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Chad Madden,Madden & Gilbert Physical Therapy
26 Plays3 months ago
In this episode, Steven sits down with Chad Madden, Founder and CMO at Madden & Gilbert PT. Head of Education for Breakthrough PT Marketing.
Learn more about SaRA Health: https://www.sarahealth.com/
Check out Madden & Gilbert Physical Therapy: https://maddengilbertphysicaltherapy.com/
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Transcript
Introduction to 'The Disruptors' Podcast
00:00:01
Speaker
Welcome to another episode of The Disruptors, where we're arming you with the tools you need to innovate within the physical therapy space by highlighting those who have come before you. I'm your host, Stephen Cohen. Now let's get into it. Hello, everybody, and welcome back to another episode of The Disruptors, where we're highlighting innovators within the physical therapy community to help make innovation more accessible to
Chad Madden's Background
00:00:25
Speaker
everybody. Today, I'm so blessed to be joined by by Chad Madden.
00:00:30
Speaker
Chad is the founder of Madden Physical Therapy and the number one most watched back pain in sciatica specialist in the world. He grew up in West Hanover and graduated from Central Dauphin High School in 1995, joined a mediocre sports career in football, wrestling, and track, realizing his strengths for in academics, not sports. He earned his master's degree in physical therapy at College Misericordia in Dallas, Pennsylvania. There he played four years of baseball, some submit cementing his legacy as a mediocre athlete.
00:01:00
Speaker
On September 2nd, 2003, he opened Manic Physical Therapy with a total staff of one receptionist in a 2000 square foot clinic on Prince Street. And his oldest son was born three days later on September 5th. Chad's treatment schedule is limited today as he focuses much of his time and energy working with and helping other physical therapy owners across the US, Australia, and I think even more countries now. He's a co-founder of that company, Breakthrough PT Marketing.
00:01:30
Speaker
Chad currently lives in East Hanover on a three acre farmette with his wife, Stephanie. They're five children, six, sorry, six children, five mini donkeys, seven chickens, two cats, a one eyed boater calling named Georgia. And I believe there's a llama in play or or two a couple of llamas in play now as as well.
The Role of Mentorship in Chad Madden's Career
00:01:49
Speaker
But Chad, again, thank you very much for for spending some time with me and welcome to the what was are the disruptors. It's a huge honor, Steven. Thanks for having me.
00:01:59
Speaker
i I kept having to laugh at the the mediocre athlete piece just because on my LinkedIn, like mediocre weightlifter is like one of the things that I have there. um and so and I know you and I have have had some ah discussions at length about the the sports worlds and and triumphs and ah tribulations ah that yeah we've gone through, but that is that is not for for here and now. That's a great bio and and a great start to this this conversation. um I would love to hear you your why behind getting into physical therapy, and then I think I love to transition quickly into like kind of why you why breakthrough. like Where's the passion that
00:02:48
Speaker
fuels you, I'm sure, with the late nights and early mornings to be able to serve practice owners across now, what is the the globe? Great. So the YPT is a simple one. When I was growing up, fairly good at math, entered competitions and did a few things like that and was very much fell into or pushed into the engineering pathway.
00:03:12
Speaker
took a lot of engineering courses and you know being semi-rebellious 16 through 18, you know how it is. um i I was doing these courses working with the very first AutoCAD one, two, and three, doing technical drawings, stuff like that. and And I went to the guidance counselor one day, Dale Halfk, I remember was his name and I was like, hey man, like I don't think this is what I wanna do, can you help me figure this out? And he gave me a list of like top 20 in demand things,
00:03:41
Speaker
so physical therapy was number one or number two. So this is like mid 90s. And he said, you should really volunteer. My mom had graduated with a therapist from high school. His name was Dale Hillbolt. He passed away, unfortunately, a few years ago. um But ah I went and started volunteering.
00:03:59
Speaker
ah in dale's clinic and I remember there was a shoulder pain patient early on and I just watched how this quickly this guy progressed in two or three weeks could barely raise his arm two or three weeks later was back to normal I was like wow this is really what I want to do for the rest of my life and yeah just always fascinated with the human body and working with people and like has always felt like home oh that's i I appreciate you telling that story. and yeah i can I can hear in in your voice how how close Dale was to you. and you know a lot of ah We've had multiple guests talk about the mentors in their life. and I don't know if you would expand on that at all ah with with your relationship with with Dale, but I think that'd be helpful. for You were a volunteer, right? so Yeah.
00:04:45
Speaker
unpaid volunteer and and yet This sounds like he might have taken you under his wing, or if you wouldn't mind talking a little bit about that. Yeah, I mean, he very much early on guided me in the right direction. You know you should be thinking about this for colleges. Here's what you need to do. Using his network to get me into, I think we had to have 40 or 100 hours of volunteer time.
00:05:05
Speaker
It was one or the other, um but they had to be in different settings. so just always make Just in general, always looked out for me. There's there's a crazy part of the story, which is this. I actually went to work for Dale for about nine months prior to opening up. um it i did not It wasn't anything to do with him, but I had ah did not get along with somebody else in the company. um and My wife was very pregnant at the time, as you read in the bio.
00:05:35
Speaker
I was like, uh, I need to make a move or if I don't do this now, I'm basically never going to do it. I had that in my head. So ended up opening up, um, Dale came to visit. And, uh, so like, even though it didn't work out with his practice and I left like.
