beginning but you did this and this and this. That was inconsistent with that. And so I want my own way. And so in those kinds of circumstances I'll be like, look, this is where I was coming from with this.

Tracy Blake (13:30):

This is why I thought it made sense. I went to a school where when I say school, like entry level physio training, was that a school where we didn't have traditional lectures? Very much. Almost everything was small group learning. And so I feel like that environment really fostered the way that I work in the team environment, in sport where everybody had the same questions. We all went off and found the information and key information, excuse me, and came back to it with our own whatever that information is plus our own experience and perspective layered in on it. And then you figured it out together what was useful, what was not.

Karen Litzy (14:13):

Nice. Well that's definitely set you up for being part of a team, that's for sure. And now let's talk about, so let me go back here. So we spoke about kind of the different tiers that may be a physiotherapist might be in how being part of the team is so important to understanding your mission, staying true to that. And I think being self aware enough to know that you're being true to that mission and that you can stand by it and back it up. And now let's talk about how does all of this that we just spoke about, what are the implications of that for athlete health and for support in sport?

Tracy Blake (14:52):

So for me, the cornerstone of every relationship but particularly in the context of sport is trust. I work in sport obviously, but I also work in acute inpatient healthcare. And I also worked in private practice for a long time and people often assume that my private practice life, my private practice, orthopedics and my sport life are the two that are most closely aligned. Okay. Particularly in recent years, I've corrected that. And then I actually think it's my hospital life in acute care and my sport life, particularly in high performance that are the most aligned and the reason why is the relationship building and the communication that they require. So when I'm working with an athlete, the way in which I can get the best out of that athlete is if they trust, but I'm working to the same goal they're working to.

Tracy Blake (15:58):

Now that does not mean that I don't care about health, right? Because sport is inherently a risky situation, right? There's a level of risk acceptance that you have to participate in them, particularly when the levels get higher. And I believe there was an article by Caroline bowling, it's a couple of years old now that actually talked about injury definition and asked high performance athletes, coaches and sport physios. And in that article, all injury was negative effect on performance. There's no mention of it risk, there's actually no mention of illness or injury. So if I can't have a conversation with you about what I think the injury is doing to affect your performance negatively, I'm only filling in half the picture. So I need you to trust me. And the way in which I garner that trust. The way in which I build that trust is making sure that you always know that I have your goal, which has performance in mind. And so I think that that component of the relationship is the cornerstone. What cannot be left out of it, however, is the role of equity and the power dynamics.

Tracy Blake (17:23):

Physio is a health profession. Health professions historically are in a position of power or a position of privilege in the context of your practitioner patient relationship, right? If that's the situation already to start, how can you know that the person is giving you the accurate information if they're already in a position where the power is shifted out of their favor? So knowing that and understanding that concept, I've tried to be really intentional and again, really consistent in actively working to even the scales. I do that. Yeah. So I regularly consistently ask athletes, not just what they think, but I start with the part that they know the most about because as it turns out, I've never played professional volleyball, I've never played any sports at a high level, right? So if I start with the part that they know the most about the technical components of that, the way that training happens, the way practices are organized. If I start with what they know and ask questions about that, and then I work the way in which I build a program back from that, what I often say to people, not just athletes, but obviously this applies to athletes as well, is that I say I know bodies, you know your body and what we're trying to do is take what we know about those two things and put them together in a place that gets you to where you want to go.

Tracy Blake (19:02):

And anything that you think I'm doing that either doesn't make sense for that for you or that you think is working against that you need to tell me early and often. And so that's the framework. That's a conversation that's happening like right away. First day.

Karen Litzy (19:19):

Hmm.

Tracy Blake (19:19):

And then I give them opportunities to come back to that over and over. And not everyone communicates the same way. So you can't expect somebody to like just be like, you spit out five minutes of like clinical decision making information at them and they're going to be like, yeah, aha, Oh by the way, this, this, that and the third. Right. That's not going to be how it happens all the time. So making sure that people have time to think about it. Give time to reflect how the place to come back to you. Some athletes want to break it down into small bite size pieces. Some athletes want to be like, just fix it. I don't want to talk about it. And that's also my responsibility to make sure all of those different types of personalities, those people with different relationships with their bodies. How the power of the emboldened to be able to say what they need to say to meet their goal. And so that's what for me, that communication and relationship building part has to be the cornerstone because it's the only way we can get anything done with the kind of both the speed in which we need to get it done in the context of sport, but also in a sustained way. Because if someone keeps getting hurt, that is also not going to help anybody’s situation both from my job security or theirs.

Karen Litzy (20:34):

Right, right. Absolutely not. And so again, this kind of goes back to being part of the team. And so what I'm sensing is, and again, I feel like as therapists, we should all know this, but the team around the team also includes the team. You can't just have the team around the team making the discussions and these return to play decisions without involving the members of the team without involving that athlete.

Tracy Blake (20:48):

Correct. And one of the things that I found, like I'm saying a lot of these things to be clear, I'm saying them now and it sounds Zen, but I found out most of these things through failure to be clear of course a million times over. It has brought me to where I am having this conversation today, but I just wanted to be clear that I did not like walk out of entry-level physio with this knowledge on a smorgasbord. No, I know. Shocking. Shocking. What kind of program was this? You went to again, that didn't prepare you for high level sport athletes shawty is what it was. But the idea that the idea that an athlete, an essential part to their healthcare team still is radical for many and they see it, they see it.

Tracy Blake (22:03):

But what happens is when there actually requires an actual power shifts to make happen. Yeah. It's hard for people when it actually requires them to let go of some of their power if it requires them to acknowledge. There was a moment in the process of programming, in the process of delivery, in the process of recovery that they are not the expert in the room. It can be a blow, particularly people who've spent in our cases years getting to that point.

 

Karen Litzy:

Oh absolutely. And I think in several presentations I've seen in writings of Claire ardor and I feel like she goes through this which with such specificity and simplicity that it makes you think, well of course, kind of what you just said. Like for some people it's a radical view that the athlete should take this big part in their recovery and their return to sport or in their health. But when you listen to folks like you or like Claire, it's like, well yeah, it all of a sudden turns into a no brainer. So where do you think that disconnect is with those people who still considered a radical idea and the people who are on the other end who are like, well, of course they should be part of it.

Tracy Blake (23:09):

Some of it is experience. And so what I mean by that is not just like length of time experience, but I found that when everything's going well, it's going well, right? There is no impetus to change. There is no disruptor that actually acts to give you a moment to or recalibrate as you need. And so when I say experience, I mean I've had instances where, to be honest, I wasn't sure if it was going well. I wasn't sure I was doing what I thought needed to be done and I was doing what felt right. Again, I was aligning with the mission that I had because I didn't have any real world context in this specific sport or circumstance that I might've been in. And then something goes wrong. And you realize in the aftermath of that, whether it's an illness, whether it's an injury, whether it's something off court altogether, right? Whether it's an abuse and harassment situation, whether it's a boundary situation, whether it's a patient confidentiality situation, right? You realize when those things go sideways, but that's whereyour power and your metal is tested professionally.

Tracy Blake (24:46):

And so I think that's one part of it. I think another part is there's ability to what they call it mission creep, right? Where over time you sort of like, this is what you think your mission is, but then you did a little of this and you do a little of this and the next thing you know, you're far away from where you started. And I think that a lot of people, I think they're in service to the mission one in sometimes they actually end up in service to the business model. And particularly in sport where the jobs or when I say sport, like high performance sport professional sport, where the jobs are few, where the jobs are highly competitive. I don't think I've ever applied for a sport job that had less than 75 applicants and upwards of several hundred in some cases.

Tracy Blake (25:43):

Wow. Everybody wants that gig. And so people can sometimes get led by the, or creeped away from their mission by the instinct to do what is necessary to stay in the position rather than what is necessary to optimize the health function and performance of their athlete. So having a situation where you've been tested and sometimes don't, aren't successful and mission creep. Those two things I think are maybe the biggest ways that aren't just related to like personality. Like those are that things can be trained or modify. Those are like the modifiable things I think.

Karen Litzy (26:44):

Great. And then, you know, we had said as we are recording this, we are in the middle of the global covid-19 pandemic. And so there is no sport going on. And so to the best of your ability, and we're not asking you to be a future teller here, but what do you think will happen to the role of physiotherapy in sport and the medical teams in sport?

Tracy Blake (27:28):

I don't know necessarily what will happen. What I hope happens is that all healthcare practitioners, but particularly physical therapists in our case because I'm biased in that direction that they recognize their role in contribution to population health in the context of sport. So public health in the context of sport, we often think of sports as a bubble and it is to a certain extent, but that bubble is manufactured. That means all parts of an athlete's existence are manufactured, right? All parts of what the athlete is provided with from a health perspective are manufactured. So have gaps are left in that it's up to you as the person who is actually in the sport context to identify and try to remedy and resolve. Right? It's deeply problematic for athletes to not have the same information that somebody who works in the public house. It's deeply problematic for athletes too, not have access to labor rights. It's deeply problematic for athletes to not have be informed and be given informed consent to participate in mass gatherings during a time of pandemic.

Tracy Blake (29:02):

And I also think there is a strong ethical quandary that comes with providing services, two events that fly in the face of public health recommendations during times like this. And I've been on record with this, I said this a couple of weeks ago, I posted about it on Twitter where there was a massive wrestling tournament happening and I thought to myself, it's wrestling, it's a combat sport. It can't happen. Like they literally would have no insurance if there was no medical covenant medical coverage provided. So if you didn't have medical coverage, the event couldn't happen. So how does medical coverage or physio coverage or what have you happen against public health recommendations? We can't continue to act in separation with each other. We need to view sports as part of population health. And then we need to make sure athletes and those in the sporting community are acting in accordance with the public health.

Tracy Blake (30:11):

At the times demand as well. And I think the Rudy go bear situation was truly, genuinely shocking for a lot of people. They were unprepared at every level, not just sports medicine and sport physical therapy. And so what I hope lingers for people is that we think about emergency action plans a lot, right? We think about how we're going to get somebody off the court in the case of an emergent issue, Encore, how are we preparing them for life in that same context? How are we in preparing ourselves as professionals in that context? And I hope that those conversations, because it turns out you don't need to be in person for that.

Tracy Blake (31:01):

That people are reflecting on that now and that steps are being taken to improve both the gaps that are specific to the city, the situation with the pandemic now, but also how do we identify these things going forward. And I think some of that had already started to show its colors around issues of food insecurity, issues of education, issues of like the younger your players are coming in. Are you providing appropriate development? I went to you as a, you know, I went to the United nations last year for the sporting chance for him, which is around sport and human rights. And last year, 2019 was the year of the child. And so there had been a special rapport to report on the rights of the child and child exploitation and snails. There is an entire section dedicated to sport and how sport has been used as a vehicle for the exploitation of the child.

Tracy Blake (32:08):

And I think of things like that, like those are the kinds of gaps. But now that you know that these kinds of gaps exist now you know, you understand in a very real way and it's kind of, it's telling in some kind of ways that it needs to strike so personally close to people's wallets and they'll help. But now that we've had that touch, now that we've been exposed in this kind of way, can we continue to be proactive in the way we address other things going forward? That would be what I would hope to see.

Karen Litzy (32:40):

Well, and I think that's I feel like very doable hope. I don't think it's like a pie in the sky. Hope. I think all of those conversations can be had and hopefully can be had by everyone surrounding sports, not just the physiotherapist or just the medical team, but straight up to owners and players and everyone else in between. So Tracy, thank you so much for such a great conversation.

Tracy Blake (33:13):

Yeah, it's been great. And I think again, like physios are really well situated because you have physiotherapists who have really like have access to the player and have access to the coaching, the ownership, the administrative stakeholders. They're well situated to be able to bring these things to light on both sides and be involved in those conversations even if they don't have out right decision making power.

Karen Litzy (33:38):

Right. Absolutely.

Tracy Blake (33:39):

Yeah. Thanks for letting me out of the shadow.

Karen Litzy (33:42):

Oh, it was great. Thank you so much. And then before we sign off here, I have one more question that I ask everyone. And knowing what you know now and where you are in your life and in your career, what advice would you give to yourself as that fresh graduate, straight out of physiotherapy school?

Tracy Blake (34:04):

I would say that you need a mission early and you need to speak it into existence. It's not good enough to keep it in your head. You need to say it out loud to people and you need to get feedback from people and whether it's clear or not. And I also think that one of the things that I learned I was 36 almost 37 when I took my first dedicated health equity class and aye, it was a workshop. And in the beginning she said for some of you this will be new information and it was specifically targeted at health professionals, not just physio. And some of you would have learned this in, you know, your first year equity studies, first year gender studies kind of course. And after the weekend where I slept for basically three days because of all the information floating in my head, I was like, there are 18 year olds walking around with this in there. And so I think that if I could go back now, I'd be like, you need to start taking those courses early. You need to start embedding it into your thinking early. Maybe you'll be better at being intentional about how you use it earlier.

Karen Litzy (35:11):

Excellent, excellent advice. Now, where can people find you if they want to shoot you a question or they just want to say how great this episode was?

Tracy Blake (35:22):

So I'm active on the Twitter, so my Twitter handle is @TracyABlake. I am not as active on the on Instagram. My Instagram still private, but if you shoot me a message I usually find it anyway. So that also works. Same handle @TracyaBlake.

Karen Litzy (35:38):

Perfect. And just so everyone knows, we will have links to certainly to your Twitter at the show notes over at podcast.Healthywealthysmart.com. So Tracy, thank you so much. I really appreciate it. This is a great conversation. Thank you so much. This is quite the podcast debut. I appreciate it anytime and everyone, thanks so much for tuning in and listening. Have a great couple of days and stay healthy, wealthy, and smart.

 

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May 27, 2020

On this episode of the Healthy, Wealthy and Smart Podcast, Jenna Kantor guests hosts and interviews Stephanie Weyrauch on advocacy mentorship.  An active member of the national physical therapy community, Stephanie has served on multiple national task forces for the American Physical Therapy Association (APTA) and actively lobbies for healthcare policy issues at the local, state, and national levels of government. Stephanie is a nationally sought after speaker and consultant for topics on social media use, generational issues, and organizational membership.

In this episode, we discuss:

-Why you need an advocacy mentor to help guide you through healthcare policy

-The benefits of being a mentor

-The key to having successful advocacy efforts

-And so much more!

Resources:

Stephanie Weyrauch Instagram

Stephanie Weyrauch Twitter

Stephanie Weyrauch Facebook

Email: sweyrauchpt@gmail.com

 

A big thank you to Net Health for sponsoring this episode!  Learn more about the Redoc Patient Portal here.

                                                                    

For more information on Stephanie:

An active member of the national physical therapy community, Stephanie has served on multiple national task forces for the American Physical Therapy Association (APTA) and actively lobbies for healthcare policy issues at the local, state, and national levels of government. Stephanie is a nationally sought after speaker and consultant for topics on social media use, generational issues, and organizational membership. Stephanie serves as the Vice President for the Connecticut Physical Therapy Association. She is also the co-host for The Healthcare Education Transformation Podcast, which focuses on innovations in healthcare education and delivery.

 

Stephanie is a Passionate Chicago Cubs fan who enjoys playing the saxophone, writing and weightlifting in her spare time. During business and leisure travels, she is always up for exploring local foodie and coffee destinations.

 

For more information on Jenna:

Jenna Kantor (co-founder) is a bubbly and energetic girl who was born and raised in Petaluma, California. Growing up, she trained and performed ballet throughout the United States. After earning a BA in Dance and Drama at the University of California, Irvine, she worked professionally in musical theatre for 15+ years with tours, regional theatres, & overseas (www.jennakantor.com) until she found herself ready to move onto a new chapter in her life – a career in Physical Therapy. Jenna is currently in her 3rd year at Columbia University’s Physical Therapy Program. She is also a co-founder of the podcast, “Physiotherapy Performance Perspectives,” has an evidence-based monthly youtube series titled “Injury Prevention for Dancers,” is a NY SSIG Co-Founder, NYPTA Student Conclave 2017 Development Team, works with the NYPTA Greater New York Legislative Task Force and is the NYPTA Public Policy Committee Student Liaison. Jenna aspires to be a physical therapist for amateur and professional performers to help ensure long, healthy careers. To learn more, please check out her website: www.jennafkantor.wixsite.com/jkpt

 

Read the full transcript below:

Jenna Kantor (00:03):

Hello. Hello. Hello, this is Jenna Kantor. I'm here with Stephanie Weyrauch. You guys probably know. I mean she's not any stranger to this podcast. How many podcasts have you done on this specific one? I wish I could say third time as a charm as we go. But I wanted to bring on the good old Stephanie Weyrauch however you want to refer to her. Or you could be like, hello, master or master, whatever you prefer. I'm going to bring on Stephanie today because she's actually my advocacy mentor. And I wanted to bring her on to talk about this because I don't think people realize this can be a thing. And so I'm like you want to come on, she's all, yo, let's do it. So this is where we are. And I wanted to open this up, especially to any student physical therapist grads who are looking to get more involved with the APTA and just don't get that guidance from someone that they trust and who believes in that. So Stephanie, why do you think I wanted to work with you?

Stephanie Weyrauch (01:21):

I think that to do with the women in PT summit. I mean I know that, I remember the first time that we met Jenna, we were at the women in PT summit. I had seen a lot of your videos on social media and you and I were friends in social media and so I remember I came up to you and I said, Oh, you're going to at four. And you said, Oh my God, you've seen my stuff. That's so cool. Sort of talking and I think you based off of your interest in advocacy and based off of, I think you knowing that I was involved in advocacy, we just started talking about it and I think that that's just how the hell, it was a really organic thing. It wasn't anything that was really formal. It was just like, Hey, we have this common interest. We know we both enjoy. I mean we both are passionate about the profession and I think that's kind of what led you to me.

Jenna Kantor (02:12):

Yeah. It's funny to say it's not horrible, but to be, I remember when I asked you, I felt like I was asking you to be my girlfriend. Will you? Will you be my advocacy is a big deal. I think this is important to bring up as somebody who's really watched to continue my involvement with the APTA making changes that I foresee that will be so great for its growth. I really wanted to bring this up because it's necessarily easy to find the right person. I think of it as dating. At the end of the day, there's a lot of people who will give you tidbits, but for somebody like you or I can say, Hey, I need to talk to, they'll be available to talk to like brainstorm or whatever, or even if it's just a hard time, get through a Rocky space. Just brainstorming, but that's extremely valuable. A lot of physical therapists who are involved, they don't necessarily believe in beyond that level where I feel comfortable to be open.

Stephanie Weyrauch (03:23):

Yeah, I mean I think that, you know, you make a really good point about finding the right person because you know, while people say that you can go up to anybody and say, Hey, will you mentor me? I mean you really have to build that relationship, which is what advocacy is all about, right? I have been a really good advocate. It's all about building relationships and so finding that person that you can be yourself around yet that person is going to be honest enough with you to tell them you know, the things that you either need to improve on. Be that critical feedback, but also give you that positive feedback to reinforce that you're doing the things and finding that balance. So I think that you make a good point about making sure that you're finding the right person. And my advice to people is if you are interested in finding an advocacy mentor, just a mentor in general, try to foster that connection. That relationship is really important.

Jenna Kantor (04:27):

I remember it was a process for me because now they know what they're doing. They have what I want and everything, but I didn't feel a hundred percent and I think that is something we forget. You just think they're amazing, but how do they make you feel about yourself when you're with them? Do they make you feel good? I've had conversations with you where you've started to get me, you know, you're like, I think this, and I said our walls, that's not where you want. It may have been with the step never on me. Things that were my specific goals and values about within myself. It's been very helpful finding someone who I can be me all the way, which is a challenge.

Stephanie Weyrauch (05:28):

And I think that that's an important thing for mentors is that creating a mini, you're creating a person who is their own individual person and has attributes that they can bring to the table to make them strong advocate or you know, whatever the mentorship relationship is about, you're just moving them along. I always think that, you know, being a mentor is even cooler than accomplishing something yourself because the mentee accomplishes something in that route. And you foster that accomplishment by, you know, facilitating their growth and making sure that they're connected with the right people. I mean, that's just as rewarding and if not even more, all the extra people that you get to touch in addition to, you know, your own personal development as an advocate in your own personal development as a leader. So I think that, you know, it's something that not only helps you as the individual mentee, but you as the mentor, it allows you to have a larger reach and what you will have just in your little bubble who in your own advocacy thing.

Jenna Kantor (06:44):

Yeah, that's true. That's really, really true. And it's not easy because like you mentioned earlier, there are people who many people say, Oh yeah, I just spoke to anyone. So you have to make a decision for yourself. Are you good with getting snippets of people and having a law or would you want someone that's going to be viable for you, devoted to investing time, give you that advice and guidance? There's no wrong answer to that. I discovered that I needed only one. Stephanie became Michael B wonder what would be a Harry Potter reference.

Stephanie Weyrauch (07:30):

So I mean, Elvis stumbled or of course not Baltimore. Baltimore does not. Definitely not. No way. Don't compare me to Baltimore compared me to the more. I think that that's another thing about mentorship that can be challenging is the time commitment. And you're right, you can have multiple mentors that you know, don't really need, that you don't really need to spend a lot of time with. But again, if that mentor is really into facilitating your growth, they're going to be, it's going to be okay that they're going to invest time. And you know, it may not be like a one hour weekly phone call when you see them. Like they're going to want to spend two hours. You can just catch up and see how you're doing. Or they'll text you or email you back and forth. And those are the men. Those are the relationships that are built on, that are built on exactly what you said, relationship. It's not just built on a normal face to face. I mean somebody that you barely know, this is something that you've cultivated, watered, and now the seeds are growing in the beautiful tree is starting to really fester to help kind of bring about that relationship that's needed to have that effective mentor help you.

Jenna Kantor (08:57):

I'm realizing we're making an assumption here. So let's answer the question. Why is it good? Why is it beneficial to have?

Stephanie Weyrauch (09:04):

I think that the benefit for it is because it helps you prep, it prevents you from making mistakes that most people make. And when I think one of the best things about having a mentor, you grow and become better, faster than maybe somebody who had to figure out along the way. Granted there's been multiple people along in the history of time who've been able to figure out their own way, but potentially they could have burned some bridges along the way. They could have had some set backs, they may have missed opportunity. And if there's one thing we know about advocacy, it's all about opportunity. And it's all about presenting your argument in the right way, at the right time for the right things that are going on. And so understanding that and understanding that, especially in today's very polarized political environment, making sure that you are approaching these issues in a way that is proper and in a way that's going to be effective. Because ultimately when you're advocating, you're advocating for your patients, you might be advocating a little bit through your profession, but in general, when you advocate, you make sure that people are getting great care. And right now our healthcare policy is very polarizing. There's lots of different opinions about it. And if you are with the right person and they're guiding you the right way, you're going to go about it in a way that's not going to be as potentially detrimental to the message that you want to send.

Jenna Kantor (10:45):

Yeah. And you're hitting on lots of great. Just like anything, any relationship that relationships, and I'm going to sum it up with a word. You could get blacklist, you can't, it's not like there's a horrible place. Nobody that made no, ain't nobody got time for that. But if you're a person who's constantly coming out like a douche, you're not going to want to know you. Just like you make me feel like crap. That's a thing. So to get, and it's even if you think you are doing something, you never really realize. If you might be cutting down on someone who was put in a lot of hard work, a lot of hard work for zero reimbursement for the profession and that has to be considered even if you completely disagree with it.

Stephanie Weyrauch (11:40):

Right. Well and advocacy takes a long time too. I mean, it's not something that you can go to one meeting and all of a sudden now you have a law passed. I mean it takes 10 it can take up to 20 years as we saw with the Medicare therapy cap to have something actually happen. And that's like a long history of that's like a, Oh that's a history in itself. 20 years. I mean I'm only 30 years old. That means that when I was 10 stuff was going on that I don't even wouldn't even know about. And if I don't have that historical knowledge and that historical information, how can I be an effective advocate? So by having a mentor who knows that history and can help guide you along some of those talking points that you have, because either you don't know the history, you're too young to know the history or you just aren't as familiar with the talking points themselves. You have that person there can give you that. And then when you go to advocate, you have that much more credibility. If there's anything that is really important in advocacy, it's first off, it's credibility and second off it's relationships. What type of relationship have you built with that person? Because if you're a credible person and you have a relationship with them, the chances of them actually listening to you when that app comes, who's a lot better than you're just random person that has no credibility, right?

Jenna Kantor (13:09):

Does natural delight is the things that I personally want to change just for voices, lesser known voices too. That's my own little personal agenda is the important part of this podcast. Very important part. Very, important part of advocacy. Advocate for lameness. So after answering, why do you have to, is it a must in order to achieve what you want within the physical therapy profession? Advocacy wise?

Stephanie Weyrauch (13:50):

I mean I would say yes because I don't know how many of our listeners are experts in healthcare policy, but my guess is that there's not a ton that are experts in health care policy and if you are an expert in health policy, my guess is that you've had a lot of mentorship along the way. I know for me, I mean healthcare policy changes daily and for me, how I have learned has been from being by people who I would consider our healthcare policy experts in addition to them giving me resources that I can use so that I myself can become a health care policy, not to mention really keep emotion out of politics and that is path of what advocacy is, is trying to present a logical argument that isn't based off of emotion, was based off of somebody else's emotion. That's going to further the policy agenda that you're trying to advocate for. And I think one of the hardest parts about advocacy, personal emotion out of the picture.

Stephanie Weyrauch (15:10):

You're there to advocate for your patients. You're not there to advocate for yourself in the end. It doesn't really matter what you believe, it matters what is needed for your patients. And so having just a mentor there to guide you through some of those, that emotional roller coaster of politics and emotion, individual politics with societal politics I think is an essential part of being an effective healthcare advocate. Additionally, there's so much information and having somebody there to help you kind of focus that information and help you figure out what you need to learn and what you can focus on is also really important. I would say yes. Having a mentor is extremely important.

Jenna Kantor (16:02):

I love that and on that note person who has been on this podcast now for this is four times. How can people find you if they haven't listened to you?

Stephanie Weyrauch (16:20):

So you can find me on Twitter. My Twitter handle is @TheSteph21 I'm on Facebook and Instagram. You can find me there or if you want to email me, you can email me sweyrauchpt@gmail.com but I would say the best way to reach out to me is probably Twitter.

Jenna Kantor (16:48):

Tweet, tweet, tweet, tweet, tweet. Well, thank you so much Stephanie, for coming on. It's a joy to share your expertise, to share you with others. Even though I want to claim you all.

Stephanie Weyrauch (17:04):

Thank you for the wonderful opportunity to come on. I'm healthy, wealthy, and smart. Well, once again, and of course it's always great to chat with you about something that I really love. Advocacy.

Jenna Kantor (17:16):

Heck yeah, me too.

 

Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram  and facebook to stay updated on all of the latest!  Show your support for the show by leaving a rating and review on Apple Podcasts!

May 19, 2020

On this episode of the Healthy, Wealthy and Smart Podcast, Jenna Kantor guests hosts and interviews Andrew Ball on rehab after COVID-19.  Dr. Andrew Ball is a board certified orthopaedic physical therapist with nearly 20 years experience in physical therapy. Drew has earned numerous advanced degrees including an MBA/PhD in Healthcare Management, and post-professional DPT from MGH Institute of Health Professions. He has completed a post-graduate fellowship in Leadership Education in Neurodevelopmental Disabilities (LEND) at University of Rochester, and a post-doctoral clinical residency in Orthopaedic physical therapy at Carolinas Rehabilitation in Charlotte, North Carolina. Clinically, Drew has mastered a wide-range of manipulative therapy techniques and approaches via continuing education and residency experiences (ultimately creating and co-creating several new techniques).

In this episode, we discuss:

-The pathophysiology of COVID-19

-Physical therapy treatment considerations in acute and outpatient settings

-Post Traumatic Stress Disorder among patients and family members

-Functional tests appropriate for patients following COVID-19 infection

-And so much more!

 

Resources:

Email: drdrewPT@gmail.com

Andrew Ball Instagram

APTA Cardiovascular & Pulmonary Section COVID-19 Resources

United Sauces Website 

 

A big thank you to Net Health for sponsoring this episode!  Learn more about The ReDoc® Patient Portal here

                                                                    

For more information on Andrew:

Dr. Andrew Ball is a board certified orthopaedic physical therapist with nearly 20 years experience in physical therapy. Drew has earned numerous advanced degrees including an MBA/PhD in Healthcare Management, and post-professional DPT from MGH Institute of Health Professions. He has completed a post-graduate fellowship in Leadership Education in Neurodevelopmental Disabilities (LEND) at University of Rochester, and a post-doctoral clinical residency in Orthopaedic physical therapy at Carolinas Rehabilitation in Charlotte, North Carolina. Clinically, Drew has mastered a wide-range of manipulative therapy techniques and approaches via continuing education and residency experiences (ultimately creating and co-creating several new techniques). He is certified by the National Academy of Sports Medicine (NASM) as a sports performance enhancement specialist (PES) and was personally trained and certified (CMTPT) by Janet Travell’s physical therapist protégé (Dr. Jan Dommerholt of Myopain Seminars) in myofascial trigger point dry needling. Dr. Ball serves on the Specialist Academy of Content Experts (SACE) writing clinical questions for OCS exam, as well as research and evidence-based-practice questions for all of the physical therapist board certification exams.

Dr. Ball currently serves on the clinical and research faculty at the Carolinas Rehabilitation Orthopaedic physical therapy residency teaching research methods and evidence-informed clinical decision making, but also contributes to the clinical track mentoring residents in manipulative therapy and trigger point dry needling. His publication record is diverse, spanning subjects ranging from conducting meta-analysis, to models of physical therapist graduate education, to political empowerment of patients with physical and intellectual disability. Dr. Ball’s most recent publications are related to thrust manipulation and can be obtained open-access from the International Journal of Physiotherapy and Rehabilitation.

Drew is married to his wonderful wife Erin Ball, PT, DPT, COMT, CMTPT. Erin is Maitland certified in orthopaedic manual therapy (COMT), certified in myofascial trigger point dry needling (CMTPT), and has extensive training in pelvic pain, urinary incontinence, and lymphedema management. They live with their two dogs one of which is a tripod who was adopted after loosing his hind-leg in a motor-vehicle accident.

 

For more information on Jenna:

Jenna Kantor (co-founder) is a bubbly and energetic girl who was born and raised in Petaluma, California. Growing up, she trained and performed ballet throughout the United States. After earning a BA in Dance and Drama at the University of California, Irvine, she worked professionally in musical theatre for 15+ years with tours, regional theatres, & overseas (www.jennakantor.com) until she found herself ready to move onto a new chapter in her life – a career in Physical Therapy. Jenna is currently in her 3rd year at Columbia University’s Physical Therapy Program. She is also a co-founder of the podcast, “Physiotherapy Performance Perspectives,” has an evidence-based monthly youtube series titled “Injury Prevention for Dancers,” is a NY SSIG Co-Founder, NYPTA Student Conclave 2017 Development Team, works with the NYPTA Greater New York Legislative Task Force and is the NYPTA Public Policy Committee Student Liaison. Jenna aspires to be a physical therapist for amateur and professional performers to help ensure long, healthy careers. To learn more, please check out her website: www.jennafkantor.wixsite.com/jkpt

 

Read the full transcript below:

Jenna Kantor (00:02):

Hello. Hello. Hello. This is Jenna Kantor with healthy, wealthy and smart. I'm super excited because I have Dr. Andrew Ball here who is going to be interviewed on COVID-19. Has anyone heard of it? Anyone? Bueller, Bueller and return to performance post infection. This is such an important conversation. I'm really excited and grateful to have you on Dr. Ball. Thank you.

Andrew Ball (01:26):

Well, first of all, please call me Drew. And second of all, let me thank you and your listeners for having me on.

Jenna Kantor (01:34):

Wonderful. It's really a joy. Would you mind telling people a little bit more about yourself so they can better get acquainted with Mr. Drew?

Andrew Ball (01:46):

I have been doing physical therapy for, I have a 20 year history in physical therapy. I've taught for a good majority of that time. I started out in pediatrics doing what I was told was the first fellowship in pediatric physical therapy and neurodevelopment at the university of Rochester, which has since kind of turned into a PTA accredited residency program at the strong center for developmental disabilities and then evolved into doing orthopedics. I hold an MBA, PhD in health care management. I went and did a post-professional DPT, but I got to sing. None of that matters really the salient point. And I think I'm using that word correctly. But don't go with it. Go with the pertinent point is that I could be any one of your listeners who treats in outpatient orthopedics who treats in sports.

Andrew Ball (02:48):

My passion is working with musical athletes. I started working with guitarists. I played piano at Peabody when I was a little kid, put that down and Mmm. And ultimately I got back into music by playing guitar, by being forced to play guitar because I was working with guitarists. And at some point it's like working with a football player and never having played football or treating dancers and never having dance. There's a point where there's a level of respect from your patients. You just don't have it unless you actually have, okay, I've done the work. You can't really speak the language. So I recognized that there were two ways, one of two ways to do that. One was to begin building guitars. So I started doing that. And then ultimately one of the guys that I built a guitar for who plays guitar for Carl Palmer formerly of Emerson Lake and Palmer in Asia.

Andrew Ball (03:58):

Basically he told me like, this guitar is great, but you really have to learn how to play or, yeah, I mean you really are going to have to learn the language of the little things like the posture and the whole, you can talk about holding the guitar, but you know, if you're a grunge player and you're playing bass, you've got to play that guitar and you gotta play that bass guitar and your name and it doesn't matter. Cause it doesn't look cool to have it in the right, you know, proper position. And the muscle memory that these guys had been in gals have been doing, you know, since they were you know, 12 years old you know, you're not going to change that. It's like changing someone's golf swing or if you're going to change it, they have to understand that it is going to be for a greater good.

Andrew Ball (04:45):

Like being able to play a 60 date tour versus having shoulder pain after 30. So, I kind of weaved and wobbled through trigger point dry needling. And I also teach for my pain seminars, but that got me into working with the Jamaican Olympic track and field team. It got me into working with the Charlotte symphony and I'm one of the physical therapists for them. But ultimately I am trust like any one of your performance PTs who is interested in that population and at the same time truly truly wants to help individuals that have a hard time finding care. And so that, is that correct?

Jenna Kantor (05:37):

Yeah, I think that's great. I mean you could go on for a very long time and I really want to get to the point because this man clearly he is a person to learn from. He has so much information to share and I'm really happy about this topic that we're diving into with COVID-19. Let's go straight into the point COVID-19. What are the effects that it has on the body that we need to start paying attention to?

Andrew Ball (05:57):

Like the first things that we have to just acknowledge cause this is going to be something new to us to consider. Right. So there's a lot of things that we need to consider. The physical I'll talk about first. And the psychological, which is a piece that we don't, that certainly performance, that's a huge issue, but that's certainly not something that most PTs outside of the performance training group really, really focuses on. So I'll start out with a friend of mine who was one of the first a thousand people to be diagnosed with COVID. She was in Washington state. She was one of the first 250. She's super, super bright. She holds a PhD in aerospace engineering or aerospace engineering design.

Andrew Ball (06:57):

She's a little bit younger than I am. How old am I? Not quite 48 years of age. And she was, is extremely fit very outdoorsy plays an instrument. So I just want to kind of walk through what she experienced. And this could be again, any one of your listeners on days zero, we'll call it before she was diagnosed. She was skiing I believe snowboarding, but skiing and had some aches and a dry cough and fatigue and experienced something that she had never experienced before that she described as chest awareness. Now your patients and folks that you work with are very acutely aware of breath.

Andrew Ball (08:06):

Right? So I kind of asked her, was that what you meant? She's like, no. I felt like I had to consciously think about every inhalation and exhalation that I chose. And that was before, before a diagnosis, but that was faint. She described it as on day one, which is the day that the fever tends to rise. Not everybody has a fever. So there's variability here that she spiked a fever of 102. She had difficulty breathing day two, that worsen. She had a dry cough and we should get into the idea of a dry cough versus a wet a cough a little bit later when we talk about the physiology of this and how it differs from a pneumonia. And had some GI dysfunction as well. And although we kind of talk about the upper respiratory issues, we also need to understand that the virus enters through the injury.

Andrew Ball (09:16):

The angiotensin converting enzyme to receptors. And, there's obviously the majority of those are or in the lungs, but there are some in the GI tract as well. They're actually all over the body, but and that's why some of the lesser talked about symptoms include things like GI disturbance and urinary issues. And in her case loose bowels by day three, that's when she had a virtual visit. And luckily because there were so few folks being diagnosed at that time, she was able to get a clinical diagnosis by that evening coded by Dave. Or that's when she went to the emergency department because she felt like she thought she had a pneumothorax. She felt like she was unable to fill her left lung with air. And they did a chest X Ray.

Andrew Ball (10:19):

They did the nasal swab. That was day four. She described it as touching her brain. I mean, it's a significant swap. /you have to go all the way up to the back of the throat in order to get right. Which is why many folks who feel like they have a mild case when they hear that they choose not to engage the healthcare system. And I really think that's a bad, bad, bad, bad decision. Because yes, 80% of folks are gonna have a mild to moderate case, but those 20% that you carry it to can have a severe reaction to the virus. That can be, it can be fatal. Five through nine, her fever began to break. Roughly day seven, she had a reflexive excuse me cough.

Andrew Ball (11:21):

She was unable to sleep. She felt like your ears were completely clog. She was coughing up blood and coughing so much that she had conjunctive like conjunctivitis, like that redness in the eyes. Day nine was what she described as noteworthy and describe that as intense exhaustion to the point where she had trouble lifting a spoon. She had trouble zipping up a jacket. And it wasn't until day 11 that she felt like having any kind of food or any kind of coffee. Now here's the critical point is performers or super, super attuned to the idea of I felt bad. The show must go on. I've got it. Push it there. And roughly day 11 through day 14, that's when the viral load is decreasing, but the inflammation is increasing. That's when people go on to ventilators. That's when people kick into this cytokine storm that we've heard of.

Andrew Ball (12:27):

And it's critical to understand that as a healthcare provider and certainly as a patient or performer, cause there have been a number of cases where people had mild cases and they push themselves during this phase a little bit too soon and died having had very, very mild symptoms and then took a turn as a day 14, she still had some difficulty concentrating. She was still exhausted. She found it exhausting to speak and still had a morning sore throat and that's considered a mild.

 

Jenna Kantor:

Okay. Wow. So I think that's, that's important to understand where these people have come from. You know, we don't, well we can get into the idea of ventilation and whatnot before we do it probably makes a little bit more sense to get into this kind of case and how we would treat them coming out of this when they can have contact and we can help them.

Andrew Ball (13:36):

Yeah, absolutely. Yeah. So kind of jumping forward into well let's take a step back before we do that. If you don't mind just into the pathophysiology a little bit, where would you like to jump back and forth? Let's if we do the pathophysiology, just because I don't want this podcast to be too long. Let's make it very brief, very, very brief so that way we can move forward. So I think it's important to understand that COVID-19 is not influenza, it's not cystic fibrosis, it's not pneumonia. And those are the diseases that when you took cardiopulmonary physical therapy, like that was the primary focus was these diseases where the airways would fill with mucus. That is not at all what happens in COVID-19. So a percentage of folks get acute respiratory distress syndrome and it's a dry cough.

Andrew Ball (14:32):

And the reason that it's a dry cough is that the airways don't fill with mucus. What's happening is that the capillaries begin to leak fluid into the lung tissue itself. So think that like lymphedema of the lung, which sounds horrible, right? So the airways are getting, a couple of things are happening, the airways are getting squashed, but still get kind of in and out, but the elasticity of the lungs is going to decrease considerably. And why she felt like she had pneumothorax. Exactly. So, the lungs start to stiffen. Much more fluid within the lungs in the lungs lining. So if you think of the lining like a balloon and having that kind of the alveoli, having that kind of consistency, normally it's as though you took Vaseline and you just slathered the balloon with Vaseline and then expect for the gas to exchange at the same rate in between that membrane and it just does a brand harder thinking of this and that.

Andrew Ball (16:10):

So the problem is not mucus. The problem is ventilation and perfusion. So part of the reason why I got very interested in this is there is a role obviously for quarantine workouts. And by that I don't mean, you know, our brave soldiers within our profession that are in acute care in the ICU and are turning patients so they don't get bed sores and turning them into prone for optimal ventilation profusion. That's not what I'm talking about. I'm talking about the therapist that the only thing that they're posting is information on what healthy people can do when they're stuck at home. And there's a place for that short, but I really feel like there is a role and a responsibility that our profession has to educate the public and to educate each other about COVID-19 and little things. So I started out just asking questions about what can we as physical therapists do?

Andrew Ball (17:20):

Right. You know, I went back to my cardiopulmonary books, you know, what is the role of putting people into a head down, a position that postural drainage. So they can get the mucus out. Well, newsflash, they don't have mucus, right? So that's not going to help. And it's not the best position for Benadryl for ventilation profusion. So that's important. And the other thing I started asking was, well, what about chest PT? You know, I was awesome at chest PT. I haven't done it since graduation, but I remember that as well. The problem with that, again, no mucus, the clear, the only thing that you are going to do if you are trying to help a performer with a mild case who is getting over COVID-19 is you will weaponize an aerosol the virus. So, you know, there were several folks that were suggesting that based on a poor understanding of the physiology and now we really have to retool and get the information out that no, the best position for somebody who has an active case of COVID-19 is prone because that optimizes ventilation profusion because of fluid dynamics and the anatomy of where the alveoli are.

Andrew Ball (18:37):

So I think that's important to understand because in performance, you know, we fast forwarding, we like to think about things like posture, right? Posture may, it can't hurt, but it's not going to make the huge effect that we think of. With some of the other respiratory structural kinds of problems. Can you see, Oh, taping can be somewhat helpful for folks who have breathing dysfunction and until folks get very, very, very far in their recovery process, that's probably not going to be helpful. When I talk about prone, these folks have been placed in a prone position for the minimum protocol I've seen is 12 hours, but usually it's somewhere between 16 and 18 hours a day and a 24 hour period to optimize ventilation perfusion.

Jenna Kantor (19:35):

Right. That's exactly right. Well, the other issue getting into the psychology of all this, Isolation, psychosis, delirium, and these are people who are in pain and I have a hard time taking a breath. Right? They can't have family members can't have family members in there. Right. So what do you think the impact of that is going to be when you see the patients six to eight weeks after the resolution of symptoms in outpatient or as a performance based therapist?

 

Andrew Ball:

Yeah, it's going to be probable in more than 50% of cases, 54% of cases. It's going to have a huge mental health impact that you can see at least 12 months later as PTSD. Now, I don't know about you and the musicians or performers that you've worked with myself included.

Andrew Ball (20:42):

I don't think that we're the least bunch and you layer, post traumatic stress a top that and what you end up with if you don't understand that walking into the room with the patient when you do the evaluation or when you treat them is a whole group of individuals, half of these folks who are going to have behavioral reactions to everything from the frustrations of making their appointments down to frustrations with the treatment process. It's just going to blow up seemingly out of nowhere. And I'm here to tell you it's not out of nowhere.

Jenna Kantor (21:25):

I get it. When you're talking about the psychological component, Oh, that's such an untapped situation. This is also new to us.

Jenna Kantor (21:39):

I don't know. I mean I guess it would just, I mean, off the top of my head would just how I am with my people when I'm with them. It's just really checking in, just checking in, asking. I would just keep asking and being like, are you okay? Let me know if this is starting to freak you out in any way. I think that that's gonna be the big thing. Like I need you to feel comfortable. I need you to feel safe and has to just be that level of, I mean, which we always have any way, but a new level of thought process, you know, sensitivity where something like going, even prone could make them go, you know, and they don't even know. They don't realize they're doing it. Their whole body could just even just naturally tense up and it could just become harder to breath just because they develop a new habit to feel like that's what it's going to feel like when they're on their stomach. We don't know.

Andrew Ball (22:28):

Fortunately or unfortunately, there's a ton of research. Oh, I'm working with patients with post traumatic stress as a function of you know, I don't want to get political here, but as a function of endless military action that are had over the course of the past years. So there's a fair amount of information on that, but awareness is going to be critical in working with these patients. Going back to infection though the question that I get asked probably more often than anything else is when is it appropriate to begin working with these folks without personal protective gear? And the answer to that is, there's some guidelines from the European rehabilitation society, but we really don't know. What we know is that patients can go stealth and can be contagious long after their symptoms disappear.

Andrew Ball (23:37):

And there's at least one case study a well written case study showing that the symptoms that the patient can shed the virus for 37 days after they're no longer symptomatic. And the problem with that is that here in the United States testing is scarce, right? To diagnose it, to say nothing of when are you clear completely of the virus. I'm not aware of widespread secondary testing. And then some of the guidelines from like the world health organization suggest that someone needs to be tested. I think it was in China. Needs to be tested twice and have a negative result twice before they're clear. And if we're not doing that, then we really have to wait six to eight weeks.

Andrew Ball (24:44):

And that's why, because you're going to be long, long past what we know to be the longest reported case. Now whether or not your patient is that, you know, new one that can where they stick around shedding the virus for 42 days or 48 days, you know, we don't know. And one of the scarier things from a public health perspective for me is the recognition that this is an RNA virus, which means that it's going to be harder to create a vaccine because like the common cold, like the rhino virus it slips, it mutates quickly. No, fortunately that has not happened.

Andrew Ball (25:49):

But there is every reason to be worried. And I don't want to freak people out, but there's every reason to be concerned that if we don't kill this thing this year, that it's going to come back every year in a slightly different form, perhaps more contagious, perhaps more stealth, perhaps more deadly. Perhaps it will shed the virus for a longer period of time before we were able to begin working with patients, which kind of gets to that economic effect. I understand that people are hurting. I understand that folks have private practices and cash based practices that have limited cashflow and they're hurting. I totally get that. Yeah. I mean, you know, and folks go, Oh, you don't understand. You work in a situation where you don't own your own practice.

Andrew Ball (27:01):

Well, that's true. You know, I have a significant impact income from teaching. So, you know, I get it. I understand that the dollars are tight, but if you told me that if we shut down for an additional two weeks and we can kill this thing completely, I would do that even if that meant a significant decrease in my salary. And at some point, I think that, and I'm not saying that everyone is a clinical doctor in our profession, I've gotten some feedback for that. But as a clinical doctoring profession, I do think that we have a solemn responsibility to the public in terms of educating on COVID-19 versus kind of filling the Instagram space with Mmm. Lots of home workouts, which are important. People need to keep fit and certainly keep their minds going while they're in quarantine.

Andrew Ball (28:10):

The problem is that there's so many outpatient private practice, cash based PTs that have a such a voice on Instagram that some of this information about just the mechanics of the disease, the physiology of the disease, how long you need to wait in order to protect yourself and your patient from either reinfection or infecting others just isn't pushing through. So, once again, thank you for allowing me to come on this podcast because I do think that those of us who have a voice in that space have an obligation to get some of this information.

Jenna Kantor (28:57):

Wow. Yeah. Yeah. It really, it is very valuable. I want to actually dive in, even though we've been going for a while, I think it is important to dive into now somebody who had the ventilator. Yeah. I think that, that we can't overlook that. There will be some people who've been that unfortunate. So could you talk about what that means with somebody who has been fortunate to recover from such a horrific.

Andrew Ball (29:28):

Sure. So, as I said, about 80% of patients are going to have a mild to moderate and they won't be hospitalized. They may, because of the stress and strain on their lungs, they may develop pneumonia, so they may actually end up, you know, having secondary sputum. But those are folks who, even with the pneumonia are going to have something that we consider a fairly mild case. 20% are going to be severe to critical. And the severe group are the ones who are going to have dyspnea. They're the ones who are going to have rapid breathing that's defined as more than 30 per minute. Their oxygen saturation is going to drop to 93%, and they'll have on a cat scan, you'll be able to see lung infiltrate. That looks like kind of a grounded glass appearance of about 50%.

