Healthy Wealthy & Smart

Healthy Wealthy & Smart: Where Healthcare Meets Business. The Healthy Wealthy & Smart podcast, hosted by world-renowned physical therapist Dr. Karen Litzy, offers a wealth of knowledge and expertise to help healthcare and fitness professionals take their careers to the next level. With its perfect blend of clinical skills and business acumen, this podcast is a one-stop-shop for anyone looking to gain a competitive edge in today's rapidly evolving healthcare landscape. Dr. Litzy's dynamic approach to hosting combines practical clinical insights with expert business advice, making the Healthy Wealthy & Smart podcast the go-to resource for ambitious professionals seeking to excel in their fields. Each episode features a thought-provoking conversation with a leading industry expert, offering listeners unique insights and actionable strategies to optimize their practices and boost their bottom line. Whether you're a seasoned healthcare professional looking to expand your skill set, or an up-and-coming fitness expert seeking to establish your brand, the Healthy Wealthy & Smart podcast has something for everyone. From expert advice on marketing and branding to in-depth discussions on the latest clinical research and techniques, this podcast is your essential guide to achieving success in today's competitive healthcare landscape. So if you're ready to take your career to the next level, tune in to the Healthy Wealthy & Smart podcast with Dr. Karen Litzy and discover the insights, strategies, and inspiration you need to thrive in today's fast-paced world of healthcare and fitness.
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Now displaying: July, 2021
Jul 26, 2021

In this episode, Founder and CEO of Rehab 2 Perform, Dr. Josh Funk, talks about his experience with the business side of physical therapy.

Today, Josh talks about how he created his business culture for employees and patients, his community outreach, and how he assembles his teams. How has Josh grown his business so quickly?

Hear about the importance of a balanced dashboard and being mindful, and get Josh’s advice to his younger self, all on today’s episode of The Healthy, Wealthy & Smart Podcast.


Key Takeaways

  • “If I think of somebody who has more autonomy, I think of somebody who’s automatically going to be more engaged.”
  • “The first thing that you need to start with is admitting that you don’t have all the answers.”
  • “We move fast, we break sh*t, we fix it, we move on.”
  • “A lot of it [growth] starts with continual self-analysis.”
  • “Me working in my business was the single biggest blockade for us moving forward.”
  • “We’ve put equal investment on people, we’ve put equal investment into our local communities, and we’ve put equal investment into the company as a whole, and as long as we continue to feed those three different areas, and maintain lines of communication, I think we’re going to continue to be successful.”
  • “A conscious capitalist is somebody that’s mindful of all stakeholders.”
  • “I view the 35-50 year old female in the community as being probably the single most influential person in your local community.”
  • “When I think of marketing, I always think of market relationships.”
  • “When you start your company based on core values, you have people that are culture champions.”
  • “Your balanced dashboard is most likely going to lead you to better decision-making and getting a better gage for what is actually going on behind-the-scenes in your business.”
  • “Much of healthcare practices from a business standpoint are extremely dated, and you are better off spending time studying businesses in other industries for inspiration.”
  • “Continue being open for inspiration in a wide variety of places. You’d be surprised, if you had an open mind, what you might be able to see in something that, maybe at one point in your life, you completely ignored.”


More about Josh Funk

Dr. Josh Funk was born and raised in Montgomery County, MD and attended Poolesville High School. Josh went on to play Division 1 lacrosse and earn a B.S. degree from The Ohio State University before earning his Doctor of Physical Therapy (DPT) degree from the University of Maryland-Baltimore. It was a little over 3 years after graduating from Maryland, that Rehab 2 Perform was founded in late 2014.

In addition to his physical therapy expertise, Dr. Funk has been equally, if not more committed to the growth of his role as CEO of Rehab 2 Perform. He has made sure that his personal development is not just reserved for the clinical side of things, but also to ensuring that Rehab 2 Perform is one of the most well-run and well-known health care companies in the area. Dr. Funk has immersed himself in business programs and community initiatives over the past few years in his efforts to ensure that the team and clients of Rehab 2 Perform are receiving everything they need to be at their best. It is his goal to push Rehab 2 Perform to the forefront of the community through innovation, progressive business operations, strategic growth and clinical excellence.

A lifelong athlete, Josh became interested in becoming a physical therapist when going through PT as a D1 lacrosse player at Ohio State. After avoiding shoulder surgery for a torn labrum and rotator cuff, Josh has been entrenched in the world of physical therapy and sports performance. Over the years, he has continually developed his knowledge base and expertise as a physical therapist through continuing education courses and working with athletes of all ages. A Montgomery County resident, Josh is heavily involved in all areas of the community throughout the region.


Suggested Keywords

Rehab, Physical Therapy, Physiotherapy, Autonomy, Community, Business, Metrics, Performance, Processes, Teams, Decision-Making, Healthy, Wealthy, Smart,


Round Table Talks: Round Table Talks


To learn more, follow Josh at:



Facebook:       Dr Josh Funk

                        Rehab 2 Perform

Instagram:       @drjoshfunk



Twitter:            @drjoshfunk



YouTube:        Rehab 2 Perform

Round Table Talk: BizPT 


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Read the Transcript Here: 


Hey, Josh, welcome to the podcast. I'm so excited to have you on today. Karen, thanks for having me. I'm just a big fan of everything you have going on and just everything you're doing for people in the profession.



Ah, thanks. That's nice to hear. And today, well, actually, this whole month, we are talking about the business side of physical therapy. And so I wanted to have you on because from what I can tell, not that I'm knee deep into your business, but from what I can tell on social media and your website is man, you are really growing, you have a budding business, it's an interesting business, it looks like your customer service is top notch. And people genuinely like your business. And they like you. So let's talk about the growth of your business and how you're able to do this in I would say a relatively short amount of time. So I'll just throw it over to you to just talk about your your business, why do you talk about your business first, so the listeners know who you are, what you do where you are, and then we'll get into how you've grown so quickly. Absolutely. So



for the listeners out there, I am the owner of rehab to perform. It's a fitness focused physical therapy company, offering, obviously physical therapy, sports rehabilitation services, concussion rehab. And then we have a couple different wellness offerings, including a golf program, golf fitness program, and our two p plus, which is kind of a discharge program, that people utilize an app receive home workouts and are able to communicate with their PT after more formalized discharge. But you know, you alluded a little bit to the growth that we've had, over the years been very fortunate past couple of years, including even during a challenging year, last year, just to continue to be able to move forward, I would if I had to break up, the time that the business has been in existence, I would say you have the first three years, and then you have the last kind of three and a half, almost four years, first three years, really just trying to figure things out, put the pieces together, do everything you can honestly to get out of debt have that minimum viable product. And when I was thinking about that minimum viable product, viable product, a lot of it surrounded creating an environment where PT was not a grudge purchase. So how do you create healthcare and physical therapy that is not a grudge purchase, it's something that has very, very minimal friction, people easily interact with it from a from a, you know, front desk customer service standpoint. And then when they actually experienced the clinical side, it is something that speaks to them, it is something that is enjoyable. And that goes for everything from just the processes and the kind of people that you have, as well as the deliverables. So, you know, these past three and a half years, we've been fortunate to, you know, heading honestly into opening our sixth location this fall. And we're very, very close to opening our seventh location. In early q1, we are based out of the DMV, and for anybody's unfamiliar with that, that is DC, Maryland and Virginia.



Awesome. I mean, it's just, it's pretty amazing. And you you hit on something that I want to talk about really quick before we go into the how you grew. But that's creating a culture that's not a grudge purchase. So let's talk about how you created your business culture, because I think this is something that is often overlooked, especially in in a lot of businesses. But how did you create that culture for your employees and for your patients?



I think if I start with the employees, I think a big part of what at least has influenced me was being in situations in which I perceived there to be too much rigidity, in terms of the how, and there was not enough autonomy given to people to just execute. Everybody executes things slightly different. And much like I would say, a good clinical framework. But if you have a very, very good cultural framework for your company, people kind of bounce back and forth between the guardrails so to speak, but you don't have this rigid playbook. Were rigid rules that are in place. There's a little bit of flexibility, adaptability, and at the end of the day, it is a shared way of doing things. It's a collective and it is not a top down style of leadership. It is more of this, what I'll call like circular leadership. So people are more familiar with, you know, an organizational chart. That's more formal, obviously, if somebody's at the top and it kind of trickles down and always whether or not it was you know, Anything from a student internship program to a specific program that I mentioned earlier, or somebody who's taking a role just on a project, or somebody who's in charge of a specific location, there is a certain a certain amount of autonomy that they are able to have. And I think that that ownership that is created really allows people to, I think, engage more when I think of somebody who has more autonomy, I think of somebody who's automatically going to be more engaged. And then if I think that I take it to the consumer, the customer, and I always like to call them clients, because at the end of the day, especially in a place like Maryland, you know, they have a choice. Direct Access is something that we have almost, you know, a, I would say, the most liberal version of it. In the United States, we have more than probably 75% to 80%, I can say definitively on a regular basis of people who come to us without having a physician tell them to come to us. So that being said, the only way that that happened was creating an environment that was enjoyable, I wanted to create chairs, a barber shop in your local bar, and deliver PT, so the more that you can make it, something that resonated with them. And for me, I always thought of a gym environment, it was very, very enjoyable, people liked being at the gym, you rarely wanted to, you know, potentially leave as well. So when you walk in, you know, it's it's open, it's friendly, there's quotes, there's gym equipment, there's a certain way of greeting people, people are going to greet you that aren't even necessarily your PT, the manner in which you're communicated to is going to be, you know, there's there's a certain amount of intent and thoughtfulness behind it. What you're going to be provided during that session is going to be something that ideally you leave with, and you go, this is personalized, individualized, and it resonated with me. So I was thought about trying to create an environment where somebody went, Oh, man, I got something small going on, I'm just going to go right into rehab to perform because I love going there, I get to go there, instead of I have to go there and that small change. And we can go down to all of the many pitfalls of your local pops, physician place that's sterile, right? It's boring, you have something that looks cookie cutter, you are doing the same thing, almost every single session, there's a lack of connectivity, right? There's not even music at some of the places in there. Everybody's wearing the same exact thing every single day, right. And we can go down that rabbit hole that people went down recently on Twitter surrounding professionalism. But I think overall just you create an environment that if I take it back to the top, you create an environment that has been shaped by so many people that have been a part of our company, too. I might be the CEO at this point. But I'm just a really good listener, just listen to people. And we make changes based on what the group wants. I'm not sitting here. And just telling everybody that I have all the answers, there was no different than advice that I gave to a young clinician the other day where he was like, Where's the first place I need to start, I was like, the first thing that you need to start with is admitting that you don't have all the answers. And the sooner you get somebody that's a cultural fit that comes in your place. And they show you a new way of doing things, the better off you'll be. But too often I think people get in a situation where they can't let go. And they can't allow other people or they think they found the special sauce. And I sit here today with a team of about 35 people. And I will tell you that I will listen to the new new front desk person that we just hired because she has new perspective and a new way of viewing things. And she can add value. And we never get to a point where ideally we're that we're that fixed project, fixed product. And then it has been that collaboration over the years that led us to both have an environment that people enjoy working in an environment that people enjoy interacting with the professional physical therapy.



Excellent. And this is gonna sound really familiar to you. But it sounds to me like your operations and processes. So if I say that to Josh, Josh and I both took while I'm still in it, he has taken the Goldman Sachs 10,000 Small Business program, we were talking about operations and processes, which is one of the modules before we came on. And the thing that resonated with me with what you just said is you you give people the process or the sub process, let's say and the details are up to them. So you're giving them autonomy. And to me that leads to innovation, it leads to better care leads to better efficiency, because you're allowing people to make the process there. own while still getting the work done, right?



Yes. And I would say that that makes me think of the number one question that we ask when something gets done wrong is not a people person, it is a proper process problem first and foremost. And we go to that person and say, hey, how can we make sure that this does not get done wrong? Again, okay, we did not provide you with enough support, we did not provide you enough clarity, we did not provide you enough, whatever. But I am asking that person who may have automatically get on the defensive because they got something wrong, quote, unquote. And instead, they're becoming a part of making sure that process is easier, it takes less steps, there's more clarity, whatever. And then there's ownership. And then they automatically feel like oh, my God, okay, now, instead of me getting yelled at, I'm in an environment where when screw ups happen, we just, we just work on it make it better, like, then they show up to work every day, you never really worried about screwing up. Because what do I tell people all the time, we move fast, we break shit, we fix it, we move on, okay. And at the end of the day, we are we're trying to move relatively quickly. We're trying to be agile, we're trying to make sure that we're doing everything we can to kind of get out in front of, you know, really the, you know, the profession in healthcare as a whole and ideally, continue to show other people that, you know, there's a different way of doing things, a different way of doing things.



Yeah, I love it. And, and that is something that I didn't really think of before until literally today. Just before we went on the air is all these like operations and processes, which I always thought were so rigid, right. But if you give people the autonomy and innovation, I can only imagine that helps you grow faster and smarter. So let's talk about your growth. How did this happen? I think we can confidently say operations and processes are a big part, what else helped you to grow your practice, because I think there are some listeners out there who might be at the stage, like I'm going to grow my practice, but I have no idea what I'm doing.



I think, you know, a lot of it starts with just continual self analysis. And I think that I finally got to a point where I recognized that me working in my business was the single biggest blockade to us moving forward. And I think part of that also was me recognizing that I, I have a little bit of a unique skill set. And that's not to say that my skill set is more important. But then from a collective standpoint, my brain works a lot more in branding, sales, and marketing. And I needed to be spending more time in that area. So let's say about three years ago, I finally stepped back. And I put myself in a position where I was spending more time than ever, on the ins and outs of the brand of our company, the brand of the profession within our company, our sales and marketing strategies, and then to be quite honest, doing a better job of making sure that we had more of a predictable rollout when opening up a new office. So at this point, you know, we have, I hate to go back to processes again, but we have a very clearly defined rollout. And it starts about six months out. And every 30 days, you're doing X, Y and Z. And there are you know, at this point it I hate to say it, but you're almost following a playbook. And much like I referenced earlier, it's not necessarily rigid. But we know that at least if we're doing these things here, and at least 90% of that we're going to put ourselves in a good place to be successful. But I think you know, the biggest thing was recognizing that I had what it took. And it was after the Goldman Sachs 10,000 small businesses program to actually operate a business because before that program, I was solely a PT, who had hired myself to deliver good PT, I wasn't necessarily doing everything that I needed to to support the team. And to put us in a position where growth was naturally happening. Now if I get back to why we're growing now, I think we've put equal investment on people, we put equal investment into our local communities, and we put equal investment into the company as a whole. And as long as we continue to feed those three different areas, maintain lines of communication. I think we're going to continue to be successful when we go in and we just opened up a new location last Monday. And I think we're going to just put ourselves in a good spot and that kind of goes to just some found Thanks for me, I know that a lot of people hear the word capitalism. And I think they there's enough stories out there and examples of, of what I would consider more of the poor version of capitalism, that crony capitalism, one that maybe is a little bit more focused on, you know, your, your, your money, right, you're just focused on bottom line. And that's pretty much it. But I think of a cop of capitalism, I always want to think about being a conscious capitalist. And a conscious capitalist is somebody that is mindful of all stakeholders, all stakeholders, being the people on your team, they all matter, the small people, the big people, whatever you want to, you know, do people that people have been with you forever, that people that are new, right, you have to make sure that you're placing value in those people. And then for us, we have five different community hubs, so to speak, that we have initiatives under just to make sure that we're making connections, we're involved or engaged, we have a pulse on the community. And then we're finding ways to meet people where they're at outside of our four walls, ideally, deliver value even without asking for anything in return. So that that conscious capitalism piece, that's one of my favorite books, I think that's always been something that's kind of been near and dear to my heart. And in putting something out there from a business product standpoint that people could look at and say, you know, what, that's a that's a big, it's a business of the future, just in terms of how it's run.



So let's talk about that foray into the community. Because that is important. So if you are setting up shop in a community, what advice do you have for budding entrepreneurs and therapists who maybe have been in practice for 10 or 15 years, but maybe they sort of stalled? You know, because that can happen? Right? So what are some examples of your community outreach or outreach? Excuse me, or how you insert rehab to perform in the community?



Yeah, I mean, I think a big part of it centers around our avatars and our avatars being like our ideal consumer, right? Who is your target audience who interacts with your business the most at the location in which you have right now or locations, and you build out the community touchpoints that that person has. So I'll be quite candid, I don't think anybody will be surprised. But I view the 35 to 50 year old female in the community as probably being the single most influential person in your local community, probably you can stretch at 35 to 55. She is in a family where she is literally dictating the decisions for the head of household, the kids, the grandparents, the in laws, etc, there is nobody who is more influential in terms of what people are doing in the family, and where they're going. So if you just appreciate that as a whole, then you start to look at a little bit more of trends. And some of the metrics surrounding where that type of demographic is interacting. And for us, we also build this into our five hubs. So, you know, from a medical standpoint, fitness standpoint, business, youth, sports, and schools, what is that particular target demographic doing? Where are they interacting? Where are they going, and then you start to have a little bit better idea of where you potentially need to develop your connectivity, but initiatives under those five umbrellas after first and foremost, creating that lead avatar is something I recommend to everybody. We do have other avatars, I would say for us, it's a competitive athlete, college athlete, high school athlete, you know, your your clubs, use sport athlete. So, you know, who are the influencers in that community, who are the influencers, providing guidance to that individual is everything from skills coaches, to strengthen conditioning coaches, to the actual sport coach, to the club director to the athletic director, and you start to build out these chains of almost influence that that these people are connected to, and you have a better idea of who you need to have that market relationship with. And when I think of marketing, I was thinking of market relationships, right? It's not necessarily creating a piece of content to put in front of somebody, it's not necessarily you know, sending somebody something and give him a hard sell. Sometimes it's just the Hey, I saw your work I'm connected with so and so they just came into the office, you know, I keep hearing more and more and I'm at least curious at this point. Can we go grab coffee or if we got on a phone call? I'd love to learn more. And the more that you're genuinely curious about people, and you're invested in learning about them, and and actually taking the time to show that you're, you're genuinely interested in in that particular relationship. I think the easier that these relationships come about their authentic people can feel them and it becomes a lot easier for you to get into what the most important is part is who you are, what you do, and, and how you solve people's problems. So once you have those three things communicated, and I should say, once you have that authentic relationship, it's much easier to clearly communicate that those three things you bring to the table once again, name, what it is that you do, and how you solve people's problems. So that's kind of a little bit of the behind the scenes just in terms of, you know, my thought process. When we go to new location, you know, we have our initiatives, you have a pretty good idea of what works, obviously, there's some uniqueness to each area. But we're starting to develop those relationships, probably a relatively early time period. I mentioned before, we have a six month clock that we function off of. And really, you're just trying to find a way to almost solve their problems before they even necessarily need to send somebody into your office.



Yeah, amazing. I love everything about what you just said. And I really hope it gives people listening who are maybe thinking of starting their own practice or expanding like this is work. Yes, right. It's not like I'm gonna open up a practice, just because I feel like it is like you have to do this is done before you open your doors, you need to know who your avatars are your ideal clients, your ideal customers, whatever you want to call them, and you have to build them out. And there's more than one. And for every single one of those, there is a separate marketing plan. There is a separate communication plan for each and every one of those avatars, you do not use the same marketing plan for Well, the 35 to 50 year old woman who Yes, the women are the users and the decision makers. We all know that they run the show. There's no secret anybody out there says no, you're sorry, sorry, wrong. But you know, you're going to market and communicate with them differently than maybe the local college athlete.



Yes, right. 100%. They have different needs, different interests, different places that they're frequently interacting in the community. 100%



I love I love everything you just said. I think that is just a wealth of advice for anyone listening to this podcast, who I can't wait to we do our roundtable next week. Awesome. Or I shouldn't say next week. We're recording this a little earlier. Tomorrow, tomorrow. All right. So now everybody, the jig is up. It's not live. But yeah, no, I love that. All right. And then last thing about growth and movement within a business is really assembling a good team. Yes. So talk to me about how you assemble your team or teams within your business.



