How To Drop Low-Paying Insurances With Sturdy McKee, PT

Are you STILL taking insurances that pay you less than your cost to do business? Why? Losing money and wasting time on low-paying insurances can be a big drain on your business and bottom line. And, from a greater perspective, the fact that owners accept negative-profit pay rates is the reason PT reimbursements continue to decline. On the other hand, there are many owners who decline these contracts and do just fine. Sturdy McKee is one PT owner who built a successful clinic on opting out of most insurance plans and shares how he did it in this episode.

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I have got a returning guest. He’s been on the show a few times in the past and one of my first guests and that is Sturdy McKee . He is a physical therapist, business coach, advisor, speaker, author and an all-around-renaissance man if you will. He was kind enough to join my peer-to-peer mastermind to talk specifically about what owners should do and what they should consider in order to go out of network especially with some of those lower-paying insurances.

I thought, “I wish I had pressed record last time,” so I invited him back to see if we could make an episode out of it because he has a unique experience in the physical therapy space. All the more people are doing it but he also has helped many owners get out of some of their lower-paying contracts. I thought, “Why not share that experience with the audience?” Thanks for joining me, Sturdy.

Thanks. I appreciate it.

For the audience’s sake, they can go back and read to your history a little bit in our past episode, should they find it. Specific to your experience in the out-of-network sphere, tell us a little bit about your ownership journey and what took you that way.

Some of the stuff overlaps but before going into business coaching and all full-time years ago, I owned, ran, grew and practiced. I live in San Francisco City where most locations and somewhere around Marin County as well. I started solo. I got laid off in front of 75 people at the UCF PT department because they were disbanding the outpatient department and I was the last per diem outpatient therapist there, way back. That was only three years out of school. I did not like what was happening with the interviews and stuff. I came home one day and asked my wife and said, “What if I tried this on my own?”

Which had always been the plan. It was not that early but I was truly thinking about going out on my own but I was not happy with the interviews and the practice models, the rest of the stuff that was happening. She was very supportive and I got a massage table, a cell phone, PalmPilot, opened in the basement of a gym and a computer to do my billing. It was a true one-man show. I told you about business cards. I got them all kiosk because we are going back into the ‘90s at this point. The fact that a PalmPilot was even a big deal. It was how I got started.

This might resonate with some of the folks who are reading. I went outside one day and it was a good gig. I have been doing this for years now on my own as strategic partners with other practice owners and the guy who’s going to become a business partner and stuff later. We are all helping each other out a little bit.

I remember walking out to the car and reaching for the door handle and thinking, “Do I want to be doing this in 25 years?” It was a resounding no. I’m like, “I have created another problem for myself. What do I want to do?” On the way home, I was thinking about that and the first thing that came to mind and is what a lot of practice owners do. It’s like, “I want to be able to hire people, grow the practice, see more patients and do all that.”

Have other people do some work too because when in the solo deal. If I go on vacation for two weeks, there’s no revenue for two weeks. I tried having somebody cover for me. I’m sure you guys have done and it never works out very well for whatever reasons. I was like, “I want to create a business, not a practice,” and had no idea of how to do that. I partnered up with Jerry back at the time. We opened another location adjacent to the 24-Hour Fitness where we had our own private office. We had access to the gym. That was a pretty good gig or location deal.

We started hiring people, which again, we did not know how to do and our first hire lasted for 24 hours. I’m not exaggerating. Probably exaggerating on the upside side. It did not take very long to figure out I did not know what I was doing. I was working long hours and my wife was calling saying, “When are you coming home?” It’s 7:00. I’m still busy. I’m making less money than I did at the hospital. We had seen a severe income reduction from the solo practice to running what’s supposed to be a business with all the other obligations and stuff and that was crazy and scary. I started trying to figure out how to run a business and what to do.

It took a little while to figure out what to start looking for because I tried within the profession. You know this and some of the older folks might know this but back then within the profession, there were not a lot of great resources. There was some stuff. When we go to conferences and there were people offering to do some consulting and then we did that and we got a report. I spent $2,000 on a long report that told us some things that we might want to do. Things like that did not move the needle for us. We were spinning our wheels a lot.

The first thing first online course I did, was outside of the PT world. That was about setting goals, getting stuff done, focusing on your business and all that. We turned a corner almost immediately. Within six weeks, we were profitable. Within about 12 to 16 weeks, I was done with my day at 2:30 in the afternoon.

I remember I had been going home from 7:00 to 8:00 at night before. I was like, “This is like magic.” I was not like some of you. I would not leave the office at 2:30 because I felt guilty. I’m done with all my stuff and I’m wandering around until my staff started telling me to leave and leave them alone. They know their jobs and get out of the way, stop that and whatever. I could then play early-bird golf or whatever and leave.

If you're doing the right thing for people, you will generally be rewarded.
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That was a revelation for me that, “There are some things out here, the resources and things I could learn and do that are going to qualitatively change my life, the business and change the rest of it.” I went through a couple of different coaching programs. I did use mentors. I started soaking up, learning and paying for anything I could do to get better on the business side. Finally, realizing for me that you could use these tools for good, not for evil and you are in charge. You can make the decisions that you want so you can learn how to sell and then do it ethically and honestly. Those are things I made a deliberate effort to do over the ensuing many years.

Along the journey, one of the things I did and this also might resonate with some coaches is I set goals for us to grow the business and the mistake that I made was I set top-line goals. Meaning, I set a gross revenue goal. “I wanted to get to $4 million. I wanted to have X number of clinics and employees.” We achieved those. We got to a $4 million run rate. We got all the rest of it and we ended up with the same profit as we were getting at $2 million or even less than. Meaning the profit margin or percentage had shrunk and I had not paid enough attention to that and preserving that. We got bigger. We were seeing a lot more people but the complexity has increased exponentially and meanwhile, the reward side of things had not increased with it at all.

The profit margin did not increase.

For those who are reading, profit is the dollar amount and the margin is the percentage amount. The profit margin was lower. The dollar amount was the same and I’m like, “It was not even double.” We doubled or quadruple the size of the business and the profit was still the same. That’s not what’s supposed to happen.

That caused me, my partners and some of the staff to stop, think, look at it and take stock. That’s where some of the business ideas and training are. We talked about this before but the cost per visit and I have a former client now that still says, “That was the thing. That was the epiphany for me. I went back and looked at it and that was the thing that motivated me to contact you. To make changes in my business, all the rest of it.”

If you are reading this and you don’t know your cost per visit, start there. What’s your cost per visit? If you are not offering a bunch of other stuff that you need to carve out and separate in your accounting and your books, your cost per visit is all your costs divided by your visits. It’s because if that’s the only thing you are selling, all your costs are related. If you have costs that are unrelated, I don’t know. I’m not sure why but if you do for whatever reason, carve that out and come up with what your cost per visit is. That will start to give you a baseline to be able to look at what you are getting paid by whomever.

