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Daniel Vapne, Advantage Physical Therapy Woodmere
35 Plays3 months ago
In this episode, Steven sits down with Daniel Vapne, Daniel Vapne, Director of Clinical Operations & Growth at Advantage Physical Therapy Woodmere
Learn more about SaRA Health: https://www.sarahealth.com/
Check out Advantage Physical Therapy Woodmere:
https://advanpt.com/
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Transcript
Introduction to The Disruptors Podcast
00:00:00
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.
Meet the Host: Stephen Cohen
00:00:10
Speaker
I'm your host, Stephen Cohen. Now, let's get into it.
00:00:13
Speaker
All right, everybody. Welcome back to another episode of The Disruptors, where we're highlighting innovators within the
Guest Introduction: Daniel Vapney's Career Journey
00:00:21
Speaker
PT industry. Today, i blessed to be joined by Daniel Vapney.
00:00:26
Speaker
Daniel, would you please... intro yourself for for those that somehow don't know you. ah Yeah, sure. So, ah Stephen, thanks for having me on. ah So my career started ah prior to PT school. I was working in private practices and overseas. I graduated from ah physical physical therapy school in 2019. I did ah arrest a residency ah to get really good in orthopedics during my
00:00:59
Speaker
residency, I was blessed to have a lot of ah
Challenges and Opportunities in Physical Therapy
00:01:02
Speaker
mentors. um And i I learned marketing, sales, like how to operate a business, like how go to do do that. ah I opened up a de novo clinic sort of during COVID, right? they They opened it up right when COVID started and no one came, right? ah So I took over like a a year later. um and I made that practice grow from scratch. Um, and then I moved to the Northeast and with that larger organization, um, I was able to, uh, expand their Northeast footprint. Um, my wife didn't want to move. And so I partnered up with a friend that, uh, bought ah a private practice during COVID from the previous owner who was still with us. Um, and I started looking at their,
00:01:51
Speaker
ah contracts and everything. I was just like, what is going on? I came from this large entity that was getting paid like $400, $700 a visit to now this small clinic's getting 50. I was like, the math isn't mathing. The service hasn't changed. i still provide the same service. What's going on? um And then during this past year, um i it i feel like it's been longer, but the last year and a half, I've been growing this ah practice in Long Island, New York. I've been publishing research with um some faculty members at um
00:02:27
Speaker
ats Hofstra with Kino Tech and I was an adjunct professor at my alma mater, which has become Toro you you University. And now I'm creating three vehicles to um increase reimbursement for private practices. One is a MSO model, one is an IPA model, and one is an ACO model, which um I figured out private practices ah would rather negotiate and spend resources with larger players than small mom and pops all across the entire ah country.
00:03:04
Speaker
<unk> There's so much to dive into. I'm incredibly excited. And yeah, from from graduating in 19 to now, you've ah you've been busy, to to say the least. Let's Before we dive into a few of those pieces that you're working on today, would love to get an understanding of why PT for you,
Financial Dynamics and Reimbursement Models
00:03:25
Speaker
right? Like, why did you choose physical therapy as career? Yeah.
00:03:31
Speaker
yeah um Like many others, it kind of fell into my lap. I didn't get hurt right away. I was ah i was ah interning at a physical therapy clinic before college, um and I just liked the environment. It was ah it was transformative, right? So like this is a place where people went And they came with the mindset, I need to get better.
00:03:58
Speaker
And these are the people and this is the place where i feel comfortable doing it. Right. um My. it's kind of evolved from, from there. Um, I always wondered like, why do people get hurt and why is it that some people get hurt more often than others? Right. So I've been diving down like these questions of like, what does it mean to be more fragile or resilient? And, uh, and I've learned a lot through PT school, through, through residency and mostly through my, uh,
00:04:29
Speaker
other patients, but I felt like this is one of the fields. Like every field is like, helps you with something. And you go to an accountant, if you need help with your taxes and figuring out like ah how much money I made and how much I lost, you go to a physical client,
00:04:45
Speaker
of therapists when you can't figure out your own body and how you're moving and what's happening here and why do I keep getting hurt or ah ah how can I be more efficient or how can I walk again? Right. Or if you're a kid, how can I start walking?
00:05:04
Speaker
Yeah. ah So there's so much we do and that's why it's so hard to define our profession big because We are literally doing anything that involves you moving your body or you performing the way you want to perform. And if you feel like you should be able to do it at a higher level, um be more efficient at it not get us tired. We touch that area.
00:05:28
Speaker
Well, and what's what's yeah we've seen that just in our own client base, right? Like even in the same clinic, you might see a vestibular patient and a pediatric ACL repair, right? Like it And there's there's a pretty wide swath, right, between those those two individuals. um and And so, so yeah, i I can appreciate that. And I like how you found it. You say it it fell into into your lap, but I'd imagine it took some –
00:06:00
Speaker
yeah Interning before college is ah is that's a good move. That's a good move on on your end. Not something that I did necessarily. I guess my interning was on the oil fields of southeast Kansas and running a pulling rig. There you go. Yeah. that ah Learned a lot there. heck of a lot. um mean including how to put together a lot of four letter words and very creative ways. ah but So, so that's why you got into PT. That is, i love that story. um And walk me through. So you you've got these three vehicles you've created, right? I know that you and I have talked about.