00:05:51
Speaker
he he checked in on me. He was an absolutely amazing person um and yeah just but one of those special people that everybody wants in their life and some of us are are lucky enough to have a few people like that. so yeah he was He was great. um Even early on, um I was struggling with back this back pain treatment model that I had been taught and he said,
00:06:17
Speaker
Here's the researchers, go find the research, go look this up, take this course. And I just followed exactly what he did. And it was, it turned out to be literally life-changing for me because that's what we built our practice on was back pain and sciatica. hu Wow. that's That's fascinating. Thank you so much for for sharing that. It just keeps reinforcing the the point that we hear over and over again on here, especially like,
00:06:43
Speaker
find a good mentor and believe it or not, there are really good people that want to give back to you. And I know there can be some of that like imposter syndrome, right? of Like, oh, like people don't want to spend time with me, but that's just simply isn't the the case as I think you've witnessed. I know I've witnessed personally, and I'm going to continue to hammer that. Even if it's every episode, like a like hammer
Marketing Innovations in Physical Therapy
00:07:05
Speaker
hammer that piece of it. oh So open up your practice.
00:07:09
Speaker
you know That's all quite a bit of success, but ah what I want to transition to is why mind breakthrough? right like what what What was that spark or what did you see that made you like this needs to exist in in the world? Yes, so long-term trend.
00:07:29
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ah at least when I opened in 2003, much of physical therapy in the country was driven by physician referral, right? So if you had physicians referring to you, that was the lifeblood of your practice. And in the very beginning, I operated under the same premise, which we all fall under, which was really from the 1800s, oddly enough, but it's if I provide high quality of care, I'm gonna get word of mouth referral and basically every other practice problem is gonna go away and never be an issue.
00:07:59
Speaker
That's not real. The AMA figured that it wasn't real in 1902 when they wrote it out of their guidelines, but that that thought process still exists today. no um I got very good at physician referrals, great at lunches, um great at communication, and we we made a lot of headway there, like going above and beyond literally five-star experience with physician communication. In 2008, that started to go away.
00:08:30
Speaker
And I kind of had it in my head early that I wanted to help other, the Ben Franklin model of what he did in printing, and that I want to mentor um or have like an apprenticeship for other private practice owners, that we were just gonna have one or two clinics. We were gonna run them very well. That's all we were gonna ever have. And then um from there, we were gonna help other practices. And I can remember early, ah this is kind of crazy. you'll You'll get a laugh out of this, but ah we had a receptionist And our total staff was four, and I was one of those four. So it was me, a PTA, and ah scheduling receptionist, billing receptionist. Her name was Patty. And I said, you know, my dream is one day we're just going to have these one or two clinics, and we're going to have people, practice owners, flying in from all over the country to our clinic here in Harrisburg to learn how we do what we do. And she said, honey, that's very that's very nice. That's going to happen.
00:09:26
Speaker
So Patty didn't last with us very long, but ah um it did came to fruition and we were able to do quite a bit. And yeah, so how breakthrough came to be 2009 to 2011, 2012 was pretty rough because in our area here in central Pennsylvania, the three hospital systems just started gobbling up the family physicians.
00:09:53
Speaker
So today, 90% plus of those physicians work for one of two or three hospital systems, healthcare systems, and they're not literally not allowed to refer out. They get scolded by the police and I've seen emails and, you know, I have friends that our kids played T-ball together and we can hang out at picnics and you know everything else but we and on like a texting relationship. I'll see like their VIPs, but they can't send patients and masks to us. So that started happening. We had to replace the marketing. um I had figured out a lot with physicians, had figured out a lot offline, was trying to figure out online, um had done a couple goofy things like started posting YouTube videos for patients. Some of them went viral. Some of them are still running. I mean, we were up over 25 million views on
00:10:42
Speaker
YouTube videos that i made in twenty ten so well that's awesome yeah but ah yeah so stumbled backwards and a few things as technology was changing with how we can communicate and educate patients.
00:10:56
Speaker
um Having said that, in November of 2012, I received the cold email. It was unbranded. It was from Carl Mattiola, who's now the CEO and the co-founder here at Breakthrough. And it was for a five-minute call. And again, completely unbranded, just was like, hey, I'm researching private practice PT. Would you be willing to hop on a 10-minute call with me um so I can ask you some questions? i At first, I didn't respond. Eventually, I did.
00:11:26
Speaker
I hop on this call, and in the first five minutes, I was like, wow, like this is way different. These questions that you're asking me, nobody's ever asked me questions like this before. What are you selling? He said, I'm not selling anything. and and I said, okay.
00:11:44
Speaker
um you're But you're about to. like Tell me what's coming." And he was like, I don't know. He said, i I'm doing research. And I said, well, what do what do you do? like Why are you going through this process? And he said, I'm actually taking a course. He said, I'm the head of online sales at Tesla Motors. And so he had been and hired by Elon Musk to sell EVs online. with the It was basically one click shopping, just like Amazon.
00:12:10
Speaker
and And he figured that you can go online and read about him. And he said, ah I had a life-changing experience in physical therapy back when I was in college playing football. He was a linebacker at LaSalle, had a shoulder injury, PT saved them from surgery. He was able to get back and play. And he said, I want to bring my skillset, my software building skillset to PT. Tell me what you're trying to figure out. So I would not admit a pain point to him, right? that i like I wouldn't talk about my pain that I couldn't market or anything like that. But he said, what do you want to do? And I said, well, I figured out a few things in offline marketing direct to the consumer. And I would love to be able to share that. So that's how breakthrough. That was the very genesis, the origin story of how it started. And then what happened is Carl went on to develop a software called Clinic Metrics, which still exists.