Andrew Ball (30:30):

So, and then you've got 14% that are severe that fit that classification and about 6% that are critical. And that's respiratory failure, septic shock, multiorgan failure. And within that group, okay 20%, about 25%, we'll end up in the intensive care unit most of which or many of which will end up on a ventilator. And if you end up in the ICU on a ventilator, your chance of survival is about 50%. So what tends to happen with that ventilated population is on roughly about day 14 we talked about how the viral load increases and then decreases while the inflammation increases. Well as the inflammation in the lung increases okay. A percentage of those folks, as I said, will end up roughly around day 15 needing to be ventilated for about four to five days. And half of them will come off and half of them will not. So the people who come off their recovery. So their recovery we don't, again, there haven't been a ton of folks, so we don't know a ton. What we do know is that in severe cases, there's going to be ICU acquired muscle weakness. They're going to have a severe loss of lung function, a severe loss of muscle mass.

Andrew Ball (32:16):

Yeah, we're getting younger too, but just as things been saying percentages. Yeah. neuropathy, myopathy. The good news is, is that we can begin to protect recovery. And the greatest, what we know is that the greatest amount in physical function will be seen. If the patient falls into acute respiratory failure, we'll see that within roughly the first two months of discharged. So that gives us some kind of a gauge. In addition the degree of disability at about a week after discharge determines the one year mortality and recovery trajectory of that individual. So we have some guidelines as far as that's concerned from acute respiratory distress syndrome, right? So that's not necessarily coded, but we believe that we can extrapolate in general what we haven't talked about is the impact on them.

Andrew Ball (33:30):

And the fact that about 30% of family members of individuals with acute respiratory syndrome end up with PTSD. So now you have this group, we're 50% of folks who have been in the ICU have PTSD and 30% those folks have family members who have PTSD. How do you think that's going to go down or like, a lot of them can't go into the hospital, but they can do a FaceTime video. So what they get to see in that FaceTime video with their loved ones in the hospital, I'm talking about after they're discharged. I'm talking about later. Yeah. No, but I'm just saying the family members with the person, I'm like their interaction. That's what I'm referring to, their reaction with it. If you're prone for 16 to 18 hours a day, right?

Jenna Kantor (34:07):

Yeah. So what do you do with these folks when you finally see them? Right. So you're going to have chocolate. Chocolate makes people happy. Right? It's funny, it's funny you say that. I'm doing a webinar with some some other instructors that I teach with and we're kind of talking about the format. And I'm a huge fan of the old school. I love the daily show, but I'm a huge fan of the old daily show with Craig Kilborne. He used to do the thing where he would like ask opinion questions. I'll ask you Reese's pieces or M&Ms no, I'm sorry. The correct answer is eminence. No, I'm sorry you were wrong. No, I would agree. But that's what he would say.

Jenna Kantor (35:13):

He would end with those kinds of questions. Kind of like his version of the James Lipton kind of five questions. What do you hope that God says when you die anyway, we're getting off track. So what I'd like to kind of go through is you're going to have folks that have worked with you in the past. They are post infection. Ah, they’re your dancers, they're your musicians in the pit. They're your directors. They're your loved ones that are going to refuse to see anyone. But yeah.

 

Andrew Ball:

Right. And of those folks, you're going to need to know what to, you know, what to do. I would say if you hear nothing else from me, remember your vitals and there's, it has to be a Renaissance now of taking heart rate, taking respiratory rate, taking oxygen saturation, taking blood pressure with every patient.

Andrew Ball (36:12):

The functional tests that we're probably gonna have to start using are things like ambulatory distance, which is going to be severely decreased. We'll be lucky if some of these folks are able to walk 300 feet. Some of them, right, if they're severely impaired. You know, that's not far enough to get from your car to a doctor's office. You normally need about 500 feet for that to say nothing of getting back to your daily life and doing your own grocery shopping with which you need at a super target or R or Walmart, you need a good half mile, you need a good 2,500, 2,500 feet. But things like the five times sit to stand test or test that we're going to need to brush up on the six minute walk test. Fortunately we can remote monitor some of those things.

Andrew Ball (37:05):

Tele-Health isn't just you know, getting on a zoom call with somebody tele health, we need to think of that in an expanded way, right? There's apps that will allow for you to do a six minute walk test or your patient to do a six minute walk test and then send you those results remotely from there, from their app. Some folks aren't going to be able to walk for six minutes, right? So at that point we're going to have to back up into feet per second or four meters per second. And we have some metrics for that. You know, we know that somebody who's under 70 at a normal walking pace should be able to walk a good 2,500 feet at a 4.0 feet per second. So, you know, somebody comes in completely deconditioned and they're walking 1.5 feet per second for 500 feet. We've got some work to do.

Jenna Kantor (38:36):

Yeah, totally. Yeah. You know, don't forget about deep breathing, deep dive. And I don't just mean you know the breath, but I mean the breadth, I mean the deep diaphragmatic breathing, bringing it all the way down into your belly, your performers should be well for those dancers who sing, that's huge. That's so huge to reconnect with it, even though that may seem so basic with them before, but have they caught the disease. And, for sure to make sure that starts to get all connected and back in check and not a stressful

Andrew Ball (38:43):

Right. You know, and then I look into things that, Mmm, that as I've spoken with some cardiopulmonary specialist, you know, all of this comes from the European rehab society. I also want to plug the American physical therapy association. I shouldn't have done this at the very top of the of the discussion. But the pacer project, the post acute  COVID-19 exercise and rehabilitation program, it is completely free, but it's time intensive. Mmm. You know, they've tried to break things down into 45 minutes or hour and a half lectures, but there's like eight or 10 of them. You don't have to watch all of them. It's free. If you want to get the certification and the CEO's is fine, go through the APTA learning center, but they've put everything up on YouTube and all you have to do is search APTA cardiovascular section and you'll get the the literature. I think a lot of orthopedic sports performance based PTs they're really tech savvy and they kind of want to get the information through podcasts or a like a one hour presentation. So that's, well, essentially what I'm trying to do is to translate.

Jenna Kantor (40:08):

That's what's so great. I mean I'm going to be sharing this in groups as well to keep spreading the information, which is absolutely wonderful. This is good.

Andrew Ball (40:21):

Well, I do add in a couple of things that I've kind of brought to there. Okay. So some of their attention and because they're kind of case study oriented, they're like, well, we're really not teaching that. But particularly for it can't hurt. And particularly for performers humming and I don't mean like humming a song. I mean a long, deep droning

Andrew Ball (40:52):

There's evidence to suggest that it temporarily increases carbon dioxide and it temporarily increases nitric oxide. And in so doing leads to temporary base or dilation, so it can't hurt. I don't know how long it actually lasts. Certainly the deep breathing and increasing walking distance and walking speed is more important. But if you're bored and have nothing else to do while you're in quarantine humming is probably not thinkers would appreciate that.

Jenna Kantor (41:28):

They'd be like, yeah, for sure. That will be a vocal way for them to get that all connected. Also nasal, yeah, there's a lot of stuff with training and staying vocally fit, if you will. So that would actually speak to there values.

Andrew Ball (41:44):

Yeah. Yeah. I could go into a lot more here. I just want to make sure that that folks have a good kind basic understanding here. You know, we've heard, you know, wash your hands, wash your hands, wash your hands. So I'll make a plug for wash your hands, wash your hands, wash your hands. And even in some other countries where the health care workers understood the severity of COVID-19 the healthcare workers seem to be a risk to themselves because they didn't properly and thoroughly and frequently wash their hands. I would say whatever you think you're doing, it's probably not enough. Okay. The other thing that I would say about the hand sanitizers that we tend to use the world health organization and FDA suggest 75 to 80% alcohol.

Andrew Ball (42:50):

And that is not what most clinics have. Most have like the foam sanitizer or the like the Purell, which is 60%. Okay. You know, plugging performers amazing, okay. Guitarists, my performance Buddha and spirit animal is Ron Bumblefoot fall who is in the band spun. Do you know who that is? No, it's not the name. He's in sons of Apollo. He was the lead vocalist for Asia this last tour. And those of you who love guns and roses he was the guitarist the main guitarist on the last guns and roses album. Chinese democracy is ridiculous as a player and he's amazing as a teacher as well in any of that. He also has a line of hot sauce and one of the, and I just love when performers do this and kind of take responsibility for the position that we're in, but a Unitedsauces.com which is the distributor that he works with has retooled one of their lines to put out hand sanitizer that is 75 to 80% alcohol.

Andrew Ball (44:20):

So that will in fact kill the Corona virus. So, Mmm. Great. Local company here in Charlotte. Highly, highly recommend and plugged them. Hey, you want to support a performer you know, during these times. And the last thing that I will leave folks with is as you are working with patients post infection, ask yourself, do you need to put your hands on this patient? Can this be done remotely? And I'm really more talking you know, it really more talking to the folks who do outpatient work, who have their own side hustle who do work in a healthcare system who are going to be pulled inpatient, right? You know, either somewhere like New York city where you are. And folks have to be kind of pulled in, you know, right down to the rural hospital you know, in the middle of nowhere.

Andrew Ball (45:32):

And there's two physical therapists, one inpatient, one outpatient, and they need help working because now they have more folks that are getting ill. You know, really ask the question, both inpatient in your cash practice, in your private practice for the sake of killing this thing. And for the sake of decreasing whether or not you're a force vector, do you need to provide that treatment? And is there someone else who can be your hands? Can you delegate that to a nurse? Can you delegate that to a family member? I really think that we're going to a friend of mine who runs another podcast Adam Meakins, has been talking about physical therapy in terms of AC DC during COVID and after COVID. And I really think that all areas of practice are going to change as a result ranging from the little things that I just talked about, you know, having to do vital signs with everybody right down to really asking the question, can I go from an interdisciplinary model of care to a transdisciplinary model of care?

Andrew Ball (46:58):

Can I let go of that professional boundary and ego. And I know that a lot of my contemporaries are not going to be comfortable with that. I think we have to be secure in the knowledge that we have more than the hands that we place on people. It's all important, but I do think that there's going to be a paradigm shift.

Jenna Kantor (47:30):

I love it. Thank you. So, for coming on, Drew, this was an absolute joy. Where can people find you and reach out to you either on social media or email?

Andrew Ball (47:39):

Well they can reach out to me. I'm on Instagram @drdrewPT. They can email me at drdrewPT@gmail.com. If I don't respond, I have a ton of spam filters. So don't be shy about reaching out to me through social media. But I really want to make it clear. I'm not the expert here. The true experts, you know, are people like Steve Tepper Ellen Hilda grass Angela a beta Campbell Telia polic you know, these are the folks that we really should be talking to are Eric. And if you really want more information, I'm happy to direct people to it.

Jenna Kantor (48:37):

That is helpful. Yeah, absolutely.

Andrew Ball (48:39):

The Easter projects, the post acute COVID-19 exercise rehabilitation project is really where folks want to go for more in depth information from physiology to post acute through the entire spectrum of post acute care.

Jenna Kantor (49:00):

Absolutely. Thank you. Thank you. Thank you for coming on. You guys give a big shout out to him if you have seen this, just so he can really see how he has impacted so many. Thank you so much for coming on, Drew. Have a great day, everyone.

 

Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram  and facebook to stay updated on all of the latest!  Show your support for the show by leaving a rating and review on Apple Podcasts!

May 13, 2020

On this episode of the Healthy, Wealthy and Smart Podcast, I welcome Elizabeth Santos on the show to discuss burnout among new graduates. Elizabeth Santos is a Physical Therapist, Naturopathic Practitioner and Author of 'New Graduate's Guide to Physiotherapy: Avoid Burnout and Injury, Build Resilience and Thrive in Clinical Practice’ an academic style of book designed to be a supplementary text for final year students and new graduates.  Elizabeth has a special interest in maternity health care and works for a talented team of physiotherapists in a musculoskeletal private practice that focuses predominantly on running and sports, pelvic floor health and pregnancy and postnatal care. She is also an active member of the Australian Physiotherapy Association, and a member of the University of Adelaide Physiotherapy Advisory Board.

In this episode, we discuss:

-Are new graduates prepared for clinical practice?

-Why new graduates are most at risk for burnout

-The signs and symptoms of burnout

-Elizabeth’s book, New Graduate’s Guide to Physiotherapy: Avoid burnout and thrive in clinical practice

-And so much more!

Resources:

Elizabeth Santos Facebook

Elizabeth Santos LinkedIn

Elizabeth Santos Website

New Graduate's Guide to Physiotherapy: 10% off with code: hwspodcast

 

A big thank you to Net Health for sponsoring this episode!  Learn more about Secure Videoconferencing and Text Messaging for Telehealth.

 

For more information on Elizabeth:

Elizabeth Santos is an Australian physical therapist, naturopathic practitioner and author of ‘New Graduate’s Guide to Physiotherapy.’ Elizabeth completed a bachelor of physiotherapy at the University of South Australia in 2006 and then went on to work across a range of clinical areas, from acute care within the public hospital system, to aged care,  rehabilitation in the home, and musculoskeletal physiotherapy where she now works exclusively. She has a special interest in maternity healthcare and works for a talented team of physiotherapists in a clinic that focuses mainly on running and sports, pelvic floor health and pregnancy and postnatal care. Elizabeth also completed a second bachelor degree in Health Sciences – Naturopathy in 2014 so that she could provide a holistic and integrative approach to her clients. Elizabeth is an active member of the Australian Physiotherapy Association (APA) and member of the University of Adelaide Physiotherapy Advisory Board.

During her career, Elizabeth became curious about the pervasive burnout she saw in the profession so she spent seven years reading literature on the subjects of injury, attrition and burnout in physiotherapy. Elizabeth has written an academic style of book that is full of the latest research to guide new physical therapists and is designed to be a supplementary text for final-year students and new and recent graduates.

The book covers key areas of clinical interest for new graduates, including how to successfully gain employment, find a mentor, understand insurance and medico-legal requirements, build relationships with clients and colleagues, and learn how to work through professional challenges as they arise.

Elizabeth provides one-to-one mentoring for new graduate physical therapists and also hosts in-person and online workshops for helpers and health professionals who wish to prevent burnout, build resilience and truly thrive in the roles they have chosen. She believes that when we take good care of ourselves we can be of greatest service to others.

Elizabeth’s intention is to help new graduate physiotherapists truly thrive in those first years of clinical practice and beyond.

 

Read the full transcript below:

Karen Litzy (00:01):

Hi Elizabeth, welcome to the podcast all the way from Australia. I'm so happy to have you on the program.

Elizabeth Santos (00:08):

Thank you for having me.

Karen Litzy (00:09):

And now a couple of weeks ago, this is just for the listeners, a couple of weeks ago, I interviewed Tavana Boggs on burnout and physical therapy and she was talking about some of the clients that she works with and yeah, we were sort of centering the talk around people who are 12 to 15 years out of physical therapy school. They've been practicing for a long time. So today we're taking a different take on burnout. So today we're going to be talking about avoiding burnout as a new graduate. And Elizabeth has written a book, new graduates guide to physiotherapy, avoid burnout and injury and build resilience and thrive in clinical practice. So we are going to talk about burnout with new grads because sadly it's a thing.

Elizabeth Santos (01:01):

Right? It is, it is. It's a thing.

Karen Litzy (01:04):

I wish it weren't, but it's a thing. So go. So talk about why you took the steps to write this book in the first place.

Elizabeth Santos (01:14):

Thank you for the introduction. And look. Firstly, I want to say it's a really exciting time to be a new graduate. I think there's so much opportunity for new graduates and for physiotherapists right now, particularly. I wrote this book last year. It was published. It really was the culmination of lots of reading and research over many, many years and actually took me seven years to put it all together. From the moment I started taking notes in the clinic one day just on some letterhead and I thought, Oh, you know, what's going on here? What's happening in the profession? I was curious about the burnout that I saw and also attrition. So physiotherapists leaving the profession because they were feeling unhappy or not really wanting to continue for some reason. I actually looked into some research on this and found a study from Curtin university in Perth, Western Australia. And that study showed that up to 65% of the participants interviewed who were new graduates anticipated leaving within 10 years. It was so, I thought, what's going on here? You know, why is this so high and what can we do about that?

Karen Litzy (02:33):

I mean that does seem very high. So they've just graduated and they already have the plans to get out of the profession.

Elizabeth Santos (02:42):

Yes, it was quite an alarming study and I've seen it those results actually communicated at conferences since and people bringing it up as a real talking point. Within the same study they found that 25% of participants predicted a long term career in physio therapy. So there were some people who were saying, you know, I am going to stick this out and I do see this as a long term plan, but not as many as you'd expect at that point in their studies. You'd be expecting them to come out fresh and excited and ready to take on the world.

Karen Litzy (03:17):

And what do you feel that it is a lack of readiness? Are they not ready for clinical practice? Are they not ready for the real world? I mean, what are your thoughts on that?

Elizabeth Santos (03:30):

That's a great question because that's also something that's been looked at in the literature a lot in Australia particularly, you know, that sense of our physio therapists actually ready to step into the real world and step into their shoes. As a clinician, you know, we try to make sure that physical therapists have adequate clinical placements and exposure to different areas of physiotherapy because we know that helps them to make decisions about their career pathway. You know, they've got that knowledge to draw on when they're choosing their first job or their second job. But there are other things that can help physio therapists prepare and feel job ready. So some of the things that have been highlighted in Australian research where that physios who have as students had experienced in sporting teams or had additional training in radiology. So people who've gone on to study and look at scans in a bit more detail, have had good experiences with that and that's inspired them to go on and perhaps work in orthopedics or musculoskeletal physiotherapy.

Elizabeth Santos (04:43):

We've also found that practicing building a supportive relationship and mentorships with colleagues, but also with other professionals. So whether that's social workers or psychologists or doctors and other allied health professions, that's become something that's really big. And there's lots of research behind that now as well. And just, you know, starting to think about which areas might interest you and what professional development you're going to go down. Which pathway are you going to go down once you graduate? And there's more and more internships which are becoming available too, which are privately operated internships through private practices and things. But yeah, so there's some of the things that new graduates can do to sort of help themselves feel that little bit more prepared and job ready.

Karen Litzy (05:32):

And so what I'm hearing is, you know, getting some inspiration from your placements, getting inspiration and that can come from different places, right? That can come from a mentor, like do they mention finding a good mentor, whether that be within your Institute, your educational institution or outside of, within the profession. Does that help with burnout?

Elizabeth Santos (05:57):

So there is some research to show that mentoring actually helps not only the new graduates, so the fresh physiotherapists coming through, but it actually helps the more experienced ones as well. It helps them to develop a sense of meaning in their work. So finding the right mentor is really crucial and I think for new graduates and for students really, you know, they've got that mentoring in built beautifully in the undergraduate training programs. So they've got these really inspiring, highly qualified, highly skilled therapists teaching them, taking them through step by step. And it's a really important relationship. But then when they become a new graduate, they suddenly lose that sense of being protected by the university. You know, they're out in the real world. It's like leaving home for the first time, you know, it's a little bit scary being out in the world.

Elizabeth Santos (06:52):

And then they've got to find mentors in other ways. And so there's two ways that you can go about finding a mentor and one is to have a mentor who's actually got really more of a vested interest in seeing you succeed. So they're the ones who probably your employer because they're going to want to see you grow and they want to see you help clients and they want to see you do the best that you can because it's going to be beneficial for you and it's going to be beneficial for the practice. But then there are other people who become mentors in your life because they've got some sort of interest in seeing you thrive as well. So it might be someone who's a family member who's a physical therapist or someone who's been an educator, but then you've formed a relationship that's perhaps, even outside the university, which does happen too with different training programs and things. So I guess it is a really important piece of the puzzle and something that, and new graduates can, you know, definitely look into and find someone who's gonna help them.

Karen Litzy (07:59):

Yeah. Yeah. And, one thing that I found very interesting from a conversation I had a couple of weeks ago about sort of helping new graduates find a roadmap for their career is to really be very clear on what your vision or what your individual mission statement is. Mmm. And it's hard, right? You really have to do some soul searching and find out what is your mission statement. And this is from Tracy Blake. She is a physiotherapist in Canada and she suggested that everyone have a mission statement and that that mission statement should not have jargon in it. It should not have physical therapy jargon, right? So you want to try and find what your mission is even as a new graduate. Write your mission out, repeat it over and over again.

Elizabeth Santos (08:53):

Tell it to people. So that becomes real.

Karen Litzy (08:56):

And I think that will help you gravitate towards the right mentor.

Elizabeth Santos (09:02):

Fantastic. I really love that. That's a great idea. And something that's really practical that the listeners who are tuning into this podcast can actually sit down and do it is it aligns with something that I read a while ago about new graduates and is actually in the book and I can't find the source unfortunately, but it was to picture your list in two years time and work towards it now. So if you can actually start, you know, that sense of who do I want to work with, what kind of clients really light me up, you know, who do I feel called to serve? And being okay with that changing over time as well and knowing that through different phases of your life. It, it may change for a little and that's okay. It was actually an experienced physiotherapist. I've just had a flash of the face where that quote came from, so I can't give him credit by name, but

Karen Litzy (10:06):

But that's fine. He'll know when he listened to that it was him. Yeah. And I always find that I love that you said it may change and morph over time because I think what gives people a lot of stress is that when you graduate, like let's say you say, I'm going to work with children, this is what I want to do, I know it, this is going to be my life's work. And then you start to work and you're like, you know, I kind of like working with athletes, I kind of like working with pregnant moms, moms to be right.

Karen Litzy (10:42):

I think to avoid some burnout and avoid some guilt, you have to give yourself permission to change because if you don't, I feel like you're carrying this baggage with you and can’t that also contribute to burnout. Especially if you're a year or two out and you're like, Oh wait a second, this isn't quite what I thought it was going to be. I kinda like doing this. But I said I was going to do this and now I guess I have to do it right. And I'm sure you've heard that before.

Elizabeth Santos (11:10):

Absolutely. And so knowing that the path will unfold step by step, job by job, and you may not be in the same role for 20 years if that doesn't feel aligned for you. And that's okay. And it's that sense of knowing and trusting, which yeah, it's just something that you cultivate over time and have to feel confident in. But it's hard in the beginning because I've heard a lot of new graduates say to me that they're concerned that if they take this first job in aged care, or if they take this first job in musculoskeletal private practice, then they're locked into that, you know, and there's no way out and there's no, and if they want to change their mind and do this, and quite often it's me then encouraging them just to make a decision. And I never you know, I never really help anyone to make a decision.

Elizabeth Santos (12:04):

I just help them to sort of look inside themselves and make lists of the things that light them up and like we've discussed. So that mission statement kind of idea is going to help them find the right path and then reconcile that and you know, and back themselves and go for it.

 

Karen Litzy:

Yeah, I think that's great advice. And now in the book, Mmm. You also say that burnout as we are talking about is an issue for new physiotherapists, right? So we talked about some things that maybe they can do, but let's back it up. Why are they at risk for burnout if they haven't even started?

 

Elizabeth Santos:

Hmm, good question. Because burnout is something that we know about and we've all talked about. We've heard about it, we've read articles, there's a huge body of research looking at burnout among nurses and doctors and psychologists.

Elizabeth Santos (13:04):

And there is a relatively smaller but growing body of research about burnout in physio-therapy too. And we know it's because there's parallels between those professions. And because physiotherapists in direct patient care, really with clients every day lots of different people from all walks of life. And there's lots of different social and psychosocial elements that go along with that. But on top of the therapeutic relationship that you're building with clients and all of those things, new graduates are juggling seeing more clients than before as well. So they might've been able to cope with seeing and processing, you know, the pain or the stories of three or four patients in one day. But then when they've got to do that for 20 or in some hospital environments and clinics, even more than that with classes and things, you know, it can take its toll. And so navigating that professional work environment and even for physiotherapists, you know, navigating their own personal processing of that can the mental load and it can add up to burn out.

Elizabeth Santos (14:15):

So I guess we can also hypothesize that new graduates are really trying to put their best foot forward too and they want to work really hard and they want to be as good as they can for their employers. So they're going to be at risk a little bit there too.

Karen Litzy (14:52):

Yeah. So it's a lot of external and internal pressures. Yeah. That kind of happened all at once. Right? You graduate and all of a sudden, boom, you've got all of these pressures from the outside. And how do you deal with that mentally and emotionally? And it almost makes me think that there should be a, maybe there are, I don't Sort of mental health support groups for new graduates so that they can almost like an alcoholics anonymous, right? So they can go in and discuss the things that are causing them to have these feelings of burnout. I don't know if that exists. Do you know, is that a thing?

Elizabeth Santos (15:09):

It doesn't to my knowledge, but it sounds like a great idea, you know, just that community. And look, I think there are some communities on Facebook that we possibly don't know about because we're not new graduates. And I do know of some student association groups and we certainly have some great new graduate programs through the professional association in Australia in terms of building those support networks in. So, you know, that's up and coming as well, which is really exciting.

Karen Litzy (15:46):

It's definitely a growth area. Awesome. All right. So let's talk about what are the signs of burnout? So signs of burnout. Let's say if you're the new grad or let's say you're someone like me who's been out for quite some time, can I see these signs of burnout in new graduates? So go ahead.

Elizabeth Santos (16:07):

Yes, you can definitely see signs of burnout in people. And I think it's important to differentiate signs and symptoms just like you would if you were, you know, a medical practitioner. Even as physiotherapists, we do look at those things separately. So the signs would be seeing that reduced employee engagement. So perhaps loss of enthusiasm for new projects or for jobs that you're given. Perhaps less willingness to contribute. A sense of lack of transparency around how you're really feeling or what's really going on for you. So quite often new graduates will try and hide their emotions a little bit or hide that vulnerability and just put, you know, hold their chin high and keep going instead of being honest about where they're actually at. If we look at symptoms, they're actually the things that you're feeling as a physiotherapist. So whether you're a new graduate or an experienced physiotherapists, they're going to be quite similar.

Elizabeth Santos (17:13):

So they will be things like fatigue. It's going to be different for everyone, but you might get headaches or you might feel nauseous at work or you might have a sinking feeling or that sense of dread about going to work. For some new graduates I've spoken to, they've even been in tears in the car going into the job in extreme cases where they're feeling not supported in their workplace or they're feeling like they want to quit or leave that particular role. So it's actually coaching people through those feelings, those emotions because they're the symptoms. You actually manifest in the body. But then there are the signs which are those bigger picture things which people on the outside looking in tend to see. If we look a little bit deeper, we can actually look at some of the research around this and look at the validated tools which have been used to assess the burnout in society.

Elizabeth Santos (18:13):

So particularly in the health professions, the mass like burnout inventory has been used. And this is a 22 item outcome measurement tool, which takes about 10 or 15 minutes to complete and it's been considered the gold standard since it was created in the 1980s it's obviously been updated since then and there are now five different inventories which are used across different settings. And they're used in the research a lot because they contain some great questions which respondents can answer. So things like I feel used up at the end of the day and you would score that with never being a zero through two every day being a six. And there's different subsets within the outcome tool so you can score each subset or each part of it. And what it does is it actually provides some information for people who are looking at burnout in different populations and it helps to categorize them into three distinct categories.

Elizabeth Santos (19:17):

So the first one is emotional exhaustion, which is where physical therapists become depleted and they might be starting to feel a bit fatigued or some of those symptoms I mentioned. And this then leads to that second stage of burnout, which is called depersonalization in which the physiotherapists stops empathizing as well as they normally would and they might even start to become detached from their clients or show signs of cynicism, which is unfortunately not a good sign as a practitioner if you're having a dig at clients or locking them in some way. Yeah, it's a sign of burnout and then that third stage, yeah, it's reduced personal accomplishment. So for new graduates this might look like, you know, compromised standards of care or reduced sense of personal achievement. Then starting to wonder if they're even a good physio at all, if they even know anything at all. And that kind of ties in with the imposter syndrome and you know, that sense of being a fraud, which I talk about in the book as well, that these are all things that you can look at if these signs are starting to emerge and take some action, talk it through, find some strategies.

 

Karen Litzy:

And I was just thinking as an employer, is this, let's say doing this Burt, the mass, like burnout, inventory, giving this to your employees, is that a good or a bad thing?

Elizabeth Santos (20:49):

I can a great question. I can't quite put my finger on that. It could go either way, couldn't it? It could, right? It could go either way. And sometimes just sitting down and having those honest conversations and actually you don't necessarily need to ask your employees if they're feeling burnt out, but you can check in on engagement and check in on, you know, are they feeling inspired? Do they have enough to work on? What kind of clients do they want to be working with? Looking at the personal mission statement stuff, sharing wins, you know, that's a big one. That sense of positivity. And that's something we do in the clinic a lot as a team, which is fantastic.

Karen Litzy (21:31):

That is fantastic. And, and I would imagine that all of that just becomes, just gives that new graduate, especially a sense of being taken care of. We spoke a little bit beforehand and we talked about the word comfort. So I can only imagine if you're the employer, if you're the more experienced, even if you're not the employer, if even if you're the more experienced physical therapist in the clinic or in the hospital and you're just checking in with people on a weekly basis, ask them, how are you doing? How can I help? What do you need help with? Are you stuck? I can only imagine that it would give, cause I know when people check in on me, it does give me a sense of comfort like, Oh, this person's in my corner. This is great.

Elizabeth Santos (22:16):

Yes. It's just that caring approach that we have to our clients that we need to then reflect out into the world, you know, for our team and checking in on people is a beautiful way to do that. And then extending that care to ourselves as well. So going, am I okay? Actually, no, I'm not. What's going on for me? What do I need to do about that? How can I take responsibility for changing that with the support of my employer?

Karen Litzy (22:44):

Yeah. Yeah. So again, we go back to having that both internal and external check-in, which seems to be a theme here. Okay. So what other big issues do new graduates face at the moment? So just so people know, we are recording this, it is in the middle of the covid-19 pandemic and there are changes in health systems, changes all around the world. How will new grads be affected by this?

Elizabeth Santos (23:15):

I think there is a level of uncertainty about the impact of covid-19 across the board at the moment. And we can hypothesize that the current situation is going to impact on physiotherapists who are final year students who are graduating out into the world. They're going to be unsure about what's available for them, you know, where they're going to be needed. Certainly clinical placements are going to be impacted. This at the moment, and this is something that I know in Australia we're working really hard on the Australian physiotherapy association as part of their advocacy role, which is wonderful. Just protecting those and making sure that we've got those roles for physiotherapy students and that they're getting all the experience they need because they do need that experience. I think we're going to see some really positive things in terms of the workforce because we're going to see more jobs.

Elizabeth Santos (24:13):

So it's actually a really positive time and a really exciting time to be a new graduate physiotherapists. So if you can look at that and think, you know, we are going to need therapy physiotherapists in key roles in assessment and treatment of injury both in the community, in the hospital setting, helping to increase or facilitate discharge I should say, and making sure that, you know, clients are actually, patients are leaving the hospital system in due course. You know, we really need those beds and the staff to be looking after people who of all walks, you know, they're still going to be in the hospital system, but yet really we need physiotherapists on the frontline as essential workers. We're seeing a huge uptake in telehealth at the moment, which is also really exciting. And that's because of the social distancing policies that are being put in place. Well clinics and hospitals remain open. Some people are still having services in those clinics and in the hospitals, but there is a large movement towards the telehealth sphere. So this is something really exciting that new graduates can learn about and put into their toolkit for use now and into the future as well.

Elizabeth Santos (25:34):

I don't see tele-health going away when social distancing rules are lessened. So I think as a new graduate it is really exciting to be able to have so many options. And because of the pandemic, all of these people who are sick and who are recovering, they're going to need our help. You know, like you said, we are essential and I think that as a new graduate that really at this point, yes, there's a lot of uncertainty but there's uncertainty across the board. But I don't think that new graduates have to be in great despair at the moment. I understand, you know those final year students who like you said, are trying to get their clinical placements, which is all over the place and just graduate for God's sakes are having a lot of stress at the moment. But I agree, I think that physical therapists or physiotherapists are in a unique position here to really show up and be part of the team.

Karen Litzy (26:44):

Earlier you mentioned being part of the team of physicians and nurses and doctors and psychologists. I mean we are going to be an essential part of that team. So hopefully if the research shows that being part of a team helps with burnout, it'll help with our new graduates now.

Elizabeth Santos (27:02):

Absolutely. And there are those vulnerable groups and vulnerable patients who are really going to need the support that physiotherapists have to provide and anyone in the community who's wanting to keep their exercises going and do those online classes and all of those opportunities which are unfolding. It's a great and exciting time to be part of the profession.

Karen Litzy (27:23):

I can't agree more. And now how can new graduate physios keep confident and keep positive? Right now we've said, Hey, it's, you know, it's not like it's a horrible time to be a PT, but how can they keep confident, positive and take care of themselves?

Elizabeth Santos (27:42):

That sense of reassurance I'd like to really impart, you know, just for new graduates to keep taking care of themselves. It's those simple things that they can do, like making sure that they keep their nutrition up and exercise and really try and inspire themselves at the moment and look after themselves and get plenty of sleep and those basic things which are useful for anyone to be honest. Because we all need to be practicing good sleep hygiene, keeping off our phones or having some boundaries around social media and the news and just looking for jobs, getting support with looking for jobs if they're in that phase, reaching out to a mentor, a debriefing if they've just started in a new role this year. So making sure that if things feel overwhelming or if they're unsure that they're asking for help and that they're asking questions and that they're supporting their teammates as well. You know, every country is going through lots of changes and there are some really sad and heartbreaking things happening in the world and we can't look away from those and we can't ignore them, but we can stay still keep moving forward as individuals and as a profession and feel hopeful about the role that we have to play.

Karen Litzy (29:01):

Yeah, I agree. And I think that was very well said. Now Elizabeth, let's talk, can you talk a little bit about the book.

Elizabeth Santos (29:09):

Good, thank you. I am really excited to reach as many new graduate physios who need this reassurance and this support the people who are looking for that sense of comfort or unsure about which role is right for them. So it's a mentor in your pocket style of book, which has an academic undertone. So there's lots of research in there. But then there's some light and funny comics which I had commissioned as well to kind of make it a little bit more enticing read so it wasn't dry because if it's too evidence heavy it can sometimes be hard to sift through. But our physiotherapists are good at that and it's designed to help you navigate all of the tricky areas as a new graduate. So things like negotiating a contract, building therapeutic relationships with clients, how to find the right mentor, how to choose professional development.

Elizabeth Santos (30:11):

So what you should be doing versus what your employer perhaps thinks you should be doing or what you know based on your mission statement I think is a good way to choose. But it also talks about the highs and the lows that you might experience and the mistakes that you'll probably make, which are part and parcel of being a physical therapist and then how to put all of that together and sort of trust the journey as it unfolds and build resilience over time. And it's written in the third person. So as I said in that sort of academic tone, but then there are some simple questions, journal prompts at the end of each chapter that you can workshop as well. And I'm happy to support people through because I think it helps to have that self reflection and actually to write some things down and go, what is working for me and what's not and what am I having trouble with here?

Elizabeth Santos (31:04):

So it's designed to help them kind of workshop and for it to be a little bit like a Bible for that first year or two. So if they have a really rough day, they can actually go home and flick it open to that chapter and go, okay, what happened here? What could I do differently? How could I learn from perhaps some of the mistakes that are talked about in the book, you know, and how can I integrate this and move forward and get the best outcome for myself and for the client, for the practice, for the team if I'm in a hospital or wherever I might be.

Karen Litzy (31:37):

Nice. So it's more than just a once read and done. You can go back to it and kind of use the tools in the book over and over again, which I think is great. And just for all the listeners for a limited time, Elizabeth is offering a 10% discount on her book when you use the code HWSpodcast at checkout. And we'll have her website, which is ElizabethSantos.com.edu over at podcast.healthywealthysmart.com and we'll splash it across social media. So we'll make it really, really easy to do this. So again the discount code is HWSpodcast. So Elizabeth, I've asked the same question to everyone at the end of each interview and I feel like in this particular episode it is the perfect question to end with. And that is knowing where you are now in your life and in your career, what advice would you give to yourself as a new grad?

Elizabeth Santos (32:37):

It's a lovely question. Funnily enough, I taught to my younger self a lot when I wrote this book because I needed her insights and I needed her stories and she had a lot of wisdom to share, which I wove through the book. And it wasn't just my experiences, it was all of the experiences of all the physiotherapists I'd ever known and spoken to. So it was a real collective of wisdom and inspiration that went into the book. And I'm grateful for that. And it's a nice moment to thank all of those people who were part of it in some way because it's created a meaningful resource. But if I could go back to 2006 I would say congratulations. And I know how excited I was at that time. And I would probably say straight up, listen, you're going to make some mistakes, you're going to make a lot of mistakes and you're going to really want to beat yourself up about those.

Elizabeth Santos (33:38):

And you're going to question the choices you've made in therapy and in your career. And you won't know if you made the right choice, but you'll have to back yourself and you'll have to know that you are enough and you have got a lot of knowledge to share. And you know, it's student experiences and it's life experience as well. So I always encourage new graduates to really draw on everything they have and know that they're always going to be in some small way, the expert in the room, you know, even if you think you don't know anything you actually do and you can draw on, okay. That strength and that knowledge in those moments. But I'd also really offer some words of comfort because it's hard to know if you're doing the right thing and it's hard to know if you've made those right choices.

Elizabeth Santos (34:30):

I'd tell myself to take some regular holidays too because I know I didn't do that enough in my first couple of years, so yeah, but just knowing that you can inspire others and that you can inspire yourself is probably the biggest and yeah, it's a really exciting time for all the physios out there and I hope that they can find some inspiration in this podcast and in these answers.

 

Karen Litzy:

Thank you. I'm sure they will. And now, Elizabeth, where can people find you on social media?

 

Elizabeth Santos:

So on social media, they can find me at whole living with Elizabeth Santos, which is my Facebook page, but the website, ElizabethSantos.com.edu probably has the most amount of resources and it has links to my new graduate mentoring and people can connect with me through email that way. And I do actually have a free chapter of the book available. If you want to jump on the email, you can do that and I'll send you a chapter to read and get a bit of a feel for what the book's about.

Karen Litzy (35:38):

Perfect. Well thank you so much. This was great and I just know that I think it will give new graduates inspiration. I think it will give new graduates a sense of comfort and of confidence as they go out into the world. So thank you so much Elizabeth. This was great. And to everyone listening, thank you so much. Have a great couple of days and stay healthy, wealthy, and smart.

 

Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram  and facebook to stay updated on all of the latest!  Show your support for the show by leaving a rating and review on Apple Podcasts!

May 5, 2020

In this episode of the Healthy, Wealthy and Smart Podcast, I welcome Jason Van Orden on the show to discuss personal branding strategies. Jason helps thought leaders to reach a larger audience with their ideas, create new income streams from their expertise, and build business models that align with their values and goals. As a consultant, trainer, and strategist, he draws from more than fourteen years of researching top Internet influencers and experimenting with his own personal experience. His experience includes creating multiple successful brands, launching over 60 online courses, teaching more than 10,000 entrepreneurs, generating seven figures in online course sales, and 8 million downloads of his podcast. His mission is to help visionaries with impactful ideas to connect with the people they serve best and the problems they can most uniquely solve.

In this episode, we discuss:

-Three keys to good brand positioning

-How to overcome imposter syndrome and position yourself as an expert

-The magnetic messaging framework

-The compounding effect of your impact on the world

-And so much more!

 

Resources:

Jason Van Orden Website

Jason Van Orden Facebook

Jason Van Orden Business Page

Jason Van Orden Twitter

Jason Van Orden LinkedIn

Jason Van Orden Instagram

Impact Podcast

Free Gift: https://impactdownloads.com/messaging

 

For more information on Jason:

Since 2005, Jason has worked with over 6000 students and clients, teaching them how to monetize their unique brilliance with content marketing, scalable courses, and automated sales systems. Many of his and students have built multi-million dollar businesses and have become top authors, bloggers, podcasters, and speakers in their field.

In September of 2005, Jason co-founded the first ever podcast about internet business and online marketing. It quickly became one of the top business podcasts in the world. To this day it’s one of the most profitable podcasts on iTunes — having generated millions of dollars in sales directly from his podcast.

Jason has spoken around the world at some of the biggest conferences (such as CES, National Association of Broadcasters, New Media Expo, and many others) teaching how to use Internet media to launch and grow influential personal brands. In 2006, he wrote the bestselling book, Promoting Your Podcast, in which he was the first to “crack the code” for optimizing podcasts to get maximum exposure on iTunes. His work has been used to teach marketing at the university level and has been referenced on sites such as Forbes.com and Entrepreneur.com. He also practices what he preaches, having created world-class, influential brands of his own.

 

Read the full transcript below:

Karen Litzy (00:01):

Hey Jason, welcome to the podcast. I am so happy to have you on today.

Jason Van Orden (00:05):

Well it's great to be here. Karen, thank you so much for having me.

Karen Litzy (00:08):

Yes, and as you know, I've been a fan of yours for a while and as my audience knows, I actually took your course on how to kind of juice up your podcast last year and I thought it was super helpful. So I want to thank you for that and I sort of raved about it to my fans on social media and here in the podcast. So it's such a, it's going to be so great to have you on today. So, yeah, thanks. And today we're going to be talking about if creating an irresistible brand and then once you have that brand, how do you create sources of income? Because of course we all want to make a living, we all want to help as many people as we can while we're doing it. But the first question I have for you is, what is your definition of a irresistible brand?

Jason Van Orden (01:04):

Sure, yeah. Good question. So in the work that I do, you know, I work with people who have expertise that they want to get out there in a bigger way and you know, some kind of message, some kind of stories. So you know, they really want to be recognized or known or even just increase their own ability to help and impact and reach people with what they do. So just to let people know, I'll be talking mostly in the vein of what a personal brand is. I know sometimes we would hear a brand and we think like Coca Cola or AT and T and certainly there are much bigger brand companies as well, but we also don't want to confuse it with brand identity like logos and like your letter head. And certainly, you know, those are assets that get used in order to maybe establish a recognition of a brand.

Jason Van Orden (01:49):

But really, yeah, what we'll be talking about and how I define as much more about like how are you perceived in the marketplace, especially by those that you want to reach and do business with you, you know, the people that you want to serve and that you want to perk up, pay attention, and listen when you've got something cool to share or sell or you know, offer as help. So, it has to do with, you know, them seeing, you know, here's who you are, here's what you do, here's who you help and here's what you have to offer to them. And hopefully those perceptions are accurate and complete and compelling so that you successfully can get their attention and move them towards doing business with you. So that's kind of an in brief how I would make some of the specifications of the word brand to make sure that we're clear about what we're talking about.

Karen Litzy (02:38):

Yeah. And I think that's really helpful because I think you're exactly right. When people think of brands, they do think of those big international, huge brands, like you said, Coca-Cola, Nike, Apple, which is certainly a brand. But I think for the sake of the audience listening to this, they want to know about that more personal brand identity that you were talking about. So let's talk about how to create that. So how do you create this sort of irresistible brand that you want your ideal customers, you want to be perceived as something that is so necessary for them. How do you create that?

Jason Van Orden (03:21):

So yeah, there are three pieces to having a good brand positioning. And, and by position, I mean, again, establishing that place in the marketplace that you want to sit. And so the first is to know like, okay, well here's who I ideally want to reach and serve and being very clear about that. I mean, there's an example I use for instance, digital photography is, I have a recently a client I was working with, who wanted, you know, a successful digital photographer wanted to get out there and help other digital photographers. You know, had great career, great clients and projects and things, and he knew there are a lot of people who kind of knew his work and wanted to be, do some of what he had been able to accomplish. And so, you know, I was like, okay, great.

Jason Van Orden (04:09):

I want to build up my brand more and not just you know, do this. This work where I got hired to go and do thermography and digital photography. And so I said, well, we need to get very clear about who do you want to help with these skills. Is it the already established professional? Is it the somebody who wants to make that jump now to being a professional, you know, they've studied and they've, you know, pretty serious hobbyist or something. Or do you want to help people who just have an iPhone and wanting to take more beautiful pictures with their iPhone? Like these are all different audiences, but under that umbrella of digital photography. So it's being very clear. And sometimes that's specifying a specific demographic though it needs to go. I think even in much, much deeper than that.

Jason Van Orden (04:51):

And you know, are there certain age groups, but the biggest thing to really understand is what are the outcomes or results that you want to help them to reach? I think it's really important to define the target customer, the intended customer in that way. Because when it comes down to it, I mean their age and their gender or these different things might help you if you're running ads and want to know where to reach them. But really ultimately the way you want to define them as it's like, Oh, these are their unfulfilled needs. These are what are the things they're actively looking for. These are the pains they're experiencing or the goals that they haven't met that they would like to meet. And those are the things that I can help them with, which is the second piece.

Jason Van Orden (05:35):

Once you know the ideal customer that you want to reach and serve, the second piece is, Okay, well how do you want to serve them? What are you going to deliver if you are there specific ones of their pains that you want to help them with or the unfulfilled goals that you want to help them with. And we call that, you know, the value proposition or the thing that you are presenting to them, whether, you know, and might be as services or products or other things we can get. It's a into that later. But so it's who are you serving, how are you going to serve them? And then there's also this third piece that's just who you are. And particularly in the work that I do and helping people with their personal branding there's a lot of noise on the internet and it can feel sometimes if you are somebody who ever does post on Facebook or put something out there and maybe you're hoping people might see it, it's easy to feel like, Oh, that's just going to get lost in this sea of sameness.

Jason Van Orden (06:31):

And so many people saying different things or the same seemingly the same things. And it's knowing that as tried as this might sound, you know, we each have our unique perspective, our unique approach, the experiences we've been through. We have our you know, our approach to things to bring to the table. And in the same way, here's my vision for people who want to have a personal brand is that in the same way that Spotify now has really trained us to be able to find whatever we want to listen to. I mean, whatever genre, whatever into your popular music like you can, there's a vast catalog and now it's not about what 100 CDs you own. It's like now you like near infinite choice. And so you have these very personalized playlist and stuff and Spotify is insanely good at them.

Jason Van Orden (07:19):

Making recommendations for us as well in that same way, be thanks to the internet over the last 10, 15 years, all the other myriad of problems and populations who need help out there and in solving and guidance, you know, there's a slice of the world that's looking for your approach, for your flavor. You are that hidden gem of a band on Spotify, quote unquote, right. So it's something about the way you show up and make them feel they're present the information or guide them or the values you have or some kind of shared meaning or something where you know, you seem a lot like they, you know, you've been in the place that they have in the past and they resonate with that. So that's the third piece of the personal brand is knowing what you bring to the table in those ways.

Jason Van Orden (08:06):

And it just really owning and realizing that you do have that perspective that many people will want to specifically hear from you.

 

Karen Litzy:

Okay. Wow. Okay. So I am going to recap that really quickly. So first you're where you want to be clear about who you want to serve. Then you want to be clear on how you're going to serve them. And then who are you and what do you bring to the table? I mean these are, I feel like number one kind of getting clear about who you want to serve. I don't know for me that's probably the easiest of the three. But getting, I think drilling down to who are you and what do you bring to the table that can be kind of difficult to pull out of yourself. Do you have any tips for the listeners on how they might be able to do that?

Jason Van Orden (09:04):

Absolutely. For me, I'm being totally selfish, absolutely not a problem. It can be hard to uncover those things. And one of the reasons why is that we often don't see what is interesting or special or valuable because it's commonplace to us and you know, and then just get old human nature. We haven't yet imposture syndrome or just feel like, Oh to like, you know, say, Oh, I'm strong in this area. Just feels not humble or something. So, you know, these things get in our way of seeing what we have to offer. And so in the work that I do, I have a lot of exercises and frameworks and things that I walk clients through to help them uncover and discover the different parts of their voice and that we're talking about. So I'll just drill into to one area here that I think is really important.

Jason Van Orden (09:53):

Like I said, very noisy on the internet, but if you can get this, this sense of resonance resonances, you know, if you've ever you know, maybe you've been seeing it in the shower or something happened, just hear it just the right note and it's just like, Ooh, it just gets really big. And because you hit just that right note that in that space sounds really big and that's what you want when somebody comes across you and your message. So here's a little framework in my research about personal branding, I've seen a lot of work. I've seen a lot of research I've done out there about the importance of purpose based brands. And when I say that I'm talking about companies like whole foods or Patagonia, there's a very specific identity. They stand for certain things. They have a certain vision of the future.