It’s pretty simple and everyone should know that. The unfortunate thing is since we don’t have any business training and if we did get some, it was post-facto after PT school and opening our clinics typically. That’s not statistics that we measured when we signed up with the contracts, the insurance contracts as they came before us.

We did not take the time to see, “What does it cost me to see a patient? Is this contract going to give me a profit?” Insurances have played that well and played us well. It’s because of our ignorance but also because that’s what they are going to do. As we did not know that, we were ignorant to that one statistic, we took on all comers.

Pretty much and their whole game has been to reduce their costs, expenses and liabilities. They’re essentially operating on the lowest bidder model. We did and everybody wants to show them how they want to show outcome measures. We want to prove to them we are worth something. We want to tell them we are different from everybody else. What we are seeing people for longer or we are PT-only. We have this extra-special way of doing things or whatever. They don’t care.

I do have people ask me or approach and say, “Can I negotiate with the insurance?” You can quit. The only time I have ever seen a payer negotiate unless you are the only public health game in town or the only hand therapist for 100 miles or whatever. If you are another ortho practice like so many, the only way I have seen any of them negotiate is when you tell them you are not going to take it anymore because they don’t have to.

We live in a capitalist system in society. I was with a couple of other capitalists and entrepreneurs and we got off on a for-profit insurance healthcare system and like, “Even we have problems with that.” When there’s a profit incentive to not pay claims and not take care of people, that’s contradictory. That’s one of the things I love about this business in this industry and healthcare, in general is if you are doing the right thing for people, you will generally be rewarded. As long as you are not selling it for less than it costs you to deliver it. If you see people through to finish their plan of care and their goals, you are going to make more money.

You did better by the patient. That’s aligned. That’s where those things are lined up and you are not selling somebody something they don’t need. You are not trying to trick them or manipulate them. You are giving them what they need in the best, most efficient way that you can. This is something you ask your therapist if you are having trouble having them see people and finish out the plans of care. “Did you write the best and most efficient plan of care?” “Yes.” “Did you get the patient to buy into that?”

Yes or no. Maybe so or whatever. You need to get their buy-in and just not tell them what to do. That’s a little tangent but if you are doing that and people are showing up, you are going to have a more successful practice. That’s cool because your patients are more successful and then the reflection on your brand and what they say about you is better.

It’s a good business in that sense. The way it’s a bad business aside from being manipulated by insurance is if you do your job, the patients go away. You got to have a way to stay in touch so they come back to you when they need you again. I used to tell patients that point blank some of them if they knew a little more about business. It’s great but it’s a terrible business model. “What do you mean?” “If I do my job, you leave.” They would laugh and go, “I get it.”

The first step for owners of those who are reading is to figure out the cost per visit. Pretty easy. If you don’t know how to get it, talk to your bookkeeper or CPA, go on to QuickBooks online. Whatever you got to do. Keep it as simple as possible. The cost for last month over the number of visits you saw for the last month. The more you can get that over months and even a year, the best average you are going to have with that number. That’s the first step. What do you tell people to do next? What’s the next lowest hurdle after figuring out your cost per visit?

Aside from maybe not asking your CPA because they are going to make it way more complicated than it needs to be.

Tell me your cost for visit. I don’t care if it’s a fixed cost or not.

Get the number, ask about the expenses. You know your visits, figure that out yourself and you don’t have to pay them for a couple of hours of work. You know your cost per visit, the next step is to take a serious look at your contracts and see are they all covering your costs. At a minimum standard, you want to at least be breaking even. We don’t want to stay there but our first step, it’s very likely that if you are in-network with a bunch of payers some of those payers do not meet your costs.

That’s a holdover from the hospitals. Medicaid was instituted in the ‘60s and the insurer of last resort and that thing. As for hospitals, in order to get the federal funding and have all the perks and things that they do, they were required by law to see those people. They had to figure out a lot of those folks that did not and still don’t cover the cost of their care so they have to get that from somewhere else.

That’s where this payer mix entered our lexicon and the hospital CFOs refer to it and use it because it’s a critical component of what they do. It’s carried over into private practice and all where you don’t have the same benefits that they do. You are not getting paid the same thing by the other, by Medicare or by anybody else. You are not getting subsidies or all the other potential safety nuts that a state-run university health system or something like that gets. Why do you take patients that don’t cover your expenses?

If those audience members have read my show in the past, ideally you are not signing on for contracts that cover expenses but at least that cover expenses and build in a profit to that number as well. There is no reason to own practice if you don’t have a 10% profit margin on top of your expenses and then properly address your contracts.

That would be the next thing to start looking at. What should your pricing model be? What should you be charging? Where I want my clients to look at it is we do a budget and don’t let that scare you because I hate that stuff. It’s simple. It’s a three-bucket budget and all your revenue goes into three buckets and you begin with profit. Start with profit. If you are looking for a 15% or 20% profit margin or whatever it is especially if you are already going operating practice, go ahead and put that number down. If you have $1 million in revenue and you want a 20% margin, $200,000 is your profit number.

Figure out what your overhead is. Your overhead is all the stuff. When you export your P&L for 1 month or for 3 months and take all your expenses that would not increase or decrease with hiring people. If you hire three more therapists, your rent will go up unless you have to move and that’s what we were talking about. If your liability taxes, insurance or base rate taxes to the state. All this stuff that won’t change, that goes in your overhead bucket. Everything else goes into your personal bucket. Every time I do this or everything else, I’m like, “What about this?” It’s absolutely everything.

It’s anything that will go up and down with hiring people, letting people go or somebody resigning or leaving. It’s everything. The taxes, the work comp, liability insurance benefits and salaries but it’s not wages and benefits. It’s all the other stuff. If your software licenses go up and down, that’s part of personnel. You’re billing expenses, if you hire people and you see more patients, it goes up, it’s part of your personnel in part because you would also have to hire people to do that if you were outsourcing it.

It’s not a fixed expense. It’s not your overhead. It goes up and down with your sales. This is straight out of Greg Crabtree’s Simple Numbers . Profit bucket, overhead bucket and personnel. It gives you your personal or salary cap. If you spend more on your personnel then what’s leftover. There’s only one place from it to come from. If you say, “I want a 20% profit and I have 25% overhead, I have 55% left by personnel.” If I’m spending 65%, it’s not coming out of your overhead.

You only got three buckets. What I hate it when people are like, “My profit is what’s leftover?” I’m like, “No. Your profit is what you begin with.” Start with your profit. Design your business to achieve the profit, that you want. This is again from Crabtree, “Be a demanding employee.” Meaning you pay yourself a decent salary and all that stuff but be a demanding investor, as far as owning the business.