00:13:02
Speaker
And ah he was sending me owners that he was talking with. I was owner number 17, that he had talked, he ended up talking with over 300 owners and he would make a personal introduction anytime an owner was having an issue with physician referrals and wanted to go direct to consumer. So eventually I was, I'll just keep rolling with this, Steven, if you're all right. Please stop me at any time. But ah he was like, no, you, and I said, listen, um I hate working with practice owners. ah This is like, I'm trying to solve these odd problems. And I remember like this one owner was like calling me during my son's T-ball game and it was, um you know, $500,000 in debt. And I'm going to be, I'm going to have to, ah you know, foreclose on my house and declare a personal, but and it was like this huge story. And my wife was like, said, give me the phone. She took the phone from me and she said, he will call you back later. And I was doing like all this for free.
00:13:59
Speaker
Right so like ah and so i had this heart to heart with carl we sat down and i was like listen man i don't really want to do this like i and he said you do he said you just don't know how to do it so he and i'll bring this full circle for you but um he.
00:14:19
Speaker
He said, listen, you just need to learn how to teach. And, uh, and I was like, okay, how do I do that? And he recommended this course. I woke up at a three 50 AM for 21 days in a row and did this course for three hours every morning. And I was really torn. Um, we had our two clinics up and running at that point, and I was filling them up and I was very complacent in my life and just happy. And then, uh, I went to game six of the NBA finals in 2014 where Ray Allen hit the shot.
00:14:49
Speaker
I'm actually in the picture. I'm right here. ah is I'm in this panel. On the way home, I had another mentor. That mentor was is Ernie Davis. He's still living. He's 93 years old now. and um and We get together for lunch once a month and we've done so for 24 years. and Ernie was the first black salesman insurance salesman in the country to write a million dollars in insurance. and He did it within his first nine months of his first job in 1960s at the height of the Civil War.
00:15:26
Speaker
or civil war sorry about that ah um ah Civil Rights Movement. And um so so he was in, uh, in Forbes and Ebony and a whole bunch of other magazines. And, uh, he just happened to be one of the first people I ever met as a physical therapist. And he, that was somebody else that was just a very lucky meeting. We were at this game together. We're flying home. And so he's 83, like a lot of gravity in his voice. And he was like, Hey, what are you going to do with your, um,
00:15:58
Speaker
Like I know you're, he you just know him as Carl, but you're talking with Carl, you're teaching these owners, like, what do you want to do? And I said, you know, man, ah sometimes I just think about selling everything and just doing nothing but commercial real estate. I have like, sort yeah if you commercial real estate, I can just live on that income. And he grabbed me like under my arm on the plane and he like pulled me really close and he said, and that would be a shame. And I was like, got it.
00:16:28
Speaker
Understand the message. So immediately after that, ended up doing that course that Carl had recommended, followed through, learned how to teach direct to consumer marketing, learn how to embrace. I mean, I'm very dinosaur like, um, but you know, embrace technology, especially with direct to consumer marketing and start figuring this out. So yeah, that's a long winded answer to, uh, exactly how I got here and the why behind it.
00:16:55
Speaker
I think there's so much there, right? I think from ah the the great mentors to it not being a like direct path, right? Like obviously it had its own lines and terms. So I think there's multiple lessons to be gathered just from your story, just even as we've talked about it in in really less than like 15 minutes, is that the the path is not going to be straight and expecting that is kind of lunacy, right? That you're going to have days where, yeah, like i when you said like I want to give it all up and sell commercial real estate, like man, yeah, there are some days when I just want to be like, you know what, I'm done. I just want to have a coach weightlifting athletes. That's it. like ah There's going to be those days um and in hours and you know whatever the the amount of time is. And so you know getting ready for that. It's not a straight path.
00:17:51
Speaker
You do have to put yourself out there and and get a little bit of luck, right? and Yeah, but luck typically happens to folks who continue to work hard and put themselves in positions to succeed. And then the last is, I think yeah you you mentioned the the videos from 2010 that and now have 25 million views, right? And it makes me think of the old, the old adage of when's the best time to plant a tree 20 years ago? When's the next best time? Today.
00:18:21
Speaker
right And so for for those that are even thinking of going on ah an innovation journey, i what could look small and inconsequential and overall like not hugely impactful today. like Time has an amazing thing called a compounding interest and and it can really can really grow from there.
Marketing Strategies and Success Measurement
00:19:02
Speaker
you'd like to learn more, check them out at Sara, S-A-R-A, health dot.com. sarahhealth dot.com. And if you'd be interested in advertising with us and helping us produce even more great stories, please let us know at steven at sarahhealth.com. Now, back to the episode. I, I do want to to talk about, you know, you're the director consumer marketing piece, right? and So you you saw this, had what was probably you saw it more real than anyone else did. And everyone else probably saw like a specter somewhere, right? Like, no, this whole position referral thing, like, we can't be tied to this or else bad, bad things are gonna happen to to our our our profession.
00:19:45
Speaker
oh and And so walk me through maybe some of the things that, if there's anything you can't share, I totally understand, ah but maybe some of the things that like you tested in a, we call it brute forcing. Whenever you do something like manually and it's painful,
00:20:00
Speaker
Like what did you brute force test early on and then you'll slowly or even quickly turn it into more of like a tech enable, ah you know, process. Yeah. So as position referrals were going away and it started, it it was very innocent in the beginning. It was like, Oh, you're just not allowed to drop off your script heads anymore. Oh, you can't bring us lunch anymore. And then eventually we just get completely squeezed out. So.
