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Daniel Sage, Hands-On Diagnostic Services.
17 Plays2 months ago
In this episode, Steven sits down with Daniel Sage, Vice President of Business Development of Hands-On Diagnostic Services.
Learn more about SaRA Health: https://www.sarahealth.com/
Check out Therapy Partners Inc. and Motion LLC: http://www.handsoncompanies.com/growyourrevenue
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Transcript
Introduction to 'The Disruptors' and Guest Daniel Sage
00:00:02
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.
00:00:15
Speaker
Welcome back to another episode of The Disruptors. where we're highlighting innovators within the physical therapy industry and helping make innovation feel just a little bit more accessible to you on each and every episode.
00:00:27
Speaker
Today, i am blessed to be joined by Daniel Sage of Hands-On Diagnostics and so much more as he and I have got to know each other. But I want to pass it over to you, Daniel, to a quick intro before we we get into it.
Implementing Diagnostics: Transforming Practices
00:00:42
Speaker
Yeah. Thanks for having me, Stephen. And again, yeah, Daniel Sage from Hands-On Diagnostics. I'm a physical therapist. I was in private practice for 30 years in South Florida.
00:00:53
Speaker
um We implemented diagnostic testing, and you speak of innovation and and cutting edge and forward thinking. and pioneering things, we were hands on diagnostics first client in 2013.
00:01:07
Speaker
We put EMG studies, nerve conduction studies, musculoskeletal ultrasound in our practice in 2013. And at that time we did it just to elevate our company, our clinics, what we were doing professionally, really sophisticated our ability to make a physical therapy diagnosis with much more accurate testing.
00:01:29
Speaker
And it was a game changer for us for 10 years. And then I sold the company. But from an innovative standpoint, hands-on diagnostics, they were doing diagnostics for their own practice since the 90s. I mean, and not many PT practices were doing that stuff. Yeah. And they brought it to the market in 2013. And I think at that time, they did a research study. Three percent of physical therapists in private practice knew that they could actually perform diagnostic
The Drive for Autonomy and Innovation in PT
00:01:57
Speaker
testing. Nobody knew about it.
00:01:58
Speaker
Yeah. like yeah And then when I found out about it, I looked into it, checked our practice act, checked the, know, the Medicare language. And sure enough, yeah. So it was an awesome journey for me. And I sold the company and now I'm just paying it back and helping them out.
00:02:12
Speaker
that man is so cool uh yeah you know i i'd say when we first got or we first started really marketing on the the remote therapeutic monitoring rtm side think that three percent may have held too and uh q1 of 2022 luckily it doesn't hold quite that low today but but still is is uh it's not nearly as high as it should be but that's not we're here to talk about so daniel you're you're physical therapist right uh started your own practice what What got you into physical therapy? Like why did you decide to go down that path?
00:02:45
Speaker
Yeah. I mean, look, I think like so many PT say, you know it's like the the passion of helping others, of changing lives. I mean, honestly, I mean, my undergrad was in cardiac rehab. I would have went to med school.
00:02:57
Speaker
um But then I had the opportunity to go in into physical therapy and and I had a vision of always opening my own practice. So two years out after i graduated, I opened up my own practice and I felt I was operating with a certain amount of autonomy.
00:03:15
Speaker
and decision-making that I can decide how I want to treat patients, what do I want to do with patients, how do I want to affect their lives. If I didn't have that opportunity, I would have went to med school because I just had that mindset and had that mindset that no one can treat a patient as good as me.
00:03:34
Speaker
And that's not being cocky. It's just being confident that I love what I do. I'm passionate about how I help people. I didn't want someone to tell me how to do what I you know wanted to do. So ah you know I went into private practice and um stumbled into something. And it was ah really an awesome ride for close to 30 years. so That's, I know. So, walk, I think it'd be really, there's, there's, there's two pieces. I think I'm going to go actually like closer in the past and then maybe back a little bit further. So you, you brought on hands diagnostics in, in 2013, right?
00:04:10
Speaker
Um, Walk me through the decision making process for you. Right. So, you know, others that are listening might be considering more innovative tools and approaches, you know, what was your decision making process? What did you need to hear?
00:04:25
Speaker
ah just I would love to get like a peek into your mind during that decision making process. Yep. So, so what I found out about it, the, the first thing after I did my due diligence that we can do it, yes, was what purpose is this going to serve for my practice?
00:04:41
Speaker
What is this going to do for my patients? What is it going to do for my staff? So, you know, I took a hard look at the sensitivities when I do an evaluation on someone's neck and I do a special test called a Sperling's test.
00:04:56
Speaker
it's 30% accurate. So I can do that differential diagnosis, that test, call it something based on performing that test and miss it 70% of the time.
00:05:07
Speaker
So there could be cases where we're treating somebody with what we think is one thing, but it's actually another. So it had to check the box off from what is it going to do in terms delivering better results for my patients? Well, the idea is an EMG nerve conduction study is almost 85%, 88% accurate.
