How To Build A Successful Cash-Based Extension Of Your PT Clinic With Stephen Rapposelli, PT Of StretchPlex

Stephen Rapposelli heard of a new business, StretchLabs, at The Graham Sessions, and immediately his heart sank. “How do they get away with providing what people believe to be PT?” he thought. However, instead of remaining despondent, he changed the question to, “How can I take advantage of this and build my own version of StretchLabs?” Since then, he’s built a successful adjunct to his PT practice which provides services that his community will happily pay cash for, without the traditional PT overhead.

Stephen opened his private practice in Delaware in 1992. He has grown to 3 clinics and has been voted the best PT business in his state for numerous years. Today, Stephen shares his story about how he developed a cash-based service and succeeded.

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I’ve got a many-time guest, frequent-flyer and the number one big fan of the show, Stephen Rapposelli, back on this episode. Stephen, thanks for coming.

It’s always a pleasure. I feel like I’m almost a friend of the family. I’ll be over on Thanksgiving.

If you haven’t read his episodes on the show before, go back and read his previous episodes because he’s got a ton of insight and it’s been fun in past episodes. Stephen has asked me the questions instead of me asking him the questions. If you haven’t met him, he is the CEO of Performance PT in the great State of Delaware.

He has been actively involved with APTA boards and the Impact magazine in the past. He is the CEO of his new brand StretchPlex , which he developed and designed in order to improve his cash-based offerings to his physical therapy patients and also, the community at large. He’s doing amazingly well at it. I’ve been trying to get Stephen on here since PPS. I wanted you on at PPS and you were like, “No. Not yet.”

It’s where we finally meet each other in person. I had to push people aside who were gathered around you and finally, met you in person.

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I want to share with the audience not only your story but what you’ve learned about your development of this cash-based service, how it’s going, what you’ve learned, what you’re doing and all that kind of stuff because I want to introduce it to the audience. I think it’s been a success even though it’s less than a year in 2022. I’ll let you take it from here. Tell us what instigated it, what happened, where it came from and where you are at now.

Let me start by letting your audience know that I’m going to say some controversial things as it relates to physical therapy and physical therapist, but I can do that because I am a physical therapist. As I like to say, it’s sewn into my fabric. I’m going to be a PT until I die. There’s no doubt about it. That allows me to say some things that I think we need to be aware of and correct if the future is going to be bright. I do think that the future is going to be bright for a lot of us but maybe not all of us.

They are effectively warned. This is their trigger warning.

The intent here is to make people aware of their blind spots. We all have blind spots and I’m usually on a weekly basis being introduced to mine or reminded of mine and to open your mindset. I can’t emphasize it enough that having an open mindset is one of the key predictors of future success. As we get older, we all have a tendency to close our minds off and be that grumpy old man shouting at the TV.

The easy problem to say in this world of physical therapy ownership is that profit margins are being squeezed. There’s pressure from both ends. Your guest, Dimi , who I love and respect a lot, said it very well in your show. Reimbursement is not going up and in many cases, it’s declining, yet there are inflationary pressures that we all feel as owners of the rising costs. You look at the local Starbucks and you say, “That’s easy because you can just raise the price of your coffee anytime you want. How come I can’t do that?” I would’ve said some quotes and, hopefully, people are like, “I’ve said the same darn thing.” Why can’t I raise my rates?

One of the offshoots of that is to start a business where you can raise and the genesis for me originally was going to the Graham Sessions and listen to the guy, “I got to hunt this guy down and find his name because I referenced him so much.” He was talking to a group of PTs and he said, “I want everybody to open up your phone and type in the phrase, ‘Stretch lab,’ and hit the search button.” We did and you could look around. There was a collective gasp and people’s mouths were dropping open. People were getting torqued over that, “Can you believe this? They have these people called Flexologists. They’re not even PTs and they’re doing what we do.”