Start with your profit, and design your business to achieve that profit.
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Get paid fairly for the risk and everything else that you are doing there too. If you asked me to invest in your business, I would want to return. I would not want to break even. To your point about the contracts, no, you are not going to sign any new contracts that breakeven but we are going to ensure that you are at least there, to begin with so that you can move on because what if you got and most folks do or have had at one point a contract or something that pays less than their costs. What do you do with that?

Before we get into that, what’s the Crabtree book you were alluding to?

Simple Numbers , Straight Talk.

You figure out your cost per visit. You’ve set your money up into your profit personnel and overhead. The next step is probably just, “Get your contracts together. What are you getting paid on average with each contract and compare it against what that number is?”

Compare that first and then think about, “Should I continue to accept this?” On those ones that you break even that a straight-up case rate or per diem rate, there may be some efficiencies. There may be a way to create a 10% margin out of that. That’s legal and ethical through operations and whatever but you got to have a baseline in order to even be able to know what to look at next. You want to establish those things, lay them out and then you can decide where you are going to intervene or what you are going to do next.

Let’s say that you see one where you are getting paid $18 less per visit than your costs. You are probably not going to make that up through efficiencies. That might be one that I want to consider exiting. I want to pause for a second and say that I have gotten these comments before, while you are out of network, in San Francisco or whatever. I don’t even own a clinic anymore. I got no dog in the fight at this point.

I’m not against the insurance companies as payers. I simply want them to pay you enough. We are not in any crusader diatribe to get everybody to go out of network. What I want is for them to pay you enough that it makes sense for you to be under contract with them. Back to that idea, if you are getting $18 less a visit than your costs from a particular payer and you are not sure whether you should leave that then I will pose it to you in two different ways. One is I will bring you another thousand visits a month at that rate. If I can deliver those to you at $67 if it costs you $85, I will give you 1,000 more of those visits. Will you take them?

No, thanks.

Everybody’s thinking, “No. Why would I do that?” If you would not take it, why do you keep it? If you don’t want more of that, why do you keep what you have? Everybody knows, “The doctors won’t refer to me and all this stuff.” That is all thinking. I had a client meeting this morning. They are going out of network with a particular payer. He has done the communication to patients and physicians. He had one 92-year-old patient come in with her daughter who said, “I got your letter. It sounds like you can’t do anything for me anymore.” The daughter and he looked at each other and they were like, “That’s not what the letter said.” She was trying to get out of coming to PT.

You heard the excuse during the mastermind. That’s the first thing that came up from one of the guys in our group. “Are we going to be able to tell the doctors and want to make it as easy as possible for them to send us all their patients and not have to consider who we don’t take as an in-network rate?” You hear that it’s the common refrain.

Here’s the other piece of feedback we got from a physician. The doctor told him, “I am tired of them taking advantage of us.” He used different verbiage but that was the gist of it. He’s like, “Good job. Give it back to them. They don’t deserve you basically.” There’s a way and a method of communicating all this stuff too and there are also some other things that we should probably talk about that you need to do before you start canceling contracts.

Canceling contracts is scary and where are those patients going to come from? You start thinking about these dynamics of if I am losing $18 a visit on people with this payer, does it make sense for me to continue seeing them? If you are coming to the conclusion, “No, it does not. Why should I do that,” but you are still not sure. You are anxious and afraid. There are a couple of things you can do to improve it.

If you are on the fence about the decision, remember my challenge question. One should go home and sit down at dinner afterwards or your beverage of choice and ask your spouse, significant other, ask your kids and put it out there for them to say, “Seven percent of my patients are paying us $18 per visit below what our cost is. What do you guys think about that?”

They might have some questions for you like, “What do you mean?” “I’m basically taking $18 from the other people that would be profit, by the way, it would be your money. I’m giving it to these people that I don’t know that are randomly assigned to us through this physician network. Do you all think that’s a good idea?” Why don’t you sit with that for a second thinking about what are your kids going to tell you? What’s your partner going to tell you? That’s a great idea.

As Mark’s daughter said it like, “No. Why would you give them $20 to perform the services? The money’s going the wrong direction.”

It’s because I want to help everybody. I’m with you. You are jeopardizing the ship that’s carrying the people. You are putting your business at risk by doing that and you are subsidizing. Here’s the other misunderstood piece. You think you are subsidizing the patient.

You think you are doing it for the patient’s benefit. We like to think that we are such compassionate souls.

UHC has the money to pay you. We were talking about this. UHC made 2021, $24 billion in profit. Reinvest, pay their shareholders and give their CEO bonuses. You are subsidizing UHC’s $24 billion profit by taking whatever they give you below your costs. You are not subsidizing the patient. That’s why they call it your insurance. It’s the patient’s insurance. It’s the employer.

They can go back but they are not going to go back unless they realize there’s a problem and if you keep taking it and not saying anything and not doing anything, not taking any action, how in the world would they ever know there’s a problem? UHC and all the rest of them are getting away with this. They’re only being so lucky that they found me and they would call. Our entire industry, the entire outpatient Physical Therapy industry was worth somewhere around $50 billion.

UHC’s profit was $24 billion with a B. Until we stand up for ourselves as a profession, that is one of the things I’m passionate about. I’m heated about it. I want you to get paid a reasonable rate for what you do. I want you to be valued. I want society to value what you do and want people to respect you and know what you do.

This takes us back to the beginning. That starts with you valuing what you do and your staff and your team seeing the value that you bring to people and how you change their lives. It’s amazing the positive impact you have on people’s lives. When we are in the business and we are day-to-day, we are stressed out about cashflow and we are dealing with staff. Doctors on the phone and a patient’s worried about something. All the little things that take your attention away, we lose sight of that. We lose sight of the forest for the trees and we are thinking about a $30 co-pay for this transaction or a $60 co-pay.

If I have my own price, maybe the patient’s going to pay $75 and that will be terrible. What are you providing to that patient ultimately? If you help them get across the finish line to achieve their goals. We think in functional terms like, “They can climb the stairs.” What is that going to let them do that they can climb the stairs knowing how impactful being able to climb two flights of stairs in San Francisco?

I bet you have to be able to do that in San Francisco.

Everybody has stairs almost. My kid, there was something on the next floor and it was a ground floor apartment behind a garage. This guy broke in. He got a look and my son is looking at my shoulder going, “Body break-in.” He’s on the ground because everybody here in my four-story flat is on the second floor. It’s the garage underneath. By empowering people and helping them to be able to climb the stairs, they are staying independent in their homes.

They don’t have to move. They don’t have to go into assisted living. What’s the value of that? Think about that for a second because now we are talking probably Medicare or something but what if someone below Medicare age can’t get up and down the stairs and has to relocate and move. What’s the cost, the emotional disruption and all the ripple effect that goes with that compared to $75 a visit and you see it on pretend visits. Is that worth $750? The value that you guys bring, the value that everybody who would be reading this brings to people is amazing and it’s inexpensive at almost any rate.