00:05:27
Speaker
we have So it raises the level and accuracy in calling something what it is. Makes sense. Then I then can then guide my treatments based on what I found.
00:05:38
Speaker
That's cutting edge. It doesn't happen in our field. And it felt right for me in 2013 because I did my thesis in PT school on autonomy in physical therapy because autonomy is an important aspect that defines a profession. there's certain things that define a profession backed by science, research-based, and autonomy is one of those things. So I really felt it would raise the level and sophistication of my physical therapist.
00:06:06
Speaker
It would really help us practice with autonomy, more effective treatment plans, better outcomes, no-brainer, really no-brainer. So that was the impetus and the push of why we did it And it it positioned me much more different than my competitors, not
Balancing Financial Benefits and Purpose-Driven Decisions
00:06:25
Speaker
even close.
00:06:26
Speaker
yeah And so really, Steve, honestly, that was the reason. The the secondary effect was reimbursements were about $500, $600 an hour. ah That makes it make sense, right?
00:06:40
Speaker
It does, but I tell everybody, you know I never make a decision because of money. because Because if I make a decision because of money, it's never enough. You need you know you want more and more money.
00:06:54
Speaker
But yeah only decision is when a decision is backed bit back by purpose, if it feels what we're trying to do in our clinics, if it does something for our patients, and what I did for my staff, I took therapists that were making $60,000, $70,000 year.
00:07:10
Speaker
we pay a board-certified person a hundred and twenty year I'd change their careers yeah hey and and and it feels good. So that was the the thought process behind it. And what I didn't realize nine years later, when I decided to sell the company, what it did for my exit, for the profit margins, for we didn't have declining reimbursements in 2013. It was still pretty good.
00:07:34
Speaker
So yeah I want to focus on one piece there because I think I i'm i want to make sure i'm right on this. So from – From Jump Street for you back in school, yeah ah you really wanted to figure out how to practice ah as auto autonomously as possible, right? Yeah.
00:07:53
Speaker
That was your drive and now you had a passion behind that. And hands-on diagnostics gave you that pathway in a a very real way that made sure – and we'll get to – check the box in terms of lenses you would make a decision on. Right. But I think it's really important for people to hear that you had a passion, which if we boil it down to like even a, uh, almost like a more primal, right? Like you wanted to practice autonomously.
00:08:22
Speaker
Yeah. And then from there it was, okay, well, how do i make it in my control to do that? And this was the, the optimal way to make that happen. Like I,
00:08:34
Speaker
I think that is, if it first of all, is my sort of like boiling of that down correct? I mean, it is, you know, the, the, the other thing that was really important to me in practice was not only taking care of my patients, but taking care of my staff.
00:08:50
Speaker
I mean, my staff was very, very important to me. And as practice owners, you know, it's like one day you go to work and the next day therapist sends you an email and says, here's my two week resignation. And like, oh, here we go again. I got to jump back in patient care. I got to drive to that clinic.
00:09:05
Speaker
So I always had the mindset that What can I do more for my staff? How can I you know take care of them better and better? And from a financial standpoint, well, if we're doing diagnostics, we're bringing in $500 an hour and I can generate three, four, $500,000 more a year. I can take care of my staff.
00:09:25
Speaker
i have more I can have more effective, sustainable bonus programs, which we did. And I could pay a therapist. The APTA data in July of 2023, a therapist who's trained electrodiagnostics under the APTA makes $70,000 more a year than any other pt Holy cow.
00:09:45
Speaker
Yeah. And a PT that's like orthopedic OCS, orthopedic certified specialist, they make eight grand more a year. But someone in diagnostics makes $70,000 more a year.
00:09:57
Speaker
so why So I'm able to offer that to PTs that when they take a job from me, never knew that they can now for free join an APT approved eight vo American Board of Physical Therapy specialty approved residency program. I just changed your career.
00:10:13
Speaker
that's That's amazing. And there's there's two pieces that I want to make sure to highlight there. And one is... let your passion drive where you want to innovate. Right. And I think you absolutely did that. And whether someone's passion is on, you're practicing autonomously, you know, I definitely hear the 10 care of your staff and feel very, very strongly about that on our side as well.
00:10:35
Speaker
But like maybe your passion, right. If you're listening is, is not that right. It's I really want to better. I really want to own the patient reported outcomes. Like all I want to look at recidivism, like wherever your passion is, let that drive you into where you want to innovate. And if you do that, it's going to be able to help you.
00:10:58
Speaker
As I would imagine you had, you know, a roller coaster, right? Which ups and downs, yeah like hopefully you're trending like the, up into the right. yeah And it it, it helps, it helps buoy you right in those, those tougher days. Um,
00:11:12
Speaker
yeah i'm good ah That is just a wild, wild delta from 8 to 70. I mean, it's just that that's crazy.
00:11:23
Speaker
Yeah. And PTs, not many know. Like when I talk to owners now and you know every every owner, every private practice owner today, their their pain points are declining reimbursements.