Here's the part that I'll be at least honest about the early part of the business and say some of it was just damn good luck. The first person that I had a part of my team probably could not have been more of a culture fit than if maybe he was a part of my own family. So we went to PT school together. We didn't grow up very far at all. From a high school standpoint. family values were all very, very similar. We had very similar outlooks on the world similar ideas when it comes to came to leadership. And when you asked us in general, what your principles and values were, that governs your life, they were very, very similar. So I was fortunate to actually and I'll probably get a couple chuckles here, I convinced him to quit his job. Right after his wife had delivered their first child, I think that their first child was four at the time. And I gave him three months of paper checks. And I said, hey, there's enough money here for you to quit your job and give it a go. But nonetheless, he helped me kind of shaped the culture of the company. Our next hire was a female was more compliance oriented, somebody that we definitely, definitely needed. And then the fourth person, some people might be familiar with Dr. Jared Boyd. He's now an NBA PT for the Memphis Grizzlies. And his commitment to I'd say, research, and the clinical side of things was kind of what Zack and I needed. And what we needed was contrast. So we overlapped on a lot. And we were able to find contrast in terms of areas in which we didn't have a natural affinity to we're really have that much interest in diving into and then moving forward. We hired people predominantly off of, once again, a collective decision making process. It was, Hey, is everybody comfortable with hiring this person? There was no one person in charge of the hiring process. And a lot of what we did was make sure that there are multiple touch points for that person to interact with our business. So whether it was an early exploratory phone interview, that then would follow into a formal phone interview, obviously, that things like a background check references, etc. And then you would actually have them come into the office and spend some time Hey, Shadow, people spend time with the front desk. And you start to get multiple touch points where every single person at the office had at least interacted with them enough to go Yes, or we've had more than our fair share of knows where somebody's got a wrong vibe, or something was said or something was picked up on. But making sure that you know, hires especially at this stage of the game, where we do have five locations, me hiring for a location, and me being the sole decision maker is silly, I do not work at an office with these, right, these people for 30 to 40 hours, I'm spending a much smaller block of time. So at the end of the day, the people that need to have the most influence are the people that actually are the leaders at that office that are at that office every single day that to be quite honest, probably have more control over what's going on in the culture and in the environment at that particular office than I do. So I once again, I think it goes a little bit more to like your decentralized leadership style. And your you have more of this flattened approach to leadership where a lot of people are involved. But if we talk about just central pieces to team, what are your values? What are your principles, those have to be the early conversational points, that that drive the conversation about whether or not this person is a fit, we have our core values literally on the wall, every single office is transparent, so much even that the clients can see them. You know, so when when you start your company based on core values and principles, everything from I mean, a couple like just basic things, obviously, you know, education, empowerment community, for us to be talking about principles on offense at all times, right? solutions instead of problems. Or we say thumb first, instead of pointing a finger, right? What can you do to potentially change something than then pointing a finger in another direction. So I think when the foundation of the company is just so grounded in in those core principles and values, you have people that are culture champions, and at the end of the day, people understand that, that the sole reason why we've been able to do that we've been what we've been able to do is attracting people for the right reasons. It's not people that necessarily are championing solely their GPA or their clinical knowledge and expertise and kind of beating their chests about how smart they are. It's first and foremost, foremost, like, how does this person align with us on a foundational level, we know that at the end of the day, that person will become the best version of themselves within the company, because they value with the rest of the collective value. So I know when a bunch of different directions there, but I think, yeah, I mean, we've been very just purposeful. And there's been a lot of evolution, I'd say there over the years and knock on wood. And I never like to honestly say this without just just being aware that it's not just me, it's our whole team. But we have only had three pts in almost seven years decide to leave the company, one was for the MBA, one was for home health, because she wanted to spend more time with their kids and another one would took a military job. So we've not had a single person yet that's had a parallel move to somewhere else in the local community. They've either completely moved in are on a base somewhere or in a professional sports organization, or in home health, spending more time, you know, raising their family things that we can't compete with as a company.



Right, amazing. And, and I really like that your approach to hiring, I guess it's the hiring funnel. You know, we talk about sales funnels and marketing funnels, you have a hiring funnel, where it starts with some exploratory calls to more formal, and then you keep going down. So you may have 100 exploratory calls. But as you funnel down into how many ideal candidates are for the job, maybe it's two. Yep. Right. 100%. So I think it's a nice visual for people to see that.



I am involved in exploratory. And that's literally about it. At this point, I will get resumes and stuff will catch my eye or somebody will connect with me on social media. And there'll be something that I'm at least like, hey, let's explore this. And I'm often handling an exploratory call on looping in people, most likely the site directors at potential offices that could hire this person. And then they actually start to incorporate the other members of their team for calls as well. So it really becomes a point where this person goes, Oh my gosh, I could be a part of this team. I bet make an impression, or different times or five different times because all of these people are important. And if any one single person says no, then we move in a different direction. And that has happened before.



Hmm. Amazing. I love it. Okay, so we touched upon your company culture, we touched upon your avatars, your team, how you've been growing? I mean, we can go on and on and on? Or is there any other major point that you wanted to hit about the growth of your company that we didn't touch upon that you're like, Man, this is super important. I really want people to know this. I think a balanced



dashboard is very, very important. And I think that in a world where people do focus a lot on productivity and utilization, right units, or how many slots you have filled, and I'm not here to say that that's not important, because at the end of the day, you need to have a business that is delivering a service for a certain amount of time, and having an individual which you're providing a salary benefits, etc, PTO, whatever, some some benefit, that certain things are also, you know, reciprocated. So it's not to d value those but to paint a better picture of business health and metrics that would support at least for us, when I think of smart growth, it's like, Alright, how do I know that we're just not adding locations, and the quality is rapidly diminishing? Okay, that stuff over there good. We get people in the doors, okay, yes, in terms of just keeping the lights on, we need to be able to have a certain amount of billable units. And if we hire somebody, they need to have a certain amount of slots allocated. Beyond that, what else is meaningful for us to continually be looking at. So net promoter score and churn rate are two big metrics that I'd say we've looked at more and more, especially over the past two years, for people are unfamiliar with Net Promoter Score, it's considered a gold standard with regards to brand loyalty, and the creating the kind of word of mouth referral generating, I think all of us are looking for. So I say this, once again, just to provide perspective, but we add locations, we have to make sure that the company stays above 90, which is considered world class. And when we don't, or something pops up, or somebody is saved below 90 for a given quarter. You know, there's certain just conversations that are had, in addition to the fact that when we have a seven or eight, or a six or below, there are certain things that are happening internally to make sure that we're being mindful that somebody is either potentially a little bit passive on what we have to offer. And they've communicated that or they potentially might be somebody who's going to drop off. And then when you think about churn rate, just think about somebody interacting with your business and having a negative experience and not even really giving it a chance for you to work with them. To get towards ideal outcomes. At the end of the day, we're trying to drive outcomes. So when you get somebody in, and you've put time and energy behind communicating what it is, who you are, what you do, and how you solve their problems, and they get so turned off after a visit two visits or three visits, that they've gone somewhere else, or they just altogether potentially left the profession. That's not necessarily a positive thing. There is metrics out there to support that, say, if they get to four visits, they are X amount more likely to actually go through a plan of care and be able to see some of those ideal outcomes that I think all business owners would think that their business can, can provide. And then, you know, outside of that, I mean, obviously online reputation, being mindful of Facebook reviews, Google reviews, those are some some big ones for us. And then not to completely discredit your functional outcome measures, right. And then there are certain things in web PT we have afforded where you're able to track pain from IE to DC are able to track satisfaction goals met, in addition to some of your outcomes measures that are a little bit more formal. And yeah, the insurance companies telling you to do them, but doesn't mean you should automatically dismiss them. Right? There's, there's often some tangible and objective data out there that a lot of other people are valuing. So take it with a grain of salt, you're not putting much like your evaluation, right and your return to sport testing, because that's the world we live in where everybody likes to argue about that all the time. You're not putting any more value on any one given thing, the more that you have this aggregation of data, the better off you're able to look at that and maybe potentially come up with certain trends or or certain things that in terms of painting this more broad picture better define your your business health So figure out your balance dashboard, your balance dashboard can be applied to a lot of different things obviously could go behind the scenes with regards to finances and stuff like that, but all other conversation 100% but you know, your your balanced dashboard is most likely going to lead you to better decision making. And giving you a better gauge for what actually is going on behind the scenes in your business. And it really, it's, it's, and I always look at that, and I go, Well, this is telling us whether or not a process actually works. And if I'm not getting what I want to hear, we need to go back to process,



I was just you took it took the words out of my mouth, I was gonna say having that balanced dashboard allows you to make better shared decision making 100 better, better shared, better shared decisions. Yes, just like just like we would do with a return to sport after an ACL. It's a shared decision making between the therapists, the coach, the parent, the the patient, whoever it is, everybody's got some input. So when you look at a good balanced dashboard, and just for people who aren't familiar when we're talking about what a dashboard is, it's where you have, what metrics you're using to evaluate your business. And those metrics can be your net promoter score, it could be your net profit, it can be patient satisfaction, it can be whatever it is for your business you want to have on that dashboard. And it's different for everyone and should be, right, yes.



and dare I say after 10k, SD, my dashboard looks a lot more like an Excel spreadsheet at this point. And I know you can relate.



I can't go into Excel spreadsheets right now. But yeah, so just so people know, like your dashboard is anything that you're using to measure something, a process in your business. So it can be a whole boatload of different things. But just like we do with patients to look at that dashboard, and be able to to look at it with your team employees, whomever, and be able to make informed shared decisions on how you're going to move that business forward. how you're going to make changes in your process, like you said earlier. So perfect. Perfect. All right. Now, last question are actually no, where can people find you? Let's talk about that first.



For sure. Instagram and Twitter is probably where I interact with the most I try to keep Facebook honestly just a community connection. So if you friend me on Facebook, don't take it the wrong way. I just try to keep the PT side of things off of Facebook. But from a professional connectivity standpoint, at Dr. Josh funk on Twitter, and Instagram, my email is also Dr. Funk at rehab to perform calm. If you really want to get a hold of me, DM me on social media, get my phone number, text me your availability, that's the best way to get things done. Email right now is very chaotic. We just opened up a new location. I'm also getting married in about three weeks. So my life is not necessarily all that organized. And just because there's a lot of moving parts right now. So email, not the best place. But I'm very happy to interact, always happy to make time for a call, especially when I'm driving sometimes I like to just honestly plan out a call for when I'm driving between locations or something like that.



Excellent. Well, thank you so much for giving people all that info. And last question, knowing where you are now in your life and in your career. What advice would you give to your younger self, let's say a young grad out of PT school,



I think I would have focused more on expanding my horizons outside of healthcare and physical therapy sooner. I think the more that I started to look at what was going on in other industries, other professions. It made me better at PT and especially made me better at running a business, I can safely say that much of healthcare practices from a business standpoint are extremely dated, and that you are better off spending time studying businesses and other industries for inspiration. It's not to say that there's not some people that are doing amazing work in our profession and healthcare as a as a whole. But I would say the collective is still I almost at this point. I wonder if it's decades behind, just with regards to just how they're operating. So continuing being open for inspiration in a wide variety of from places, you'd be surprised if you just had an open mind. What you might be able to see in something that maybe at one point your life you may be just glanced past or completely ignored.



Love it. Excellent advice. Josh, thank you so much for coming on. And again for the listeners tomorrow at 730. Yeah, right. No eight. Oh my gosh, where's my head tomorrow? The 27th at 8pm we're going to have our roundtable with Josh, Eric mellow Michelle Callie and shantay Cofield. So if you haven't signed up yet, definitely sign up because we're gonna be talking like this but probably more in depth and we need your questions. This is a this is your chance to ask people like Josh and Shantae and Erica and, Michelle, any question you want to have these four people together on one sort Stage, it's not going to happen anywhere else. So now's your chance, ask those questions. You ask those burning questions to four amazingly successful entrepreneurs in the physical therapy space. So I encourage you all to sign up. You could do that at podcast at healthy, wealthy, smart, calm, click on the tab that says round table talks. So Josh, thanks so much. And again, looking forward to tomorrow. So thanks.

Jul 19, 2021

In this episode, CEO of Performance Physical Therapy, Michelle Collie, talks about the business of physical therapy.

Today, Michelle talks about the lack of business knowledge of physical therapy graduates, the belief that marketing and sales are bad, and the importance of encouraging entrepreneurship. How do we change the public’s understanding of our roles in health care teams?

Hear about the challenges Michelle has faced, how she maintains her company culture, and get some great advice, all on today’s episode of The Healthy, Wealthy & Smart Podcast.

Key Takeaways

  • “I do think that it’s our responsibility for the well-being of our profession that we do include some basic business information.”
  • “People don’t know what we do. We don’t do a good job of explaining the value.”
  • “Any way we can support small businesses is going to be helpful for the future of our profession.”
  • “You definitely have to work on yourself a lot, and be very mindful of what you need as a person if you want to be a leader in an organisation.”
  • “How you act at a holiday party or social event, is going to have a big impact on what your organisation is like.”
  • “Get comfortable with the word ‘money’. It’s not a bad word. Just think of money as one of the things that helps us be able to evolve as a profession and serve more people in our communities.”
  • “Be curious about learning more about business.”
  • “Believe in yourself earlier, and address the fears that you have of your lack of knowledge and your inability to do things. Make your mistakes earlier.”

More about Michelle Collie

[caption id="attachment_9677" align="alignleft" width="150"]Michelle Collie headshot of Michelle Collie[/caption]

Michelle Collie PT, DPT, MS is the CEO of Performance Physical Therapy, a privately held practice with clinics in Rhode Island and Massachusetts.

Celebrating 21 years since it was founded, Performance employs over 230 people, with ongoing growth plans, including 2 new clinics opening this month. Performance PT has celebrated many accolades including being the recipient of the APTA-PPS Jane L. Snyder Practice of the Year, and 7 times, Rhode Island best places to work award.

Michelle currently serves as the president of the RI chapter of the APTA and chair of the PPS PR and Marketing Committee. She was a member of the PPS Covid Advisory board and is a two- time recipient of the PPS board service award.

Michelle is a board certified orthopedic clinical specialist.

Suggested Keywords

Well-being, Knowledge, Business, Physiotherapy, Culture, Marketing, Sales, Money, Entrepreneurship, Leadership, Healthy, Wealthy, Smart, APTA, PPS, Therapy,

Recommended Resources

August 20th Graham Sessions:

Marketing Resources:

To learn more, follow Michelle at:


Facebook:       Performance Physical Therapy

Instagram:       @performanceptri

Twitter:            @performanceptri

LinkedIn:         Performance Physical Therapy RI

YouTube:        Performance Physical Therapy

BizPT Round Table Talk

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Read the Full Transcript Here: 

Speaker 1 (00:03):

Hey, Michelle. Welcome back to the podcast. I am so happy to have you here for this month, where we are talking all about the business of physical therapy. So welcome.

Speaker 2 (00:13):

Thank you, Karen. It's great to be here.

Speaker 1 (00:15):

And I mean, you and I have talked business in the past, like I said, in your intro, you have several offices within your business and you've really grown your business into a really great place to work. And I think that that's so important. It seems like your employees are happy. You're happy, and that is not an easy thing to do these days. So kudos to you for that. And that's one of the reasons why I wanted you to come and be part of this discussion this month, because you are a physical therapist with multiple locations. You're not just a solo preneur, right? So how many people before you go on, how many people do you employ, just so that people can get an idea of, you know, the, the breadth and width of your practice.

Speaker 2 (01:04):

We currently have approximately 230 employees. Now we've got openings case. Anyone's looking for a job, but as I know, everyone else is looking for employees as well. This is a common problem throughout the nation at the moment, but yes, 230, but still growing.

Speaker 1 (01:21):

Yeah. Which is amazing. I mean, that's, so I always think about that as they're in, like you're helping 230 people grow their wealth, improve their families, keep their lives going. I mean, it's a big deal. It's a lot of responsibility.

Speaker 2 (01:37):

It's a great point. And I kind of guess I love that opportunity to do that because people often say to me, oh, do you miss treating patients? And I am like, well, I do. But now I feel like I get to somehow have a larger impact on a whole lot more people. And I, yes, I love to treat patients. I love the care that we provide as physical therapists, but I do love knowing that I'm helping to provide a place for an employment for lots of people to work. And I especially felt that through COVID and the way that we were actually able to keep all of our stuff on, we did have to furlough for some of our administrative staff, but then ultimately we're able to bring everyone back. And and that was something that helped me get through the pandemic actually, knowing that I was able to have a positive impact on the fiscal sanity of all, for lack of a better term for many of the people in our community.

Speaker 1 (02:32):

Yeah. Which is amazing. And now, you know, this month we're talking all about business, you have a growing thriving business. So how much of the business of this business knowledge did you get when you graduated as a physical therapist? How much did you learn in PT school? Well,

Speaker 2 (02:48):

Probably about the same amount that every PT that's graduating these days you know, and to be fully transparent and clear, I took over performance. I actually purchased from the original founder. I was a clinic director there. It was a smaller practice with 16 employees and I was very pregnant, eight months pregnant. So I thought I was invincible. And through a seller finance note and an SBA loan, I somehow ended up with this practice and a lot of debt. And the first day that I officially owned it, which was I think three weeks before I had my first son, I walked into the office manager and said to them, don't tell anyone this, but people keep talking about financial statements, but I don't really know what they're talking about. So I prided myself on being a good PC and really loved that the value of physical therapy and what it provided to our community and patients. But when it came to actual business knowledge, especially those off to do with the financial management of an organization, and even thinking about things such as marketing and human resources, I would say I was completely ignorant and didn't have one scrap of knowledge.

Speaker 1 (04:04):

Right. And so this is obviously a huge deal challenge for our profession, right. So what can we do should, should these topics be included in school?

Speaker 2 (04:16):

I mean, I, of course I'm a proponent of it for a number of reasons. And I do, and I really respect those folks had in academia and I bought them, challenged them. You know, why don't you include some more business information and the curriculum. And the response is usually I revolve around time. We don't have enough time. And the other one is, is that always students don't want to learn that they want to learn physical therapy things. However, I do think that it's Sarah, truly a responsibility for the wellbeing of our profession, that we do include some basic business information. And that's not just because some people will want to go and start a business or be part of the business. So yeah, it will help those folks. But I do think for, let's say the staff PT, if a staff PT has a little bit more understanding of, let's say what marketing is, then they suddenly are better at advocating and speaking to their patients about the value of what we do.

Speaker 2 (05:17):

If someone is able to understand some of the communication skills that align with marketing and even sales, then we will suddenly see word of mouth referrals go up. When someone understands financial management a little bit more, they have a better understanding of how to code, how to negotiate your salary, the meaning of different kinds of salaries and what they mean in the longterm. So I think having some basic business information seats up every individual, no matter what setting they're working in to be a better manager and better, better more knowledgeable for the career and the longterm. We hear so often PTs talking about burnout. We hear them talking about lack of reimbursement and not getting paid enough and obviously student loans. But I think with empowering our graduate San UPTs with some bitter understanding of business and how it works, it actually gives them some foundational knowledge. So they actually can do something and make a difference rather than just this overall overwhelming complaints we hear, oh, we're not paid enough. Reimbursement keeps going down. Student loans are too high. We have at least problems with their proficient, but we need to empower our next generation to have some business knowledge. So they can ultimately help do something about this crisis that we're headed into.

Speaker 1 (06:44):

Yeah. And, and I think even being able to make a financial statement for yourself, it doesn't have to be a business. You don't have to own a business, but you should know, well, how much money are you bringing in? What are your costs after that money comes in? What are your debts and your liabilities? And you can look at that and, and make a budget. It may help you be able to better budget yourself to be able to pay off those student loans or, you know, do the things that you want to do. I mean, I find, I found that learning all of that has just been so eyeopening for me.

Speaker 2 (07:19):

Yeah. I couldn't agree more. And especially these days, we, you see different compensation packages coming out, different kinds of variable salaries. Oh, you know, if you work per diem versus full time, or maybe I do wanna, you know, have a side hustle, but understanding the long-term financial implications of those decisions can be really important and again, and how you to make the decisions that are best for your career. So you can actually work in the seating and provide the kind of care that you truly want to, and being out of balance out the money side of it and in the clinical side of it. Yeah.

Speaker 1 (07:55):

I couldn't agree more, I think, and I, you know, I do hope that at the very least when it comes to teaching business courses, I mean, at least help therapists understand the financial aspects of a business, whether that be a hospital, a skilled nursing facility, an inpatient facility and outpatient facility. I just think understanding that will give them a better idea. Like you said, of salaries negotiations, how much are you getting paid? Whether it be per code per patient, like you said before, you started a little, a little tweak and what you code and how much you code can compound exponentially.

Speaker 2 (08:35):

Exactly, exactly. Very small changes in your coding changes of business. But I also think speaking to that, having a knowledge of the kinds of employers that are out there, and that's a side of businesses as well, understanding the difference between for profit nonprofit, understanding the difference about PE and corporate owned and public on versus privately owned. There is not one that is better than the other at all. There a great PTs who are in corporate practices. There's also crappy PTs and corporate practices, same thing for private practice. It's all over the place. However, if individual PTs have a basic understanding of the, those different businesses and how they're set up, it gives them a more well-rounded approach to being part of that team, no matter who they decide to work for, or at least they want to go out in the business on their own.

