Improving This Key Stat Nets THE MOST Gains With Shaun Kirk Of PT Practice Success

Shaun Kirk of PT Practice Success has been a business coach for decades. From his perspective, owners have had to be ever more conscious of productivity and efficiency to be profitable. In the past few years, one KEY STAT has become more critical than ever in determining whether PT clinics will be maximally profitable or not. This episode will cover that one stat, how to implement it, and how to hold those expectations of your team. Do you wish to take your practice to the next level and far beyond? You better tune in to this episode because Shaun is ready to help you!

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A longtime friend, mentor, and previous guest on the show, Shaun Kirk , who was with me, the CEO of PT Practice Success , he was one of my first episodes when I started the show. I can’t even track stats back that far, but your episode was one of the most popular and downloaded, where we talked about the six areas of the PT business to focus on. You shared a ton of great contact back there. If people want to read that again because it’s still very pertinent and also hear about your awesome story to success, I would recommend everyone go back and read that. Before we dive into things, thanks for coming on. I appreciate it .

I’m happy to be here. It is exciting to see how the show has grown. The people that you get on to the show, I’m so impressed. Well done, Nathan.

Thanks. It’s great. It’s fun to get some positive feedback here and there when I go to conferences and whatnot. People get some value out of this. It’s because I have a great network that includes people like you who can share valuable information for PT owners and how to improve their businesses. Share with everybody who hasn’t been here for the past couple of years. I’m sure there’s only a handful that has stayed on top of all the episodes, a little bit about your history story, where you are coming from, and where you are at.

I’m a physical therapist by training. I keep my license alive, but you wouldn’t want me treating you because I haven’t practiced as a clinician for quite some time. I always jokingly say that sometimes you will see practices that say, “We treat you like family.” I hope you don’t treat anybody like family because when I treat family, it’s like, “Move and stretch.” I then slap them on the back and give them a bag of peas or something like that. I don’t practice presently but I have been a private practice consultant for many years. I am working exclusively in the physical therapy or physiotherapy world in US and Canada.

I started out as a failing, struggling practice owner, and needed some help and got some guidance, good training, and coaching and started applying my business. I realized that I had certain skills that were good at helping other people get through the challenge of business ownership and management. Although I never talk about how to treat a patient better, you would never want to take advice from me but I could tell you how to grow your business a little better.

I have been doing that for a long time, and I was in private equity for a number of years, buying PT practices and building the network there. I did that for a few years. I can’t deny that I learned a lot, particularly if someone is getting ready or starting to queue it up toward sale what to do for that and get the fattest check but I didn’t like that world, and I liked working with private practice owners.

You have been doing it for many years, and I wonder what keeps the fire burning. What keeps you juiced up about coaching? You could be coming up against the same issues over and over again, even though it’s a different decade. There are always therapists that you have to drag along to pull them towards success, and that’s hit or miss whether or not they’re successful. There are some who are off on their own, but what keeps you going?

You are as valuable as you help people. I like to work with people that I like. If I don’t like them, I don’t want to work with them. Although the people are paying me, they are my friends like you and Will. That friendship is important to me, even though we may no longer have a business relationship. I like the idea of helping people. If you can have a job in life where you are helping people live better lives, that’s pretty good. As a clinician, you are doing that as a PT. As a practice owner, you are doing that on a bigger scale, but when you can influence practice owners to double and triple their business, then I look at that as a trickledown effect of being able to help others.

It has evolved over the year, no doubt about that, but the purpose is still the same. It’s to help people. I like to help people so that they can help someone else and be better business owners, help better patients, and improve conditions and people’s lives. Practice owner, make more money. If you are a patient, you are getting better faster.

As you look back over the years and maybe more recently, what are some of the biggest blind spots that owners have or in other words, what is something that you routinely see being an issue in the clinics that you are working with that keeps them from progressing and being productive, effective, etc.?

One of the things that I see a lot of here in the last couple of years is the need to be more profitable. Everybody knows the problems that we face. If you are in private practice, you have declining reimbursement, and we have been experiencing that forever. When I was in practice many years ago, my highest-paid therapist made $52,000 a year. We made $117 a visit. Everybody would see about 70 visits down per week. He had to be a mental furball to fail back then, but now it’s different.

One of the things I’m finding is that if you have been in practice for a number of years and you haven’t had a productivity mindset. You have your staff with you, and it’s like, “Deliver great care,” but not in a physically responsible manner that suddenly these guys are freaked out a little bit. The therapists are not focused on being busy and filling their schedules but they sure are happy to get a raise every year. The only way you can make more money is to make more money so that the clinician has to generate more revenue per head.

The only way you can make more money is to generate more revenue per head.
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Not to say that that was never an issue years ago and even back when we worked together. I don’t know what you are finding but I’m finding more interest in how to handle declining reimbursements and stay ahead, how to maximize the productivity of the staff, and how to get the staff to make changes, more so now than ever.