00:06:44
Speaker
In process. one ru Two of them are like in process, but yeah, one is a little bit more refined than the others right now. Fair enough, fair enough, right? So these three vehicles that are are in flight, right, ah they they are moving forward um and help connect the dots for for folks and help And both from like a historical they get to know you a little bit better, but also from like your thought process, right? So so the goal of this is to be able to help people feel like they got one or two tactical, tangible pieces of insight and advice to help make their own innovation journey that much easier. so So walk me through from wherever you want to start between where we left off and and where you are today. like
00:07:29
Speaker
What did you recognize? what did you do? Right. And maybe even like a little bit of what you would do differently to, to go from there to, to today. Yeah. Yeah. So, uh, um, I joined my friend at his private practice. Um, and I started looking at the numbers, right? Like how much do we get per visit? Like the things that a usual operator looks at, what's like our payer makes that, and I started looking and i was just like, what is going on here?
00:08:00
Speaker
Like, Like, how is it that one pair is paying us $50 a visit? And then with someone else seeing them, they're getting paid $59 a visit just by who signs the the note. Right.
00:08:13
Speaker
And then,
Navigating Payer Systems and Insurance Networks
00:08:14
Speaker
right. So depending on when the contract happened, when the credentialing happened, um, and then I started diving deeper. It's like, all right, well love let let me try to move this up. No one's talked to someone from the, the like, uh, payer side in,
00:08:29
Speaker
in years, maybe maybe decades. um yeah and so And so some pairs, you know, you can get to a person and they make it hard. Like you send an email, you have to go to the secure portal. Getting into that portal is very hard because you have to use a secure link. And like, there's a lot of friction there.
00:08:48
Speaker
um I don't know if it's on purpose or this or that, but like there is a lot of friction with dealing with these larger entity groups that, you know, pay us for the serving their ah members. um So I was in the process of doing that. I was able to negotiate as a small practice with one pair um through their like third party administrator, which was they wouldn't go directly to me. I had to go through a third party. um And another payer said, no, our, our networks closed. Try back in, in, in three months. And i was just like, what do you mean? I'm seeing your patients now in in my clinic with one of my therapist therapists. Why can't you just add me in? And they're like, no, our networks closed. I was like, so I tried again in three months and,
00:09:35
Speaker
Guess what? The network is still closed, buddy. And and then I tried again. And I was just like, this is this is awful. So I couldn't even get in.
00:09:46
Speaker
So someone had to co-sign my notes for until i um, until I met an MSO that started out and, uh, in, in, in the dietician space. And that MSO, um, is in New York and New Jersey and that's called a Zaya care.
00:10:03
Speaker
Um, and I met them, um, and they didn't realize like what they had, like, they're like, we're focusing on dietetics first and we have all of these other groups, but we're really trying to focus on that first. And I'm just like,
00:10:16
Speaker
Like, what's the biggest problem that they have? And she said, well, like they like only 1% of people that have insurance really use dietitians. Like it's not utilized. And I'm just like, so you have these physical therapists contracts and you have like one or two practices and, but they're not even sending you referrals to the dietitians. Why don't we get private practices in, we don't have a problem getting getting patients, especially if the private practice has been around for over three years.
00:10:52
Speaker
That's not physical. That's, that's not physical therapist problem. Our problem is our X per visit. There's only so many people that we can see per day. we need our X to go up.
00:11:02
Speaker
Um, like we could have 10% cancellations and we still, our margins are small. yeah Like we we need the the our value, our our reimbursement per visit to go up so we can pay our people to keep up with inflation. We can pay so that when new people come into the field, that they can pay down their loans. It all comes back to that. like it all like to To me, that is value. And I've always been like, what who who who dictates that? And why is it when I move from one entity to another entity, the payer values me differently, what but I'm still getting giving the same service. So I linked up with, that
00:11:46
Speaker
this mso and we started creating a pt product that is a wraparound because every every practice is different. Like they use different EMRs, right? They have different processes. How can we make it to streamline, to decrease their admin work with verifications, authorizations, because the billing process starts before the patient walks in through the door, right? You need to make sure you can see that patient, right? That they have benefits that like the premiums that they're paying every month can actually be you utilized by you.