Is this person compared to some of the alternatives like physician, visits, surgeries, MRIs, X-rays and medications, you name it? Compared to this, we saved the whole industry money.

Value what you do and see that value you bring to people and how you change their lives, because the positive impact you have on people's lives is amazing.
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We save the entire system, the entire society a ton of money. We help people in amazing ways and we get paid the worst of anybody for it. I get upset about that. You mentioned one and I always want to bring this one up. What if they have surgery, they still generally need PT. They did not avoid one thing. They added a whole bunch of cost to it.

I want owners to understand what the basis is and then be able to charge what they are worth but also be able to feel good about it and get their staff and their teams on board with it. It’s because we as a profession, I’m talking about all licensed and other ancillaries, everybody involved with this industry, in this business where there’s a little bit of the peace corps gene. There’s a little bit of volunteerism. We are in an environment that’s being run by for-profit, major corporations and stuff and that’s who’s determining our payment and what we are worth and they shouldn’t be. You should be in your patient should be.

Starting with figuring out your cost per visit. Compare that with the contracted rates that you are receiving. We getting into the mindset of I getting comfortable in the mindset that you are worth more, that you provide greater service as a whole for these patients than what you are getting paid typically from insurance companies and change the narrative to, “These are our rates and this is what I deserve for the service care.”

The next steps based on what you were sharing with us was to get comfortable and the way you put it was upping your game. Figure out, how you can improve that patient experience. How can you improve what’s unique about you and your clinics so that you can show that off so the patients when they come in can get a different experience there than anywhere else? That also includes great care.

I’m going to do a quick plug. Matt and I are working on this and we are releasing it. Around the upping your game stuff, that’s in there. Also, the KPIs and a bunch of other stuff. It’s a workbook. It’s not a narrative. We are not going to tell you a bunch of stories about when I was 23 and what I did and all the other crap you don’t want to hear about.

This is a workbook that I wanted to design for my kids to learn how to run and build their businesses. Be a generic version for all small businesses and stuff as well. The idea here is how to up your game. Number one, if you have got a business and people are coming to, you are already doing something they will be well. Something makes you stand out. There is a reason people come back to you and they came to you in the first place.

Your unfair advantage as a practice owner even if you have got 6 to 10 clinics is that you can talk to your target customer probably now or the next day. You can go to the next room. While you are treating patients, whatever, you can talk to these people, you know who they are. Your ideal patient is not necessarily whoever pays you the most. It does not necessarily, it’s not the 40-year-old female. That’s ATI and everybody else is the big guys’ target customer. You are unique and different. Who do you love working with? Part of the reason I’m saying it’s not the 40-year-old female is that when you start defining that person, demographically, you lose sight of who they are.

What I want you to think and change your mindset on that side is who do you love? Who are you excited about seeing first Monday morning? Who will you move your lunch for? Not because it’s the right thing to do or you need to or whatever but because you would rather see them as a patient than go to lunch. Who are you excited about being there late on Friday afternoon, even though you have got to drive up to Tahoe and go through traffic and stuff and you are like, “This is going to be a cool start to my weekend because they are awesome and I love them.”

Those are the people that are your target customer. Those are the people you are going to talk to in the house. “Why did you come back? Why did you send your mom?” They are going to tell you what’s unique about you. The other thing about that demographic thing is if you do that, this is where it gets confusing for people like. They are not all 40-year-old women.

They are not. It might be a seventeen-year-old cross-country runner. It might be an 83-year-old tennis player. There might be a 42-year-old in a wheelchair. I don’t know but whoever those people are, there’s a psychographic behavioral thing or thread that is similar in all of them. Those are the folks that are going to be motivated. They appreciate you. They like what you do. They see the value in what you provide.

You are more energized after working with them or while you are working with them than the rest of the time. Those are the folks that you want to talk to them. You want more of those people and they exist. They are not a demographic segment. They are a psychographic segment if you will but then you are up to your game. You think about them and you think about all the touchpoints in your business. You make a list and the list sometimes gets a little long. We have this broken down in the book too but what you are looking at is all those touchpoints, how many of those are your moments of truth?

You don’t necessarily want to be known for your intake paperwork but your intake paperwork is a touchpoint. It’s one way they experience your brand. When they are doing that, my goal was always to make that suck less. It’s not great. I don’t want it to be terrible. If I can neutralize those things and make it okay or improve it even a little bit or make it even a little bit better than okay. Great but that’s not what I’m hoping people go talk about it in our space. The things that you want them to want to be known for are the things that those people told you how awesome you are, why you are different and why they came back to you.

“My doctor sent me to this other place the second time and I tried it and it was terrible. I came to you.” “Why?” It’s because whatever those things are, that’s the stuff you want to dial-up because those are your moments of truth. Those are your opportunities. If you have ever read Seth Godin’s Purple Cow , those are the opportunities to be qualitatively different from everybody else. Even if that’s a little quirky or weird, you don’t want to dial that down and try to be like everybody else, which is so much of what we do, not in our social lives and our professional. Our business, we are supposed to be professional. I should have been wearing a jacket and tie and pulled that crap before too.

That’s not who I am and I don’t want to. I wear a jacket when I’m on stage maybe but I have gotten past that. I’m not trying to look like all the other consultants and all the other coaches. If you don’t like me, that’s okay. The folks who do like me are going to get it even more because if you are authentic and you are real and even if you are a little weird or quirky, dial that up. I love the hours goes to eleven versus got it on tap. Dial it up to eleven.

When you are saying up your game, it means to improve what’s unique about you, exaggerate that but also speak the message that’s going to attract more of that psychographic, the word that you used. Clarify that message to get more of that person in your door.

They are your target customer. When you define who they are and we are calling them target because they are not the whole target. They are the bullseye, they are the number ten. If you delight the few, the number tens so you will get the many. You will attract many. Delight the few to attract the many. Make the number ten super happy with what you do. The 9s, 7s, 6s and 5s will all come to you.

The counter-intuitive piece of this is the more narrowly you focus and define that individual and the more you tailor the entire experience, not just your messaging. Messaging is important but every piece of the experience to them, the better you are going to make it for a whole bunch of other people. When I’m saying up your game, up to your game for that customer. What’s going to make their experience better for them? That’s back to whatever they are telling you. A lot of it. If it’s that you listen, don’t go, “Good job. I listened well.” How can you do that even better?

I can listen better.

How can you make that even more intense? How can you make sure that it’s consistent across all your staff? Can you practice it? Can you create processes around it? Can you train for it? Can you make sure to recruit people accordingly? You are accentuating and dialing up the thing that makes you unique whatever that might be.