Speaker 1 (09:30):

And, and I don't know if you have the answer to this, but do you have, can you think of off the top of your head, any resources that may be practicing PTs or new graduates can utilize to help them understand? Let's say to be more financially fluent in the physical therapy world. So let's say you didn't get it in school, which odds are you probably didn't. Where do you have any resources that people can learn more? Well,

Speaker 2 (09:57):

The one that's out there, which we don't actually do, I don't think a good enough job of messaging and marketing and here's, I can do that right now, but obviously the private practice section or, you know, and maybe it should be called the business section because it does have all the resources there for, for business. And again, that doesn't matter if you're a pediatric or orthopedic or in a hospital or in home care, the business of PT is everywhere. And I think the private practice section has tremendous amounts of resources for that they have, for instance, a whole series called finance 1 0 1, which is multiple videos, just on finance marketing 1 0 1. So educational opportunities, webinars, all of those, there's a huge amount of resources through the private practice section, their annual conference, and many, many people who work in all kinds of different settings come to get a through that chapter of the AP TA. So I would say for anyone with any business interests, it is a very non-threatening welcoming chapter for peoples that people at all different times in their career and all different kinds of practices to come to.

Speaker 1 (11:09):

Yeah. Excellent. All right. Thank you for that. So now you've said it a couple of times marketing and sales, and I know you're on the marketing committee, so we are going to dive into that. So what about the belief that marketing and sales is bad? Like it's icky. It's like people should know what we do. Why do we have to go out and market ourselves and be like, quote unquote used salesman, used car salesman, not use salesman.

Speaker 2 (11:38):

So incredible. I tried to flip it and say that to me, marketing and sales, we should call it advocacy because what it is is actually advocating for who we are and what we do. I was speaking to a student the other day, actually. And I love speaking to students because it's really interesting to hear when and how they learn their sort of opinions and biases. And this student was telling me about their clinical affiliation and that he couldn't understand why all doctors weren't telling their patients about direct access and we have direct access, but doctors don't tell their patients. And I see this, I say to the student, I see, did you, did you, does your mother know what [inaudible] is? And he goes, no, I had to explain it. And I see it. So let's first of all, stop using this word direct access because no one understands what it is we like to use it.

Speaker 2 (12:36):

But first of all, we have to be able to communicate and let people know. And then I said, do you think that the average doctor healthcare professional knows that you could see us without a referral? I don't know that because we never tell them how are they supposed to know that? So I think what it is is when we're marketing is really about advocating or educating people don't know who we are and what we do Magento here's my random guests is that 40% of PTs. And I just made that number up. But I asked a lot of people, 40% of PTs got into the field of PT because they were injured as teenagers. And they learned about the field and I was one of them. And I, I would love to know what percentage of PTs out there had ACL tears, because there is every second PTI made is like, yeah, I told my ACL when I was like 15 and I fell in love with my PTs.

Speaker 2 (13:28):

And I realized what a difference it made to my life. And then I decided I want to be a PT. Like, why do we have to be, you know, we experienced it. That's how we found out about it. But yet we don't want to tell other people about it. We think it's icky for some reason. So I just always try and push people. People don't know what we do. We don't do a good job of explaining the value. People have biases and think, oh, you just helped someone after they've had a stroke to walk things like that. But I think it's time that we don't just say, yes, we take care of all different kinds of people. Get them back to their life and doing what they want to love. We actually have to take it a step further and say, no, no, we're actually a major solution. When it comes to the issues with MSK, MSK ailments are a huge problem in our society. And we have the ability to keep people moving so we can decrease those downstream costs, such as knee replacements, hip replacements, chronic illnesses, your diabetes, your obesity, your hypertension. So the value in Walt we can do and create is way, way more than even what we message on a day-to-day basis at this stage. And we have to do a bit, your job of it.

Speaker 1 (14:40):

How do we do a better job? That's the question, the million dollar question, great.

Speaker 2 (14:46):

How do we do a better job? You know, I've worked at PPS and we've tried to pull PR committees and PR companies to help us with it. But I think at the end of the day, what we've found most useful is is doing grassroots advocacy work, ensuring that every student comes out and understands how to describe and how to talk about and the meaning of it. Yeah. Yeah.

Speaker 1 (15:14):

And, and I, like, I always tell people, if you want people to know what you do, what we do as physical therapists and you have to put yourself out there to do it. So it's not just talking to each other within the profession. We know what we do. You know, I always encourage people like you know, pitch yourself to your local newspaper, get a column, right. Like I said, this too, like in my PPS talk that was online last year. I went step-by-step and taught people how to do that. And then a couple of weeks later, I got an email from a woman who watched it and she said, I, I, I was able to get a column with my local newspaper

Speaker 2 (15:59):

Colson. Exactly. You put yourself out there and don't think I just have to be a PT in the clinics. I like you do a podcast. Mine's very different. My podcasts I do with different healthcare providers in our community, including PTs. And we discuss things such as how to stop running or picking your right running shoes, or what do you do if you've got back pain or how did you manage through COVID, but putting out information so that people in the community see, you see you as experts in movement and health and wellbeing and not just the clinician that your primary care doc seems to you once they don't know what to do with you because of your ongoing back pain. We're a whole lot more.

Speaker 1 (16:44):

Yeah. Yeah. And I think physical therapists in general, this is just my opinion, but they really need to get off the sidelines and start taking control because a lot of this, like, is it up to the AP TA to do all of this? No. You know, as an individual physical therapist, you have to put yourself out there as well.

Speaker 2 (17:03):

You really do. And I, I do get a little frustrated when I see people on social media bashing the, a PTA about all the things that a PTA should be doing. I think what we've seen in the year, we've seen changes in our profession such as, Hey, we're all now doctors, a PT thinking that this label would suddenly change how the public and how healthcare providers perceived us a new title, a new label, or a fancy ed doesn't change who we are. It's how we behave. So we have to behave like professionals. We have to stop being on the sidelines and actually get in and play the game. When it comes to health care, sit at the right board tables, be confident and comfortable calling out local docs, countable care organizations, insurers, and letting them know the role and the value that we provide.

Speaker 1 (17:57):

Yeah. Perfect. Couldn't have said it better. Excellent. Now, you know, this whole month is all about small business or not small business, but about businesses, entrepreneurship. And, you know, in speaking, before we went on the air, we were saying how important small businesses and entrepreneurship is to I think bringing back this country after hopefully as COVID starts to recede. So can you talk a little bit more about that?

Speaker 2 (18:27):

Yeah. I mean, you see it in every industry, that's entrepreneurship, these are where the new ideas, the crazy ideas and small businesses have the opportunity, the luxury to be savvy and make quick changes in what they do. COVID sore that, I mean, who were the first folks to suddenly provide telehealth services? It wasn't the big corporate or hospital run facilities. It was the savvy small businesses who were able to flip their operations overnight and suddenly implement telehealth. And of course that led the way for everyone else being able to follow. So I think COVID helped to prove it and show that that is the way that the world works. Entrepreneurship, small businesses seems to drive innovation. I think now in the world of physical therapy, we are seeing major challenges with reimbursement and payment. I personally, and a big fan of my moving towards value-based payment.

Speaker 2 (19:24):

I really despise the whole, you know, the more you do, the more you get paid, I would much rather the, we are paid to keep or get our patients healthy and have good outcomes and just find the journey to get there. But I think it's small businesses that had the opportunity to, to take on risk and try different ways, whether it's with employers or whether it's with healthcare insurance, healthcare insurance companies like go to these different organizations and pitch, then pitch different ideas. Now you're going to get turned down probably 90% of the time. That's okay. But then you're going to find little pilots and you're going to find opportunities. And even when I look around the country, now I hear from colleagues and peers who are like, oh, I'm in this kind of financial model where we're doing health screenings and we're just taking care of the lives. And someone else says, oh, we've got a subscription paced program to keep people moving. So there's different pilots going on. And it's small business that has the ability to be innovative and do those that then we can ultimately model after. So I think any way we can small support small businesses is going to be helpful for the future of their proficiency.

Speaker 1 (20:39):

Yeah. And I love that. You said they could be more innovative and nimble and, and that's true. That's true. Most entrepreneurs because they don't have to go through a million different boards and get approval from XYZ. They could say, well, this is what I'm seeing in the market. This is what our clients want. So let's try it.

Speaker 2 (20:59):

Exactly, exactly. And you can do it at a clinic level. You can do it at company level. You can do it with, oh, let's try this program at this clinic and see if it works. And yeah, you can be very savvy and very timing and get these things done quickly. It's small business might not have all the resources and may not have whether that's financial or brains like people power, but usually entrepreneurs are pretty savvy about finding solutions to some of those challenges and problems. And that's where the likes of PPS and a PTA can be really helpful because it's pretty easy to find other people with that business or entrepreneurial ship desires that can come together and help each other. Yeah,

Speaker 1 (21:41):

I agree. And now, you know, as we're talking about business and you have a thriving business at this point, but what were the challenges of your business and a view as an entrepreneur now, I think you mentioned one of them earlier being, having no idea what financial statements were, I'd say that's a challenge. But for people listening for who might be maybe wanting to dip their feet into the entrepreneurial pond, so to speak, what are some challenges that came up for you and what did you do to overcome them?

Speaker 2 (22:21):

As you said, that I started writing out a list of challenges because I've made a lot of mistakes. I've had many challenges. I heard an interesting quote. I read an interesting quote today, actually. If I could have my time again, what would I make? All the mistakes, same mistakes. Yeah, I would, I would've just done them a lot sooner. So I could've got the mistakes out of the way earlier, but I think some of the challenges, a lot of the challenges were with delegation and leading things go, it's very hard to step away from patient care when that's something that you're very comfortable with and you think you're good at so managing time and I hear that coming up a lot with business owners, how much, you know, should I treat patients or not, not, there's no right answer there. You know, it depends what makes you happy.

Speaker 2 (23:06):

And it depends what you enjoy doing. So delegation was a big pot. Someone else told me the other day, I liked this quote as well. You know, you're delegating enough. If you want to have a growing business that if three times a day, you cringe now you cringe because you had given something, a project or a task or something to do at work to someone else so that they have the opportunity to grow and evolve. But you cringe because you look at them doing it and thinking, oh, I could do it a little bit faster. I could do it a little bit better, or I might do it a different way, but that's okay. And you have to get to that stage of going like, you know, you could call it 80 20 rule, but that rule of going like it's, it's actually a gift to be out on power and allow other people to grow and evolve.

Speaker 2 (23:53):

So learning how to manage that can be had the culture things interesting. When you've got a very small practice, the culture just happens automatically and you have this amazing culture as a practice grows and evolves. You have to become much more disciplined and diligent about how to actually execute on maintaining and having a great culture. So something you have to be aware of putting the systems in place as you grow and evolve, the more systems you have in the place in place, the smoother things can run. And it creates actually a structure, a structure that actually allows innovation and allows people to be creative, but they've got the walls and the guidelines of how to do that in a safe way. So I don't know, those are the key things that came to mind for me. You know, it really comes back to managing your time, how you delegate, how you let go of things.

Speaker 2 (24:47):

You got to keep becoming more and more humble that every year I realized how much I don't know. And it just seems to be almost, it's like my list of things I don't know, actually is increasing. So I'm not sure if I'm just getting older and losing my memory, or if I'm just becoming more aware of how clueless I am, but I guess I'm comfortable owning that at the stage. So I think, and being comfortable with who you are and your own skin, you definitely have to work on yourself a lot, take care of yourself a lot and and be very mindful of what you need as a person, if you want to be a leader in an organization.

Speaker 1 (25:20):

And what is your advice to maintain culture as your company grows? Because that's like you said, I'm really glad you brought that up because people join your company because of the culture. And if you grow and you let it go, or something happens, then people are going to leave. So how did, how did you do that? How did, what is your company culture and how did you maintain it?

Speaker 2 (25:44):

I liked the question. What is your company culture? Because I mean, I think of our culture is a very much like work hard, play hard, definitely a lot of fundraising up a lot of philanthropy, a lot of giving back to the community. Now, maybe what would happen 15 years ago, it would have been like, Hey, let's all dress down this month for this great organization and get together and do a 5k for them. And they will go out to her via what's. The net would stay the same for a great culture and getting to know people as individuals now, as with a larger organization, we have to be much more diligent about or more mindful about hearing from all of our people who should we dress down for and choose carefully based on the feedback and then communicated appropriately, have some PR involved the social media, making sure everything's much more streamlined.

Speaker 2 (26:38):

So all of the good happens, but it just takes a lot more work. It just doesn't happen quite so easily. So you just have to put the work into it determining what kind of feel you want it, social events, what kind of behavior expect again, you know, speaking your late leadership, how you act at a holiday party or at a social event is going to have a big impact on what your organization is like. And if you want to dress up like a pirate and dance around, which is what I do then yeah. You're going to create a different kind of culture to someone who's going to come across in a different way. So you just gotta be really mindful that as you grow, people are watching you and how you behave and that's going to drive it a lot of the culture.

Speaker 1 (27:20):

Yeah. I think that's thanks for elaborating on that because I feel like that's a piece of the entrepreneurial pie that often doesn't get addressed.

Speaker 2 (27:30):

I agree. I think especially if you have a smaller company as that grows, you think you can, it's easy to forget about culture because it almost seems fun and that is fun. And it almost seems like, is it silly that we're talking about what events or what we're going to do to build culture, what team building things, but it's really, really important because your people are everything. And if we're, I always just say to my stuff, sometimes people say to me, what do you actually do? And I'm like, really my job is to keep you all happy. That's really all it comes down to because when you're happy, you'll give good care. If you're miserable, the care you give sucks. If you're happy, you give good care. And if you happy you'll stay. So my job is to keep everyone here simply saying

Speaker 1 (28:16):

You're the C H O chief happiness officer officer. Exactly. Pretty much. Yeah. Well, that's a great title. Actually. You should put that on your cards. Bring that up to PPS. Ask how, asked how many businesses in PPS have a chief happiness officer. Yeah. And see, see what we can see what shakes out on that one. But yeah, I, thanks for elaborating on that. I just really wanted the listeners to understand that your business is more than dollars and cents

Speaker 2 (28:48):

Completely, completely. And if it was just business dollars and saints, it would be kind of boring. I do think it's wonderful. Seeing the PTs, who own practices, they do it with no matter what the size you do. It, we all love people and making people happy and better. And whether you're their employer or their physical therapist, it's not that much different.

Speaker 1 (29:09):

Right. Absolutely. And now before we wrap things up, what are the key takeaways you want the listeners to come away with with R D from our discussion today?

Speaker 2 (29:19):

I would say that get comfortable with the word money. I know I'm going to go straight to business. It's not a bad word. It's not a bad word. And as PTs, we don't like talking about it. Oh, I don't want to talk about my salary or I don't want to do this, or I think I should get paid more, but I don't really want to understand it. Like, it's just, just think of money is just one of the things that helps us actually actually be able to evolve as a profession and serve more people in our communities. I don't know if that came across very professionally or not, but I do think people should be comfortable with it. Be proud of what you do. And when someone at the local bub you're a barbecue, or when you're grilling with friends, complaints to you about your back, their back pain, help them and tell them what you do and make sure they get the care they need. And don't sit back and, and let them have to try to figure it out on their own. And and just be curious about learning more about business. It's not scary and it will help. The more you understand, you'll have more control over the decisions you make. And I actually think you become a better clinician because you're more mindful of the value of the services that you're providing.

Speaker 1 (30:32):

Excellent. And where can people find you if they want to get in touch? Do they have questions? They want to learn more about your business?

Speaker 2 (30:39):

Pretty easy to find live up in little road, mighty Rhode Island. We like to call it. So email's the easiest way. You've I, and through my practice, performance PT, R You'll find me on Facebook and on Twitter as well. I'm not as savvy on social media, some of you, but I love getting emails from people and helping other PT students, practice owners, different kinds of business owners out there.

Speaker 1 (31:06):

Great. And we'll have the link to your website at our website at podcast at healthy, wealthy, in the show notes for this show. So people can one click and get straight to your website to see what your business is all about. And if they have any questions, like Michelle said, highly encourage you reaching out to her and emailing her to ask questions. That's what we are here for. And Michelle before. Last question is knowing where you are now in your life and career. What advice would you give yourself as a new grad?

Speaker 2 (31:39):

Well, that's a good question. What advice would I give myself as a new grad who as a new grad, I would just as a new grad, I would say, believe in yourself earlier and address the fears that you have of your lack of knowledge and your inability to do things. So, yeah. Maybe make your mistakes earlier. Michelle is what I want to say.

Speaker 1 (32:06):

Excellent advice. Well, thank you so much for coming on for our month of business. And of course, we'll see you in a couple of weeks at our business round table, which will be on the 27th of July. Think at 8:00 PM Eastern standard time where it will be you and Eric and mellow and Josh funk and Shantay Cofield AKA the movement. Maestro people probably know her better with her Twitter, with her Instagram handle than her actual name. But I'm really looking forward to that. I think we'll a really robust conversation because we've got just like PPS, we've got those four different personas, totally nailed down. We've got your solo preneur, we've got your more traditional PT practice, which is Michelle's. We've got a newer grad with an, a growing practice in Josh and we've got a non traditional PT. So working as a physical therapist, but not with patients in Shantay. So and that was total coincidence. I didn't even know that when I plan this out. Perfect. So I'm really looking forward to it.

Speaker 2 (33:15):

So, and I just think it's really cool when you get these different kinds of business owners who are PTs and all different kinds of businesses. It's awesome. Yeah.

Speaker 1 (33:24):

Yeah. We'll have a nice, a nice step meeting of the minds. So everybody definitely sign up for that. And the link for that is also in the show notes for our round table. So Michelle, thank you so much for coming on and I hope to see you hope to see you soon. I hope to see you too.

Speaker 2 (33:41):

Karen. Thank you so much. Of

Speaker 1 (33:43):

Course. And everyone, thanks for listening. Have a great couple of days and stay healthy, wealthy and smart.


Jul 12, 2021

In this episode, Co-Founder and CCO of WebPT, Heidi Jannenga, talks about the trends that were revealed in the State of Rehab Therapy Report done by WebPT.

Today, Heidi gives an overview of the Rehab Therapy Report, and she talks about how technology has benefitted the industry, business continuity and growth, and the reality of burnout. How has the pandemic impacted business revenue, budget, and employment.

Hear about the lack of diversity in the industry, the disparities in advocacy and associations, and the tech adoption boom of 2020, all on today’s episode of The Healthy, Wealthy & Smart Podcast.


Key Takeaways

  • Survey results show that 77.4% of rehab professionals identify as white, 6% as Asian, 5.5% as Hispanic/Latino, 2.8% as Black/African American, and smaller percentages as American Indian, Alaskan Native, Native Hawaiian, and other Pacific Islander.
  • “There are huge gaps in terms of not reflecting who our patients really are in every area of the nation.”
  • “40% of the [women] respondents said that they now hold C-Level executive positions. That’s a 10% improvement.”
  • “Almost every clinic leader I talk to today are at pre-Covid numbers, and most of them are above pre-Covid numbers.”
  • 50% of therapists, and 42% of therapy assistants reported feeling more burntout now than they did prior to the pandemic.
  • “60% of rehab professionals said that they didn’t participate in any of the numerous advocacy efforts from last year.”
  • “Even if you disagree with some of the decisions or directions of APTA, that’s all the more reason to be involved.”
  • “It takes a lot of vulnerability and confidence to say ‘I don’t know.’”
  • “As a leader, you shouldn’t have all the answers. You become a crutch to those that work with you if you’re the only one who has all the answers.”


More about Heidi Jannenga

Dr. Heidi Jannenga is a physical therapist and the co-founder and Chief Clinical Officer of WebPT, an eight-time Inc. 5000 honoree, and the leading software solution for physical, occupational, and speech therapists.

As a member of the board and senior management team, Heidi advises on WebPT’s product vision, company culture, branding efforts and internal operations, while advocating for rehab therapists, women leaders, and entrepreneurs on a national and international scale.

Heidi has guided WebPT through several milestones, including three funding rounds: an angel round with Canal Partners, a venture capital round with Battery Ventures, and a private equity round with Warburg Pincus; five acquisitions; and numerous national corporate and industry awards.