00:12:19
Speaker
Um, and so they do that. And then once we see them do the billing process through them, um, and then get reimbursed back to us. So we created a product in like end of April, May, we launched several practices, right? There's whenever you launch like a prototype, there's some bumps in the road. Now we're trying to integrate with more EMRs where, all right, like you get it in and it comes in and it like auto post and it's more automated, right? The less people that needs to touch the process, the better. Like, yeah e you know, this from your work, like, you know, ah in like consulting management, consulting, make things streamline and automate so that you can be more productive with your people. Because in this day and age, our people are
00:13:13
Speaker
our our most expensive resource and we need to make sure that they don't get burnt out by doing tedious work and that they feel fulfilled in the work that they do and they feel compensated. Right.
00:13:25
Speaker
Um, and so that's kind of what we created there. Um, and, uh, so that's one vehicle, the, the MSO. So it's a multi-specialty organization. So,
00:13:36
Speaker
What I found out payers like to have things grouped to together. So if you can have dietitians, physical therapists, therapists occupational therapist therapists, speech language pathologists, maybe midwives, maybe an MD in there, um there's a premium there for having that all under one roof. That's more ICD-10 codes. That's more claim volume, which is like, if you have more claim volume, it means you're servicing a lot more members. That means you have a bigger footprint. So we're going to incentivize that. So in that fee-for-service model, that's incentivized.
00:14:14
Speaker
um So that's about the MSO route, like like the members aren't really, don't have equity there, but in the IPA way, everyone's a shareholder of the IPA.
00:14:29
Speaker
that's a little bit more complicated when you have everyone have an equal say, right?
Exploring ACO Models and Medicare Advantage
00:14:33
Speaker
So yeah that's why that one's not in flight yet, um but we're trying to figure out, all right, is it going to work? And we have a lot of people that like this. So we we created this nonprofit IPA i in in in new york uh it's called the private practice network ipa and we wanted it to be non-profit and be our like pass-through so that these large payers can talk to all these small practices under one umbrella as well um still figuring out how to make everything work it's not as established as a
00:15:09
Speaker
of the mso was right they got credentialing under wraps they got billing under wraps they got verification checks like they built it out and now it's just scaling there uh the ipa we're still figuring it out from the ground ground up um and so the difference there is there has to be some uniformity there um yeah and uh And that's very hard to to to do, especially when you're a private practice owner and you've done things a certain way. And Jim and Bob down down the road um have done it their way. Right. So it's hard to get everyone doing things.
00:15:49
Speaker
You know, the same way and system and systemize everyone. um So that's. the other side there. And then there's the ACO route ah where it's an accountable care or organization and payers like that big because you're sharing risk there. You're sharing their risk.
00:16:05
Speaker
And so they, they might give you like a fixed sum per year based on the past three years. Right. And like every year you'll try to save costs here. It's all about like percentages and depending on claims volume, it might like increase. Right. And here you have to work with like,
00:16:25
Speaker
primary care physicians a lot more because right now all the value-based care stuff centers around them. right. yeah So when when you work with them, it's like, all right, how are you going to reduce total cost of care? And we know musculoskeletal injuries is like most of healthcare, right? It's like 60% utilization is and MSK injuries.
00:16:48
Speaker
um And physical therapists is only like 5% of the whole like healthcare care spend. I think it's like PTOT is like 5%, right? So yeah if we know that, all right, even with all we're doing, we're 5% of spend in imaging and surgeries and procedures and drugs are a lot more, maybe we can actually decrease that. And so The APTA has done a phenomenal job the last several years in their policy and what they're pushing out. One of the best things they've done is ah actually having that economic impact study, right? Like yeah actually showing costs, right? And our value.
00:17:28
Speaker
um And payers see that, but they don't know what to do with it. using in an accountable care organization to say like, Hey, we actually can save money here, here, here. And this is how much on average. And this has all been done by an independent actuary group.
00:17:45
Speaker
yeah And yeah, they're like, okay, maybe let's trial this out. So that's the next vehicle saying like, all right, let's do this on a larger scale be because we if we only have a little micro a system here, it's very hard to show like if it works, but if we can have dance practice and like a hundred other practices doing this and maybe we can actually you know, show that we're providing more value, especially with those like Medicare Advantage plans where like a lot of that is going through that value-based care right now. And we're going to see how that happens. It's like a little experiment for the next five years.
00:18:24
Speaker
I, let's let's start at the back and work way, know, I guess, but whatever, the the last piece work way back. um The the aco is just really, really interesting. um yeah I think you know the focus on Medicare Advantage plans makes a ton of sense, given that a Medicare Advantage plan makes the most money when they can manage a sick person the sickest people well. right like that's When they have that RAF score, right what is the risk adjustment factor? I'm not sure of that, but yeah that RAF score, like when that can be really high, but costs can be really low, that's... like
00:19:01
Speaker
Right. Golden, golden. And you luckily you don't look hard, right? What is it? ah The Bellin Hospital did this as well as the VA a with military and having PT as a conjunction with primary care. Like you don't have to.
00:19:16
Speaker
create like You don't have to look far, and then you're able to see where these models really, really work well. So I think while a longer burn right on on that on the ACO front, i think there's so much opportunity there. Thank you for listening to this episode.
