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Owning your own practice
199 Plays13 days ago
In this episode, Miranda and Josh talk about owning your own practice and how everything shifts when you’re the owner—your role, your mindset, your responsibility, and the way you show up for your team and your patients.
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Transcript
Introduction to Hand Therapy Academy
00:00:06
josh MacDonald
Hi, I'm Josh McDonald.
00:00:07
Miranda Materi
and I'm Miranda Macerri and we are Hand Therapy Academy.
00:00:11
josh MacDonald
So in addition to having Hand Therapy Academy and all the stuff that goes with that, we also own clinics. And so Miranda and I have a total of about five clinics around the greater in Phoenix metro area. And so we run clinics, but we also treat in those clinics on a regular basis, pretty full time. So
Autonomy in Clinic Operations
00:00:28
josh MacDonald
we thought we be it would be interesting to hear kind of how we treat differently and how we maybe do things a little different now that we own clinics versus when we were just employees in a clinic like like we were for so long.
00:00:39
Miranda Materi
Yeah, I think for me, a big one is, and the reason why I really always wanted to have my own clinic was the autonomy to make decisions about what what we sell, what we don't sell, if we need to be seeing someone that can't afford it. I think that's a really nice thing, but it's hard when you start having staff and employees because then they're asking you to make judgment calls And, you know, you don't meet, you maybe don't know the patient, you maybe aren't working in that clinic. And you're like, well, we need to be fair to all the patients. So I think those are some tricky questions that have happened to me. So I've learned that we really have to have, as we've grown, we have to have some sort of streamlined process where we treat everybody the same.
00:01:22
josh MacDonald
Yeah. Yeah. That autonomy is nice.
Benefits of Quick Decision-Making in Patient Care
00:01:25
josh MacDonald
I've worked in big hospital settings where it's layers of management. And if the staff come to me and someone says, hey, can we do this?
00:01:33
josh MacDonald
We can just decide to do that. And we can decide, hey, we're going to run our evals differently. Or, hey, we want to let's all try this scratch collapse test for a while and let's track our results and see if it's something we want to do.
00:01:44
josh MacDonald
So it's nice to have that choice, whether it comes to financial issues and writing off costs for low income patients or Just making the decision to do something differently because we can and we want to help out another staff member or run something differently or order a different kind of splinting material or whatever it is.
00:02:01
josh MacDonald
We can just do that on our own. Right.
00:02:03
Miranda Materi
Right, like if we're getting approval for a flexor tendon split and the patient needs it that day, right? Like if you were working at a big clinic, they'd say, oh, that patient needs to pay or we have to wait to get off. So you're sending that patient away versus now we have the autonomy to say we can make that.
00:02:18
Miranda Materi
And what I tell my team is, do first of all, do the right thing for the patient first, right?
00:02:24
josh MacDonald
Yeah.
00:02:24
Miranda Materi
And i I just feel like that'll come back to us in a good way. So it may cost us, you know, 50 bucks to make that splint, but at least we're doing the right thing for the patient and also we're doing the right thing for that referring provider.
00:02:37
josh MacDonald
Yeah. And I'm making sure both the referring provider and the patient understand what we're doing. Like, Hey, we're kind of taking on the chin on this one, but you really need this today. So we're going to go ahead and do it, but you don't have that choice at some of the bigger companies.
00:02:49
Miranda Materi
Yeah, you definitely don't.
00:02:50
josh MacDonald
Yeah.
00:02:50
Miranda Materi
And I remember um working for one when I started and it was someone needed silicone gel sheeting. And I remember thinking like, well, my other place where I was a student, we would just give it away.
00:03:00
Miranda Materi
And at this place, you know, we were like up charging. and i was just thinking like, oh, I didn't get into the therapy business to upcharge or to make, you know, $10 off a piece of silicone gel when we, you know, that's something that we could just give or at least give it to the cost or the cost that we have with that supply item.
00:03:06
josh MacDonald
Yeah.