In 2017, Heidi was honored by Health Data Management as one of the most powerful women in IT, and she was a finalist for EY’s Entrepreneur of the Year. In 2018, she was named the Ed Denison Business Leader of the Year at the Arizona Technology Council’s Governor’s Celebration of Innovation. She also is a proud member of the YPO Scottsdale Chapter and Charter 100 as well as an investor with Golden Seeds, which focuses on women-founded or led organizations. Her latest venture is called Rizing Tide, which is a foundation dedicated to fostering diversity and inclusiveness in the physical therapy workforce.

Heidi is a mother to her 9-year-old daughter Ava, and she enjoys traveling, hiking, mountain biking, and practicing yoga in her spare time.


Suggested Keywords

Covid, Survey, APTA, Rehab Therapy, Report, Data, WebPT, Diversity, Physiotherapy, Advocacy, Technology, Burnout, Business, Healthy, Wealthy, Smart,


Recommended Resources

The State of Rehab Therapy 2021:

The State of Rehab Therapy Webinar:


To learn more, follow Heidi at:


Instagram:       @heidi_jannenga

Twitter:            @HeidiJannenga

LinkedIn:         Heidi Jannenga


Subscribe to Healthy, Wealthy & Smart:


Apple Podcasts:




iHeart Radio:     


Read the Full Transcript Here: 

Speaker 1 (00:03):

Hey, Heidi, welcome to the show podcast. I'm so excited to have you on today.

Speaker 2 (00:08):

Thanks Karen. So excited myself to be here. So thanks for the invite. I really appreciate it. Of course.

Speaker 1 (00:14):

And today we're going to talk all about the key trends that were revealed in the state of rehab therapy report powered by web PT. But before we get to those trends, can you tell the listeners how all of this information was compiled?

Speaker 2 (00:32):

Sure. So we actually started conducting this industry-wide survey of the rehab therapy industry and what we consider rehab therapy is PT, OT, and speech back in 2017 that was the first time we released the state of rehab therapy report. And essentially we were trying, we had a lot of questions about the industry that we just honestly couldn't find the answers. And so we decided, well, we're just going to put out a survey to ask the questions we want answered topics ranged from business financials, operational structure, patient volumes, job satisfaction, technology trends, demographics, like we just really wanted to dive into sort of slice and dice the industry a little bit more as far as data goes. And we took a little bit of a pause in 2020, obviously due to COVID. But we did actually launch the survey at the end of the year. And so that's what we're talking about now. As far as the results go and we collected, I think over 6,700 responses, the majority of, of whom treat patients directly. So either as therapist or assistance, and 60% of them were from outpatient private practice. So the other 40% were from other therapists who work in other areas of the industry. So we feel like the findings really you know, give a good sort of breakdown of what's going on in the profession as a whole.

Speaker 1 (02:10):

Let's just dive in, then let's talk about some of those trends. So I will just kind of throw it over to you and we'll go through the major trends that you found. So let's, let's start.

Speaker 2 (02:22):

Yeah, let's just kick it off with something that's top of mind. I know for a lot of businesses and not just in the PT world, based on some of the occurrences within 2020, and that's really focusing on diversity. I think we've talked about it a lot that we, we all sort of know that there's this issue of lack of diversity within our profession as a whole. We're pretty much racially, very homogeneous. Our survey results showed that 77.4% of rehab professionals identify as white. Our results showed 6% identify as Asian five and a half to identify as Hispanic or Latino 2.8% identify as black or African-American. And then smaller percentages of the American Indian or Alaska native and native Hawaiian and other Pacific Islander. And so if you sort of then contrast that right with the overall society of, of the U S I mean, there's just huge gaps in terms of not reflecting who our patients really are and in every area of the nation.

Speaker 2 (03:42):

So, you know, we, we asked a little bit of why some of the factors that are leading to that, and, and I, I think that, you know, we can sort of hypothesize a lot on, you know, the flood student recruitment. Like we're just not getting them in. We're not, for whatever reason. They don't know how cool it is to be a physical therapist. They're not attracted to it. So the recruitment is kind of broken. And so from there you just have a limited hiring pool. And so of course, you know, I think what a lot of people are sort of now attacking also is just, do we have some unconscious bias, like, do we need more training of our, our teams and recruiting processes within our own organizations to sort of eliminate and hopefully put a little more attention on trying to, to become more diverse in our employee base.

Speaker 1 (04:33):

Yeah. And you know, like you said, that this is not unexpected to continue to show this lack of diversity and, and yeah. Where, where does this start? Does this start with recruiting teenagers out of high school, into undergrad and then recruiting from undergrad into grad school? Is it exposing more you know, people of color just to the profession in general? You know, there are some people doing great job with that, like Jasmine tools in Southern New Jersey. I don't know if you know Jasmine, but she created a girl scout badge, a physical therapy girl scout badge. And she works mainly with girl scout troops in inner cities in Philadelphia. So you've got all these young girls who now know what physical therapy is because they're getting their physical therapy badge.

Speaker 2 (05:25):

That's awesome. I love that. Yeah. And we need more of that obviously happening at an earlier age to just, I mean, we've talked a lot about it. I knew you've talked about it on this podcast about sort of the brand problem of actually attracting patients in, but that also is reflected in attracting amazing people of all, you know races, color, everything like, you know, into our profession as a whole. Now I will say Karen, that we did see something positive you know, we, you and I have talked a lot about sort of the misrepresentation of women in leadership within our profession. And we did see a pretty good uptick. We we've also always talked about it in terms of you know, 70% of therapists are women and yet only 30% of them hold any kind of leadership position whether it's clinic, director or above manager. But we did see that number go up from where it was. And so 40% of the respondents said that they now hold a C level executive positions, which I thought was mean that's a 10% improvement. So huge. That was awesome to see.

Speaker 1 (06:45):

Yeah. I love hearing that. That's a huge, that's a huge jump. 10%. Excellent. Well, that's a, that's definitely a positive. Okay. So let's go to another trend that came out of this report and it has to do with technology. So can you expand on that?

Speaker 2 (07:04):

Yeah. So I'm sure that a lot of your listeners can relate. Telehealth was an explosion that had to happen during COVID. We were all stuck at home and people were in the midst of rehab, some hurt themselves doing, you know, working out at home using their, their Peloton or whatever it was, and they still needed therapy. It wasn't like people stopped needing PT, right. Or rehab therapy. And so tele-health exploded. So the use of, of platform tele-health technology platforms spiked significantly over the last year, although we saw about 75% of clinics that actually implemented tele-health during this time, we've now seen that number completely plummet down to two pretty low numbers. So people are going back to status quo. Now that most cities and states are, have opened back up. So it's going to be interesting to see how this trend continues.

Speaker 2 (08:14):

I do a whole tangent, we could do a whole nother podcast, I'm sure on how do you, how can we put, how can tell a health be you lies a, from a patient experience perspective, but also from a reimbursement payment perspective, like how do we make sure that is there, is there a hybrid potential in the future to, in, in my assessment, reach more people like we, you know, we always talk about the 90% problem, right? If 90% of patients who have a diagnosis that could be beneficial in rehab therapy, aren't getting to us. So how do we expand that opportunity? Tele-Health has it, has it, has the potential to be a of that? Yeah. I experienced

Speaker 1 (08:57):

That over. COVID that exact thing now I still am. I am still using tele-health because I'm in New York city as a lot of people know, and there are still people who are like, not, not just not comfortable, you know? Right. So I'm still using it. But what I found was that, so I have a cash based practice. And so some people were like, Ooh, it's a little pricey. Do you have a way around this? And I said, well, why don't we do one session in person? And then we can move to tele-health and maybe do half hour sessions on tele-health, which will be less expensive. Right. And it was a great mix. I do that. I did that a lot with kids. I mean, you can't keep a kid's attention for more than a half an hour in person or on telehealth and teenager, forget it. Right. So I found, oh, this is a perfect use of tele-health. So it's, it's still allows me to create the revenue I need for my business. And it's certainly a less expensive option. And I would argue a very very convenient and, and maybe just the perfect option for that subset of people.

Speaker 2 (10:04):

Yeah. I agree. I'm, I'm very much in favor of understanding the patient experience and the flexibility that telehealth can allow patients. Right. I think that there's just a lot of discussion right now on how do we get paid for that? Right. And whether or not does it tele-health is, should we be paid the same amount as an in-person in-person visit versus a tele-health visit? And I think it's still up in the air. Like, I, I, I fully can see it from both sides. Right. but to your point, the expense side of what your, your cost as a individual business owner on tele-health is significantly less. Right. And you could, the volume of people that you can kind of stack up to be able to see is significantly more. Right. And so, I guess also the, there's still a lot to be known about the outcome, right.

Speaker 2 (11:03):

Is it truly beneficial for the patient experience? Because, you know, there's, there's data now coming out that telehealth is actually expanding the utilization of care of in-person. So people aren't getting Nessus it's, it's increasing the number of visits in a episode of care because it's not taking the place of in-person it's adding to in person. Right. So we still need to understand and pull the data 2020 to understand how it fully impacted. Cause you know, insurances are always leery about adding more visits and paying out a little bit more for treatment, but if the outcomes are better, that to me always speaks volumes as

Speaker 1 (11:48):

Well. Yeah, absolutely. Now, was there any other technology aside from tele-health that reported being used more like, were there any apps or any, you know, other types of, of tech or was tele-health really the, the main thing?

Speaker 2 (12:04):

Well, telehealth was the big one. But I think there were a lot more folks that decided to ramp up their direct access marketing efforts. So I thought that was really interesting, like in order to, to keep in contact with your patients, right. And also keep some volume coming in. Again, we, it, it sort of pushed people in areas that they knew they should be doing, but now had the opportunity to do during this sort of time. You know, we, we were talking a lot about it at web PT. This is the time to work on your business when maybe you can't work in your business. Right. And so we saw, you know, marketing significantly ramp up for a lot of clinics, whether it was, you know, working on their website to their digital marketing strategy things like that.

Speaker 2 (12:59):

And then figuring out some different ways to offer more non-traditional services, whether that's, you know, like you cash-based services, ride share you know, nutritional counseling, like additives sort of things to their repertoire of services that they could add add on additionally to the clinic, which, you know, all great things. So I think it's just expanding the opportunity for more revenue streams through the use of technology mainly via their site or zoom or, you know, other things where they can have a larger audience all at one time versus having to only have a few that you had to physically come into the practice. So that's really cool to see.

Speaker 1 (13:49):

Yeah. I think it COVID sort of forced people to think outside the box. So instead of just sticking with, well, it's been working and then all of a sudden, wait a second, this literally can't work at the moment. So what do we have to do? So it may be, it, it sparks some more creative thinking from people. Absolutely. Yeah. That's a good thing.

Speaker 2 (14:10):

That's a good thing right. Out of your, out of your proverbial

Speaker 1 (14:14):

Box. Yeah. Yeah. And, and oftentimes you'll have business growth from that, which leads us to our next point. Let's talk about what a great segue let's talk about. Business continuity and growth, which when I read this, I was like a little boy. So go ahead. Let's talk about that.

Speaker 2 (14:35):

Okay. Well, as you can imagine, it was a bit of a mixed bag, right? I mean, there were quite a few unfortunate closed doors that happened at practices. It was also a huge opportunity for some of our larger organizations, enterprise organizations in the profession to continue with their consolidation and bringing more clinics into the fold. But we did find, you know, we, we've been doing a lot of education over the years on the business side and really have talks about how important it is to have that rainy day fund of, you know, at least three months of expenses. Now we all know that COVID happened longer than that. We've been under this COVID umbrella for longer than that, but truly having to close your doors probably did not have to happen for more than 90 days, depending on what state you were in, but essential, we were essential workers.

Speaker 2 (15:32):

Right. So, you know, the bright side of that was that I think 38% of leaders that took the survey said they did have that. So 40% of respondents said, yep, we had what we needed to do. We hunker down, we did some of that. There's other things that we could outside of the box during that time. Right. and we survived. Right. And so that, to me, it was just really heartwarming to see, like you hear horror stories and other industries, restaurant, and other things where man, they just suffered big time. Right. And so it was good to see that from the private practice sector there were still significant amount of businesses that were remained viable during this time found ways to continue on with some other revenue streams. And as a matter of fact, 34% of our clinic leaders said they were already starting to open more practices and locations within the next five years.

Speaker 2 (16:37):

So they're not, you know, struggling right now. And as you know even though our visits completely plummeted for a few months, like they quickly ramped back up and almost every clinic leader that I talked to today are at cope pre COVID numbers. And most of them are above COVID numbers. They can't keep up with the volume right now for the most part, so good problems to have. I'm just excited that, you know, again, we we were at the forefront of, of essential workers helping people in need, whether it was specifically in orthopedic you know, rehab, but also there's so many great stories of how clinics, you know, were out there helping folks. And now we have the post COVID long haulers that we're now getting into our practices. So the value of PT did not dwindle during this time, which is, which is great to see. Yeah,

Speaker 1 (17:38):

Absolutely. And now, as we talk about these clinics ramping up and more patients coming in and more work for the PTs, well, oftentimes you can kind of see where I'm going here that can lead to burnout. So talk about the, the topic of burnout that you found within this report.

Speaker 2 (17:59):

Well, this was a problem pre COVID, so it's not even anything super new. We we've continued to report on this. It can, you know, the, the slope is on the RA is going in the wrong direction. Based on our, our, our survey 50% of therapist and 42% of therapy assistants reported feeling more burned out now than they did prior to the pandemic. Most of them cited reasons for that burnout or fear of contracting COVID and just reminder, you know, this survey was taken at early this year, end of last year. So we were still sort of in the thick of things changes in their work hours and sort of change in the whole overall clinic morale.

Speaker 2 (18:51):

We're all experiencing some, you know, mental health sort of pieces fall out great word fallout from all of this. Right. And so, as you can imagine, that was reflected in the survey. So, you know, at the, at the same time, even though they reported this, this burnout most of them have said that they obviously still love our industry. They don't have any necessarily thoughts of, of potentially leaving. Although we do, we are seeing some, a little bit of that. I think just like every other industry, when you couldn't work, people picked up their heads and said, Hmm, what else is out there? And we are seeing, you know, a few, a few more percentages of people looking outside of clinical care, which I I'm, I don't think is necessarily a bad thing to, to continue, you know, projecting a, an awesome brand for PT professionals. But outside or doing things now in nonclinical care nonclinical work.

Speaker 1 (20:00):

Yeah. And I've definitely seen a lot. I've seen that sort of trend as well as moving away from patient care and going into nonclinical roles, which, like you said, there's nothing wrong with that. You have to do what feels good for you. What, what advice would you give to a PT who is maybe they are one of those 50% who are feeling burnout or feeling like we hope it's not feeling apathetic towards the profession and their patients, but that is part of, of the burnout feeling burned out. Is that real, like apathy for just doing the job? So what advice would you have?

Speaker 2 (20:48):

Yeah. You know, most of the time and I'll speak to myself and when I feel burned out, I have to get back to the root of passionate around why I'm doing it. Why, why do I love, why, why did I get into this in the first place? What is my purpose sort of in being a PT and you know, and figure out, you know, what's causing, what are the root causes of, of, of these feelings of burnout? Is it the current position I'm in? Do I just not like who I'm working for? Do my values, not line up with my employer. Like some of these things like people, you just, you still feel so lucky to have a job sometimes during time. And then, and then now that, you know, things are kind of opening back up. I think a lot of people are coming out of COVID experiencing like, holy crap.

Speaker 2 (21:38):

Like, what am I doing with my life? They they've lost their family members. They've lost friends. Like it's, it's kind of this wake up call for a lot of people to say, holy crap, what am I doing with my life? Like, is this really what I want to do and love to do? And so you see a lot of people struggling with that and maybe not perhaps loving what, where they are and what they're doing. And so they're kind of in this burnout phase and I, again, this was taken in like December, January, right? You've been hunkered down for a whole year with not a positive end in sight, even at that point. Right. I mean, it's starting to come out of it. So things were kind of doom and gloom in the country. We're just transitioning out of, you know, a present presidential race.

Speaker 2 (22:27):

There was a lot of change and a lot of turmoil going on in the, in the country at that point in time. So I think that's also reflected here, Karen. I would say this is probably similar to what you might ask any average American during this time. Right. So I would just take that into consideration as we look at these numbers, but you know, one of the things we didn't talk about here with regard to demographics is also just the, the student debt that is still a, such a huge problem in our profession. And it's just, it's not getting any better necessarily. And so again, compounding your student debt on top of, oh my gosh, do I really love my job? Like, there's an COVID and everything else, like, there's just you just, you feel kind of in despair. Right. And so I think that's, what's really reflected here again. What would I tell people I'm like, again, go back to the roots. Like what, what do you, why do you love what you do? Or why, why do, what did you get into this profession to do and find a path to be able to make that happen?

Speaker 1 (23:40):

Yeah. It's like you said, it's sort of stress upon stress upon stress with uncertainty. Yes. And that's really difficult for people, especially when you have a boatload of student loans and wait, no, one's hiring now. Right. When this was taken, when the survey was taken, we weren't at those pre COVID levels yet because the vaccine hadn't been widespread yet. And so yeah, I can understand why a lot of people felt burnout and, and quite honestly, I agree with you, I would say 50% plus of Americans felt burned out at that time as well.

Speaker 2 (24:20):

Yeah. And, and going back to some of the COVID impacts, like when the survey was taken, you know, our survey results showed that a lot of clinics were in that uncertainty phase of not exactly knowing when they were going to actually meet or exceed or even get close to their budget that they had projected for 20, 21. Right. And so there were cutbacks being made perhaps, you know raises were on hold. Right. There's just a lot of factors as an employee or as a therapist that you're kind of like that uncertainty really does not make you feel good. Right. So I think all of that is reflected. I mean, there's so many facets that that can be reflected in that burnout number, especially after the year we just had.

Speaker 1 (25:07):

Yeah. Yeah. It's not just one thing. It's a lot. Yeah. It's a lot. Okay. Is there, what were, are there any other sort of major trends from the report that we didn't hit on yet that you want to make sure the listeners get?

Speaker 2 (25:22):

Well, you know, I'm a huge advocate on advocacy as you are. And you know, we always kind of want to know, like where, and how are people doing advocacy? How do they get involved with the profession? How did they get involved to, to stand up for where the profession and no, no difference in, in years past, you know, the, unfortunately the PTA and the OTA and even ashes to some point, Ashleigh actually has done a fabulous job as far as galvanizing their SLP base. But AP TA and, and almost 50% of those responded to our, our survey said that they were either not members or had no intention of being members. Cause they didn't feel like it added value for the cost of, of being a member. And so, you know, from an advocacy perspective I, it was also a dismal number to sit to show that 60% of rehab professionals said that they didn't participate in any of the numerous advocacy efforts from last year,

Speaker 3 (26:43):

Which was

Speaker 2 (26:45):

Again to my heart. I will say though, that that is a significantly yeah. Lower number, which is still sad because we did rally a lot of people last year around the 9% cuts and all of that. I think more people than ever, I guess, if you look at the, you know, the positive side of this, more people than ever did get involved whether it was, you know, to provide tele-health to have an avenue for more for revenue, the 9% cuts, you know, all of those things definitely rallied folks to become more involved, but we still have, you know, to your words earlier, some apathetic PTs that just don't understand, maybe it's just don't even understand how advocacy works. They don't feel like they have time. It doesn't make a difference, like all the excuses that people want to give. So it's always a point of contention for me, whether it's, you know, if you want to be a member, I believe everybody should be a member of the PTA.

Speaker 2 (27:45):

It's your association. They represent all everyone in, in the profession as a whole. I know they struggle because it's just, there's so many opportunities for PT and, and specializations within our profession that everybody wants to raise their hand and say, you need to represent me. But at the end of the day, we're all physical therapists and that's what we need to, I feel like we must come back to and so, and also with the PT pack, you know, and, and having been a previous trustee, I know how hard it is to in the small, small percentages of people that do contribute to this hugely important effort of how advocacy has to be done in meetings and people knowing who you are as an association and as a group, and why it's so important to, to not have cuts to our profession. Right. I mean, they are just ignorant to, to essentially what we do on a regular basis and how much we get paid for it, or lack thereof.