00:19:31
Speaker
This would not be possible without sponsorship of Sarah Health. Sarah is the relationship operating system for physical therapy practices, driving better patient outcomes, improved arrival rate, and improved financial margins.
00:19:45
Speaker
If you'd like to learn more, check them out at Sarah, S-A-R-A, health.com, Sarah health.com. And if you'd be interested in advertising with us and helping us produce even more great stories, please let us know at Stephen,
00:20:00
Speaker
app Sarah health.com.
Innovative Business Ideas and Sponsorship Acknowledgment
00:20:02
Speaker
Now back to the episode. I think we talked about this, but and I'll put it out there. My, my next business idea, right. Uh, is PTs being the ones who run the health risk assessments with like an NP or MD on call. Right. Cause cause then like, Hey, like United, right. You're paying signify health 300 bucks for this, this health risk assessment. Okay.
00:20:24
Speaker
Pay us the same $300,000, and you get a movement assessment out of it, ah but all the same data. You probably actually get more because I would argue that based on my interactions with MDs and MPs and PTs, that PTs are generally better at getting the context and social determinants of health Part of that is the system in which they both operate, right? Like you have typically 30 to 60 minutes with a patient. Primary care might have three, right? It's not purely a skill set, right? It's a bit of the system. So, like, you know, not not disparaging any of my doctor or NP. friends, including my wife, who is a family nurse practitioner. So I had to be very careful there. um
00:21:08
Speaker
The IPA that, ah yeah, it almost sounds like a, almost like a little bit of a a B Corp, right? And thinking of it that way, like, yeah, you're doing it through the nonprofit. um But the idea that you can give ownership in a a larger entity, right? I think that's That's very cool. And the MSO with Zyacare. Yeah. I mean, that makes so much sense. I just, all that makes so much sense to me. And what I want to come back to is where do you get the energy to do these things. So if I'm reading between the tea leaves here, um and maybe there's something that happened in, in child, I'm not a, you know, that type of therapist, but something that happened in childhood or or something else, like,
00:21:52
Speaker
I feel a very like Robin Hood persona coming from you and like the most positive sense, right? Of like, Hey, you see these payment in ag in ag inadequacies to providers and you want to go fix it both from the practice owner. I heard you talk about that, but also from the staff therapist perspective, like you shouldn't be coming out of school with $300,000 in debt and only be getting paid 75 grand. Like that's, that's just that,
00:22:19
Speaker
that's not realistic, right? Like if any business school in the U S had that as they're probably in the world, right? If any MBA program was like, Hey, guess what? Like, here's the deal. I'm like, no, like absolutely not. Like hard pass. Um, now granted you could argue that you don't, you're not doing something as edifying as, you know, taking care of people, uh, typically, post MBA. And I would absolutely say that, you know, in my experience that that is true. Uh, but,
00:22:49
Speaker
asking people to do that is not, is not sustainable. It's not sustainable.
Systemic Challenges in Physical Therapy
00:22:55
Speaker
Um, so yeah, I, I'd be curious your, your reaction to my, my Robin hood comment.
00:23:02
Speaker
Yeah. Yeah. No, uh, it's, uh, it's, you're right. Like it's, uh, I feel like, Like we're here because of just being not vocal and not active, not active in policy, not active with with and telling our our like patients like like what's going on, not being transparent um for. And, you know, I'm sure this exists in other professions, too, but we've done a really bad job as a profession.
00:23:35
Speaker
um telling our peers in healthcare care what we can do, right? And so on on that side, and and they're the ones, the MDs are the ones creating most most of the policies. Like the AMA is huge, right? The AHA is even bigger, right? So if if no one knows what we can do, and and like everyone does PT, but they don't realize that PT is not valued so high.
00:24:05
Speaker
um But if you look at like all the other countries that have something similar to us, like the the physios and stuff, they they're valued so, so high and their health outcomes are better, are way better better. And I'm not saying just physical therapy can increase health outcomes.
00:24:21
Speaker
I'm just saying like, if, Physical therapists are utilized effectively. we can actually bring people from the bottom up. If we triage first and because of how much time we spend in the relationships we provide, we can send people to the right provider. Right. And for the right interventions or more right intervention.
00:24:43
Speaker
then we like imagine a surgeon that has to see like his whole schedule is filled with probable surgeries rather rather than possible surgeries. Yeah. Right.
00:24:55
Speaker
That will make their lives so much happier or the, the orthopedist that knows like I can inject like 85% of my schedule versus like 35%, right. And it's, it's efficacious. So I'm not saying there wasn't waste in the nineties and the early 2000s. And I'm sure it was over you utilized and I'm sure the payers have good reason to do what did they're doing.