Jason Van Orden (10:38):

They guide their company according to that. Their messaging community, certain things in a very clear and compelling way. And that's just two of many examples I could go to. And the research is clear that that leads to more loyal customers, repeat customers, you know, fans and advocates that share your stuff with other people. And this is what consumers want today. Thank goodness. You know, I think 10, 15 years of some really just like shenanigans in the corporate world, not only I dimension, just upcoming generation of millennials, that purpose based stuff has gotten really, really important. So what does that mean for you? How can you you know, if you're feeling driven by all this, you probably do have some kind of purpose inside you. But what does that even mean to like clarify and communicate that? So here's a little framework that I have.

Jason Van Orden (11:23):

I went and I study kind of the work I've done helping build personal brands as well as some of these companies and what they do. And I came up with five elements. I'll just briefly go through, I call this the magnetic messaging framework and it is one of many facets he can pull up to really find that uniqueness about you. So first thing is beliefs. What do you believe at the core that drives the core of the work that you do? What do you believe about the world? What do you believe that maybe goes counter to what is popular, you know, wisdom in your industry. What do you want the people that you want to reach and serve? What do you want them to believe after they've worked with you or come across, you know, your offerings, what do you want them to believe about themselves and about the world?

Jason Van Orden (12:04):

So I'll just use myself as a quick example here. I have this belief that we do need more people out there building that personal brand, rising up and owning it and going and finding that slice of the world that they can help. And if we can have a ground swell of that will solve a lot more of the world's problems than if we were just to leave it to, you know, big corporations, big organizations, government, whatever. I mean, Hey, they have their part to plead to. But this is a wonderful opportunity the internet has given us. And that's a belief that I have one of many that drive my work. Second of all, vision, what is the vision you have of the future? I'm not talking about just a vision statement for your business and all that might be important, but paint a picture like this is the future I want to see and work for and create.

Jason Van Orden (12:44):

I'll give you an example from another woman that I was coaching where she is in the health. And actually she was in the dieting, you know, what you'd call even the dieting industry and she has as a recently in last couple of years, stop using that word at all. She came across some research and things. She said, that's it. I gotta stop talking about dieting when it comes to the women I'm working with, you know, with helping them love their bodies and different things. And, you know, she decided I have to take a completely different approach and she now believes it has this vision of the future where like we get rid of the dieting industry or that world, it may seem like a huge daunting task, which is like, we absolutely need to take that down. It is not serving us well.

Jason Van Orden (13:22):

So that's, you know, a big vision thing. It's bigger than her. And when people do business with her, they are, they also see themselves as being a part of that and people want to be part of something bigger. Again, going back to companies like Patagonia or whole foods, there is a certain vision you know, Patagonia is all about like the sustainable future, right? So what does that vision you want to create? So beliefs and vision, value, we always talk already talked about it a little bit as being very clear about what you offer to them, what's in it for them if they do business for you. The fourth thing is contribution. So what do you bring? What does your work do that goes beyond the monetary exchange and the value exchange with your customer. I mean, that's important and they pay you and you render a service or give them the product or whatever the case may be.

Jason Van Orden (14:04):

But how does that contribute to the community or the industry or even the world at large? And I'd like to think that in the work that I do helping elevate all of these thought leaders that it contributes in that will solve more of the world's problems. I mean, I'm not claiming that myself, I can go in and help enough people to solve all the world's problems, but I'll make more of the dent if I help more people find with their ideas and their expertise, the people in the problems in the populations they can help the most. And so that's how I see my work contributing even beyond what it does for directly to my icons, my customers. And then the final thing is a reason why you do what you do other than making money. And for me, once I was one simple example is I see it as a compounding of my own impact and specifically working with people who want to have a personal brand and be a thought leader or get their ideas and things out there in a bigger way.

Jason Van Orden (14:58):

It's like, well, Hey, it's like compound interest. I help you know, a person they go help 10 or a hundred or a thousand. Then I helped another person and they help 10 or a hundred or thousand. And so that's a reason why I do what I do besides money or the freedom directly benefiting to me. So those five things, beliefs, vision, value, contribution, and reason why, if you flesh those things out and then talk about them in your content and your keynote speeches with your clients in your marketing, in your say on your website, on your about page, on your social media, now you're going to be creating something that really has a uniqueness around it. And that's one key way to do that.

Karen Litzy (15:35):

That was great. Thank you so much. And I really loved that end piece. How you finished on that? That concept of compound interest. Yeah. Because oftentimes we don't think about what we do as effecting the, we kind of only think about it as I am working with a patient and I make a difference in that patient's life. Right? But I'm not thinking that because I made a difference in this patient's life. They were able to make a difference in their children or their parents or their friends or their family because they're going out and doing what they're meant to do because I help them do that.

Karen Litzy (16:18):

And I just, yeah, I just, I love that concept and I don't think I've heard it really put quite that way before. And I think it's just wonderful to think about it that way so that when, cause oftentimes as healthcare providers we can be a little shy, I guess it could be the word or uncomfortable with asking for monetary exchange for what we do. Right, right. And yeah, a lot of times, especially in healthcare, you're tied to that insurance system where, you know, you're waiting for the insurance to pay you or you could have a cash based business where the patient pays you directly. But so often there's this shyness or this inability to kind of ask for that monetary contribution. And I think people get so fixated on that that you forget about all the other stuff that you're doing. That sort of compound interest that you said goes beyond that monetary amount. Because I think if people see that, then the monetary amount, yes, we need to make a living, but people will be like, yeah, sure, here you go. I get it.

Jason Van Orden (17:33):

Yeah. Right. And when they understand yeah, and it definitely comes across again, by the time they do business with you, with this kind of messaging. Yeah. People, not only are they just like identified with you and like, no, I want, I want you, I want to be the one to help me. But yeah, they understand that and whether it's conscious or unconscious and says, yeah, this idea of like, Oh, I'm also part of something a little bigger than me here. This is cool. You know? And that's what people want these days.

Karen Litzy (17:59):

Yeah, absolutely. Well, now let's say we fast forward. We have gone through that framework. We feel like we have a good solid footing on what our brand is and our messaging. So let's step into now how to create sources of income from that messaging. And that messaging, of course, is using our expertise.

Jason Van Orden (18:28):

Yeah. So when it comes to creating different sources of income, there's one key asset to be very clear with. And then I can share another four-part framework. I'm big fan of frameworks and we've actually covered some of the pieces of that framework which are being very clear. So there's four pieces to coming up with some kind of offer. When I say offer, it could be a service, it could be a product, you know, something that you're offering to people to buy and exchange value with you. So the first piece is well, we already talked about knowing very clearly who your ideal audience, customer client is. And then the second piece is being very clear about understanding the outcomes and the results and the unfulfilled needs. What's most important to them, what's top of mind? What is their, what I call their tooth ache, pain and other, they literally have a two thing.

Jason Van Orden (19:18):

But I use that as an example because if we have a tooth ache and it's not going away, we're going to call the dentist and go get it checked out. Right? It suddenly becomes a top of mind thing. So how do you know what that is? Well, you go when you talk to them. I'm always encouraging my clients to go and do market research in the form of having conversations with people who fit the description of their ideal person, the person that they want to reach. And this could be current clients or past clients are also just people who aren't, haven't done business with them. But you know, for you, Karen could be listeners of your podcast or people who are on your email newsletter list and you know if you regularly get on the phone with them and it's not to say like, Hey, I have this idea for a product.

Jason Van Orden (19:59):

What do you think? It's really to listen a lot and ask good questions to hear about their experience. You know, what are they dealing with? What are they trying to accomplish? Why haven't they reached that? That's the big thing is why haven't they been able to do that thing that they want to do yet? What myths and misconceptions are they maybe dealing with? What questions do they have? What's not? What knowledge gaps, what tools do they need to acquire, what have they tried before that maybe didn't work for them? So you know, the better you understand their experience in this way, then you as the expert can, you'll see the through lines, the thread that draws the jury, that ties these conversations together. And you can kind of like read the tea leaves so to speak and go, Oh, okay, I'm seeing something that's missing here.

Jason Van Orden (20:36):

Or something that I think that I could do in a particularly helpful way. And then at that point, you've got, you know, those first two key components, your ideal customer and their ideal thing that's really important to them. And that's, we're going to come up with a great, a great offer. Now to get a little more specific at that point, you as the expert have some kind of process and this is the third piece, some kind of process for helping them get from a to B. You know, so if you're a physical therapist, I mean, I, I'm not claiming to know that much about physical therapy, right? But like I've done some before. I had a knee injury and then you need to get some range of motion back. Right? So the third, the physical therapist I went to see, you know, immediately, you know, it was assessing and everything and then in her mind was, you know, going, okay, yeah, here are the things we're going to need to do to do over the next several weeks.

Jason Van Orden (21:25):

Then a process to bring that to bring that about. I have a certain process that I go through to help my clients, you know, figure out what their personal brand is or you know, create and launch their first online pro, you know, I different. And so if you're very clear about what that process is and particularly kind of your unique approach to it, again, going back to what's unique about what you offer that process now is something that you can wrap in a variety of what I call experiences, which is the fourth piece. So we have the ideal client or customer, we have their ideal outcome. We have your process for helping them reach that outcome. And now it's just a matter of wrapping it in different experiences. Now, here's what I mean by that. If we imagine a spectrum and on one end of the spectrum is kind of your, what I call your high end high high touch offers.

Jason Van Orden (22:13):

So that would be, you know, as a physical therapist, the hands on one-on-one work as a consultant, as a coach showing up one-on-one or the, you know, so it's much more nuanced and direct and people are going to pay more for that kind of experience and expertise on the other end of the spectrum with clients that I work with is something that would be like purely hands off. Something like a digital course for instance, that you know, somebody can buy the so, you know, say I went online and I'm sure there's a lot of physical therapists can be like, Whoa, bad idea. You need to actually go to a physical therapist and understand that maybe you know, putting aside my ignorance about all of the physical therapy, you know, maybe then as a thing, after they worked with you for several weeks or whatever, there's some, you know, downloadable set of videos that then they can go through on their own at home or you know, whatever it is that you're wanting to help people with.

Jason Van Orden (23:02):

So that's at the other end of the spectrum, purely digital do it themselves. And then there's everything in between and you're basically asking yourself three questions. It's like, okay, how are people going to get access to me through this offer? And so, you know, is that going to be direct one on one? Is it going to be, maybe there's some kind of, you know, a lot of my clients end up performing some kind of like group Q and a or coaching calls, whether they can help a group of people at once. It's kind of like, you know, your Lyft or Uber share ride. If the driver has three people in the car, they're getting paid by three people as opposed to one person. Right? So that's a, you know, how do they get access to you and finding a more scalable way to do that.

Jason Van Orden (23:38):

The second thing is how do they get access to the information? And that might be, you know, through like you did that podcasting course. I did that, the information, there was a series of group calls, several people on a call and I was doing those trainings and then saying, here's where you can walk away now and the action steps and what to do next this week with what we've talked about. So how do they access the information or the knowledge or the tools? And then the third question is how do they access each other? And this is a powerful thing and wrapping in an experience. Because if you have a lot of people showing up, have similar goals and desires, it's actually you really valuable for them to be a part of a group of people who are working towards similar things and normalizes, you know, the issues that they're dealing with.

Jason Van Orden (24:22):

And they can get insights from others who are in the same place as they are. And this is where we see things like Facebook groups or LinkedIn groups or Slack you know, channels or ways that your clients can actually talk to each other, which again, it's huge value without your direct input. Other than that you connected them. So when you have those four pieces, the ideal client, their ideal outcome, your process for getting them there and then deciding of what is the experience, you know, now you can craft. And the cool thing about knowing clearly what that process is and maybe take that first piece of the process that's like an assessment piece or whatever the first step is. And you can make that a smaller product and make it lower price. So it's easy for people to go like, okay, yeah, I'll say yes.

Jason Van Orden (25:04):

Did that baby step into doing work? You know, or experiencing your expertise in some way. And then all the research tells us they're likely that way. More likely now to do business with you again and spend more money with you at that point. Or maybe you decide it's time to write a book. Okay. The book is maybe an overview of your process or you get invited to do a keynote. It's like, okay, there's, well here's one slice of my process, one, one, one piece of what I help people with. And that can be the basis for that for that keynote. Or maybe you decide, okay, now I want the entire process packaged up as a group coaching type experience that happens over eight weeks online or a two day workshop or right now you can, you can play with it in a lot of different ways, but that process is a really important asset. So those are your four steps and kind of how all those pieces come together.

Karen Litzy (25:51):

Awesome. Well, I love a good framework. So thank you for that. And there's one thing that you said as you are kind of going through that framework that I just want to back up and touch upon is that idea of being an expert. So oftentimes, and again, you touched upon this as well, is that feeling of imposter syndrome and things like that. Is that feeling of, am I really the expert? Like there are people out there who might have more experience than I do. How can I put myself out there as the expert? So what do you say to that?

Jason Van Orden (26:29):

Well, there probably are plenty of people out there who have more expertise than you. There always will be there. People have there have more expertise or experience in marketing branding to me. But again, it goes, there are too for people to do business with you. It's about trust. And trust is actually made of two components. It's made of credibility, which, you know, that's expertise. Have you, you know, done the hours of mastery. You've gotten the degree if you need it or whatever. It goes into that credibility. Have you gotten results for people before? And we lean on that a lot and that's okay. It is important. But then likability, credibility plus likability is trust. And often that likability is even more important than the credibility. Now again, you need to be able to deliver the results, but what does that likability, well, that goes back to resonance and for some reason, I mean, I think we've all, you know, I could have gone to one physical therapist and been like, yeah, something just doesn't drive here.

Jason Van Orden (27:16):

I need to go to another whatever for whatever reason. Right? And at that point, it wouldn't have been like, which one has more experience? It's like, which one do I vibe with? Or if you've ever gone to like hired a therapist or something like that, right? Just to kind of give a little more of an extreme example. But so that's one thing I would say. Another thing is that you know, if you do struggle with impostor syndrome, a great Google search to do is imposter syndrome celebrities. And you're gonna see a huge list of like Tina Fey and Tom Hanks and Maya Angelou and people who are like stories. Like, why are these people like doubting themselves? They're like, amazing. Then another thing that I would say to that is, you know, that process of going and having those conversations with your marketplace, those can be very energizing and actually confidence boosting.

Jason Van Orden (28:04):

Cause as you're talking and hearing their experience, it starts, you start going seeing it's like, Oh yeah, I can help with that and start getting excited about it and wanting to do it. And so that's another, you know, little anecdote to that. And in the end it's, you know, you don't ever have to be claimed to be something that you're not, you know, you very clear and you know, again, what your strengths are, where you can create results to what extent, and there are going to be people that just decide to work with you for a number of reasons. And it's not just going to be price or geography. Sometimes it might be, but again, if you know, that resonance piece comes in a lot too. So there's a few different things. And then the last thing is all I can say is like, go back to my belief that it's like, look, there's so many people in this world, 8 billion plus lots of problems to solve. Lots of people looking for guidance and help. So, you know, be that one specific band on Spotify, be that one person that knows that slice of the world is looking for. I'm going, you know what, you're the person I've been waiting for to hear this from. So how can I work with you? And that's what we're going for.

Karen Litzy (29:08):

Perfect. I love it. Now as we wrap things up here if you could leave the audience, although I think what you just said was probably, I shouldn't have even asked this question, but I'm going to ask it anyway because I want you to be able to kind of give the major points you want people to walk away with from this conversation, even though there were so, so many, I took a lot of notes.

Jason Van Orden (29:34):

Yeah. I mean, I'll just punctuate kind of the big point. And, and with just a very brief anecdote or story, and that is like back in 2008, I got a phone call from a woman in Austin, Texas. She had a child, she was pregnant or no, she had two kids at the time. And she, both of her pregnancies had been very high risk. In fact, she had gotten put on bed rest, you know, or you have to stay there for months and I'm sure that's gotta be so stressful. And it was a really difficult time for her. She from the African American community and she just found that particularly in that population, the resources for high risk pregnancies were really under like the date. There just wasn't enough of them. So, you know, fast forward, she's got her two healthy kids, thank goodness everything.

Jason Van Orden (30:19):

And she's like, I want, I need to share my experience and my story, you know, she's even gotten, you know, gone and gotten some what's the word I'm looking for, you know, accreditations or even, I can't remember exactly what she, you know, went and trained in, but she definitely got some that credibility expertise part, but then she also wanted to share her story. And so she said, can you help me launch a podcast? I said, yes, absolutely. So she hired me to coach her and consult her through that. And you know, fast forward a few months, or maybe it was a half a year or so, and she started getting emails from people in Ireland and Australia and Oman in the middle East. And you know, this one woman and in Oman said look, I gotta thank you for helping. Like save my child.

Jason Van Orden (31:04):

I hadn't, no, when I found out that I had to be on bed rest and there was this high risk of losing my pregnancy, like I didn't know what to do and where I live, there really isn't like what much support or empathy and so your story, your podcast, your perspective, your expertise gave me the strength, the will, the knowledge to be able to get through that difficult time. So what I'm trying to punctuate there is like how many of those connections are waiting for you out there, the listener, you know, who's listening to this right now and whether you reach them through a podcast or a blog or videos or through social media or speaking or whatever the case may be. There are absolutely those stories. You know, that that story can be true of you. And that's why I do what I do is to multiply that phenomenon that I've seen time and time and time again over the last 10 or 15 years.

Karen Litzy (31:54):

Yeah, I mean you just, you never know who's listening or reading or watching and you never know how the words that you say can truly, truly affect another person. And that's a great exit story is a great example of that.

Jason Van Orden (32:10):

And I don't know if you can hear a little bit of music, Karen? But somebody is having a dance party with their car suddenly. So that's not just me like, you know, winding down our interview with like, I'm going to do a saucer.

Karen Litzy (32:21):

You're in a play, you're going to play yourself off at the Oscars. Just slowly playing yourself off. That's so thoughtful. Well, actually before you exit, I have one last question. So I ask everyone this, knowing where you are now, in your life and in your career, what advice would you give to yourself as that young guy straight out of school?

Jason Van Orden (32:49):

Yeah. Well wow, that's a big one. I mean, I think what I would say is that, you know, you're only scratching the surface when it comes to what's possible for you and especially in getting to know yourself. So just, you know, keep searching, keep looking, keep discovering and uncovering the layers of yourself. And because, you know, that guy thought he was going to be an engineer for the rest of his life and so many other, I'm such a different person now and that's good. I mean a lot of growth and hard things and went very different directions than I thought, but it would just be that encouragement. It's like, look, you're just getting started and thinking is going to be very different. But you know, keep, keep digging and hoping and pushing and even when it gets hard.

Karen Litzy (33:35):

Great advice. Thank you so much. Now Jason, where can people find you?

Jason Van Orden (33:40):

Yeah, so I actually have a new podcast where we dive into stuff like this. It's a podcast called impact, a subtitle, how to build or how to grow your thought leadership brand and business. And so you can check that out and find it on all the major directories or at jasonvanorden.com. And then the one other thing I'll mention is if you go to magneticmessaging.download, you can download, you know, I went very quickly through those five aspects of the messaging, but you can download the framework, it's like a full guide with questions. Take you through that and if you want to dig into that exercise some more. So that's magneticmessaging.download.

Karen Litzy (34:20):

Awesome. Well thank you so much. And just for everyone listening, we'll have the links to everything that Jason just said. So his podcast, his website and the magnetic messaging over at the show notes for this episode at podcast.Healthywealthysmart.com. So if you weren't taking notes like I did, don't worry one click and we'll take you to everything that Jason just mentioned. So Jason, thank you so much for taking the time out and coming on the podcast. I really appreciate it. This was great.

Jason Van Orden (34:50):

Yeah, so much fun. Thank you Karen

Karen Litzy (34:52):

And everyone else. Thanks so much for listening. Have a great couple of days and stay healthy, wealthy, and smart.

 

Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram  and facebook to stay updated on all of the latest!  Show your support for the show by leaving a rating and review on Apple Podcasts!

Apr 27, 2020

On this episode of the Healthy, Wealthy and Smart Podcast, Jenna Kantor guests hosts and interviews Dr. Lex Lancaster on student loans. Dr. Lex Lancaster is a Doctor of Physical Therapy with a passion for performance, pelvic, and pediatric PT. Lex Lancaster also designs websites for health and wellness practitioners.

In this episode, we discuss:

-Lex’s experience navigating loan repayment as a new graduate

-Considerations for pre-DPT students when applying to schools

-Helpful tips to start tackling your student loan debt

-And so much more!

Resources:

Email: AlexisLancasterpt@gmail.com

Lex Lancaster Twitter

FitBUX Website 

Lex Lancaster Website

 

A big thank you to Net Health for sponsoring this episode!  Learn more about Four Ways That Outpatient Therapy Providers Can Increase Patient Engagement in 2020!

                                                                    

For more information on Lex:

Alexis Lancaster is the graphic designer on the Healthy Wealthy and Smart podcast. She earned her Bachelor of Science degree in Biology, a Graduate Certificate in Healthcare Advocacy and Navigation, and graduated with her Doctor of Physical Therapy program at Utica College in Utica, NY. Lex would love to begin her career as a traveling physical therapist and hopes to eventually settle down in New Hampshire, where she aspires to open her own gym-based clinic and become a professor at a local college. She loves working with the pediatric population and has a passion for prevention and wellness across the lifespan. Lex also enjoys hiking, CrossFit, photography, traveling, and spending time with her close family and friends. She recently started her own graphic design business and would love to work with you if you have any design needs. Visit www.lexlancaster.com to connect with Lex.

For more information on Jenna:

Jenna Kantor (co-founder) is a bubbly and energetic girl who was born and raised in Petaluma, California. Growing up, she trained and performed ballet throughout the United States. After earning a BA in Dance and Drama at the University of California, Irvine, she worked professionally in musical theatre for 15+ years with tours, regional theatres, & overseas (www.jennakantor.com) until she found herself ready to move onto a new chapter in her life – a career in Physical Therapy. Jenna is currently in her 3rd year at Columbia University’s Physical Therapy Program. She is also a co-founder of the podcast, “Physiotherapy Performance Perspectives,” has an evidence-based monthly youtube series titled “Injury Prevention for Dancers,” is a NY SSIG Co-Founder, NYPTA Student Conclave 2017 Development Team, works with the NYPTA Greater New York Legislative Task Force and is the NYPTA Public Policy Committee Student Liaison. Jenna aspires to be a physical therapist for amateur and professional performers to help ensure long, healthy careers. To learn more, please check out her website: www.jennafkantor.wixsite.com/jkpt

 

Read the full transcript below:

Jenna Kantor (00:00):

Hello. Hello. Hello. This is Jenna Kantor with Healthy, Wealthy and Smart. Really excited to be coming on and interviewing Dr. Lex. And what's really exciting is she is in the middle of this like name change possibility, so it may be Lancaster in the future or Brunel, her married name, we don't know. So you're getting an insight interview during the gray zone. Anyhow, want to thank you. First of all, thank you for coming on Lex for this interview. So for those who don't know, she actually works behind the scenes with Karen Litzy on this podcast and other things. She created the amazing logo for the women in PT summit and she's just kind of like really amazing on social media. For those who don't know, she's also a new grad who is dealing with loans. L. O. A. N. S. give me an L , give me an O, give me, ask him.

Jenna Kantor (00:57):

And that's right. That's what we are talking about. The fun, joyous roller coaster of student loans. Now before this. All right, before we go into details, right before we go into details of all your journey, if you were to compare the journey of loans, is it more the feeling that you get when you're going up the roller coaster and it's getting really, really high? You're like, Oh my gosh, am I going to live? Or is it that drop feeling like, Oh that first drop. So which one would you compare it to?

 

Lex Lancaster:

It's more like, I would say it's more like the drop, but that drop happens like halfway through your third year of PT school and then you're like, crap. Oh my God. I guess that's if you're lucky. Cause sometimes you don't think about loans until after you graduate and then the rollercoaster happens. Then I will say though that after that initial drop and you really freak out, it gets better.

Jenna Kantor (02:01):

You remind me of Oscar in the office where he's talking to an imaginary child or person saying it gets better, it gets better, it gets better. Well, I wanted to reach out to, Lex, when I reached out to her because she had done a post on social media about loans and that's what inspired this in the first place. And I thought, of course there's great experts out there like Joseph Bryan who is a wonderful resource for loans. But I wanted to get a student perspective on this from beginning to end. So what were the first steps you did before you even graduated for your loans?

 

Lex Lancaster:

So my first and second year, and really the first part of my third year, I didn't even think about loans. I kind of thought in the realm of it's just another drop in the bucket at this point. You know, I just didn't think like money. It's not that money wasn't factor.

Lex Lancaster (03:00):

It's that I had to pay for things. So it's not like I said, well, I can't really afford tuition, so I'll see you later. So it was just a drop in the bucket. And you know, I got to the point where $1,000, $2,000 books, whatever it ended up being, was just that drop in the bucket and halfway through my third year, aye, what to say? I saw a fitBux post about student loans and I think I actually got a bill from one of my loan companies and they had said, you owe money halfway through my third year of PT school. And I was like, Whoa, that is not okay. So I ended up contacting them and it was just a, you know, mistake on their end because we have that forgiveness for six months after we graduate or the deferment. However, at that point I was like, wow, this is what my monthly payment is going to be.

Lex Lancaster (03:56):

And that's what I had seen. And that was only one company. So at that point I kind of, I want to say it was January because I was on my last clinical and I reached out to fit bux and I just basically said, Hey, I don't know what I'm doing. It's all I said. And Joe was extremely helpful. I ended up setting up a class, an online class, because the third year, most programs, you're off campus. So with our program we were all on clinical and I figured my entire class was struggling the same way I was. So we set up a seminar, an online seminar with Joe and he went through, or Joseph, he went through every single aspect of student loans, what to expect, how to choose your plan, what works best, what doesn't work. And you know, for the students that attended, it was super helpful.

Lex Lancaster (04:44):

So we left that little online webinar with him with understanding definitions of the financial world. Because at that point in time, I had no idea what any of the terms meant, Mmm, you know, it's extended prepay, blah blah, blah, blah, blah. All of the things that they talk about that you need to understand before you choose your plan, make your payments and really get going on student loans. So at that point I felt okay. I was like, all right, we're good. We've got a plan and we understand the layout plan. And then what happened was I had to register for the NPTE, buy my study materials and for lack of better terms, wait around to get a job. So in that period of studying, cause I finished clinical in March, I took the test in July. So luckily for me, I had my online business to kind of keep me afloat to make a little bit of money within that period.

Lex Lancaster (05:49):

But without that, I mean I still took out, I put my NPTE on a credit card, I put my study books on a credit card and it was an interest free credit card. So I knew that I would be able to pay that off once I got a job. But I was still struggling because throughout college I did not save money. I had a job, I was a graduate assistant, you know, I had jobs, I just wasn't smart about it. I didn't save money throughout the entire process and that kind of put me in a position after I finished clinical. So while I was studying for the NPTE kind of saved some money, what I could save paid what I had to, but I did not pay on my loans. So I left my loan to start paying until the six months after I graduated.

Lex Lancaster (06:33):

And for lack of better terms, I cannot remember what it's called. But we have that six month period after we graduate that you don't have to pay on them. And then when six months hits you have to start. So I started at six months. But anyway, long story short, I met with Joe probably four more times. Just I think it was four times we went through every possible scenario after I got a job so that we could decide what, how much money I should be paying each month. And we went through the technology on the Fitbux website. That helps you decide what payment plan is best for you. So really fit bux helped me the most. I did not, there's a lot of podcasts out there that you can listen to, but I stuck with fit bux because it was one, it was free to talk to them and to Joseph pretty much, you know, he found time for me to talk and I really appreciated that.

Lex Lancaster (07:29):

So I guess like I said, it was the roller coaster. The drop of the roller coaster was when I got that bill and then it continued dropping until about November when I made my first payment. And now at this point I don't even think about it. I don't see the money, the money that I pay toward my student loans, I don't even see it. It just goes into an account. My student loans pay by themselves and I don't do anything. I'm on automatic payments. So now I'm kind of at that coasting I guess. So, yeah. Well and you post what, what? I forgot what your post was. It was a good one that was very pointed. I'm trying to like look it up literally during the podcast interview cause that's the way to go. Well. So discover sent me an email cause I have a credit card with discover, that's who I took out my interest rate credit card with last spring. And they sent me an email and I just said, are you paying too much in student loans? And I got the email and I just kind of chuckled and I was like, how'd you know? So I posted on my story. Mmm. Basically, how are you a mind reader discover? And then I've said, you know, I do pay, I pay $1,400 a month right now for student loans. Mmm. And I basically said that my payment is semi aggressive. It's aggressive by any means. If that was the case, I'd be paying close to two.

Jenna Kantor (09:00):

Mmm.

Lex Lancaster (09:01):

But then I had said, did you know that income based repayment is not guaranteed? Your forgiveness after 2025 years is not guaranteed. The interest rate on that can go up. Mmm. Or the tax rate on that can go up. Excuse me. And you have no idea what that tax rate can be. And when you forgive your loans, you have to pay that tax right then and there. So the way that I just look at it and everyone always says to me, well why are you paying so much on your student loans? They always question it. They're like, well you don't have to do that. But in reality, you know, I'm just like, yeah I am paying a lot my student loans, but I have to do it. Cause if I didn't do it, I'd be putting the same amount of money in a savings account to pay the taxes 25 years later. So I was frustrated at that. I think that day I was semi frustrated just because I had gotten an email and I was like, how'd you know?

Jenna Kantor (09:58):

Yeah, I am paying a lot. This is your post. It was sad realizations of being an adult on a high deductible plan. I pay greater than 500 a month for health insurance. I still need to pay 6,000 out of pocket before my insurance will help me. What a broken system. And I don't have a suggested solution because this is me right now. And you showed your brain like, Oh yeah, that was, that was my one about health insurance. Oh, that was health insurance. Oh my gosh. That's my health insurance. But I gotta pull up my story. I have it somewhere. Well that one's, that's another one. Another, another thing. If you want to reach out to her, that was a sidebar. It was smooth and yet totally off topic. It was so good. I'm glad you brought it up. It just felt so good to go there. So would you say you're out of that stress zone, you're out of that stress zone. Now that you have that plan going for you with your loans, you're just like, we're good.

Lex Lancaster (10:59):

You know? Yes and no. Yes, because I don't see the money come out. I know it's being paid. I know I pay a little bit over what I need to pay, so I'm paying it off a little bit more aggressive than I need to. And I'm on a 20 year plan right now, but my goal is to pay it off in about seven or eight years. I would say that because I'm transitioning from travel PT to permanent I'm back on the nervous train because with travel PT you make more money. You do pay more because you have a Oh, a tax home and you have a, you know, you duplicate your living expenses, so you do pay more in rent, et cetera, but you make more money because you don't have that permanent home and you're away from home. So I used my travel salary, most of the, I think I was putting close to 50%

Lex Lancaster (11:53):

Toward loans in the beginning. But then as soon as I found out that I was not going to be a travel PT anymore, I stopped. So I backed off. I took my monthly payment and my required payments and I decided to pay about $250 extra for both companies each month. So that's not even close to what I was paying. So I'm like I said, I'm back on that. I'm a little bit nervous. I don't know how I'm going to afford living. I don't know. You know, because I have a mortgage for a loan payment and my fiance Kyle also has a mortgage for a loan payment. He's also a PT. So we're both just kind of at the point where we're paying our required payment, paying a little bit over, and then we're going to see how it goes. Well, like I said, I don't see that.

Lex Lancaster (12:44):

I don't physically pay it every month, so I feel like mentally it makes me feel better. I'm not watching the money go out of my account more or less. It's already paid. I don't have to worry about it. It's paid on by the due date and then that's that. Mmm. So yeah, I would say talk to me in about two months and we'll see how I'm feeling when everything changes and I transitioned to a permanent.

Jenna Kantor (13:36):

That's hard too because when you are graduating, I did see this with a lot of my fellow classmates. Everyone had this, Oh, I'm going to go for this, this, I'm talking about niches. You know what they want to treat, and I saw a lot of people just start working for anyone and I think that's because when they see that number, those loans you owe, it's just you get, it's like, I need a job right now. I need a job right now. I don't talk to me. I just need a job I need. And it's really unfortunate and you're experiencing that now you're going, okay, now I want to go for what I'm dreaming of, like my dreams and doing that. You're seeing how that's causing that anxiety again about the financial situation, which is just, it just sucks what we owe in school. It's just horrible. And then even with what we get reimbursed for us physical therapists for most of us get paid on the low end as new grads, which I think that's just, I think those words are just an excuse for employers to offer lower pay. That's it. They were like, Oh, new grad. Cool. I can only afford to hire new grads right now. Right. So that's bad. That's bad. That's feeding into a really bad system there. That's my opinion. But that being said, it just, and so then you're just barely surviving with that. But then if you want to go off and do your own thing, if you are really going to be listen to your loans, you want to do it for 20 years. Exactly. More different 20 years cause you're like, Oh I need that.

Lex Lancaster (14:51):

Mean I think a lot of people do that. It's scary. Right? But then we get burned out.

Karen Litzy (15:05):

And on that note we're going to take a quick break to hear from our sponsor net health. This episode is brought to you by net health net health outpatient EMR and billing software. Redoc powered by X fit provides an all in one software solution with guided documentation workflows to make it easy for therapists to use and streamline billing processes to help speed billing and improve reimbursement. You could check out net hell's new tip sheet to learn four ways that outpatient therapy providers can increase patient engagement in 2020 at go.nethealth.com/patientEngagement2020

Lex Lancaster (15:39):

No I never see this money, but I hate my life. And that's, and that's the thing. It's like, you know, Kyle and I are starting a cash based PT on the side. Our side hustle. We are going to start that because we just want to, we want to treat how we want to treat and not be dictated by insurance, but that's a talk for another day. Mmm. And you know, that's, it's great for us. And you know, to be honest, we would, we would burn the ships and just do our cash business right now and just do that and not have a full time job. But we can't because we need to have money to pay our loans because the last thing we need to do is default. And you know, I guess our method of payment was based on travel PT, not based on permanent and a cash business.

Lex Lancaster (16:22):

So when we moved our loans from federal to private, we have to pay that payment. Now income-based isn't a thing. So we're required to wait. We need to wait because we need to have guaranteed income in order to not default on our loans. But like I said, as soon as you put out a budget, the loans are 1400 rent is 1800 and then you add food and you know, a little bit, you have to have fun money, a little bit of fun money. And that's almost 85% of our new salary. Yeah. So I don't, I don't really know how yet to fix that because what is your option? You know, you can't just make things, you can't make rent less expensive, you can't make your loans less expensive and they're not going anywhere. So unfortunately, I think that this is a scenario that a lot of people face out of school if they don't choose trouble. And that's why income-based is the most feasible. That makes sense because how else do you live on that? You know, I was just a grad student income. Right, right. You know, how else do you live? You don't have money to pay on those loans. And some States don't let you pay. Don't let you practice on that temporary license. Like New York state, a lot. A couple of my friends practice on temp licenses, so they were able to, you know, build up some

Lex Lancaster (17:50):

Money. But if you're not part of those States that allow you to do that, you can't practice until you pass your NPTE. So it's hard to build up that savings account. So that's one recommendation I have for anybody that's in school who's listening to this. Make sure you're saving money, whether it's 10 bucks a week, five bucks a week, it doesn't really matter throughout school. Save money and just put it somewhere and don't touch it because eventually you're going to need it. Even if you don't think you will neet it. And even if you think it's completely out of this world that you'll ever have a situation where you need a little bit of extra cash but save that money. Mmm. And for lack of better terms, I would not use it until you absolutely need to start the savings account now and don't wait until you have a job.

Jenna Kantor (18:37):

There's no reason why you can't save five bucks a week. Yeah, yeah, no, that, that does make perfect sense. And that's definitely been something that I've leaned on is having a savings account myself. So I get what you're saying. Yeah. And for anyone listening, I mean, if you might find yourself going, Oh, but where's the answer? It's the whole process of this interview itself is not necessarily to give you all the straight up answers. I really would like to just resort to the fact that it's good to know you're not alone. Yeah. And it's okay to talk about this with people. It's okay to be frustrated with your pay. It's okay to be freaking out about your loans. It's okay to feel burnt out because you're working somewhere you don't like just to get escape those loans. All of that's okay. I mean, this is unfortunately a very common struggle amongst new grads and something that the APTA is working, really trying to figure out how they can address this issue.

Jenna Kantor (19:34):

Cause really at the end of the day, it's the schools that are choosing to charge you guys as much. It's the Dean and it's not just the PT, it's the entire school that's saying, okay, let's increase the amount so we can make a new building or whatever they're going to use the money for. So with that increase in cost, it's all by school. That's where you need to look first in my opinion. Yeah. You need to look first. The APTA it’s like how we treat patients. You know, we sit there and we're treating the symptoms, you know, or do you look at what caused it all along? So same idea. And if you, I want to just focus on your own plate right now on what to do for yourself. Absolutely. If you really want to make a larger difference, it's talking to your institution and become the voice which works.

Lex Lancaster (20:28):

But if that's something you just made up right now that speaks to you? Well it makes sense because I have, I have people that I know that literally they graduated PT school with less than 70 grand of loans and that was putting everything on within a loan that was not paying for part of school out of pocket. They literally graduated with that much because their school cost that little bit of money. And when I heard those numbers and I'm, meanwhile I graduated after undergrad and graduate school. I was at about $220,000 is where I'm at. I don't know where I'm at today because I haven't looked at it to be completely honest cause it's like I'm just paying one month at a time. But I just, I was baffled. How did you get out of school with that little of loans?

Lex Lancaster (21:24):

Like how did you do that? And they basically said that when they chose a PT school, they chose a cheaper school and you know, I, I loved my school, absolutely loved my school. I would have not wanted to go anywhere else. That program alone has, you know, changed me as a person. I love Utica college. So I'm not saying that I would choose to go somewhere else. However, I was so baffled that the tuition is so different. I had no idea. I literally had no idea that different DPT schools have different such drastically different costs and that particular person almost has her loans paid off and she's, I think, Hmm. Five or six years out of school and she barely had to pay anything. Yeah. So I guess so what you're saying is so true. You know, we have to talk to the right people.

Lex Lancaster (22:22):

You know, why is this and it's an increased by, what is it like one or 2% for a year? It goes up. I have not kept up on that, but I do know that what our parents paid alone was significantly less than what we paid. Yes. So it's just, yeah, it's a really vicious, right now it's bad. It's bad. So, I mean, you could, you could sit there and think it's the loan company to get back. I'm like, no, it's your school. It's just school. They're the ones who said you need to pay this much. We don't get reimbursed that much to be able to pay that in a reasonable amount of time to live our lives. Yeah. That's very sad. It is very sad. And when our degree went up to the doctorate level, our reimbursement didn't increase. So it made it when we required more school. Yeah. Our reimbursement is actually now going down propose anyways, that 8% correct. That it's, that's for specific situations and it's not for sure yet. I say this now, but it's still being fought. We're not doing well in fighting it, but I believe it's not set in stone yet. Like I said, I don't know when they go out, so I'm curious.

Lex Lancaster (23:46):

The state of things will affairs will be at that point then. Yeah. The reimbursement doesn't reflect, we're just not paid enough reimbursement wise. So employers don't really have a choice. Yeah, it's, yeah, it stinks. It's a shame. It is a shame.

Jenna Kantor (24:06):

Well, thank you so much for coming on. I really appreciate it. Do you have any last words you would like to give just regarding loans and the stress of it that you would like to give to anybody listening? It's just really feeling helpless right now.

Lex Lancaster (24:20):

Mmm. My biggest piece of advice, well, I'll say two things. The first thing is, like I said before, start saving money. Now. Don't wait. And my second thing is reach out to the people who know what they're talking about. Don't try to solve problems yourself because you're going to waste time and you might even waste money. Mmm. Fit bux is completely free and it's a shameless pitch because of how much they've helped me. They are free to talk to. If you have questions please reach out to them. Joseph is incredible and his teammates are incredible and I still do not know what I'm doing down to the T. I use their program to decide what I'm doing. Reach out to those people. Don't waste your time trying to figure it out yourself and

Lex Lancaster (25:12):

Understand that it does get better. As awful as it seems when you first start out, it does get better and you start to figure out a plan and everything just kind of goes from there. Don't feel like you're stuck. Reach out to people. Twitter is amazing. You're not alone. A lot of people are going through this, probably every single PT in existence. So just reach out. Don't feel like you're alone ever. And yeah, I think that's it.

Jenna Kantor (25:41):

I love it. Thank you for coming on. How can people find you on social media or email?

Lex Lancaster (25:47):

So my email right now is AlexisLancasterpt@gmail.com and on social media. I am @LexLancaster_ So you can reach out to me there.

Jenna Kantor (25:57):

I love. Good underscore is nothing like a quality underscore. Well, on that note, thank you so much for coming on. Thank you everyone for tuning in and have a wonderful day.

 

Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram  and facebook to stay updated on all of the latest!  Show your support for the show by leaving a rating and review on Apple Podcasts!

Apr 20, 2020

In this episode of the Healthy, Wealthy and Smart Podcast, I welcome Jennifer Thompson on the show to discuss how to adapt your business during the COVID-19 Pandemic. Jennifer Thompson has served as President of Insight Marketing Group since 2006 and helps physicians and private medical practices throughout the U.S. attract and retain patients and rock-star employees. Jennifer has 20+ years experience in marketing and business development for start-up organizations and as a marketing director for a Fortune 500 company.

In this episode, we discuss:

-Understanding the Impact of Online Reviews on Your Bottom Line

-Why You Need to Provide Cross-Generation Communication Training to Your Staff

-The Death of Social Media Marketing and What to Do Next

-5 Ways to Create Big ROI with a Small Budget

-And so much more!

Resources:

Insight Marketing Group Website

Dr. Marketing Tips Twitter

Insight Marketing Group LinkedIn

Dr. Marketing Tips Podcast

Loom

InsightMG Podcast: Ep. 193 | Understanding the Impact of Online Reviews on Your Practice

InsightMG Podcast: Ep. 221 | How to Get Started on Telemedicine in a Hurry

InsightMG Podcast: Ep. 219 | How to Communicate During a Health Scare or Natural Disaster

Insight Courses 

 

A big thank you to Net Health for sponsoring this episode!  Learn more about Four Ways That Outpatient Therapy Providers Can Increase Patient Engagement in 2020!

 

For more information on Jennifer:

Jennifer Thompson has served as President of Insight Marketing Group since 2006 and helps physicians and private medical practices throughout the U.S. attract and retain patients and rock-star

employees. Jennifer has 20+ years of experience in marketing and business development for start-up organizations and as a marketing director for a Fortune 500 company.

 

In 2010 & 2014, Jennifer was elected to the Orange County Board of County Commissioners where she made decisions that impacted over 1.2 million citizens and 60+ million visitors. Jennifer was often recognized for her use of social media and community outreach in her elected role. In 2013, Jennifer’s company helped a client win the Social Madness competition in Central Florida and go on to place 8th nationally.

Jennifer is a serial entrepreneur who wakes up every day at 4 am ready to change the world. She has been invited to share her knowledge at multiple MGMA association meetings and conferences, the Florida Bones Conference, the American Academy of Orthopaedic Surgeons and AOA-36 on the topics of social media, reputation management, and leadership. She is also the co-host of the DrMarketingTips Podcast available on iTunes.

 

Read the full transcript below:

Introduction (00:07):

Welcome to the healthy, wealthy and smart podcast. Each week we interview the best and brightest in physical therapy, wellness and entrepreneurship. We give you cutting edge information you need to live your best life, healthy, wealthy, and smart. The information in this podcast is for entertainment purposes only and should not be used as personalized medical advice. And now here's your host, Dr Karen Litzy.

Karen Litzy (00:41):

Welcome back to the podcast. I am your host Karen Litzy. And in today's episode our discussions around covid-19 and what health care businesses, physical therapists, physician practitioners, what they can do to continue to help their clients and their patients during this time. So today I am so happy to have on the program, Jennifer Thompson. She has served as president of insight marketing groups since 2006 and helps physicians, physical therapists and private medical practices throughout the United States attract and retain patients and rockstar employees. Jennifer has 20 plus years of experience in marketing and business development for startup organizations and as a marketing director for fortune 500 companies. Now in today's episode we talk about how healthcare companies need to change the way they're doing things during the covid-19 pandemic. Jennifer's very specific and goes through certain phases that your company must do to continue to help people in your community. We also talk about understanding the impact of online reviews.

Karen Litzy (01:57):

This is during a pandemic and once we get through this, why you need to provide cross generation communication training to your staff, the quote unquote death of social media marketing and what to do next and then ways to create big ROI or return on investment with a small budget. I'm telling you, everyone take out your pen and paper, your computer, take notes. Everything in this episode is practical. You could start doing it today and for those of us who are anxious or struggling because maybe we're not seeing the volume of patients we used to and our incomes are starting to see that, starting to reflect that most of the things that Jennifer is suggesting we can do takes very little or $0 million to achieve it. So I want to thank Jennifer for her time and her expertise. And if you are a health care practice owner, you must listen to this podcast from beginning to end.

Karen Litzy (03:12):

So much good information there. So a huge thanks to Jennifer Thompson and if anyone has any questions, you could go to the podcast show notes at podcast.healthywealthysmart.com. You've got all of Jennifer's information there, all of the things that we talked about, one click will take you to it. So a big thank you to Jennifer and of course I want to thank you, the listeners for tuning in each week. We would love it if you could leave us a review on Apple podcasts and tell your friends, tell your family thank you so much and enjoy.

Karen Litzy (03:51):

Hi Jennifer, welcome to the podcast. I'm happy to have you on and I feel like you're here at like the perfect time.

Jennifer Thompson (03:58):

Absolutely. Thank you for having me. It's great to be virtual and all of us are kind of hunkering down at home, but this is a great way to pass some time.

Karen Litzy (04:07):

Exactly. And like I said in your bio, you have helped physicians and private medical practices attract and retain their patients. You've been doing this for a very long time, but I have to think the recent pandemic has kind of shifted things a little bit for medical practices. So before we get into the kind of the bulk of what we had originally planned to talk about a couple of weeks ago, I would love to get your professional outlook on marketing, on finding patients on how we can do that in these times of this pandemic.

Jennifer Thompson (04:50):

Yeah. And I think that like it's just the right place at the right time. So when all of this was starting to come to fruition and it looked like we were going to be on restrictions and stay at home orders our team, that really shifted very quickly to reach out to all of our clients and say, Hey, look, we want to be a resource to you. You're not set up yet on telemedicine, but let's get you set up. So we've had the opportunity to help about two dozen practices get up and going with the Titan telemedicine solution in about 24 hours. And so once we got them all going and everybody's kinda rocking and rolling right now we started shifting the conversation to, okay, well how can we take telemedicine now as an option? Like a tool in your toolbox and market that and how do you market the practice when you're only, you know, maybe you have or you have limited hours or you have limited access and maybe you still have providers coming into the office, but you know, it's just a different environment.

Jennifer Thompson (05:50):

And the telemedicine in general is a different environment. So I think the first phase of how you attract, retain patients in this new kind of unchartered territory first is you got to do the stuff that's immediate and you have to kind of put out all of these immediate fires. And so that's like, you've got to update your website. You've got to reach out to your existing patients to let them know you're still seeing patients. And maybe it's just a different method. You've got to go out and update all your Google my business listings to include telemedicine, to include it in kind of changes to your hours. So there's some immediate things that you have to do. Of course you've got to update all of your social media and you need to, you know, start thinking about one, you want to let people know you're doing telemedicine.