Speaker 1 (28:56):

Yeah. And, and what I would say to people listening, even if you disagree with some of the decisions or directions of a PTA, that's all the more reason to be involved so that your vote, your voice can be heard. And, and maybe you can change some of those things that you don't like. I mean, I understand it's a slow ship to steer. It's a big organization. Like, you know, it's not like a nimble small private practice owner who can change things on a dime, you know, but it is a big ship to steer, but the more and more people, especially younger therapists that can get involved and have their voices heard. I think that there's a good to make a difference

Speaker 2 (29:43):

For sure. And I, I think just understanding how you can get involved, whether it's, there's lots of ways to be involved, even if it's financial for now, or maybe a kind of, maybe it's just time, like there's lots of different ways to, to add your voice and your voice does matter. And I think that more than ever is important to, for people to understand. I think we had the most it's not just even therapist's voices, but patient voices. We had the most number of patients that was something we, we rallied so well with this year is to get the patient voice heard with regards to the 9% cut, especially on the Medicare side. And so I think that was pretty impressive and made a huge, huge impact with the legislators, with regard to the effect and why we've had some significant progress in, in mitigating those cuts.

Speaker 1 (30:40):

Yeah. And oftentimes, like you can be involved in like the easiest way possible by just like going onto a website and putting in your zip code, finding the people and pressing a button and it sends it up. Like to me, it sends it off to like Chuck Schumer and, and Kiersten Gillibrand. And I don't know. Yeah.

Speaker 2 (31:01):

It's so easy. Even if you don't know who your legislators are, the apt [inaudible] like, there's so many sites now that are help making this so much easier to become involved to, to, to lend your voice right. In a way that is super impactful and only takes a couple minutes. Yeah.

Speaker 1 (31:24):

If that, and you don't have to be a member to do that yes. Nor do your parents or your friends tune in seconds and it's free. And if you have a smartphone, it literally takes two seconds and a LA it's all pre-written. So, yeah, I agree. I think positive advocacy efforts are so needed and like you said, they, they make a difference, you know? So, okay. I think we talked about a lot. We talked about diversity technology, COVID advocacy business growth. Anything else that really jumps out at you from this report?

Speaker 2 (32:09):

No. I think those are the big highlights. You know, we look forward to, to now be able to compare this is a a great sort of slice in time, immediately post kind of post COVID bef just immediately prior to the, you know, getting back to quote unquote normal as far as visit numbers and things like that. So we definitely look forward to doing this again next year. So I, your listeners to participate in the future again, to get your voice heard and to, to really be able to reflect more of what's going on in the industry.

Speaker 1 (32:53):

Yeah. I think it's great. And where can people find this report if they wanted to read the whole thing?

Speaker 2 (33:00):

Yeah. If you go to web of rehab therapy or if you just go to our blog page you'll find it and it's a free to download. It's actually a 60 page report full of graphics. And like, if you're a data nerd, like dive in, because they're there, we have sliced and diced it and made this beautiful. Our team is just awesome. And did a lot of work to, to make this digestible from anyone, even if you're not a data nerd to bring out the highlights. And then also Karen, we're going to be doing a webinar coming up in just a couple of weeks. So you'll find that on our website as well. You can sign up for the webinar. We'll, we'll go in much deeper depth as far as the details of, of more of these topics that you and I have talked about today.

Speaker 1 (33:57):

Excellent. Excellent. And they can, all that can be found on the web PT website. Yep. Perfect. And where can people find you on social media, things like that if they want to follow you or get in touch or ask you questions? Yeah,

Speaker 2 (34:12):

I'm on LinkedIn. I'm also on Instagram at hydrogen Nanga. So it's J a N N E N GA. And yeah, happy to engage on social, do it quite a bit, especially on via LinkedIn. So love to connect with any of your listeners.

Speaker 1 (34:31):

Excellent. And then finally, last question. What advice knowing where you are now in your life and career, what advice would you give to your younger self? Maybe you're that PT right out of PT school.

Speaker 2 (34:47):

Yeah. it's a great question, man. I have to reflect back quite a few years when I was a young TT now. But I think that the biggest piece of advice I would give is really around not thinking that you have to have all the answers. So I had a hard time when I first came out of the, I felt like, okay, I'm a, I'm a physical therapist. Now I'm in front of my patient. That credibility of any question they have are going to ask me, I have to know the answer. And that's not always, that's not true, actually the, the ability to say, I'm not sure that gets, let me get back to you and truly providing research, great response versus an off the cuff, maybe not perfect response. I think sometimes it can be so much more valuable in your overall long-term credibility with that, that particular patient or other therapist or leader.

Speaker 2 (35:59):

It takes a lot of vulnerability to say, I don't know. And a lot of confidence to say, I don't know, but I wish I would have been able to do that maybe a little bit more on the beginning and not felt the pressure of having to feel like I needed to know all the answers because Lord knows, I didn't know all the answers back in the day. I still don't know them today. Right. And you know, one of the other interesting things, just from a, as my growth, as a leader in this same sort of vein is what I've learned over time is that as a leader, you shouldn't have all the answers, right? It's my people come to me now and they've learned over time, like you become a crutch to those that work with you or for you. If you're the only one who has all the answers, right. Versus putting it back on to them to say, well, what do you think? Like, what do you think the answer is? Coming to me with solutions, not just a problem. And so to me, that's training and bringing in new leaders. I learned that from, from a leader who was a mentor to me quite a few years ago. And so that's another sort of way that now I've shifted that same response from a leadership perspective.

Speaker 1 (37:24):

Oh my gosh. I could talk all day on this from a leadership perspective who may have to do another podcast on it. So I think people would love it. Well this was Heidi, this was great. Thank you so much such good, good information for anyone in any of the rehab therapies, PT, OT speech to download this report, dive in and, and use this report for your own business or your own practice, you know, that's what these reports are for, right. To kind of not just look at it and say, oh, that was cool report, but to actually use the report and use it to be a guide maybe to your business or to your practice. Yes.

Speaker 2 (38:04):

Yeah. That's exactly right. Like how, how in your business decision trends that you're seeing in industry that you can validate some of your decision-making on is exactly why we've, we've put this out there to the public with no cost to you. Like it's, it's really just to, to benefit and give back to this industry that we love so much and want to see flourish. So Karen, thank you so much for having me. I really appreciate the opportunity. Congratulations on all your, can't say enough, how awesome you are with your advocacy and as an influencer and, and true thought leader in our industry. So thanks for everything you're doing with this podcast and, and, and all of your other ventures. It's, it's awesome to watch you and see how much of an impact you've been able to have in our profession.

Speaker 1 (38:57):

Thank you. That's so nice making me blush aside from the large scratch for my cat on my cheek, where it's already red. Thank you so much. I really appreciate that. And everyone, thank you so much for listening to this episode, go download the report today. We'll have all the links to it at the podcast at podcast on healthy, wealthy, under this episode. Thanks for tuning in, have a great couple of days and stay healthy, wealthy, and smart.


Jul 5, 2021

In this episode, Owner and Founder of Velocity Physiotherapy, Erica Meloe, talks about the business of physical therapy.

Today, Erica talks about her previous career, how to foster motivation and commitment in patients, and addressing company culture. What does it mean to be out-of-network?

Hear about the biggest lessons Erica has learned in her career, the importance of mentorship, and get some valuable advice, all on today’s episode of The Healthy, Wealthy & Smart Podcast.


Key Takeaways

  • “Being an entrepreneur, you need to be able to know what your strengths are, and really work with those strengths.”
  • “I learned over the years to delegate out what I don’t like to do or what’s not in my strengths.”
  • “Practice makes permanent. It does not make perfect.”
  • “If you put a computer between you and your patient, you decrease the outcome by 50%.”
  • Some important definitions
  1. Co-pay. This is a fixed amount that’s generally used for an in-network model.
  2. Co-insurance. This is based on a percentage of the bill.
  3. Balance-billing. This is balancing the bill up to what you typically charge.
  • “Lately, a lot of plans are being reimbursed as a percentage of Medicare.”
  • “A lot of being an entrepreneur is mindset.”
  • “Why reinvent the wheel when someone else has done that?”
  • “Be unapologetically yourself.”
  • “We need to find joy in our life, and whatever that is, we need to do more of that.”


More about Erica Meloe

Erica Meloe is a board certified physiotherapist in private practice in NYC. After a decade solving financial puzzles on Wall Street, Erica took her MBA and her problem solving skills into the clinic. She specializes in treating patients with unsolved pain and her mission is to raise awareness of the physical therapy profession to a level like no other.

Erica is co-host of the podcast “Tough To Treat. A physiotherapist’s guide to managing those complex patients.” She is also a thought leader in the profession and helps her patients as well as her colleagues empower themselves to lead and live with purpose.

Erica’s book “Why Do I Hurt? Discover the Surprising Connections That Cause Physical Pain and What To Do About Them” was released in June of 2018. She has also been featured in Forbes, BBC, Women’s Day, Better Homes and Gardens, Muscle and Fitness Hers and Health Magazine.

Erica is also fluent in Spanish and loves traveling!


Suggested Keywords

Physiotherapy, Therapy, Health, Motivation, Commitment, Consistency, Practice, Entrepreneurship, Culture, Mentorship, Business, Mindset, Healthy, Wealthy, Smart


To learn more, follow Erica at:




Facebook:       Erica Meloe PT

                        Velocity Physio NYC

                        Tough To Treat (Podcast)

Twitter:            @EricaMeloe


Instagram:       @toughtotreatpodcast

Pinterest:         @emeloe

LinkedIn:         Erica Meloe

                        Velocity Physio

YouTube:        Tough To Treat

Business Round Table on July 27, 2021 at 8:00 PM EST 

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Read the Full Transcript Here: 

Speaker 1 (00:04):

Hey, Erica. Welcome back to the podcast. It is always a pleasure to have you on, so thank you for coming back.

Speaker 2 (00:11):

Thanks. Thank you Karen, for asking me, I can't believe it it's been, I remember our first podcast was probably 10 or 11 yeah. Years ago.

Speaker 1 (00:19):

So yes. So long ago, like way way, the beginning of healthy,

Speaker 3 (00:23):

Wealthy and smart. You were

Speaker 2 (00:27):

On the second street. I was just, so I remember taking a car going up in the elevator and sitting there in the office. Oh my God. Yes. It's a pleasure to be back on again. Thank you so long

Speaker 1 (00:37):

Ago. Gosh. Yeah, that was a long time. It was like 10 years ago. And now this month we are talking all about the business of physical therapy. So I thought who else to have on who better to have on than you, who is a successful physical therapy entrepreneur business owner here in New York city. So before we get into your, what your business structure is like and how you run your business, I would love for you to remind the listeners a little bit of your background. So just so people know, Erica had a career before she became a physical therapist. So talk about that and how that career prepared you for your role as an entrepreneur.

Speaker 2 (01:24):

Yeah, that's a great question. I, it's funny, I've gotten much more involved during this time being at home a bit more during COVID with the whole wall street and and, and the whole, the financial markets, cause I've had more time to look at it, but I graduated just in brief. I have an MBA from stern school of business at the NYU stern school. And after graduation, I ended up working for an investment bank, a global investment bank and international foreign owned bank, literally starting in Karen, when I tell you and I'm dating myself, but I started like just before the market crashed. Okay. Like the 87 crash,

Speaker 3 (02:05):

I was going to say, you have to, you have to be more specific. There's been a few. So,

Speaker 2 (02:12):

So that was, and I started off in research and, and that was all great, but I ended up going on to a trading floor and it's, it's a, you know, like a huge trading floor with a lot of seats and it's an open, open area and mostly selling and trading international bonds, futures and options. And I, I really, I loved it. I loved, I really enjoyed working on wall street and I think that it was a different time back then, way different than it is now. And, you know, somebody asked me recently, why did you leave? And I was like, I didn't want to retire on a trading floor, which was the truth. You think God. Right. But I, I, I often think about why did I like it so much and how can I take that, that part of the business into anything else that I do.

Speaker 2 (02:58):

Right. And I liked it for many reasons. And one of it was, I was part of a team, you know, and I think the team of people, you know, we talk about collaborating in our, in our, in our world. I do very well with people, with a team, people who are team players. And I think for me, that's why I think in physical therapy land, I've been, you know, in the profession going on. Yeah. Committee's trying to run for different positions because I like being part of that team. It's just an, and we all have a lot in common too, I think as well. So it, and that's, you know, I got to talk to people on the phone a lot. I was, it was very much, it was back in the old days where we actually had to pick up the phone and call people and not, and it wasn't all computers.

Speaker 2 (03:42):

So that's the point. I think for me, I enjoyed the most and, and also figuring things out and problem solving. And as an entrepreneur, I mean, we have to figure things out all day long. Right. I think for me, it's, it was being a team player was definitely the main thing why I miss it. But I also liked the, the fast pace and, and, you know, yes, we're in New York, we all liked the fast paced and certainly not as fast as it used to be. That's for sure. But I enjoyed making those quick decisions and, and, and talking to clients and analyzing with them to solve their problems. So it's similar to physical therapy, right? I mean, we deal, we see patients, we try to, we talk to them, we try to figure out, you know, what, what's going on, what's going wrong with them or what their problem is.

Speaker 2 (04:33):

And, you know, I did recently a a paper for I'm doing part-time some courses and I did something on the therapeutic Alliance and the therapeutic Alliance, the quality that is the most important is really being, being a good listener and like listening to your patients, listening to your clients. So that's how I'm when I was on wall street. I, I really, this is when we had great expense accounts. Peter I've waited, you know, I flew to Mexico city for, for lunch one day with, for the central bank and came back. I exploited, I mean, that's the life I loved and I, to this day, I do miss it. I'll be, be honest, you know? And I, I was able to fly. I didn't, I didn't, I only covered a few international clients was mostly of domestic, but it was establishing those relationships, maintaining those contacts.

Speaker 2 (05:25):

I know you talk about like the concierge I read your article actually in an impact magazine. It was excellent. And it's about, you know, it's that extra service it's that, it's that developing that relationship. It's going that for mile. And, you know, I was one of the top sellers on the desk. And when I left people, some of my top clients were like, we liked you, or, you know, the, what if they use the word like, but they were like, you never shoved anything down our throats. I never shoved the deal down their throat. I never shoved anything down their throats. It was a, and I think that's, what's, I've taken a lot from that, you know, in a nutshell that, that whole experience, you know,

Speaker 1 (06:05):

And as an entrepreneur, where, where does that sort of plug in? Where does that fit? How did that help you grow your practice? Because you have a thriving practice in New York city. It doesn't happen overnight.

Speaker 2 (06:20):

Oh no. Oh no, no, no, no. And to be honest with you, I think as entrepreneurs, we are lucky in the sense that, you know, since we don't work for somebody, we work for ourselves, right. We have a little bit more leeway to discover things about ourself and what we want to do to grow the business. Right. and I think that what has from taking from the wall street experience the ability to that, what's the word I want to use. It's almost like being an entrepreneur. You need to be able to know what your strengths are and really work with those strengths. So when I first started out, I knew that my strength was I did the strength finders 2.0, you know, everybody should do that. It's, you know, and I'm like a learner achiever. You have to be a connector. I swear you have to be a connector.

Speaker 2 (07:14):

Right. You must, right. I'm a learner achiever like maximizer input and responsibility for those of you who have done that. So for me, the way I work best is when I play to my strengths. And I learned over the years to delegate out what I don't like to do, or what's not in my strength. Like, I it's just, why would you, do you, you know, we have the ability to do that. So playing to your strengths is that one of the first things I learned early on, because, you know, people say, oh, you can be a generalist physical therapist. You can treat everything, but what makes you different from the person down the street? Right. And for me, it's like, and I'm still, I still hone this to this day. This is all a work in progress. But you know, it's the problem solving. I love to figure stuff out.

Speaker 2 (08:06):

That's just basic. I love to figure stuff. I look to look at a trade when I was on wall street to figure it out, how can you make money? How can I make you money? Because if you make money, I make money. Right. And you know, if you feel better, if I can make the patient feel better, I do make more money. Cause they'll refer their friends and family. So it's very similar mindset. I think that was the hope. That was the answer you wanted, but it's, for me, it was really honing on, on what I did best. And then more recently, Karen, I looked at patients who I really like to treat. And what was the common thread, right. Wow.

Speaker 1 (08:45):

You knew what was it? What was the common thread?

Speaker 2 (08:49):

The, honestly it was being motivated and coming in consistently and being committed to going the full pro the full, raw, the full round. Don't come for two visits and don't come back. You want to, you're, you're literally, you are committed to having someone look at your entire body from the brain to the foot and looking at the connections in the body and be willing to commit some time to getting yourself better. That was the commonality,

Speaker 1 (09:15):

But, and they were athletic. But here I have, I have something to say about that. So was that the common thread they innately had or was that something that you helped to foster in them when you first see them, those first one or two visits?

Speaker 2 (09:34):

Yes. I helped to foster that. How

Speaker 1 (09:37):

Do you do that? How do you do that? How do you help to foster that? So,

Speaker 2 (09:41):

So when people phone initially, I'll backtrack a second. When people like this recently I had someone come in to sit, you know, she said, I'm seeing a well-known therapist in New York, blah, blah, blah, et cetera. What makes you different? And I was like, this is what makes me different. And I start off and I say, everybody says, they treat the whole body. You know, it's everybody treats differently. But what I do is I look at the connections in the body of the relationships of the regions, of the body, to each other. And I don't just treat your symptom. I look at your impairment and I look at their relationship with the head to the PIP, the need of the foot. And I tell them a story. I say, I have a patient recently. She had a pet issue in her pelvis, low back pain.

Speaker 2 (10:18):

And her driver was her foot. And I explain a little bit about why I do that. And I do that with patients when they first come in, this is what I say. I say, look, I don't want say, look, I basically tell them it's w I try. I listened for quite a bit. And then I basically tell them that it's, this is a relationship. And we're trying to change your movement patterns. If learning is very important, and I need to know how you learn best practice makes permanent. It does not make perfect. So you need to be able to come in and I'll say this to them. I need you to come in consistently at the beginning, once a week, I generally don't treat twice or three times and they start a surgical. But I'll treat for the hour. And I'll say, you know, minimally once a week for, let's say three weeks, I need to front load the visits because I'm trying to change strategies and trying to train your change, your brain.

Speaker 2 (11:11):

And I need to do that with a lot of input at the beginning of the treatments of the treatments. And if you want to space those out after I'm fine with that. And if patients can't do that, I basically say for whatever reason, if it's financial or Trey or vacation, I tell them that that's okay, but you won't get the same results. It will take longer. And the people who come in at the beginning, who front-load them get results quicker, and those are the people. And I looked at that list and that very true. They were coming in consistently and front-loaded, but I tell them that, but you know, it's based on the assessment and if I can give them, like, I don't want to say a wow, but if I, if they get what I'm trying to say, I can make a change in the first visit.

Speaker 2 (11:55):

Then they are more convinced of coming in more frequently. And I think because I do a lot of listening and I ask questions that not many people ask. I mean, we're similar. You and I, but I think that they don't get a lot of that outside of, of medicine, traditional medicine. And I think that when I explained to them, I'm trying to change your movement pattern. I'm trying to change your strategy. You're, I'm trying to work with you. You know, I'm trying to change how you move about your nervous system, your neuromuscular recruitment, things like that. And I, I, I work with them. I'll have the move and I can see I can. And I take P ever since COVID started, I've been with that Darla health. I've been taking more pictures in the office because I can really, I mark them up on my apple preview. And I'm seeing things that I never saw in the clinic before. And then when I show them this, they're like, oh my gosh. Wow. And I think their brain starts to change immediately when they in the first visit. And I think that that's important to get that buy-in at the beginning a little bit to help them come more consistently.

Speaker 1 (13:00):

Yeah, absolutely. If you don't have buy-in in the beginning, then they're not gonna, they're not going to be that patient who you said this common thread is they're motivated and committed. But I think that yes, if people are coming to see if they're seeking out a physical therapist, they're somewhat motivated, maybe committed, but it's, you who's educating them and listening and going that extra mile, making them feel comfortable, making them feel heard. And that's why you have motivated and committed patients. Correct. So it's a combination of the patient and what you do. So don't say, oh, it's just these motivated people.

Speaker 3 (13:43):

Good point [inaudible] I

Speaker 2 (13:47):

Know. And it's so funny because the, the, because we spend so much time listening, that is the form of communication, the best therapist or the best communicators. I mean, when I was doing this paper for therapeutic Alliance, you look at the, there's a like different pieces of the puzzle, listening and communication where like 70% of the outcome. I mean, maxi, Missy acts, she's a researcher at a McMaster, right? She says, you know, you walk into a treatment room, I'd say for somebody who's, you're, you're the fifth person you walk in there, hypervigilance, you know, distracted, you've exerted a no cebo effect on your patient before you even sat down. And they're not coming back after that. Right. So it's so important. And to, to know that, and I think that that'll help them make, make changes. You, if you go in there, you can be the best therapist ever and, and try to get them to be more motivated and committed. But if you're distracted, that doesn't work.