00:20:29
Speaker
The quick thought, there are five ways that we can get new patients in private practice. The lowest hanging fruit is reactivations. That's our patient list. So for years, I had been talking, this is brute force.
00:20:43
Speaker
I forgot about this, but we in the very beginning, I had a small desktop printer that was probably like $400 and devastating for me to spend that $400 when I was starting out. and and and so four hundred bucks I did over a million copies on that printer. It is not designed to do that.
00:21:05
Speaker
um But every month we had a growing patient list and I would send out, and I remember I would do this on like some sort of Microsoft Outlook, design it myself, write the whole thing every single month, and we would send it out. And I had no idea what to put in it.
00:21:22
Speaker
Right. I was just clueless and I was thinking, but I still send something out. So I would introduce staff or highlight a patient, a patient win with their permission, of course. And we had a little misspelled word contest in there and stuff like that. but And we would print it on this hideous green paper.
00:21:41
Speaker
that ah it was the cheapest paper I could buy at like Office Max or Staples or whatever it was and I just bought 10,000 sheets of this so we would print them out and then my grandmother ah who passed away in 2009 my mom's mom and then also my aunt Helen who is still living they would come in ah they would sit in the back we would have this little folding table and they would just be loudly gossiping the whole time. And they would sit and fold all of these letters and we would mail them out. And it was like with a stick on postage stamp. And like, I mean, this is crazy, right? um But, you know, in the beginning it was a couple hundred letters and then over time now it's, we're up to, you know, 30,000 of those every single month. And obviously we work with an outside company to fulfill that. But in the beginning it was that. And what was crazy, I did not understand direct response marketing yet.
00:22:37
Speaker
um but I knew that when we send something out, we had a lot of reactivations coming back in and we would get more word of mouth referrals. I understood that concept early, so that was offline. Online, we started with, ah I think this company is now defunct, but ah one social media, there was a gentleman named Joe Soto, who somehow I got connected with out of the Midwest.
00:23:00
Speaker
and And this idea was ah like e-magazines. I think they were called e-zines. So this is like early email marketing, like 2008, 2009. And we started doing some of that. And the idea was the fantasy is that, well, email is free. And it's going to replace this gargantuan effort of time and money that we're doing with direct mail.
00:23:26
Speaker
And we quickly saw that it it wasn't going to replace it. like it you know A direct mail piece, we we needed like a two to four week timeline and to be able to send that out. In email, we could change very quickly. like I could change it within a minute, but um it it just wasn't going to have the same sort of response. um So I was fairly clear with that. Why did we stop right there, actually? i love So, yeah, I think people get into this analysis paralysis where they think they have to measure everything, like have all the answers, right? you The way that you're talking about this makes me feel like you you knew in your gut, like, hey, this is working, this is working better than this. Like, maybe even taught me if you can, you know, remember back to like, even some of those, like keep the conversation how it played out in your head. Yeah. So,
00:24:19
Speaker
Well, that you know, there's a, there's some cliche where you reorder the ready game fire to like fire. a but jerey But that's pretty, I mean, most of my professional career early on was backing myself into a corner and then figuring out how to work out of it.
00:24:35
Speaker
So right like it' it's we most of us have a jaded experience and then we open up and then all of a sudden I discover I have no idea how to market at my services. I have no idea how to hire people. I have no idea how to you know that billing or technology was even if I thought you know people just Scheduled at the computer and that's all there was to it. There's a lot more than that. So um getting back to your question ah You want it like a specific Just even how you like thought through it, like, you know, as you were sending out the monthly letter, right? And were you tracking the so you were tracking the reactivations or you just like gut feel it feels like I've seen more people that I know come back in I kind of what was that that or a bit of both. Yeah, I had a very generic dashboard that I kept by hand. So I, I kept metrics by hand in the beginning.
00:25:31
Speaker
And i would every day I would write down four vitals, new patients, visits, ah ah attendance rate for that day, and total cash collected. And i would then I would tally up weeks. And and like I never missed. So it was like by the time I went home every single day, I had those four things written down. And then I would, again, this is by hand like in an Excel spreadsheet in the beginning.
00:25:57
Speaker
And I mean, now we just print out a report in five seconds, the EMR. but ah So I would tally that and then weeks become months, months becomes quarters, quarters become years. So I knew that whenever I sent out that patient newsletter, there would be an influx of new patients. I was not discerning amongst five different new patient channels. But I knew total new patients would go up every time I would have this effort.
00:26:21
Speaker
And I could see the same thing happen in email, but not at that time, not quite as powerful as direct mail. And again, this is early 2000s. Yeah. I just think it's so valuable for people to hear that they don't have to have all the analytics set up prior, right? Just track the thing in Excel. I mean, there we still do a heck of a lot on that front. and Like for example, for for conferences on our side, like I have a pretty good idea of how many new clients that we're going to to convert or to to grab at a breakthrough event. It's like, all right, it's about three to five per event and like here's how it looks and you know just can can make the r ROI case in my head. and I don't need to think about it any further. um i just So many people that I talk to are think they have to have the the plane fully built before they
00:27:12
Speaker
It's like, no, not at all. But I'm sorry to interrupt. ah So you you looked at, so you saw, okay, ah email was not going to replace the direct mail, right? And so then what what what happened next as you started to go through that?