Jennifer Thompson (06:39):

But then second is you want to figure out how is this going to look for the short term after I've put out the immediate fire, how am I going to now get more patients in? One area that we've seen a bunch of success in is going old school, you know, like your referring partners. And there's so many times where we'll send somebody from the office over to our referring partners to bring them lunch or to kind of build those relationships and whatnot. Well, we can't do that anymore. So now there's only one industry left in the entire world that actually has fax machines. And I just sent out faxes this morning for a couple of clients where we're sending out big bulk faxes to all of their referring partners from their EHR. They're pulling it out, pulling down that data.

Jennifer Thompson (07:28):

And we're sending out kind of, Hey, we're open and accepting telemedicine appointments. And so yeah, there's some things that you have to do that are thinking outside of the box. And that was kind of the immediate, and then the second piece is what do you do now to keep yourself relevant? And so I was on a call yesterday morning with a bunch of orthopedic surgeons. We always meet at like 6:30 in the morning because that's always pre-surgery. And we were talking about the numbers of, you know, new patients versus returning patients and how are we like balancing the telemedicine appointments in terms of other appointments. And it looked as if the marketing, it's good right now, you know, you want a market that you have this as a tool in your toolbox, but it wasn't necessarily driving new patient counts. The telemedicine option, what was happening is your internal sales, your internal folks are the ones that are driving telemedicine appointments because you're looking at those followup appointments, people coming in for you know, second and third appointments and trying to get your, the ones that you at the end of the patients that you already had on the sheet and getting them into a telemedicine appointment instead of a standard.

Jennifer Thompson (08:41):

And then now, Oh, we're looking at kind of the big issue with practices is that not only do folks need to know we're doing telemedicine, but for most practices, still maybe not in New York city, but for most practices, you know, in areas not as populated. They're still up and running for business. You know, they're still doing emergency surgery and things of that nature. So how do you let patients know that you are up and running and do it in a way that's memorable or that is going to cut through all the noise and the clutter. And so like before when I was saying you gotta to put out the fire, you put out the fire, the immediate. So part of the immediate plan is you need to put a red bar and we say red because Red's a good emergency color that in healthcare you really shouldn't be using.

Jennifer Thompson (09:26):

You put a red bar at the very top of your website and you go straight to your covid-19 resources or any of your important announcements. But that kind of red bar, you know, people aren't going to your website to check it out to make you relevant. So now we need to think about how do you brand yourself and how do you brand yourself in a way using social media. And because social media is still free and if you're good at it, you'll get some traction. And, I talk a lot about this idea that social media is dead and I will say social media, if you're just on it, it is dead now. But if you're in it, it's very much alive. And so now's your chance to be in social media and to get your message across. And what I mean by that is we have a group this morning orthopedic group who wanted to really get the point across that they're still open, put together a great little video of a doctor with an athlete who was in there for a knee injury.

Jennifer Thompson (10:24):

She signed the waiver, the release on it. They put together a great video showing how they're treating patients. So they're both in their mask. He's washing his hands, you know, and he does the quick exam. Then he washes his hands and she sits in a chair. He's about 10 feet away. They've got the video, they've got some music to it, and it's just, Hey, we're here and we're open. We have a PT practice that we're working with. They've started doing telemedicine across 26 different office locations and all day, every day they're sending us videos and great photos of them in practice showing how the physical therapists are doing their job with a computer screen and showing us the different things that we're doing. So it's just how can you be relevant now and kind of spreading that message and having fun with it. Because when people are at home right now, they're either watching TV where they're scrolling through their feeds. So how can you create that thumb stopping content?

Karen Litzy (11:27):

Excellent. And I love in the putting out the fires, the Google my business listings saying that you're doing tele-health. Hello. I have to do that today. The moment we end this call, I am going to Google my business and putting that in there. I did not even think about that cause I'm thinking about, I'm calling all of my individual patients, I'm emailing people, I'm keeping people updated, I've updated my website, I've done all that stuff, but I have not done that piece so that I need to do that as that should have been my phase one. And then I love the kind of how you're getting new patients because it's true. I think you're seeing in a lot of practice, at least what I'm hearing is that you're existing patients are doing tele-health, but how can we get new patients on board? So do you have any advice, let's say a new patient contacts me, I do a free 20 minute consult with them, kind of explaining tele-health. Are there any sort of must have pointers or any way that we can close that to help that prospective patient feel confident that they're going to get what they need?

Jennifer Thompson (12:37):

Yes, and I think that, I think part of that falls on you making sure that the patient is ready for what this new experience is. But we were so my teams, we do marketing, so we have, we're in the trenches on the marketing side of things and then we have a training side of the business. And so we were looking at updating a patient experience training that we've got currently. And then, how do you update it kind of with this telemedicine and telehealth component to it? Because we've been having a bunch of conversations about, it feels a little bit like the wild wild West and when the regulatory environment was kind of opened up, we would see providers and some of them, a lot of the ones we would work with. And we would call and say, Hey, do you want us to get you set up?

Jennifer Thompson (13:22):

And they would be like, no, I've already got this covered. I'm doing it on FaceTime, I'm doing it in WhatsApp. And we were like, no, you've got like they may be, they may be allowing you to make some mistakes right now just to get through this. But you've got to train at your patients from the get go of how you want this. And so you can't take somebody from a FaceTime call to later on doing a HIPAA compliant portal that they have to log into a remember a password. So we want to train our patients from day one. So I think that's part of the decision that you as a provider have to make is what's going to work for you. Not just for today but for long term. And then from the training side of our business, of course, we're always looking for a way to have fun with it from patient experience we put together and I'll send the student, cause we put together these great, I think they're great videos a day in the life from the provider's standpoint.

Jennifer Thompson (14:14):

And it's a series of tips of things that you should remember. Like for example, you shouldn't drive your car and do a telemedicine appointment. You shouldn't. That seems reasonable. You shouldn't, you should tell everybody in your house that you're with patients so they shouldn't be walking around in the background in their underwear because these things happen. I was going to say like it seems basic but it's not. Yeah, you gotta be patient with people because they're also going through this experience for the first time. Just because you’re not in the same room doesn't mean you have to shout. They can hear you. You've got to remember that you might have a great connection and you have, you know, your wifi is strong, but you may be talking to somebody and they're receiving it differently. And so we're all going through this for the first time together. And so I think understanding, like just taking a step back and remembering that this is unchartered territory. And so you know, are there things to pay attention to? Yes. But I think it starts with the provider and how you prepare the patient for that visit.

Karen Litzy (15:24):

Excellent. I love that. Yes. And definitely send those videos along and we'll put them in the show notes. At podcast.healthywealthysmart.com under this episode because I think people will definitely get a lot of value from them. And again, I can't believe you have to say like don't walk around in your underwear, do you as you're doing that. But like, like you said, the videos are made for a reason. So people were doing it.

Jennifer Thompson (15:52):

We had a provider this week or last week send something in. It was like a picture cause we asked everybody like send them photos of you doing telemedicine so we can use them for things. And he sent a photo and he had a shirt was like stained up and like, Oh over here. And we're like, doc, no, we didn't see patients day to day like this. So you can't see patients that way either.

Karen Litzy (16:17):

Yeah. And I think that's something that's really important I think because people think, Oh well I'm at home. I can be super casual, but you don't want to be casual to the point of a stained shirt and looking unprofessional. Right. There are ways to be casual, whether it be like smart athletes, your wear or a pair of jeans and a top, but you still want to look presentable because especially if this is a new patient who's seeing you on telehealth as a physical therapist when this is over, maybe you want them to continue to see you. So those first impressions still make a difference. So thank you for bringing that up.

Jennifer Thompson (16:54):

They absolutely do. And I think people just forget that. And you know, I think, I think it's okay to have fun with it too. Like, you've got to be professional and you need to be the regular provider that you always are. But from a marketing standpoint, a little levity goes a long way right now. And what are some examples of a little levity going along way, if you have any off the top of your head? Yeah, so we're having a lot of fun with these kinds of patient experience, customer service, telemedicine training videos, which we put out our first round of them yesterday. So we're just trying to have fun with them, like make fun of how crazy it is. We have a group that has it's an orthopedic practice that has a lot of athletic trainers that they employ.

Jennifer Thompson (17:38):

So one of the athletic trainers, because nobody's in schools right now, has been furloughed. And so what we're doing with him is he's got like a four year old son at home and he's doing a daily series on social media as the athletic trainer, providing tips on how you can stay active and how you can prevent injuries at home. So he's doing things like yesterday, he's sitting on the couch with the son reading a book and he's like, Oh, I see now you're here. You know, welcome to my living room. Here I am at home with my four year old son, Jackson. We're going to read two pages of book and then we're going to do jumping jacks and then we're going to run in place. But he's doing a series just so it's fun and it's cute, but it gets a lot of engagement at the same time. He's like getting the main message across and it's something that people are stopping on and he got great traction. Maybe a thousand people looked at it yesterday. So, Hey, it's good traction, no money. And it's keeping them relevant. Plus it's keeping him relevant in a furloughed position.

Karen Litzy (18:38):

Yeah. Oh, how great. What a great idea. Love it. All right now something that I think we can talk about that can help your bottom line and that can help your practice grow is the impact of online reviews. And that is one thing that I don't think has had that much of a change even during this time. So can you speak to the importance of those online reviews and understanding them?

Jennifer Thompson (19:06):

Yeah, I absolutely can. So I think a lot of times practices will come to me and say, what if I could only focus on one thing because I don't have any money? What would be the one thing that you would tell me to do? And I hands down, always tell them that you should focus on getting as many reviews as you can and not because reviews you don't need just five star reviews, but you need lots of reviews. And I referenced back to a study that that we found that was, that was cited in the wall street journal and it was a study by a company named Juan plea. And I will send you the details of this for the show notes. So wildly does study of at 25,000 freestanding medical clinics. And one plea is actually a credit card processing company. So they were looking at cash based business for 25,000 freestanding medical clinics and they were tying the revenue to the cash based revenue, two star ratings and reviews.

Jennifer Thompson (20:11):

And so basically the couple of the top line, top level findings that they have are like medical centers that claims their listings on three or more of those websites, meaning like rate Indies, healthcare, vitals, Google, things of that nature. See 26% on average more revenue than practices that don't. So if there's ever been a reason for why you need to really pay attention to online reviews outside of, it's the number one way people choose their provider and if there's ever been a reason, it's because it's directly tied to your bottom line. Medical practices don't respond to online reviews, make 6% less than practices that do. And I'm not suggesting that you, that you respond in a way that violates HIPAA, but you can respond in a way that doesn't even identify that somebody is a patient and you can provide them a phone number that if they have something negative that they can follow up on, that's a 6% difference in revenue.

Jennifer Thompson (21:10):

And the one that really gets me the most is that practices that are rated five-star across the board actually see less revenue than practices that are afforded to a 4.9 star. And that's because we all realize that everybody is not perfect and the general public is not ignorant to that. So they expect that you're going to have some negative reviews. But it was just most interesting that you can see that that indirectly court, there was a direct correlation and you know, focusing on star ratings and then going into reviews. And for me it's just, it was just good data because everybody loves good data. Sure. And I got really involved in, I mean we identified that reviews were probably a place to focus our business. You know, years ago and things were just starting out. But I was in politics for years and when I was in politics it was right when social media was starting to take off.

Jennifer Thompson (22:09):

And just like medical providers are limited in what you can say and respond to. As an elected official, I was limited in the state of Florida to the sunshine law and the sunshine law prevented a lot of what I was allowed to say and not allowed to say online. So I got really interested in this whole like immediate feedback. Everybody thinks that they've got an opinion now and how these opinions get shared and then what you can and can't say to them. And then I would have doctors that would come to me and the doctors would say, Jen, I just want you guys to get rid of that negative review. And I referenced orthopedics cause I have a lot of orthopedic clients and this would happen a lot with them, but when it was a work comp case and somebody who didn't want to go back to work or if it was somebody that wanted opioids and they just couldn't get their fix, they would go online and just bash these doctors.

Jennifer Thompson (22:59):

And it got to the point that work comp aside, I would have to say to the doctor, doc, if you're consistently getting negative reviews, we've got to deal with what the root of the problem is and not keep dealing with the negative review themselves. And so we would start doing sentiment analysis on the reviews. So easy tool, especially if you're stuck at home and you've got some time on your hand, pull all of your reviews offline and take, hopefully you're using a service, you just couldn't get them in a spreadsheet. But look at the reviews and look at that data and figure out what it's telling you. Because usually it's not between the provider patient that somebody is upset, they're upset about a billion process or upset about a wait time. They're upset about some kind of follow through about some kind of customer service issue and that's how you can get to the bottom of your reviews and then make changes at the practice level that are actually going to have a real impact on what people are saying about you a lot in public. So I think reviews are just a plethora of good information. If we start thinking about how we can use them to make small adjustments at the practice.

Karen Litzy (24:05):

Great. And how do you recommend clinicians ask their patients for reviews?

Jennifer Thompson (24:15):

I used to say suck it up and just ask for them and then it got to the point that I would say, here's a card to tell your patients where you want them to go. Now I would prefer the clinician not even be involved in the process at all. I would prefer that every practice out there work with some kind of third party partner that has a secure file transfer where you can send your list over of patients on whatever frequency you want. And then that provider, that software sends it out to your patients and they ask your patient for reviews. And that way every single patient gets treated the same. And you guys focus on delivering the best care possible and stop worrying about, you know, I'm not a sales person, I just want to focus on patient care. I don't want this person cause they might've been upset or I forgot to ask, don't worry. Like do I think that you should just remove yourself from that equation and just find a way to automate the process.

Karen Litzy (25:11):

Nice. And what are some examples of third party partners to help automate that process?

Jennifer Thompson (25:17):

So I exclusively use doctor.com now. But there's a bunch of them out there and so there's like review conciergedoctor.com. There's a bunch of them out there.

Karen Litzy (25:29):

Okay, cool. I've never heard of those, but that's really helpful. Thank you.

Jennifer Thompson (25:33):

Yeah, it is. It's a good way to get reviews and not to have to worry about it. And I will suggest this too, if you're at a practice that has like a lot of high volume have a page built on your website where you can capture internal feedback and then put signage up. Because that way if somebody is sitting in your waiting room and they're getting pissy that they'd been there too long, give them a way that they can get something off their chest so they feel like they need to go do, you know, leave you a negative review.

Karen Litzy (26:03):

Smart, smart. I like that. Right? So they can say, Oh, I've been here forever. Oh, I can complain here instead of complaining on Google or, Oh, fabulous. Exactly. Fabulous. So that could just be like a page on your website or something that says, Hey, if things weren't optimal for you, what can we do to help? Something like that. Feedback and feedback pages are very easy and everyone knows what to do. Yeah. Oh, excellent. Excellent. This is such good information. I'm taking so many notes. That's why I'm asking questions. I'm like, let's drill down into this further. All right. So something that seems like has been a constant theme from when we started about how do we kind of get through this pandemic in a way that's a positive for everyone involved and talking about reviews is communication. So let's talk about communicating with your staff and what do we need to provide within that communication training. I know it's a big question.

Jennifer Thompson (27:13):

So no, I love that you're asking it and I love that. I have some kind of relevant examples right now. So we do training for staff a lot around kind of employee engagement and everything kind of around how do you enhance the patient experience. So, and we put this together because of these docs saying, fix my reputation. And we said, you can't fix your reputation, so you focus on your people that plus unemployment's been at record lows. I mean, totally different conversation right now, but unemployment was at record lows. So how do you engage your employees? But we've been able to use the platform. So that's on demand training, delivering like 10 minutes a day type of thing. But we're using the platform to communicate with employees, but you don't need a platform to do this.

Jennifer Thompson (27:59):

So I think the very first step when you have a crisis is just to come up with a game plan and don't forget to think about it from a marketing perspective as well. You know, if you're going to communicate to your patients that you are offering telemedicine, don't assume that your employees know what's going on. And so, especially, if you're a large practice and you have people that work remotely or you're in multiple locations, consider putting together a weekly, maybe it's a video that you can send out. There's a great tool that I use all the time called loom L double O M love it free. You know, there's no reason not to and you don't have to house the videos. You can send it to people. Consider an email, like a regular email chain for those employees. But I've got a practice that I'm working with now that we actually got this off the ground this week and they have about 300 plus employees and they have multiple locations and a surgery center.

Jennifer Thompson (28:59):

And what we've done is basically we created a closed Facebook group for them and we are solely using it to communicate with employees that are now, some are in the practice, some are at home, some are furloughed. And the big concern is, especially in healthcare, is the bottom's not going to drop out from a revenue stream down the road. In fact, in a couple months, we're probably going to be working our tails off Saturdays and Sundays and nights because people are still going to want surgery. They're still gonna need their therapy. They're still, everything's going to happen. So you can't afford to lose furloughed employees. So now more than ever this practice in particular doubling down on communication and what they're doing is we're working so we manage the social for some of these accounts. So we're working on a patient facing social media, but now we're working on employee facing into closed groups.

Jennifer Thompson (29:56):

So now I'm reaching out to doctors saying, Hey, give me, send me a video offering words of encouragement. Show us how you're working from home. And then it's employees show us, you know, what you look like in your PPE. Show us how your eyes are having social distancing, talk to the people that aren't in the office and tell them how much you miss them. Celebrate birthday, celebrate anniversary. So it's this whole other thing. And I think that because social media allows us to create that sense of community and sometimes we lose that and not everybody's paying attention to emails and official communication. So it's working and it's a lot of work, but it's working and I think that it's going to do what it's supposed to do.

Karen Litzy (30:37):

Yeah, it's a great idea. And I think, I mean I have my own practice, I'm not an employee, but if I were an employee of a company and I saw that CEO or our owner getting on and giving us encouragement and at least acknowledging that we're still part of the company, even though maybe were furloughed or maybe were from home or now we're part time, I think that goes a long way. So I think that's a really a really great idea. And I'm assuming on these Facebook closed groups, you're not exchanging sensitive patient,

Jennifer Thompson (31:13):

Nothing like that. No, this is like top level and the CEO, this one, I've really got to commend him. He's being transparent, which I think is so important. Sharing the uncertainty of what's going on. You know, the practice applied for a PPE loan, they may not have gotten that PPE line. They've got about $3 million a month that they've got to deal with and overhead. So that's a big one. You know, as they typically give pay increases for working anniversaries, they had to tell everybody, you're not going to get these pay increases right now. We're going to deal with it in a couple months. Right now you're not. So just kind of communicating and answering questions that people are afraid to ask, but getting in front of it. And I think that that's a big kudo to that CEO.

Karen Litzy (31:56):

Fabulous. Good stuff. Good stuff. All right. Now we'll finish up with one more topic that I think we want to cover and again, relevant at this time, but ways to create some big return on investment or ROI with a small budget because I think now everyone's tightening their belts. We have, like you just said, what if you can't get these loans? What if you can't do X, Y, and Z? Everybody's budgets are shrinking. So how can, what are some ways that we can get some big impact on our shrinking or smaller budgets?

Jennifer Thompson (32:30):

All right. Couple of things that we're doing with our clients. So this is like real world may or may not be working, but we'll see. Cause we're pivoting like on an hourly basis sometimes yes. But first and foremost longterm strategies is double down on your online reviews. Thousand percent do that. Pay attention to where people are having conversations and become part of those conversations if you can. I say that specifically because we tell a lot of our clients, you know, you want to create great relationships  with your patients, you want to get lots of online reviews but really what you want are like raving fans and those fans that when somebody new moves into a community or has a need, the first place they're typically going is like to next door or to Facebook. And they're asking for recommendations for someone and you know, to help them with whatever their need is.

Jennifer Thompson (33:27):

And if you've got patients out there that are really like singing your praises, they will do this for you for these recommendations. And so you want to make sure that you stay top of mind and stay in top of mind. Doesn't mean spending a bunch of money. It means being visible. So it goes back to don't just be on social media and schedule some lame posts three days a week through a scheduling software. If you're going to do it, do it. And I think the pandemic is, is forcing us to think about sometimes some things outside the box that we've always said, I want to get to this, to create this great content, but I don't have time. Well, you have time now, so create the great content because in a couple of months you're going to be so busy, you're not going to know what to do with yourself.

Jennifer Thompson (34:09):

And so I think that's really important. And then maybe start thinking outside the box of things that you hadn't thought about doing before. I have a large practice that I work with that hosts an annual seminar, a biannual seminar where they offer CEUs to athletic trainers and allied health professionals lots of physical therapy people that come into this and they have their ortho doctors on their panels typically. And then they'll invite others from all over the country to come in. They'll get the CEUs and then they'll offer them, well, chances are, and they get about 700 people every time that come to the saying it's great for them, the chances are they're not going to be able to do it this year. And so we're already having discussions with their providers who they already have the credits so they can get in the next couple of weeks here, taking that all online and getting with for them particularly they're gonna focus on athletic trainers right now because they can offer those credits.

Jennifer Thompson (35:10):

But we're going to transfer that to an online forum and these doctors are going to give the same talks live in a zoom setting and at the end they can have the survey done and they can offer seat use. But it's a great way to build relationships that they typically wouldn't get that chance to do. And so just kind of things like that out of the box thinking like we have class or doing live Q and A's on Facebook and you know, taking those live Q and A's and then recording them and then we can use them in videos and other things down the road. So I think we just need to be authentic, you know, have fun with it, but have fun in a strategic way and then double down on being where your potential patients are being part of those conversations and then just making sure at the end of the day you deliver great customer service to everybody.

Karen Litzy (35:55):

I love it. And none of that takes a lot of money at all. No. As a matter of fact, a lot of that was free. Yup. It was all free for the most part. Yeah. Amazing. Amazing. Well, Jennifer, thank you so much. I mean you have given us so much to think about and ways that we can pivot our practices to be relevant in this time and to prepare for the future when hopefully things start to open up and return to different. I don't even want to say return to normal, but we'll return to a form of normalcy. I think it's always, I think things are always going to be a little different from now on, but to at least get out of more of a lockdown situation where we can actually see more people in real life. And I think it's like you said, putting out the fires are important, but then looking to the future is I should also be part of our plan. At least that's the big takeaway that I got from this. Absolutely. I think you hit the nail on the head. Yeah. Awesome. All right. Now the last question I asked this to everybody. Knowing where you are now in your life and in your career, what advice would you give to your younger self? Say straight out of school,

Jennifer Thompson (37:13):

Stop stressing out about everything so much. Just stop stressing out. You know, if you work hard and you put yourself in the right situation and you prepare yourself academically and through experiences, don't say no to things. Say yes, go in there. Experience so much of it and realize that as long as you're doing what you need to do, you're going to end up where you're supposed to be.

Karen Litzy (37:35):

Love it. Thank you so much. Now where can people find you? Where websites, social media.

Jennifer Thompson (37:42):

Yeah, absolutely. So you can find me at insightmg.com which is insight I N S I G H T M as in marketing, G as in group.com and you can find me on anything social under the under the handle at dr marketing tips. So that's dr marketing tips. And you can find us on iTunes at the dr marketing tips podcast as well.

Karen Litzy (38:09):

Awesome. Well thank you so much. This was great and everyone we’ll have all of those links and the show notes at podcast.Healthywealthysmart under this episode. Jennifer, thank you so much again. This was perfect for the audience and I think they're going to take a lot out of it. So thank you so much. And everyone else. Thanks so much for listening. Have a great couple of days and stay healthy, wealthy, and smart.

Karen Litzy (38:36):

Thank you for listening and please subscribe to the podcast at podcast.healthywealthysmart.com and don't forget to follow us on social media.

 

Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram  and facebook to stay updated on all of the latest!  Show your support for the show by leaving a rating and review on Apple Podcasts!

Apr 14, 2020

On this episode of the Healthy, Wealthy and Smart Podcast, I welcome Daniel Chelette, Amy Arundale and Justin Zych on the show to discuss some questions from our presentation at the Combined Sections Meeting in Denver, Colorado entitled, Turning the Road to Success Into a Highway: Strategies to Facilitate Success for Young Professionals.

In this episode, we discuss:

-How work-life balance evolves in your career

-The physical therapy awareness crisis

-How to tackle the female leadership disparity in physical therapy

-Burnout and when to pivot in your career

-And so much more!

Resources:

Amy Arundale Twitter

Daniel Chelette Twitter

Justin Zych Twitter

 

A big thank you to Net Health for sponsoring this episode!  Learn more about Four Ways That Outpatient Therapy Providers Can Increase Patient Engagement in 2020!

 

For more information on Daniel:

Daniel Chelette is a staff physical therapist at Orthopedic One, Inc., a private practice in Columbus, OH. He graduated from Duke University with his Doctorate of Physical Therapy in 2015. He is also a graduate of the Ohio State University Orthopedic Residency Program and Orthopedic Manual Therapy Fellowship Programs. He became a Fellow of the Academy of Orthopedic Manual Physical Therapists in April. Since June of 2018, he has served as the Chair of the Central District of the Ohio Physical Therapy Association. Daniel’s interests include evaluating and treating the complex orthopedic patient, peer to peer mentorship, marketing and marketing strategy and advancing the physical therapy profession through excellence, expert practice, and collaborative care.

 

For more information on Justin:

Dr. Zych currently practices physical therapy in Atlanta, GA as an ABPTS certified orthopaedic specialist (OCS) and a Fellow of the American Academy of Orthopaedic Manual Physical Therapists (FAAOMPT) with Emory Healthcare. Additionally, Justin is an adjunct faculty member with Emory University’s Doctor of Physical Therapy program and a faculty member of Emory’s Orthopaedic Physical Therapy Residency. Justin earned his Bachelor of Science from Baylor University, then graduated from Duke University with his Doctorate in Physical Therapy. He has completed advanced training in orthopaedics through the Brooks/UNF Orthopaedic Residency and OMPT Fellowship programs, while concurrently practicing as a physical therapist and clinic manager in Jacksonville, FL. Justin is actively involved with the Academy of Orthopaedic Physical Therapy and Academy of Physical Therapy Education. He has identified his passions lie in clinical mentorship and classroom teaching, specifically to develop clinical reasoning and practice management for the early clinician.

 

For more information on Amy:

Amelia (Amy) Arundale, PT, PhD, DPT, SCS is a physical therapist and researcher. Originally from Fairbanks, Alaska, she received her Bachelor’s Degree with honors from Haverford College. Gaining both soccer playing and coaching experience through college, she spent a year as the William Penn Fellow and Head of Women’s Football (soccer) at the Chigwell School, in London. Amy completed her DPT at Duke University, and throughout as well as after, she gained experience working at multiple soccer clubs including the Carolina Railhawks F.C. (now North Carolina F.C.), the Capitol Area Soccer League, S.K. Brann (Norway), and the Atlanta Silverbacks. In 2013, Amy moved to Newark, Delaware to pursue a PhD under Dr. Lynn Snyder-Mackler. Working closely with her colleague Holly Silvers, Amy’s dissertation examined primary and secondary ACL injury prevention as well as career length and return to sport, primarily in soccer players. After a short post-doc in Linkoping, Sweden in 2017, Amy took a role as a post-doc under David Putrino at Mount Sinai Health System and working as a physical therapist and biomechanist at the Brooklyn Nets. Outside of work, Amy continues to play some soccer, however primarily plays Australian Rules Football for both the New York club and US National Team. Amy has also been involved a great deal in the APTA and AASPT, including serving as chair of the AASPT’s membership committee, Director of the APTA’s Student Assembly, and as a member of the APTA’s Leadership Development Committee.

 

Read the full transcript below:

Karen Litzy (00:00):

Hey everybody, welcome to the podcast. I'm happy to have each of you on and I'm going to have you introduce yourself in a second. But just for the listeners, the four of us were part of a presentation at CSM, the combined sections meeting through the American physical therapy association in Denver a couple of weeks ago. And our talk was creating a roadmap for your physical therapy career. And afterwards we had a Q and a and we just had so many questions that we just physically couldn't get to them due to time constraints and the such at CSM. So we thought we would record this podcast for the people who were there and the people who weren't there to answer the rest of the questions that were in our Slido queue. Cause I think we had quite a bit of questions. So, but before we do that, guys, I'm just gonna shoot to you and have all of you give a quick bio, tell us who you are, what you do, what you're up to, and then we'll get to all of those questions. So Justin, I'll have you start.

Justin Zych (01:00):

Sure, so I'm Justin Zych. I'm currently with Emory university. I am teaching in an adjunct role with the DPT program and then also the orthopedic residency. I went through and did an orthopedic residency and manual therapy fellowship through Brooks rehab in Jacksonville and did my PT education with Duke university.

Daniel Chelette (01:28):

Hey everybody. My name's Daniel Chelette. I also graduated alongside Justin from Duke in 2015. And also completed an orthopedic residency at the Ohio state university and then stayed on and completed a fellowship and with manual therapy at Ohio state as well. And then worked in an outpatient orthopedic clinic for a couple of years and then was fortunate enough to have the opportunity to join on and work as a physical there, the player performance center with the PGA tour. So actually up to two months into that and it's been a pretty cool experience. So that's where we're at right now.

Amy Arundale (02:15):

Hi, I'm Amy Arundale. I'm a physical therapist and biomechanistic with the Brooklyn nets. I also went to Duke although a few years before Dan and Justin and then worked in North Carolina for a little while as a sports physical therapist as well as working with a large soccer club before going and doing a PhD at the university of Delaware under Ireland Snyder Mackler. So did research on primary and secondary ACL injury prevention did a postdoc in Sweden with Juan activist and Martin Haglins before moving here to do Brooklyn.

Karen Litzy (02:56):

Well, thank you all for joining me and allowing the listeners to get a little bit of a glimpse into our CSM talk for those who weren't there and for those who were, and maybe we didn't answer their questions while we were there. We can answer it right now. So Daniel, I'm going to throw it to you. I'm going to have you take the lead for the remainder here. So take it away.

Daniel Chelette (03:20):

Let's do it. All right, so just a quick little background of the foundation or basis for this talk. It really focuses on some lessons and things that we have learned through the four VAR unique experiences up until this point about professional growth and professional development and things we've learned, the easy way and things we've learned the not so easy way. And just tidbits of wisdom we've picked up along the way and we thought it'd be valuable to put it together and have a talk for CSM. And that's kind of what well what the basis of all this was. So towards the last portion of the talk we just opened up wide open Q and A. and we got through a few questions but we've got a handful more that we're going to go with. So we're going to start out with let's see. What do you recommend for the future PT that wants to get involved in a specific section of PT but wants to remain local to their community?

Amy Arundale (04:26):

I can start with that one. I think one of the nice things about being involved in the like sections is a lot of times they actually are based where you're at. So they don't necessarily, they may require going to conferences but they sometimes don't even require that. So it's really easy actually to stay local and still contribute and get involved in the sections. Really. The big piece there and is just reaching out and saying, Hey, I'm really interested in getting involved. How can I volunteer? And that might be, you know, helping with a membership that, which might be making phone calls or emails or following up with people who have maybe accidentally dropped their section or their APTA membership. It might be helping with various other projects, but a lot of times those are actually you know, maybe they're internet based or they're going to be through conference calls. So it's pretty easy to stay local.

Karen Litzy (05:27):

Yeah, I think that's a great answer. I'm pretty involved in the private practice section of the APTA and I would echo what Amy said. A lot of you can get involved in committees. So a lot of the sections have individual committees and most of that work is done online with, maybe you have to go to the annual meeting of that section, but that's just once a year. And the good news is if you're doing a lot of things online, you're meeting people. When you go to, let's say the section meetings each year, you'll get to know people in your immediate local area. And it's a great way to start making and nurturing those connections in those relationships. So then you'll have people in your immediate area that you can go to for guidance and just to hang out and have fun as well. But I think starting, like Amy said, just have to ask.

Daniel Chelette (06:27):

Yeah. That’s beauty of the age that we live in is that it's really easy to connect be a long distance. So technology allows us to do that. And I'm a part of a committee through the American Academy of orthopedic manual physical therapists. It's the membership committee. And everybody's all over the place where all across the country. And that was just something I got plugged into and I've met a lot of cool people through it and have made some connections within that realm. Be that, so there's a lot of different like online and long distance ways that you can get connected without being connected, which would be, is it helpful if there's a particular area you want to stay in, but you still want to get connected? Two people within your community but also outside.

Karen Litzy (07:17):

All right, Daniel, go ahead. Take it away.

Daniel Chelette (07:21):

All right. We're stepping it up here. This next, and this is a good metaphysical question. Do you compartmentalize your life? How do you approach the interaction between family and professional domains?

Justin Zych (07:36):

So yeah, that is a really deep question. I'll try to go through and answer to the best of my ability. I think that that intersects a little bit with my section of the talk, which really focused on trying to make sure that you could handle all of the new responsibilities that come with being a new physical therapist. I'm getting used to the responsibilities and productivity expectations, but while also at the same time understanding that it's important to have a balance outside of the clinic and a really good work life balance. So as far as compartmentalizing it, I don't know if I've specifically sat down and tried to put things into boxes. I do have a little bit of a blend. I mean, even my wife works for a different physical therapy company, so we share a little bit of a shared language with that.

Justin Zych (08:24):

But it's important that whether it's documentation or other things. When I leave the clinic, I try to leave and make sure that I have a little bit of time for me and time to focus on whether that's my own professional development going and taking advantage of opportunities like this to meet and talk with other people or just relax and kind of step away from the responsibilities that you go through throughout the day. So that's a great question, but a very, I think you're going to find a bunch of individual answers from it.

Daniel Chelette (08:56):

Yeah, I think it really, it's an individual question kind of like Justin mentioned in, I think for me. What I've found is, you know, maybe well work life, work life balance, particularly going through residency and a fellowship you know, work life balance, a 50, 50 split, maybe not completely realistic, it's a work life division. So where you just have, you have things within your life, be it relationships or activities or whatever. We are able to unplug a little bit from work. And those might be bigger parts of your life at different points in your life. But it's being able to, you know nurture and engage in all aspects of who you are as a person. And not just work, work, work, work, work but kind of be guided by what you're passionate about, what's important in your life. And those will take up bigger sections of your life pie at different points in your life. So it's just important to try to have a division but not necessarily think that you have to keep that division at a certain level at all times throughout your life because life changes.

Amy Arundale (10:11):

So my old advisor LENSTAR Mackler and I've also heard Sharon Dunn use the metaphor of juggling. And they talk about juggling rubber balls and crystal balls. So your crystal balls being the things that are like really, really important. The things that you have to keep in the air because if you drop they shatter, so those might be like family, they might be important relationships. They might be work. And then you also then also have rubber balls. So rubber balls would be then things that if you drop they'll bounce back. They're not quite as crucial to keep in the air all times. And, that balance between some of those rubber balls and crystal balls is always going to change. But that there are some things that you have to keep in the air and some things that you can let drop or you might have, they might have a different kind of juggling cycle than others.

Amy Arundale (11:07):

So yeah, I think it changes from time to time. You know, I've had periods of time where I've basically just worked full time. My postdoc was a great example. I was basically, you know, going to work during the day working on postdoc stuff and then coming home and trying to finish off revisions on my PhD papers. And I was in a long distance relationship at the time, so it kind of just worked that I was literally working, you know, 14 sometimes 14, 16 hours a day. That's not sustainable for a long period of time though. And I'm guilty of sometimes not being good at that balance. I would like to think as I've gotten older, I'm better at creating time where I'm not working or you know, actually taking vacations where I'm putting an email like vacation, email reminder on and not looking at emails.

Amy Arundale (12:04):

But it's going to change from time to time. Those priorities will change as your life changes. So I don't know if it's necessarily compartmentalizing, but prioritizing what needs to be, what's that crystal ball? Are those crystal balls and what are those rubber balls?

 

Karen Litzy:

Okay. You guys, they were all three great answers and I really don't think I have much to add. What I will say is that as you get older, since I'm definitely the oldest one of this bunch, as you get older, it does get easier because you start to realize the things that drive your happiness and the things that don't. And as you get older, you really want to make, like one of my crystal balls, which I love by the way, it's Sharon Dunn is genius obviously. But for me, one of my crystal balls I'm going to use that is happiness.

Karen Litzy (12:58):

And so within that crystal ball, what really makes me happy. And that's something that I keep up in there at all times. And at times maybe it is work. Maybe it's not. Maybe it's my relationship, maybe it's my family or my friends or it's just me sitting around and bingeing on Netflix. But what happens when you get older is I think, yeah, I agree. I don't know. And I think we've all echoed this, that I don't think you compartmentalize. You just really start to realize what's the most meaningful things for you. Right now. And it's fluid and changes sometimes day to day, week to week, month to month, year to year.

Daniel Chelette (13:55):

All right. And one, one quick thing on that last question. Kind of a hot topic, particularly in the medical doctor community is burnout and resiliency and you'll see those terms thrown around a lot. And I think a big thing is to realize that those types of things as far as burnout and kind of getting to a point, we're just sort of worn out with what with the PT professional, which do on a daily basis everybody's susceptible to it. You know, we can all get caught in this idea that maybe we're indestructable or you know, Oh, I can take on as much as I wanted to or need to like machine X, Y and Z. At a certain point it's a marathon, not a sprint. And you have to sort of like Karen and Amy alluded to that prioritization is huge. And definitely gets a little bit easier as you gain more life experience and kind of see what matters and maybe what doesn't so much.

Daniel Chelette (14:51):

Okay, now they're kind of good solid question here. So I'm going to paraphrase a little bit in, So companies, businesses usually do something really specific now for a specific product or a service or something like that. They focus on one thing.

Daniel Chelette (15:02):

In PT, we do many things. Is there an identity crisis within the profession of physical therapy? And how do we address it? So I’ll kind of get the ball rolling? That's a heavy question. I think to a certain degree, I don't know if I would say crisis, but I do think at times like I use the situation of if somebody asked me what physical therapy is. Initially I have a little bit of a hard time describing it. I think, I guess the mission statement of the vision 2020 is sort of what I fall back to. It's a really good snapshot of how we can describe what we do. It's basically helping to optimize and maximize the human experience through movement and overall health and, you know, but that in itself is a little bit vague and a big picture and sort of hard to really put a specific meat too. So, yeah, I think, I think to a certain degree it's a little bit hard to say what is physical therapy’s identity? What do you guys think?

Amy Arundale (16:21):

I would say, I don't know if we have an identity crisis, but I think we have an awareness crisis. I think the general public's knowledge and awareness of physical therapy and then also within the medical profession, the awareness and knowledge of what physical therapy is I think is a massive problem because that knowledge and awareness isn't there. And probably part of it then comes from us. I think, you know, Dan, what you're saying, I think that is that kind of, if we can't describe ourselves then no wonder other people can't figure out what we do or how we do it. So I'll give a shout out actually to Tracy Blake who's a physical therapist and a researcher in Canada. And one of the things that the last time when we sat down and had a chat was, she kinda gave me this challenge was if someone were to walk up to you and ask you what you do, come up with a way to describe what you do without using any medical terminology.

Amy Arundale (17:28):

So without using movement, without using sports, without using some of our fallback terminology, like come up with that elevator pitch of this is what I do. So I'm happy if you've got that at the ready. If you understand that, if you can kind of, yeah, the drop of a dime, give that, you know, five seconds spiel about what physical therapy is, then suddenly, you know, that person knows. But we've all got to have that at the ready and we've all that. I'd be able to do that so that we can put it in a common language that, you know, your next door neighbor can understand, that your grandmother can understand. So when they come to you and say, you know, you know, my hip's been bothering me for six weeks and I've been going to a chiropractor you've got that language to be able to say, well, have you thought about physical therapy?

Amy Arundale (18:29):

When you're talking to a doctor in a hospital or even just in a, you know, normal conversation you know, you've got that ability to say, well, Hey, you know, what about PT? Yeah, let's not put them on an opioid. Let's get them into physical therapy. So I think it's really a Big awareness crisis.

 

Karen Litzy:

Okay. So Amy then my challenge to you is to Tracy's point, how do you answer that question? And then I haven't even bigger challenge though I'll say to everyone, but how do you answer that question?

 

Amy Arundale:

So I've written it down. Let's see if I can get it right. The short version of mine is that my goal is to help athletes at all levels develop into their optimal athletic being as well as develop their optimal performance. What if someone says, well, what do you mean by optimal? That's a good question. What does that mean exactly? How do I help you become the best you can be?

Karen Litzy (19:27):

Okay. Not bad. Not bad. Excellent. Very nice. Very nice. So now I have a challenge for the three of you and let's see. Daniel, well, no, we'll start with Justin. Let's put him on the spot first. Great. All right. So I was at an entrepreneurial meetup a couple of years ago, and the person who was running this, Mmm gosh, I can't remember his name now. Isn't that terrible? But he said, I want everyone to stand up. In five words. So you have five fingers, right? Most of us. So in five words, explain to me what you do. So talk about stripping it down to its barest essentials. Simplifying to the point of maybe absurdity. It's hard to say what you do in five words, but Daniel, I'll start with you. So someone comes up to you and you say, I'm a physical therapist. Five words. This is what I do. Help people live life freely.

Karen Litzy (20:48):

Okay. That's not bad. Not bad. Justin.

Justin Zych (20:51):

I'm not going to use a sentence, but facilitate. Educate. Yeah. Facilitate. Educate. Empower. Does that count that I repeated like six. Now, restore, empathize. Throw the thighs in there.

Karen Litzy (21:09):

Nice. Yeah. When I did this for this little meetup, I said, I help people move better. That's what I said. Those were the five words. I help people move better. But I do like where I think maybe if we put our heads together and we mashed up all four of ours, I think we'd come up with a really, really nice identity statement that is maybe 10 words. So maybe we can put our heads together after this and come up with a nice identity statement made up of 10 words. And if we were at CSM, we would have the audience do this. This would have been one of their action items. So what I'd be curious is for the people listening to this, you know, put an action item put, what are your five words, what would you do to describe what physical therapy is? And then if you're on Twitter, just tag one of us. You can find all of our Twitter handles at the podcast, at podcast.healthywealthysmart.com in the show notes here. So tag one of us and let us know what your five words are because I'd be really curious to know that. Excellent. All right, Daniel, where are we at?

Justin Zych (22:42):

So actually I want to, I still want to go back to the last question cause I think there's a really good point in there. So Amy hit it really well with the awareness issue versus the identity crisis within our profession. I, I think one of the things that sets us apart is how dynamic we're able to be. And the skill set that we're given in, you know, when we have our DPT education and when we graduate, you know, granted, you know, we're using the term as a generalist where you can go and specialize further. But I think that that's a, that's a rare but very very powerful trait of our profession is that we're able to help across a spectrum of a lot of patients. The challenge that I would say if that question was worded a little differently is if we focus specifically just on one section, so is there an identity crisis within the orthopedic section?

Justin Zych (23:36):

If somebody comes in and they have hip pain, are they going to be treated differently by all four of us and then therefore does that make it really tough for us to come up with this five words, 10 words statement? Because we're, we're very heterogeneous in how we, how we address patients still kind of within specific subsets. So I think that's probably the bigger crisis if you will. We still have a, you know, even within specific sections, a 10 lane highway instead of, you know, two or three based off of specific patient needs.

Karen Litzy (24:10):

And do you think that publication of CPGs helps that it for people who, and this is going off on a totally other question, I realize that, but following up with that, do you think CPGs published CPGs help with that and staying, I guess up and current on the literature can help with that? Do you feel like that is something that might close that gap of huge variability?

Justin Zych (24:39):

Yeah, I think the way that they're designed, that's exactly what they're trying to do is they're trying to take all of this, this you know, research literature review that we should all be doing and put it in a really nice, you know, consensus statement for us and then give us, you know, specific things to look deeper into the CPG. So I think that it's there, it's just again, how do you, is everybody finding that? And if they are finding it, are they applying it properly, you know, towards their practice. So I like that the information is coming out there. At this point, I'm not completely confident that it's reaching throughout, you know, the spectrum of everybody that it should be. But hopefully, you know, it continues, especially with, as we have new people graduating, we really start to develop that as more of the norm. And then it's a lot easier to not necessarily standardize but get everyone in in a couple of lanes instead of 10 lanes.

Daniel Chelette (25:36):

So Justin, just to play devil's advocate what about the good things that come with having 10 lanes versus two? And there's some people that I completely am on board with what you're saying, but I think there are plenty of folks that would say, well that's the beauty of physical therapy is that it can, you know, you can really make it make it individualized and what it is to you and you can treat. Obviously there's principles that you abide by, but you can be different then the PT next to you and different to the PT next to them and I can still offer high value. What would you say to somebody who would say that?

Justin Zych (26:26):

I think that your statement you just said is completely fine. But, the issue that comes about that is that therapist who wants to provide the individual approach, have they, you know, exposed themselves to enough different approaches or different ways that they would look at it, that they can be truly individual to the patient instead of saying, okay, I'm going to focus on I’m a, you know, to throw anyone or anything under the bus here, but I am specifically a Maitland therapist. I'm specifically a McKenzie therapist. And then that approach fits that patient all of a sudden, as opposed to being able to expose yourself enough to be able to flow in and out. Again, based off of what you said, which is I completely agree with that individual approach. So making sure that you have that dynamic flexibility to cater your skills. Sorry, a little bit of a tangent there, but can't help myself.

Amy Arundale (27:37):

I'll piggy back and put a shout out to people who want to get involved. But one of the things that the orthopedic and the sports section, I'm going to go back to their old names, the orthopedic section and the sports section. In the newer clinical practice guidelines. One of the things that I think Jay has done a great job of is kind of forming committees around each guideline on implementation. So when we did the knee and ACL injury prevention clinical practice guideline, we actually had a whole separate committee that we pulled together that was in charge of how do we help disseminate this information and help clinicians implement it. So that was putting together a really short synopsis for clinicians, a pamphlet or just like one pager that can be like just printed off and given to a clinicians. It was two videos. So videos of actual injury prevention programs, one for field based athletes on one for court based athletes. But getting those out, just like you talked about Justin, you know, that that's sometimes where that or that is where that gap between research and clinical practice comes. And that implementation is so important, but it means that yeah, there's a chance to get involved for people who are interested in helping those guidelines really kind of truly get disseminated in the way that they need to be.

Karen Litzy (29:04):

Great. And I think that's also really good for the treating clinician because oftentimes as a treating clinician, we feel like we're so far removed from the researchers and even from the journals that you think, well, what is my contribution going to do? Like how can I get involved? I'm the J word, just a clinician. And so knowing that these committees exist and that as a treating clinician, you can kind of be part of that if you reach out to get involved I think is really important because oftentimes I think clinicians sometimes feel like a little

Karen Litzy (29:42):

Left out, sort of and left behind as part of the club, you know. So I think, Amy, thank you so much for bringing that up. And does anyone else have any more comments on this specific question or should we move on to the next one?

Daniel Chelette (29:59):

Alright. So Amy and Karen, this question is geared towards you guys. So the question reads while PT is a female dominated field, there is still a disparity in female leadership. Do you have advice for female student physical therapists who may desire those leadership roles?

Karen Litzy (30:24):

I would say number one, look to the APTA. Look to your state organization, look to your, even where you're working and try to find a female physical therapist or even look to social media, right? Look to the wider world that you feel you can model. So I think modeling, especially for women, for people LGBTQ for people, minorities is so important. So you want to look for those models. Look for the people who are like, Hey, this person is kind of like me. So I really feel like I can follow a model, this person, I would say, look to that first and then follow that person, see what they're doing, try and emulate some of, not so much of what they're doing in PT, but how they're conducting themselves as a professional. And then like I said, during our talk, reach out, you know, try and find that positive mentor of try and find that the mentorship that that you are seeking and that you need and that you feel can bring you to the next level, not only as a therapist but you know, as a person and as a leader within the physical therapy world.

Karen Litzy (31:46):

And I think it's very difficult. I'll do a shameless plug for myself here really quick. We created the women in PT summit specifically to help women within the profession, a network, meet some amazing female and male leaders within the profession and have difficult discussions that need to be had to advance females within the profession. And I will also say to not block out our male counterparts because they need to be part of the broader conversation. Because without that, how can we really expect to move forward if we don't have all the stakeholders at the table. So I would say speak up, speak out, look at people who are at the top of their game.