00:11:36
Speaker
working harder and harder in the business, yeah ma retaining staff. so And I'm a firm believer that you know practice owners, the business should be working for them. In order for me to be the dream maker, in order for me to enjoy what I do, to continue to open up practices in this town, in that town, the business has to work for me.
Innovating Amidst Financial Challenges in PT
00:11:58
Speaker
If I'm working for it, I become a slave to it. I can't create on it. I can't build on it. And if I can't create and scale it, I can't help as many people as I want.
00:12:07
Speaker
So I'm a firm believer that, you know, sometimes practice owners, they get stuck in there in that one lane. So if we're talking about innovation, And in taking that leap of faith, well, sometimes it requires coming out of that comfort zone, out of that lane that we know to figure out what do we need to do.
00:12:27
Speaker
And it might be a little uncomfortable because we've never done it before, but we got to do something different. Otherwise, year after year, we're getting cut more and more in our reimbursements and it's not okay. It's really not okay because I believe in the private practice PT. I believe in what we do, but we can't do the same thing and expect a different result, especially in the next couple of years. And the last five years, Medicare's conversion factor cut 10.3%. Yep.
00:12:53
Speaker
yeahp Yeah. I know. I know we've been at a couple breakthrough events together, right? And then the graph that Chad Madden always throws up where you could see that the conversion factor is less today than it was in 1994. It's just like, it's just, it's a very sobering and infuriating chart to look at. But it's, that's real. And I couldn't agree with you more.
00:13:16
Speaker
The, yeah As you implement it. So obviously you you led with patients and then the patient outcomes. yeah And I will say that is that's been our experience as we talk to practice owners across the nation.
00:13:29
Speaker
ah No matter if it's a single you know owner operator, all the way up to, hey, we have 5,000 clinicians. Right. it does need to be outcomes led for it even to get exciting for, for folks. And I don't think it's that way in every other medical, ah like industry or vertical, however you want to describe it, right. profession And that's something that makes me really proud to be in the PT space is like, that is of utmost importance. And so as
00:14:00
Speaker
So you talked a little bit about the decision making process to to move forward. about yeah I'd love to take actually like the next layer the onion there, right? So did you what was the framework you used? You're like, okay, we're going to look at outcomes, then staff, then business?
00:14:14
Speaker
like how Or was it just was it more of like, we're going to weight these things? like How did you build that decision framework to figure out what you're going to move forward with? Well, the thing is, and I will speak to that too, like yeah as PTs, we're all about outcomes, we're all about taking care of patients, doing the right thing, and and really sometimes sometimes a little a little excessively, but it is what it is. But I can tell you this, we did, in Hands-On Diagnostics, we did a research study in 2020.
00:14:44
Speaker
We took 462 patients that all had an EMG, nerve conduction, and ultrasound performed. 61% of those patients, the therapist had to change the treatment plan because they were treating something that they didn't know about that they found out on a diagnostic test. 61% of the time.
00:15:04
Speaker
So if you talk about outcomes and raising the bar, my God, we've we've had cases over the years. Podiatrist sends a patient to us for plantar fasciitis, pain in the bottom of the foot.
00:15:15
Speaker
We're treating it, not getting any better. Well, before diagnostics, the patient either one would self-discharge and say, well, they didn't help me. Two, go back to the doctor and say, they didn't help me. Doctor's in in somewhere else.
00:15:27
Speaker
Three, doctor does an injection medication and other things to try and figure it out. But after diagnostics, we actually did a lumbar EMG on the patient and it revealed the patient on a bulging disc.
00:15:39
Speaker
It has nothing to do with the foot. So treat you treat the back, the foot gets better. Or we had cases where you think it's ah coming from the neck. We do an EMG. The scalenes, the muscles outside are pushing on the nerves out here. Treat the soft tissue.
00:15:53
Speaker
Symptoms get better. So from an outcome perspective, there's nothing like it. There's nothing – innovatively, there's nothing a physical therapist can do in an evaluation that will substitute 80%, 90% accuracy in advanced diagnostic testing that we we provide.
00:16:13
Speaker
Well, what you're talking about is a – not even – titration of care is ah is ah is as a terrible phrase. Let's strike that one from the record, right? But like you're just – you're being – I mean, let's call it surgical, right? Like it's, it's, Hey, this is exactly where we need to go.
00:16:32
Speaker
and we have an extremely high level of confidence there to be able to do that. And I would have, I'd have to imagine that, it and I'm definitely going to get over my skis and then you're going to help with some data that I'm sure you have, right. is. I'd have to imagine, especially for your newer grad PTs, like, Holy cow. Right. Like,
00:16:53
Speaker
this has got to be huge. And of course, I'm not saying that it doesn't help the the more, you know, the the veterans out there, but gosh, i mean when I think of my own career, right? Like yeah all these, you know, the new grads now have like, know, generative AI for Excel and we had, you know, not that. right like I got to think in my, my non-clinical, i'm just trying to come up with a, ah you know something similar, but gosh, I can't,
00:17:22
Speaker
Maybe I'll just stop there and then let you you you talk. Well, yeah I know what you're going with. And there's that article that the APT put out in July of 23, and they compared salaries.