You have to gain with the patient experience and the messaging. What timeframe are you considering for that? It depends on how quickly you implement things and it could be very individualistic but if someone’s like, “I’m going to dial this in. I got my cost per visit and I’m going to up my game.” Have you seen or experienced how long it takes for people to grab a hold of what that patient experience is and improve it enough? What do you say?

I have done this in my own business and I have helped lots of people. Dozens of practice owners now do this as well. The answer that comes to mind is about twice as long as you think it’s going to take. You can do some of these in tandem some in parallel. Meaning that you can look at your contracts and stuff while you are raising the bar on your customer service game.

While you are improving your touchpoints. While you are looking and focusing on those moments of truth. You can look at other things that you can add on. I want to also say that there’s no finish line per se. It’s always in motion. Even when you think you have got it dialed in, you might find out something from your NPS scores and surveys that you need to work on. You might have a payer that everything was going great with that decided to go from $130 to $67. Now, you’re faced with another decision.

The playing field is moving. The goalposts are always moving. I’m not sure it’s ever completed. I think what you end up with is a process. If you do this stuff and you implement it and you do it well and you commit it to your playbook, you can repeat it. In California years ago, fortunately, he came into the governorship. He wanted to get rid of work comp fraud. They basically slashed work comp. They created a disincentive for people to be doing it at all. We are comping from $100 to $58.

It’s a state-run program. We did not think the rates were going to drop by half. We don’t expect that but it happened. Now they are back and they are not $58 anymore but at the same time, it’s like, “What do you do? Do you adapt with that?” That brings up another one. “They are not $58 anymore. Do you opt back in?”

Canceling a contract does not mean that you never, ever go back and take them again. If the environment shifts, if they figure it out and raise their rates. It’s a reasonable one for you and you want to opt-in. That’s fine too but now you have got a process that you can repeat and you can iterate improve upon as well because we talked about this but don’t cancel all of them at once.

Pick one where if everything goes wrong, it won’t cripple your business but if you make a mistake, you will learn from it and you can move on. If a physician gets upset and stops referring to you, you learned. Be judicious about the decision you make and which one you are going to let go of. Even if you have got four that are bad, pick one, make it small, test it, go through, work on your communication and prove it.

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There is an art to all of this as well. Make sure you are doing all the steps and then you learn from that and you get better and better at it. I did not ever cancel everything at once. It was as the market shifted. As the payment rates went down. We were in-network with Cigna for a very long time until they went from $130 a visit to $60 or $70 or whatever it was with all the additional demands, bureaucracy, paperwork and red tape. It made that decision easy and it made the process clean and simple and straightforward because we’d already done it a half dozen times.

Where do you find most of your owners that you talk to that are doing this? Where do they drag their feet the most? What’s the hurdle? What’s the hiccup? I can imagine if you are talking about the patient experience and upping your game, they can drag that out and try to get it perfect and drag their feet say, “I don’t have that quite dialed in yet so I’m not sure I want to go cancel that contract yet.”

You are probably right but I think that’s an expression of their fear and anxiety around it. The biggest thing is around themselves. Once they decide and decide that they are going to take a deliberate risk, a measured risk, calculated risk and do this then there are other hurdles. Some of it’s coming up with the letters and the verbiage. For my clients, I have got templates about things people have used and ideas. I will review all that stuff with them and make sure and raise issues.

I try to preempt. We also we will test it with certain target, safe people that we can share it with that they can get feedback from their actual part at Vesper and from the physicians that are important to them and all that stuff. It’s a longer process than you expect. It’s not canceling going out but that’s in order to do it safely, intelligently and to mitigate the risk. If something does go wrong, it does not cripple you.

It might hurt but you can fix it. The other biggest impediment is getting the buy-in your team because it seems to happen, not all the time but it happens frequently enough to be noticeable is that there is a therapist on staff who says, “My patients who are randomly assigned, I don’t know why there’s there any different but my patients can’t afford the new rate.”

That’s based entirely on subjectivity and fear. They don’t know that they don’t know their patient’s financial situation. People can say whatever they want to say. The patient can say, “It’s expensive,” but I told you this. A block and a half from my house, I was taking pictures to send to clients who are dealing with those kinds of ideas or those types of things. It’s the front of a little Japanese restaurant with the sake bottles and this little half bottle sake cost $70 and there’s a beer bottle next to it for $9. There’s another for $26 and there was a bigger bottle for $18 or something. People will pay for what they value.

It’s our job to connect the value with what they are doing and what they are investing in. We get hung up on the money but that’s not even the biggest impediment to people coming to see most of us. The time, the effort beginning off work or going home late or whatever it is they are doing, we are not convenient. They are already making a serious commitment to come to see you especially two or three times a week, out of their normal week. I don’t want to go see you three times a week and spend the drive time, the parking and the time when they are with you away from work, family or whatever. That’s a major investment. The money almost pales by comparison to some of the other things and you are going to hurt me? That’s the perception. Hopefully, you are not.

I might be sore. I have got to put forth the effort, I have got to get uncomfortable. You are going to touch me. I don’t know if you can touch me. All these other things that we take for granted or we see and like, “We are busy.” They are in and they are out. I don’t think about all that other. Making a huge investment. It’s way more than the money and that’s for the frame of reference to start thinking about, “If I make it awesome, they get what they want.” They achieve their goals and not even their functional goals but remember whatever that transcendent goal is.

They get to play soccer. They get to run again in the races. They live to stay in their home. Travel or play the ball with their grandkid, travel with their family, all of those things come into play and we don’t think about that. Sometimes we tell a patient story or they come back in or they send us, I had a physician who was a patient of mine, she was in pretty bad shape. She was not sure things are going to be cool.

After treatment and a couple of months later, he sends me a picture of herself on the ice with her hockey team and she’s like, “You guys are awesome. Thank you so much.” That’s what she got from it. Not, “I can walk or even do rounds or work without back pain.” That was important to her but it was like, “That was an important item,” and then she also got to be back with her friends back in her community active. Now that she can play sport again, her cardiac going to be better. Everything’s going to be better. Those are the things that you are doing for people. We get, “I don’t know if they can pay a $40 co-pay versus a $35.”

That person, in particular, she’s a doctor but I’m sure she would have been happy to pay $1,500 or $2,000 so she could play hockey again.

Thanks for saying that. We rank our benefits. Emotional is the most compelling and people will be like, “Wait a minute.” Emotional, functional and financial are the three types of benefits that you provide people. You already mentioned the financial. We save people tons and tons of money. They don’t even realize it but we saved the society and system a ton of money. We save individual patients a ton of money. If you don’t have to have surgery, we saving you a ton of money. We tend to get caught up on that again but that’s not the most compelling and then functional is better but the other thing about functional is in the healthcare world, that’s not guaranteed.