Speaker 1 (14:43):

Yeah. I mean, just put yourself in their shoes. That's all you need is, is like just a smidge of empathy, you know? Cause we all, you don't have to be like an empath. You just need a smidge because like, we all know what it's like, like when you go to the doctor and, and you're trying to like spill your guts to them. And they're like on their commute computer. Aha. And you're like, well, nevermind. I don't feel like telling you anything.

Speaker 2 (15:10):

I know. I know. And you literally, if you put a computer between you and your patient, you've decreased the outcome by 50%. Wow. That was an interesting statistic I found. And so now people are looking at me and this is extra work for me. And it's something I'm working through, but I literally barely write in the first part of the interview. I'm just listening to them and looking them in the eye. And I'm like, I'm trying to remember, and I have a good memory, but I'll write a few things down, but I'm listening to them. And I'm just passive, to be honest, if they don't give, I don't get what I want. I will ask other questions. But I think that that writing that paper on the therapeutic Alliance, even as an entrepreneur, because yes, we have the, we have the ability to make it, make our own schedule.

Speaker 2 (15:54):

Right. Have the freedom to do that. We have the, we have the freedom to tell people we don't want to see them. You know, I literally someone said to me recently, I don't know what you think about this is that you should have an application process to have them become your patient. I was like, Ooh, that's interesting. I'm not sure I'm there yet, but that's an interesting concept. You know, how business coaches do that a lot, you can apply for the program, right? I'm not sure I'm there yet. I can, you know, I can talk to somebody on the phone and get an idea of who, if they're right for me or if they're not, I'll say maybe there's somebody else, but I don't like, like a formal application process to do that.

Speaker 1 (16:32):

Qualifying people. I mean, I guess you can, but I, I mean, I think that you're doing that in that first visit by saying, you know, I, I really want you to be committed to this process. Is that something you think you can do? Yes. Right. how do you learn best? Because I want to make sure that my teaching style matches your learning style depending on who you are and how you do things. And, you know, what's interesting is you know, there's StrengthFinders, there's all these different things. In the Goldman Sachs class that I'm taking now, we used one called people styles at work, by Bolton, Bolton and Bolton second edition. And it basically it's 18 questions and it splits you up into four different kinds of learning styles or leader, sorry, leadership styles. But you can use that even with your clients and with, if you're an entrepreneur, let's say you have multiple people working for you.

Speaker 1 (17:31):

You can have them take these take this test or quiz if you will. And if someone is more analytical, maybe you want them doing this kind of work. If someone is more, there's four different kinds, there's analytical, which I think you are which would be less assertive. But some of these, I, I don't agree with that. I mean, it's, they're not all perfect, but less responsive to others, task oriented, precise, and attentive to detail, prefers to work with procedures and symptoms motivated by the right way to do things I, and, you know, we sort of fall into things that might be a little analytical, a little expressive, but there's our analytical, your exp you could be an expressive and amiable or a driver.

Speaker 1 (18:22):

And it's, it was very interesting to look at that, even from a client standpoint. So as you're talking, you can kind of guess like what the, what maybe your client is and how you can. So if they're more analytical, maybe you're going to want to hit them with your facts, your figures, your numbers. If they're more expressive, maybe you're going to want to hit them with the things that sort of tug at the heartstrings. If you're more amiable, if you think they're more amiable, then you're gonna maybe want to challenge them a little bit. So they're not always just yessing you all the time. You know what I mean? Yeah,

Speaker 2 (18:58):

Yeah, yeah, absolutely. That's, that's a great that's a, that's a great tool. I have to look into that. It's funny because I sent out some questionnaires ahead of time as well. I do the CSI questionnaire and the DAS questionnaire, and I get a good idea of, of just what their personalities are by looking at those. And some people I see them and I look at them, their questionnaires and they're like completely different people, you know, honestly. Right. But that gives me an idea of just their, just their overall persona. And then I explained to them, you know, I explain how I assess and I just say, and they're like, well, why are, you know, why are your hands in my armpits type thing? And I'll cause I'm well on the thorax, the head had the feet and I'll say, well, I'm, I explained the rules of the game.

Speaker 2 (19:39):

I said, I'm just gonna explain the rules of the game. Cause we don't know the rules we can't play and they all laugh and it's fun, you know? Cause I think it's just a way to make people feel at home. And I think it's funny because when I weirs ago and when I was working for other people as like a staff PT, yes, I'm older now, but I, I feel that as an entrepreneur, you can, you can express yourself differently and you have more freedom than if you were to be with, you know, sort of in the confines of a culture, like a corporate culture, like on wall street. For me, I wasn't confined in the sense because it was all about getting the deal done, making the money is pretty driven by money, right. So there were kind of no limits at that point back then.

Speaker 2 (20:18):

So you did what you felt, whatever you, whatever you do, you get the deal done. And we didn't really have, it was just, we had limits obviously, but it was very different. We weren't reigned in so much, you know, and then we were able to sort of be ourselves a little bit. And I, I always believe that things happen for a reason. I believe that I was meant to cover central banks are meant, I was meant to cover other banks at other different hedge funds because of the analytical style that these people have. You know, I think, you know, people say you find patients, I think patients find us, you know?

Speaker 1 (20:54):

Absolutely. Yeah, absolutely. And that's where, you know, your website, your wording, your copy, all of that can reflect that. And you hit on something that I want to touch on quickly too. And that's company culture. So how did you, and you have a partner and he gal, how did you guys address your company culture, the culture of your clinic, where you sort of very what's the word I'm looking for?

Speaker 2 (21:31):

Like, did we have like something

Speaker 1 (21:33):

Like, was it purposeful, did you sort of purposefully, like this is going to be our culture, this is, these are our values and what we want to reflect on our business. Yeah.

Speaker 2 (21:45):

I mean, we didn't do that formally. But we certainly, if it evolves over time, because it naturally the types of patients that would, that would come into the office would be those ones who sort of have been elsewhere or have, you know, really wants I don't even want to say hands on approach anymore, but more of a, of a, of a whole person approach and that it naturally evolved that way. And that sort of like when we did at one point when we were gosh, I think this was when we first started, we actually had to go up to Columbia university to speak to the student center up there. And, you know, we did a little PowerPoint and in that PowerPoint, it was, we talked about, you know, why the, you know, the hip is related to the foot. And, and so it evolved over time that, that whole, that whole culture and, and, and we were out of network from the get-go all right, because we knew that in order to treat this way and certainly New York rents, you know, you know, they're changed now, but back then, it was you, you could not at least in New York state, cause we're like, like the lowest reimbursed state in the country, right.

Speaker 2 (22:55):

I mean, you cannot maintain a business in New York city on an network network, unless you see, you know, five patients an hour, which is unacceptable to me. So that is not the way I'm I treat. And even, you know, it's funny when I graduated PT school, I called up a lot of places that I was going to interview at and see how many patients they saw an hour. And if it was four, I didn't go for the interview. And I had, I was lucky I had a career change. I had some savings, so I could be a little bit choosy, but I, I, it's very stressful working in that kind of an environment.

Speaker 1 (23:25):

Yeah, absolutely. So let's talk about the structure of your business. So you said you've been out of network from the beginning. So what does that mean? Can you explain to the listeners what that means?

Speaker 2 (23:34):

Yeah, so we don't contract. So basically we don't contract with an insurance company. So we have, we take Medicare. We are what we call par for Medicare. So that's con that's a contracted in New York city rate. And, but other than Medicare, we are out of network, which means that if your client has out of network benefits, we can do one of two things. You either build the insurance company directly. We charge them the co-insurance and then we get paid. So we get paid or the patient pays us directly. And then they submit the claim themselves, or we can submit the claim for them. So the majority of patients now have no out of network benefits. So what we end up doing is just billing the patient directly. And there are some insurances that we don't take it all. And so even out of network, so what we'll do is we'll just, the patient will pay us directly and then they'll submit on their own. We just give them a receipt, but out of network. So long-time patients of ours. We will bill the insurance company for them and wait for the insurance company to pay them, pay us, excuse me. And we'll charge them the co-insurance and that's gotten much less lately.

Speaker 1 (24:51):

Yeah. And can you explain what a co-insurance is?

Speaker 2 (24:55):

Yeah. So there's the co-pay and the co-insurance, the co-pay is a fixed amount. That's generally used for an in network model. So you have a 60 per dollar copay when you see a specialist. So co-insurance is based on a percentage. So for example, I work for, you know, large company, a here in New York, I have Cigna, my benefits are 70%, 30% Cigna will pay 70% of what's reasonable and customer in 30% is the co-insurance that 30% of the co the co-insurance is based on what you bill out of network. So you bill $400, the co-insurance can be 120 bucks, or it could be lower. We generally drop it lower. Okay. But we're because we're not contracted with, with any insurance companies. So a lot of people lot of lately, a lot of insurance companies have been sending patients letters like you, just so you know, you're seeing an out of network, I'm using this in air quotes, out of network, physical therapist, just so you know, they can balance bill you. So they're doing a lot of these sort of nefarious practices to get the patients saying, well, I don't know if I want to do an out of network practice, and they've been doing this for a while now, but in my patients know better. But recently someone brought in a piece of paper and it was not, was not a bill. It was just a statement of fact we've received charges, you're out of network, just, just FYI. They may balance bill you, which is, you know, they never did that before.

Speaker 1 (26:21):

Yeah. And balanced billing is

Speaker 2 (26:24):

They're going to build. So I'll use a simple example. Let's say $300. We charge, for example, let's say that's the number the patient's covered at 70%. Assuming. So let's say that it's, that would be two 10. That's usually not what they pay. Let's say they pay one 50. The co-insurance we charge was 50 bucks. That's $200. We can bill them to a hundred. That's a balanced bill means you balance you balance bill up to what you've charged.

Speaker 1 (26:48):

Got it. Got it. Yep. Just so people understand what all the well, because we're throwing out a lot of terms here. I want to make sure people understand, because this is all about the business of physical therapy, right. This whole month. So this is, this is literally the business, right.

Speaker 2 (27:04):

And I will, and I will. Yes. And I will tell you lately, a lot of plans just for anybody who's wants to do an out of network and bill and accept what they pay. A lot of plans are being, being reimbursed as a percentage of Medicare, which as we know is not great. So more often than not, you do not know that upfront. Sometimes they'll tell you, we do mostly electronic right now. And they won't, if there's nothing on the site that says patient is reimbursed at a certain rate, so you'll get paid. And then you realize, oh no, this is not enough. And so, you know, and that happens a lot of times after the fact. And so we have to, we have to you know, make the different part of the difference up in the co-insurance. So it has to, it's just, we have to, because of the, you need, we deserve caring.

Speaker 2 (27:51):

We deserve to get paid. This is what I say every night or every morning I write in my journal, my work is of high value and worthy of massive compensation because it is yes, we deserve to get paid. And and patients accept that now a lot more than they used to, a lot of patients now do not have out of network benefits at all. So they just pay and that's that, and that also comes down to your ideal client, right? Who, you know, you want, do you want somebody who's just going to like, you know, ask you to drop your rate or cause they, they will do that. They will ask you to drop your rate. And I generally don't do that anymore. You know, it's a special situation of course, but because those people are not sort of going to stick around, right?

Speaker 2 (28:36):

You want a lot of people who have no problem paying and it, depending on what your rates are, they will stick around and they will have no questions asked. And that, you know, as, as an entrepreneur, you will hone that ideal customer avatar over time. But speaking from experience, it is very frustrating when you, you, you treat an hour an hour and 15 minutes sometimes with people in any insurance company, out of network reimburses you at a percentage of Medicare, that's a joke. So you and I would get angry over it. And so at a certain point, you know, I, you know, a lot of I'm happy that we don't have out of network benefits a lot of the times, because it will save me that frustration and anger and the patient can just get reimbursed themselves, you know, pay me directly. But once again, as a new PA, if, if we have people who are just starting out or they're five years in the business and they want to start their practice, they may have to do that. And you're going to learn over time that the reimbursement changes from between insurance companies in between dates of service. I mean their insurance companies who we bill out of network will pay different rates for the same codes. It's just ridiculous. It's ridiculousness. And, you know, we have a small practice, someone who has a large practice like that, who's getting hurt like that. You need to almost hire us, hire like an advocate or somebody who can negotiate for you, you know, because that that's, that's a full-time job.

Speaker 1 (29:57):

Yeah, absolutely. And, and I think that it was really important to go through all of that, because that can be really confusing, especially for a new physical therapy entrepreneurs who want to start their own practice, who are on the fence. Should I take insurance? Should I not take insurance? I always tell people, call insurance companies and find out what they reimburse in your area. Yeah. Because it may be worth it to take an insurance, take one insurance and not take the others because there are insurance companies that may reimburse 120, 150 a visit. Hey, that's not bad.

Speaker 2 (30:33):

I will tell you there's a couple of patients. And if it's planned dependent, because there's far and few between, like I can count on one hand, the amount of patients I have who have like the platinum insurance plan. Right. And you will get paid more than your direct rate, which that number is dwindling. I've had people therapist asked me recently, should I? Because of COVID because of the financial stresses people are under, should they start billing out of network for their patients? And I basically tell them what I just told you. It's, it's, it's a great service you can offer. But if you don't have an assistant, you will be on the phone way too much than you want to be on the phone. Okay. so it just misses out your priorities. Yeah. Yeah.

Speaker 1 (31:16):

And actually my next, that was going to be my next question for you is if let's say a, a budding physical therapy entrepreneur comes to you and says, gosh, what, what was one of the biggest lessons you learned when in the course of either starting or now continuing to run your business? What would that be? Hmm. I think

Speaker 2 (31:47):

With regards to, I would say being willing, being open and being open to collaboration, being open to like expecting the patient to do the right thing. Because a lot of times we can say, oh, their patients never got going to pay. They're not going to do this. They're not going to do that. And I think that a lot of about being an entrepreneur, and this is one of the biggest lessons is, is your mindset. It's the vibration that you have. And it may sound woo woo. But trust me, it works. You know, 80% of this is mindset. 20% is execution. You know, you can sign up with an insurance company, you can do the billing, you can put the codes and you can do the evil, right. It's about minds. If you expect people not to pay you, or if you expect people to, you know, B B be difficult with, with regards to where, if you expect with insurance, we expect to have a difficult time.

Speaker 2 (32:44):

You will have a difficult time. And a lot of it is mindset. That's the biggest lesson I think because the technical stuff can be, can be taught, you know? And when I first started out opening the practice, I was looking for a mentor in our profession and, you know, Karen, I still, I couldn't find one. And it was very frustrating because I was I was, you know, did have an MBA, but the school of entrepreneurship didn't was not open at stern. And when I was there, right. So I was coming from a corporate culture, transitioning to an entrepreneur, an easy transition in terms of mindset, but not an easy one in terms of logistics of, you know, what does it take to be an entrepreneur versus working for a corporation or corporate it's very different. You have to really advocate for yourself.

Speaker 2 (33:32):

You have to know who you have to know who you are treating. Your marketing is huge. You have to really learn a lot about that even before way before you even, I mean, I w I wouldn't say learn that before you start your business, because most people, if we did that, we would still not have a business. You know, I would just start and go and you'll learn, you know, but, but the mentorship is huge. I think because why reinvent the wheel when someone else has done that? So talking about the 80% strategy, why, why reinvent the wheel, find somebody in our profession who can mentor you, right. That can help you do that. And the 20, the mindset is stuff is, is, is you, you can learn with mentors or finding somebody outside of our field to help you with that. But that's, that is important.

Speaker 2 (34:17):

And I believe that the, the, I know we've got a lot of business groups out in our field right now who charge very large sums of money to, to, you know, to up to, you know, and they're great programs, but I will throw out an option. You know, there are a lot of great physical therapists out here, you know, who have business backgrounds, who are entrepreneurs, who have successful businesses like you and me, we, we could all easily help out people, you know from a mentor program. And, you know, we need to grow the profession. We need to grow our physical therapists. And I think it's important that we give back and, and it being, and, and learning one of the main things I've learned as side's, the mindset is learning to be a mentor and learning the importance of mentorship. Because I didn't have one when I first came on and I still don't have one yet. I'm still looking, but, you know, that's why I have a team and collaborate with people like yourself, you know, cause we learn. But I do think that people should like you and I are like on the front lines, so to speak, right. We're, we're, we're, we're seeing patients, we're, we're actually doing it, we're running a business. And I do think that is important when people look for programs out there. Right. Because I think it's, it's, you know, we've done all the hard work. Why reinvent the wheel? Yeah,

Speaker 1 (35:41):

Absolutely. I couldn't agree more. And I think that's great advice for any upcoming entrepreneur in the physical therapy space. And before we jump off, where can people find you, if they want to ask you questions, if they want to know how you do things, where's the best places for people to reach

Speaker 2 (36:00):

You? A couple of things, we have a podcast with the wonderful Susan Clinton and myself it's called tough to treat. Yes. we've got our a hundred, our hundredth episode was last week kind of

Speaker 5 (36:11):

Crazy. Right. I was so proud my God.

Speaker 2 (36:14):

So there's our website, tough to and I've got a bunch of website, our business, the website, but I'll give you like the way to reach me is all my handles on social media are at Erica mellow. And my email is

Speaker 1 (36:31):

Perfect. And your website, Eric

Speaker 3 (36:33):

And Yes, yes, yes.

Speaker 2 (36:37):

Yeah, no, I'm thinking more philosophy. Physio. One is being redone right now. So that Erica is a,

Speaker 1 (36:42):

It's a good one. Perfect. And we'll have the links to all of that at podcast dot healthy, wealthy, and the notes for this site for this podcast. And I know that you've answered this question before, but I'll ask it again because you know, more advice from you is not a bad thing. And that's, what advice would you give to your younger self? Maybe like fresh, forget, forget you your first job out on wall street, or even your MBA. How about like fresh out of undergrad?

Speaker 2 (37:18):

That's a good question. And you asked this of everybody, right? I, I know this, I know you do. I think that, and, and I'm saying this now because I've experienced so much throughout the life, I've lost loved ones and things like that, but be unapologetically yourself. You know,

Speaker 1 (37:39):

I know don't we waste too much time being somebody else. Yep.

Speaker 2 (37:44):

Yep. It's at it is. Yes, we have. We do. And I think that if we are Susan always calls me my podcast. CO's a confronter, I'm like, I'm not really a confront her, but I do, you know, have opinions. And I think that we that's the advice just, you know, open your mouth basically and be up, be yourself.

Speaker 1 (38:09):

Excellent advice. Because like, like you said, we waste so much time trying to be somebody else and trying to conform to what people think we should be instead of just being who we are.

Speaker 2 (38:19):

Yes. And I, and I think that if I were to give an like other advice, because there's so much burnout in our profession now is that, you know, we need to find joy in our life and whatever that is, it varies for everybody need to do more of that. And this is a practice that I've done. So I recently went to a polo match gesture day. And so I have every year I have a thing called magical moments. And if I have a magical moment like that, I write it down. So it can be like, you know, spinning at soul cycle and Hudson yards during a pandemic, you know, or, or, you know, going to the, met with my niece or going to a polo match or Disney when I, and so at the end of each year or new year's Eve, I'll look at that. And I'm like, oh, I actually did have a nice year because I think we don't write those things down, you know? And I, and I think that's good for, for, for us to do.

Speaker 1 (39:10):

I love that. I love it yet. Another great piece of advice. Well, thank you so much for coming on the podcast and we will see you again at the end of the month on Tuesday, the 27th of July for our business of physical therapy round table talks, I'm really excited. And for all the people listening, you can find that out in the show notes as well, how to get more information on that round table. So I'm looking forward to that. So thank you so much, Erica, for coming on

Speaker 2 (39:45):

Again. You're welcome, Karen. Thank you. And, and to all

Speaker 1 (39:48):

Of you guys listening, thanks so much, have a great couple of days and stay healthy, wealthy and smart.


Jul 1, 2021

In this episode, Co-Owners of Kornetti & Krafft Health Care Solutions, Dee Kornetti and Cindy Krafft, talk about all things maintenance therapy and care.

Today, they talk about maintenance therapy in the home, diversifying revenue, and they bust a few maintenance therapy myths. How can maintenance patients have a goal statement if they’re never going to get better?

Hear about home-based therapy, teaching patients to self-manage, Medicare part B, and their book The Guide to Delivery of Home-Based Maintenance Therapy, all on today’s episode of The Healthy, Wealthy & Smart Podcast.