00:17:33
Speaker
They also talked about the ideal therapist that really significantly makes it makes a big splash is someone out three to five years that's now going into diagnostics.
00:17:44
Speaker
Because they they're just going to change their career for the next 15, 20 years. I talk to owners now and I'll tell an owner, look, what's your goal? Well, I want to exit and sell my company in the next five years.
00:17:55
Speaker
Fair enough. Let's put diagnostics in your practice for all the right reasons.
Diagnostics: Enhancing Practice Value and Professional Scope
00:18:00
Speaker
Professionally, I can i can easily slam that in. But- If I'm an owner, and I was, and i i and the only reason why I'm with hands-on diagnostics is because when I retired from my company, I spoke to Demi, our owner.
00:18:15
Speaker
He's like, look, come work with us. Come help practice. I said, great. cause I can't sit around doing nothing. my my passion ah My passion about it is I watched what it did for my practice. I did not know when I put diagnostics that nine years later, i'd be looking at declining reimbursements that Didn't really affect me as much as I'm bringing in so much money in diagnostics that when I sold my company, I got a significant multiple and a great EBITDA because of that. So now when I talk to owners and if their goal is the next five years exit, well, I can tell you right now, if you take an owner today,
00:18:53
Speaker
They do nothing differently in five years based on the trends of reimbursement. The value of their practice is going to go down. Yep. And owners will say to me, well, we're going to offset that with more volume. Got it.
00:19:07
Speaker
We can work on our better percent arrival. People are arriving to the clinic. We can try to renegotiate contracts. which are all important things, but it's not going to make near the splash of EBITDA and profit margin increase of putting diagnostic testing in where these guys are making $400, $500, $600 an hour, not even close.
00:19:26
Speaker
And they're willing to work harder and harder to generate more volume when they're getting reimbursed less and less. we have So the owner, I tell the owner, look, if your goal is five years, don't get trained in diagnostics yourself.
00:19:41
Speaker
Take a PT that's in your practice three, four, five years out. Set their career off for the next 15, 20 years. You're going to change their lives. They're going to change your practice. They're going to commit to your practice because they got it's one of the things that they have to commit to the practice if we're paying for their residency. But I just, as an owner, I just changed the value of my practice, probably 20 to 30% and my multiple times a couple.
00:20:04
Speaker
And I just took a PT that's three, four or five years out and I just changed their lives. Thank you for listening to this episode. This would not be possible without the sponsorship of Sarah Health.
00:20:16
Speaker
Sarah is the relationship operating system for physical therapy practices, driving better patient outcomes, improved arrival rate, and improved financial margins.
00:20:26
Speaker
If you'd like to learn more, check them out at Sarah, S-A-R-A health.com. sarahhealth.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.
00:20:46
Speaker
Right. As you raise your EBITDA percentage, right, your multiple goes up. And also like if you're raising the percentage, it means also the, you know, the actual number itself is going up. Right. And it's, it really is like, Oh, well, instead of at, two hundred at 200,000 EBITDA, right? Getting a a four X multiple now at 250, because that percentage is so much better the business is so much more efficient, you're getting a five or six X multiple.
00:21:12
Speaker
Oh yeah. Like that's fun math. That is fun, fun math. Yeah. and but And the thing is I never knew that. See, when I put diagnostics in, my mindset was, what am I doing for patients, my staff?
00:21:23
Speaker
Yes, I'm raising my profits, but I was making great money then, too. So what the necessity level of fighting declining reimbursements was not near as what it is today. So fast forward, when I sold a company, i'm like, I got to help practices because this this is not fair.
00:21:38
Speaker
And I talk to owners all the time. And we signed up at practice. She's 69 years old. She just signed up with us about a month ago because her practice isn't worth anything anymore.
00:21:49
Speaker
And the only way she's going to sell it is to raise the profits. She's not doing that with straight reimbursements, what's happening in the market. So she put in diagnostics. I spoke to this other guy in Long Island.
00:21:59
Speaker
He's been in practice 40 years and he still works 60 hours a week because he can't afford to hire more staff. So we'll put diagnostics in, he'll train in it. He'll make four or $500 an hour.
00:22:12
Speaker
Now he can afford someone else, let them do the PT work. Now he's not working ah like a slave into it, treating 20 people a day, 60 hours a week. He's able to step back and do something much more higher level. And the other thing I want to mention is from an innovative standpoint,
00:22:30
Speaker
PTs are now able to play in the sandbox that only neurologists and physiatrists have been doing. they're They're generally the caregivers for, you know, the providers for EMG, ultrasound, nerve conduction studies.