00:03:22
josh MacDonald
Yeah. yeah
Smart Billing Practices and Insurance Maximization
00:03:24
josh MacDonald
Another thing that I am much more attuned to as a treating therapist is being smart about how I bill units and how i structure. I'm not structuring my session to for billing purposes, but insurance makes us jump through hoops and play games. So I'm going to play the game by their rules. And if I did four activities and they allow me to bill for four different codes based on those activities, I'm going to pay attention and divide those codes up accordingly and get the most out of it. And then make sure my staff do too, because we all do well when we bill wisely and and take advantage of the system insurance has set up for us.
00:03:59
Miranda Materi
Right. Yeah. When we do it efficiently and and do it by their guidelines, right? We're not like changing it.
00:04:03
josh MacDonald
No.
00:04:05
Miranda Materi
We're just following their rules.
00:04:07
josh MacDonald
Yeah. Yeah. So I tell my staff, you know, if that patient comes in and sits down and says, I have to leave in 10 minutes, then don't bill for more than that unit's worth of time. But if they're there for an hour and 15 minutes and you've done things in self-care and therapeutic activity and neuromuscular re-ed and therapeutic action, bill all those units instead of just clustering one, because it's easier for your documentation to put four units in one code and not get billed full rate for all the subsequent codes.
00:04:32
josh MacDonald
So being smart about that is, is, is good.
00:04:32
Miranda Materi
Yeah. So then a question for you is, so then like when you have therapeutic activity, do you make sure that every patient, like if you're doing, I don't know, the risk maze or something, and you put that under therapeutic activity, is that risk maze always under therapeutic activity for every patient?
00:04:50
josh MacDonald
No, no, because I'll do it for range of motion purposes for maybe a distal radius fracture, but I'll do it for neuromuscular re-add for an ulnar-cited wrist pain where we're working on proprioceptive skills.
00:05:02
Miranda Materi
Yeah. And I think that's important. So like, since you, you made that point, it's saying why you're doing it, right? We need to document why we're doing it.
00:05:07
josh MacDonald
Got it.
00:05:09
Miranda Materi
That way it justifies why the risk maze is a neuromuscular re-ed for this patient, but for this patient, it's in the therapeutic activity. And think that's a hard one for students to understand too.
00:05:16
josh MacDonald
Yeah. Yeah.
00:05:18
Miranda Materi
And, but basically you need to explain it from the insurance standpoint.
00:05:22
josh MacDonald
Yeah.
The Importance of Thorough Documentation
00:05:24
josh MacDonald
I did a, um, I was a, um, expert on a case, a legal case a while ago on a deposition and it was all about someone's notes and another therapist's den notes. And it really made me rethink how I do my notes because I thought, man, if two years after seeing a patient, someone opened up my notes and held me accountable in court to those notes, Man, I don't know how good that would turn out. So I started really focusing in on making sure all of my any given activity we do, I include what we did, why we did it, how long we did it for and what makes it a skilled service. Those four things can sometimes be one quick sentence. But those four things make sure that when someone two years from now asks me about a patient I don't remember, I can go back and say, that's all you need to know. It's in the know.
00:06:08
Miranda Materi
right yeah definitely i think documenting those four things is very important for each thing you do right you're not going to remember in two years
00:06:13
josh MacDonald
Yeah. Yeah.
00:06:16
josh MacDonald
Yeah. Do you
Personalized Scheduling for Patients
00:06:18
josh MacDonald
schedule patients differently now that you own a clinic? Like your own patients on your regular caseload, is this the scheduling change?
00:06:26
Miranda Materi
Um, yeah, I would say it's scheduling. It's a little bit different because it's based on the, it's based on one insurance, right? What can I legally do? Like I know with Medicare, or we can't double book those, those sorts of things. And then secondly, it's based on the patient needs. So like if I have a high acuity patient, I might mark in their chart,
00:06:44
Miranda Materi
um, one-on-one for an hour knowing that, yeah, that's maybe not what will give me the most bang for my buck, but I know it's, what's best for that patient. So it's always balancing those things and then making sure that the patient gets the care they need. And I think that's the great thing about being, you know, owning our own businesses. That's something we can balance. And that's something I tell my team too. If you have a patient that needs you to be one-on-one with them more than, you know, I'm fine with you booking that way. That's not a trend we'd always want to follow because I think we would lose money doing that.
00:07:13
josh MacDonald
Yeah. Yeah.
00:07:14
Miranda Materi
How about you?