00:25:20
Speaker
But I feel like we're an underutilized resource and I'm not saying as a whole, like now we're, there's not enough physical therapists because of how the system operates and yeah there's not and an incentive for more physical therapists to stay in the field and be clinical because we tap out. Like right now I'm seeing so many physical therapist therapists at technology companies, at sales companies, at this and that, like they're out of the field in like three to five years. So like, I think Larry Benz published an article that says of the, of the ones that could work and see people clinically,
00:26:00
Speaker
I think only 20% are, and I don't know where he got those numbers, but think about that. Like we have such a huge problem in the United States of access to care.
00:26:11
Speaker
And we have these networks closed for physical therapists to even join them because probably their roster has someone from three pre COVID that hasn't touched a life yeah still on them.
00:26:25
Speaker
And you can't even see their patients. And it's just wild. And I think from a young age, i I've just seen like like how ideally things should be. And just I've never taken no as an option. I've always found a yes. Like I've, ah you know, I haven't like both of them my parents are immigrants. We like I had to figure out how to get what I needed in order to thrive. And so you figure it out. Like know,
00:26:59
Speaker
You do that. And so what now? And in my one and a half years of b ah being an owner, I want to pay my employees as much as I possibly can.
00:27:09
Speaker
And I want to keep up with inflation. And I want to like my biggest thing is how happy my biggest KPI is how happy and how purposeful can I make my employees feel right? I think you are at the private practice section, right?
00:27:27
Speaker
a conference, there was an awesome keynote speaker. Can you make your employees feel purpose so that they can make the patients and everyone that they serve feel more purpose, right? Because those people that do not have purpose have more mental health um ah problems in their life where they're struggling through that. And um if In physical therapy, that's our whole job is to have people perform the way they want to perform.
00:27:57
Speaker
Like they're spending their most valuable resource with us and that's time. And they're spending three hours a week, like sometimes like two two times a week, sometimes like one time. But that time is so hard, especially in this day and age where things are just taking up more time. There's more things to do. They're spending time with us and that's huge. And we should be,
00:28:20
Speaker
compensated so so that people would stay in the field and treat because everyone loves being a clinician. They just hate that there's no room and there's a cap there. There's this glass ceiling because reimbursement keeps going down.
00:28:32
Speaker
And if it doesn't keep up with with with inflation, we're going to have actually less skilled people here that can actually make a difference in everyone's life. And physical therapy still is going to be utilized, but you're just not going to be able to find one. Yeah.
00:28:46
Speaker
Yeah. Yeah, that's it is a scary potential future that I want to do everything in my power to prevent. um Because and I agree with you, like at some point, right, like it's just going to erode, erode, erode. And it's a bit like the, you know, the story of the the frog in the water. Right. Like keep turning up the heat. i At some point it becomes frog
Impactful Patient Stories and Reimbursement Progress
00:29:09
Speaker
stew. Right. um and And that's that's it.
00:29:13
Speaker
I. I want to shift into my my next question. um And so i don't want to assume, i think i know the answer to this, but I want to assume um you what your proudest PT, so your your career proudest career achievement has has been to date.
00:29:33
Speaker
and Hmm. It hasn't happened yet. It has happened. So on, on, on, on the micro level, right. So from like clinician to a patient, like the a amount of lives I've changed and seeing like kids take their first steps that were like,
00:29:52
Speaker
eight months delayed, nine months so ah delayed, and then three to four is, is it's you, you get them walking. Like that's awesome that you can share that moment with like an, an, another family yeah getting a, a stroke patient who hasn't um been able to get down to the floor and, and, and feel comfortable or confident to get back up um in two years to do burpees. Like, like,
00:30:20
Speaker
incredible that he can do like eight in a minute now versus yeah a few years ago, the fear of getting on your, his hands and knees, um, uh, getting someone who couldn't be intimate with his wife being because he had pain in his, uh, in his, uh, private area.
00:30:39
Speaker
Right. Um, like, and, he and he just got married and this and that, and he couldn't do that. Um, um, And it was ruining that moment in his life that's supposed to be so special and wanting to have kids and stuff and helping him through that in like three to four weeks to where like he feels confident and he's got that, you know, you know, little mojo back.
00:31:02
Speaker
Yeah, like Pippen his step like that is huge. Right. And just like creating just an impact that on all those lives are great. I feel like I haven't I've started accomplishing and improving the reimbursement rate for practices in New York with certain payers. But my work isn't done yet. And i feel like once I can get that average visit with commercial payers to at least CMS rates for everyone so that Practices can actually take people in network and actually stay open. Because in New York, like especially in the downstate region, there's so many out-of-network practices because they cannot pay their people, pay their rent, pay everything if they took insurance.