I’m only slightly exaggerating for effect, but I thought to myself, “This is bad news.” That was my gut reaction to it. I thought to myself, “What if? Why don’t we do that? Why can’t we do that?” I think part of the problem is that we’ve got to stop thinking like PTs and you know what I mean when I say that. It’s the scenario where your patient says, “I love this gym ball.” “Go find it online. I’m sure they sell it on Amazon.” You’re like, “Why can’t I provide that good or service that my customer finds valuable?” That’s a key line there that I’m going to go through over and over again. You have to obsessive only say that in your own mind. “What good or service my customer is going to find valuable and why can’t I provide it? If I can’t provide it, how can I provide it or shouldn’t I provide it?”

This is what makes me upset with the PT industry. I hear and read articles about how we need to justify our effectiveness as PTs. I know Mike Horsfield is on the same page because he said, “We don’t need any more white papers. We don’t need any more studies about the affections of PT. We need to provide value.” Objective value is important, yes. I don’t know about you, but I’ve had plenty of patients that have come in and I used heat and steam, ice and steam at times. They would say, “If you guys did this for me and that was all, I would think you’re the best thing ever.”

I had people say that to me.

We are not willing to accept that.

It’s because somebody some time ago said, “Studies show that it has no effect.” When my mother pulls her back muscles out, she comes to my office and says, “Honey, will you please put me on that heat and electric because it makes me feel better.” I’m going to do that and that’s my mother who I love. Why wouldn’t I do that to anybody who asked me to do that?

It was dumbfounding for me at the time because I was like, “You can’t just come in for heat and stem because then I’m not doing anything for you.” I was like, “I don’t know how to get reimbursed for that and I wasn’t willing to put two brain cells together to figure out how I would.” People would probably pay me.

For decades, people would come to me late in the day. For example, they were teachers, “If you would put me in this private treatment room, turn off the light, put me on that heat and electric, I would pay you money just to do that and leave me alone for the 20 minutes.” We’d laugh. We’d he-he and ha-ha over and as I said, after many years of hearing that, I said, “Why don’t I do that?” I started doing it and people started paying cash for it. I’m like, “Is this wrong?” My customer tells me what they want. I happen to have it. I put a fancy name on it. I called it a Napatorium.

You come in and you take a nap for 20 minutes after work. Your husband or kids won’t talk to you. There’s nobody here. We leave you alone. You feel good. You leave being relaxed. Is that worth an exchange of value of money? You can call me crazy all you want. I increase my margins that way and there’s nothing wrong with that. Because if I go out of business, I can’t help anybody, can I?

Let’s talk about value because you said the word value. I’m going to show you a formula for value and we’ll talk everybody through it. This is not mine because there’s not much that is truly mine. I steal from everybody. This is a formula made by a guy who I admire that I recommend to all of your audience Google search or YouTube or whatever it is that you do. His name is Alex Hormozi. He is the CEO of Acquisition.com. He has a book called $100M Offers . That is a fantastic book that I’m telling you. It’s a cheesy title, but it changed my business life for the better.

In that book, among other things, he describes what value is. He said that value is a fraction. There’s a numerator and there’s a denominator. The bigger you can make the numerator and the smaller you can make the denominator, the bigger the overall value is. He says that the numerator is a combination of a dream outcome multiplied by the perceived likelihood of achievement of that outcome. That’s the numerator over time delay multiplied by effort and sacrifice.

Let’s break that out. If you have a clearly spelled out dream outcome, it increases the numerator. If the perceived likelihood of achievement is great, that’s an increased numerator. If you have an increased time delay, it takes a long time, increasing the denomination. If it takes a lot of effort and sacrifice, that increases the denominator. It decreases the value. Let’s put that equation into a real-life situation.

Let’s pick something random. Let’s use physical therapy. What’s the dream outcome? I’ll be the non-successful PT. What’s the dream outcome? What did you come in for? “I don’t know. My doctor sent me.” You didn’t even know what the dream outcome is, so that’s the problem. The perceived likelihood of achievement. That’s me saying, “I guarantee.” What’s your guarantee? “The perceived likelihood of achievement.” If you have a strong guarantee, that’s high. You’re coming in for me to treat your back pain. “Sometimes it feels a little bit better, sometimes it doesn’t.” It’s back pain. They are now exaggerating it.