Karen Litzy (32:40):

And then in a high level positions, Sharon Dunn, Claire, the editor of JOSPT, Emma Stokes, the head of WCPT. All of these people, if you reach out to them or you hit them up on social media, they will most likely get back to you. It may not be really fast, but they will probably do that. So I would say look to the broader physical therapy community. Look to the world of physical therapy right down to your individual clinics because I think that you'll find there are a lot of people to model.

Amy Arundale (33:41):

Mmm, yeah. Yeah. I 100% agree. I think modeling and mentorship are huge. Finding people that you connect with and who can give you honest, upfront feedback but also support. So I feel like I'm pretty lucky in both having really strong women who I consider as mentors, cause I think that is important. When I was part of the student assembly, Amy Klein kind of oversaw the student assembly and she became someone who I really look up to and admire and will go to for, I know she'll give me it straight whether it's you know, good or bad, I know she'll give it to me straight and I need that. But then also Joe Black is somebody who's also been a longtime mentor of mine recently. And the Stokes I've connected with and that was just meeting her at a conference. And we connected at a conference and had an amazing conversation and that's developed further too. So I think mentorship and then getting involved seeking the opportunities. Mmm. And seeking and creating, cause sometimes they're not already there. Sometimes, you have to create them yourself. Some of those opportunities that you want going out and saying, Hey, can I volunteer here? Where they may not have had volunteers before. So finding those opportunities that you want and that you think will help you develop towards your end goal.

Justin Zych (34:53):

I was just going to say really quick of course you two have been, you know, great examples of how females can Excel and create their own path.

Justin Zych (35:08):

The thing about mentors is with mentors, it's so important to have a variety of mentors because you're going to pick out different things that the mentors are going to help you with. One of my most influential mentors was a female. She was, you know, I was involved with her in the fellowship program that I was in. And she really helped give me some really blunt but helpful feedback that helped a lot with some of my soft skills. So I'm kind of exposing myself a little bit, but she told me that after my lecture, it was on the cervical spine. She was like, yeah, like the content was great. You just weren't likable and just kind of threw that right at me, let me chew on it a little bit. But that actually really changed how I approached a lot of different things and helped me develop those soft skills.

Justin Zych (35:55):

So at the same time, she helped me through some managerial struggles that I was having. So that variety is incredibly important. And I've been a mentor too. You know, some of my mentees were females and they're doing amazing things right now and I hope that whatever feedback I gave them, they took the right things from and continue to move forward. So it's an issue that goes across, you know, the gender lines. And as males, I want us to be aware that it's going on as well. And not to lead into that discrepancy that Karen described, but still provide that same level of mentorship, same level of opportunity and consideration. So it's a great question and hopefully the gap narrows as we go forward.

Daniel Chelette (36:59):

Oh, here's another good one. Any recommendations for a PT that is two years out and feels completely lost and, or in the wrong setting?

Justin Zych (37:10):

Yeah, so I'll start with that one. You know, of course understanding that I probably don't have the exact answer here. This really tied into my portion of the talk, which was the importance of the clinical environment within your first couple of years of development. And then also making sure that you understood that we clarified the difference between being engaged in your environment, in your system, and even in your organization versus being burnt out. And how those two aren't necessarily exactly the same thing. Burnout is something that we describe as more of like a longterm reaction with like physical manifestations where engagement is more of deciding how you want to use your remaining effort in the day, the effort that you can discern as I can do this to go home and watch Netflix or I can do this to really give back into my system.

Justin Zych (38:06):

So I actually had somebody right after the talk come up to me and just say that she really appreciated just hearing it and understanding that there are a lot of people that have that same sense where your question's coming from. So I just want to put that out there first of all. So I would say first reflect on what first off what you want out of your clinic and see what they are and are not matching. And if you've been in that for two years, that's a pretty good trial run to figure out if there's a different environment that maybe you would want to consider that's going to work more on engagement. What maybe that you want to be more involved in a clinical instruction and be a CI. Maybe you want to do some project management, have some more specific mentorship or it's just the way that they're setting up their productivity. So is it a question that I'm glad you're steering into right now? But it's gonna take a little bit of reflection not only on what your expectations are of the clinic and how you see yourself as a therapist but going even further, you know, keeping your system, your clinic accountable for are they meeting or at least trying to meet and keep me engaged in those environments. So we should, I wish you luck with that reflection.

Amy Arundale (39:27):

Nailed it.

Daniel Chelette (39:29):

Crushed it, man. I just got, I mean, that was a sick answer, man. That was right, right on the money. And the one thing that I would highlight is what I spoke on in my portion of the talk is try to strip it back and think, okay, like what am I about as far as life goes? Like, what am I passionate about? What am I into? What gives me energy? And then kind of builds yourself back up, okay, what as far as work goes, what aligns with that? And then why do I feel a disconnect with where I'm at? And are there ways that I can change my current situation kind of within it? Or do I need to you know, do I need to move on or do something different?

Daniel Chelette (40:22):

So I would try to use your personal passions and sort of your foundation of who you are as a person to help you kind of reset and try to figure it out. But you know, I think that's a great question cause we all go through it at some point in time. And you know, the concepts of burnout. Mm. Oh, reduced engagement and things. That's all part of the game. And those are completely, but I think burnout obviously isn't a good thing, but don't feel bad or guilty if and when you run into those things. Cause we're all humans. And, they can happen but know that there are ways that you can move out of that and move past that. And that's one of the cool things about PTs. There's so much to so many different things to do and get involved in. But yeah, great question.

Amy Arundale (41:15):

That passion was just like the one word that I felt like we needed in that answer. So I think those two are perfect.

 

Karen Litzy:

So we're good. We hit all the questions. So I'm going to ask one last question. It's a question that I ask everyone and Justin, I'll start with you. Not to put you on the spot again, but given what you know now in your life and in your career, what advice would you give yourself as a new grad fresh out of Duke.

Justin Zych (41:47):

Okay. Yeah, no, that's an awesome question. I think the biggest advice that I would give myself is to not have expectations of quick motion, quick development. I'm going through. And in my talk I talked a little bit about, we were in Denver for CSM. So I talked about using the French fry approach with skis where you go down quickly or the pizza approach where you go slowly. So making sure that at times, I was looking at the, you know, what I would tell myself now is make sure that you're looking at just that next step and not focusing on the step that's three or four away. So that you're really present in those moments cause there's a lot of development things that you can potentially miss over as you're trying to really quickly make it to that next step. So take a little bit more of that ski pizza approach.

Amy Arundale (42:40):

Fabulous. Daniel, go ahead.

Daniel Chelette (42:42):

I think what I would say is it's a marathon, not a sprint. You know, it's as far as, you know, career goes in, life goes, it's not just, you know, going 110% each and every day. It's being able to look at the long game. So with the short game, kind of along the lines of with what Justin said, just keeping in mind that Mmm,  it's a marathon, not a sprint. You have to keep the big picture in mind.

Amy Arundale (43:47):

For me, it would be like give yourself permission and that I think that extends to a number of different things. But you know, one of the big ones is kind of self care, you know, kind of giving your self permission to take that time off or to let something else be a little bit higher priority. Whether that's working out or spending time with people, kind of give yourself permission to you know, take that step back and look at things from that 30,000 foot view. So you can really see that big picture. So I think that would probably be mine.

Karen Litzy (44:32):

Excellent. And then I feel like I've answered this question in various iterations over the years, but I've really think what I would tell myself. Yeah, right. Knowing what I know now and when I first graduated, which was quite a long time ago, would be from a career standpoint to get more involved. Whether that be in the APTA or sections or things like that. Because I really wasn't involved and from a personal standpoint is like I needed to calm down. Yeah. Like the Taylor Swift song, like I needed to calm down and that's what I would tell myself. Like I was always kind of go, go, go, go, go and I have to do this and I have to do that. And so I would tell myself like, calm down.

Karen Litzy (45:27):

Things will happen. Kind of echoing Justin and Dan, like I really that's advice I would give to myself is like, calm, calm down, you'll be fine. So that's what I would give to myself. So you guys, thank you so much. All of you for taking the time out and answering all the rest of these questions I think will be really helpful for people who are there and people who weren't to get a little taste of what we spoke about at CSM. And like I said, everybody's social media handles and info will be on the podcast website at podcast.healthywealthysmart.com in the show notes under this episode. So you guys, thank you so, so much. I really appreciate it. And everyone, thank you so much for tuning in. Have a great couple of days and stay healthy, wealthy and smart.

 

 

Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram  and facebook to stay updated on all of the latest!  Show your support for the show by leaving a rating and review on Apple Podcasts!

Apr 6, 2020

In this episode of the Healthy, Wealthy and Smart Podcast, Jenna Kantor guests hosts and interviews Adrian Miranda on the Academy of Orthopedic Physical Therapy.  Adrian Miranda, class of Ithaca College Physical Therapy '07, was born and raised in Manhattan. He currently practices at Windsor Physical Therapy in Brooklyn, NY. In addition, he is a medical consultant and content creator at a Virtual Reality rehab start-up called Reactiv.

In this episode, we discuss:

-Educational resources available at the Academy of Orthopedic Physical Therapy

-Diverse mediums used to disseminate research to clinicians

-How to be involved in advocacy on the state and federal level for the PT profession

-The importance of research for both advocacy efforts and clinical practice

-And so much more!

 

Resources:

Email: AMiranda84@Gmail.com

Cell phone: (585) 472-5201

Academy of Orthopedic Physical Therapy Twitter

Academy of Orthopedic Physical Therapy Website

JOSPT Website

 

A big thank you to Net Health for sponsoring this episode!  Learn more about Four Ways That Outpatient Therapy Providers Can Increase Patient Engagement in 2020!

                                                                    

For more information on Adrian:

Adrian Miranda class of Ithaca College Physical Therapy '07 was born and raised in Manhattan. He currently practices at Windsor Physical Therapy in Brooklyn, NY. In addition he is medical consultant and content creator at a Virtual Reality rehab start up called Reactiv. In the past Adrian has also worked in media including video producer and a television host for BRIC TV ("Check out the Workout") a local television station in Brookyn. Previously he was a faculty member in the TOURO College Orthopedic Physical Therapy Program as the Director of Clinical Residency education. He also was an instructor for Summit Professional Education teaching continuing education (Shoulder Assessment and Treatment) He is currently the Chair of the PR/Marketing committee for the Academy of Orthopedic Physical Therapy (APTA) and contributes to APTA Diversity, Equity, and Inclusion initiatives. He previously held positions in the NYPTA as Chair of the Minority Affairs committee of the NYPTA, member of the programming committee, and Brooklyn/Staten Island Legislative liaison. He also teaches media including video editing, video production at Brooklyn media non profit BRIC. In his spare time he swing dances, does crossfit, has a web series called Gross Anatomy on Firework, and dabbles in theater.  

 

For more information on Jenna:

Jenna Kantor (co-founder) is a bubbly and energetic girl who was born and raised in Petaluma, California. Growing up, she trained and performed ballet throughout the United States. After earning a BA in Dance and Drama at the University of California, Irvine, she worked professionally in musical theatre for 15+ years with tours, regional theatres, & overseas (www.jennakantor.com) until she found herself ready to move onto a new chapter in her life – a career in Physical Therapy. Jenna is currently in her 3rd year at Columbia University’s Physical Therapy Program. She is also a co-founder of the podcast, “Physiotherapy Performance Perspectives,” has an evidence-based monthly youtube series titled “Injury Prevention for Dancers,” is a NY SSIG Co-Founder, NYPTA Student Conclave 2017 Development Team, works with the NYPTA Greater New York Legislative Task Force and is the NYPTA Public Policy Committee Student Liaison. Jenna aspires to be a physical therapist for amateur and professional performers to help ensure long, healthy careers. To learn more, please check out her website: www.jennafkantor.wixsite.com/jkpt

 

Read the full transcript below:

Jenna Kantor (00:00):

Hello. Hello. Hello, this is Jenna Kantor. Welcome back to another episode on healthy, wealthy and smart. I am here with Adrian Miranda who is a physical therapist who you have probably seen on social media quite a bit. Adrian, would you first tell everyone exactly what your job is that we are going to be discussing and in which section of the APTA?

Adrian Miranda (00:21):

So my name is Adrian Miranda. I am the chair of the public relations committee for the Academy of orthopedic physical therapy.

Jenna Kantor (00:30):

Yes, that's right. A mouthful in which I could not get off. So I had Adrian saved for me. Well Adrian, first of all, thank you so much for popping on today for a nice little interview. So I want to first just dive in because I don't know anything about the orthopedic section in the sense of what is it is that you guys are doing for me as a new grad, I'm always thinking the JOSPT, that is a great resource and that is it. So we're going to be diving into more of what the orthopedic section is doing at this point so we can all learn and better appreciate it. And also for those who are considering joining the section, you'll go, Oh, this is for me. Or actually it's not for me. I'm just gonna be sitting with other sections instead. So first of all, what is the big focus for the orthopedic section?

Adrian Miranda (01:23):

Well, the orthopedic section does a lot of things. But let's talk about the focus on education. So as you said, the JOSPT that is actually a joint collaboration between the Academy of orthopedic physical therapy and Academy of sports physical therapy. One thing, so I became the chair, I guess I spent two years I believe now or going into my second year, but I was part of the community for about six months before that. And one thing I would challenge anyone or ask anybody to do is actually go to the website, orthopt.org. Look at all the tabs, scroll through it. And you can find so many things that when I became the actual a chair and I went, I'm just perusing and just looking at what the Academy does. Cause my goal was like I think the Academy does a ton of stuff that not many people know about.

Adrian Miranda (02:12):

You're going to learn so much about how much work and effort goes into and how many resources you can find for yourself or your colleagues educationally. There's a lot of independent study courses. The one that you may know if you've either going through residency finishing residency and taking your OCS, but it's the current concepts which is of, I say it's a staple. If you want to take the OCS, you should have the current concepts, you should be looking for the current concepts and reading through it. That's going to be a huge, huge resource and who get better to go to then the Academy itself. Besides that, cause there's so many courses, even things that I didn't know about. For example, there was actually a concussion independent study course. As you know, many of us, even myself in the clinic are starting to get more and more referrals for patients who have had a concussion diagnosis. So that's out there. There are other courses that are older. Some you get the current courses you get see you use for their courses that you don't get. For example, there is a triathlete course, there is a postoperative course, there is a work related injuries course, auto accident, all these are resources that anybody can use. And that's just kind of the tip of the iceberg as far as courses that you can purchase. And moving forward there are some free resources as well.

Jenna Kantor (03:31):

That's very helpful. So for somebody who doesn't have time, Oh, I feel like I'm speaking for everyone when I say that than going, Oh my God, I have to go and like playing the tabs. How much time is that? I have other things on my to do list. You just gave an overview of the education part, but what are some highlights on things that stood out to you personally within that that's being offered?

Adrian Miranda (03:54):

So none of us have time. You're right. And so I think one of the things that you're going to start to see is easier access to information. So for example, even if you look at any of our social media threads which if you’re looking at orthopedic within a you're gonna find, for example, we had a patellofemoral infographic. You're going to start to see some more smaller snippets because the Academy has realized that yes, people don't know how to digest the information and put into clinical practice right away. You have to really large clinical practice guideline is 70 pages or 50 pages. And then how to kind of digest that and to put it back out in the clinic. We’re trying to create easier versions of that, whether it's infographics. We are also partnering with podcasters like yourself to disseminate information from the authors themselves to give you the information so you can have passive listening.

Adrian Miranda (04:46):

In other words, you don't have to read, you can actually be driving to work going on the subway. You can be on your lunch break and listening to information from authors or researchers of these publications. So we're trying to make smaller tidbits to make it digestible in a form that's also accessible to most people. So we've been looking to long form writing. But right now it's infographics are trying to get onto podcast and educate more people, but we are looking into the fact that there is a time constraint in our physical therapy profession.

Jenna Kantor (05:20):

Yeah. That's excellent to learn. So for the orthopedic section, with the information that you have provided that they're already offering, which is incredible, who is your audience when you're creating the infographics or the infographics for us to better understand, are they infographics where we can reshare it to patients?

Adrian Miranda (05:45):

So good question. These are for us. So the push is actually for us clinicians to get a better grasp of this literature and a cliff notes initial format. However, if you look at JOSPT and I think moving forward, we're trying to also create a little bit of public awareness. So have you seen in JOSPT patient perspectives? That's one way that you can utilize and share it. And I actually remember when they first came out in my clinic, I printed them out in color, put it on the walls and the rooms and patients actually read it and ask questions about it. But as far as what you'll see further moving forward, like the infographics, it's going to be more for us, for the clinician so that we can actually suck in the information and be able to distribute it out to our patients in the easier manner.

Jenna Kantor (06:27):

Yeah, that's a big deal. As a clinician myself or I'm putting together a lot of dance research and creating it on this long form document with links to different research to have it disseminated will be great because the time is taking me to create that. It's a lot of time. It's a lot of time. And I know other clinicians don't have that, so I'm creating this for the dance community at large. So I think that's a really big deal that you guys are looking to make that information more available because there's always regular research and I just want to point this out because nobody can see it.

Adrian Miranda (07:05):

Anyways, I just wanted to put this out there before we continue. Another question. We are also looking for ideas. We want to engage with our members. So if you have any ideas about how to disseminate this information in a different way, we're talking about even long form writing. Some people love to read and that's totally fine. We're trying to look into different options. We're definitely looking for suggestions, people to collaborate with us people to a similar to what you are doing Jenna. To collaborate with us, give us new ideas. We're definitely looking for innovative ways even some old ways that we can bring back to help our clinicians better understand this information and be able to utilize it.

Jenna Kantor (07:44):

I love that. So this is a newer concept, but we have discussed about it. How is the orthopedic brainstorming, how to bring in other people who are providing information and education to help what we bring to patients.

Adrian Miranda (07:58):

I think it's people who are doing the work. Researchers, also clinicians, people who are in the clinic and researching, you know, we're in the clinic and researching. But the Academy definitely has some of the top researchers, people who have their pulse on newer topics. And one of the things that, that also stand in me was when the concussion dependence study came out. And I think that's to show that right now we're going to see an uptake in physicians referring concussion patients to our profession. And we have to be ready for that.

Jenna Kantor (08:31):

You are on the PR committee, so you know a little bit about the public and the relations. You're like Samantha from sex in the city, but not anyway, so I digress. What is it that you guys are doing and focusing on within the marketing committee alone and who is your audience for that?

Adrian Miranda (08:50):

We just want to show you stuff. We want to show you and teach you things. For example, if you look at our recent posts, we wanted to share what happened at CSM. We actually have the Rose award, which if you were in a, for example, a rural setting, if you're doing home health care, you can actually watch his full speech on his study. That had to do with how many visits was optimal for home health, physical therapists. So those are the things that we want to kind of bring you inside and say, Hey, look, this is what we're doing. We are finding committee members who are have skills in different aspects of the media. Which like I said, we're looking for people, we're always looking for people and new ideas. But when I came in, as I told you I wanted to share everything that the Academy was doing at one point I will look there's actually even some certification for imaging.

Adrian Miranda (09:43):

If you are interested in imaging or you think you want to dive into any type of imaging for your research, your PhD or even if you're a new graduate who says, Oh, I really want to learn more about imaging. There is a special interest group for imaging with resources and there's I believe there is either a discount or something and you can again, you can kind of scroll through the social media cause we did post it at one point. We just go through so much information that I can't tell you everything on the up the top of my head. But we're trying to share information that you would actually have to go and scroll and look for on the website. We're trying to make it more accessible. So there's just so many things that we want to it's like a media company really.

Adrian Miranda (10:23):

We're just trying to share what things we do and what opportunities. Oh, another example is the federal advocacy forum. So there is the money into the Academy will provide to a student to actually attend the federal advocacy forum. I believe the deadline has passed for that to apply for the scholarship or the grant. But those are things that we're trying to do. Before I was at CSM and the chair of the practice committee came up to me and said, Hey, is there any way that you can share this? And so those are things that we, even through email marketing, you may have seen it. There was also other programs like CoStar, which you'll have to kind of look it up or go online or go on the website or social media to find out about it.

Adrian Miranda (11:07):

It was about innovation and science. And it's not just for physical therapy. So there's a lot of opportunities, volunteer opportunities, ways to get involved, resources, educational materials. So the peer committees, just trying to say, Hey, you know, those of you on social media, there's all this stuff that you can do. Right now if you look online, soon enough there'll be like a residency Q and A. So there are many of you who are interested in going into residency or currently in residency and we're trying to reach out to that population as well. So there's a target population. It's really the Academy members. So we don't have new grads or old grads. There is a little bit more of a push to get attention from new graduates and students, but we want to be able to share as much information that will help our members. So we are a member facing organizations.

Jenna Kantor (11:58):

That's really great. That's actually fantastic. Okay. I'm going to ask a controversial question more because the concept and idea is definitely backwards was what we're pushing for in the physical therapy profession regarding research. We want to be research based, we want that these studies to back up everything we do. We're doctors for, you know, for sake. So what about physical therapists who are just going, I don't need the research in order to treat these patients and get them better. I'm not saying this to criticize them. I'm not saying this to separate us. For somebody who's not interested in all this data and everything, what do you guys have to provide for them that they would be specifically interested in where it is, where they treat primarily orthopedic cases.

Karen Litzy (13:00):

And on that note, we're going to take a quick break to hear from our sponsor and be right back with Adrian's response. This episode is brought to you by net health net house outpatient EMR and billing software. Redoc powered by X fit provides an all one software solution with guided documentation workflows to make it easy for therapists to use and streamline billing processes to help speed billing and improve reimbursement. You could check out net health’s new tip sheet to learn four ways that outpatient therapy providers can increase patient engagement in 2020 at go.net health.com/patientengagement2020

Adrian Miranda (13:34):

Well, I mean, you can believe that, but it's the cases that you need research to show data, to show numbers, to go to Congress, to go to insurance, to push things and push agendas.

Jenna Kantor (13:44):

Oh, I like what you're saying regarding going to Congress advocating, thank you. Continue. Yeah.

Adrian Miranda (13:48):

So you need to prove that things work. Now there's many things that you cannot get data on or you just haven't created the right methodology for it. So you haven't created the right structure, the right research methods, the right way to capture those results. We're in a big data-driven time right now. So whether you believe that you don't need research and that it's there and we have to utilize it and it is actually necessary to help with reimbursements. So it might not hit you right in the face when the patient walks in, but it's going to hit you somewhere. So yes, research is extremely important. And it's not the end all be all as well. The way we get research is from an evidence case reports from the things that just occur. And then you go back and say, Hey, why did this work?

Adrian Miranda (14:34):

It didn't work. Or it did work and it worked because for all the wrong reasons. But if you don't have a scientific method for that, you're never going to know. Listen in the PR committee. So I'll tell you something. And many of you may be in the technology sector, marketing sector and digital marketing. We analyze what our members were engaging with and it turned out that CPGs our members were engaging with and we actually pivoted a bit more to give you more of that content. And we're seeing that you are engaging with it more. So if we didn't have that data, we wouldn't be able to give you what you want or even what you need. It is very important. You may not see it right away, but there are things that help agendas be moved forward and prove our worth.

Adrian Miranda (15:20):

As physical therapists, you can say it all you want, but if you have numbers, you really can't argue with numbers unless you're dealing with larger entities that have bigger pockets than you. But even at the end of the day, you fight hard enough for it. You're gonna get it. Direct access is moving along okay. And they're saying, we don't have any restricted direct access, but if we didn't have studies that are coming out saying that early intervention, but physical therapy reduces costs of healthcare achieves healthcare savings, we can't push that bill forward because we didn't have the data. Now we do have the data. So I would say that the sometimes or the reason for not agreeing with research has, you know, personal experiences and negative experiences. Maybe not even understanding research and what it does. Maybe you're wasting money on. These are one large universities doing all this data and research, but you need to think about it a little bit differently.

Adrian Miranda (16:17):

And the more research we have, the better research and better data. The more that you'll see we're helping more people in the community. The more that you're seeing businesses, physical therapy, business thriving, and being able to kind of give back to the community and give back to their employees as well. So it's this kind of circle. It's almost like a spin diagram that without research, without the community, without the clinicians to enforce it, we're not going to go anywhere. So I would say those people that don't believe in research it's like air. It's there. You need it. Love that.

Jenna Kantor (16:50):

Start to touch upon it. I want to dive into it. More advocacy. What is it that the orthopedic section, say three things right now that you know of, that they're advocating for on Capitol Hill?

Adrian Miranda (17:03):

Okay. So one of the things that did for the 40th anniversary was create almost like a mini documentary. Which was eyeopening to me. I didn't realize how much the Academy of orthopedic physical therapy advocated for States and governor and national issues. They actually were very instrumental in practice things all over the country and even helping with the right access bills right now at this moment. I couldn't tell you specific things. But if you go look at that video, which I think it was ast year, CSM I interviewed a lot, most if not most of the past orthopedic presidents who actually served on the APTA board. And yes, and some of them currently do it will be enlightening to see how much advocacy in the Academy actually provides. So having said that I couldn't tell you on top of my head exactly what they are working on at this moment legislatively, but just know that they are and they're also helping other components with their efforts and their resource. So if you, again, maybe you don't want to be in the public relations and marketing, but if you have some type of legislative issue or some type of issue that you have reached out to the Academy, they might be able to either guide you, steer you or help you connect with the APTA itself. Anybody in the government affairs, we actually have a committee directly for government affairs.

Jenna Kantor (18:38):

That's great. And you can even go on the website I'm seeing right now there is a tab for governance. It's literally on the major main page, so you go to governance and when you put your little mouse or a little hand on there, it'll go down and you can get information on what they're doing in their strategic plan. You click on that and it will take you into vision statement and goals so you can really see what they're doing right now for the lines with you and what you want them to be fighting for or if you want, there are points you want them to address in which you can then reach out to them to make that difference. Thank you so much, Adrian, for coming on to speak and educate about the orthopedic section. I really am a beginner with this myself because I've been a member for, since I was a first year student and never looked into any of the resources until this conversation right now. I think this is literally with the exception of joining the performing arts special interest group. The only time I've really gone into the the webpage. Oh look and we just opened it up. So current practice issues right now.

Jenna Kantor (19:43):

In what month, we are March, 2020 direct access imaging, dry needling, mobilization versus manipulation and practice issues state by state. And then you can get more details on that as well on orthopt.org. You just click on that governance and it'll get you there.

Adrian Miranda (20:03):

Is that answering the question about what issues are being dealt with by the Academy?

Jenna Kantor (20:08):

Yes, that does. That does. And the one who clicked and fell and grabbed that page. So we could just go onto practice, current practice issues and boom, bada bang. Thank you for coming on. Are there any last words you have for anybody who is considering joining the orthopedic section? But they're on the fence right now.

Adrian Miranda (20:27):

Join. There's really no drawbacks. If anything, here's what I recommend to anybody. If you have, there's two aspects. If you really want to get involved, there's someone who has been involved in school or someone who really wants to help other PTs. You wanna help the profession get involved. There's ways to get involved. You can be a member and do nothing and just hang back however you can make such an impact. I've had people recently asked to join or to be able to assist in the public relations committee. If you are somebody who has a lot of gripes and is really upset with what we're doing, go ahead and join anyway because you could actually be a change. I remember having this conversation with somebody in New York state. I was at a PT pub night and they were complaining to me about what this time I was actually in the NYPTA and what the APTA does.

Adrian Miranda (21:11):

And I let him go and just vent. And finally after like 20 minutes of venting, I was like, you know, I'm the chair of this committee, I'm a part of this committee. I'm on the MIP team that the board needs. I thank you for saying all that stuff. And his whole face going to drop. Like, Oh my gosh, I'm talking the wrong person. And I said, no, no, no. The fact that you're that passionate about it, you should join and you should make a change. All of a sudden, you told me you should bring it up at meetings or talk to your district. That's at the state level. At the Academy level. You can do this same thing if you're upset at the laws of dry needling and your state joint Academy, see how you can be part of the practice committee if you're upset about direct access, if you want to get involved in writing, if you want to get involved in editing you know, there's small, obviously there's very few worlds for that, but there are opportunities if you wanna get involved with pure committee, please join.

Adrian Miranda (22:04):

But there's so many things that you can help fix if you're upset about something and there's so many things that you can help improve if you're pleased with it. So I think there are so many opportunities to also enrich your life, enrich some of your skills and goals and even your practice. So I don't think there's any drawbacks to joining. And then we would love to have as many members as possible. You also want to have members that engage. I think when I talked to the board, we have meetings, our main goal and the people who've been around longer is that our members engaged with us. And you're not just someone who's going to sit back and just watch. Although that is okay, we want to be members. But I think it's also important to if you have a skill, if you have a passion and if you want to help our profession or your community get involved in and find where your spot is.

Adrian Miranda (22:48):

There's so many areas. There are seven special interest groups, there's several committees. There are several task force that you can be a part of. So I would definitely encourage you to reach out and listen. Organizations are challenging. There's a lot of people, there's a lot of need out there. There's a lot of different opinions and even it might say, this is an issue in my practice is an issue. My employees is my employers. That reimbursement is patients, this the demographics. There's a lot of things that we can help with numbers. Just like we're talking about research, we have a lot of numbers can be powerful. So if there's anything I can impart is that you can help be part of improving or be part of a change.

 

Jenna Kantor:

I love that. Thank you so much. Adrian. How can people find you on social media and do you also have an email even for them to reach out to you?

Adrian Miranda (23:36):

Well, how about this? I'll do you one better because I learned it because usher and Gary Vaynerchuk are doing it now. I'll give you my cell phone. Feel free to reach out. I will give you my email just for sure. The social media Academy of orthopedic physical therapy. And my name is Adrian Miranda. You can find me at AMiranda84@Gmail.com. And my cell phone is 585- 472-5201. I'm very available. So I happy to talk on the phone cause sometimes, actually nowadays that's quicker than an email or even texting back and forth. Send me a text message. I would love to hear your input and hopefully we want to hear how we could be better as well.

 

Jenna Kantor:

Wonderful. Thank you so much for coming on. Have a great day. Everyone.

 

Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram  and facebook to stay updated on all of the latest!  Show your support for the show by leaving a rating and review on Apple Podcasts!

Mar 30, 2020

Social Distancing for Rehab Therapists

Leveraging Part-B In-Home Care and Telehealth in Your COVID-19 Response

 

Recorded Thursday, March 26, 2020  |  2:00PM EST

 

In light of the recent COVID-19 pandemic, the CDC has recommended ‘social distancing’ as a key tactic to help reduce the spread of the virus. In this webinar, our guest speakers will discuss two options to help rehab therapists continue delivering care during COVID-19.

Hilary Forman, PT, Chief Clinical Strategies Officer for HealthPro-Heritage, a leading consulting and therapy management firm, will share best practices for effectively and safely delivering care through Part-B in-home care. Additionally, consultant Rick Gawenda, PT, President of Gawenda Seminars & Consulting, will discuss telehealth legislation now in effect, which supports the practice of ‘social distancing’ while continuing to deliver necessary outpatient rehab care.

Included in the webinar are details related to:

  • COVID-19 pandemic and CDC recommendations
  • Risks associated with traditional therapy ‘clinic’ settings during COVID-19
  • Benefits and best practices associated with delivery of Part-B in-home care
  • Telehealth legislation and application for rehab therapists

 

The continuation of outpatient rehab care plans during this unprecedented time requires careful thought as to how we adhere to new recommendations while providing the quality of care traditionally delivered in public locations such as outpatient clinics and gyms. This webinar is designed to help you as you seek ways to adapt your care delivery in today's new environment.

 

Resources:

Gawenda Seminars Website

Healthpro Heritage Website

Rick Gawenda Twitter

Hilary Foreman LinkedIn

 

For more information on Hilary:

Hilary is an experienced, sought-after health care reform expert with a dynamic approach to advising providers within the post-acute care industry. As a solutions-oriented leader and consultant, she meets the challenges of a rapidly changing health care environment with innovative clinical and financial strategies. With more than 15 years of experience in rehab management, Hilary has worked with hundreds of clients to optimize marketplace strategy, clinical program development, and compliance integrity.

Hilary has presented at several association meetings to share up-todate information and insights as well as her thought- provoking approach to meeting the challenges of health care reform initiatives.

She has established a reputation for facilitating meaningful partnerships between post-acute care (PAC) providers and upstream and downstream cohorts. Hilary’s philosophy encourages open collaboration, proactive communication, and honest dialogue regarding outcomes, safe care transitions, and financial opportunities/pitfalls.

With a keen sense of humor and a no-nonsense approach to solving problems, Hilary has the ability to assist groups in thinking strategically, challenge the status quo, and ultimately succeed in leveraging positive outcomes.

 

For more information on Rick:

Mr. Gawenda has presented nationally since 2004 and currently presents approximately 100 dates per year around the United States.

He has provided valuable education and consulting to hospitals, private practices, skilled nursing facilities, and rehabilitation agencies in the areas of CPT coding, ICD-10 coding, billing, documentation compliance, revenue enhancement, practice management, and denial management as they relate to outpatient therapy services.

 

Read the full transcript below:

Tannus Quatre (00:00:02):

Welcome everyone. My name is Tannus Quatre and today I'll be kicking us off with our webinar on social distancing for rehab therapists. Before getting into our topic I'd like to take a moment to acknowledge and appreciate each of you that are on the call today, as well as the teams that you work with to serve patients in your communities. As a physical therapist myself and as part of an organization that proudly serves rehab therapists, this is a really heart wrenching time as we watched this coronavirus pandemic unfold and impact lives across the world, including the interruption of the care that you provide to your communities. As part of our effort to help rehab professionals continue to deliver care in your communities during a time of putting my hands in quotes here, social distancing and sheltering in place, phrases that are new to us, we've assembled a team to present for you two business models today, part B in home care and e-visits.

Tannus Quatre (00:01:03):

And we hope that these will facilitate the continuation of the care that you provide while helping your patients and your staff adhere to guidelines that require that during this time we limit our physical exposure to one another. We've got an amazing speaker lineup for you today. Starting off with Rick Gawenda, physical therapist, compliance and billing expert and president of Gawenda seminars. Rick's going to help us understand some recently expanded legislation regarding telehealth and e-visits for rehab therapists. We have Hilary Foreman, physical therapist and chief clinical strategies officer with HealthPRO heritage. Hillary is going to walk us through health pros, part B in home rehab model and how this model is uniquely positioned to help protect her patients and her team during a time of social distancing. And we have Sheila Cougras, registered nurse and director of compliance at net health, who together with Sarah Irey, also a physical therapist will be setting the stage for us today by introducing us to COVID 19 and considerations that impact us as rehab professionals.

Tannus Quatre (00:02:12):

Now, today's webinar represents our best efforts to help rehab therapists adapt to a very unique circumstance. We're working right alongside you to adjust and learn as things change and I know for all of us things are changing hour by hour at this point. So in our webinar today we'll be sharing some information that is both fairly broad in nature and then we're going to be zooming in to discuss details that are really pretty technical. So we hope that the information will help you stimulate thoughts and ideas that you can use to continue care for your customers, but please do know that the information is changing rapidly and you're going to need to verify if and how this information applies to your particular business. Now finally for me on a housekeeping note, we're going to be pretty fluid with this webinar today and we're going to take the time needed to cover the information that we have planned as well as time for Q and A at the end.

Tannus Quatre (00:03:06):

If you have questions that come up during the presentation, please use the Q and A function that you'll find on your desktop or your phone and we'll get to as many of your questions as we can. At the end of the webinar, we have about a thousand attendees on the call today, so we probably won't be able to get through all questions. So we'll be providing our contact information following the webinar so you can reach out to us for followup if and where that that is needed for you and for those that cannot attend, that may be within your organization or colleagues that you'd like to have attend this webinar after the live version. We will be sharing a recording following the live presentation today, so expect that in your inbox. So with that, I'm going to hand it over to Sheila Cougrass and Sarah Irie to introduce us to COVI- 19 and clinical considerations that apply to rehab therapists.

Sheila Cougras (00:04:00):

Thank you, Tannus. As Tannus mentioned, I'm a registered nurse and a certified wound care nurse that is certified in healthcare compliance. I have been at net health for the past 12 years and serve as the compliance subject matter expert for our products. But before I even get started, I really sincerely want to thank all of you on the front lines who are caring for our patients and communities. What you're doing is really, really appreciated and very much noticed throughout the world. I'm going to also first state that we recognize that all of you are being inundated with a lot of information for COVID-19 that's coming in through, you know, firehoses a lot of information and it only seems so appropriate though that we open with a high level of information we're receiving every day from the CDC to other regulatory and professional agencies across the country. It's also important to note the information is being updated every minute. Even as we speak. I'm reading and learning that new regulations and legislation is introduced at us at a startling pace. We already have over 500 bills and 250 regulations that have been introduced and proposed across the States and the use of the executive order has skyrocketed.

Sheila Cougras (00:05:17):

So we also recognize that this information varies for all of you. Depending on where you provide services, you may be in a home health, you may be in a SNF, acute hospital, private practices, assisted living facilities and with that said you may have a lot of variations with your facility and local policies and federal guidelines. So we want to keep that in mind. As we know, corona virus has been around for a long time. It is a group of related viruses such as SARS that causes disease in humans, in animals, the world health organization, they recently identify COVID-19 is a new virus group, Corona virus which typically respiratory illnesses and most will recover as we know without special treatment. As we've heard, it mostly impacts our elderly population and those that have specific underlying conditions or immunocompromised. We are also hearing about many of the treatments that are off label that are now being made available being introduced today for treatment. But currently there is no vaccinations and treatments are just now starting to be introduced off-label. It is active in all 50 States and I guess it's also active within our surrounding four jurisdictions of our country. And the last we seen reported I know that this is obviously probably updated since, but the last reported by the CDC is 27 are reporting community spread.

Sheila Cougras (00:06:46):

We are hearing that it is also being noted by the new England journal of medicine that COVID-19 is also stable in aerosols and on surfaces that can last from several hours to several days. So we want to keep that in mind when a person sneezes or coughs without proper coverage into their elbow or their sleeve, it creates a bubble of air that contains the virus. It could be suspended for hours and so with that said, if someone walks through that area an hour later, they could potentially pick up the virus.

Sheila Cougras (00:07:23):

So this slide is not only to share with you common recommendations from CDC and the world health organization, but also think about setting up competencies for your staff and educating your patients. We obviously want to maintain that good hand hygiene as being occurring washing for at least 20 seconds with soap and water and hand sanitizer with at least 60% alcohol reasoning is because those soaps we use contains surfactins which neutralizer removes the germs from the pathogens such as COVID-19 that has a crown like structure and outer membrane made of lipid molecules and protein that is then runs down the drain. Do not touch your face. We hear that a lot with unwashed hands is specifically your eyes, your nose in your mouth where there's much entry into your system. Where if face mask, if indicated by your facility policy protocols, we know there's a lot of uncertainty in this area due to the limitation of supplies.

Sheila Cougras (00:08:21):

So please check how and when you are to utilize face mask and the type of mask you should be wearing Disinfect your common touched surface areas. Often whether it be tables or knobs, countertops, desk, phones, keyboards in any other equipment that has commonly touched you. It's also helpful if you increase ventilation by opening windows or adjusting the air conditioning and we also want you to limit food sharing, stay home if you're feeling ill or have an ill family member and most importantly is you're going to hear threaded throughout this presentation and as Tannus mentioned is social distancing maintaining a safe distance three to six feet between you and others. It's so important given how this virus is transmitted. Sarah will speak to this further but before I hand it off to her, I want to share that a I have been listening to other professional organizations speak about ideas and best practices they're sharing.

Sheila Cougras (00:09:14):

I was on a call a couple of days ago with American hospital association in CMS with Sima Burma where she was encouraging the physicians to share ideas. Some are setting up tents outside of their offices to do the screening conducted prior to allowing the patients or staff to enter the building. Some are calling the patients prior to their appointments and asking a series of questions provided by the CDC to triage those patients. And many of you are hearing utilizing telemedicine and you will hear more from our other panel speakers on that topic. Additionally, I heard that in HPCO, which is a hospice professional organization just yesterday. They're getting so creative that they're providing care through windows and standing outside of the patient's home and looking at the patient through the window and addressing the needs with the caregiver at the door. So as we know, this is the time to really get creative and treat your patients safely as much as you can.

Sarah Irey (00:10:07):

Thanks for that great information Sheila. Before we start, I'll let you know a little bit about me. I'm a clinical liaison for net health, but my background is as a physical therapist with nearly 20 years of experience working in various settings including private practice, hospital outpatient and acute care and skilled nursing facilities. I'm lucky enough to use my clinical experience here at net health, but I do some clinical work still now and then. Let's continue to build on what you learned from Sheila. An important part of social distancing includes being able to identify patients and staff who have COVID-19 or who may be a risk of carrying or contracting the disease. Many facilities are now using screening protocols, as Sheila mentioned, to identify these individuals. If you're part of a larger organization, check your organization protocols to determine the process for screening patients and staff and know how to refer them for additional testing if they're possibly infected.

Sarah Irey (00:11:12):

If you don't have a formal protocol, you might want to consider creating one using sources from the CDC website as well as checking with your state. The CDC outlined some recommendations such as using your clinical judgment. Clinicians should use their judgment to determine if a patient has signs and symptoms of COVID-19 and should be tested so the signs and symptoms that you've heard about include fever, cough, and difficulty breathing. Other risk factors are having contact with someone who has or is suspected to have COVID-19 or pneumonia of an unknown cause within the last 14 days. Someone who's recently traveled outside of the United States or in an effected area and someone who has residents in an area with community spread of COVID-19. Like Sheila mentioned, your screening can actually begin before your patients arrive at your clinic. When you're making appointment reminder calls.

Sarah Irey (00:12:09):

You might want to consider asking screening questions and making recommendations for exposure risks in mildly ill or high risk patients to stay home per social distancing guidelines. We realized that many of you may still need to see patients in a clinical setting. So let's consider some ways to keep you and your patients safe while keeping social distancing in mind no matter where you treat your patients. First, follow the screening guidelines we just discussed to decrease your risk in your clinic. You also may want to ask patients to wash their hands prior to starting the treatment session and after you could even maybe consider having them stand on one foot to practice balance while they wash if it's safe, right? Wash your hands as well. Always follow standard precautions and use PPE per your organizational protocols. Be mindful to follow the six foot social distancing guideline in the waiting area and your treatment space.

Sarah Irey (00:13:09):

So you might need to modify your waiting area seating setup or your schedulings practices to support this model. Maybe use private treatment rooms for patient visits instead of the gym area. Avoid group and concurrent therapy treatment and consider treating patients in their rooms if they reside in a skilled nursing or assisted living facility. Also think about if you can change treatment and treatment plans to decrease physical contact with your patients, but still provide quality care. Examples of this might include instruction and self mobilization techniques instead of manual adjustments or mobilization or instructing the patient in use of tools for soft tissue mobilization such as foam rollers and trigger point release balls rather than direct therapist to patient touch. Also consider keeping your patients with one provider per visit instead of sharing care to decrease contact. So you may need to change your scheduling and staffing practices there. Finally consider educating patients on alternative treatment options such as part B in home rehab and eVisits. So let's learn more about part B in home rehab with Hilary foreman from HealthPRO heritage.

Hilary Foreman (00:14:22):

Thank you so much Sarah. And as Sarah said, my name is Hilary foreman. I am the chief clinical strategy officer at HealthPRO heritage. I am a PT by background and I've been lucky enough to be with HealthPRO for about 18 years now. I'm moving from operations into our clinical role. I have the honor of being in charge of our clinical and consulting business lines over our rehab services that span across the post-acute continuum. So as Sarah said, I wanted to talk to you about our first business model, which is part B in home rehab. Though HealthPRO heritage did not start this model in light of the current COVID-19 situation, it now more than ever in this era of social distancing has become one of our standards as it makes more sense as a consideration. This model can be used by both rehab companies and home health agencies to better meet the needs of some of our seniors.

Hilary Foreman (00:15:19):

So let's start with what is part B in home rehab. Very simply, it's the concept of the traditional outpatient therapy model being provided in a patient's home as opposed to a free standing clinic or the gym of a senior living community. Services still remain covered under Medicare part B. They may also be covered by managed B or some commercial payers as well. By being able to deliver this service in a patient's home, it provides a lot less anxiety for a patient and a much happier person. Patients in this scenario are not home bound, but due to other circumstances prefer to stay in their home, whether it be convenience, safety, or cost. One caveat to this model is that because patients aren't home bound, they can also not be receiving any part a benefits as this is a part B benefits. So those two insurances do have to be separated.

Hilary Foreman (00:16:27):

So why would we do part B in the home first? As I said, it would be convenience of care. According to some recent AARP statistics, over 89% of patients over 50 years old would prefer to receive these type of services in their home for many of their own reasons, but now in the era of social distancing, this can be a more protected setting. This can also be a great solution for protecting some of our most vulnerable patients, but continue to provide those essential rehab services with reducing the risk of illness or injury to those patients.

Hilary Foreman (00:17:14):

As we continue down the path of why we would do this, one of the other has to do with a lot of the regulations going into place. Many of us are looking to expand our referral base, so whether you're a rehab company or a home health agency, chances are you're looking for different partnerships in your community. In light of changes with PDPM on the skilled side and PDGM on the home health side and changes and just the level of competition in many markets, you may be looking at different ways to partner with other people in your community. Whether you're looking to expand with physician services, many outpatients we think of as partnering with orthopedic physicians. We all know that orthopedic physicians tend to use their own clinics or hospital based rehab settings. In this model. Healthpro heritage chose to partner more with primary care physician groups in order to better expand into the community.

Hilary Foreman (00:18:17):

These primary care physician groups, we're community-based or we're already partnering with many of the senior living and assisted living communities in the areas. This paired nicely with their house calls programs, so we just like the physicians would start making house calls. It became a very good word of mouth referral source for us as well as a network between different senior living communities who wanted to partner their therapy across all their levels of care. So having therapists provide services through the home health agency as well as part B in the home. This helped the therapist become a standard part of the community, whether it be on that campus or in the greater community. Another reason you may consider why we would do part B in the home is just to reduce overhead for providers. This model reduces costs associated with brick and mortar clinics and the costs associated with keeping those running or even dedicating space within an assisted living or independent living community for patients.

Hilary Foreman (00:19:27):

This reduces a lot of their anxiety. It may also save time, money and effort for them traveling, worrying about parking and worrying about keeping all their appointments straight by having us go to them. It is a lot of their worry. And lastly, in order to follow any of the trends in healthcare, we all have to change, diversify and grow. Most importantly, meeting people where they are and where they want to be. Chances are that is going to be in their homes. We wanted to be able to offer more alternatives to where they could get the essential rehab they needed. Now again, in the era of social distancing, we were able to meet them in their homes and it was a great new business model for us as well. So killing two birds with one stone, but now as Sheila shared in the era of COVID-19 we did have to take some additional rehab considerations.

Hilary Foreman (00:20:28):

So we at HealthPRO heritage, decided to do a few things before we ever entered someone's home. First, we implemented a very strict policy of staff monitoring where staff self-monitor temperature checks twice a day, attest to whether or not they have any signs or symptoms. We even instituted a smell check. Some of the more recent literature indicated that people ahead of coming down with the symptoms of COVID-19 had actually lost their sense of smell. We also reviewed contact or exposure history, looking at what would be a low or high risk exposure and choosing whether or not therapists would see some of our most immunocompromised patients in their homes or not. We also instituted patient screening calls as Sarah suggested, making sure that we not only asked about the patients themselves, but anyone else that might be in the home at the time of the visit.

Hilary Foreman (00:21:28):

So many of our seniors have their spouses or older children home with them. They may be caregivers for grandchildren, so we did want to make sure that in addition to asking just about the patient, we knew about them as well. We did follow the CDC guidelines on what we could and couldn't ask, but it also helped us explain to our patients what infection control steps we would take prior to coming into their home. We did focus a lot on our staff and making sure that they understood what those infection control steps were. We did add additional steps in light of the current situation, especially when it came to clean bag and equipment technique. We wanted to take extra care of everything we did or did not take into a patient's house and how we were able to take care of that.