Key Takeaways

  • “It’s never been that if you don’t improve, then services aren’t covered.”
  • “Rehab potential is the responsiveness to care.”
  • “The myth of coverage has some roots in the denial issue.”
  • “If there’s room for improvement, a restorative or improvement course of care is what your skills would be indispensable for. That’s what would make your care medically necessary under the Medicare benefit.”
  • “If someone else can do it just as well as I can then this is no longer considered skill.”
  • “We are helping patients be accountable for their chronic disease management.”
  • “There are times that we are indispensable to help people improve and recover function back to a prior level or maybe beyond, and then there’s times we are needed to preserve and stabilise their exiting function so that their quality of life can continue on in the fashion that it currently is.”
  • “Be a bit more open-minded with how physical therapy really works in reality. Don’t assume that what your path at the moment is THE path and can’t vary and can’t change. There are many other ways you can utilise your skill to benefit those around you.”
  • “Don’t be afraid to ask questions, and don’t think you have to know it all.”
  • “If you’ve got a great idea, or you have something that is a passion, and you’ve got that intersection of your passion and your skill set, go for it. Start to explore that. The possibilities are endless.”


More about Dee Kornetti

Dee, a physical therapist for 35 years, is a past administrator and co-owner of a Medicare-certified home health agency. Dee now provides training and education to home health industry providers as Owner/Founder of a consulting business, Kornetti & Krafft Health Care Solutions, with her business partners Cindy Krafft and Sherry Teague.

Dee is nationally recognized as a speaker in the areas of home care, standardized tests and measures in the field of physical therapy, therapy training and staff development, including OASIS, coding, and documentation, in the home health arena. Dee is the current President of the American Physical Therapy Association’s Home Health Section and serves on the APTA’s national Post-Acute Work Group.

She serves as the President of the Association of Homecare Coding and Compliance, and a member of the Association of Home Care Coders Advisory Board and Panel of Experts.  She has served as a content expert for standard setting for Decision Health’s Board of Medical Specialty Coding (BSMC) home care coding (HCS-D) and OASIS (HCS-O) credentialed exams. She holds current credentials in Home Health Coding (HCS-D) and Compliance (HCS-C) from this trade association.  Dee is also on Medbridge’s Advisory Board for development of educational content on its  home health platform, and has authored several courses related to OASIS, Conditions of Participation (CoPs) and therapy.

Dee is a published researcher. on the Berg Balance Scale, and has co-authored APTA’s Home Health Section resources related to OASIS, goal writing and defensible documentation for the practicing therapist. Dee has contributed chapter updates to the Handbook of Home Health Care Administration 6th edition, and co-authored a book, The Post-Acute Care Guide to Maintenance Therapy published in 2015, along with an update in 2020 titled, The Guide to Delivery of Home-Based Maintenance Therapy that includes a companion electronic workbook.

Dee received her B.S. in Physical Therapy from Boston University’s Sargent College of Allied Health Professions, and her M.A. from Rider University in Lawrenceville, NJ. Her clinical focus has been in the area of gerontology and neurological disease rehabilitation.


More about Cindy Krafft

Cindy Krafft PT, MS, HCS-O is an owner of Kornetti & Krafft Health Care Solutions based in Florida. She brings more than 25 years of home health expertise that ranges from direct patient care to operational / management issues as well as a passion for understanding regulations.

For the past 15 years, Cindy has been a nationally recognized educator in the areas of documentation, regulation, therapy utilization and OASIS. She has and currently serves on multiple Technical Expert Panels with CMS Contractors working on clinical and payment reforms and bundled payment care initiatives.

Cindy is an active member of the National Association of Home Care and Hospice (NAHC) and currently serves on multiple committees. She has written 3 books – The How-to Guide to Therapy Documentation, An Interdisciplinary Approach to Home Care and the Handbook to Home Health Therapy Documentation – and co-authored her fourth, The Post-Acute Care Guide to Maintenance Therapy with her business partner Diana Kornetti PT, MA, HCS-D.


Suggested Keywords

Maintenance, Therapy, PT, Physiotherapy, Improvement, Assessment, Goals, Home Care, Rehabilitation, Accountability, Medicare, Myths, Health, Healthcare, Sustainability,


Book Discount Code (10% OFF): KK2021

The Guide to Delivery of Home-Based Maintenance Therapy


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Read the Full Transcript Here: 

Speaker 1 (00:01):

Hi, D N Cindy. Welcome to the podcast. I'm happy to have you guys on. Welcome. Welcome. Thanks for having us happy to be here. Glad to be here. Excellent. So today we are going to be talking about maintenance therapy. So when a lot of physical therapists think about maintenance therapy, they often think that, well, this is something that's not reimbursed. This is something that maybe the patient doesn't quote unquote need. So today we're going to talk about what it is, some of the myths and a lot of other stuff surrounding maintenance care. So my first question is, can you define what maintenance care is or maintenance therapy?

Speaker 2 (00:47):

Okay. Karen, this is Cindy. I'll take that one. I think, you know, just as you were saying, the word maintenance, I'm sure at least one listener twitched, a little, the eye Twitch, the uncomfortable many times when you say the word maintenance, it looks like, you know, people react like you swore in church to like, oh, I don't do that. Or I, you know, somebody does that and get in trouble. And, and I think even the word has become a barrier. So Dee and I have tried to reframe the conversation by getting to the heart of what it is by referring to it as stabilization of function. So putting aside that baggage and the history of the word, the approach to care is saying I'm utilizing all the wonderful things I know as a therapist, my ability to assess and all of those great things and develop a care plan. But the end result that I'm going for is a stabilization or preservation of their functional level or slowing of decline. I think maintain can get people tied up in knots and miss the point or think that we have to do all kinds of different things, which we'll talk about in a moment with the myths. But I really think it helps to, to approach it as we're talking about stabilizing someone's function.

Speaker 1 (01:58):

That makes a lot more sense. And I really like that word. And you're right. I feel like maintenance care does kind of give people that, oh, I don't know if that's quite my lane, but when you say stabilization of function, preservation, decreased speed of decline. I think physical therapists are like, yeah, of course that's what we do. We'll think about it. We, we, we treat patients that have these chronic diseases right there. We don't share them. They go to doctors, numerous doctors, you know, cardiologists primary care, right. With their, with our heart conditions, they see nursing, right. They see all kinds of disciplines and all kinds of professionals. But they're never getting cured. They're it's management of their symptoms, right? So, so it's to like Cindy said, we are, we're going to preserve function. We're going to, you know, optimize their ability.

Speaker 1 (02:50):

We're gonna re hopefully use our skills, knowledge, and ability to reduce their demand or their requirement, higher cost centers of care. What happens when you have poorly managed symptoms of chronic disease, like COPD or CHF or diabetes, these people use urgent, emergent care. These people go in the hospital. This is extremely costly to our, to our medical system. And it's, it's not sustainable as an aging pie, you know, as we age as the population. And so this idea that there's things we can do to have people function optimally, no matter what phase or stage of this chronic condition they're in too, so that they're not as dependent or on higher cost centers of care, or they don't realize the kind of sequella, you know, think about a diabetic with poorly managed blood sugar, you know, that starts to develop retinopathy Neff, prophecy, peripheral neuropathy, right? All these other problems that happen. You know, that's all very manageable. If we can get an early and often and preserve an optimized, I even say optimize function. So we're not improving people necessarily because sometimes they haven't already experienced a decline. A lot of times we're just going in there to share what we know so that they can be accountable and manage these chronic diseases themselves. Yeah. That makes so much

Speaker 2 (04:16):

Karen. I would add to that, you know, for your listeners, cause some folks, you know, D and I have been talking about this for years. Some folks have a difficult time with this conversation, not just the word, but the concept. It sounds good. It sounds valuable. But I think we have to take a moment and acknowledge how deeply as therapists. We have defined ourselves by that word improvement. You can see it in our documentation. If you're going to get physical therapy, you're going to walk five feet more or 10 feet more, every time I get near you because that's, that's what I have to do. And that if I'm not improving you, we've all been told that if, you know, after a certain number of visits or certain number of treatments, if you don't see improvement, you're obligated to discharge people. When you start finding out that, that isn't really true and it hasn't really ever been true.

Speaker 2 (05:06):

I think we've got to give ourselves a little bit of grace here and realize that this can be quite the seismic shift internally about how we value ourselves as therapist, how we define ourselves and how we're defining ourselves to our patient populations. I think to the patients, to the potential patients, to our other members of the interdisciplinary team, we've done such a bang up job, talking about improvement, that when they don't feel that they're going to improve as, as the beneficiary or other members of the team say, well, that's patient, isn't going to get better. They don't even refer them to us. They don't even come to us because we've created this wall of you have to be able to get better, or you can't come to physical therapy.

Speaker 1 (05:47):

Yeah. Oh, I'm sorry. I was going to say, Cindy, what's your favorite line? When you talk about how we are addicted, like we, we are ingrained with improvement. What is your favorite line to say?

Speaker 2 (05:57):

Oh, well, I created a little, self-assessment like you answer these questions to get these points about how addicted are you. Because it, I feel very comfortable using that word because this challenge is a lot of those core beliefs. And we have identified ourselves by this. So tightly that it's like, okay, we, we have to step outside of our comfort zone a bit. And then as we see therapists start to do that, then we get the questions. Then we get the, okay. I kind of understand it, but what about this? And what about that? And what about this other thing? And that's when the myths all start to bubble up to the surface with where did that even come from?

Speaker 1 (06:40):

Yeah. So let's talk about some of those myths and see if we can bust them. So I will, I'll take, I'll throw it over to you guys. Either one of you can start, but let's talk about a couple of myths of maintenance therapy for me. One big one is, well, it's not covered.

Speaker 3 (06:58):

It's not covered by insurance.

Speaker 1 (07:00):

I'll take that one. This is thing. Yeah. Well you know, maintenance has been part of the Medicare benefit under any Medicare beneficiary part a or part B, since you can find it in the Medicare benefit policy manual, as far back as the, as the 1980s. So it's been around forever. This is not new, that Jimmo V Sebelius case that was brought forward. Just kinda shine the light on it, but it's never been that if you don't improve and services aren't covered or you don't have no, this idea that rehab potential is the ability to improve no rehab potential that we all typically document at some point is the responsiveness to care, right? That's what rehab potential is. Whether the care is going to allow you to improve from where you are at the baseline of assessment or to maintain or stabilize your function from where you are now without any unforeseen event in the next three, six, nine, 12 months, two years, are you going to be able to manage this condition and not decline, right?

Speaker 1 (08:13):

Or if you're in a progressive type of disease process, are you functioning optimally? And are we slowing that deterioration or decline? That is a normal part of the condition. So Cindy, I can pop a punch it over to you. And since we talk about it being paid, I think we busted that Karen. Right? We busted that pretty good. Okay. So, so other payers, I don't know, but anybody that is a Medicare provider, so under part a or part B, it, it is part of the benefit. Okay. So Cindy, talk to me about what are the type of conditions that are covered by maintenance as if the diagnosis determines it? What do we know about that?

Speaker 2 (09:00):

Well, very often what we hear is, okay, I understand maintenance therapy. I know what it's for. It's for people who have progressive neurological conditions. So it would make sense for Parkinson's. It makes sense for Ms. It makes sense for ALS. So it must be those three patient populations that are maintenance. Okay. We got to step back for a minute. There are patients with those three conditions that benefit and have the ability to improve with therapy. So it's not Parkinson's is synonymous with maintenance. And there's nothing in the coverage criteria that is diagnosis specific. Diagnosis is only one piece of the conversation. It is where are they functionally? What are the, what is the impact of this diagnosis and their resorted comorbidities on their functional ability? And what does a therapist know? What does that skill that you bring to the table that is unique to that discipline that is indispensable to this patient?

Speaker 2 (09:56):

But I think the myth of coverage has some roots in the denial issue. We, we can't go past this point without acknowledging that therapists have seen denials for providing maintenance therapy, that you did not show improvement in wham. They took away payment for part of this care, which is what drove the Jim versus civilians conversation that led to the court settlement with CMS to basically say, you know, Hey, we've looked at this benefit. It doesn't say you have to improve to get services. And, and we're, we're good friends with Judah Stein who was the lead attorney in that case, and still has the ability to call CMS back on the carpet and the legal sense about how that settlement has played out since, because CMS basically approached it with a oops, you're right. It doesn't say that shame on us, but it's like, wait a second.

Speaker 2 (10:48):

You've been denying coverage of services for a long time. And so it's very hard to say, yes, it's in there. And we understand it's in there. And D and I've explained the fundamental pieces of that, but there's still that I got denied, or I know somebody who got denied this can't possibly be true and it's unfortunate. And my personal opinion is I have a really hard time with CMS, just kind of Oop, seeing it versus, you know, ownership. And we saw a subsequent event to the initial Jimmo case that compelled CMS to put on their resources, particularly on their website, where they had to quote disavowal the improvement standard. So not just say oopsies, but say you have to flat out say that does not exist. And if beneficiaries qualify for these services, they absolutely should get them.

Speaker 1 (11:36):

Yeah. The, the, the woopsies sees that my bad defense never, ever seems to go over well, does it? No, no, no. Okay. So we talked about, is it covered? We talked about diagnoses covered. What other big myths are there surrounding maintenance therapy? All right. I

Speaker 2 (11:59):

Got one for you. D I got, you know, where I'm going. We very often hear they say, okay, so if it's not about their diagnosis, I need to assess the patient. Right. Figure this out. So now looking at what I typically do in an assessment, oh, test and measures. Well, those must not apply. Then I wouldn't be using tests and measures on a maintenance patient. And we would say, well, why not? Well, why would I measure something if I measure it again later? And it's the same, then why did I measure it to begin with? So any thoughts on those tests and measures in the maintenance patient D

Speaker 1 (12:32):

Yeah. Well, and, and I'm going to tie it to goal statements too, from there, right? So, so this idea, why do we take objective measurements of patients to establish a baseline, right? And we need to do that regard, you know, based on the presentation of the patient, regardless of their diagnoses and comorbidities, because we want to see if they're functioning at, or near where we would expect them think of a class three heart failure patient, are they functioning where you would expect, you know, a class three heart failure patient to function, or are they functioning like end stage, right. Class four, are they functioning below where you would expect them to function? And so obviously if there's room for improvement, a restorative or an improvement course of care is what your skills would be indispensable for. That's what would make your care medically necessary under the Medicare benefit part a part B that's what it would do so that the tests and measures, establish that baseline.

Speaker 1 (13:30):

And you compare, this is how the patient's functioning. This is how we'd expect them to function. Now, when you get a patient who is functioning at, or near where you would expect them to function with, with their PR their presentation, the question you have to ask yourself, as you don't just jump right to maintenance, right? You can't just say, okay, this a maintenance patient. They need me. Yeah. Basket. What do they need me for? You know, is there something I can teach them, train them, provide them so that they continue to stay, be stabilized, maintain, be accountable for their care over longer period of time. Right? And if the answer is yes, then you absolutely should pick them up on, on, on a maintenance course of care, because there's some sort of skills, your knowledge, your expertise, that which makes you, you, what I like to call the magic, that is me as a PT, right.

Speaker 1 (14:21):

And we've all had those magic. That is me moments. When you ever, whenever you walk or, or you, you readjust a, an assisted device to properly fit a patient and people look at you like, oh my gosh, why didn't we think of that? And it's just like, because you're not the magic. That is me. I mean, I, and we take it for granted. So the idea is that tests and measures absolutely help you establish a baseline and determine if there's room for improvement or they're functioning at, or near where you would expect them to function based on the severity, the course, the interplay of these disease processes. And then that helps you pick which course of care restorative or improvement, stabilization, or maintenance. And then you have to say, this is what my skills are going to be medically necessary for. So, so I'm going to tie that now to the next thing that comes, because if we get people this far down the myth-busting trail, Karen, the next thing they say is, well, how am I going to write a goal for that? I mean, if I'm not going to write something to improve, I mean, our, our documentation is called progress notes. I mean, you want to see how addicted we are. That's Cindy's line, right? We write on progress notes you know, Cindy, talk to us about goal statements. How can, how can maintenance patients actually have a goal statement if they're never going to get better?

Speaker 2 (15:43):

Well, I think, you know, we talked, we talked about coverage criteria, and then the documentation piece goes with that because I can't, and I'm going to kind of work backwards because what we'll see at times is therapists kind of go, okay, I understand it. And then you go to the goal statements and every one of them says, maintain this to maintain that I'm maintaining strength to maintain ADL's. And it's kind of like, okay, let's, let's take maintenance out of it for a minute. That that doesn't measure anything. What ADL's are you talking about? You didn't give any sort of quantifiable way to say what you're trying to maintain. So the goal solution is not to stick the word maintain in there as many times as humanly possible. It's still looking at it as we should be looking at it is what is that quantifiable element?

Speaker 2 (16:29):

How am I measuring something so that I can demonstrate whether or not we've improved it or stabilized it or slow the decline. And then the end piece is how was this functionally relevant to the patient? So I think what happens at times when D and I work with agencies about writing goal statements for maintenance, the by-product is actually their goal writing overall gets better. Because I think we've lost focus. We think, oh my gosh, I have to have an HCP goal, right? Because that's another addiction, you know, patient will have, you know, visual be independent with Hep. Well, it doesn't say what it's for. Why do you tend for them to do it forever? We don't know, but you have to have that goal. Then you have to have a strength goal. So, oh gosh, this has maintenance. I'm going to put, you know, increase a quarter grade. And yes, Karen, I have seen that documentation, the plan to increase one quarter grade, it's like, can you just go to maintenance and stop trying to improve in minuscule, teeny tiny amounts?

Speaker 1 (17:27):

How, how is that measured? I

Speaker 2 (17:30):

Have no idea. I thought half a grade was bad, but then we get into quarter grades. We see assessments that contain the terminology of severely poor. I thought poor was like the basement. I didn't know there was a tunnel under the basement. So this goal writing is really a good place to say, am I focusing in on, what am I quantifying? Why is this functionally relevant to this individual? Then we're setting the stage as to why therapy is in fact necessary for this person. I think the, I will maintain this to maintain that. Doesn't really speak to that. And then we'll go see, I got a denial. That means this whole thing is, is self fulfilling prophecy. They don't pay for maintenance. I will never do this again. And it's like, yeah, but did you really cover what you needed to cover and speak to why the therapy was important and why they needed to have it now? Yeah. Oh God,

Speaker 1 (18:24):

No. I was going to say, that's great. Thank you for that.

Speaker 2 (18:29):

But I think the extension of that, and I guess my way to push the ball back to D here as it were, is okay. So I've assessed them. I did my test and measures that wrote some goals. Now the issue becomes, I got to establish a care plan. So how often am I going to see them? And this is where at times, you know, when we had the ability to see folks in person, I swear people's heads are going to start spinning around in confusion because we start talking about things like you don't necessarily see these folks every week. You may see them once a month. And then D what about PRN visits? Can, can therapy use visit frequency? I mean, don't, we have to go or see them or interact with them at least once a week or else this won't be paid for.

Speaker 1 (19:14):

So talking about service utilization, you know, it's my answer is it depends. What does the, what does the beneficiary, what does the patient need, right? And so do I have to go three times a week for them to stabilize function? Do I have to go once every three weeks? What does it take? What is it that I'm doing that is indispensable for them that only can be provided by a therapist? You know, they can't go to the local you know, green, orange theory and have somebody work out with them in the gym and get the same benefit. What, why, why do you know, why does it have to be me? And so we, so we have to have an understanding of what's it going to take? How often do I have to go? And so when Cindy's talking about PRN visits, that's like a big no-no in home care for therapists, right?

Speaker 1 (20:04):

Under the Medicare part, a benefit in reality, it's not nurses do it all the time. You know, when they have to adjust Coumadin levels, right? For, or blood thinners, when they have to, if people still even on Coumadin, when they have to do sliding scale insulin adjustments, when they have to run labs, when they update or they're changing wound care orders, they write PRN visits all the time, but supposedly therapists can't do that. Well, that's not true because think about it. I think in, when I'm making this care plan, I'm not writing everybody for three weeks for I'm writing this person in five times a week, because they just got out of the hospital for an elective surgery. And I'm going to go every day, because if they went to an ER for SNIF, rather than home, they'd probably get daily therapy. Right. Okay. And this person was referred from maybe from their physician.

Speaker 1 (20:54):

And, and we're in the second episode of care, if you will, the second certification period. And there were still as ensuring that they are being, that they're stabilizing function. They're still teaching training oversight, checking, following up on 30 day reassessments to confirm that our interventions are actually working well, if I'm waiting on a piece of equipment, maybe that I decided, okay, we're going to get them a splint or something to meet, or we're going to get them this, this device. And we have to go through all the machinations with DME. I could write that I'm going to go out one time a week for four weeks. But what if that device doesn't come in for two weeks, what am I going to do? Just go, yada, yada yada. And the second week of that 30 day period, or do I just write like a PRN visit that says, you know, when the device comes, if it's not a, you know, when I would normally go out, if it's not going to be there, when I'm planning to go out, I'm not going to let it sit in my office or the back of my, you know, the boot of my car for another week.