That represents a low numerate. I can’t identify the dream outcome. I don’t have a high perceived likelihood of achievement. By the way, it’s going to take at least 12 to 14 visits or 8 to 11. It’s going to take about nine. We’ll see about 4 to 6 weeks. That’s a significant time delay. Also, effort and sacrifice. “You’re going to have to do these exercises every single day or three times a day. It’s probably going to hurt.”

Having an open mindset is one of the key predictors of future success.
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Unfortunately and this is a slight exaggeration. You can see how physical therapy has some work to do to demonstrate its value. Again, here I am being controversial. There are PTs that are probably wanting to jump through right now and find out where I live and kill me, but it doesn’t matter. It’s not about what you think. I’m a physical therapist. I know exactly what the value is, but it doesn’t matter what the marketplace thinks.

In contrast, I can go on my phone right now. I can go to Facebook. I can find a good-looking person who looks good in a bikini or Speedos who tells me that they’re going to fix my back pain right now. All they have to do is download their custom program. Pay now, you get the download and do these exercises. It’s effortless and you’re going to feel a lot better. They just use that equation to demonstrate that they have high value and they’re getting the customer.

Eliminate your back pain in five easy minutes a day.

I’m not advocating that it’s what we have to say, but I do think that you have to set up a business model that addresses these. If you don’t, that’s bad marketing and sales. It affects your operations. The whole business falls apart because you can’t demonstrate the value of what it is that you’re selling and selling is not a bad word in physical therapy. I’m sorry to tell you, but everybody’s selling something.

You’re selling a plan of care. You have to sell a plan of care.

The marketplace does not care whether you’re a Doctor of Physical Therapy or not. They only want their solution solved right now with as little effort as possible and they want to be pretty certain that it’s going to happen. That’s what value is. Now, you can ignore it and that’s cool. You might not like it, but that doesn’t mean that it’s not true. It means that it makes you feel uncomfortable. You never stop seeing your business through the eyes of the only person that matters and that’s your customer.

We have a hard time unhooking our PT hats from our bodies, especially if we’re also business owners. It’s very hard to do that. Now, where do we win? What can we take advantage of? This is a good thing. You can develop a business where you achieve these things and demonstrate high value. You win. As a matter of fact, the reality is that by providing PT, we gain the trust of our customers, which is gold. Believe it or not, if you come to see me 8 or 10 or 12 times, you’re going to trust me. You’re going to like me. You’re going to know me.

In the end, if I say, “Nathan, you need this gym ball. We’re going to put it in the back seat of your car. I want you to get this ball,” you’re likely going to be like, “You’re right. Let’s do it.” What’s wrong with that? I’m not selling your whole life. I’m selling you something that I truly believe is PT. We should spend a lot of time saying, “I’m not trying to sell transmissions. I’m not trying to sell encyclopedias. A person who comes into my office, what would they probably like as well?”

I call that the McDonald’s effect. If you go into McDonald’s and you buy a hamburger, it’s likely that you’re probably going to want French fries and you’re going to probably want a soda. Why don’t I offer French fries and a soda to go with a hamburger that you’ve already ordered? That’s why I started that side business StretchPlex. It’s because people would say to me constantly, “When I’m done with this knee replacement PT, I would come in here if you would just stretch me out.”

Since I’m so sharp business-wise, after about many years, I finally decided that maybe that’s something I should look into and what would be the obstacles to offer that to people as an add-on? As it turned out, a lot of people would like that. Another reality is and this is where PTs are their own worst enemy. When you talk about sales and marketing training, people think, “You’re unethical. I should never have to do that. After all, I’m a physical therapist. I’m a doctor of Physical Therapy and people should inherently, through providence, know how valuable I am. I shouldn’t have to explain my value proposition.” In this day and age, I’m sorry. That might’ve worked in the ‘80s, but it’s not going to work now because there are all kinds of options.

You’re up against social media influencers and if you think that the letters behind your name give you the authority, they don’t care anymore. They want to go with the person who’s got the brand, the pretty marketing, on all the social media channels, making it easy and effortless.