If I’m buying a furnace, the functional falls below financial because the furnace is going to work. If it does not, I take it back. I buy the one that’s going to function for the size of the house I have or whatever but the function is table stakes in that world and your world in our world. It’s not. Would she have paid a lot more? Maybe. For a guaranteed outcome? Yeah. For someone she trusts? Yeah. I’m not even trying to go say, “I should have charged her more.” No, I want to have it be of great value. I want to work. It’s what they get from it. It’s what you do. It’s what I do.

It’s not that we help your business be more profitable or something. It’s that you have more freedom. You have more time, you feel more control and you are more respected. Your team’s running altogether. All those things that are, like it reduce the stress, you see the athlete effect on people. It’s cool that the piano looks better but that’s not the end all be all.

I got to go on a vacation for two weeks. My business did not fall apart. To me, that’s normal. To them, it’s like the first time in twelve years. How cool is that like, “Let’s do it again? Can you do four weeks next time?” “If you put all the things in place and your team knows what they are meant to be doing and you have the right people in place, yeah, you can.” They go, “I never thought of that.” You totally can. Back to your thing, the first step is mentally, can I do that? Can I get over it? Is that what I want to do? Then owning that goal and creating a strategy to pursue it. That’s what you guys do with your patients every day now.

To get a little bit into the weeds, what you did with your practice then was not just what Aaron LeBauer might or how they are set up as cash-based therapy, where it’s simply $175. I pay you, you pay me and then we are done. Where I’m trying to go with it is and not necessarily the semantics of cash. I know you had your ideas on that.

Separate from that and maybe people are not used to what you were doing in this model and that is finding out what the insurance would pay for your clinic not participating with that insurance company. What they might reimburse you and then charge the patient the difference based on what your service rate was.

It’s a great point. Thank you for bringing it up. Aside from we are all getting paid in cash, I would get this and I am thanking you because at conferences or somebody would hear something like, “You are all-cash pay.” Number one, we are all cash pay. They are putting direct deposits into your bank account but it’s still US dollars. It’s money.

Number two, I would say, we are out of network or not contracted with certain insurances. I’m not sure what you mean by cash payment. The patient pays you or whatever. No. They do but they don’t. I did everything the same. I’m going to say everything because it was literally everything and again, people will say, “What about this?” Everything was the same. Every single step was the same, except we weren’t accepting the price point that Aetna said we were worth.

What I want to emphasize there is to get the patient scheduled, get their insurance information, call and check their benefits, figure out what that would look like based on our point, not the payers. The only thing was I did not care what the allowed amount was except where it might influence how much total they would pay but our price was our price. If your price is $100 and non-contract. I don’t like out of network because that’s their terminology, not ours but I’m not contracted with ABC insurance and they are out of network.

Their not contracted rate is they are going to pay $40. I call the patient back and say, “Your insurance says they will cover $40 of it. Our price is $100. You will owe $60 at time of service.” Just like you do with your copay is $25. Your co-insurance in this instance would be $60. Would there be more to the patient? Most of the time but we were always surprised and people were shocked or some of the time that was not the case and a lot more frequently than we thought initially.

Even where it was sometimes it was like, “They are in-network co-pay is $35 and they are going to owe us $45.” If we are not worth the way we do things and all the work we put into it and the patient experience. The rest of it, if we are not worth the $10 or the $100 over the course of their entire plan of care then we need to figure out how to earn that. We are not going to discount it either because we are going to earn it and convey the value.

You talked earlier about what your price point is, what a rate is. I’m assuming, based on your experience with working with clients, it’s more than $100 per visit. If you are working with most outpatient orthopedic owners, they have a cash rate of $75 to $90 per visit and that still does not cover their expenses. If we can get people out of that mindset and go back to, “What is your profit margin? What do you want it to be?” Go back to the three buckets that you were talking about. Usually, that number is going to come up higher, at least above $120. I have not done this math as many times as you have but you are going to probably see what range across the country the price points should be.

I want to work backwards and think about your budget and your costs because everybody’s context is different. That’s one of the reasons I’m not a big fan of benchmarking because if I’m benchmarking against industry standards but I’m doing something qualitatively different. I’m in a place where the demographics are different or my referral sources and diagnoses.

There are so many layers to it that I want to look at what’s your rent? What’s your overhead? My champion client is in Silicon Valley and has an overhead of 20%. I had a client that signed on with me a long time ago while back in Indiana with a 47% overhead. I say that the rockstar champion is 20% because I got mine down to 22% when I was in San Francisco but they beat me. I’m like, “I started looking at his stuff and asking questions like, ‘What are you doing?’”

We are talking high rent district again with low overhead. How are you working on that? How is that happening? Part of that was a forcing function almost because it is so expensive here that we are a little more attentive to it. Maybe it is in some others. It’s a matter of survival. You had to figure that out or you would not have a problem.

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Somebody comes to me with a 47% overhead expense and I’m like, “Something’s up.” That’s out of acceptable range. We are going to look at, how do we get that under control? What have you but generally, overhead runs somewhere between 20% and 30%-ish. If you set your profit margin targets to 15% or 20%. If you are going very far over twenty, you are doing something significantly different from most.

If you are doing the same things as everybody else, you could probably expect 10%. That tends to be what that if we are benchmarking in the industry averages but why do you want to run a million-dollar business for $100,000? Do you want to $200 million business with $200,000? The other misconception is that $200,000 I will go home with you. No. You reinvest a chunk of that back into the business maintenance, raises, other capital expenses, new equipment and you name it. It gets whittled away real fast.

Yes, don’t forget the taxes. At the end of that $200,000, you might get $60,000 or something when you leave the bank account happy, pay your taxes and buy the new thing or fix the reformer or whatever the world you have to do. That evaporates real fast and people tend to think, “You are making a lot more.” Maybe not but that’s why that’s referring back to Crabtree’s book. It costs 10% and you break even because we don’t think about, “We are reinvesting in using that profit.” We are using it on things. We are not writing a check to ourselves and it gets eaten up by taxes and other expenses.

I’m glad we talked that through because as I mentioned so many cash pay rates for those outpatient clinics are $75 to $90 because I don’t have to pay the biller and this is going to be an immediate agreement between us. It should be significantly more than that. If you are looking at the numbers then you have to be comfortable with your rate.

It chafes me that people give a discount. You are already giving discounts. You are giving discounts to everybody supposedly for delivering any more patients or whatever it is. I don’t know. You are counting everything and you are operating on a 10% margin. I think about this every time we go to one of the local coffee shops.

The owners are parents and their kid is in one of my kid’s classes, all through elementary school and they will always undercharge us. There’s always a discount and sometimes I looked at it and go, They are giving up their entire margin and probably more.” I always leave the bigger tip and stuff when they turn around because it’s owner-operated. It’s the couple that runs it. I’m like, “If I bought $12 worth of stuff and you gave it to me for $8, maybe you are covering the expense of the coffee and the pastry but you have got other expenses.