Evolving Marketing and Team Collaboration
00:27:28
Speaker
yeah so then we um After that, we wanted to figure out a way to market direct to the consumer. so I tested ah some very expensive, poor working print ads in the beginning. ah Banner ads were a thing. I don't know if you remember that. yeah oh yeah They were gross. it it was and Everybody was selling space on their website. and ah Yeah, so wasted a lot of money doing that.
00:27:55
Speaker
and really trying to figure out something. So in the very beginning, the most common thing that I saw other clinicians doing was advertising like a free screen. Everybody's doing it though, right? So there was no real benefit there. And then what I learned is the more that I studied marketing and got into that was there are really three things that we can offer in marketing. We can offer, and by the way, I always, like most other clinicians, I always blamed the media type that I had selected.
00:28:23
Speaker
So if it was a print ad, I would never blame it on me. I would always blame it on on, well, that newspaper doesn't work. Like they they must have never worked. My messaging is perfect. kid no Nobody ever thinks about the messaging. We can talk about that a lot. but ah ah so In the very beginning with like a print ad or radio or TV or whatever I was advertising on or a banner ad, we were all always offering free screens. and Then one once I learned that you can really offer three different things, you can offer a free product or service right or you can offer education.
00:28:57
Speaker
Right. So there are the three things you can offer. And then when we tested education, which in our case was the way I had been doing workshops since 2000, like my first year as a PT. This is a crazy story, but I'm actually really good friends with.
00:29:13
Speaker
ah He was 16 years old at the time, somebody who came to my first workshop ever, and we're he's now 42 years old or something like that, with a 16-year-old of his own, but ah kind of crazy. But um yeah, so had been doing workshops for a while. We started promoting them with print, and it that went really well.
00:29:32
Speaker
And I got that from, I heard another owner talking about doing newspaper inserts on Golden Abroad insert um and doing testimonials. It was a dentist from, I think, Missouri that I had heard that. And then I i was like, ah, I wonder if we could promote the workshop. And we did it and we had like 96 people register for a workshop. And I was like, holy cow, this is crazy.
00:29:55
Speaker
So we did that. Eventually that media died. And what we were forced to do is people were getting their news online. And then we had 2009, 2010, 11, we had to start converting over to advertising online to figure out how to do that. I wasted over a hundred thousand dollars in figuring that out.
00:30:15
Speaker
When I met Carl, he was like, Hey, what are you trying to figure out with your marketing? And I was like, well, i'm I'm doing this offline really, really well, trying to figure out how to do it online. And he was like, just give it to me. And, uh, so he ran, uh, one weekend or one week he ran ads for our next workshop and like 37 people showed up and I was like, all right, like I don't have the skillset to figure out this out. So if you can just help me do this from here on out. And, uh, yeah, that's.
00:30:45
Speaker
the So over the years, as media comes and goes, we have to be flexible and adjust, but it starts with, I think you called it brute force in the very beginning. then And then over time we get more and more viable and streamlined, uh, eventually, but, uh, yeah, it's a, it's a process that we have to go through and almost any system within the practice.
00:31:10
Speaker
Absolutely. I would imagine that you as an owner, I don't even mean that in the broad sense of the businesses you've owned, is you you look out and you probably see a hundred, maybe a thousand buyers that need to be put out, right? It's like, which one do you go choose? And that that whole decision-making process I think is is key. And you know I think another piece that I'm picking up here too that I think it's worth highlighting is you can go it alone, but it sure does help if you surround yourself and bring in, you know, whether you call it a teammate, a co-founder, an employee, like whoever it is, like surround yourself with folks of the the same or preferably a better caliber. Like, I don't know, my team is way higher caliber than I am. Thank goodness. And that just, it's not a one plus one equals two when you start adding in those types of of talents.
00:32:11
Speaker
Exactly right. yeah Everything that I'm talking about here is really a we. I wasn't alone in the journey. One of the biggest turning points is exactly what you're talking about ah for me, Stephen, which was early on, I was like, you know what what does this look like if I'm not our best clinician? And maybe I should just hire clinicians who are way better than me. I'll give an example. At our last event, there was a ah runner who came through.
00:32:36
Speaker
and ran on the treadmill. um I had requested the family get an MRI um just based on what I had seen, and I i can't read an m MRI well. I mean, I took courses in it, but ah We have Mike Fink on staff who teaches nationally. Um, he's going to DVD. He's scrolled through immediate, like immediately saw the injury was like, Hey, look at this. This muscle's on Slack. Looks like an avulsion fracture. Just went through the whole thing and it took two minutes. And, uh, you know, it's the point that you're bringing up with mentors. Um, and, and I have a pretty strong point for you on that. But, uh, the,
00:33:21
Speaker
I was with an owner yesterday who was looking at me talking about Rev Per Visit, which is probably the biggest pain point in all of physical therapy right now. is we're you know We have this tremendous downward pressure on reimbursements and everything else. and We can talk about statistics until we're blue in the face, but it's not going well for us. It's not headed in the right direction nationally.
00:33:42
Speaker
And this owner was like, uh, it was a husband and wife. We were on a call and she said, everything that is in the system that you're using in your practice. Won't we just figure that out eventually? And I said, well, how long you've been in practice? And let's say it was 10 years. And I said, how's that going? Like, do you have an abundance of time?