I’m a board-certified specialist in orthopedics. Do you know how much I had to explain that one to people and their eyes still glazed over? They said, “So are you going to make my back better?” You have to get off your high horse a little bit and say, “I have got to deliver value to a customer in exchange for, in this case, money and there’s nothing wrong with it.” We started this business and it’s been going pretty darn well. Some lessons learned and I’m not saying that everybody has to do this.

Don’t jump too quickly. Be clear. What are you offering now? For a traditional PT owner, maybe you offer gym access where you pay a flat rate per month and they can come in and work out.

I did that for many years.

For me, no one took advantage of it. What are you offering in StretchPlex?

What we offer is assisted stretching. We offer personal training, massage, compression garments with SportPump and percussion. Those are the things that people said they wanted.

I assume the steam and the heat as well if they want it?

No steam because here’s my first lesson learned. We endlessly test. We said, “Wouldn’t this be cool within the four walls of our clinic?” We started doing it within the four walls of the clinic and we started getting busy. The next thing you know, people are starting to fight over space. The PTs and the people who were providing the wellness services are trying to fight over the space.

We said, “Let’s try a separate location.” We built a separate studio just for wellness services. We test that out and we see how that goes. There are a lot of pros and cons to doing each one. I probably don’t need to go into the subtleties, but we endlessly test everything that we assume. Here’s an assumption that I made. Everybody who is a patient is going to naturally want this wellness service. They’re going to fall right into it. It’s going to be like walking over a very small bridge. After a couple of months, we found out that 75% of our new wellness customers were coming in from Facebook ads.

We’re like, “That’s weird. I didn’t expect that.” It’s because we had run Facebook ads for the PT side and we were never getting anybody. We’re just throwing money out the door. Facebook ads don’t work for physical therapy. It worked for the wellness stuff. People were coming in left and right. Dozens and dozens of leads a week on Facebook ads and we couldn’t have predicted that.

We looked at the data and be ready to pivot. Now, these lessons are learned to apply to everything and all your business. It is not just a wellness business. It applies to your PT business. Do you do that? Do you endlessly test things and then alter your procedure or your process based on the data and what it tells you? Many of those assumptions have been disproved.

You did that with Easton.

I did it for Eastern because, in no way, shape or form did I want anybody to think that I was trying to do physical therapy without a prescription, insurance or a physical therapist because we don’t have physical therapists doing these wellness services. We decided we’re going to make this a separate tax entity, location and a different name. It has nothing to do with physical therapy.

Here’s the other thing that we didn’t realize. We do have these wellness services within our clinic. Some of them and we had people that were calling up and wanting to have these services. When we said, “You go into performance physical therapy and we’re with them.” “No. I tried physical therapy before and that doesn’t work.” “That hurt my feelings because I’m a physical therapist. I told you that.”

You have to swallow your pride a little bit and say, “Wait a minute. Just because I think everybody should love and know physical therapy, that’s not necessarily the reality. People want the solution to their problem.” I don’t think that it’s bad to accommodate people’s ideas and notions of what a label says or means.

Some people’s experience with physical therapy is pain and torture. Every time somebody says that it hurts my heart a little bit. You’ve heard it. I don’t like that because it’s not. It shouldn’t be. I’m getting a little tangential. I’ll get back to the point, though. We’re endlessly testing and finding that we’re getting referrals from other physical therapists in the area to this wellness business. What’s wrong with that?

It’s like a physical therapy clinic, but you don’t need a prescription. You’re not going to see a physical therapist. Some trained personnel apply these things or even massage therapists provide some of these offerings. Do you schedule on the hour or the half hour?

Anywhere from 0.5 hours to 1.5 hours because we also do massage and personal training. In your neck of the woods, people may not like personal training. People may not like massage. If I had a ton of people who said, “I want you to put me in cryotherapy. I want to be in a nitrogen tank up to my neck for three minutes,” I would do that. Why not? Why wouldn’t you?

I’m challenging people to open their mindset of what it is that you can, should or would offer a customer who is ready, willing and able to pay you to do that. As long as it’s not unethical or illegal, it’s good business practice. You might say, “That’s unethical. There’s no physical therapist on site.” If one of our body coaches is stretching somebody and something doesn’t feel right or seem right, they’re trained to know. They go, “That neck looks a little bit too stiff. I think you should go see the physical therapist for performance physical therapy.”