Hilary Foreman (00:22:19):

The other issue we have run into, and I'm sure many of you on the call have as well, is the availability of PPE. In cases where we do have low risk or high risk situations, patients still may have required care and we did have to make sure that people had the correct availability of PPE and understood proper use and retirement of that PPE well in the home. We did ask our therapists to continue to maintain social distancing rules from others in the house, in the apartment or in that senior living community. We did see that there was a lot of opportunity there as well. We were able to be another set of eyes for our seniors in the community or in the senior living community. Looking for other needs they may have. Being able to address things such as medication that may need to be delivered, additional signs and symptoms of other issues outside of COVID-19 that may increase a patient's risk of rehospitalization and we were able to work better with our senior living communities in that way.

Hilary Foreman (00:23:29):

So now that you know a little bit about our model and now it's time to look to see if this is the right model for you as you're possibly considering this as part of your growth and diversification strategies. There are a few things both pro and con you should consider if you are a home health agency, there are differences between billing part a and part B. You still do have a homebound requirement. You have to look at what those billing differences as well as what the different therapy documentation rules might be because this is part B and the home. It does follow traditional part B documentation and billing guidelines with all of the modifiers attached. A benefit to this is for the home health agency. Being able to provide additional rehab services after perhaps nursing services have ceased as a need, gives you the ability to divert those critical nursing visits to more high risk patients that may be elsewhere in the community. In this case, rehab would focus mostly on safety in the home and basic ADLs. If you're a rehab company, there's a little bit more to consider here. We were able to, in different parts of the country operate this model either under a group practice or a rehab agency. These both models have specific regulations by state that vary and we did need to look into all of those different rules and regulations and setting up the different practices and different locations.

Hilary Foreman (00:25:05):

The other challenge we had was looking at our therapists and their skill sets. This is a unique model because you do blend the skillsets of a home health therapist by being in the home, being more innovative and looking at what you have available to you in a home to provide therapy while mixing it with true outpatient skills. So looking at our therapists being able to work at the top of their license and looking at things from medication management all the way down to manual therapy. As Sarah shared, we did have to make some alterations in the care we've provided recently in light of some of our infection control procedures. But to our patients still receiving that essential therapy was still most beneficial in some cases in making this decision, you may have to actually look for additional consulting services in your area to help you either set up this program or work through the regulations. I hope this gave you a good overview of this possible new business model. And now to talk about our second alternative business model, I pass to our next speaker, Rick Gwenda.

Rick Gawenda (00:26:16):

Thank you very much. My name is Rick Gawenda. I am a physical therapist. My wife, I and another business partner do own two clinics here in Southern California. And then also for the past 17 years I have been a national speaker and national consultant in outpatient physical occupational speech therapy as relates to documentation, CPT coding, diagnosis, coding, payment reimbursement compliance. And all stuff nobody really likes to talk about. So with that, we're going to talk today about telehealth and e-visits. As we go to the next slide. This information I'm going to share with you is current as of 2:00 PM Eastern time today. Cause obviously I used to say things, you know, change weekly or monthly things are changing hourly. We're seeing many state governors mandate insurance plans in their state cover telehealth. We're seeing insurance companies doing this on their own saying they're adding PT OT SLP as telehealth providers. And we are waiting patiently for updates from these centers for Medicare and Medicaid services. So again, everything is current as I speak today. Most likely things would change either tomorrow or early next week. We are in the Medicare program as well as maybe other insurances in many States.

Rick Gawenda (00:27:47):

So speaking with the Medicare program first, so CMS, the centers for Medicare and Medicaid services issued a document over a week ago and they talk about three types of virtual services that you see here on this slide. And the commom mistake I'm hearing people make is they're using the terms eVisits and Telehealth interchangeably synonymously, the same as, and they're not the same. They're completely different. So again, three types of virtual services per the Medicare program right now. Medicare telehealth visits, which we're going to give you the current status of that coming up, virtual check-ins, which were not apply right now to PTs, OTs and or SLPs. And then we're going to talk about eVisits that will apply to PTs, OTs and SLPs.

Rick Gawenda (00:28:45):

So as I speak to you today, now about, I believe it's around 2:30 East coast time, March 26, the Medicare program still does not pay for tele health services for outpatient, physical, occupational and or speech therapy services. They consider this a non-covered service because the Medicare program does not pay for these services for therapy and they consider it non-covered. You right now today can provide tele health services to your Medicare part B beneficiaries and charge them your cash rate for the telehealth services. And an ABN, an advanced beneficiary notice of non-coverage would not be required to be issued to the Medicare beneficiary. You can issue a voluntary ABN to the Medicare beneficiary if you want to and I do recommend you do that but it's not mandated. You issue an ABN to the Medicare beneficiary and the reason why it's not required is an ABN is only issued when normally the services are covered by the Medicare program, but under the circumstance you think Medicare is not going to pay or since right now today, March 26 telehealth services provided by PT OT SLPs or statuary, non-covered and ABN would not be required.

Rick Gawenda (00:30:24):

Also, if you are familiar with the ABN form in section G there's three boxes and the patient's supposed to select one of those three options in section G since your issue in a voluntary ABN, you are not going to ask the patient to choose an option. The patient does not need to sign and date the ABN because you're not going to be submitting the claim to the Medicare program. So people haven't been asking me, well, Rick, what CPT codes do we bill to Medicare for telehealth? You're not going as I speak today, you will not submit a claim to Medicare if you are providing telehealth services for outpatient PT, OT SLP to a Medicare part B beneficiary because it's statutorily non-covered. And since these services are non-covered, the mandatory claim submission is not required. Now I will say there is a barrel that we expect the house to vote on tomorrow called the creating opportunities now for necessary and effective care technologies.

Rick Gawenda (00:31:32):

The acronym is connect, C O N N E C T act, the connect act and in section three seven zero three of that bill. If it gets passed by the house passed by the Senate, everything stays in president Trump signs it. It's going to broaden the authority of the secretary of health and human services to wave tele-health requirements as they currently are. So we're hoping that once the house is supposed to take a voice vote on that sometime tomorrow followed them by the Senate. My opinion only, it should pass pretty easily. Hopefully the president signs it, then hopefully then the secretary of health and human services would then waive the current restrictions house for Medicare beneficiaries and allow PTs, OTs and SLPs divide those services and build the Medicare program for that. Also, as we speak today in the office of management and budget, there is an interim final rule regarding COVID-19 and some updates in that interim.

Rick Gawenda (00:32:43):

Final rule. Unfortunately we have no clue what's in that interim final rule. It could be some things way too. What I'm still going to talk about here today about E-visits could be about tele-health, could be about easing restrictions and supervision, requirements of assistance, could talk about certifications recertifications it could have nothing about therapy and you know, we don't know again, it's still in the office of management budget to OMB. Hopefully it leaves there either later today or tomorrow and then gets published in the federal register. But that's why I add that disclaimer. We expect things to change with the Medicare program here shortly. We expect clarification to come out from CMS on some things we're talking about right now during today's presentation.

Rick Gawenda (00:33:38):

Let's talk about now e-visits. So again, e-visits and tele-health are not the same. The two are completely different things. So CMS did come out over a week ago and say that they would pay for eVisits provided by physical therapists, occupational therapists and speech language pathologists. I cannot stress enough that top bullet point, they must be initiated by the patient for each E visit, which means the patient needs to reach out to you, the provider, either via a phone call, via an email request. In this E visit. Now CMS did clarify you, the provider of therapy services can educate the beneficiary on the availability of this service. So you can send out an email to your current established patients about the option for ae-visit and all of that. So you can quote I guess like a better word, advertise this service. However the patient must initiate this visit now, but we don't know.

Rick Gawenda (00:34:42):

Here's this third bullet point says patient must be an established patient with the provider who is conducting the visit. And what we're hoping to get soon from CMS is clarification and the definition of an established patient. Because these G codes I'm going to talk about in a moment on the next slide, they actually are brand new this year just came out January 1st of 2020 and to be honest with you, they were not designed for what CMS is allowing us to use them for right now. This is not the purpose of these codes. Now these codes are kind of a, a knockoff, kind of a shoot off of the nine eight, nine seven zero CPT code nine eight nine seven one CPT code nine eight nine seven two CPT codes that are used by physicians for evaluation and management services for these visits done through an online patient portal.

Rick Gawenda (00:35:45):

Now when you look at the physicians and the definition of established patient for a position, this is somebody that has, you know, maybe seen that physician within the last three years. We don't know how CMS is using that definition of established as it pertains to PT, OT, SLP. I'll be honest, it could be established patient as in this is a patient that you were currently seeing for therapy services and now they can't come into your clinic right now you've shut down your clinic, you want to do an visit. Is that what they mean by established patient? Could established patient mean this is the patient you've seen sometime in the past three months, the past six months. Are they going to have to go back, you know, quotes three years like they do physicians. We don't know the answer right now. What we do know though is if you're going to do an evisit any Medicare beneficiary that that patient could not have been seen by you for a physical visit within the previous seven days for the same condition.

Rick Gawenda (00:36:48):

And then once you do this evisit they're not coming in to see you within seven days for that problem. Now, CMS does say that you must use an online patient portal. And I'm giving you the definition of an online patient portal by the office of the national coordinator for health information, which is a secure online website that gives patients can be it 24 hour access to personal health information from anywhere with an internet connection. And there's the URL link for you cause people, you know, if you read the CMS information that's come out, you know, you saw, CMS mentioned that they're the lax scene, they're kind of easing the HIPAA rules and regulations. You know, you saw CMS mentioned Skype and mentioned FaceTime, they mentioned Skype and FaceTimes for tele health services, not for E visits. So right now again we're trying to seek clarification from CMS and boy, can you do a phone call, can you use FaceTime, can you use Skype before we get that clarification.

Rick Gawenda (00:37:57):

I've got to, you know, talk here and say you have to use an online patient portal. And again, you can go on the worldwide web, go to any search and you want to go to, I just use Google and type in a search box, you know, types of online patient portals. You know, what is an online patient portal? You know, I know my physician, and again, I'm not endorsing this product. My physician uses the call it, it's called charm, C, H, A, R, M, all capital letters where she can send me my test results. You know, my lab results. She can give me updates on my medications. You know, I create an account, I log in, I see my test results, I see her email, I can respond to her, she gets notification and with things like that. But again, it must be initiated by the patient for each E visit.

Rick Gawenda (00:38:54):

Next slide. So here are the three G codes, G 2061 G 2062 G 2063 and I cannot stress enough those words that are underlined, assessment and management, and then shooting the tib time during the seven days. So let's talk about what are the seven days. When is day one? When is day seven so here's my example. Let’s say on Monday, March 23rd the patient reaches out to you either via a phone call or an email requests in any visit. You don't respond to them until March 25th. March 25th is going to now be day one, which means six days later that's going to end that seven day period. So, so say you know, March 23rd the patient's sent you an email requesting any visit and they had some questions for you maybe about their home exercise program or should I use ice or should I use heat or how many times do you want me to do my exercises a day?

Rick Gawenda (00:40:03):

Things like that. You respond to them on March 25th and as I say, I'm going to make math easy here today. You spend five minutes typing out the instructions, answering their questions. You send that to them on March 25th on March 27th the patient responds, requested another e-visit with additional questions on Friday, March 27th and you spend another five minutes, you know, answering their questions, whatever that may be, send it back to them on Tuesday. March 31st patient requests another E-visit with additional clarification. They want some information from you. You spent another five minutes on March 31st answering their questions via email or via that secure online patient portal. You send it back to them. That's, and that's it. There's no more other e-visits within that seven day period. So I kept math simple. So you did three separate eVisits spent five minutes each time answering their questions via email, sending it back to them.

Rick Gawenda (00:41:12):

When you add up five plus five plus five that is 15 minutes, that's going to fall between 11 to 20 minutes. So on that last day to service, during that seven day period on March 31st you're going to bill one unit of G two zero six two because the QM to time during that seven day period was 15 minutes. And the question I know you want to ask me is, Rick, can we do more than one seven day period? You know, can I bill G 2060 to say from March 25th to March 31st but that from say April 3rd to April 9th, I spend 27 minutes. Can I do G two zero six three and ms dancer, you hate for me today, we don't know. We're seeking clarification from CMS because again, these codes were not developed for this purpose. We did not know COVID 19 epedemic was coming when these codes became effective January one of 2020. So we're not sure if CMS as well as other insurance companies are going to allow us to build these G codes for more than one seven day period. Now you see it says underlying assessment and management as the go to the next slide.

Rick Gawenda (00:42:33):

People always want to know what is a qualified healthcare professional. And this definition comes straight from the American medical association. So if you have a CPT book, you know, especially or more current one, but if you have like a 2018 2019 2020 CPT books at the beginning of the CPT book, a Roman numeral number of pages explains how the book works, where the AMA provides this definition of a qualified healthcare professional. And in really the key is the words or the sentence who performs a professional service within his, her scope of practice in independently reports that professional service. Well, as a physical therapist, an occupational therapist, a speech language pathologist, you meet this definition because in a private practice you enroll with Medicare, you enroll with other insurance companies, you get an NPI number, you can report the CPT codes independently of anybody else that people was asked for.

Rick Gawenda (00:43:35):

Rick, what about a physical therapist assistant or an occupational therapy assistant? Can they report these G codes you just spoke on was to go to the next slide. You can now see the definition of a clinical staff per the American medical association. And you see in that first bullet point is a person who works under the supervision that'd be physician or other qualified healthcare professional that goes on to say, but who does not individually report that professional service. So that would include a physical therapist assistant and an occupational therapy assistant. So right now it's my interpretation. I know APTA interpretation that PT assistants, OT assistants, you know, can't provide the evisit. And also if you get a definition, if you go back to two sides from replays, you know it says assessment and management and really who's assessing the patient, who's managing and changing what's going on with the patient. And that's really within the scope of practice of the therapist, not the assistant. Now again, we're hoping to be CMS allows assistants do these G codes. We don't know waiting for clarification, but right now I don't feel comfortable saying they can do it based on the definition of a qualified healthcare professional as well as the words assessment and management. Because that is done by the therapist, not the assistant.

Rick Gawenda (00:45:09):

Now how about modifiers? Now, CMS did say if you are submitting a claim on a 1500 claim form and if your Smith claims on a 1500 claim from you are a private practice, the Medicare program did say to attach this CR modifier to the applicable G code. If you are a non private practice, you submit claims you be zero for claim form. You would not only attach the C R modifier to the G code but you also need as a condition code the R. So again that R is not a modifier that R is a condition code. Now we are hearing issues and concerns from households around the country that these G codes can't be submitted, can't be built on the UBS or four claim form. We are still waiting for clarification from CMS on this. You know, can hospitals, can facilities that submit claims any UBS four claim form? Can they bill the G codes? A part of me thinks yes, I'll be honest. Part of me thinks no because again, these G codes, a kind of a knockoff of the nine eight nine seven zero (989) 719-8972 CPT codes which are really the physician codes and typically physicians are only been at any 1500 claim form. But again, we are just waiting for clarification with CMS as well as other insurance companies. Can non private practices bill these G codes and get paid by that insurance company.

Rick Gawenda (00:46:56):

Now, documentation for an evisit extremely important that at minimum each E visit you do must have the following documentation. You must document that the patient initiated and or requested the visit. You must document the patient consented to the visit and then you must document these services, the education, the training that you provided during that e-visit. So an example I gave where you did visits one on March 25th one on March 27th one on March 31st you would have a note for each date of service that will contain at minimum these three bullet points, but the billing would not occur to a date service March 31st

Rick Gawenda (00:47:51):

Now let's talk about telehealth and tri care. You know Tri-Care, believe it or not does cover house services and they've done so since July 26 2017 and that top moral point, that sentence is right out of the tri care manual that they cover telehealth services if these services are otherwise covered. Tri care benefits, well since Tri-Care covers outpatient PT, OT, SLP services, this means that they would cover telehealth services for PT, OT and or SLP services and nicely my Tri-Care is they allow payment for telehealth provided both asynchronous and synchronous. Now non-Medicare, it's the answer you hate. You've got to go check with every insurance company. And when I say every insurance company, we estimate they're over 6,000 insurance companies in the United States. Whether they cover telehealth, it's all over the board. If they do cover tele-health, which CPT code or CPT codes they allow or want to see all over the board, which modifier or modifiers do they want and every CPT code all over the board.

Rick Gawenda (00:49:17):

You know, this is changing hourly because we're seeing many state governors issue declarations, issue orders mandating all insurance plans in their state that are overseen by their insurance commission, you know, cover tele-health. That's great. You know, we've seen some insurance companies like Michigan blue cross California blue shield of blue cross blue shield of North Carolina do this voluntarily where they now expanded telehealth for PT, OT SLP on a temporary basis. And again, the CPT codes, IMC and I'll all over the board which ones they want. Just, you know, when to kind of maybe give you some guidance here. The most common codes I'm seeing be and allowed for tele-health a PT and OT are nine seven one one zero 30 exercise nine seven one one two neuro re ed nine seven five three zero safety activities, nine seven five three five self care, home management and for speech is nine two five zero seven.

Rick Gawenda (00:50:30):

The treatment of speech, language, voice communication, Archway processing disorder. You know, don't try billing ultrasound for through telehealth. A manual therapy would also be a no through tele health cause your hands have to be on the patient. The other thing to ask when you check with these insurance companies is are they covering tele-health for only patients that were already established. You know, you've already seen them for therapy. There's already an active, you know, plan of care going on and now they can't come to your clinic. Or are they also covering tele-health for new patients as well? That's something you're going to want to check. If you're in a private practice setting they usually want to see for the place of service code for telehealth be a zero two. So again, extremely important to check with each insurance company and their coverage of telehealth services.

Rick Gawenda (00:51:34):

You know, how do you keep up to date with all this, you know, number one, stay current with your national associations. APTA. Also check your state associations website. You know, most of them now have a dedicated page for COVID-19 many of them are, you know, doing daily updates and information that they find out. You know, why not go bookmark your top four or five, six insurance companies that you deal with in your practice. You know, and again, go to Google and search box. Just type in for example, Georgia Medicaid provider page, tri West provider page, Nebraska blue cross blue shield provider page. In those last two words, stay the same provider page. That's what you want to get to on insurance company's website to provider page. And most of them now have a dedicated COVID-19 page and they've got dedicated page for, you know, quote, telemedicine, tele rehab, tele-health and those three terms don't all mean the same thing we've got. I think we're using them synonymously right now and I'm okay with that. But they are different. But get on those payers websites. If you're not on social media, get on social media, get on Twitter, get on Facebook. Many of us are putting out tons of information hourly on all of the changes.

Rick Gawenda (00:53:02):

Not to get too excited about these G codes. Just so you know, the Medicare program has about 112 different payment localities across the United States on just using each choice, Michigan. And you see the approximate payment amounts here. And before we go to get questions. And one thing I really want to say about tele-health. You know, normally if you're gonna start tele-health in your practice in your organization, it's usually about a four, five, six, seven, eight weeks start up. Yeah, I know a lot of people are trying to start tele-health in 24 hours and 48 hours. Be careful, you know, even though CMS has eased the HIPAA enforcement doesn't mean you can be careless. Just because CMS has eased HIPAA does not mean other insurance companies may not come after you. You know, you got to make sure you have your policies and procedures in place.

Rick Gawenda (00:53:52):

They're going to do telehealth, you know, have you updated your consent forms to include telehealth services, have you gotten your consent forms to your patients for them to sign, you know, how you document in the medical record and keep a track of, is the patient consenting to telehealth, have they consented to be videoed and have that recorded and saved in case they want to look back at it? You know what happens if you are doing a telehealth visit and you're doing it with Tannus and you see Tannus all of a sudden he grabs his chest, becomes short of breath, he falls off his chair, there's an emergency situation. You know, what's your policy? What's your procedure to address those kinds of things because you could have a liability. So again, you need to check with a healthcare attorney to make sure you got the proper policies and procedures in place. Because my hope is those of you that initiate tele-health, like right now when the COVID-19 pandemic is done, I'm hoping you're not done with telehealth. I hope you continue to do tele-health into 2021 2022 2023 as I think this is an important aspect of your business growth. Keep in mind, tele-health is not appropriate, not applicable for all of your patients.

Tannus Quatre (00:55:16):

Outstanding. Thank you so much Rick. Hilary, Sheila, Sarah wonderful presentation. We're going to get into some Q and a now and I will go ahead and moderate this portion of the webinar. And while we're doing this, we have our contact information up on the screen. So for those that would like to get in touch with us, if you have further questions or would like to learn more about what each of us and our organizations are doing to help rehab professionals adapt to COVID-19. We want to have this up on the screen. So with that we've got a lot of questions coming in and I know that we're right up against the hour. Like I said before, we're going to be kind of fluid with this, so if you're able to stay on, we're gonna answer as many of these as we can and then anything that we're not able to get to, we'll figure out a way to follow up with you independently afterwards. So I'm gonna start with I'm going to start with one here. For Rick, would encrypted organization based email be considered a secure patient portal for delivering he visits?

Rick Gawenda (00:56:23):

Yeah. Great question. And again, my opinion, my interpretation as it stands right now today is yes, because the email is encrypted, which usually requires a patient, you know, to create a username and a password to then access that encrypted email.

Tannus Quatre (00:56:24):

Perfect. Another one for Rick here. Are these codes billable by home health organizations or just outpatient organizations?

Rick Gawenda (00:56:54):

Well you know, when you say home health, if you're doing quote part B in the home which we believe you can bill the G codes. Again, we're just saying for clarification where if you're talking to home health under say part a under a home health agency plan of care, the G codes would not be applicable to that setting.

Tannus Quatre (00:57:19):

Excellent. Thank you. And we're going rapid fire here with Rick. I've got another one here for you. What POS code should be used for hospital-based outpatient clinics with any commercial insurers? Should it still be zero two or does it need to be different?

Rick Gawenda (00:57:33):

Yeah, great question. And again, if you are a private practice, and again some hospitals you've got offsite clinics that are set up as a private practice and you submit any 1500 claim form if you do in telehealth services, the place of service code would be a zero two. If you are a non private practice, which again could be, you know, as a hospital outpatient department, you know, hospitals can I have clinics ops site but they still fall under the hospital umbrella. You submit claims, NAU B zero four claim form in place of service codes are not used, most likely what you're going to have to use, which we didn't really talk about today. When you go to CPT codes you plugging up to put you to modify your GT or a modifier nine five on the CPT codes and that indicates that it was tele-health provided through a synchronous communication.

Rick Gawenda (00:58:32):

Now I know the follow up question is going to be which modifier do I use? It depends on the insurance company. You know, some insurance companies may tell you to use modifier nine five some may say to use GT if you're not a private practice. So again, unfortunately you just have to check with every insurance company you want to do tele-health with. And that's why I'm stressing so much to make sure you've got your policies and procedures in place and you've checked this through risk-management your attorneys to make sure you got your I's dotted, T's crossed and all of that.

Tannus Quatre (00:59:08):

Excellent. Thank you. Okay, so one here about part B in home. So Hilary if you can unmute. How is reimbursement different for part B in home versus in a free standing outpatient clinic? Right.

Hilary Foreman (00:59:21):

Great question. It is not that is why if a home health agency does choose to implement this program, they are going to have to look into a different way to do their billing. So it is still done by CPT code with modifiers just like a traditional outpatient setting.

Tannus Quatre (00:59:41):

Great. Thank you. Hillary. Another one about part B and home, how long does it take to launch part B in the home? If I only have done freestanding outpatient therapy?

Hilary Foreman (00:59:55):

It would depend on two things. One, if you were going to go a group practice or rehab agency route group practice is much quicker to get up and running, but there are some restrictions, especially depending on the state that you're in. A rehab agency is a much longer process and does require some additional filings. Some of them depending on the state you're in, you can do some retro billing in some cases. So you are able to start before everything is completed, but it's very state specific. If you, whoever asked if you want to reach out and let me know the state, I'd be happy to point you in the right direction for those answers.

Tannus Quatre (01:00:36):

Great. Thank you, Hillary. Okay. Another one here for Rick regarding eVisits. So per webinar a previous webinar or attended Medicare calls, e-visit a non face to face consultation, therefore Skype and such may not be required can be done via email or phone call. Is this accurate?

Rick Gawenda (01:00:57):

I'm sorry, what? I'm not understanding the question. Are they asking, is Skype and FaceTime allowed for a e-visit?

Tannus Quatre (01:01:03):

I'm interpreting this as is it required. So this, I'm going to go ahead and restate it. So Medicare calls e-visit and non face to face consultation, therefore Skype and such not required, can be done via email or phone call.

Rick Gawenda (01:01:21):

Well again, as I said during the presentation when CMS discussed Skype and FaceTime in that publication they released, they were using Skype and FaceTime for quote telehealth services not for an E visit. So right now an E visit needs to occur via email or a secure online patient portal. We are waiting for clarification with CMS regarding a phone call. You know what a phone constitute that cause right now as you know, a phone is not considered an online secure patient portal. So right now I can't tell you to use a phone to do an E visit. So right now I would say use encrypted email or use a secure online patient portal such as charm or you know, other online patient portals that are available to you.

Tannus Quatre (01:02:17):

All right, thank you Rick. Okay. Another one on E visits. When asking for an evisit do they have to, so the patient, does the patient have to directly address it as this or can they electronically ask a question? So for example, through a communication portal for us to then address outside of the clinic and we can count this as a patient contact.

Rick Gawenda (01:02:41):

Yeah, it's a great question because you know, again, this is like not what these codes are designed for. So obviously if a patient sends you an email asking a question I guess my recommendation if you want to play it safest, which is what I really have to do right now on this kind of call, is do you respond to the patient and say, you know, would you like me to respond to your question via an encrypted email via a secure patient portal, as an E visit? And if that patient then responds, yes, I would, you know, then I think that that's the request. And then you, I think you then save that email and then you go and address their question or questions that they had. In my opinion only is I think CMS is going to kind of be lenient on this right now.

Rick Gawenda (01:03:34):

I think other payers would be lenient on this right now, but again, you just in case something were to happen, you kind of need to cover your rear end and have that documentation there. I also think that since these codes don't really pay a whole heck of a lot of money you know, when you look at that G 20, 63, you're spending, you know, 21 or more minutes with them during a seven day period, you know, that payment's going to be somewhere between 32 to $36 depending on what state you're in, what locality you're in. So I don't see CMS really doing a bunch of audits on all of this stuff, but it's more just from a legal perspective and to protect yourself in case something happened where it happened with the patient.

Tannus Quatre (01:04:19):

Great. Thank you. So I've got one here. I'm gonna pose this to Hillary and then Sarah, you may want to chime in on this as well. Are you tracking COVID-19 related cancellations? How are you doing this in your EMR?

Hilary Foreman (01:04:36):

We are tracking missed visits in our EMR. We just haven't placed in the notes section. And we're just trying to look at it. We unfortunately are seeing quite a few many more and the home health side then on the senior living side. But I think as we go we are starting to see more and more people I want to say get more comfortable with infection control both on their side and on our side. So we expect to see that pick back up. Our customers are able to, for some of our products create custom questions or custom cancellation reasons so that they can just click that that was the reason and then they can run some cancellation reports on cancellations due to COVID-19.

Tannus Quatre (01:05:30):

Great. Related, do you know or have an estimate of how many PT clinics are still open versus temporarily closing doors due to COVID-19. Anybody want to take a stab at that?

Hilary Foreman (01:05:47):

I can speak for healthpro heritage that's very state specific. We have some States where it was ordered that they all closed, voluntarily closed due to whether or not they were treating a very immunocompromised caseload. They voluntarily chose to close for safety reasons. But I would say maybe half and half at this point for us.

Rick Gawenda (01:06:19):

And this is Rick, I think, is this an educated guess? I agree. I think it is state specific. I would also say it's probably also region specific within a state and the number of cases going on. And as I said already, the types of patients you're seeing in terms of diagnosis and also the age of the patient, their comorbidities, their risk for COVID-19. You know, obviously, did you have a patient that was now diagnosed with COVID-19 and they were already in your clinic yesterday or two days ago, three days ago. Is that going to force you then shut down and quarantine your staff? I think it's going to be a tough number to really figure out until months down the road.

Tannus Quatre (01:07:02):

Yeah. And some of the tracking that I've had some visibility into from a new claim flow perspective, I'm seeing we're seeing about 40 to 60% kind of in that range, regional specific decrease in the flow of new claims. And so you can kind of extrapolate from there in terms of what utilization is looking like in some private outpatient practices. So thank you. Okay, so this one's for Rick. When billing the G codes on a CMS 1500 form, would we bill just the CR modifier or would we bill GP CR or a PT E visit?

Rick Gawenda (01:07:45):

That is a great, great question. And you're going to love my answer. I think everybody knows my answer by now. We're seeking clarification of CMS on this and now if you are familiar with what CMS calls always therapy or sometimes therapies, CPT codes, those are the ones that always have to have the GP, the G O or the G. And modifier attach them when submitted to Medicare if done under a PT OT SLP plan of care, we're in the 2020 version of always in. Sometimes there'd be codes G 2061 G 2062 G 2063 are not listed in that file, which means right now as we talk today, they're not considered always or sometimes therapy codes, which technically means then GP, G O G N would not be required. However, we are hearing rumors from CMS that for some strange reason they're going to actually add G 2061 G 2062 G 2063 as sometimes therapy CPT codes. Then that would require GP, G N G O modifier, which then means they would actually apply to the annual therapy dollars threshold. Now that's what we're hearing rumors that they're going to do again, so we don't know right now, you know, because we're waiting for clarification. You know, obviously people like me, we've submitted all these questions to CMS trying to get clarification, but as you can imagine, they're swamped. They're trying to figure things out and we're just waiting for those answers to come out.

Tannus Quatre (01:09:28):

Thank you. Rick. got one here for Rick or perhaps Sheila. Do some of these probable changes in Medicare also apply to Medicaid?

Rick Gawenda (01:09:39):

Well it's number one. No. so you think Medicare changes is for Medicare and again, as I always say as I use the word Medicare, that is traditional Medicare doesn't include Medicare advantage. Now would that be in said by law, Medicare advantage plans at minimum have to offer and cover the same services that traditional Medicare does while since traditional Medicare is now covering. So they say those threeG codes, 2061 2062 2063. That means the Medicare advantage plan is also supposed to cover those codes as well. But this is not applied to Medicaid because Medicaid is state specific.

Tannus Quatre (01:10:27):

Great. Thank you. Okay. Hillary how many patients per day can a typical therapist see in part B in home care versus traditional settings?

Hilary Foreman (01:10:42):

Oh, it'll be significantly less. It depends on if you are doing the party in the home. On a senior living campus where the residents are much closer together or if it is in the larger community. So it is very different than a traditional clinic. It would be much more aligned to a home health type where you're counting more visits per day. So when doing modeling for that if you have access to what traditional, depending on your geography productivity expectations on the home health side, where they would be much closer to that. So it could be again, depending on your geography could be 50 to 60% of what a traditional outpatient would be. Thank you. Rick. Regarding initiation and consent by patient, does this have to be written or can it be verbal?

Rick Gawenda (01:11:41):

Well, it's going to be verbal. You almost find a recorded. So I would get it written just to cover yourself. So that again, I, you know, any time you're on this, these kinds of calls and as a consultant, you always gotta, you know, give I guess the most stringent advice or whatever. So I would say to have it written. And it could be something too that, you know, do you send them a document out and once they request a visit, do you create a document that you can send to them? Again, I'm not endorsing this product, you know, via DocuSign or some other format where this is all typed out and you had the patient, you know, electronically sign and date, you sign and date and then you say, that document is what I would do because you also gonna need to figure it out if you're going to be doing tele-health because how you get an EMU consent forms and all of that, that they're going to be consented to telehealth if they can be consented to being videoed and it'd be recorded and all of that.

Rick Gawenda (01:12:41):

So I will always say to try to have as much written down that a patient signs or they sent you an email, something like that that you can save to show just in case you got called out on it.

Tannus Quatre (01:12:55):

Great advice. Okay. What is synchronous versus asynchronous?

Rick Gawenda (01:13:03):

You know, asynchronous would be like that online patient portal. So again, I'm not endorsing the product called charm, so it's kind of a one way communication. It's kind of delayed. We're not live together. My doctor sends me an email, she maybe sends it at 11 o'clock in the morning. I comes into my email box. I may not sign into my account to eight o'clock tonight. I go lead, but she says I may or may not respond to her today. I may wait till tomorrow. Send her a question back or say thank you for sending. When should I come see you were synchronous talk communication, which is really what I think I hope you're going to be doing. If you're doing tele-health. It's live simultaneous two way audio, visual communication. So you know, think of face time. Okay. But you know, there's, and again, as I say some of these platforms and not endorsing them, like doxy, zoom. I know Google has something out there. There's a lot of platforms out there, think of FaceTime. So I can see Ben, Ben can see me. I can demonstrate exercise to Ben, I can watch, do the exercises, correct him. So it's live, simultaneous audio, visual communication.

Tannus Quatre (01:14:20):

Great. Thank you.

Rick Gawenda (01:14:21):

And again, I love Google. Just go to Google and type in asynchronous versus synchronous communication and all that will come up and you can also find different platforms you can use as well.

Tannus Quatre (01:14:35):

Okay. Awesome. okay. Hillary. I'm a physical therapist in private practice. Am I allowed to do in-home part B or is it only for a group practice and or rehab agency?

Hilary Foreman (01:14:48):

It would be for a rehab agency or a group practice. So there are ways to convert into those to be able to, there's some filings, again, depending on the state you're in that can easily allow for that. But you do have to go through some of those hoops to get there.

Tannus Quatre (01:15:07):

Okay. Thank you. Rick. Okay. So this one says just clarifying that we cannot do an evisit to qualify as a fifth or 10th visit.

Rick Gawenda (01:15:20):

Correct. So as we understand it an e-visit is not going to count as a visit towards the Medicare 10th visit progress report. So, for example, you know, you had a patient you know, come in and they had already had eight visits and then you shut the clinic down. A patient is apprehensive about coming in for an actual visit and now you do two eVisits, that's the next, you know, on March 26 and March 31st that's not visit nine and visit 10 towards a 10th visit progress report. So as we understand it today, e-visits do not count towards the 10th visit progress report. They don't count as an actual visit where a patient came in to see you.

Tannus Quatre (01:16:12):

Okay. Thank you. Okay. And I'm doing a time check here. We're going to continue for a few more minutes. We got a lot of questions coming in so we will do some followup from here. But, but I am going to kind of roll through a few final questions here. So this one can be, this may be Hillary, Sheila, Sarah. What PPE do you recommend or are you seeing in use for an asymptomatic home therapy patient?

Sheila Cougras (01:16:41):

This is Sheila. Hi. I would definitely recommend that you check with your local carrier or not your local carrier, but your local facility protocols and what supplies are available and what they have set up. It's been strongly recommended that protocols are set up at the local levels and what your state, local health departments are recommending. That would be your first place to check because I'm not sure which state you're in, but there is a website for all the States and you can check your local Health department.

Tannus Quatre (01:17:19):

Yes. absolutely. So we can work that into our followup communications. Here's another one. Can you elaborate? This is for Hillary. Can you elaborate a little more on the differences between home health provided via home health agency versus rehab company or provide a good resource, which explains the difference.

Hilary Foreman (01:17:39):

I'm sure I could actually provide we have a side by side that I could provide that you could share as part of the followups from this. A lot of it has to do with the billing process. Some of it has to do with credentialing of the therapists. For example, in a group practice, there's eight 55 B forms where therapists have their own PTN numbers. Only therapists can provide services under a rehab agency. Different States, different filings. Assistants might be able to provide those services to do the part B in the home. So there are the state specifics and then there's the therapist specifics. And then there's the billing specifics. So those are probably the three big buckets. But like I said, we have a side by side that I'll make sure that you have to send out.

Tannus Quatre (01:18:32):

Thank you. Hillary. Rick, are eVisits covered at the same 80, 20 percentage as a typical outpatient visit where the patient is responsible for a 20% co-insurance or that 20% gets sent along to their supplemental or secondary insurance.

Rick Gawenda (01:18:49):

Yes. CMS did say that the, you know, the G 2061 2062 2063 that they would count towards, you know, any deductibles, any co-insurance would apply. So again, the Medicare program and on my last slide where I gave you the pricing for Detroit, Michigan, the Medicare program with the 80% of that allowed amount and if they have a supplemental plan your that their Medigap plan, hopefully they would pick up the other 20%. They don't have a supplemental plan and then the patient would be responsible for the other 20%.

Tannus Quatre (01:19:26):

Thank you Rick. Are work comp carriers, paying for telemedicine for PT.

Rick Gawenda (01:19:34):

And my favorite answer, yes. No maybe so it depends and again, I noticed the answer people hate. Unfortunately back when I graduated PT school way back in 1991, it was pretty easy for us back then because every state just had one worker’s comp. We've had Michigan worker’s comp, Nebraska work comp California work comp, but now we have all these middlemen like align network, one call, med risk, etc. You have unfortunately have to do due diligence and check with every insurance company. And I'll be honest, you could call an insurance company and we're just going to make it Ben and you talk to Ben Monday, Tuesday, Wednesday, Thursday, Friday. And you asked them the exact same questions. I have days in a row and Ben gives you five different answers on five different days. Now that's not because he has five different personalities, more, no offense to the people on the insurance lines right now.

Rick Gawenda (01:20:27):

They have an impossible job right now there that they're not knowledgeable on COVID-19 and all of these changes that are going on and things like that. Because I'm hearing people all the time say, why called United health care? And they tell me they pay for telehealth with therapy. Where did you get the link? Did you get the citation somewhere on their website? No identity. Because if you go to the UHC website, UHC, that paid for telehealth. So again, what you're being told on the phone may or may not be correct. So again, very important to know how you're asking the question. And maybe kind of go for the answer you want to get, you know, kind of phrase the question. So the answer may be your way, but you have to answer your way. Ask them for the citation, you know, ask them on your website. Where is it, you know, can you walk me to a site? I can see it in writing cause it was not in writing. It may or may not be true what they're telling you on the telephone.

Tannus Quatre (01:21:27):

Thank you. Okay. So we're going to do three more questions and then we'll go ahead and wrap up at that point in time. So I just want to do a time check here. We're mindful of everyone's time. Hilary, how are you documenting new patient screening calls prior to initiating care?

Hilary Foreman (01:21:47):

In a variety of our systems we were able to add an additional note. In some systems we actually added the screening questions. So either we would do the screening questions and then the patient note would be together. So then once we did the visit, they would be together. And in some cases we've done the screening questions followed by a withheld or a refusal. If something in that screening then indicated that we should not be seeing the patient that day or they refuse that day or whatever those challenges might be. But we actually had added those to the system for that exact reason.

Tannus Quatre (01:22:28):

Thank you. Sarah, do you have anything to add on that? I'm not sure if there's anything that you're seeing with customers documenting screening calls.

Sarah Irey (01:22:36):

I would agree definitely with Hillary. The only thing is, you know, check with your organization.

Sheila Cougras (01:22:42):

Depending on, you know, your organization might want you to put it in your registration software if you have a hospital interface versus the actual act up documentation application. But definitely important to document those screens.

Tannus Quatre (01:22:58):

Okay. Thank you. Okay. Rick, are there any differences for critical access hospitals with telehealth? Evisits billing or reimbursement?

Rick Gawenda (01:23:10):

You know, again, with the e-visits we are waiting for clarification and CMS on, you know, can non-private practices, you know, go for the G codes, be paid for the G codes. So once we get that answer, of course that would apply, you know, whether you're a hospital or a regular hospital a while. So, you know, put a class that's health was, you are not paid under the Medicare physician fee schedule. You are paid any cost ratio basis. That's the other code unknown. And again with Keller house, do you want to check your conditions or participation with the Medicare program as a telehealth provider? Again, Medicare does not pay for telehealth, then they have to meet the two contracts with the other insurance companies that you've signed. So again, I think whether you're a critical access hospital, a regular hospital, your home health agency, do you impart, be in the home, you're a private practice. It's kind of doing your due diligence and check in with all those other insurance companies.

Tannus Quatre (01:24:09):

Okay. Thank you. So, Sheila, I'm going to direct this one to you. And this is in, and then more broadly, we're getting a lot of questions have come in about specific guidelines with regard to protecting employees and patients and use of masks and PPE. So, the one question that I think encapsulates it here, do employees have the right to refuse to treat positive COVID-19 patients if PPE is not available? We know that PPE is in short supply and not available in some areas. And so the way that I think that we should frame this up is do you have a recommendation for resources that our audience can use locally that can help guide them in the right direction for some of these broad questions about safety of caregivers and how they're treating patients in this COVID-19 period.

Sheila Cougras (01:25:04):

Yes, that's a really tough question. There are some resources like you said, that they could check with our state practice acts as well as looking at their local professional chapters and seeing if they can provide guidance there as well as their local health departments. And what are their rights? Is employees and receiving that PPE, I am hearing that quite a bit. And it's all over the news. That PPE, is it a high demand and there's shortage everywhere across the country. So that's a really hard one for me to give guidance or advice on, but there definitely are resources where you could check where are your rights in protecting yourself when you're employed. So I would start with your state practice act as well as your professional organizations and your local health departments.

Tannus Quatre (01:26:01):

Great. Thank you. Okay. So we're about to wrap it. There have been some questions coming in about access to these materials including the slide deck. Yes, we will make this all available to you. The recording. I think it's going to come out to you automatically and we will find a way to get you the slide deck as well, whether that's an included in a link in that email or some other means. So yes, we'll make sure that you've got all of the information here. I want to thank our presenters. This is just you know, we spun this up very quickly you know, over the past few days, I really appreciate you taking the time and investing in our ability to help our rehab professionals get this valuable information.

Tannus Quatre (01:26:47):

So special thank you to Rick Gawenda and Hilary Foreman. Also Sarah and Sheila for helping us put this together and to all of you that are out there on the front lines adapting your business models to continue the rehab care that is needed in your communities. We just really appreciate you. Thank you and are thinking about you constantly. We will have additional webinars that are coming out of the net health organization by you registering for this webinar. We will be able to make contact with you and let you know about those if you would like to attend more sessions and once again thank you so much for attending be safe and be well.

 

Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram  and facebook to stay updated on all of the latest!  Show your support for the show by leaving a rating and review on Apple Podcasts!

Mar 28, 2020

On this episode of the Healthy, Wealthy and Smart Podcast, Jenna Kantor guests hosts and interviews Clay Watson, Tyler Vander Zanden and Kelly Reed on the Private Practice Section’s Key Contacts. PPS is more effective with the support of members who are dedicated to advocating on behalf of the industry. You can get involved in the section's advocacy efforts by becoming a Key Contact, joining the key contact subcommittee, or by taking action online via the APTA Legislative Action Portal.

In this episode, we discuss:

-What are the responsibilities of the PPS’s Key Contacts?

-How a Key Contact bridges the gap between legislators and constituents

-The personal and professional benefits of being a Key Contact

-And so much more!

 

Resources:

Tyler Vander Zanden Twitter

Private Practice Section Key Contacts

 

A big thank you to Net Health for sponsoring this episode! 

Check out Optima’s Top Trends For Outpatient Therapy In 2020!

                                                                    

For more information on Clay:

Clay Watson a Physical Therapist and owner/operator of Western Summit Rehabilitation, a consulting and therapy services staffing agency for home health. He is a  Past President of the Homecare and Hospice Association of Utah, a member of the Utah Falls Prevention Alliance and a recipient for an NIH falls prevention grant. This year I received the Excellence in Home Health Therapy Leadership Award from the Home Health Section of the APTA.

For more information on Kelly:

Kelly received her COMT (Certified Orthopedic Manual Therapist) from the North American Institute of Orthopedic Manual Therapy in 1994 and is an Orthopedic Certified Specialist (OCS). She received her Physical Therapy degree from Pacific University in 1983.

Kelly prides herself as being an excellent general orthopedic physical therapist. She specializes in lower-extremity dysfunctions, biomechanical assessments related to running/sports injuries, and assessments from minimalist training to custom-molded orthotics. She focuses on injury prevention through balancing the full body, not just the area of pain.  Additionally, she has specialized in the area of Temporomandibular dysfunction (TMD) for over 30 years.

Most recently she has been active in starting a BreathWorks program focusing on evaluation and education related to breathing physiology and its effect on overall wellness and healing. Her clinical skills continue to move in a direction that empowers clients to achieve their highest level of function in a balanced fashion.

Kelly was a 3-sport collegiate athlete and continues her love of athletics through her own personal training, running, yoga  and being a supportive presence  at her kids’ sporting events. An outdoor enthusiast, she loves trail running, hiking, gardening, camping, and keeping up with her husband Greg and their 3 active kids.

For more information on Tyler:

Dr. Tyler Vander Zanden is the former Founder and CEO of Movement Health Partners, a private practice company partnering with federal, corporate, and educational agencies to provide physical therapy services.  Tyler currently serves as a member of the Key Contact Subcommittee for the Private Practice Physical Therapy Section (PPS), where he meets with legislators to increase awareness of the key issues facing physical therapist-owned businesses and their patients.

Tyler earned his Doctorate of Physical Therapy from Marquette University along with a BS in Exercise Science.  Upon graduation, he completed a post-doctoral residency in Orthopedics from the University of Wisconsin-Madison.  Tyler is a board-certified by the American Board of Physical Therapy Specialties (ABPTS), as a clinical specialist in Geriatric Physical Therapy.

Tyler has an avid passion for high performance, technology and entrepreneurship and speaks regularly about finance and technology as it relates to the future of physical therapy.  He currently resides in Austin, TX where he serves his church and community and is launching his next start-up venture.

For more information on Jenna:

Jenna Kantor (co-founder) is a bubbly and energetic girl who was born and raised in Petaluma, California. Growing up, she trained and performed ballet throughout the United States. After earning a BA in Dance and Drama at the University of California, Irvine, she worked professionally in musical theatre for 15+ years with tours, regional theatres, & overseas (www.jennakantor.com) until she found herself ready to move onto a new chapter in her life – a career in Physical Therapy. Jenna is currently in her 3rd year at Columbia University’s Physical Therapy Program. She is also a co-founder of the podcast, “Physiotherapy Performance Perspectives,” has an evidence-based monthly youtube series titled “Injury Prevention for Dancers,” is a NY SSIG Co-Founder, NYPTA Student Conclave 2017 Development Team, works with the NYPTA Greater New York Legislative Task Force and is the NYPTA Public Policy Committee Student Liaison. Jenna aspires to be a physical therapist for amateur and professional performers to help ensure long, healthy careers. To learn more, please check out her website: www.jennafkantor.wixsite.com/jkpt

 

Read the full transcript below:

Jenna Kantor (00:00):

Hello, this is Jenna Kanter with healthy, wealthy, and smart. I am here with three newer friends this year. We all our key contacts with the private practice section and we're coming on. Well, they're going to do more of the talking here. I'm just going to be doing the questions and if we're coming on to just say, Hey, this is a great opportunity to get involved. If you do not like the CMS cuts, this is what we do. We go and speak with the legislators to talk about that. We're getting more people to come and join us in this huge movement to fight for our profession, especially the private practices for all you people are working for private practices. This is the committee to be a part of, so please, please join the APTA, come join us and be a part of this great movement. I am here with Kelly Reed, Tyler Vander Zanden and Clay Watson. Yes, you guys. First of all, thank you so much for coming on. So I'm going to hand it to you first. Kelly, how did you first learn of being a key contact?

Kelly Reed (01:06):

Yeah, so I've been a member of PPS since I got out of PT school and I've always been involved. I've been on the board of PPS and wanting to get back into it. And so I just put my name out there, who needs help, how can I be helpful, wanted to kind of get on the government affairs committee. And instead I got asked to be on the key contact task force and it's been amazing.

Clay Watson (01:33):

I'm friends with some other physical therapists who've participated in this project and we had some interesting legislative successes in our state that helped reform some payment policy issues. And it kind of led to them asking me to help out with the congressional level.