00:34:02
Speaker
would test a whole bunch of things, or would you just rather learn from people that have done it already? and it's you know Now, with Breakthrough, it's not just me. It's thousands of other owners that have implemented the processes and are in you know the and In Arizona, they do it a little bit different than Texas, and they do it a little bit different than Pennsylvania and you Florida and New York and every other state. There's all these little adjustments and colloquialisms and adaptations that people have. um But I said, hey, if you have a ton of time for testing and you have time freedom go galore, first of all, that's very rare in private practice right now. But if you have it,
00:34:43
Speaker
go nuts. yeah and that That was the end of the conversation um the in a very positive way. and um The other thing that I want to say on mentorship is i mean I've been blessed with three amazing mentors. and I did something by accident in the beginning. um One of the earliest dinners that I ever had was a ah gentleman. He was a commercial real estate owner that I had leased from in the very beginning, and he went from zero to $500 million dollars portfolio in about 25 years. Absolutely amazing.
00:35:21
Speaker
And he had four Ivy League degrees from three Ivy League schools, Penn, Wharton, and Harvard. And it was an intimidating first meeting. And he ended up spending about three hours with me. And um when I got home that night, i like my I was just overwhelmed. And I wrote down every single point that I could remember.
00:35:48
Speaker
and i and including this very obscure reference from a Harvard Business Review in like 1967, and I went up and found the actual quote that he had, and I wrote him an email the next day, I said, Norm, I said, here are my notes from last night, and it was two pages of notes, and I said, I just wanna make sure that I understood you correct. that would The second I did that, it was instant, like lifetime,
00:36:15
Speaker
Right. Instant like credibility for the rest of my life. and I've asked him some very not intelligent questions through the years, but the second that I did that, it was like, okay, I value your experience. I respect everything that you've done in the marketplace. Please show me. and then Anytime that i was in a bind as i was buying and selling commercial real estate he was always there to support me he's completely retired now i still reach out to him you know once a year and he always has a very amazing answer. um For me because of what i did twenty twenty one years ago.
00:36:52
Speaker
thanks Such a great practice, right? And I'm reading or guess listening, as as is my ah typical mode, ah to the speed of trust by Stephen Covey, junior, I believe, not the the senior. ah And yeah, it's it's all about, ah you know, how do you get to trust, right? Do you believe someone? um And do they have the the character? Do they have the competence, right? I mean, so I think part of that that confidence piece in showing it, which is entirely in your power, right, is to do exactly that, right? Send the handwritten thank you note to follow up and just show that you actually listened, right? And that's such sage advice. And I could just plus one, plus one, plus one, like absolutely, that is,
00:37:46
Speaker
I've seen that in in my career. And even like personally, like some of my my best friends were created from just like, oh, like you wanna do that? Okay, like let's let's go do it. I think of a really close friend of mine, his name's ah Andrew Deloge, and we met in undergrad. And he, long story short, my dad owned some oil leases and used a heating element that his family company produces called Watlow,
00:38:16
Speaker
And he, you know, we, we met, uh, we got just talking and going, Oh, I'd love to see that. Like, okay. And then three weeks later, we're driving from Manhattan, Kansas down into, uh, to near Iola and actually did it. And I think there was like, that is a, definitely a non, call it like non-career professional story. But I think it shows like, if you just follow up, show up and be there.
00:38:43
Speaker
You're going to be surprised at how much you're going to make yourself stand out from the rest of the group. Just respond to the emails, like they just the simple, basic stuff. ah But I really appreciate you giving that anecdote for how you created that lifelong mentor with something that probably even helped you, right? Like I love writing those because like, okay, like here's all my takeaways and now I'm not going to forget them.
00:39:09
Speaker
after I go to sleep tonight, right have like osmosis into the pillow and it all falls out. So i I thank you very much for
Addressing Revenue Challenges in Physical Therapy
00:39:18
Speaker
that. we yeah You mentioned on that call the the two owners ah revenue per visit. And you're right, it's it's it's going down. And I will stand here and say that remote therapeutic monitoring is not the silver bullet to it. It's it's not gonna be helpful, absolutely. but five to six bucks revenue per visit is is going to to help, but it's not gonna change the world, right? And we're very open and just like, yeah, this is it is what it is. and So you would love, not maybe not so much of the statistics side of it, right? But as you look at the declining revenue per visit, how what brings you optimism and and where do you see there there being opportunities?
00:40:10
Speaker
Yeah, great question. um And this is probably the thing that i've the one area that I've spent the most time on in the past year, especially with practices that are ah mitigating the revenue per visit decline.
00:40:25
Speaker
so
00:40:28
Speaker
Having said that, there are four big areas where I see owners winning. um The first one is what what is the biggest leak in terms of profitability in any private practice?
00:40:42
Speaker
Typically the most common one is underutilized schedule time. So I've hired a therapist, they're not busy. um And the second one is underutilized um space. So every month we're paying those expenses, employment expense and space expense, which is rent, your you know, your rental um or lease or whatever you have utilities, et cetera. um But if they're not filled, if that's not for near capacity, we're losing a lot of money.
00:41:12
Speaker
Flushing money, ah oh it's unreal. So that's one area where if a practice has, let's say, 3,000 square feet and they only have two clinicians and they could really house six, the game is let's get to six as quickly as possible, right? So that's number one. Number two is- Can you say that for a second, actually? Because even when you talked about your dashboard that you created when you were first starting out, ah you you didn't you didn't say cancellation rate, you didn't say arrival rate, right?