They scan the QR code that’s on the wall, which pops up a form and that body coach fills in the person’s name and sends it to the front desk over the PT side. That front desk person calls them and says, “Judy said that your neck is bothering you. Do you want to come in for a free discovery visit?” Now, I’m referring to the PT business. I don’t have to worry about the doctor down the street who has his own PT shop and isn’t going to refer to me anyway. I become the driver of that business. Again, you may think that it’s bad, but I don’t.

The patients that come in, I envision they almost have a menu in front of them and they order off the menu, “I want this, that and that.” Is it that simple?

You can do that or you can come in and the way we’ve designed it. What differentiates us from a stretch lab? When you go into a stretch lab, you get the program. “We’re going to do this first, and then we’re going to do this and that.” At our place, they’re trained. “Steve, what’s bugging you?” “I’m 57 years old. My neck and back feel like a steel drum. We’re going to spend the next 30 minutes on your neck and your back. That’s all we’re going to do. I’m going to stretch it out. I’m not going to worry about stretching out your forearms because you said it didn’t bother you and you don’t want that anyway.”

It’s an obsessive focus on what your customer is asking you for. That sounds pretty basic, but I’m telling you, it is not normal out there. It’s not common. If you just do that, if you obsessively focus on delivering what your customer asks for and that’s what birthed this program, you’re going to be successful. People will come back for more and they’ll come forever. Going back to that value equation, they don’t have to get a prescription.

You don’t have to check their benefits. I don’t know if I told you the story. One of my friends texted me and said, “My sixteen-year-old has a tight groin running cross country. He’s got to meet tomorrow. Can you come in for physical therapy? I’m a physical therapist and the first thing I thought was, “I’ve got to find out who the doctor is. I got to get a prescription. I’ve got to find out what insurance they have. I’ve got to check the benefits. I’ve got to explain to them what their copay is going to be.

I’ve got to find out if they’ve got to beg a PT to stay and I went, “Just call Matt over at StretchPlex. He’ll get you in now.” She’s like, “Thanks.” She texted me back. She said, “Matt got me in, stretched Michael out and Michael felt fantastic. By the way, I bought a stretching package for my husband because he’s tight and my mother-in-law because I want her to love me.” With that one text, I made $910 in cash in one day.

I’m not saying every day is like that. What I’m saying is I eliminated the time delay, the effort and the sacrifice. The dream outcome was very easy to define and the perceived likelihood was good because we say it. Our guarantee is, “You’re going to feel better after this first session or the next one is on us.” It’s a pretty good guarantee. Why not? Why wouldn’t I say that?

I can see where the friction is with some physical therapists who wouldn’t like that.

Don’t do it then. It’s not for you. I’m telling you my journey and how I’m doing it.

The lesson I learned and applied to every business is that you can't and shouldn't do it all yourself.
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You’re going to train this Matt to be with a certain level of knowledge to say, “This is outside of my realm. You need to go see physical therapy.” They’re also going to be able to ask some questions about, “Do you have a history of cancer? Maybe I’m not the right person right now to provide you blank?”

By the way, a body coach is a name that I made up, so it means nothing, but that’s okay, and so is a flexologist. They’re all made-up names. I can either damn them for doing that or I can have a little fun with it and make up my own name. If somebody came up with a body coach, my next name is going to be a body mechanic. I’ll just keep making up names.

These people have a four-year degree in some kind of movement science, whether it’s exercise science or physiology or something. They get certified by the National Academy of Sports Medicine. They come in there with a NASM certification. That’s an additional level of training and then they have on-the-job training.

By the time that they put their hands on somebody, they know what red flags look like and who you should be careful with. There’s always somebody who’s a phone call away, but in no way, shape or form do we say that it’s physical therapy because it isn’t. If that person thinks they need physical therapy, we know somebody who’s good.

Here’s the other lesson learned. Eighty percent of success is marketing and sales training. People are just dropping the phone right now because what PT wants sales and marketing training? Zero, none. They don’t want to have to do it and that’s okay, but it’s the fuel for every business, marketing and sales training. What we found because we tested it, the more we devoted to multi-platform training of sales and marketing, the more successful we became.