Tyler Vander Zanden (01:53):

I actually got invited last year at the 2019 Graham sessions in Austin and I live in Austin. And that really kind of propelled me to do something, a call to action and how can I get involved personally. And so I looked at PPS to see where I could be of service and one of the openings was this key contact position.

Jenna Kantor (02:15):

I love it. And just to make sure for any students who might be listening, PPS stands for private practice section. So it is a section of the APTA. Clay, I'm going to move to you just because my eyes just happened to look up at you. So what does a key contact do?

Clay Watson (02:33):

We have been asked to develop relationships with specific legislators and every member of the private practice section and the APTA lives in a congressional district or they have a Senator and it makes sense to pair up people who have vested stake in policy to have a relationship with a representative or a Senator from their state. And this program designed to help us have longterm relationships so that when policy needs are coming up, we'll have a listening ear and there'll be able to hopefully hear the sides of our argument that are most beneficial to our profession.

Jenna Kantor:

Kelly, what is the time commitment with this?

Kelly Reed (03:14):

Yeah, minimal. We are asked, well a couple things, we have a monthly meeting and we are given contacts of which you just email the people and try and hook them up with their legislator and that might take, depending on how long your list is, you know anywhere between 15 to 45 minutes. Then we have an hour meeting and then the bigger thing is that we are provided all the information we need and when an action item comes out they send it to us and then all we have to do is basically cut and paste a letter and send it off to our legislature.

 

Jenna Kantor:

Yes. Would you Tyler mind differentiating between being a key contact with private practice section and also being a key contact on the committee?

Tyler Vander Zanden (04:09):

Yes. So being a key contact in general, what we're asking of those individuals that they be a private practice member and that they live in the district to what we're trying to assign them to. So we want them to have a relationship with that Congressman or Congresswoman in their specific district. So like as Kelly said and clay said, when there's an issue at hand in the profession or just to private practice in general, that congressional leader has a name and face of a person or a clinic that they can say, Oh, wow, you know, Kelly or Jenna or clay, like, you know, you're dealing with this right now and you're one of my constituents. And so we can have that relationship. And so that's what it looks like more at the key contact level. For us, like Kelly said we're on the committee side.

Tyler Vander Zanden (04:55):

We're the ones who are providing education to that specific key contact in the form of emails. We'll kind of give them block templates. So when they have to make that communication, it's not so hard. We send them and the practice or a chapter here sends us emails that they can be kind of up to speed on these legislation things. And then we recently had shot some videos in DC explaining the roles of the key contact. And so there'll be some videos that we'll have on the PPS website that they'll be able to always link back to if they need more education.

Kelly Reed (05:33):

Yeah. And I just wanted to build on those videos. They're short snippets, they won't take a lot of your time, but it gives you a lot of key information, just the nuts and bolts of what you need and you can look at them at your leisure and really helpful information.

 

Jenna Kantor:

Yeah. Clay, does it work? Does making a phone call if instructed to do that to sending an email or meeting with the legislator? Does that or is that a waste of people's time?

Clay Watson (05:59):

Well, it wouldn't be a waste of time or we wouldn't do it. Right. I mean one of the most interesting things when we had a legislative fly in this fall, I was with another therapist who had actually written the letter to get the wife of one of our congressmen into physical therapy school and it was her first employer. Now she's a home health physical therapist and that's what I do. I'm private practice owner, but I work in home health and when we are asking him questions specific to our industry, he understands private practice and he understands home health better than almost any Congressman out there. And so that's just a huge listening ear that we wouldn't have if we didn't have those longterm relationships.

Jenna Kantor (06:41):

I really just want to add in person is more effective than on the phone. On the phone is more effective than email. It is like any other relationship. So really the best way to make no change is to not do anything. What we're doing is the best way to make a change. It's where we have this insane power as constituents. Now for you, Kelly, what has been the biggest thing that has moved you and how the private practice section runs and works with the key contacts? Like what do you think is just so incredible that they do to make us so efficient with what we do to put our message out there to the right people?

Kelly Reed (07:27):

Yeah, I've been really impressed with the amount of information that PPS already has put together and the task force and members before us that are currently on the task force. Basically they hand you everything you need to be able to do your job to make and develop a relationship with your Congressman. It's really easy and I want to say for those who may be put off a little bit about not getting politically involved, we have to, this is our profession and when we know what we know, we know what we love and all we have to do is communicate that message. We build relationships every single day and that's exactly what this is just talking about what we love.

Jenna Kantor (08:11):

I think that's excellent. And any last words that any of you would like to say in regards to becoming a key contact for anyone who might be hesitant on jumping in?

Clay Watson (08:23):

One of the most important things I've learned is the value of the mentorship I've received from participating in this. Every time I have a question about how to approach an issue with one of our legislators, I have three or four other therapists who are also doing it that I can ask. They may know context about the legislature themselves and how to approach them on specific issues and they know the nuance of the issues in a way that helps me understand them with a lot more depth. So it's sort of like a pretty high value team to help the whole situation move forward and that's invaluable.

Jenna Kantor (08:56):

I love that. Thank you so much. And if you're wondering, I don't know what this is for me, why am I listening to this? They're just selling me, telling me to get involved. This is where the change you want to happen. I get the most interactions on my personal Facebook page when I write the word happiness because people are happy in the physical therapy world. This is what we are doing to make that huge change. I am saying this statement very strongly. I know everybody can have their own opinion. This is mine, but this is the majority of the profession in which I interact with which are non-members. This is the big culture of unhappiness and this is where we make that change. The private practice section are movers and shakers and are listening and taking such great action. These people who are here, who I'm interviewing are passionate, kind humans. We are all volunteering our time. We are all not getting paid and we're all doing it for you and we would love for you to join us because your voice is valuable.

Clay Watson (09:58):

Well, I think most of the time the people who are unsatisfied with the profession are the least engaged and sometimes they are very engaged in are not happy. But generally speaking, the more you're involved with the APTA, the more voice you have and the more ability you have to affect change. As physical therapists, our whole life is based on helping people affect change. And if you feel disempowered or however you want to describe it, the way to get that power back is to follow your own practice and dig in and take responsibility for it as much as you can. And there are many times when you're going to do it for not, that's just how life works. But the truth is trying to get better is amazingly empowering. And once in a while you get lucky and you actually do make a big change.

Tyler Vander Zanden (10:46):

Yeah. And I just wanted to say one more thing to dovetail is you're not alone. So if you're right now, if you're stuck and you're trying to figure out what to do, you have to start somewhere. And one of the beautiful things about getting on this subcommittee now less than a year is the networking and everything that the PPS and all the people that I've been able to meet not only in private practice, but then as a result of this legislative work that we've done. So something really to consider and if your slot is taken if you want to get on here and we don't have a specific slot open in your district, you can always start these efforts on your own and we would always be able to help you with that education that's still on the website there for your use.

Jenna Kantor (11:28):

I love it. Thank you. Thank you to each of you for coming on, this has meant so much to me. I know it means a lot to you as well. If any of you want to learn more, you can go to the private practice section website. It's under the advocacy tab where you'll find committees and you'll find key contacts. That's how you can get involved. Thank you for tuning in. Take care.

 

Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram  and facebook to stay updated on all of the latest!  Show your support for the show by leaving a rating and review on iTunes!

Mar 26, 2020

This episode of the Healthy, Wealthy and Smart Podcast features a Private Practice Section Webinar, “Telehealth NOW” to address ongoing concerns for physical therapy practices during the COVID-19 pandemic.

In this webinar, we cover:

-How to navigate telehealth terminology and different vendors

-State and federal telehealth regulations to frequently check

-How to effectively bill for telehealth services

-An example of a telehealth physical therapy visit

-And so much more!

 

Resources:

Lynn Steffes Twitter

Mark Milligan Twitter

Ali Schoos Twitter

PPS Covid19 Resources

ZOOM Recording of Telehealth Now Presentation 

Telehealth NOW Presentation slides

PPS Promoting Telehealth to Patients

PPS Tips and Tricks to Starting Telehealth

PPS COVID19 FAQ

PPS Telehealth Coverage Policies during COVID19  

 

For more information on Lynn:

Lynn Steffes, PT, DPT is President/Coach/Consultant of Steffes & Associates, a rehabilitation consulting service based in Wisconsin. Providing consulting services to rehab providers nation-wide working.

She has enabled providers to achieve optimum success in the delivery of high quality, cost-effective care to their patients/clients.

 

Coaching/consulting in:

  • Marketing, program development
  • Selection, training & support of Practice Marketing Specialists
  • Customer Service initiatives, patient alumni programs
  • Lifestyle Medicine Programs
  • Negotiating managed care contracts, payer relations

 

Dr. Steffes is a 1981 graduate of Northwestern University and Transitional DPT in December of 2010 Evidence in Motion's Executive Management Program.

 

For more information on Mark:

Dr. Mark Milligan, PT, DPT, OCS, FAAOMPT earned his DPT at the University of the Colorado. He is a full-time clinician and owner of Revolution Human Physical Therapy and Education, a concierge PT practice and micro-education company. He is adjunct faculty for 3 Doctor of Physical Therapy Programs. Mark has presented at numerous state and national conferences about telehealth, pain science, dry needling and has been published in peer reviewed journals. He is the founder and CEO of Anywhere Healthcare, a telehealth platform for all healthcare disciplines. He is an active member of the TPTA, APTA, and AAOMPT.

 

For more information on Ali:

Ali Schoos received her degree in physical therapy in 1982 from the University of Puget Sound. She is a co-founder of Peak Sports and Spine Physical Therapy, practicing in Bellevue, WA. 

 

Ali has been active in numerous roles in the Physical Therapy Association of Washington (PTWA) and APTA.  She  has chaired her state private practice Special Interest Group (SIG) and Orthopedic SIG, and  currently serves on the APTA Private Practice Board of Directors. She is also currently serving on the PPS COVID19 advisory task force. She is a past board member of the Bellevue YMCA and on the King County Regional Advisory Group for the Alzheimer's Association

 

Read the full transcript below:

Carrie Stankiewicz (00:00:05):

Hello everyone. Welcome and thank you for joining us for this special webinar tele-health NOW. I'm Carrie Stankiewicz with education and program manager for the private practice section. Before we get started, I'd like to review a few procedural items to submit your questions. Please enter them into the Q and a box which you can access from the zoom menu. We'll collect your questions there and the speakers will respond to them. As we go through the presentation, we expect to have a large number of questions so we need to manage them carefully in a moment. Ali Schoos will give you some parameters around entering your questions. If you have a technical question, you can type that into the Q and a box and I will respond to you in text. Please note that with the extremely high volume of companies and individuals that are now using online platforms for conferencing, there is a strain placed upon the technology and the infrastructure. Our vendors have done their best to provide a high quality experience, but neither we nor they can control internet slow downs resulting from unusually high volume. In the chat box, we posted a number of resources for you to refer to. Please feel free to copy these links and save them for future reference. This webinar is being recorded and will be posted on the PPS website for everyone to view. And with that I'll turn this over to PPS board member Ali Schoos to get us started.

Ali Schoos (00:01:26):

Thanks Carrie. Hi everybody. I’m Ali. I am a private practice physical therapist from Bellevue, Washington. And thank you for that musical introduction. I am the cofounder of Peak Sport and spine physical therapy in the Pacific Northwest. And I do have the honor to serve you on the board of PPS. I'm also on the advisory task force around all things COVID-19 and this webinar is a result of that task force. Our goal is to bring you business owners relevant information right now to help you manage your practice through this crisis and come out whole on the other end. But the end a couple things about our question process. There are 500 of you on this webinar. So we do expect to have probably more questions that we can answer. So we would ask that when you post a question look and see if anyone else has posted a similar question so that we don't get bombarded with the same saying.

Ali Schoos (00:02:28):

Don't ask state specific questions that's relevant to the laws in your state and mandates in your state. So we're not going to be able to answer a state specific questions, although we will keep a copy of all the questions that come in and try to deal with them later. We will stop intermittently to answer as many questions as we can and I'm going to apologize in advance. I don't think we're going to be able to answer every single thing that you asked, but we'll do our best. I would like to introduce our main presenters. Dr. Lynn Steffes is a graduate of Northwestern university and earned her transitional DPT in 2010 from evidence in motion's executive management program. Lynn is the president, coach and consultant with Steffes and associates. It's a rehabilitation consulting service based in Wisconsin. Lynn provides consulting services to rehab providers among a wide range of services including marketing and program development selection and training and support of practice management specialists lifestyle medicine programs, negotiating contracts.

Ali Schoos (00:03:34):

And Lynn's also been a frequent provider of content, the educational webinars that KPS puts out. Our second presenter is Dr Mark Milligan who earned his DPT from the university of Colorado. Mark is a full time clinician and owner of revolution human physical therapy and education, a concierge, PT practice and micro education company. That was a new term for me, Mark as an adjunct faculty for three PT programs. He has presented at numerous state and national conferences on tele-health, pain science and dry needling. And he's also been published by peer review journals. Mark is the founder and CEO of anywhere healthcare, a TeleForm platform for all health care disciplines. And with that, I would like to let Lynn take it away.

Lynn Steffes (00:04:32):

Okay. So welcome to this webinar. And before I get started, the first thing I wanted to say to all of you is really we're here honoring you for the good work that you're trying to do in serving consumers in your marketplaces. So we know that all of you are incredibly dedicated, compassionate, amazing clinicians and business owners that are looking at this COVID crisis today. And then also looking forward and seeing how can we best serve our patients. And, many of you may be continuing to serve some people in your clinics or you may not be, but we certainly wanted to talk about this really important option. And to give you a little bit of background on some details with it. So with that, I'll jump into more of the content information. So the objectives that I'm in a primarily deal with are just looking at the position, talking a little bit about the statutes and rules that will govern your ability to deliver and access these services. And also some information about payment policy, whether it's federal, state, commercial, work comp. And then I'm going to turn it over to the real expert who is Mark Milligan. And so I kind of get stuck with the fun stuff, the payment and policy things. So next slide.

Lynn Steffes (00:05:58):

So APTA has long had a position that tele-health is an appropriate model of service delivery and as long as it's delivered with the same essence really that we deliver care. And so this isn't new to APTA to be looking at telehealth as a way of delivering care. At a state level. Different States have different rules or excuse me, statutes and rules that govern your ability to deliver telehealth care. So rather than us focusing on any one state today, what I'm recommending to you is that you reach out to your state level associations. APTA has a site that looks at state statutes and rules and determine what your current level of coverage is regarding tele-health. So there are two different aspects of telehealth that you would need to look at that are legal at a state level, which is obviously governs what you can do within your scope of practice. And the one is your statutes and rules that govern your scope. And the second one really is, are there specific tele-health laws in your state that would in any way limit you from delivering those services?

Lynn Steffes (00:07:17):

Keep in mind that if you've looked before or downloaded those policies before they may have been updated or there may be some emergency provisions in place. So I encourage you to begin there. So that’s an important first step. Certainly anytime you deliver outside your scope of services, your malpractice insurance is no longer required to cover you. So it's important to do. So one of the things that we want you to think about is as your considering telehealth we want you to first check your state practice act to verify just as I had mentioned, and then also find out if there are emergency provisions. It's possible that your state practice act is silent on tele-health and as long as there isn't a prohibition that I would turn to your chapter for guidance and they're examining boards need look further, you certainly are going to document legal and ethical reasons.

Lynn Steffes (00:08:14):

You're converting patients to telehealth visit, so if you've never done tele-health before or eVisits and you're going to start doing so, I think it would be important for your practice setting to document that transition and the decisions that were involved. You're going to also have to make sure that you are securing consent for each of your patients along with the right to refuse. I've been most of you know that your individual States have consent laws that govern what type of consent you have to get and it'll be important for you to get consent for telehealth or evisits and the format from your patients. Most of the time it will be fine to secure that consent verbally and to document when you received it carefully in the medical record. It's also a good idea to look at what types of emergency policy procedures you might need to put in place.

Lynn Steffes (00:09:10):

For example, if you were to be teaching a patient exercises and they're working on them in their home through a telehealth visit and they fell, what would you do to address the emergency? Are there other folks that their family members, caregivers there and then how that might be handled. And that's something you may even want to look at with your legal team. Keep in mind also if you're going to start using telehealth, that a secured portal is ideal and if you have a secure portal or something that is designed to share information over the internet or phone, you're going to need a business associate agreement in place that ensures HIPAA compliance. I think Mark's gonna deal a little bit later with some of the other HIPAA things that give us a little bit of wiggle room right now and then finally make sure and review your malpractice insurance policy to make sure you're covered.

Lynn Steffes (00:10:03):

I know HPSO provided guidance that we have a link on. And I also know PT1 PGM provided guidance on that saying you're covered. So, real quickly, I want to just start off by saying there are different types of visits. I think when this was first announced that Hey, Medicare is gonna cover a PT as a tele-health service. Everyone got very excited and what they didn't realize is that Medicare actually is not covering telehealth. Instead, we're going to talk about the distinction between the eVisits and then telehealth. We also have third party payers, commercial payers that are covering assessment and management visits and not tele-health, and then the actual telehealth visits. So we're going to kind of explore those three areas, but we want you to really listen for which area might fit your practice in your regulatory environment.

Lynn Steffes (00:11:03):

So true tele-health. Let's start with the good news. If we could do true telehealth and we can often, we're going to bill our 9700 codes. We're going to continue to apply the GPP PT modifier, but we're going to also use the OTU place of service code, which is going to communicate that we're doing tele-health. Now, some payers may actually be looking for either a different modifier or an additional modifier. So we're going to talk a little bit later about how you get that information from your payers, but it certainly is important.

Lynn Steffes (00:11:47):

I wanted to start off by saying that a lot of codes are out which are often used in telemedicine, which is physician covered telehealth 99421, 22 and 23. These are actually evaluation and management or ENM codes and those codes are really reserved for physicians or other qualified non physician providers such as PAs or NPs in general. These codes exclude therapist's ability to bill. However, we have been hearing occasionally that there are third party payers that want us to use that code. So I'm just going to say if someone suggests that you use those codes to bill those services, make sure that they provide a URL or a link for you so that you can see the policy that ensures that you will be covered for those codes. Because those are traditionally not therapy codes. Payment from Medicare. So we were super excited and we heard tele-health is covered. And really that was a misconception at the beginning. Medicare doesn't consider physical therapists as an approved telehealth provider. The list is in the bullet below. But Medicare advantage plans can actually make their own decisions and may choose to cover tele-health itself. A lot of times policies are carrier specific.

Lynn Steffes (00:13:20):

This slide is really pretty important and it's just to give you the sense that take a look at the date of this press release, CMS finalizes policies to bring innovative tele-health benefit to Medicare advantage. That was April of 2019, which seems like a hundred years ago right now. A very different time. And so Medicare advantage plans definitely had plans to expand telehealth services, but those plans also did not include PT, OT and speech. So this is not a new idea or a new fight that we're trying to leverage. However we may be in a unique position and I'm kind of a silver lining person and I'm hoping that this opportunity might actually give us a window to get in next. Your Medicaid programs. As you know, Medicare is more federal and Medicaid is state driven. So some Medicaid programs have tele-health policies.

Lynn Steffes (00:14:24):

The telehealth reimbursement policies vary state to state. Those are very fluid. We just have had multiple updates being published in the last three days in Wisconsin. So I know for a fact that you're going to have to kind of stay on top of that to determine if you're trying to serve the Medicaid beneficiaries in your state. How that policy might change in response to the COVID crisis. So keep looking and you're going to have to, this is a moving target. So keep in touch, keep going. So what type of virtual visit again and we talked about there's an evisit, there's assessment and management or tele-health. Let's look at what the actual definition for an evisit is in the 2020 physician fee schedule. Final rule, CMS described eVisits as non face to face, patient initiated. So I want you to really pay attention.

Lynn Steffes (00:15:21):

This has to be initiated. So the contact has to be initiated by the patient. Digital communications that require a clinical decision. So again, clinical decision, that's really important. So you are going to have to document that clinical decision making was made during the contact of a visit that might otherwise typically been provided in your office. So this is the definition of an e-visit and the code descriptors that Medicare is using. Our hick picks codes are related to the eVisits and they're really designed as a short term, kind of like a, I always think of it as like a bridge loan when you're building. They're designed to cover short term up to seven days of assessments and management activities that are conducted online or through a digital platform. And then again include clinical decision making. So what's an online patient portal? HHS has described a patient portal as a secure online website that gives patients convenient 24 hour access to personal health information.

Lynn Steffes (00:16:29):

Patient portal requires a secure username and a password in the absence of broadband access online accounts or smart phones or other means. CMS has indicated they want the service to the furnace, so they're giving us more flexibility. Mark's going to talk more about the technology a little later, but I just wanted you to know the Evisit has, you know, variety of opportunities including something like doing FaceTime with your patients. Go ahead. The billing and coding is what I think you're all waiting for. So physical therapists are eligible to use the Hicks picks codes and these codes require a CR modifier and the CR modifier really indicates that they're related to the COVID crisis. So we have G two Oh six one six two and six, three again, the definitions qualified, non physician healthcare, professional online assessment management. It has to be for an established patient.

Lynn Steffes (00:17:27):

And lots of questions come up. What is an established patient? It is a patient who you're currently seeing under a plan of care. And so what would happen is if you were seeing the patient, you'd have the next seven days to provide some type of E interaction with that patient that provided clinical decision making in input with them. That would be much like what you do in the office. And so the different code levels are really time-related. So imagine that you saw someone today's Wednesday. So imagine that you saw them in person on Monday. There would be a seven day consecutive day window at which time you could have one contact with them or you could have a couple contacts. Each time you had a contact you would have to document the contact information. But really when you actually go to bill the code, it would be a summary of the seven days and the documentation at that point in time would summarize what type of clinical decision making assessment and management occurred over those contacts. As you can see nobody's retiring with this funding. We've got the five to 10 minutes at 1227, 11 to 20 2165 and 21 or more minutes at 33 92 so pretty limited. The place of service is the location of the billing practitioner, which Medicare is suggesting that we would do places service 11 and you can deliver these services via the phone.

Lynn Steffes (00:19:10):

Assessment and management are comparable codes. Non hick picks but they're CPT. So nine, eight, nine, six, six, six, seven and six, eight and those are actually used for telephone assessment and management services, again by a non qualified physician health care professional to once again an established client. But this one further expands and says a parent or guardian. So these are again established patients and they have to be initiated by the patient. That doesn't mean that you can't contact the patient and offer them this service. It doesn't mean that you can't help them set up et cetera. It just means that the call itself that you're doing, the assessment and management code has to be initiated by the patient. The assessment and management codes have a little bit more parameters put around them. And one is that the call can't or it can't originate from the provider and it can't be within the previous seven days.

Lynn Steffes (00:20:13):

So the case I gave earlier for the visits, it would have to be seven days prior. And then it would be the assessment and management calls and then you couldn't see them again within the next 24 hours. So there are these windows of time, seven days prior you couldn't have had a physical one-on-one visit with them and 24 hours after. So as of right now, if you're going to be doing these assessment and management codes they would have those limitations. These are codes by the way that I'm starting to see emerging from some of the commercial pairs as covered in lieu of the hick picks codes.

Lynn Steffes (00:20:59):

These again are telephone discussion times thereby to 10 minutes, 11 to 20 and 21 to 30. And of course, because these are other payer codes, you'd have to look to the payer for coverage of the codes and payment. So true tele-health, we're back to that. There really isn't a specific CPT code for true tele-health. You would be using the therapy codes, the 9700 series paired with the OTU place of service code, which would indicate that it was provided remotely. Because if you're going to be providing these CPT codes, face these what are called face to face codes, which I would argue if you're doing telemedicine or telehealth, excuse me, they're face to face, you're going to have to verify that the payer allows you to use these codes when they're tele-health. So you can't just build these codes leading the pair to believe that they were provided in our office X. I wanted to say payer policy is fluid and that is followed by multiple exclamation points.

Lynn Steffes (00:22:07):

This is changing so fast. I literally just got off the phone before I stepped on this call saying we've got legislation coming in our state that's going to do some mandates. So you may have to check regularly. For example, in the state of Wisconsin, our governor just issued a stay at home order. So peers are going to have to reevaluate their policies if they want to continue to have their enrollees get services. So when you are, whether you hear from one another provider or whoever that someone covers telehealth or someone covers assessment and management or EAD visits, I would suggest that each time you call, you verify benefits and you're going to ask several questions, are you or the physical therapist eligible for telehealth payment? If so, which CPT codes would be completed via telehealth, so which CPT codes will be approved and then what modifiers are required.

Lynn Steffes (00:23:07):

So the modifier GT or 95 is often used in facility billing and the place of service OTU in independent practice billing. And then you're going to want to also find out what their payment rate is. So if they allow you to build nine seven one one zero will there be parity in what they pay you or equivalency and what they pay you based on telehealth versus in office. Are there any restrictions on the location of the PT or the patient? Because of course, right now if your PTs are practicing from home, that would have to be okay or your patient may actually live in a CBRF or other facility. Then what devices or applications do they have any restrictions on that and what if any consents are required and then any special documentation requirements. So those are some of the good questions to ask.

Lynn Steffes (00:24:00):

The other thing I will say is regardless of what they tell you, if you can get a link to their peer policy or anything in writing from them, I would highly recommend that you do that. And then don't assume that what is not covered today will not be covered tomorrow. And what someone tells you is covered may not be covered. I've already had providers that said, they called and asked about telehealth. They said it was covered and when they called back in a second patient, they said, well that's not what we meant. So be careful. And finally both Mark and I have been using this a lot. The center for connected health policy has a ton of great resources, but one of the best that I think you're going to want to download that will give you far more details than I'm able to give you in this brief discussion is their billing fact sheet. So the link to the billing fact sheet is here and I wish you the best. I think we can provide amazing services in person and also via these wonderful technologies. So thank you.

Ali Schoos (00:25:10):

Thanks Lynn. So a number of questions, they've come in and I answered a few of them. So if those of you who received the answer, if that wasn't enough clarity, ask it again. But then I'm just going to let you know what some of the questions are more clever. We can answer them. One, yes, you'll have access to the presentation after it's over. This is being recorded and it will be posted on the website, the next question, will we have access? Why need an option to refuse consent? Wouldn't the person just declined to sign consent? It said in the consent form that we have to give them the option to refuse.

Lynn Steffes (00:25:49):

Well, part of the option to review is, and that's a really good question, is if someone gives consent once, they still have an opportunity to withdraw consent or refuse it in the future. So someone tells you, you know, I'm happy to do telehealth or I'm happy to do evisits and they give you consent and the next time that you're in contact with them, they call and they say, I don't want this anymore. They always have that opportunity to review. So that's typically what that's for. I will say that each state practice act and sometimes an overriding practice act over healthcare professionals tell you what's required for consent.

Ali Schoos (00:26:28):

And then another person asked about the secure patient portal being ideal, but it didn't CMS make a, the HIPAA compliance issue more lax and the pre-cancers yes.

Ali Schoos (00:26:43):

Mark, he's got that later in the presentation. Can you build the e-visit code every seven days or just once and done?

Lynn Steffes (00:27:01):

As far as we don't, I don't know. We've been asking that question if it can be billed repeatedly. We've heard yes. And we've heard no. So I'm not sure. I don't know Ali or Mark, if you know anything more.

Ali Schoos (00:27:14):

It's the same thing. And I apologize, we cannot get a straight answer on that. I think some people are saying, I'm just going to do it more than once and see what happens. Again, it's not a big charge. You're not going to get rich or go broke. So if you want to try it, the worst that'll happen is that a bit tonight.

Lynn Steffes (00:27:30):

Right. And we haven't had to seven day periods to try it yet. They've been released. So it hasn't even been an opportunity.

Ali Schoos (00:27:36):

Right, right. And then does the evisit have to occur within seven days of the last in-person visit or could it be 10 days or 14 days after the last in-person visit?

Lynn Steffes (00:27:53):

I don't think there's a restriction that says it has to be within seven days. I just think it can't be sooner than seven days.

Ali Schoos (00:28:00):

Yeah, I understand. Okay. and then someone wanted an example on it, an example regarding the verbage to justify the clinical decision making to use an evisit

Lynn Steffes (00:28:16):

For an individual patient or the practice.

Ali Schoos (00:28:18):

So when you're documenting, you know, political decision making. Yeah.

Lynn Steffes (00:28:23):

Okay. So you could document that either the facility or the patient or the clinician made a decision that it was safer to do an evisit versus the in person visit. And that there was a good, a good reason to do that in your clinical decision making would reflect that you advise the patient or gave the patient it's specific instruction. The patient asks you questions, you update an exercise program, you perhaps revisited how they're doing on something and gave them feedback. So again, it's kind of like you're documenting a regular visit but the clinical, so I would decide that you did the visit you know, virtually for a fairly simple, straightforward reason that that was what was appropriate at the time due to the crisis or for the patient. Now, Mark, you may address this later when you're talking about tele-health on an ongoing basis because there's lots of good reasons to do it. But right now I think we're talking COVID.

Ali Schoos (00:29:29):

Right? And then Mark you want to address now or later what you might be documenting when COVID is over.

Lynn Steffes (00:29:38):

Right.

Mark Milligan (00:29:42):

So this is a new space to navigate. And so when this crisis is over, I think that this will be a normal part of a plan of care. Right? So it will be an expected plan of care that you will put forth in a patient that they will have a combination of both digital and in person visits. If you line it out from the beginning and set it up that way, then there no deviation or there a deviation from your initial plan of care. That's how I would handle it.

Ali Schoos (00:30:10):

And then one person did ask if you have, if the patient, if you do a second seven day visit, yes. The patient would have to initiate that phone call the second time as well or that contact the second time as well. Yeah. Can you see a Medicare patient per tele-health per cache? Some many visits are covered and I did answer earlier. Yes. You can see Medicare patients for past, since telehealth is not actually covered.

Lynn Steffes (00:30:39):

Absolutely. Any patient where it's not a covered service unless you have, for example, say you had a contract with a certain commercial payer that had a prohibition to doing any services, which rarely do they for a non-covered service. You would inform the patient that this is not a covered service and you could go ahead and bill cash for it. For your Medicare patients. And ABN is not required, it's optional, but some folks will use the optional ABN kind of as a backup to ensure that they feel that their Medicare patients were well informed that this was not a covered service.

Ali Schoos (00:31:17):

That's a great question. Wanting to know if your PTA can provide the telehealth service if the supervising PT is not online with them because it's virtual

Lynn Steffes (00:31:30):

Currently for Medicare. The answer I believe is no, but I don't know with other payers. And that would be a question. If you were anticipating a PTA providing the services telehealth services that you would ask. I would think that the visits because they involve clinical decision making and the assessment and management would likely not be covered. But I can't, I think telehealth would be flexible. What do you think Mark?

Mark Milligan (00:31:59):

Right, so Texas just, I think we also have to default to the rules and regs of the state level as well. Texas just eliminated the verbiage that eliminate, that took PTs away from delivering tele-health. So state rags may have a prohibition written that physical therapist assistants can't provide that care. I need, I'll pull up the Texas specific language that I believe there's a caveat that says that it cannot be used for supervision, but no one has defined whether or not a PTA can perform it being unsupervised. Does that make sense? PTs are not physically being supervised in all scopes practice, right? Like in home health settings. PTs are not digitally covered or supervised by or physically supervised by PT immediately. It's by phone contact. Right.

Ali Schoos (00:32:48):

Well I get in state law. Yeah. And obviously in a private practice for Medicare there has to be onsite supervision.

Mark Milligan (00:32:58):

Right. So state law and then I'll, yes, I can check with the Texas regs too, but it's a state regulated issue.

Ali Schoos (00:33:06):

Yeah. Very good question. And there they are pouring in now guys. So lots and lots of questions here. I'm trying to go through them. Should we keep going and let Mark deliver and then we'll go back and ask more answers. And some of these make an answer with Mark's presentations. We'll come back to these. Yup.

Mark Milligan (00:33:23):

All right. So thank you for allowing me to be here and being with you guys in this presentation. Lynn, I know that you said earlier that that's not the exciting stuff, but that's what everybody wants to hear. So regardless if it's exciting, it's definitely information that is necessary for all of us to continue to keep our doors open and see patients. Right? So again, I'm Mark Milligan, I'm out of Austin, Texas and we're going to cover, basically we're going to cover just what tele-health is. We're going to get some baseline terminology, technology who players in the game evidence and then kind of how to implement it in a practice. Then is going to actually talk to us how to implement it into practice, right. Ali is has implemented this into her clinic. She's delivered care.

Mark Milligan (00:34:09):

She's also as a clinic owner has implemented as a clinic owner. So she's going to give us the nitty gritty on how this actually looks for a private practice owner. So we're going to start with basic terminology because again, terms, words have meaning and terminology can be misleading. And there's been a lot of misleading terminology that's been spread around the physical therapy world since tele-health and eVisits have all been introduced. So tele-health really is just a very large, broad term that describes any type of health, education or delivery of care using telecommunications technologies. And as you'll see that it applies to almost every profession other than medicine. Telemedicine is specifically owned and basically utilized only and exclusively with physician deliver care and their extended providers. Right. So I think one of the bigger issues that came across our country earlier or late last week was when tell them when I think the president said that telemedicine is going to be available for everybody and that you know, that there's these broad sweeping terms where it doesn't really change if you hear the term telemedicine, it doesn't shift anything for physical therapists necessarily.

Mark Milligan (00:35:21):

So you have to do your due diligence when it comes to looking at the information about telemedicine and who that applies to. Right? And so also when you look at your insurance policies and, and other types of documents, make sure that you're referring to telehealth or telerehab for physical therapy services. If you ask about telemedicine benefits, you will not be considered a provider for telemedicine. So make sure that you make those two distinctions. So tele-health again is we help manage our patients through their own their own illnesses to improve self care and access to education support systems and treatment. Telerehab is more of our specific a tele term, if you will. So really it's about delivery of rehabilitation service over a communication that works and the internet. So you can do assessment and functional abilities in their environment and clinical therapy.

Mark Milligan (00:36:12):

So when you're looking at benefits, you can also check to see if they have tele rehab benefits. Telerehab benefits also shows up more in clinical research, right? If you do research and look into the efficacy and effectiveness of digitally delivered care, tele rehab will be a much more used, utilized term than tele-health for physical therapy specific. Tele-Health again really accomplishes and encompasses all types of providers, dentists, counseling disaster management, consumer and professional education. So really tele-health is one of those terms that is not a very good descriptor of exactly what we do. But during these times, it's the most accepted term of what we do. So out of the all those things, just make sure that telemedicine, you understand that does not apply to us as physical therapists. And to make sure that if you hear something about telemedicine that you clarify that or that you clarify that those rules apply or may or may not apply to us.

Mark Milligan (00:37:13):

Some other terms that are coming up across the country are models of telehealth, right? So some terms of delivery so right now currently, what you're watching and how we're interacting would be a live video or synchronous technology. So this is a live two way interaction between the person and the patient and the caregiver or the patient, a caregiver or provider using the auto visual [inaudible] communications technology. So this can be used for both diagnostic and treatment services. And it's just like anything you've done on a video call with your family. So as long as you're live face to face talking to the patient, you're good. Second term is asynchronous. You'll hear this term floated around a circle. The asynchronous modes of communication are basically or otherwise known as store and forward. This is non live communication, right? So this could be emails of HEPs.

Mark Milligan (00:38:05):

This could be a recorded video of exercises that you send the patient. This could be a recorded exercise where the patient demonstrates their exercises and sends it to you. It could be lab results, it could be any type of electronic communication that happens on non-life, a synchronous video. So that's the important differentiator in those two modes of delivering telehealth. So those in some States, these get specific, I in Texas, I'll just give Texas, I'm here in Austin and Texas, you can't initiate tele-health via asynchronous mode of delivery. You have to have a live synchronous session before you can actually utilize asynchronous care. So depending on the state that you're in, that may impact the mode and model of how you deliver telehealth. So please be mindful of these types of definitions.

Mark Milligan (00:38:59):

Also there's remote patient monitoring is another term that's used. This is really about data health data that's collected from an individual at one location and delivered electronically to another. So when this comes to a lot of patients that have chronic diseases that they need to be monitored or something needs to be checked on them regularly, like wait for patients that have CHF they have a digital scale, they can weigh themselves daily and then that data is uploaded into the physicians portal or cloud and then they're monitored on a daily basis remotely for any progression of weight gain. That could be a contraindication or a need to necessitate a medicine change due to CHF. Typically right now, not a lot of physical therapists are in this space. They may be monitoring some of those patients, but they're not too many PTs are actually delivering this model of care.

Mark Milligan (00:39:50):

Typically this is a physician or hospital base. And then mobile health really depends on or is determined by apps and different mobile devices and things that appear that can be very portable, including tele-health. So I would, I would umbrella tele rehab and M health together because you can deliver it via a PDA, cell phone or tablet. Right. So this is more just to the, the more mobile you are as a provider, you can do telehealth with someone on the beach. And depending on your place of service code, you could deliver telehealth while you're on the beach. So just think about that as, as we talk about more app based functions of some platforms that could be applicable to that. So some of the technology that's really out there that we'll pretend I'll briefly brushed these just so you're aware of them, but know that right now in this time of the COVID 19 crisis, some of these may not be the best thing to implement into your practice right now, but know that the virtual reality and tele rehab is an extremely that's a very quickly developing technology where patients put on goggles and they can meet and go into augmented reality and meet their therapist in different spaces to perform exercises or to see exercises demonstrated.

Mark Milligan (00:41:03):

So it's a really cool technology. There's motion technology where patients can see themselves on the computer. And so they were they were able to look through and see themselves moving or get the movement collected from their body and pushed into a system. So sensors and body body monitoring have been they're an interesting technology where you can actually wear a piece of clothing or have a different sensor that will sense your body positioning and space and alert you and change your posture. Haptic technology as really interesting to me. It's cloth and clothing that you can actually generate sensations through distantly. So I could, a patient could have on a haptic cloth and then I can manipulate something a hundred miles away and they could feel the sensation on their skin. So I know if anybody has a new car and they're, and they've, you know, kind of diverted out of their lane and their seat has vibrated on there.

Mark Milligan (00:42:00):

But think about that as haptic technology and how that can be utilized in physical therapy for tactile queuing and for input AI, artificial intelligence that will come into play when we look at a larger type of systems and startup companies that are leveraging AI in order to deliver a digital physical therapy PDAs, electronical medical records, wireless technology, mobile apps are all just different ways that people can connect and also get data and information that can be a really important for medical monitoring. Right? So I think we all notice the explosion with the Apple watch that started to take a heart rate and other sensors and other vitals. And so that would be an idea of wireless technology and then that would also tap into the Apple medical records. So it all kind of is encompassed and in those, in that realm as well.

Mark Milligan (00:42:55):

So just terms that you should be aware of, not necessarily in the immediacy for the deployment of telehealth into your practice, but just to be aware of. So for your business really to get down and dirty and tele-health, typically it takes some time to implement telehealth into a practice. So do due diligence. You need to come up with your business plan, your patient demographics, right? Some people will not want to tele-health or they wouldn't choose telehealth at a given rate. But now with the current situation, many people are seeing this as a really viable option to dilute, to get care delivered to them. But you also have to make sure and take into consideration general cultural and generational issues. And also there's a tremendous bias amongst the long low income patients because they don't have access to high broadband wifi or they may not have a tablet to get care or they may not have access to a safe space to exercise.

Mark Milligan (00:43:46):

So please take into consideration patient demographics and the ability to deliver care because that may be impacted greatly depending on the patient population that you serve. So you also need to have relevant current healthcare delivery systems to how you deliver care. If you you need to make sure it blends with your current type of care and the delivery method that you deliver to your patients, you need to have skills and responsibilities as a PT providing tele-health. I'll touch on this briefly. Ali's going to cover some of this is that you've got to have good video, adequate etiquette. You have to make sure that you have, you know, appropriate lighting room to move and you need to be able to communicate nicely over video. And so that's a different wait, I know some of you have always had been on a tele on some type of teleconference when there's 48 people talking.

Mark Milligan (00:44:35):

Understanding the rules and kind of engagement by a telehealth is important to know as well. You also need HIPAA compliance scripts for patient communication and the protection of PI, right? If you're delivering care in a busy area where other people can hear you, you're transmitting their PI. So making sure that you take precautions and steps in order to and to protect your patients who you're treating digitally and on the other end, patient needs to be protected as well. And you also need to make sure you have appropriate policies and procedures in place for consent for medical emergencies. What Lynn covered earlier to protect PI, I know there's talk about people recording visits, right? Some payers I know in Texas are requiring recording visits to get paid for a telehealth. And so that video becomes a part of the patient's PI.

Mark Milligan (00:45:21):

So how are you going to store that? Who, where are you going to store it? How long? I mean, you store it from the normal five years. Right? So making sure that you have all of your business practices and policies in place for procedures is really important. And then your IT development and installation. Every system is different. Right now across the board you could have a list of a hundred different ways to deploy tele-health in your business. Just depends on how that model fits into your business and your patient flow. And to your workflow. So right now because of this rapid adoption, there's a lot of trying to navigate in plug and play systems, which is pretty normal. But it's even become more apparent that the need for some centralized systems for delivering this digital care.

Mark Milligan (00:46:08):

So you need it. That's my second question. You need a strong IT department to make sure you have secure system set up in place with your policies and procedures and protocol, right? So your equipment, I really want to make sure you're HIPAA compliant because as lens that earlier there has been a lowering of the shield of HIPAA during this COVID crisis. I'm going to sit here and tell you that you should always choose a HIPAA compliant, secure platform to deliver care if it's available. If it is not, then you may in that circumstance use a non HIPPA compliant platform, which we'll talk about later. But you need to do your due diligence in documenting why you chose that. And you need to document the time, the approximate length of time that that patient's PI was could have been compromised and the patient needs to be able to consent to this non HIPPA delivered care.

Mark Milligan (00:47:00):

Right? So I think that's an important part that a patient, like Lynn said about denial of their consent. You need to inform the patient, Hey, you know what? This isn't a secure platform. This is not a HIPAA compliant encrypted platform. Are you okay with continuing to go through with this? And they may or may not say yes, right? So you need to make sure that your connectivity reliable, you need to have bandwidth, audio and video interface quality. You need to make sure that the staff can use and learn the equipment both easily and onsite and remotely when needed. So can this function when you can't get to the clinic? Right. That's a great question. And is the system compatible with your current hardware software? Most tele-health systems right now can integrate. It just takes time. There's a process, typically integration of a telehealth system, depending on how you deploy, it can take a couple of weeks and maybe two to three weeks depending on branding and depending on how you want it to look.

Mark Milligan (00:47:55):

And so the scope of how you can deploy it into your clinical practice, the timeframes can vary anywhere from 12 hours, six hours to two, two to four weeks to six weeks, depending on the level of integration and the level of branding and the level of system that you want to deploy in your practice. All right, so some simple, the beautiful thing about this is most systems operate with very simple hardware, right? So you have some wifi up and download speeds that need to be a minimum. The minimum requirements, they need a laptop microphone or a headset. I prefer a good old wired headphones, right? I know this seems antiquated, but most people are switching to battery power to rechargeable headphones and they're lasting for an hour or two and then they're dying. So if you're in the middle of a healthcare day, if you're treating and training and triaging patients, I highly recommend either having a couple of sets of rechargeable earbuds or headphones or just go old school with cables and you don't have to worry about that at all, right?

Mark Milligan (00:48:56):

The mobility may be a little bit limited, but it depends on how you function in that telehealth visit that this may be restraining or not. It just depends on how you're set up. But again, it's hard. It's very challenging. Once your headphones die to do a visit through just the speakers on your computer, the qualities, it goes down pretty quickly. And then you need to think about what you're surrounding yourself with. You need to create a neutral background. We need to have a quiet room. You need a room to move as Ali will show you soon. That movement and room for both the therapist and the patient are super important because this isn't a normal, this isn't a normal treatment in a clinic where you have a table and you have a confined space and you do everything within that space, right?

Mark Milligan (00:49:44):

This is an opportunity where you have to help the patient move and show them. So Ali was going to be an amazing demonstrator of how you need to have the space both for the provider and the patient and similar on the other side, the patient needs that wifi service or cell service in order to get those uploads and download speeds. And there's simple tools that you can send to your patient but they can check it's just you can, there's probably 20 free links that they could just click a speed test and it can check the speed of their wifi. So that's an easy way to make sure patients have the capability. So there are other technology out there like VR and all these fancy systems. But look, when the rubber meets the road right now we're trying to get everybody on and adopting telehealth as quickly as possible.

Ali Schoos (00:50:28):

And these are the bare requirements, the essentials that you need. So practice models of telehealth. Actually, I was just a good time to stop or is it for questions? Yeah. All right. Well let's pause. Well, you're muted though. There we go. That's smart. Thank you. I've been madly typing away, so I'm really trying to answer the questions that I can just to simplify things and if there are questions that I think the whole group has to hear, I'm trying to save them. So we've been doing a little bit of both Mark. You've got some really good questions and land these yeah. Either one of you. If a patient has authorized visits, do the telehealth visits count towards those authorized visits? So if they'd been given six authorized visits, would Pella and I have a telehealth visit? Would that be one of them?

Lynn Steffes (00:51:21):

I guess if you're authorizing the visits and you're authorizing tele-health and that is one of the visits. Telehealth itself. Yes. if you're doing E visits or the assessment and management calls, those are not counted. And so I think it depends. It's pay are going to be peer specific. Mark, I don't know if you have any, anything else, but to me a telehealth visit is a visit. It's truly therapy. It just doesn't have to be, it doesn't happen to be physically present. So I would say it would count. But in the case of the eVisits, we've been told they do not count either toward the therapy threshold or toward the visit count.

Ali Schoos (00:52:04):

Yeah. And if insurance isn't paying for the visit at all. So let's say you had two in clinic visits in one telehealth visit, if the patient, it's cash for the telehealth visit and that would not count towards their authorized business because insurance company isn't counting it. Oh, that's a good point. Yeah, absolutely. Yeah. And if you needed authorization for an in an in clinic visit, you would need authorization for a telehealth visit. If it's going to be paid for, unless your insurance company waives that. So you really have to ask every single one of your payers what their policies are around this. All right. Amazing. Just the language that you said just there is confusing enough for a million people to navigate that. I want to say that better Mark to explain it was part, no, I'm just saying it was perfectly explained yet. It's still so confusing. No. Yeah. somebody want clarification. The seven, they felt like the seven days after the last in clinic visit it helped the 70s started after the patient reaches out requesting the phone call. No, it's actually the plane. Right?

Lynn Steffes (00:53:13):

There's be a separation of seven days from the last at least seven days than the last time you saw the patient to build the assessment and management code and then you can't physically see the patient for another 24 hours. And so I think what they're trying to do is say, Hey, you know, this clinical decision making probably isn't need right away. I don't know if I agree with that, but if you're going to see them any way, they probably didn't need this call. I'm not saying I agree, but I'm just saying that's my interpretation. Mark. Do you know anything else?

Ali Schoos (00:53:46):

And, and I think just to clarify one more time when I think it's a misunderstanding when it's an assessment management versus,

Lynn Steffes (00:53:53):

Okay. So the Eve visit did not have that same restriction. It's assessment and management that has that restriction.

Mark Milligan (00:53:59):

Okay. So could you clarify when the visits can be seen?

Ali Schoos (00:54:07):

It has to be more than seven days after the patient was last seen and it has to be an on Epic open.

Lynn Steffes (00:54:14):

Yeah. To be an established patient on the product.

Ali Schoos (00:54:17):

Right, right. But it can be 10 days later, 14 newsletters throughout the COVID process actually.

Lynn Steffes (00:54:23):

And I've not seen anything that says you can't see them within 24 hours after that. I've not seen that. So do you guys have speak up? Yeah.

Ali Schoos (00:54:36):

Does the patient have to be in the same state of the time of the event as if there's a super important Mark?

Mark Milligan (00:54:41):

Yeah. So licenser compact rules and state licensure co licensures rule here, you must have a license in the state that the patient resides in to deliver care for that patient or have practice reciprocity through the licensure compact to provide care to that patient. There has been floating rumors around this country that are licensed. We now have national scope of practice and that w our limits of state have been dissolved by some magical powers, but that I can tell you that that has not occurred. And that we still have to maintain state boundaries for our licensure on a state level. So the location of where the patient is, you have to have a license in that or practice reciprocity in that state.