It’s your salaries, replacement, your overhead, your rent and taxes in San Francisco. All the other crazy stuff that they have to put up with and I’m like, “I’m going to put more than the $4 difference back in the tip jar.” I want to support small business owners. I don’t know why we do that too. I know the feeling of it and how it sometimes feels good but again, if you are at all in doubt, go home, talk to your kids. Tell them, “We cost us $85 and we shouldn’t be charging $125. I’m giving it away $90 if somebody pays the time of service or $75 which is even worse. What’s your take on the stadium?

Fourth, fifth grade or higher, they are going to be like, “I’m sitting there in my head going to fight.” When I was twelve, I would have gone in there and collected $125 and kept the other $15 giving you $75. I would have been totally cool with it. My little entrepreneurial head is like, “I will split it with you. I will give you $100 and I will keep $25 for everyone I collect.” I do that after school.

I love how you said that your processes don’t at all. If you wanted to keep some in-network contracts, if you want to participate in some contracts and not participate in others, the processes don’t change. You are simply saying, “This is what your insurance is willing to pay us for our services.”

This is what they say they’ll cover.

This is what they say they will cover and this is our rate so when you come, you are going to be expected to pay this at each visit. You still billed the insurance as an out-of-network provider and expect payment in return and no different than the in-network thing, you are doing it on an out-of-network basis. Based on that, I think that’s where some people that nuance gets them hung up because they are assuming, “If I’m going to drop the contract then maybe I’m going to charge $150 a visit.”

Everything’s going to change.

It’s not. You are still going to charge them $150 in total but their insurance is probably going to kick in $60 to $75 per visit.

You don’t know until you call and find out. That was the other thing. Patients would say, “What is aside from Blue Cross, which out here was $25 for everybody. If you are in contract with them.” They would call and say, “What’s Blue Shield going to cover? I’m like, “I don’t know.” “Don’t you see a bunch of Blue Shields?” I’m like, “Yeah.” “Why don’t you know?” “Google’s contract is different from Nordstrom’s is different from city and county is different. That’s why we call on every single individual patient.” The thing with that is like, “That’s more work.” “Yes, it is. It’s more work.”

It might be more work. I hope you are doing it but we would do that with every single patient because it was better for the patient. That was built in, baked into the price and everything else. To the operations, system, hiring, to know how many people staffing all the rest of it but we knew we needed to spend X number of hours a week doing the calls and finding the benefits.

They went through that. We went through that. At one point, the communication was not great internally and there were some folks trying to keep it a secret. The patient shows up and will be upset. It’s like, “Why are they upset?” “We did not tell him.” “Why did not you tell him?” “It was a lot. We were afraid to tell him.” “You waited until they are here to surprise them? That’s the solution?”

They are not going to say but now they are angry that they drove up. Seriously, that’s no. Being as transparent as possible, letting people know what they are in for. The other one thing here too is and let’s put this in the context of whether you are taking contracts or not, co-pays and co-insurance have gone up. Deductibles have gone up.

All this stuff we are talking about with the exception of saying, “I’m not going to take this contract anymore,” it’s applicable to everybody. What the patient’s responsibility is and the value that you need to convey the demands there have gone up. You need to up your game regardless because they are not opting to go to another provider that charges less, they are opting to not get a car or to get a salon pass. To go to the chiropractor or do something for somebody else. You guys do the best work with musculoskeletal patients of anybody out there, the best results of anybody out there, particularly for the price, why are you not getting them into your clinic? Why are you not helping them? You are letting them go somewhere else, lay out the case. This is why we are the best place for you. This is what it costs.

This is what your insurance will pay and then they will make the decision. Let them. Don’t ever apologize and don’t allow your staff to apologize. I had this happen. “I’m sorry but your co-pay is.” No. “I’m sorry your hospital has not yet.” Why are you sorry? It’s their deductible. It’s the plan they chose. I’m sorry you got hurt and you need us but that’s what we do. We are here to help you. Let’s get rolling.

The right communication seems to be such an important and integral part of this as you are talking to patients. Using the right words, the right phrasing and overly communicating like you stressed in our mastermind. Tell them, tell their doctors, tell their friends, tell them again, in writing and in person and on the phone.

As you are opting out and your benefits.

Communicate to them over the phone and also when they come in and then write and then verbally. Over-communicating and using the right phrases. It sounds like you guys either gain through a lot of experience or through a lot of role-playing to find out their proper phrasing views.

I love that you brought that up. Let’s come back to role-playing but one of the reasons for over-communicating is we are all overwhelmed. There is so much noise. In order to break through and get anybody to hear you at this point in time, in this day and age, you have got to repeat. You have got to come back. You have got to make sure. Ask them and ensure they heard you and can repeat back or tell you what it was. I’m still fascinated about how I think I was abundantly clear on what I said and then someone says, “They reflect back to me what they heard me say.” It’s like, “That’s not even close to what I intended. How do we fix that?”

That whole communication thing. Multiple times repeating the same message and stuff. Think about that with your marketing and your patient education too. You have got to repeat it. You got to review it. You got to ensure they can do it and they can repeat it back and all that stuff. That is one huge thing. With role-playing, Jack Daly is a guy who wrote The Sales Playbook . I took his idea for the playbook. I’m like, “Why don’t we have that for the whole business? We should have a business playbook.”

I worked with clients on that too but the idea there is you are creating repeatable processes and stuff. Role-playing practice if you have a process that whether it’s new or not and he did this with his sales team. They wrote down the process and then they put people in triads and his sales team. He had a company of 2,600 salespeople at one point.

They broke up into groups of three and they role-played. They rotated between the prospect, the salesperson and an observer. They rotated through and they had an objection they were going to practice. They went through it twice a week, every week. In the third person, the observer could not talk, nobody could talk until the end of it. Everybody had gone through the role-play. Once they had all gone through, they did that for fifteen minutes in each one rotated. They spent the last fifteen minutes debriefing, what did I see? What I hear, what I learned and all that. The way he presented it was two things. Number one, if I have a sales team that’s practicing two hours a week, do I have a better chance of winning or dominating the industry?

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Two hours more per week than anyone else, for sure.

The 2,600 people practicing were more effective and better. That’s why he grew and got as big as he did. The other thing you said about that because people and getting people to buy into this and clients and teams to buy into this is difficult sometimes. Here’s the thing. We like to pretend we are kids and we will pretend other times. With your coworkers sitting there and doing what you do every day, you are not going to pretend I’m the patient.

It provides amazing insights to watch other people. I could not agree more. It’s valuable and when you can get people to test it and try it out. You can do it in a staff meeting. They will be uncomfortable but they will start to see the value. They will see how somebody else does. They will start learning. They will be interested. The other thing Jack said though was if you are not practicing with each other, you are practicing with your customers.