What do you mean by multi-platform?

It means that you’re going to read this book, then you’re going to watch this video and you’re going to do this little lab. You’re then going to do a group role-play. It’s multiple platforms because we all learn differently. Honestly, in your heart of hearts, you know that PT staff would probably benefit from sales and marketing.

They have to. If they’re going to be successful, yes.

That’s 80% of success in any business, which separates the people who make it from those who don’t because it’s necessary. That’s a takeaway. The next lesson learned and applied to every business is you can’t and you shouldn’t do it all yourself. I get calls from PT owners who are like, “We’re thinking of cash-based services. We heard about your program. We’re going to do it ourselves.” I’m like, “Go ahead.” I’ll even give you checklists of what you should do. “Here are the things that you should do in this order.”

What they quickly find is that they can’t and they shouldn’t do it all because they’re already a busy PT owner. If you’re a PT owner and you’re thinking about adding cash-based services. You’re thinking that you’re going to be the guy or gal running the show. You’re going to fail because you don’t have enough time to do all the things you want to do or need to do already.

Your first job is to identify who is going to be accountable and responsible for this and how do I elevate them. You either have to go find them or you have to bring them up through the ranks. It’s very situation-specific. We probably all know in our careers that there’s that one person who was like a PTA or a front desk person or somebody who had it all. They could do it all. They were jacks of all trades. You could plug them anywhere and they would do well. That person would be perfect to be a manager of your cash-based program.

You then got to get them trained and you have to recognize that you have to develop them to do that and then they answer to you, but you’re not the one who’s in there making the Google profile and doing the Facebook ad. You can do that for maybe 1 or 2 weeks, but you can’t. That’s a lesson learned, “I’ll do it myself,” and 99.9% of you won’t.

If this is what you want to do and you have somebody who’s proven that they’ve done it, then you pay the price and then you have them do it to you. You say, “You can tell me how to run the place and give me the playbook so that I don’t have to take 6 to 9 months of making mistakes,” because that’s discouraging. Oftentimes, we don’t have that time.

That’s why franchises are successful, which all plays into the Who Not How concept.

It’s an excellent book, Nathan.

Don’t focus on the how. Focus on, “Who do I need to find to get me over this gap? How do I get from point A to point B faster,” and paying extra money to do that is worth it.

The linchpin statement is that you have a vision of what you want your future to be. Once you decide on that and once you’re aware of it, then you can move forward in a logical way. I’m here to say that open up your mind to what’s possible. It can be done. It is being done and it is a path for the future success of PTs because I want all PTs to thrive except the jerks. I don’t want them to thrive, but all the other ones I do and this is a way to do it. That’s in a nutshell.

I love how you’ve taken something that would have and it did. It cut a bunch of physical therapy owners off the needs of Graham Sessions, who hear about stretch labs. It threw them sideways to the point where they’re just going to rail and rally against stretch labs as a whole and maybe make a mean face as they drive by it. Number one, you decided to change your mindset and ask, “Why can’t I do that? Why can’t I take advantage of this opportunity?

Also, make an irresistible offer so that I’m so differentiated that there’s no price pressure.

Why can’t there be something between doing things on your own, using medications and full-blown physical therapy? Some people don’t need a full plan of care for the 6, 8 or 12 visits. Maybe they just need a couple of visits and why go through the effort and sacrifice to do that and then a physical therapist tried to sell me on twelve visits when I only need 2 or 3. Why can’t there be a middle ground there that we can take advantage of?

Find out what your customer wants. Provide it to them abundantly and they’re going to leave happy. Here’s an example. We offer massages. Why doesn’t a person go down the street and get a massage from Hand & Stone Massage or whatever those franchises are or Massage Envy? They can compare prices, which I don’t want to be part of that competition or I can make my massages so much better that there’s no comparison. When somebody comes from massage in StretchPlex, we start a little heat to your neck and back. Right there, that differentiates you.