00:41:40
Speaker
you looked at how many visits there were that that day, and I was just talking to another owner yesterday, and and she she's not a PT by by background, and that's how she thinks about it. She's like, if I can refill a cancellation, I'm not gonna ding anybody for it. In fact, if anything, I'm gonna keep praises on my front desk for getting that that' that spot filled. So maybe, how do you feel about Like that conversation, right? Are you like a cancellation rate or is it just visits per day? Like, how how do you how do you think about that? Yeah, we we call it attendance rate. yeah I mean, our standard is 92%. And we...
00:42:22
Speaker
In our situation, we're looking at quite a few clinicians, and where we know that any time a clinician drops off a cliff with a tenance rate, they're likely dropping something out on the very first visit in terms of patient education. So, yeah, we look at that. And, yeah, we have names for syndromes for the clinicians that that's happening to. but we'll we'll ah We'll skip over that part. So there's the first two, clinician time, space, and then yeah, go ahead. So that we call marketing for profit, which is like that bucket. The second bucket is lifetime patient value, which is where RTM comes in.
00:43:00
Speaker
Right. So is there something that we're already doing that we're not really billing for charging for? So that is, you know, Sarah health, the RTM. So can we, is there a way that we can get reimbursed? Are we leaving money on the table by not charging for something we're really doing anyhow?
00:43:18
Speaker
um Is there a cash-based service that we should be adding? That's a huge one. um Is there anything else that we should be doing around serving the person who's coming through with other treatment technologies or other services to help them get a better outcome? That's the second bucket.
00:43:33
Speaker
The third bucket is insurance relation. This is quick and easy. You can attract more of your best payers, you can attract less or drop your lowest payers, and you can renegotiate rates. and Then the fourth big bucket is what I would call practice math.
00:43:50
Speaker
right like you know so if Let's say we had two-hour appointment slots and our 90% of our insurance companies that we participate with are going to max out the reimbursements at four units.
00:44:05
Speaker
In that hypothetical example, you can see we're giving away a lot of care. So we need to so scheduling on the hour would be better than scheduling on the two hour, right? So we have to be willing to look at that based on our own payer mix and based on the insurance contracts that we have in place while we're making sure that we're being compliant and ethical and everything else that we need to do by responsibility to the patient. But those four big buckets are really how we can mitigate um declining revenue per visit over time. And we see owners being very successful with this. I mean, we've had owners that have increased that you know just by paying attention to those four buckets, 20% increase within a year, um so which is a pretty big deal. That's awesome. I i mean, as a patient that wants to see this ah wants to c PT not only survive but thrive, like could the idea that physical therapy could not exist
00:45:00
Speaker
as as I hit that Medicare age is there's not a word for it. It's beyond terrifying. Like the idea of losing my movement and then everything else goes from there. It's like, as soon as I can't move, I'm i'm done. And I know that. ah And so when I hear stories that and it almost like averages, like, yeah, we're helping boost by profit by 20%. Thank you. Right. As as from for myself as a patient,
00:45:27
Speaker
who wants to be able to be seen in the future and be treated and be cared for and be taken to 110, 115% of where I was. Thank you. Yeah, yeah there's a margin of safety that we it's there's a game we must play.
00:45:44
Speaker
And if we're not willing to play it, we go out of practice and we limit you know accessibility to care, which is a very, it's a very real problem. I i talked with two owners last week who both closed their practices. um One last day was Friday after I think it was 44 years in practice.
00:46:05
Speaker
m Absolutely brutal to go through so that your original question was what can we do about revenue per visit through the four big buckets and if owners you know if we're talking with an owner and they're not willing to start paying attention to that we know there's a high likelihood.
00:46:22
Speaker
that they're less than 10% margin and their speed bump away from having to close their doors forever and that is brutal because you have such a bad you know in terms of dollar per outcome i would put physical therapy up against any other profession and really the family of conservative care, which includes PT, chiropractic care, podiatry, dentistry, et cetera, I would put up our outcomes against anything else in medicine or healthcare right now because there are a lot of expensive procedures that that don't have the the same results that in terms of positive outcomes. And yeah, I mean, we need to fight for that. And it's really right now with that all the pressure that is within the industry, it's really an opportunity for those that want to learn how to do it.
00:47:09
Speaker
to to fight for their and their practice and keep their doors open because it's a huge marketplace advantage right now.
Future of Physical Therapy and Revenue Streams
00:47:16
Speaker
Absolutely. i just you You hit the nail on the head and that is yeah on physical therapy, having such high ROI when you think of the dollars put into the outcomes that that come out. And in my opinion, that is not research facts, you know, granted is Physical therapy in particular is not just movement health. ah You have behavioral change specialists that can do more than just get you feeling better. right It can truly give you, like so many times you come out with a better tool, a better habit, something else that that causes a behavioral change in a patient's life.