Speaker 1 (21:52):

Or I'm not going to write an add on order. I'm going to have this PRN, but well, it's come in. I wasn't planning on seeing you for a week. I'll bring it out there, fit, adjust it, set it up, teach you how to put it on Don and doff it, you know, check your skin, how to wear it, everything you need to do. It's the same thing. Think about when you think about Karen, when you tell your patients, oh, Hey, if you have a problem with this exercise program, give me a call. How many calls do you get? I don't get that many calls. And then I go back out there and they're doing like rhythmic gymnastics with the Sarah band. And I'm like, that's not what we taught you. Right. That's not the correct exercise. So, so this is a way this, this kind of go out as often as you need to, and not one visit more is appropriate, not just for maintenance, right?

Speaker 1 (22:37):

So, so writing, writing utilization is really hard for people to understand, because they're used to seeing their patients every week and that doesn't sometimes have to happen. How long do you have to wait to see if the exercise program was efficacious two weeks, three weeks, four weeks, how long, you know, you've got to base it on what, you know, what the evidence shows us? What, what, what our, you know, our, our scientific literature says that's important. So, so I have one more myth to kind of finally push the ball back to Cindy since utilization depends. So now we've got people test to measure some kind of goals that aren't just written, maintain. We have utilization. That seems to be very beneficiary specific, Cindy now, cause they're on maintenance. I got to see them for the rest of their life, right?

Speaker 2 (23:29):

Yeah. That that's, that's very common and, and it kind of splits into different ways. Karen, sometimes it's the, I made a lifelong commitment because they could decline at any point in time. So by that standard, this is forever or there's the gleeful hot maintenance, a great way to go for patients that don't want to be discharged. So as opposed to them crying, when I talk about discharge or the daughter runs back to the doctor and keeps getting orders, I'll just put them on maintenance and then everybody's happy. Okay. You can't do either one of those things you still are accountable to skilled, reasonable, unnecessary. So the benefit is clear. You can't just keep going or having them come to see you at the clinic, just because you're nice. This does need to require the skills of a therapist. We're still accountable to all of those criteria.

Speaker 2 (24:19):

And as di said earlier, if there's nothing left to teach, train, or do I can't just do it because you either don't want to, unless I stand here or the caregiver doesn't want to have someone else can do it just as well as I can, that this is no longer considered skilled. And that's what drives the decision to discharge as well is when I have taught you what I, everything that I can the program I've given you is effective. It is in fact stabilizing function. There are no more adjustments to make. There are no things that need to be changed, then you really don't need me anymore. And that's where I think that it comes back to again, how are we finding our value that I think we've gotten very used to. They come to see us X number of times per week for this number of weeks in a row.

Speaker 2 (25:07):

Then we say, okay, you're done. The order is done. If anything goes wrong, then come back again. Where maintenance really makes us think about a term we use very often is how are we dosing ourselves? So thinking about ourselves, like a medication, when do they actually need that encounter with a therapist? And when we've reached a point where you don't need it, there's nothing I'm doing that is uniquely therapy, then we need to stop. But I think the hard part in that, Karen is some of our skill and touched on one, oh, I had just a piece of equipment in the family looks amazed because that is a skill. You, you know how to do that because of your training. I think sometimes the decision to discharge, we jumped the gun too fast, whether it's a maintenance approach to care or restorative by this. Oh yeah.

Speaker 2 (25:53):

They got it. They understand it. I don't really, you know, they're just doing the same thing, but are you still contributing something? Are you still making any sort of adjustments? Are you convinced? Because on the restorative side, I've never understood these, you know, lofty strength and improvement goals for a two week care plan that suddenly, you know, the, the they've gained a whole muscle grade in two weeks. I don't know what literature I missed, but this, this, this will be great because I'm going to go join a gym for two weeks when it's safe for me to do so. And then I will be fixed in two weeks. It's all done. So I think it, again, challenges us to think about, have we done everything that we can, are we confident as do? You've said more than once. I mean, we've taken care of mitigating concerns.

Speaker 2 (26:37):

I mean, if they may have a completely unexpected stroke next week, I'm not expected to be telepathic, but I have looked at your condition, given you the tools and resources. And in fact, whether there is nothing left for me to adjust to do, I am going to discharge. So there is active discharge, planning and maintenance care. We are, we are not saying because of this decline risk, then I'm here forever. And we also have to be careful because a lot of beneficiary advocacy groups have done a great job, educating our patients about this, who will then come at us with the resource. You can't discharge grandma because I've got this GMO thing. And it says, you have to, that's where I think some therapists have gotten caught and been like, oh, okay. That looks like an official document. I'm going to keep having you come to the clinic. I'm going to keep seeing you in the home. And it's like, wait a minute. That's why you have to know what the rules really are because yes, beneficiaries should be educated, but they don't necessarily understand the coverage criteria very well, just because they want this to continue. Doesn't mean it's automatic because of that, Jim. Okay.

Speaker 1 (27:43):

Yeah. And I think that that is where your judgment as a physical therapist and as the authority figure in that situation, you really have to come down from on that and, and be able to explain exactly why you're making that decision instead of just being like, oh, okay. I guess I'll just keep seeing the men, even though it's at this point, not medically necessary. So what, what advice do you have for the physical therapist who might be in that situation? How do they then speak to the caregiver, the patient, et cetera. So that's, that's happened to me cause I've been providing maintenance therapy. When I had my Medicare certified agency in central Florida, way back 2008, 2009, been doing it a long time because we get tired of people. We get them better and then they'd go off and then they decline and then they come back on.

Speaker 1 (28:41):

I'm like, we're missing something. We have to be able to monitor these people. I watched nurses do it all the time with the monthly catheter changes, right? Because most people are not good at self cathing and preventing infection and doing it accurately. So they'd end up in the hospital, you know, with some sort of puncture or something or an infection. So, you know, monthly catheter changes can happen for years and years with nurses. So what were we missing here? Here is the bottom line for clinicians. I, when I have taught and trained everything and my skills are no longer necessary. You ask yourself, is there somebody that could oversee that could carry this out with you? Because it really just requires sometimes the assistance of another person or a cheerleader or somebody to motivate you or supervise you. What we have a lot of patients that might have cognitive and limitations.

Speaker 1 (29:31):

And even if that person isn't available, just imagine, just ask yourself the question. If that person holographically appeared in the room, right, and said, teach me train. And they were capable. Would you give it to them? And if the answer is yes, then you should no longer be going anymore. So what I tell patients is I will say to them, I understand that you want me to come, but as a licensed physical therapist, I have a fiduciary responsibility to the payer and the payer has requirements. And one of them is medical necessity. And at this point you need to do this, but you don't need me as a physical therapist to do this. So I can teach and train you, your spouse, your family member, a paid caregiver, or you can pay me to come, right. But I cannot bill your insurance for this because I would be in essence, fraudulently saying, it's still required.

Speaker 1 (30:27):

My skills, knowledge and ability when I'm telling you it doesn't, it just requires another pair of hands or somebody that could be shown a lay person, how to do this. And so they're like, oh, well you calm. And then I'll tell them, this is what it costs to privately to pay for a physical therapist. And some people take me up on it. And some people say, oh no, I'll get my grandson to come over. Can you show him how to do it? And I'm like, that's great. So, so I think we have to, like Cindy was saying, we have to understand the regs. We have to understand this. Doesn't go on forever. We have to understand that when we are going to sign our name with our credentials, so hard earned right through through education and practice that we are basically signing an affidavit. If you will.

Speaker 1 (31:13):

That says, I attest that this meets the requirement of this third-party payer. If Benny therapists stopped, many clinicians heck stopped and thought about that. They might not provide some of the services that they're told they have to provide or do the things they have to do, but it's really comes down to our license. So when I sign that and say, this is medically necessary, I I'm going to make sure that I show that my skills and my contribution to that visit is a billable visit. If I no longer have needed for that, then I can teach and train someone else, or I can discharge them from the third-party payer and they can pay me privately. They could, it can be a cash based service. And that has happened.

Speaker 3 (31:56):

Yeah. Yeah. That

Speaker 1 (31:57):

Makes so much sense, guys. This was so good. I just know that therapists are going to have a much better idea of what stabilization care is versus maintenance care. We won't use that term anymore. Maybe we can, we can change that preservation of function, care stabilization of function, carrot just, it sounds it's. I think it sounds better for the therapist and quite honestly, like more humane, more human for the person that we're caring for. Instead of just maintaining someone, you know, we're preserving their function, we're their ability to do the things that they want to do. Just sounds so much more, I don't know, human than maintenance care. It sounds so cold and sterile. I don't know. Maybe it's just me. No, I think, you know, for me, when you say that, it makes me think that we are helping patients be accountable for their chronic disease management.

Speaker 1 (33:01):

Right. We are teaching them what we know and how important it is for people with aerobic impairments that they have to maintain that lung capacity you know, within the confines or the constraints of that disease process so that they can continue to do their self care, which is metabolically demanding. Right. So, so it, it really, it really shifts responsibility. I think maintenance is a very passive sort of thing that, you know, we're, we're maintaining range. You know, I, I think you know, people that were doing stuff to versus where we're in we're we're arming people with the ability to manage and be accountable for their chronic disease and to, and to function optimally within the constraints of those, that disease or those diseases through a stabilization or preservation of function. Yeah.

Speaker 2 (33:55):

And I think it's important to, to just kind of circle back a minute that we don't want the visual now to always be maintenance patients or stabilization patients are very debilitated, have to have a caregiver, very ill individuals. These, we can teach these types of programs to the patients themselves, for them to self manage. I think sometimes, you know, okay, I'll give it up. It's not Parkinson's ALS and Ms. I got that point, but these must be like really sick, bad off people. They might be, but they might not be, they might be the heart failure patient that's functioning pretty well right now, but has a history of pushing themselves too hard. So the now kicks in the fluid overload. It ends up back in the hospital because they're overdoing. How do you better task plan? How do you help someone understand when their disease process gives them good days and bad days?

Speaker 2 (34:45):

What, what do we want them to do on a good day? What do we want them to do on a bad day? Because we know many of our folks that are receiving therapy. Cause they basically think that we're gym instructors, we're gonna, you know, show up for the treatment, wearing spandex and tell them to drop and give us 20 anyway. So we're trying to get past that, but on a bad day, too many of our patients, regardless of diagnosis, sit and wait until they feel better, maybe, you know, with a recent orthopedic surgery, a little bit arrest, okay. We encourage some rest. That's not a problem. And some of these chronic diseases, you're one day turns to two days, turns to a week, you haven't done much of anything and now you've compounded the problem. So I think you're right. It does feel like we're utilizing our skills in a more person focused way meeting them where they are.

Speaker 2 (35:34):

But I think, you know, very often just briefly we'll get the, well, what are the treatment interventions for maintenance you didn't in this whole conversation, give us any treatment strategies because it's not about the treatment. It's not about the assessment. We do what we do. We have the tools in the toolbox, but what, what are we trying to get to? What is the end vision for this individual? And then I'm going to utilize what I know how to do best in that context. I just think for a lot of us, we felt that door was never open. That you were not supposed to do that. That if you could not show significant improvement that you had to discharge and Dee and I have seen therapists, when you see the wheels turning, I've said a couple of times we need to develop like a stages of grief equivalent for the discussion of maintenance, because we'll have people get mad.

Speaker 2 (36:21):

Like I can't believe nobody told me this. And then you'll see guilt, you know, oh my gosh, I've had patients and I discharged them. I thought I was doing the right thing. I'm a horrible therapist. What am I going to do now? And it's like, okay, let's just start looking at the information and change what we do going forward and not go backward and be all upset and think we're horrible or mad about who lied to me. It didn't tell me about this before, but we do need to start making a difference. Cause D and I heard far too often, you know what? That was interesting ladies, but we don't do that here in this clinic. We're not going to do maintenance therapy. And it's like, wow, you just get to unilaterally, decide you're out. If you want to be out, that's fine. But then you want to direct them to a clinic that does do it because if they need it and they qualify for it, then find them a provider who will, but this kind of, oh, I never heard of it. I'm not participating thing is, is very frustrating in the current environment.

Speaker 1 (37:14):

It's, it's not correct. I mean, we have to understand beneficiaries have paid into this benefit. They are entitled to it. And if their presentation is such, that stabilization of function is the appropriate course of care. They are entitled to it. It is part of their benefit package. You don't have a right to say, oh, we'll take you on care. But you know, you're not going to get that. That that's that's you, you can't do that. I mean, you either provide the care that is within the insurance. Right? I mean, think about it. If you went to Jiffy lube for your 32 point checkup and they charged you 90, 95 and, and you only got 10 of them because that, oh, we don't do those other 22. Would you be paying for, I wouldn't as like, listen, I'm entitled to this. This is what I'm appropriate for.

Speaker 1 (38:07):

It's part of my benefit. Maybe you don't do it, but you can't determine that I don't get it if it's part of my benefit package. So it really comes back to the beneficiary. If they're entitled to it, we, as professionals are not ones to say, we can recommend and say, I don't think that's the appropriate course of care. But to literally say, we're, you're not getting that component of your benefit. I don't think that would go over very well. Do you care? Do you not? No, not at all. Not at all. Especially with, you know, like you said, people have been paying into this, their whole working lives. If it is part of the benefit you should offer it. For sure. And if you're a physical therapist who says, I don't know how to do that, well, you better get educated and learn how to do it.

Speaker 1 (38:56):

Exactly. The things that I am not the most gifted at as a therapist. So I'm not just going to start dabbling in dry needling. Okay. That's that's not my area. Oh yeah. Just give me some, you know, go into the pin cushion and let me start working on you. It's a skill set and it's something that you have to understand the rules and regs. You have to understand what the payer source requirement is, but we as clinicians don't need any other evaluation skills. We don't need any other tests and measures. We don't need special interventions. What we need to understand is that there are times that we are indispensable to help people improve and recover function back to a prior level or maybe beyond. And then there's times we are, we are needed. We are indispensable to preserve and stabilize their existing function so that their quality of life can continue on in the fashion that it currently is perfect. I was going to say, do you want to button it up? But I feel like that did it, but now listen, before we wrap things up, let's talk about the book, the guide to the two delivery of home-based maintenance therapy. So talk about the book, where can people find it? And what will they get out of the book? If people go and purchase this book, what are they getting?

Speaker 1 (40:16):

Well, they're going to get DNA, Cindy. That's what I'm going to start with. They're going to get us, they're going to get us. They're going to get an updated version. I think it's the only book. And actually it's our second edition and really focused on community-based care part a and part B for Medicare, right? Whether it's part B in a clinic or part B in the patient's home. And we really focus on the rules and the regs. And we and, and literally walk you through common case scenarios. We try to myth bust, and we try to give you a how to like how to start to think about this, because I think theoretically or conceptually when, Cindy and I talk about this and we've been talking about this for eight or nine years now. And teaching on this, people don't disagree with this. They fundamentally understand, they just don't know how to operationalize it. They don't know how to, if they see it. Okay. Well, I understand what you're saying. I understand. I, I agree with you. That would be, I could see where that would happen, but then how do I do these things we've talked about? So Cindy, what does this second edition really afford them? This time around that, you know, it was kind of like a value.

Speaker 2 (41:30):

Well, I think part of it came from, we were folks, as you just said, understand the concept, but then struggling to say, I got chew on this for awhile. This is really going to change my core, that I am not just defining myself by improvement. I got to work through some stuff and figure out how to do that. And so our first edition started out. We have a consistent scenario throughout to really talk about assessment and goal writing and detail and all of those pieces. But then as we looked at the second edition, we said that that's a good place to go. You got a nice, consistent scenario. It builds throughout the entire book. So you have opportunity to do that. But then this time around you know, I think you got the sense. I tend to be more in the regulatory nitpicky, wheelhouse, and D tends to go toward the operationalization side.

Speaker 2 (42:18):

And so she brought up, why don't we put a workbook with it? Why don't we add to that idea of a consistent scenario and say, what are some additional knowledge application activities? How do you comment that same thing about assessment or goal writing a little bit differently than one scenario to really get the juices flowing about how to do this. Now, the challenge is, is there a right answer? Like, do I just go to the answer key? And there was only one way that could have been done while listening to this conversation. There was quite a few, it depends. How often would I go? What would I focus on? So the answers give you some context, some suggestions, some validation, but it was not meant to be, there's only one way to do this. And in a scenario, you know, five sentences long, you better figure out exactly what you would do all the way through this only one path, but it's really to help kind of put those guard rails on and say, well, did you think about this?

Speaker 2 (43:14):

Or what about that element to, to be able to say, okay, I am understanding this. So I could use that as an individual to go through that process, or I could use it in an organization and do it as a group activity, but to really help people continue to process what sounds like. Yeah, I got it. But now I have a patient in front of me and, and I'm still stuck. Old habits die hard. I still struggle with the goal. I still think I can fix this. I, I still feel that voice in my head. That's telling me if they're not getting better, you're not supposed to be here. So people need that opportunity. So we wanted to provide that in a tangible way that, you know, doesn't really lend itself to an educational event unless the thing was days and days long, and people camped out with us, which nobody wants to do. But gives them that opportunity to come to step away, think about and come back to it at their own pace.

Speaker 1 (44:07):

Awesome. And just so everyone, all the listeners out there the book, the guide to delivery of home-based maintenance therapy, it's on the Kornetti and craft website, but we will have a link that takes you directly to the book and, and listeners. If you use the coupon code KK 2021, you'll save percent on your purchase. We will have all of that at the show notes at podcasts on healthy, wealthy, under this episodes, you don't have to remember it. You don't have to send everybody DMS and things like that. Just go to podcast at healthy, wealthy, click on this episode, it'll be under the resource section in the show notes. So we will make it very, very easy. That's all you got to do is one click, and it'll take you right there. So now before we wrap things up, the question I ask everyone on the podcast is knowing where you are now in your life and in your career. What advice would you give to your younger self?

Speaker 2 (45:19):

Come on Cindy? I would say, well, I, I would say to my younger self to be a bit more open-minded with how physical therapy really works in reality. I think career-wise would come out. I came out very, this is what I'm going to do. And, and briefly my goal is I'm going to work in a traumatic brain injury unit. I loved working with that population as a student, I'm going to be a famous therapist in a big old rehab facility. And now I'm going on nearly 30 years in home health and have never actually worked in a, in a fancy schmancy rehab clinic. I started this kind of on the side, fell in love with it and never went back. I tell, I tell students all the time, don't assume that what your path is at the moment is the path and can't vary and can't change whether you go into teaching, whether you go into other avenues there's a lot more possibilities and it took me a little while to process that piece to say there, there are many other ways you can utilize your skill to benefit those around you.

Speaker 1 (46:28):

Excellent. D I would say to my younger self I may not come across that way now 30 going into my 36 years a PT, but I would say don't be afraid to ask questions and don't think you have to know it. All right. So I, I think that I kind of stayed in my box a little bit more and got really, really good at what I did. Some of that time, Cindy was in a traumatic brain injury a locked unit and I got very good at what I did, but I had a lot of questions about, but what if, but why not? Right. And I think sometimes I kind of just that maybe I shouldn't ask that question. I was a little bit too con you know, self-conscious about it. And so I, I think the idea is ask those questions, be fearless.

Speaker 1 (47:18):

And, and instead of asking, why would I do that? You know, look around. Why not? You know, I'm a big, why not, if you've got a great idea, you have something that is like a passion, and you've got that intersection of your passion and your skillset go for it. Right. A good friend of Cindy and mine Dr. Tanya Miller started event camp for kids. Like when she was like a new grad PT. It's like in it's what, 27th year. And she's written grants for it. And, you know, they take these kids on ventilators out in kayak. I mean, you can do it, you can do it. So be fearless and don't be afraid to ask questions. Don't don't, don't think, oh, well, I don't know as much as Karen Litzy or I don't know as much as Cindy craft, you know, start to explore that the possibilities are endless. That's what I would have told myself when I was younger, fabulous advice from both of you. And I couldn't agree more. Thank you so much for coming on for sharing all of this great information and your book, and it's just sounds great. So thank you so much, Dee, and thank you so much, Cindy, for coming in. Thanks for having us, Karen. It's always nice talking to you. Pleasure. We had a great time. Excellent. All right. And everyone who's listening. Have a great couple of days and stay healthy, wealthy and smart.