We then put those sports pump sleeves on and squeezed their legs for ten minutes. We get all that fluid out of there, “That feels wonderful.” That’s what we say. We put a little lavender and eucalyptus behind your lower mastoids, so now they get a little aromatherapy. That costs nothing, but it’s enough to be stacking your service so that when you add it up, people are like, “There’s nothing like this. I don’t care what they charge me. It’s worth every penny what they do to me. They put a little oil behind my ears. This makes me open up my pores and I feel good. I’m all relaxed. They’re squeezing my legs.” How do you do that with your other services? That’s an open-ended question for everybody to start thinking about. How can I differentiate what I’m doing now and make it comparable to anybody else?

Also, they’d be willing to pay 2 to 3 times what they could if they did it on their own and found a massage therapist down the street.

That’s right, because when you go down to Cancun and you get that massage on the beach, you’re paying $180 for that. That’s insane, but you’re on the beach. You’ve got your wife with you and you can hear the music playing. There’s a Mai Tai waiting for you. All that stuff is stacking the offer so that you’re going to pay a premium price. There is nothing wrong with it. Let’s take the remaining time we have together on something that we like to do together, which is let’s turn the tables on Nathan.

Before we get into that because I don’t want to forget to do it. Bear with me. If people want to find out about StretchPlex, how do they get that?

You can probably Google search it. If you want to search for me on LinkedIn , I’m on LinkedIn. I don’t have a common name. It’s Rapposelli, like wrap it up and sell it. If you Google search that, you’ll probably get that or some of my Italian and ancestors. Also, you can reach out to me. I’m pretty easy to find. They can email me.

You’re teaching your whole concept to other PT owners across the country to do exactly what you’re doing. You talked about cash-based services and you’re talking about maybe some laser therapy or massage therapy. It doesn’t move the needle, per se. I don’t make enough to justify the effort but what you’re saying is something on a completely different scale.

It’s been profoundly shocking to me how people instantly understand it and again, basic business principles. Let’s make it simple. If you can make your offer simple, if you can make a concept simple, if it’s easy to understand, it’s probably a good thing. If it’s very complicated and people are furrowing your brow and you explain it to them for four minutes, it’s probably not a good idea. It should be really basic. “You get your pizza in 30 minutes.” That’s easy. “We get your packages delivered overnight.” It’s easy to understand

A $5 footlong.

You look in the marketplace and see the successful simple offers, and then you say, “How can I do that?”

People need to reach out to you if they’re looking for a cash-based service and looking to offset what’s happening on the general decline in reimbursement.

I’m simply saying that I’m one guy who’s proven that it can be done. I’m not saying you have to do it my way. I’m just saying, “Here’s a way that I’ve done it.” Think about how you’d like to do it.

You love asking me questions.

I have to ask you questions that you’re not prepared for.

Now, we’re turning the tables. I am no longer the interviewer.

We’ve got a couple of questions for you, Nathan. What has been the biggest cultural difference between you living in Arizona and you moving to Alaska?

In Alaska, these are hardened people. They’re not focused on impressing you at all, whereas the Phoenix Metroplex areas are very much about what you’re wearing and what you’re driving. That’s not the case in Alaska. When you live in Alaska, there’s a reason, typically. Not a lot of people are from here, but the people who moved to Alaska are either trying to get away from something or going to something.

A basic business principle is if you can make your offer simple and easy to understand, it's a good thing.
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They don’t want to be messed with. There aren’t a lot of fences around our homes. There are plenty of trees. It’s much more open in that regard. What was striking when we first came to Anchorage to market for the diagnostics that we were doing, they knew immediately that we were from out of town. Do you know why?

Why?

It’s because we came in slacks and button-down long sleeve shirts. They knew immediately we were from out of town. The room went cold. We recognized that and the next day, it was essentially a pair of jeans and a polo with tennis shoes on. They’re not worried about looks and fashion. Most of your front desk personnel are going to have colored hair, tattoos and body piercing. That’s normal.

A professional tip that you would give somebody is having emotional intelligence enough that you can read the room and respond, so to speak.

That carries through not just professionally but in everyday living. Friends come up here and they go to church with us and they say, “I didn’t bring anything to wear to go to church.” I’m like, “What you’re wearing is going to be better than 50% of the people there.”