00:22:42
Speaker
But now a PT can do what a physician's doing? Game changer. Oh. I... I love that. And you had a few other episodes we've talked about that a PT is more than just a physical therapist, right? Like more than just a movement health ah professional, right? There's, there's, especially as we talk about another like behavioral change, right? Like PTs have some the best, if not, I'd go as far as say the best
00:23:14
Speaker
skill set to affect behavior change in a patient, would right? Like you're getting people that have never exercised before to exercise. You're getting people to be able to rethink the way that their body moves. You're getting to rethink habits. Like all of that happens within that, you know, 10 visits or however many visits, right? Yep.
00:23:33
Speaker
30 to ah an hour with that that patient. And it's because a real relationship gets driven and as a result. And I just, I love this idea of allow of facilitating a more accurate plan of care based on the diagnostics.
00:23:52
Speaker
And even if i Yeah, even if you did have fewer visits per episode, like your self-referral rate is going to be through the roof.
00:24:03
Speaker
i People are going to know that you're being extremely ju judicious with their resources, right? So your self-referral rate going to go through the roof. You are going to have great word of mouth and and and you know referrals.
00:24:17
Speaker
from other patients and gosh, I got to imagine even your referral resources at the the MD level are are going to get even more excited as well. Like, okay, well I know if I send them to Daniel, then have the likelihood that they come back to me with a similar issue. the recidivism goes way down.
00:24:34
Speaker
objective right yeah it's and it's It's a very, like there's just so many like ripples, right? To to to that a positive ripple effect yeah from there.
00:24:45
Speaker
we we We, as we really penetrated the community, what we decided to do is we let our physicians know that we had a residency in diagnostics. You know, at first, therapists were like, oh, am I going to annoy a doctor because they do diagnostics or they do EMGs? Okay. So if a neurologist is my referral source and he knows that we're doing EMGs, we respect and we don't do EMGs on his patients if that's what he wants.
00:25:10
Speaker
ja we We have physiatrists that send diagnostic referrals to us. We have huge orthopedic groups that send diagnostic referrals to us pre and post surgery to see the health of the nerves and so forth.
00:25:24
Speaker
So the exciting thing is a PT practice. We became a referral source. Like a doctor writes a prescription to go his MRI facility. They're sending patients to our PT place for an EMG and not the neurologist.
00:25:38
Speaker
And why? The quality of our reporting is significant. Neurologists, You know, sometimes they have a nurse that does a nerve portion. They come in, they drop the needle. They're in, they're out.
00:25:49
Speaker
They do EMGs once a week because they're doing a million other things. Yeah. Our PTs, this is what they do. So the quality of the test is amazing. we We turn around results within 24 to 48 hours.
00:26:02
Speaker
Our referral sources value that. sent and and just started sending people to us just for diagnostics. And even before I retired, my one, the guy, Sean, who's a training, orthopedic calls him up. Hey, Sean, got this case, blah, blah, blah.
00:26:19
Speaker
I'm doing surgery in two weeks. I'm going to send them to you. I want you to do the EMG, do this, do that. And then Sean would call the doctor up with the results and go over it together and guide the doctor in terms of his surgery.
00:26:30
Speaker
I mean, what PT is having that communication with a surgeon? They're not. That's autonomy and PT. That's raising the game. and And I can tell you this, you're right.
00:26:42
Speaker
PTs, the greatest PTs know how to connect with the patient, motivate them, reach them emotionally, touch them mentally. I got all that. But if I can do all that, plus I'm going down the right lane because I've got accurate diagnostics, I just hit a grand slam.
00:26:58
Speaker
and And you're right. Doctors loved it. They saw the value of patients. Patients in that research study we did as well, I forgot to mention, 90% of the patients felt more engaged.
00:27:12
Speaker
They felt more understanding of their problem because they're watching their PT evaluate their shoulder, doing an ultrasound and showing them tendon and the inflammation and what they're working on. it the The trust factor is significant.
00:27:26
Speaker
Oh, i there's a couple of things that that come to mind, but absolutely, right? You give... You make it, you put it in like layman's terms, right? For the patient, right? Like, oh, okay. That thing isn't supposed to do that.
00:27:39
Speaker
Right. I mean, and I'm not a clinician. i yeah Gosh, the last, ah the last like biology or anatomy class I took was in freshman year high school. yeah So, you know, physics was easier for me. So I went that route. Yeah.
00:27:54
Speaker
yeah yeah underground um But like that can make a lot of sense. And when I hear, and just get put into my my own terms and on um the value of it.
00:28:06
Speaker
One of the things I do in my training is we do velocity-based training. So we know how fast fast the bar is moving at different points of the lift. And that is exactly like oh, what do we need to work on? Like, it's not a, okay, well, let's try working on a you know deficit pool for four weeks. Like, well, your your problem isn't from your, you know, the lift off to your knees. it's really from your knees to your hip.
00:28:30
Speaker
So we're just going to like overload your quads for the next four weeks. Like it's she targeted, right? And and people, they they don't want to be in pain for any longer than they have to be. And so ah just, I mean, the the value prop is as a patient just makes so much sense.