00:31:50
Speaker
like Yeah. how And your insurance goes up every year. It's like another tax. Like yeah it's if, if we count since like 2008, when like it's mandatory to have health insurance, insurances if we count health insurance as another tax, we are the highest tax society. I think I saw that, um, from my previous ah mentor, Zach, um, a Walston where he like showed like, Oh yeah. Like if we, if we, uh,
00:32:18
Speaker
just have health insurance as a tax. It's a mandate mandatory tax going to public companies that are traded on the S&P 500. And if you look at their earnings, right, since 2008, where, you know, everything happened and it was just like, yeah, everyone gets health insurance, which I think is great. I think everyone should have some sort of insurance policy so they don't go into debt and they feel like um It's not this burden, but it still is. Now you have this premium that you have to pay. And then a lot of us have a deductible. We have to pay even to access yup our benefits. And then then we have a max out of pocket on top of it. So it's it's we have ah a tax to have health insurance.
00:33:03
Speaker
and then
Critique of Healthcare System Inefficiencies
00:33:04
Speaker
we in And then we have these, um we can't even use it until we pay an additional like $5,000. I'm just like, when does that stop? but That's crazy.
00:33:15
Speaker
The and I'm looking at my bookshelf. I don't I don't see it immediately. But next time we're together, if you don't read it before, then I'll bring it to you. It's it's Dave Chase and with Rosetta Health. And he the CEO's guide, I think it's the CEO's guide to fixing health care. I think that might be be it. But he goes into all of that.
00:33:41
Speaker
And it's yes, he does call it like the silent gutting of the middle class occurred through the way that health care has been. mandated and monetized. And so and he he even goes in like, hey, you know, if you're above 500 employees, there's like an 80 percent chance you're on a self-insured employer plan, which means basically the United, whoever you're choosing, is just acting as an an administrator. And they typically take a percent off the top. And so they are highly incentivized to actually see reimbursement go through the roof. Like they'd have no issues paying 500 bucks for an eval at ah you know at Johns Hopkins, right? Like, okay, then we actually make more money on that. um so So all that's fine and dandy for us. um
00:34:35
Speaker
And yeah, that that realization was pretty, eye-opening and and that's on the commercial side. On the work comp side, learning about the structure of shared savings contracts was also quite enlightening, um albeit we are a beneficiary of it in a way for a lot of these TPAs that cover remote therapeutic monitoring, like the RTM codes and pay pretty well for it. Now, I would argue based on the data that we've seen that it's a really good investment. Like if you can get that much better of a clinical outcome, right? And your failure to progress like drops off a cliff.
00:35:13
Speaker
okay, then the likelihood that they're going to stay on, like that that employee is going to need to be out for a longer period of time than expected is low. um There's some good research around if an employee feels more cared about when they get insured, um that they're less likely to you know litig litigate in any way, shape, or form. And
Employer Challenges and Healthcare Models
00:35:32
Speaker
so, gosh we know anything, it's that patients do like the check-ins. um they They appreciate it quite a bit. um So can we say that we're reducing you know work comp lawsuits? No, I don't think we can ah today. Can we say logically it's not crazy to think it could happen? Yeah, I feel pretty comfortable with ah with with adding a little bit more softness in there. But ah you're you're entirely right. It is a a massive, almost invisible tax tax
00:36:06
Speaker
that you're you're not thinking about because it's not on your – it's in a separate part of your pay stub, right? You're like, oh, i I have to have that. um Also, I'm going to add, you said employers at 500, but what about the ones below that? They get also – like, you know, cut too. So you're, you're seeing these small businesses actually hit even harder to be, because they can't self-insure. Right. And um they can invest in that type of in infrastructure too. So they might have to go into these PEO plans or as as and that, and those go up every year also. And, and, and, and that cuts them. So if you're trying to grow to over 50 employees, you're,
00:36:53
Speaker
It's tough. And then once you hit 50 employees, you have to have health insurance and you have to to do this. And that's a how am I going to pay my people more if I have to have all these other guidelines and stuff there. So that makes it really hard. But I'll also add, remember when Berkshire Hathaway and Amazon and I think it was cha Chase, like j b bordy Chase, yeah they they were going to try to tackle this, right?
00:37:18
Speaker
And I think they like gave up, but they had some valuable insights there. Right. And their biggest insight is when you actually keep get health care, like um um what what was like inhas in-house, in-house health care. Right. You can actually decrease out of the cost. So if like if like we actually have a.
00:37:41
Speaker
like a doctor on staff right so if we were big enough like barclays or jp morgan to have like an in-house doctor if anyone need needs it just could go in there's no barrier of entry you see them that if you have a pt like in-house like if you're like ah a factory worker um and there's a pt or an ot there right shout out to my ot's they do great work and they're awesome in that in that in that ah environment They're really great. They educate. um
00:38:13
Speaker
But that actually brings costs down for health care spending. And so their self-insurance starts making sense there. Right. Where where because they have an an employee just like a legal team is in house.
00:38:28
Speaker
yeah Right. It's a lot cheaper than outsourcing it. Uh, now you have your PT, your doctor in house where they, they can triage you give you reassurance, educate you and start telling you exactly what you need to do to like not miss work. Right.