Switching gears, you’re an aggregator of knowledge. It means you gather from a number of sources and owners across the country knowledge and experience. At the time of this episode, we are halfway past 2022. What’s happening out there, Nathan?

In the PT industry?

I’m being specifically vague. I want you to fill in that blank any way you want. You can talk about the micro-level for PT practices and PT owners. You can talk about the macroeconomic scenario. Are you getting any wind direction vibe from people? Are people saying, “The recession’s coming and my visits are down,” or is it, “We’re going gangbusters no matter what,” or, “What’s going on with this economy, or is it all across the board?

I’d say on a micro-level and when I say micro, I’m talking from the PT industry level. Everyone’s looking for a physical therapist. The demand is there and I shared this with an episode with Will . The demand for physical therapy is there and it’s only going to increase because of the number of people that are turning 65 every day for the next few years. It is in the tens of thousands.

The demand is there and the physical therapy staff is getting squeezed because they’re not able to meet the demand. They don’t have enough physical therapists. That’s what I see generally. I’m sure there are plenty of therapists out there who are like, “I need more new patients.” The people I’m talking to, new patients aren’t the issue. They don’t have a therapist to meet the demand.

Not that they’re necessarily overwhelmed with patients, but the demand is there such that many patients aren’t able to get in at the frequency that they need to on a weekly basis to come in, get good care and see the results. That’s why I’ve been promoting more people to go out of network with the lesser payers.

If you’re looking for a physical therapist and patients who are having a hard time getting on your schedule or having a hard time rescheduling and they’re only coming in one time a week when they should be coming in three times a week because you are so loaded, just start filtering out the low payers. It’s easier said than done, but get rid of the United Healthcare $65 reimbursement rate that’s been like that for the last 2 or 3 decades. It hasn’t changed and met the demands of inflation because you’re getting squeezed. Unfortunately, we play that victim card super well to our detriment, so take a stand.

Nathan, you are a coach. Do you have a coach?

Yeah. I’ve got a couple.

What do you have a coach for?

I’ve lost weight. I’ve got a coach for my weight loss. I got a coach for my coaching business who’s directed me on my coaching stuff and led me to this point. I’m still looking for more.

How many coaches would you say you’ve had over your life?

Double-digits. Since we started getting some consulting and coaching between Will and me and that started in 2011. In the past decade, I’ve had at least ten coaches. Some of that has been a life coach, professional PT coach and business coach.

Would you say that that was a worthwhile investment?

I’ve paid hundreds of thousands of dollars in coaching in the past decade and it got me to where I am. I’d do it again.

It’s interesting that every successful person I know says the same exact thing. As time goes on, you’ll pay more and more for that smaller and smaller slice that you need to work on because the return on that investment is so great.

I talked to somebody who is looking for a performance coach and I didn’t know what performance coach was quite clearly because when I say performance coach to you, you’re thinking of someone who’s going to make that athlete better. Now, there are performance coaches who are a variation of life coaches that will look at the nine different aspects of your life between social, financial, spiritual, physical and relationships, you name it. They will talk to you about where you are weakest and how you want to improve next to improve the performance of your life in general. There are even more coaches coming out differentiating.

To round out my answer to your second question of what direction are things going on a micro-level? That’s what I’ve been talking about in the physical therapy space. On a macro-level, in general, there seems to be a poor lack of leadership across the board. People would love for a strong leader to come up with who they can respect, trust, admire and look to. We don’t have those figures anymore. It’s sad. Back in the day, there was a JFK or generally, Ronald Reagan appeared to be someone like that, but you don’t have that anymore. I think that’s a missing piece.

They say bad times create good people and good people create bad times or something along those lines.

Thanks for your time, Stephen. It was great to catch up and hear about what you’re doing. I’m glad you took the time to share with the audience what’s been successful for you because it’s something completely different that people aren’t looking into and they need to.

It’s fun to share and I always love admitting to my mistakes so that fewer people can make them. You’ll make your own. Thank you.

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The post How To Build A Successful Cash-Based Extension Of Your PT Clinic With Stephen Rapposelli, PT Of StretchPlex appeared first on Physical Therapy Owners Club.