00:28:47
Speaker
So, so, so much sense. I, I do want to come back um to you and and ask a question that I, really like asking. Yeah. And going to put you on the spot. So I don't think I'm going give the heads up on it.
00:29:03
Speaker
If you had a magic wand and could fix one thing within physical therapy, what would you fix? the reimbursement model is horrid.
00:29:15
Speaker
The absolute is horrible. It's, it's unconceivable. That's the right word. It's inconceivable to think that in the last five years, reimbursements are going down. The value of us,
00:29:28
Speaker
from an insurance carrier's perspective, is less and less. Medicare, and in private practice that don't do a lot of Medicare, oh, i don't do a lot. So yeah, but you know what? Most payers eventually follow the trends of what the federal government is doing.
Facing Declining Reimbursements in Physical Therapy
00:29:42
Speaker
And Medicare just cut the PT evaluation code 3.4%, I think, this year. The most sacred code to the physical therapist is not manual therapy, therics, balance training. It's the evaluation.
00:29:58
Speaker
It's where the PT is putting their thinking cap on determining what's wrong and coming up with treatment plan. Well, guess what? Our government says it's worth less and less. And it's not right. We're the ones that are keeping people out of hospitals, away from medications, injections.
00:30:14
Speaker
We are you know holistic practitioners, changing lives and people, keeping them healthy and living longer. Why are we getting value less and less? So the reimbursement model is horrible.
00:30:25
Speaker
And let's face it, every PT, every private practice PT that has a purpose and a passion, in order for me to scale that and to facilitate that, I need money.
00:30:37
Speaker
Money is a form of energy that allows me to fulfill a purpose. And if I don't have that, I'm strapped, I'm stressed, I'm anxious, I can't take care of patients, I can't take care of staff.
00:30:50
Speaker
But we're getting reimbursed less and less. So really what that says is what's going to happen to the private practice owner in the 12 24 months, 36 months?
00:31:00
Speaker
Why should a private practice owner be busting their butt for all these years, taking all this risk on and managing staff of 30, 40, 50, 100 people and the value of the practice is getting less?
00:31:12
Speaker
Yeah. It doesn't make any sense. No, you know, I hear you say reimbursement, but know what I think I hear as a almost like an undercurrent to that is the value, the, the understanding of the value of a physical therapy.
00:31:30
Speaker
And if, if I'm hearing that correctly, I, you know, I would agree with that in that. A similar analogy that we as a society, we love our firefighters, right?
00:31:45
Speaker
But we don't give a lot of love to the people that put in the fire alarm. And I think very similarly, physical therapists have so much impact in ah and helping people to avoid way more expensive, you know bigger, bigger levels of of treatment. Right.
00:32:03
Speaker
And yeah so they they create all this value. And i don't actually think there's a lot of people that say, oh, I don't believe they're creating value. It's just, gosh, it's a terrible job of proving it and figuring out ways to extract the value.
00:32:20
Speaker
and so yeah Yeah, our lobby too. The problem is we we don't have a strong lobby you know at and at the federal level and and that's unfortunate. AMA obviously is the strongest.
00:32:32
Speaker
Chiropractors have a pretty strong lobby. Ours is not the strongest. So we just get stepped on and we get looked at as like personal trainers and we're not. You know, it's like ah used to work in brain injury before I went into private practice. Well, you know, treating someone post-stroke, that's extremely technical stuff.
00:32:51
Speaker
But I'm still the same PT then as I am in my private practice. And my thought process and my critical thinking is the same. It just happens to be with the shoulder, a hip, a knee, you know, balance issues and things like that. Yeah.
00:33:02
Speaker
We're just getting devalued year after year. So my purpose and passion now is to let private practice owners know you don't have to sit and take it. And you can work on certain things that'll help.
00:33:15
Speaker
But if you really want to elevate what you're doing professionally, if you want to innovate what you're doing in terms of ah operating your practice, how you're treating patients, We have, wouldn't you want to play in a sandbox of neurologists and physiatrists?
00:33:28
Speaker
Wouldn't you like to have CPD codes at your disposal that are making you four or $500 an hour? You deserve that. We deserve that. Why? You know, the other thing is this, I'll tell you this.
00:33:41
Speaker
I promise you half these EMGs and nerve studies neurologists do, you know what they probably do with the result? They say, this is what it shows. Take this medication. Yep.
00:33:52
Speaker
So what we do is we say, here's what the results are. Now we are going to do certain neuromobilization techniques based on those results because we teach practices how do perform certain neuromobilizations based on the results of an EMG nerve study.
00:34:06
Speaker
So now we teach practitioners how to implement a treatment based on the results of an EMG and actually do something different. Boy, that's really using a diagnostic test for a clinical utility value versus what a neurologist does.
00:34:23
Speaker
That's innovative. Well, and then you got to talk about the, you know, the pharmaceutical route, right? And it's not cheap. It's not cheap to go pick up that, like no matter where it stands in your formulary for your payer, right? And all a sudden it's like, oh, I don't want to pay 75 bucks a week for medicine or gosh, have a $40 copay. No, yeah.