00:38:44
Speaker
So all of that stuff can actually decrease, everything but because it's all done there on site or that did they can check in with remote therapeutic monitoring after that to make sure that they can continue to come back to work because the people that are out longer, it's a way harder to get them back in afterwards. And just from a mental standpoint, also, it's just so hard as well, physically and mentally.
00:39:13
Speaker
Oh, absolutely. And we saw it firsthand. So we um we have not been in the fee for service for more than about, I guess, whatever you know March of 2022. Prior to that, we spent about four years you call it value based care, right, or population health. But we were working with PT and AT groups that were on site directly with employers and were paid lump sum to manage the population. And so i remember Uh, remember we, we, we, I about law i've about had a heart attack. So we get in and people are using Sarah and it's, it's all going really well. Um,
00:39:55
Speaker
And then we get some of the initial data back and ah the group that we were working with protein tactical, we're kind of both freaking out. Cause we saw the number of incidents go up by like 30%, like, Oh no, like this is bad. Like, this is so bad. um They go talk to the fire chief, come back and are just like all smiles. Like what happened? Like, Hey, people are getting like going to you for a shoulder strain. And we've already started to see over like the I think we we're working with in like nine, 12 months at that point. Like, look, yes, our strains and sprains are going up, but our tears are falling off a cliff.
00:40:36
Speaker
So the fire chief is like, this is great. Like we're, we're all, we're all gravy here. Like this is, this is, this is fantastic news. you can tell me, um, you know I have, instead of having a hundred or 10 people out for six months, I have a hundred people out for six weeks. Like even in that dramatic of a, uh, like an example, like still give me like the a hundred out for six weeks. Uh, so yeah, that's having an in-house experience.
00:41:03
Speaker
whether it's, you know, kind like outsourced in-house or just fully in-house, you know, that's quad men premise in these others that are are doing it. I think there's a ah lot of really good opportunity
Community Healthcare Advocacy and Reimbursement Enhancement
00:41:14
Speaker
there. um Well, I know we're starting to get into the the the time here. So I'm going to pivot to my final question, which is also my favorite. shirt Okay.
00:41:26
Speaker
Daniel, if you had a magic wand and could fix one thing within PT, what would it be? So I'm a big fan of like community healthcare. care And so what I've seen, ah like in the last 20 ish years, I'm only like 32, but, but, but i remember, um is I'm seeing, uh, more and more consolidation. Um, and that doesn't help anyone that doesn't help.
00:41:55
Speaker
Um, that doesn't, doesn't help the patient. Some say it can because you have interoperability and healthcare and yada, yada, but when you have more community providers that live in your community, that see your patients out there and like, they know that there's someone there that can help them, that they can walk into their office and, um, and see them like community providers are those small mom and pops, uh, where I am now. Like I see, like we have therapists here that have been here for 30
00:42:29
Speaker
In 20 years, right? Like, you know, that amazing value you provide, like that, that entire zip code, like they know, like, oh, this place gets me better. And you have that rapport. And they know, like, they have so much trust in you, because you've seen them like, you like, it's human nature, we are going to get hurt.
00:42:51
Speaker
And one of the things that makes a society, do do you know the one thing that like makes a society? it was It was discovered by, I think, I forgot, archaeologists or anthropologists. It's a healed broken bone.
00:43:05
Speaker
All right. Like that's the foundation of a society. Is there someone there to take care of you when you're down and out? And we are those people, we we can start creating that. We create the community and a place where people actually get better and they heal, right? And you need to be supported during that process because it doesn't happen overnight. um We all know that. we we We live in a world where things do happen overnight. Thank you, Amazon. But so but our body is efficient.
00:43:37
Speaker
Only as well as we're healthy and it, it, it takes as much time as it needs and it needs to be stressed gradually, like returning to work gradually. And, and, uh, we need to become more resilient. And that happens when you have so many people care about you in your own community.
00:43:53
Speaker
And when you work for a bigger conglomerate where people are moving this and that, like, like I see, see this, like, Physical therapists are leaving jobs in less than a year now, more than ever. Like, it's just like, go, go, go. Because the problem is it's not that they want to, they have to go to where the dollar it can stretch more, right?
00:44:15
Speaker
Like the expenses are so high and they're hitting that top end. And that's why they're leaving being clinical, even if they're good or or not good, because the dollar can only go so high in this production, you know,
00:44:30
Speaker
ecosystem that we have for fee-for-services and that where they're not incentivized to stay clinical for 20 years, 30 years. You're not seeing that happen.
00:44:41
Speaker
anymore. I'm not saying people should be everyone should have their own journey. But the people that I spoke to that left to go into tech and stuff, they're like, I really miss, I really miss this. I really miss having that relationship and getting people better and seeing that even though they're fulfilled now and they can see a ladder of director of sales or clinical liaison or account executive coding, right?