00:48:03
Speaker
and Yeah, you're right. like Eli Lilly can't ah manufacture that and they can't put it through for Patton. So at least not yet. Maybe there's a peptide out there that can do that. We'll see. um I doubt it. Also, I'm not taking it. the But yeah, I completely agree with with all those points. And while we're, while at least it's Sarah Health today,
00:48:31
Speaker
it Our core focus is around facilitating the RTM reimbursement to increase that revenue per visit. We are seeing drops in cancellation rates and other, you know, called auxiliary benefits. And I i don't know exactly what the business will look like in five, 10, 15 years, but I, you know, it's kind of funny how you mentioned at the very start that you you told ah Was it Patricia? What was her name? Patty? patty yeah Yeah, Patty. like you know I think think we're going to have people flying in here like I did a few weeks ago to Harrisburg to check out what we're doing. And you know I've gotten laughed at a couple of times for for this, which means I think that means I'm on the right path, ah which is I'm going to figure out how to grab more dollars into PT
00:49:28
Speaker
from areas that no one else is looking at today, right? Like why in the world is Signify Health paying a nurse practitioner somewhere around $150 to do a health risk assessment in someone's house when they're getting physical therapy and a DPT could absolutely do it? Like what why, right? And why are there this massive groups of startups that are grabbing key dismeasures and helping with H-caps, like all these other things when the relationship and the data exchange and the PT visit like goes far beyond any of the things that you can collect outside of it. So i I think there's something special about the relationship that gets made between a PT and a patient, and you're obviously figuring out ways to use that today, right? Like reactivation, referrals, references to other patients, and and not that it's all about monetizing it, right? but
00:50:25
Speaker
i you're, you're in a battle, right? So you got to use what you have available to you. And so, you know, Chad, I love, I've really enjoyed the you two, almost two and a half years, I guess it'll be three here pretty soon, that that we've gotten to to know each other. And I just very much appreciate what you're doing it and helping to drive the industry forward.
Tackling Education and Insurance Challenges
00:50:49
Speaker
We're going to end on one last question, which is, if you had a magic wand,
00:50:56
Speaker
and you got to fix one thing within PT, what would it be? And no, you can't ask for more wishes. I'll go ahead and get in in front of that. But if you had a ah magic wand and it could fix one thing, what would it be? Yeah. um It's the same problem, but I think there are two ways to solve it. So I would want one of these. The first one is the cost of education today for a DPT.
00:51:25
Speaker
is absolutely insane. So um when I graduated in 2000 from College Misericordia, up 1-0 in the College World Series right now, so co-cougars, um they yeah the maximum I was allowed to borrow for my Master's of Science and Physical Therapy degree was $24,000. So I graduated with 24K total.
00:51:53
Speaker
We are seeing students come through now that are at 300K and that's in debt. So now they have a mortgage payment for the next 30 years, right? I was able to retire my student debt in a few years, like very quick and easy. My first job, $41,000, right? So almost doubled my total student debt. Today, you know, your entry level DPT is coming out at 75K.
00:52:23
Speaker
with 300. So we want like 10X the wrong way. So magic wand, I would use it on that, solve that problem. Or the other one is be more valuable in the marketplace.
00:52:37
Speaker
If we look at the conversion factor for Medicare alone, when I was volunteering, when I first volunteered in a PT clinic 1994, compared to today, the reimbursement rates on the conversion factor for Medicare is lower today than it was 30 years ago.
00:52:55
Speaker
And that's no adjustment for inflation. So if you add in inflation, it's or we're worth less than half of what we were 30 years ago um for a single visit, which is also insane. So if you you have to decouple one of those. It's either the cost of education or we're getting reimbursed more by insurance companies for the services that we're providing. I'll take either one, Jeannie. So and differently of ah we can go either way.
00:53:24
Speaker
Oh, that's... Man, I... If I had to pick is after off the cuff, I think I would go education. I think it would go education, as you know, with working with many practice owners. There are a lot of practice owners who are business owners by accident um and not the best at extracting value.
00:53:55
Speaker
and didn't get into it for that. And so I think if, but I don't want that to get, I don't want that to get lost along the way, right? And so I think there's some really amazing things that that altruistic attitude provides to patients. And so I think if I was to choose, you know, from your two wishes, I think I'm gonna go education because it's a, you're right, it's a mortgage for the rest of your life at a house that you'll never get to live in. that's it's Because it's I think it's PTs and veterinarians are the highest ah basically debt to income ratio in the US back and forth. Well, Chad, thank you so much.
Podcast Conclusion and Resources
00:54:41
Speaker
Please, if you want to tell your folks that somehow don't know you where to find you and all that, please do. But before we wrap up. Yeah, so very easy to find online.
00:54:52
Speaker
um Breakthrough is very straightforward. It's getbreakthrough dot.com. um I am, if I'm allowed to say so, Steven, I do host a course specifically around revenue per visit where we talk about adding RTM and ah those four, we call them the for-profit levers, which is really learning a system to scientifically go out your revenue per visit and improve it based on your unique practice. um That course is called profitability under pressure. We accept applications at a getbreakthrough.com forward slash apply. And so if you're an owner and you're interested in that, you can go there, getbreakthrough.com forward slash apply and to apply for the next course. Yeah, I believe a pop is ah the abbreviation, which I find that's that's great. ah
00:55:47
Speaker
So yeah, don't go to getbreakthrough slash pop, go to obviously to getbreakthrough slash apply to do so. But Chad, thank you so much. I really appreciate your time. your openness to discuss everything from your volunteering at at the start through your your mentorship opportunities that you were able to make the most out of and some really tactical tips for folks to be able to, yeah I think, get at least a couple things from this and hopefully also for the the owners that are listening. so
00:56:24
Speaker
hope and optimism, and even a ah route to go to be able to increase there their revenue per visit and be able to treat patients, not just for the next year, but for the next decade and beyond. My pleasure, Steve. Thank you for listening to another episode of The Disruptors. I hope that you were able to take one or two things the away that you can apply immediately to your own innovation journey. As always, I'm your host, Stephen Cohen. This is sponsored by Sara Health. Let's keep moving.