00:34:45
Speaker
no yeah Right. Like, like which one do I want to to go down? um And sometimes it could be that easy, right. For, for patients, but unless you're even like setting it up for that to be, be possible, ah yeah then, then that, that,
00:35:01
Speaker
that that opportunity isn't there for the patient. And then they don't have the agency like we've talked about prior. Like you really, again, you're giving them agency over their own body. yeah Here's the information. Let me help make you an empowered patient person.
00:35:15
Speaker
And let me show you that our, our bodies are incredibly resilient. They're malleable in the best way and they will heal they're taking down the right path.
00:35:28
Speaker
Taking the right path. Yes. You take that example of a podiatrist and you know, patient, Oh, you have plantar fasciitis. Take this medication. Maybe they do an injection. I don't know what they do medically. Then go to therapy.
00:35:39
Speaker
Now we're wasting all these healthcare care dollars, treating something that is not that I discover on an EMG. That's perfect. That's the way we should operate. I mean, I, I, Throughout the years, and when we were doing diagnostics, evaluating PTs, it's like so almost malpractice.
00:35:55
Speaker
If a patient's coming in with some kind of referred pain, radiating pain, numbness, teeming, weakness, it's almost malpractice if i don't perform that test because what if it's something else? we have So what we would do is we communicated with our doctors.
00:36:10
Speaker
Once they knew that we had a residency program, they were like, really? They started sending their own patients to us. And then we also we also went into doctor's offices. I could put a trained therapist into doctors, and we put diagnostic testing in a doctor's office.
00:36:25
Speaker
So the doctor now has his own in-house diagnostics yeah for his own patients. He doesn't have a center neurologist. he He's now an informed decision maker because he gets the results of a diagnostic tip and says, well, you know what?
00:36:37
Speaker
The nerve's not that bad. You don't need to start and go to therapy. Or it's bad. You don't need therapy. Go to this guy. yeah they become more informed when they make a referral. And by the way, they're billing and collecting $400 or $500 an hour, paying us cash at $250 an hour.
00:36:52
Speaker
So the doctor's making a spread of $300 an hour for what I provided him. I'm paying a PT $60, $70 an hour. I make $100 and everybody wins. yeah It's a no-brainer.
00:37:03
Speaker
i I love ah love that. And based on them what you're telling me I would have to to completely agree. And it's when it's it's what we shoot for at Sarah as well. like There are enough things that are taking money out of PT's pockets. We are not we are not one of them and it will never be one of them.
00:37:21
Speaker
And making it no-brainer, right? like Especially, i think, for for what Hands-On Diagnostics provides is... like not only yes, the the reimbursement and the better outcomes, but also like as a PT, I got to imagine you hear quite a bit, like you're giving me agency back for my career.
00:37:41
Speaker
Right. And like, I think that mindset shift. I mean, even when you and I spoke from what you guys do at Sarah Health, we spoke. I mean, what was it like? You can make like $3, $4, $5 more a visit? Was that what we were talking about? No, like $5 or $6 is about the average that we see. Yeah, I mean, I'll tell you what.
00:38:04
Speaker
And I think I mentioned to you that our partnership dropped in Atlanta nationwide. yeah I'll tell you what. If we were able make $5 more a visit, maybe they wouldn't have done that. and and And in terms of what you guys do with patient engagement, so again, same thing. What's the purpose? Well, better patient engagement between therapist and the patient.
00:38:24
Speaker
um It's a value-added service. Oh, and on top of it, I can make $5 more a visit. Okay, let's go. mean, it makes perfect sense. Yeah, but I think a theme that is run through this conversation is you really do, as you think about any sort of innovation within this space, you do have to think of it in more than just one lens, right? You need think, okay, what the patient outcomes?
00:38:49
Speaker
What is my impact to staff, right? You can split that into clinical, non-clinical. And then what is the impact of the practice? and But I think you do it in that order and you know end up in a really good spot at the end.
00:39:00
Speaker
And for for us, like, okay, the outcomes have to be better. Let's go prove it. And so we did a study to be able to see like, okay, what happens? like oh, all right. The patient's on Sarah got to a 14 point better outcome.
00:39:14
Speaker
functional outcome based on the the photo score, then the control group. Okay. That's great. They didn't 2.3 fewer visits. Okay. Well, well that's fantastic. And a $47 per episode margin increase for the practice. Like bing, bing, bing. Like let's like, how often do you want to play this game?
00:39:31
Speaker
Yeah. um And yeah that's it seems like you ah you have done that similar framework of patients, staff, practice, made sure it works across all three. But you go through it in that way and you really end up with something that's valuable to everybody.