00:45:07
Speaker
They miss interacting with people. That's why so many of us got into the field is you got to spend so much 30 minutes, 45 minutes, an hour with a person over the course of 13 weeks or to eight weeks or 10 weeks. Like you become their friend. It's it's yes like, and, and, and they, they have such, they're so grateful for your service. And you're so grateful that you are being part of that journey for them.
00:45:38
Speaker
and Like I wish I can do that first in New York and Jersey and then like across the country because you know this as well as everyone.
00:45:48
Speaker
New York and Jersey, the reimbursement rate is probably the lowest in the country, right? It's it's. New York is like the highest standard of living, right? And the the lowest of the country. So if we can actually make it here, we can make it anywhere. yeah i i agree with that. And and i I really like your point too on ah community and then even those that leave the profession still ah keeping a some sort of toe in the water, right? So I know our chief clinical officer, Paul, who I think you got to meet at PPS, he still treats a day or two a week. um It just,
00:46:24
Speaker
it just helps. It just helps, at least for for his position. You could argue for sales, maybe not, but I don't know. um i like If you're in it, you understand it.
00:46:34
Speaker
But anyway, that's I'm not here to opine on that. So anyway, ah Daniel, thank you so much. I'd like to wrap up with a a couple of of insights that I try to i find throughout our our conversation. And You know, I think a couple that I found is don't be afraid of letting your passion drive you to peeling back the onion and finding somewhere to to go and and play. Right. um and And I think that that you've shown how that can be very successful in a relatively short amount of time, just like. Letting that passion take you, owning it, and then just peeling back the onion in and not not taking no, but in a way, like also not taking just like, well, because it is what it is, right? and not taking that as a as an answer. um you know I think that's a very, very, very salient point. Yeah.
00:47:32
Speaker
And I think that's what we're going to leave people with is let your passion take you and don't take no or it is what is it it is as an answer.
Collaboration and Industry Consolidation Concerns
00:47:42
Speaker
And you might find yourself in a similar position sooner than later. So where can people find you ah yeah what you? What would you like to leave the the audience with?
00:47:55
Speaker
Yeah. Yeah. So, um, I'd also like to add one thing is, is you can't do it alone. All right. So like, I, I, I couldn't have done this much in six months if I didn't meet people, talk to them about these big ideas, um, and try to create a difference. I have a lot of, um, a lot of other private ah practices that have, uh, championed like this,
00:48:24
Speaker
cause this is like their problem too. And they're willing to take their like ego out of it too. Like all of us are, you know, we have our businesses and this and that, but willing to actually sacrifice time there, which as a business owner, no one has enough time and debt dedicate at least an hour a week or two hours a week to like a cause like this, um, is huge. And that's why i was able to do it in such short,
00:48:52
Speaker
amount of time, six months is big because I'm working with so many other people. Uh, everyone can, can find me on LinkedIn. That's where I guess I'm like the most active. Um, I'm, uh, I'm gonna probably try to go into more socials once my kids are a little bit older, but, uh, it's hard with three kids, man. yeah And, yeah um,
00:49:12
Speaker
if If they want more information of like the currently active a vehicle, um they can go Zyacare.com. And ah ah they have a team there that is trying to champion this. So they're going to try to make this work. And PT and OT practices are like they're like ah a backbone. But they're going to start trying to get more speech language pathology.
00:49:40
Speaker
pathologists dietitians are there and uh trying to expand out later but it's all about the existing physical therapy and ah ah occupational therapists because new york consolidation is happening at a fast rate um it's like these mom and pops are go going down like every every day it it seems like I'm seeing that generation of physical therapist therapists, they can't sell it to the new generation because they have so much debt from school and everything. So, so their only exit strategy is taking an EBITDA from like USPH, um, or, or, um, or one of these other groups that are just getting bigger and bigger and and bigger. And those groups, you're not seeing those clinicians stay there for,
00:50:32
Speaker
um 20 years, um unfortunately. So i'm I'm hoping that I can like stop that in its tracks so that next domino doesn't fall be because it won't be good for all of us.
Conclusion: Improving the PT Industry
00:50:46
Speaker
no my opinion From my opinion, it won't be good for all of us. No, I mean, i don't want to grow I don't want to grow old in a world that doesn't have PT. I... Uh, no, just no, like, uh, no. Uh, you know, I'm going to do my darndest to help prevent it and, um, and, and highlight stories like yours to help people realize that, Hey, they can make a change too. Um, and so with that,
00:51:14
Speaker
Daniel, I want to say thank you so much for your time, for your advice, for for your story, and for your effort in helping create some more equality in payments so that way we can turn this field that you and I both know and love from different sides of the equation from just barely making it to to for surviving to thriving. And so with that,
00:51:40
Speaker
They know where to find you. And thank you for listening to this episode of the Disruptors. Thank you for listening to another episode of the Disruptors. I hope that you were able to take one or two things away that you can apply immediately to your own innovation journey.
00:51:54
Speaker
As always, I'm your host, Stephen Cohen, sponsored by Sarah Health. Let's keep moving.