That’s what went through my head. I’m like, “We are practicing on patients.” From my perspective, One of the things I work with my clients on is trying to become the coach of their team, not the hardest working player all the time. Moving into that mindset of the battalion, at least a couple of hours a week but if you take that analogy out and think about like your kid’s Little League team or soccer team or whatever. There’s no practice and they go out on the field and the coach is like, “Jimmy, you are playing first base, do your best.” How’s it going to work out for you against a team that’s practicing five hours, six hours a week? You are going to do all right but is that what you are doing in your business?

Overcoming those objections, getting your team to start to buy in and see the benefits. I’m not suggesting you have everybody doing two hours a week. That was a very specialized, specific situation but if you are never practicing with each other and never role-playing and never creating a safe space to screw up to make mistakes that you can learn from or share with each other, where’s that happening? We are human. We are making mistakes. We are messing up. If we are introspective, perhaps we learn.

To speak to that point, I have a friend of mine, Mike Bills, who he and his team will spend 30 to 60 minutes a week role-playing how to get a referral from a patient. Getting a family or friend from a patient and doing that on the regular basis has become such that their patient referrals are 10% of their new patients. Sixty percent of their new patients come from family and friend referrals of current patients because they focus so much on role-playing and talking to a patient about who in their network needs physical therapy, why and how they can help them.

Who needs physical therapy? Who needs my help? Who else could we help? Think about that for a second. Who do you know? You go home tonight somebody’s going to be complaining about their knee, back or neck. I had a client. He will hand out and hold a business card in his hand and go when discharging somebody, “I know you know at least two people who could use my help. I wrote my cell phone on here. You give that to them. You tell me when they are going to call because you are going home, you have achieved your goals. What I need from you especially if somebody asks, how can I help you out, guys? You were wonderful. You can replace yourself because I now have an open slot.” There are lots of ways to go about it but I love your emphasis on practice and role-playing because that’s how we can mess up. That’s how we can get better.

Thanks for your time. We have spent plenty of time on this. I appreciate it. It speaks to one of my clients I shared with you. Thirty percent of his visits per week we are such a poor pair that 30% represented 10% of his gross revenues. It took him a couple of years to finally write the letter and go out of network with them and it was scary.

It took him two years because of the fear and the importance of this conversation is to help owners understand that it does not have to be. It requires a little bit more effort. It does require you to be a little bit more specific, which some people might not be comfortable with but the benefits outweigh. It’s important to consider that there is a process. Get to know your data and the objectivity behind it.

Sometimes that data alone tells you the story and what you need to do. That there’s still that emotional component like you was talking about. Find a way to improve your patient experience and up your game. Be clear about the type of patients that you want to see and talk to them and focus your messaging towards them. Start with that smallest payer first and role-play, figure it out, do what you need to do to communicate as much as possible and go forward. Gain that little bit of experience that is hopefully a win so you can learn, move forward and start getting paid what you are worth.

The last thing I would say there is don’t go it alone. You don’t have to hire me but get somebody to help you because people have done this before. You have experience with this. You can help people. I can help people. I have done these dozens of times. This is not a pitch for any individual. Here’s the last thought I will leave you with so people can use this when they are thinking about running their business or when they are coaching their team.

We are conditioned therapists, particularly but everybody in healthcare, everybody in a professional position whether they are an attorney, an accountant or an architect to be right. We all got good grades in school in order to get into PT school, graduate school, medical school or architect. To be right and you had to do it by yourself. What’s collaboration called in school and it’s not a group project. If you collaborate on your final exam, what do they call that?

Cheating.

We are conditioned and think about how many years we were in school. Even if you are 60 years old and you have been out of school for 35, 40 years and you are like, “That’s not me. I’m a team player.” What about the people you are hiring? What about the folks you are talking to and bringing up out of school and stuff? Imagine this. A 24-year-old with two decades of conditioning to be right and do it by themselves. We are conditioned, taught and programmed to go it alone and the irony is the moment you graduate from school, nothing else is a solo endeavor. Everything’s a team sport.

You are expected to fail and ask lots of questions, which were are not conditioned to do.

You are going to mess up and it’s totally cool. One of my jobs is to make the mess-ups, not quite so bad, skin your knee, don’t break it and get back up. You are going to make mistakes, embrace them. You are going to play on a team, embrace that. Learn to do it. The better you are at it, the more success you are going to have. Don’t try doing it all yourself. Don’t try reinventing the wheel. You don’t have to.

That is one of the reasons why I started the show. I had developed this network of successful PT owners that when starting my business, I wished I had as a resource to know that I was not on an island and that these successful PT owners are willing to share the successful actions if you ask them. That’s the importance of networking and learning. There are so many other resources out there nowadays. It’s great to see but it’s time to collaborate and it’s time to get some support and guide you via experience and the network of others to improve your business and you don’t have to struggle.

I’m a big fan of masterminds and I have one with another coach and all that but there’s also real value in working with somebody like you. One of the advantages we bring is you see behind the curtain of so many other businesses and learn from so many other owners and all. I still get calls about it. I want to talk to you about when you sold your practice. I want to talk to you about a time when you did X, Y, Z. I’m like, “That’s great but I got 75 other points of data that I can share with you too.” It’s because when you call somebody about their experience and when they give you advice, most of the time they are trying to tell you what worked for them.

Their context may be entirely different. That’s where you as a coach can come in and say, “Let’s explore that and make sure we lay it all out and make sure we understand your situation. Yes, they might have done this but is that going to work in this situation?” You can extrapolate that right back out to your patients. “My buddy Tom only went four times to PT and he was fine.” You are looking like, “His diagnosis was completely different. He wanted to walk home. He did not want to play soccer again.” You are like, “What are you talking about?” You are doing it for the client and for the patient. You are not saying, “Follow me. Do exactly what I do.”

Thanks for your time and thanks for sharing. It was awesome to have you, if people wanted to get in touch with you, how do they do that?

SturdyCoaching.com or Sturdy McKee on LinkedIn. I’m easy to find.

Thanks for your time. I appreciate it.

Thank you so much for having me. Thanks.

He loves working with business owners and helping them realize their Visions. He loves helping and watching them grow as leaders. He loves seeing their cultures bloom and their energy grow as they engage and loves working in and on their companies. HeI loves helping them figure out where their passion intersects with what pays the bills.

His background includes starting and growing companies, hiring and coaching employees, developing leaders and managers, advising and helping founders at all stages, and failing more than a few times. The school of hard knocks is real, but it’s a great teacher. His hope is to provide you shortcuts around and over some of the most painful lessons and to accelerate your growth and progress both for your business and as a leader and visionary.

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