00:39:49
Speaker
And then it doesn't become a flavor of the week saying it's like, yeah. No, this is just part of our DNA now. It's just what we do. Yeah. Well, I think too, also, because we put remote therapeutic monitoring, you know, when I was in practice, like you guys do, because we need to scrape every penny. We need to figure how are we increasing value? but And is it good good for the patient? But i can tell you this.
00:40:13
Speaker
There are practices and owners that don't do something like that or they don't look at diagnosis because they're complacent. They want to stay in their lane. They don't want to disrupt something. You know, it's another thing. I'm working on an EMR now.
00:40:26
Speaker
Now's not the right time. I'll tell you what. When is it is the right time when you're at the bottom of the of the ladder wait when you're when you're when you're completely ah
The Necessity of Risk and Innovation for Growth
00:40:37
Speaker
you know on your back? No, because complacency equals death. If you're not expanding and changing forward thinking, you're shrinking.
00:40:45
Speaker
And things like what you're doing, what we're doing, practice owners, it's a must. Because yeah think if you think you're gonna do the same thing and try renegotiate contracts, okay, maybe, i mean, I know cases where the insurance carrier pays a little bit more this year, and guess what? Next year, they take it all back, they cut it.
00:41:04
Speaker
They did it with my buddy's practice in Buffalo. They gave him like a 25% increase a year later, they got rid of it. I mean, you know, those kinds of things, We're putting control in the hands of the insurance carrier.
00:41:18
Speaker
Yep. Okay. And I get that they're paying us, but the more that I diversify in Sarah, how hands on diagnostics, again, it fits the right model. Why it's better outcomes, better patient care, increased reimbursement, no brainer.
00:41:35
Speaker
So the owners today, owners today, the ones that are innovating, forward thinking, thinking outside the box, willing to take a chance, are going to be the ones that flourish and prosper.
00:41:46
Speaker
And the ones that aren't going to be the ones that are slaves to their practice and have no freedom of time and no freedom of money. Oh, freedom of time. That is a as a magic. That's such a good phrase to use, too, Daniel. I appreciate you saying that particular writing. And I think it reminds me of a quote from a book i'm reading right now called Arate by Brian Johnson, which I suggest to everybody. It's fantastic.
00:42:11
Speaker
It's an ounce of discomfort today. is immensely, immensely better to swallow than a pound of regret tomorrow.
00:42:24
Speaker
Exactly. And that ounce turns into a pound. It probably turns into a ton, right? And just don don't let that happen.
00:42:35
Speaker
yeahp it Don't let that happen. Yep. Yep. That's so true. It's very true. Well, I know we're about up on on time, Daniel. This has been a fantastic conversation. So I'm not surprised based on on how fun our conversations have been in person.
00:42:54
Speaker
ah if If you could leave our our folks with, you know as you think back to, I think put yourself back in your shoes in 2013. I'm like, okay, we need to do something different and and i need to innovate in some way. and why What advice would you have either a given yourself now that you've been all the way through it or be even yeah know what what would you what would you say you did right?
00:43:22
Speaker
Like what mindset, just a piece of advice for for our listeners. I believed in myself. I believed in taking risks. I was passionate. I'm still passionate about what I have to give.
00:43:34
Speaker
i believe that I can make things go right. I believe that I can expand my business. I believe that taking calculated risk and feeling nervous about it and a little worried is okay because I believed in me.
00:43:48
Speaker
I believed in what I could do. So for the practice owners that are out there, you just got to, you know, you got to grant yourself the knowledge that it's okay to feel concerned.
00:44:00
Speaker
Oh, if I do this, what if, but the more that we sit back and take a passive role, we're going to get crushed. So being able to take calculated risks and make sense, but believe in yourself and And taking good risk that is healthy for the business is a good thing.
00:44:18
Speaker
So it's, you know, being complacent and staying in the lane, that is not good. Because it just introverts the owner. They get stuck in the practice, taking calculated risk, believing in who you are, and having the resources around you.
00:44:34
Speaker
Go for it. You know, I'm going to say something. I'd curious to see if you would agree the summary. What do you want to be? you want to be absolutely perfect and great at dying or you just want to be good at growing?
00:44:47
Speaker
Yep. I don't know they'll be getting growing. No question about it. Yeah. Oh, yeah. and No question about it. And that and that's my that's my passion now. i'm I'm going to continue to communicate with practice owners, help them to the best of my ability, but really help them think that it's okay to take a chance.
00:45:03
Speaker
It's okay to take some risk. If it makes sense, you'll be successful. Go for it. Go for it. Absolutely. Absolutely. Well, Daniel, thank you so much for the time. and I really appreciate it I think that you've given some really tactical pieces of of advice to our folks, which is always the goal to make it to make innovation, you know, one little bit Iota more accessible.
Conclusion and Call to Action for Listeners
00:45:29
Speaker
And I think you've achieved that in spades today. So with that, thank you very much for joining me. I appreciate it. Pleasure. Thanks, Steven. Talk you soon, bud. 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.
00:45:46
Speaker
As always, I'm your host, Stephen Cohen, sponsored by Sarah Health. Let's keep moving.