Ali Schoos (00:55:29):

Thanks. And then Mark, we are only, this person wants to know if they can only see current patients for telehealth purchase. Can they see new ones? And again, the answer is different if it's Medicare or commercial payers can explain that.

Mark Milligan (00:55:43):

Yeah, of course. So for Medicare, they've established that it has to be an established patient for an evisit. So for initiation of an evaluation, it's going to be state level. If you have any regs and rules for your state that that doesn't allow you to do that. I've not heard of that yet. In fact, some policies in this country are just paying for the evaluation only by a telehealth, which makes no sense. But you can, for cash based patients, you can do it at a treatment and about and evaluations and treatment based on your state rules and regs. And so same thing for commercial based on your state rules and regs, you can perform an evaluation and treatments. So we have to default to your practice act in order to make sure you can do those. But are you guys aware of any States that don't allow? Well, there are a couple of States that have been questionable, right? Arizona just came through this morning saying that they have tele-health abilities to practice that. But I'm trying to think off the top of my head. If any state doesn't allow telehealth for physical therapists, my brain is a little mush. Right.

Ali Schoos (00:56:50):

Wow. That Arizona. But they just changed it. That's when you said that just changed today. That's allowed it. But I couldn't tell you which ones still maybe don't.

Mark Milligan (00:56:59):

So defer to your state rules and regs. If you can participate as a provider and provide telehealth services, then that shouldn't limit you as to whether or not you can eval or treat. But it may, it may.

Ali Schoos (00:57:13):

Okay. I'm typing one more answer here. Someone asked if they could take care of patient, just skip over the whole evisit process and do a telehealth visit. And the easy answer is yes. You don't have to do EVAs. That's just because they have Medicare in favor of a telehealth visit.

Mark Milligan (00:57:29):

They have to pay cash for that telehealth visit though. Right?

Ali Schoos (00:57:40):

Sorry. I'll chance to seven days at the end, I think. Why don't you go ahead and keep going back.

Mark Milligan (00:57:45):

Yeah. Awesome. Sure. Thank you. Those are all great questions. And those questions, again, the beautiful thing about the ambiguity of this presentation is that all answers will not be valid within the time that they've left my mouth. So you can't, or Ali’s mouth or Lynn’s mouth. So things are changing on an extremely rapid pace. And so please be mindful and please be considerate or consider that these answers may not be applicable tomorrow depending on the circumstance. So current practices in telehealth, really I like to break these down in just three kind of buckets, right? Companies that provide a service for you as a business owner to connect with their patients and provide care. There's companies that have licensed providers that actually deliver care. And then there's companies that use technology and sometimes a human combination to deliver care, right? So this bar, so the bar, the top one is what I want to focus on with all the PPS owners, because that is who you want to connect with in order to provide your patients with care.

Mark Milligan (00:58:47):

Okay. The other two, I would consider these to be in competition, right? So video platforms are platforms out there that allow you to sign up either a monthly or subscription. Some are free, and you can use their services in order to deliver care through your staff to your patients. That's the important key here. Again, I'm the founder of anywhere.Healthcare. We are HIPPA compliant platform that allows schedule and messaging with the connection of video. We're a relatively inexpensive for now we have it as $10 a month for three months to get everybody on board. And as fast as possible, our normal prices, $25 per provider per month zoom, there's a free version, there's a free version that's not HIPAA compliant. But HIPAA compliant for zoom for providers is $200. Five providers is $200 a month, so $40 per provider per month.

Mark Milligan (00:59:36):

Coveo has a free system. Doximity has a free system. But these are just basic. You're, you typically pay for bells and whistles in these systems, right? So doxy.me we'll offer you a room based system where you just send a link to the patient, the patient meets in the room and that's what you do. There's no messaging and there's no other type of communication or ability to for the patient to sign on. I think that, you know, it's unique that I said platforms in here, but not all of these are actual platforms by definition of the secure platform from Medicare. So back to Lynn's point earlier, I think there's needs to be distinction that some of these like zoom and doxy and Skype they do not have portals, secure portals that patients have to sign into to qualify as a visit communication anywhere healthcare does.

Mark Milligan (01:00:25):

And I believe clock tree has a patient sign in as well. And so you need to be, when you look at these platforms, take into consideration the patient population that you're treating. So when it comes to, we'll get to the HIPAA compliance and just a little bit we know right now due to the lax of HIPAA rules and regs that you can use things like FaceTime or Google chat or Skype or Apple. What else? Facetime. There's Google. There's WhatsApp, there's lots of different communication platforms on your phone right now. They're advising that at this time that you can use those as long as you document well. But choose a platform that's secure if possible. All right, so tele-health platforms and systems and EHR is also anywhere healthcare Cario Bluejay in handheld med bridge now has a telehealth option practice.

Mark Milligan (01:01:17):

Perfect. EMR has a tele-health option. PT everywhere is an EMR with a telehealth option. So these are going to be a little bit more in depth and how they engage you and your system and your clients. So some of these, I know Indian health in handheld has a complete patient management or CRM, a customer relationship management system. You know, PT everywhere is an entire EHR. So some of these systems may not be right for your practice right now because of the integration needed at this point, not very many people want to go through an EHR integration or transfer during the middle of a healthcare crisis. So these are all opportunities as you look into the future. First kind of systems wide platform setups that you can take into consideration for your company. Companies like you, health, wellness, health, physio, physio, reflection, health there.

Mark Milligan (01:02:08):

Now these companies are companies where a patient can click on this website and be connected with a therapist by their company. So this would be in my consideration, the competition to private practitioners across the country, right? So these are companies that are providing tele-health for, for PT specifically and others in the game such as hinge health, simple therapy, Chi health and Kyo are all app based that solicit direct to patients. So you can search simple therapy or Chi health and they are an app base where a patient will pay a small monthly fee in order to get web delivered. An avatar directed exercises or exercise videos. And I bring this to mind because these four companies, this is a huge exploding space and musculoskeletal care because these are contracting with major employers to be their provider of musculoskeletal care or their first line in musculoskeletal prevention.

Mark Milligan (01:03:02):

So as private practice owners, we need to be really aware of this, of these companies in the space. Because just last year alone, those four companies had $165 million in capital investment, right? They had massive amounts of funding that were pushing at these because they're scalable and because they have infinite amount of users because they're AI driven and you can deploy them rapidly to, to huge audiences. So really be mindful in how you communicate about the services that we offer and the importance of what we do. Because there's people out there and there's companies out there, there are trying to eliminate the physical presence of physical therapy across this country. So knowing the rules is really important, right? The biggest important thing that you can know as a PT providing telehealth is that you can treat, you have to treat the patient person the same way as if in the clinic.

Mark Milligan (01:03:54):

This is paramount. So you have to have consent form signed. You have to have consent to treat, you have to have all your your dots. Dot eyes I's dotted and T's crossed. When you're treating patients to make sure that you treat them just like they're in person. This, just because you do a digital cash based visit doesn't mean you don't have to document. And I say that only because people have asked me that, right? This is a real patient. You have to treat it as a real patient, as a real visit. So please be constantly professional and how you manage patient care. Knowing the licensure compact is also super important. The patient, what I defer to earlier, the patient, you must have a license or practice reciprocity in the state that the patient resides in. There have been talk about, well, what if somebody goes on vacation?

Mark Milligan (01:04:38):

What if somebody goes on or their summer home? That that is a very gray area that hasn't been well defined to my knowledge. Have either of you heard of anyone defining them being out of their compact state for a defined period of time? I have not. So you're talking about the patient or the therapists, right. Let's say my patient in, I have compact reciprocity in Missouri. Let's say my patient in Missouri goes to Indiana for four weeks. Can I now treat them while they're in Indiana because they're not in a state that I have a license or compact or reciprocity?

Lynn Steffes (01:05:17):

Well, it really is, it's my understanding that it's the location of the patient at the time of the encounter. We've had lots of questions on this behind the scenes as well. Like what if my patient is, their residence is in one state and I'm doing tele-health and another if they were to come to me, I'd be covered, but then they would be in your state. So in the case of telehealth, it's my understanding that if you are licensed in the state, whether through your primary license or compact license that the patient is in at the time of the encounter, then it's covered. If not, it's not covered any different.

Mark Milligan (01:06:01):

I've just, there's been people argue like, what if my patient goes skiing in a state that doesn't cover in Nevada and they hurt their knee, right? And they're gone for a week and I still consult them while they're gone for a week. Technically, since they're not, you know, they're not a resident, they're not living there. So those questions are extremely gray right now. So I would default back to the current rules and regs that say that the patient has to be in the state that you have license to practice them.

Ali Schoos (01:06:24):

Yeah. I think people want them to be great because it sounds like they're only gone for a week, but that doesn't only gone for me as a Trump law. So unless we're specifically pulled, that is true. I would not do that.

Mark Milligan (01:06:37):

Right. And why should you care? One, you could, it could be damaging to your license too. You can pro, you can really do a lot of targeted marketing across those areas, right? So you can now reach people across the country. HIPAA, a fun topic. That's the old definition of HIPAA that we need to maintain or the telehealth provision we need to maintain it. But really current language means that we, they're going to, they're not going to impose penalties for noncompliance. And so under this notice, Apple FaceTime, messenger, video chat, Google Hangouts, Skype, Mmm. Can it be used to provide without risk that they will be imposed penalty on. However you need to notify those patients that these third party applications or predict potentially introduce risk and that you need to get an okay to use them. Again, this is temporary.

Mark Milligan (01:07:26):

Most of the information that we're talking about with insurances and compliance and everything are all temporary orders. So make sure that you're understanding that it's out of the essence that you maintain as much as you can. Cause separate costs a lot of money. All right, so why should we care? It works. Customers want it. I'll go through these pretty rapidly because right now customer driven decision making is not as, I don't think is as relevant, but after the fact that we need to come back to this when this is over, this is relevant. Customers want this. Customers by age group want to try a telehealth across all demographics. And so just make sure that you understand that before we had this crisis, many people would love for their care to be delivered digitally. And so across. There's different reasons that they have time savings, faster service, cost savings, better access to professionals.

Mark Milligan (01:08:21):

However, there were some perceived barriers as a person in person care was a preference. There's privacy concerns, uncertainly about reimbursement tech and then how to use it. All of these things can be alleviated during these current times with communication and helping your patient understand the technology that you're using. Right? But why should we really care as a profession because it works, right? There's been a lot of studies that look at the efficacy of our effectiveness of telehealth in tele rehab specifically. There's been over 50 studies that and more coming out that tele rehab is a benefit or as is no less than effective as in-person care. All right. There's one major study with Veritas from Duke that they looked at a 300 ortho patients that had total knee replacements. Half of them went to inpatient or half of them went to outpatient orthopedic and clinics.

Mark Milligan (01:09:12):

The other half went to home with an app to get exercises and there was no difference in longterm outcome or total cost in three months after discharge and they saved almost $2,800 per patient. So there are studies that are coming out and post-stroke MSK, pulmonary rehab, cardiac rehab, joint replacements, low back pain that have all demonstrated that digital delivered care, whether that be in person or some apps can be just as effective as in person care. So knowing that those are the cases that we actually can make an impact digitally. It's an incredible opportunity for us as a profession, right? But I think we also need to step into the space and own our profession because others recognize the viability and the validity of how we use technology to treat musculoskeletal conditions. And they're stepping into the space too in a hurry. So it's just the beginning and now I'm gonna turn it over to Ali who's going to you know, my back hurts. Ali, can you help me?

Ali Schoos (01:10:08):

So, yes, I can, I'm going to screen you via telehealth before I let you come into my office. So Carrie, I think you're gonna try to give me the full screen Mark when those are off. MarK Fullscreen.

Ali Schoos (01:10:28):

There we go. All right, so you guys, I asked him to put me on full screen. I don't have slides because I really want to talk to you in a way that you are going to be talking to your patient when you do a telehealth visit. So I had been thinking about doing telehealth for a couple of years and that's a whole nother story why I didn't get off the dime and do it. But when the COVID pandemic struck and it hit really in the Seattle area first, in fact, the nursing home facility that was the epicenter of the outbreak is just up the road from my office. I knew that we needed to get going and get telehealth in place. And although it feels like that was a year ago, it was really about 10 days ago and we've done it, we've gone from zero to providing telehealth in 10 days or less.

Ali Schoos (01:11:13):

Actually, actually we did it in six days. So the thought process that I went through was shoot first aim later and looked at, gosh, let's just go with a free platform. Let's just get going and do this. And the very first platform that I signed up for, I looked at I realized that tele-health was something that we want to be offering as a long game, not just a short game. And I wanted it to be more robust and then I would be paying for a platform regardless. So I looked a little deeper and decided that I the two things were most important to me was HIPAA compliance because I didn't want to change platforms because I'm not compliant now and I'm going to be compliant. And the second issue was really having access to someone who could walk me through the process.

Ali Schoos (01:11:58):

I didn't want a platform where I had to figure all of it out. I wanted someone who could tell me, I'm not a techie person, so tell me what that meant. Do I need, how do I, how do I set it up? What does the patient need? And so this is not a PPS endorsement. I did use I am using anywhere healthcare with Mark and he has walked us through the process. So you know right away when you were able to get I got all my therapists signed up before I even knew what I was doing. Got all a therapist signed up and asked them to go in industry and start using the platform. Have visits with coworkers, have visits with friends and family and just practice and get comfortable and make sure that they were able to do it at the office.

Ali Schoos (01:12:42):

Where did we want to do it? We ended up choosing my office as the best place. This is my home, not my in-clinic office. And then I asked everyone to look into their homes and make sure that they have the appropriate technology and appropriate space to do it at home as well. While they were doing all of that, we were working on the other side to make sure that we had the patient invitation letter or patient welcome letter that we had a letter that describes the patients what they needed to do on their end and have available. And then the consent form, which was all within the platform, which is all online and portal. And then I had my, you know, diving in like I do, I had my front desk start calling the patients who had been canceling their appointments to see if they wanted to take a tele-health option.

Ali Schoos (01:13:27):

And lo and behold, not very many of them did. So realized I think we need a transcript for how we talk to patients about telehealth. And I don't need to let the patient understand the value of tele-health, but to make sure my staff understood that about your health. And it made it pretty clear that people don't really understand how can you do physical therapy through a computer. You have to be able to touch me. Right. I mean, you touched me all the time when I'm in the clinic and it's very true. We do touch our patients and that's a very important part of what we do. But I think the majority of what we do is education and exercise. And that can be done very effectively across this platform. You have to make sure that your therapist and your patients understand that.

Ali Schoos (01:14:11):

So the next thing we did after a script that everyone would use is I created a video and put it on our Facebook page that is too long, but go ahead and go to my Facebook page and look at it so you can get ideas on what you want to do and don't want to do. How we did it for two reasons. One was to explain what we're doing during the COVID crisis, how are altering how we see our patients, and then explaining the telehealth option to them. And then I walked through with them what an actual visit looks like. And so they're looking at their computer while I'm talking to them and said, you know, if we're going to ask you the same questions that we're gonna ask you when you come in for a visit, I want to know what your history is.

Ali Schoos (01:14:55):

I want to know any special tests you've had done. I want to know what makes you worse and better. And then really critically, I want to ask you about red flags, meaning things that are important for me to know to make sure that you are appropriate for me to treat, to safely treat across the health platform, so that if there is something amiss, I can handle that by referring you on to another healthcare provider asking more questions. And again, in this crisis maybe doing a phone consult with another provider to make sure that we get you the appropriate care if telehealth is not. So you do need to make sure that your providers are asking the same red flag questions that they should be asking when the patient is in the clinic. So it's not really different, it's just enhanced importance for me.

Ali Schoos (01:15:42):

So the next thing we did then is have the physical therapists, Oh, let me back up a little bit. I do want to explain to you the other important thing about when you're on this call and what I did on my video was demonstrated for patients. What that visit after those questions would physically look like. So if I'm seeing the shoulders always easy to explain here, if I'm seeing a patient has shoulder pathology, I want to make sure that I have enough room and they have enough room for me to move around and show them what I want them to do. I can't just say, well, you know, flex your arms to 90 degrees or do XYZ because I can't touch them or cue them as easily. I need to be able to show them. So I'm going to ask them to raise their arms above their head.

Ali Schoos (01:16:25):

I just said, I can't really see what you're doing. I want you to push your chair away. Okay, stand up for me now. Go ahead and do this for me. So move your arms. Great. Now can you reach behind your back? Show me what that looks like. Let's go sideways and Oh, that's sucking kind of funny right there. I think Ellie has a rotator cuff problem and you know, go through all their emotions and I might say, well, can you resist yourself? So push down against your arm while you're trying to raise it. Does that hurt? Can you do that? Don't use right or left because that's backwards in a screen now it's even worse than are in the clinic. So say raise your involved arm or injured arm or however you want to do that and your resist that. Make it bend your elbow and push down against your arm.

Ali Schoos (01:17:05):

When you tried to touch your shoulder, just the same kind of cues, but show them what it is that you want them to do. If it's on their back, their knee, you're going to, I can only see part of you. Guess what? My screen moves and you are allowed to move during your tele-health. It's going to tell your patient, I want you to move your screen now so I can see your feet. I'm going to be able to see you. You know, do a little squat for me. Go ahead and hang onto the wall if you need to use the desk. So you're going to use the things that are around you. Turn sideways and then forwards. I can see what your back looks like. You have the ability to have your patients do quite a few things. You don't even, you know, you're looking at their shoulder.

Ali Schoos (01:17:47):

Let's just screen your neck out a little bit. So backwards, any pain going into either are so you can do quite a bit. And your history should have cleared out a lot of your red flags and, but you know, if you're concerned about something more serious that you can't evaluate across the screen. So once you've done all that therapist and a patient, well, much better idea that, Oh, I guess you can do this with me. And then you might want to ask your patient to have some things handy for you to be able to show them what you think they're going to be able to doing, whether it's stretching bands or foam rollers or some lightweights, or even teach them how to make some lightweights at home so they have something to left when you get to that point. Mmm. And then the final thing, two final things.

Ali Schoos (01:18:33):

I had our patient, our therapists call all of our current patients or who were current prior to the COVID crisis. Call all of them. Check in on, I'm asking how they're doing, is there anything that you need from us? And then explain our telehealth and e-visit options to them. Let them know that they can go to the Facebook page to look at the video to understand it a little bit better. And then just that personal touch. And then we are next emailing all of our patients through our patient engagement platform to let them how again that we have altered our in office visits due to the COVID crisis so that are stay in place, mandate by the governor. We will still be seeing extremely essential critical patients in the office. But our largest mechanism for reaching out to them and monitoring them and help them rehab during this time is through telehealth.

Ali Schoos (01:19:24):

So, and I think that's really critical so that when they think they don't need you today, maybe in a week or two, they realize, wow, I really do need to talk to my physical therapist. What did she say about how I could get ahold of her? And they'll go back to that email and find that information and reach out to you, especially if your office is closed, make sure that they know how to contact you so they can do that telehealth visit. And on many of these platforms, there's a mechanism for the patient. They can use the platform to reach out to physical therapists. And that's how we did it. So like I said, six days, we did our first visit from when we said go. So there you go. Mark, back to you and Lynn and let's answer some more questions. Yeah, that's great.

Mark Milligan (01:20:08):

That was awesome. Yeah, it was, I think the important thing that all providers need to understand is there's a learning curve here, right? There's a steep learning curve and you really have to, you have to practice it. Like Ali said, yet everybody practiced before this. And also you need to be, I like to term it humble and open with your patients and understanding that, look, this is new for everybody. This isn't how we've done things for years and now it's time to do something differently. So if you are, if you are if you're with your patient when I started doing this, I'd be like, you know what, John, this is the first time I've seen somebody with knee pain on a virtual visit. Let's figure it out together. Right? And, and work through it. And, and it also gives you opportunity to see where your patients live and the equipment they have.

Mark Milligan (01:20:50):

I know Ali said that you can, they can have equipment, but you know what a can of beans, some cans weigh 16 ounces, that's a pound, right? And they, most people have a belt. And so a belt becomes a great nerve glide or a stretch strap to do nerve glides with. And you know, you just have to get really creative and be a Ninja when it comes to a telehealth visit. IFor me it's really exciting for problem solving because you, you really just a giant problem solver. So thank you Ali. That was amazing.

Lynn Steffes (01:21:19):

Ali, we had a lot of questions. I wonder if I could take a minute and ask some questions that were specific. So one of them was can you talk a little bit about your patient demographics?

Ali Schoos (01:21:33):

Yeah, I think my patient demographics are pretty typical outpatient or so. We have about 20% Medicare 22 maybe it's going to range a little bit, but we see everything from junior high age athletes, kids through that Medicare population. I would say we have a fairly, our geriatric population is fairly active, but about 5% of them are pretty geriatric.

Lynn Steffes (01:22:01):

What about socioeconomic wise?

Ali Schoos (01:22:04):

Socioeconomic imagine value values on you guys? I'm like tech plans. So socioeconomically, I live in a high wealth area, but we also have one of the biggest immigrant populations in the United States. So there's a mix. You have a mix of lower socioeconomic status, but I'd say probably obviously higher than in much.

Lynn Steffes (01:22:27):

Yeah. There are also some questions just about the name of your practice and your Facebook and websites and maybe after you can take a minute to type it in.

Ali Schoos (01:22:36):

Yeah, I mean, I think Carrie, that's on the reason I was like, if not, I'll make sure it's on the resource link.

Lynn Steffes (01:22:42):

Okay. And then there was a question, a specific question. I don't know if you or Mark could take it about the vestibular patients. Give an example of how you might treat a vestibular patient.

Ali Schoos (01:22:56):

So that's a great question, by the way. That is one of the people that I think is essential. And so we have seven treating therapists. We will probably have one therapist in the office or going to the office as needed. I would say a really acute vestibular patient probably needs an in office visits. You could make sure that they're not having a stroke or that, you know, what's the problem? However, let's say, say someone you've seen before that has a recurrent problem or those of you who are vestibular therapists. I'm not, but we do have him in my office, so I don't want to misspeak here, but let's say you can do it on telehealth. I know therapists can demo an epley maneuver. She can actually have a plant and have her computer screens set up. Just got it for me and demo how to do an epley maneuver for the patient. So it is possible if that was your only choice, you don't have to think about what's best for the patient. And if the patient can't access anybody and they're scared to go to the emergency room and your office isn't open, you showing them how to do an Epley maneuver is better than what they're getting otherwise. So there's my answer.

Lynn Steffes (01:24:04):

That sounds good. Mark. There is a question that came in that I think would be perfect or two questions for you and one is that they indicated one obstacle I've been running into is getting the medical history and the body chart filled out on line. Do you have any advice on resources for getting people were converted to digital or interactive version?

Mark Milligan (01:24:24):

Oh yeah, so that's a great question. Great question. So there's actually a couple of companies that do intake digital intakes once, I think it's called intake queue. Is it actually a company that you sign up for their services and they do digital forms? But there's also, I have, when I first started my practice, I just, I'm not that, even though I'm in tech, I don't do a lot of tech, so I don't know how to convert PDF. So I just had, I went to fiverr.com and had somebody do fillable forms for all of my forms. So a fillable PDF form. You just email that to the patient and they can fill it out on their computer and sign it and then just save it and email it back to you. So that's been the easiest way that I've found to do a digital intake is just have your forms be PDF and fillable.

Mark Milligan (01:25:13):

You know, and, and in these times, like I've also emailed patients and had them fill it out at home and then hold it up to their camera and then I've taken pictures of that and then reviewed it. That's another way to do it. And then knowing that I'm going to see a patient in person, I'll often, or you could have them fill out some of the forms and have them take pictures and send it to you over a secure method or email it through you for their phones so pictures can work. So you have to get creative in that space for sure. But fillable PDF forms have been by far the easiest. I have my entire intake paperwork as a fillable PDF form.

Lynn Steffes (01:25:51):

Okay. That sounds good. There's a question about documentation of the sessions and I guess the biggest thing I would say is document. Like you're doing an in person, just go ahead and document that they gave consent, your location, location in the platform. I guess the other thing is the other question I thought would be good to answer live is how long are the sessions? Usually it's tele-health.

Mark Milligan (01:26:16):

Yeah, so that's a great question. Ali can also respond to this with our clinicians. So an initial eval can be anywhere from 30 to 70 minutes. It really depends on the patient. It depends on their condition. It depends on their comfort, the technology they're set up. But followups are typically in the 20 minute range, 20 to 25 minutes. They're not very long. Because you just get it done. You're not entertaining and asking about cats and seeing how their life is, you're really just getting in there and getting it done. For those cash based practitioners out there who want to charge patients cash, I would take your hourly rate and divide it by four and I would just bill in 15 minute increments. Right. Just give the patients manageable, manageable chunks of time that they can pay for and not have to think they have to see you for an hour for a PT visit. And so it makes it, I think, affordable and approachable for some patients. And you can still charge the same hourly rate. It's just broken down in chunks because some people don't need a lot of time. They may just need to review the hip hike and clamshell and, and S sideline abduction exercises that you gave them. That'll take 10 to 15 minutes. But so do it that way. From my experience. Evals anywhere from 30 to 70 and then followups are pretty much 15 to 25, some of them.

Ali Schoos (01:27:29):

Yeah, Mark. So that's what we're doing. We're doing initial evals for an hour because we want to make sure that if you get into this across again at via platform that you really haven't had time to ask all the important questions and all that. That's great. But that return visits have so far, 30 minutes have been adequate for us. Again, I think you can be a little bit more efficient. Some that chitchat doesn't happen. So I think you might even be a little bit more efficient. I'm a chit chatter myself. I'm with my patients and yeah, so I think that 30 and 60 is good. And there was a question about how we're getting reimbursed for these visits. We've been doing them for less than a week, well a week. So I have no idea in terms of if insurance is going to pay us, we have done our due diligence to the best of our ability as to who might pay us and we will bill those insurers. We're doing a cash rate when we know it's not covered and we reduced, we made the choice. Everyone has to do this for themselves. I think there's pros and cons. We reduced our rate mainly because so many people are going to be out of work right now and we don't tell her that's new to my clinic. So we reduced our rates, we didn't make them free, but we reduced our rates to encourage people to utilize the service.

Lynn Steffes (01:28:41):

Mark, there was one other question. I know we have to tie things up, but do you find that your telehealth clients over time, not just for this COVID crisis, but that they offer, may offer a brief first free visit or a sample visit as a way of helping people understand what to expect?

Mark Milligan (01:28:58):

Right. So I think the business owners on this call need to think about how they're going to integrate digital care into their practice when this is over. Right? And so one of the ways that I've seen to be very effective is to offer a button on your screen that just says contact for, would you like a free video consult, right? Just do a free consult just like you would in a free screen in your clinic. And that helps them both get comfortable with it, expect it. And also there's been some good, some good data that we've gathered that people that do that telehealth video visit and then show up into your clinic, have more, I have a higher rate of completed plans of care than if as if they do just a walk in free visit. So just because of the dynamics of the end of it where you, they have to sign up for care and it's awkward.

Mark Milligan (01:29:42):

So if a patient does a video visit and they show up, you know, they're invested, right? They get to meet you face to face before and so they're more likely to stay. So I think that when this is all said and done, finding ways to integrate telehealth into your clinical practice and how it makes the most sense will be necessary. But yes, there's, I mean, you can give away care to any body on this planet. It's legal to give care to Medicare beneficiaries. You can donate care. So you can you would a free screen or a free tele-health touch or free visit is perfectly appropriate way to help introduce people to digital care. I know we're at a time, how do you guys have it to tie this up?

Ali Schoos (01:30:26):

So if I can intervene and I guess I think, thank you Mark and Lynn, you guys just did a great job and everyone, they really have worked very hard. I had no idea how fast these guys are turning around this information for you. So thank you very much. I'm going to put a plug in for your keeping us an ABT boards. They are working their tails off to get people as current information as they can around rules and regulations and billing and tele-health and managing your practices. So when we're going to keep doing it, ups website is open to the public. We've taken a firewall down for all information about COVID, so please use it even if you're not a member. Lynn and Mark and I, and then we'll meet after this to decide if based on what happened today, we should do a follow up webinar. So if that's an interest to you, type something in real quick. And then just use the website. If you have more information or you know, reach out to one of us. Anything else that Mark you or Lynn would like to add? Dive in. Just dive in and do it.

Mark Milligan (01:31:28):

Yup. Just dive in. Just do it. Be kind to one another and understand that this is a working together. We can become a better profession because of it. So that's my final word. Bless you all for doing what you do. Thanks so much for serving as a sounding board.

Ali Schoos (01:31:45):

Thank you. All right, thanks everybody.

Carrie Stankiewicz (01:31:50):

All right, thank you all for attending today. As we've noted, this will be recorded and posted on our website along with a copy of the slide presentations and all of the links that we've referred to are in the slide presentation. And most of those links are to resources that are directly on the PPS website. On our COVID 19 page. So if you haven't already, please take the time to explore that page. Ali and Mark and Lynn, thank you so much for your time today and I'll wish everyone a great evening.

 

Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram  and facebook to stay updated on all of the latest!  Show your support for the show by leaving a rating and review on Apple Podcasts!

Mar 23, 2020

Live from my personal Facebook page, I welcome Dr. Mark Milligan, PT, DPT from Anytime.Healthcare as he discussing how we can implement telehealth services into our physical therapy practice. 

In this episode we discuss: 

* How to set up a telehealth platform
* How to perform an initial eval and follow sessions
* How to bill (at least what we know right now)
* The paperwork you need to start seeing patients today
* And so much more! 

Resources: 

Anytime.healthcare

Doxy.me

Connected Health Policy/Telehealth Coverage Policies

State Survey of telehealth Commercial Payers

Telehealth Paperwork

 

For more information on Mark: 

Dr. Mark Milligan, PT, DPT, is a board certified, fellowship-trained orthopedic physical therapist. He specializes in the intelligent prevention and treatment of all human movement conditions.

He is a full-time clinician with multiple patient populations and is the Founder of Revolution Human Health, a non-profit physical therapy network. Helping others create the best patient experience and outcomes through his continuing education company specializing in micro-education is also a passion.

His latest venture is creating the easiest pathway to access healthcare for providers and patients with Anywhere Healthcare, a tele-health platform. He is an active member of the TPTA, APTA, and AAOMPT and has a great interest in the pain epidemic, public health, population health, and governmental affairs.

Read the full transcript below: 

Karen: (00:07):

Welcome to the healthy, wealthy and smart podcast. Each week we interview the best and brightest in physical therapy, wellness, and entrepreneurship. We give you cutting edge information you need to live your best life, healthy, wealthy, and smart. The information in this podcast is for entertainment purposes only and should not be used as personalized medical advice. And now here's your host, dr Karen. Let's see. Hey everybody. Welcome back to the podcast. I am your host, Karen Litzy and in

Karen  (00:40):

Day's episode. I am sort of re airing a Facebook and Instagram live that I did last Wednesday with dr Mark Milligan all about telehealth. So a little bit more about Mark. He is a board certified fellowship trained orthopedic physical therapist. He specializes in the intelligent prevention and treatment of all human movement conditions. He's fulltime clinician with multiple patient populations and is the founder of revolution human health, a nonprofit physical therapy network, helping others create the best patient experience and outcomes through his continuing education company specializes specializing in micro education is also a passion. His latest venture is creating an easy pathway to access healthcare for providers and patients with anywhere. Dot. Healthcare. This is a telehealth platform. He is an active member of the Texas PTA, P T a and a amped and has great interest in pain epidemic, public health, population health and government, governmental affairs.

Karen  (01:41):

I should also mention that he is also on the PPS coven task force. So if you want to get the most up to date information on how the coven pandemic is affecting physical therapists in private practice, you can find that at the private practice sections website. It's all free even for non-members. All right, now onto today's podcast. Like I said, this is a recording from the Facebook live that we did last week. And in it we talk about what is telehealth. We talk about how to set up telehealth, how to implement telehealth, how to conduct a telehealth session for an initial eval or for a followup. We talk about how to get paid for telehealth and this is the information that we knew at the time. That was last Wednesday. Like I said, things are moving really, really quickly here. So the best thing to do in Mark says this is to check with your individual insurance providers, check with your state things are moving really, really fast.

Karen  (02:45):

And of course finally we talk about answer a lot of viewer questions. So a big thanks to Mark and I think this is really timely and I hope that all physical therapists that if you're listening to this, that you can set up an implement your telehealth practice ASAP. Thanks for listening. So today we're talking about how to implement telehealth into your physical therapy practice. As we all know, the COBIT 19 virus is causing a lot of disruption in healthcare and we're hoping that telehealth can help at least mitigate some of that interruption for the sake of our patients, for the sake of our own practices and for our businesses and for our profession. So Mark, what I would love for you to do is can you just talk a little bit more about yourself, where you're coming from and why we're doing this interview.

Mark  (03:34):

So Mark Milligan, Austin, Texas physical therapists board certified fellowship trained, but also for the last few years have stepped into a telehealth space and have anywhere healthcare, which is a digital platform for delivering healthcare. It's agnostic to provide her, so PTs, mental health providers, anybody that needs a HIPAA compliant platform to connect with patients. So the current situation is it's pretty mind blowing, right? We're seeing a, a world changing epidemic that will change the landscape of healthcare as we know it today. For several reasons. One is that people will be now exposed to a delivery of care method that they weren't otherwise are supposed to before. So telehealth and tele PT and tele medicine had been out there for a long time. Teladoc started in, in 1987, somewhere in there. So it's been around for a long time, but a rapid adoption of telehealth has really occurring right now for physical therapists.

Mark  (04:30):

What we need to know and what are the most important things right now are how it applies to us in this landscape. How can we be the best providers to meet our patients? Demand to help quell fear, doubt and an anxiety for our patients as well as, as providers and our businesses. And so stepping into this space is, it's been a little bit overwhelming. It's been a nonstop 70, 96 hours really. And so everything that I say today may or may not be true and four hours or smart [inaudible] because of how fast things are changing. So yeah, I think that tees it up. You want to kick it off? Yeah,

Karen  (05:10):

No, I think that's, that's great. That's perfect. So let's start out with, we got a number of questions from people from different therapists from around the country. And I think let's start with the number one question is how do you actually set it up? Totally basic one Oh one. So let's start with that,

Mark  (05:33):

Right? So the first thing you have to make sure is that you have patients that want this. And right now everybody wants that, right? So patient adoption of technology can be challenging, especially especially generational. So the issue with in, yeah. Pre COBIT has been adoption by, by therapists and by patients just because of ease of use. Now it's a, it's a forced adoption. So now we're in a set up where we, where are going to want this regardless of whether or not they want it. So first thing is patient population. Second thing is you need to look at your business, right? You need to look at your patient workflow and your business flow. So you need to have the appropriate from a business standpoint, you need to have a liability to make sure that you're covered in the telehealth space. So in my experience over the past few years, almost every liability insurance cover, it doesn't see telehealth as a, is a different delivery mode for physical therapy.

Mark  (06:26):

But with everything changing rapidly, it would be real. It would be highly advised that you contact your liability insurance provider and make sure that tele-health is approved as, as in your cupboard. All right? So that's logistics. Secondly, you need paperwork, you need onboarding paperwork for digital visits. You'll need a telehealth consent form and you'll need the digital release form. And if you're recording visits, you need to have a very specific form that that allows you to record patient visits. Some States don't allow recording some. And so you have to be very mindful of that. So onboarding paperwork, it's, it's good to have in fillable PDFs so that a patient can fill it out and then send it back to you digitally. Making sure that that transmission is is secure. You can also have E faxes, right? So they can electronically fax to you over a secure portal as well. So just basic things that we haven't really thought about as providers we need to adopt as mobile providers. Right. So, Oh, go ahead.

Karen  (07:24):

I know, I was going to say, so when we're talking about who is the best, what is the easiest way for us as a clinician to get that paperwork

Mark  (07:32):

Right? So they can email me. I've gotten a tele-health consent. I've got I've got that. So they can just email me at market anywhere. Dot. Healthcare. And I can send 'em I'm been sending that out over Facebook. I'm happy to share that with people. And of course you need to make sure and adapt it for your state in your practice. It's a word doc so you can switch out the logos and everything, but I'm happy to provide that for people. They can pass that that step.

Karen  (07:57):

And then one more question on paperwork and things like that. So when we are calling our insurance, our liability insurance carriers, aren't there specific questions we need to ask them or like what is the best way to have that conversation with our liability insurance providers?

Mark (08:16):

Right. Just say in this facing time that we're starting to provide care digitally. Am I covered for providing telehealth as a physical therapist? Simple. Straightforward.

Karen (08:25):

Okay. And so you may already be covered in your current policy, it might be part of your current policy, you just don't know it and then you're not, is that then added as a rider to your yes.

Mark (08:38):

Typically it's a very inexpensive writer. Okay.

 Karen (08:41):

All right. So before we set everything up, we get our liability coverage covered and we get consent forms, which can email to you or you can share them on under this post. It's whatever you feel more, most comfortable with or what might be easiest. And then we do what we got the paperwork covered. Now what?

Mark (09:06):

So you're sending that out to the patient. So they need to agree to be treated digitally. Right now it's really an interesting space. The CMS has waived temporarily a HIPAA privacy with when it comes to digital communication. I'm can't stress this enough that this is a temporary wave in, in the absence of mass abilities to communicate or HIPAA compliant platforms that patient that people are able to communicate via other means of non HIPPA compliant video software. So right now Skype and FaceTime are considered and what's the other one? Zoom and zoom and those well-known platforms are, are open, enable all those zooms just increased their prices yesterday. Yeah, so I would argue that you could use the, what's free and what's available right now in preparation as you prepare after this is over, you'll need to go back to HIPAA compliance. So in the immediacy video platforms are readily available across all. You cannot use public facing video platforms like tick talk or other things that mass put out your video. Okay.

Karen (10:22):

Instagram live or Facebook live. You can have your patient video, you can have your patient treatment sessions over live video,

Mark (10:30):

Right. That it means sounds, it sounds obvious, but you never know where people will do right by a group session. You can just do a giant group session. I'm going to train everybody on the East coast of America on a Facebook live.

Karen (10:42):

Yeah. Okay. All right, so good to know. So no one social media lives like we're doing right now, but for the time being during this outbreak, we can use face time, we can use zoom, we can use Facebook, zoom, Skype,

Mark (10:59):

Right. Totally. And you need to make sure that in your notes and documentation for your intake software or your intake paperwork, that you are waiting, that the patient is waiving their HIPAA rights during this time due to the COBIT outbreak and you are using this unsecured software and you will return to it as soon as possible. Right. Okay. This is a window. This isn't something that will last. And you need to note for your own CYA that you are, you acknowledged the existing coven scenario and that you will prepare for post that with, with my platform. Yeah. Yep. So technology on the technology side, it's really easy because you can plug and play as long as you get someone's if they have an iPhone or if they have Skype, easy set up, you can connect technology there. So once you get the form signed, you have the informed consent, the HIPAA, the HIPAA included waiver as well to sure that they understand that they are on an, they have to understand and agree to an unsecured network.

Mark (11:58):

Even though you can provide it, some people may not want it because FaceTime, that's all easily hackable. Right? So so they may not, or may, they may, they may not want to agree to that. So just have to be transparent with them in the, in your services. Right. So once you get that, I mean, it's really a matter of getting the patients, depending on your system, everybody's so different. So if you're, if you are a concierge PT and you're practicing out there for a fee for service cash base, you handle all your own scheduling when it comes for their time, you just flip them and you just call them on FaceTime, right? You collect their face, their number and you connect that way and you do your treatment, which we'll talk about in a bit, some other scheduling systems. You may have to, you know, type in a telehealth visit and your scheduling system or have some type of a demarkation for a telehealth visit versus an in person visit.

Mark (12:47):

And so work with your scheduling software, work with who you work with in order to make sure that that's appropriate so you can have the right amount of, or the right type of scheduling so you know where to go and what to do and how to bounce it. A billing, again, for the concierge practices out there, this is fee for service. Tele-Health doesn't take as long as normal to as normal PT. So I have my hourly rate broken down into 15 minute increments because it's roughly about 15 to 30 minutes. Is it an average tele-health followup evaluations in the last 40 to 50 minutes? But it just completely depends. So fee for service, it's really straight forward. You just charge per time, per minute, dollar, dollar, dollar, $52 a minute to 15 minute depending on your price point.

Karen (13:29):

Okay. All right. So now let's get into, so knowing how to actually set it up. So we've got a lot of these different things. What are some other platforms? I know anywhere. Dot. Health care. Doxy.Me.

Mark  (13:46):

Yup. Doxy.Me co view. So anywhere. Dot. Healthcare is the platform that I created. It's straight forward. Right now I'm offering you a $10 a month, unlimited use for anybody for three months while onboarding everybody. So to, to help people get to see patients doxy dot. Me actually has a free version where that's a, a room where people meet. So you can actually sign up. The patient is sent a link, they click on a link and it drops them right in a meeting room. Super convenient, super easy. There's no bells and whistles and it's free right now. So you can do that. I think a couple of other platforms I've seen throughout the Facebook live of Facebook groups that I'm in a few platforms are pushing out a free entry level software right now. So it's everywhere. So I think

Karen  (14:31):

We'll use G suite

Mark  (14:32):

D suite, right? So G suite, if you have a BA with, with Google, you can use Google meet. Right now actually with the, with the HIPAA waiver that's happening right now, you can actually use Google hangout. That would be another appropriate thing to use as long as the other person has the G suite or Google doc, a Google suite downloaded on their computer. So there are lots of, there's literally lots of options now there, there are other companies that offer other features, right? As you get into anywhere that healthcare, not only as a platform, but also as a billing feature and a scheduling feature. Doxy dot. Me if you upgrade to the higher levels, has a scheduling feature, a messaging feature, all types of stuff. So it really looking for different platforms. You need to be, do your due diligence and test them out to see what fits your practice best. I mean, some, some have exercises that are completely a part of the package that you can just have an HTP that sends right out from the program. Some have an actual, a range of motion measuring system so people can move their arm or their body in front of them. The then they can actually measure range of motion live on camera, which is pretty cool. So it just really depends on the need for your, your practice and also the practice size.

Karen  (15:44):

Got it. Yeah. Okay. So that's a lot of options for people going from free to low priced too.

Mark  (15:52):

$200 a month for co for HIPAA compliance zoom.

Karen  (15:55):

Right, right. Yeah. Yeah. Okay. So lots of options there for people. So we know we need some onboarding paperwork and we need to call our liability insurance carriers to see if they cover telehealth. Presently. And if they don't, then we need to ask them to put an addendum on and you can, they can do that immediately. It doesn't take like 30 days for that to happen. Right. Should be immediate. Okay. And so once we have all of the right paperwork and everything we decide what platform we're going to use and you just gave a whole bunch of different platforms that people can use. So all of those platforms are pretty easy to set up. And like you said, you send a link to the patient, they'd drop in and boom, there you go. And at this time we can use Facebook and Skype and, and not Facebook, sorry, Facebook. We can use Skype, regular zoom face time, all that. Okay. All right. Now

Mark  (16:58):

You may need other equipment though. You may, depending on the situation you may need. So some people, a desktop versus a computer are versus a tablet versus a phone all matter, right? So a desktop computer tends to be really well for you to have good communication and see the patient really well. But it's also very challenging for me to move my desktop to show somebody how to get on the floor and exercise, right? So the part of being a a digital physical therapist is that you have to be able to move and your equipment has to move with you. So some people use, I, you know, some people use a selfie stick to demonstrate exercises, right? Some people have one of those little iPhone holders that can be multiple or wrap around something so they can have different angles or show people at different places.

Mark  (17:41):

So understand that desktop can be good for this face to face interaction and the, and the immediate subjective interview. But maybe moving towards the objective exam or, or showing the exercise parts you may want to find or have a different device that's more mobile. So just thoughts for that. And you also need to think about your area or your headphones, your microphone and your lighting that can all add or take away from the experience of the digital experience. So making sure that you have those things. I use, I'm old school. I just use the old wired ear buds. They, when you're on the computer a long time, the wireless can die, right? And then all of a sudden you don't have new headphones. So I'm always a fan of just good old fashioned things that won't die on you after a long day of work.

Mark  (18:26):

So something to think about. You also may want to get a tripod to hold up your computer or you can get a standing desk. So there's lots of options in that space. But also you have to be considered for your backdrop. I love your backdrop that you have there in New York here and with the, with the cherry tree, that's all. It's very Boston's. That's awesome. I just have a plain white wall. Just be mindful of the environment that you're delivering this care in, right? You don't want you to be distracted. You don't want the patient to be distracted. You need to connect with the patient. Some of the key things that you need to think about are the connection that you're going to have with a patient. Something you can do easier face to face. It's challenging to get the connection and to have the emotional connection with the patient by a digital care. So setting up the environment for not only you to feel safe and, and that you feel comfortable that you're, no one's going to bust in, but also your patient needs to feel safe in that space too, so they can communicate to you in a free way that their patient information isn't being broadcasted to other people as well. So backdrops, microphones, computers, tablets, all have to be taken into consideration while you're doing this, while you're doing this intervention.

Karen  (19:32):

Okay, thank you. Those are great tips. How about cats that could, that could help or hurt you. Right? People love a cat. Great. If not, it can be a problem

Mark  (19:44):

Or at least they're not allergic to it. They're alerted to it. It doesn't matter. Right? So

Karen  (19:47):

Right. So pets can help or hinder, just kind of depends. Okay. So we've got, let's say now everyone has a better idea of how to set it up. And then the next question I got was how, Oh, they said this is great. Sound isn't great. I don't know why this sounds not great on, on Instagram, but, well, I mean it's going to be out on it as a podcast as well. So we'll, you'll be able to hear full sound tomorrow. At any rate, I dunno what to do. I could get my earbuds, but as we just said, what if they time out on me? Yeah. Okay. So let's talk about let's talk about how do you, what was it? How did, Oh, how do you actually execute a session?

Mark  (20:40):

Yeah. So once you've got somebody on the line, once you've got a patient in front of you, right? We know from our PT and our PT exam that about 80 to 90% of your differential diagnosis occurs in the subjective. So you go back to your old way of being, you shut up and you listen to the patient. Right? So, you know, so this is also assuming that you're doing an evaluation via telehealth, right? So most people at this space have patients that they'll flip from brick and mortar or in person into telehealth. So that's a different beast, right? So that's followup. That's exercise progression. Those are obvious things, right? That you're going to show them. You're going to talk them through their progression and talk to them about what they need to do next. Maybe show them a few new exercises when you're, we're, we're going to get, what we're talking about right now is the new patient that you'd never met before and what, how do you gain information to get them treated?

Mark  (21:33):

So subjective is key, right? You need to have your differential diagnosis hat on. You need to ask the next best questions, their intake form. You should have looked over, created your hypothesis list and make sure that you have a good idea of what you're trying to discover. It's your responsibility as a provider. I know it's written in the Texas legislation that if you, if the patient is not appropriate for digital care, you have to get them to an in-person provider, right? So doing your, you still have to do your red flag screens, you still have to do your due diligence and your differential diagnosis and make sure the patient's appropriate. Right? This is, you have to consider a digital visit to be no different than an in person visit. You have to take every precaution that you would take. I'm minus taking vitals unless the patient has their own, you know, portable, vital kit. You're gonna have them do that. But you have to take every precaution you would from an initial evaluation perspective as you would in a digital space. So going back to forms, you also have to have your intake form and consent to treat in there as well. That needs to be signed off as well.

Karen  (22:31):

So the, the same sort of forms that someone would have if they were coming to you or if you're like a mobile practice like me, you have them sign that initial paperwork regardless of whether you're seeing them in their home, in your clinic or, or via telehealth completely.

Mark  (22:48):

This is, you cannot be this any differently. Right? So take it, having all the consent to treat forms, signed all your intake paperwork done, differential