00:07:15
josh MacDonald
um I think when we worked at the surgeon's practice before we owned our own clinics, we were pretty high volume. So we were comfortable seeing a larger number of patients than maybe I think a lot of clinic employees in clinics.
00:07:27
josh MacDonald
And so I kind of carried that into what I expect of us as therapists. And I've had to kind of hedge on that saying, I know what I could do, but that doesn't mean I should expect that of a new grad.
00:07:39
josh MacDonald
I shouldn't expect that of someone who's busy studying for their CHT. Like, i need I adjust my expectations based on what that therapist is capable of and what that clinic sees and the load expected.
Tracking Productivity and Staff Involvement
00:07:53
Miranda Materi
Right. And then what about like, are you tracking, and I know we have software for this, but do you track each of your therapist productivity? And then do you guys talk about that in your clinic?
00:08:04
josh MacDonald
um We don't talk about it as a group. I don't spend a lot of time on the productivity software itself. We have someone who kind of, keeps a general eye on that. And I'll usually just kind of ask a question every once in a while, usually about performance review time, just to make sure everyone's optimizing, getting the most out of any given visit. How many units per visit are you able to bill for that patient on an average? um I'm not watching how many units, excuse me, how many patients they see because the therapists in general aren't responsible for generating more referrals. They do do some marketing, And I think that's something, too, that I expect out of staff to say, hey, if we want all boats to rise with this tide, then you're going to have to go help with some low level marketing as well. But but I'm not expecting them to see like a minimum of X amount of patients, because if it's snowboard season and everyone moves from our retirement communities, you can only do so much about that.
00:09:00
Miranda Materi
Right. Or like if, you know, the flu is going around, you're going to have a bunch of cancels and then, you know, but it it definitely affects the bottom line.
00:09:04
josh MacDonald
Yeah.
00:09:07
Miranda Materi
Right. So.
Challenges and Rewards of Owning a Clinic
00:09:08
josh MacDonald
Yeah, yeah. and And we've talked about owning a business as a roller coaster, and it's our job to make sure that the staff doesn't ride that roller coaster with us and not letting that seep into our day to day communications with them. And it's it's OK for us to ride that roller coaster. It's part of the job, but they shouldn't on it with us.
00:09:27
Miranda Materi
Yeah, definitely. But I do also think it's fair for like, at least with my team, I think it's fair to say like, hey, like these last few months, you know, our numbers have been a little bit lower than we would like, or, you know, like kind of share some of those things with them just so they know from our standpoint to like, hey, like this is, you know, I need to maybe go out and do some marketing or maybe I need to, you know, call that patient that didn't show up, you know, because a lot of times I think they're...
00:09:43
josh MacDonald
Yeah.
00:09:56
Miranda Materi
Of course, it's not their fault when they don't show but I think there's things that the therapist can do to show the patient that they care and to get patient buy-in so they're coming back for their appointments. And then ultimately the patient is getting what they need.
00:10:08
josh MacDonald
yeah And to track their own caseload and not leave it to the front desk to so to go through missing patient reports, but to say, you know, these are the, maybe the 40 or 50 people I see in a week.
00:10:20
josh MacDonald
If I haven't seen this person in a while, you're going to realize that sooner that so-and-so hasn't been in, you know, it's Tuesday and they aren't here today. Oh, they forgot to schedule. You're going to notice that sooner than a front desk person when they're just names on a report.
00:10:32
Miranda Materi
Yeah, and if you have the downtime, who are they going to want to hear from? Are they going to want to hear from your front desk?
00:10:35
josh MacDonald
Yeah.
00:10:36
Miranda Materi
Maybe, but ultimately, if the therapist calls them, they're like, oh, wow, this person really does care about my my therapy and if I'm getting better.
00:10:43
josh MacDonald
Yeah. Yeah. So we definitely do things a little differently now that we own and run clinics, but there's always ways to grow and we're always challenging ourselves, but it's definitely a roller coaster of owning your own business.
00:10:56
josh MacDonald
So if you have any questions, we'd love to hear from you.
00:10:56
Miranda Materi
Yeah.
00:10:58
josh MacDonald
Reach out to us at Hand Therapy Academy on our social media platforms or info at handtherapyacademy.com.