Much of the talk has been about declining reimbursements because that’s an overall trend. It’s becoming a pinch point now because of inflation and the salaries that the physical therapists are getting from hospitals and home health still. It’s hard to keep up with that. It’s hard to compete with six-figure salary offers in a metropolis. You can only come to the table with $75,000 to $80,000 to still be profitable. That’s hard because now those two things are coming ahead, and it’s pinching the profits.

One thing that I look at, particularly in recent years, more so than before, is one of the things that happens with a lot of practices. I talk about how they will have a brick in the practice that stops its growth. You will see the volume get busier and busier, and then it will flatten out. You talk to guys, and sometimes they are in practice for ten years and like, “We have been seeing about 250 visits.” “For how long?” “Ten years.”

Busting through that next stage is a little bit on the challenging side. What do people do? They pancake their care. They get more volume and decrease the frequency with which the patient comes in. If you see a new patient, get $100 a visit, and they are going to come for twelve visits. “You are going to see them one time a week. How much money are you going to make?” “$100.” “How about twice?” “$200.” “How about three times?” “$300.” They will get better outcomes, and that has been communicated by you, me, and others. It’s pretty much known.

If you think you are going to get better outcomes and see a patient once a week, you are wrong. It doesn’t happen. One of the things I have been focusing on with folks, and it blows up everything else, is the average patient frequency. We want that to be about 2.1. If we can hit 2.1, then we maximize the revenue per week that we can bring in but it blows up a lot of things.

For instance, therapists have to be good at selling. If they can’t sell the plan of care, then we have a patient-directed plan of care. If they are good at selling the plan of care but the front desk isn’t good at getting people to keep an appointment, then we lose. If the therapists are already busy with patients with a full schedule, they can’t put more people in the end, and that’s a flunk for the owner because he has not been recruiting aggressively enough beforehand. I’m mostly coaching. When you dial a stat with a client, it begins to blow things up. They realize, “We’ve got a lot more blemishes than we thought,” but if you take your average patient frequency, which I usually find about you and most of those guys that I talk to initially are running about 1.5 or less.

I thought you might say 1.3 or 1.4.

I’m being generous because you probably have smarter owners reading this. If you go from 1.5 to 2.0, that’s a 33% increase in your revenue and visits per week.

It’s a significantly greater increase in your profit because your expense line stays the same.

What I say by putting a brick in the practice is that volume comes up to a point where everybody’s schedule gets filled, and then we stretch out the care, and then everything flattens out again. We start stretching it out, and it flattens out. I don’t know how you guys were. You started your practice before you, and Will came together but with myself, every patient was coming three days a week because I was flat broke and needed money and had one patient.

You sold that plan of care.

I sold that plan of care like nobody’s business. As you get busier, then you start doing twice a week or the big mistake is 2 to 3 times a week, and you say it to the patient where they are going to walk out and say 4 or 3 times. No, they are going to say two times.

If they schedule for three, they are going to say, “Why not cancel one of them?” As you said, 2 or 3.

It’s not that important. Dialing in that from working with me, I focus a lot on the operations and the efficiencies and the operations because there is a change in the cushions of the sofa, and sometimes that is the difference between having enough money to pay your staff and having profit or not. If we back up the bus, we put a lot of new patients in but we are sloppy, so we lose a lot of money.

What kind of pushback do you get from your clients? That’s a stat that I have my clients track. There are a lot of them that I have to talk them through it, and then we have the conversation about their importance and how it can affect them. I will even bring up a template that shows the increase in revenue and a significant increase in profit that they can receive, yet it still doesn’t change. As we talk through that, do some of your owners stumble or hesitate? What pushback do you get from trying to improve that staff?

I don’t get a lot of pushback but I don’t get a lot of compliance. They totally agree with you, “Nathan, it only makes sense,” but that stat doesn’t change. We are always looking at how our staff’s behavior has to change. We have to change their point of view. Sometimes we have to change the owner’s point of view, and it has to start there.

Basically, trying to say to your clinical team, “I need you to be more efficient and productive in how you manage cases.” One of the barriers to that is also if they did get to 2.1, do they have enough staff to treat those patients? If they don’t, then we are concurrently pushing on a recruitment project. Assuming that there’s bandwidth and they are not getting it done, I sometimes will bypass the owner altogether, and I will go, “It sounds like you can’t sell this so that I will do it.”

When the time is done, I’m working with the client who’s going to look back and go, “I don’t know. It didn’t work so well.” It could be that he didn’t do it. I will go, “I will sell it,” then I will have a webinar with the guy’s clinical team and group some things and get them to agree. I did one a few days ago with one of my clients in Massachusetts. It’s a good practice, and I found out what’s the barrier. The barrier was finance. The barrier was the copay and deductible.

“What do I do with that?” I go, “You have to sell the value.” Not everybody can stroke a check three days a week. You have to have your payment plans, care credits or whatever you might be doing. That practice didn’t have any of those types of things established. That blew up the need to solve that problem so that the therapist would feel less concerned about the dollars and cents of physical therapy.

We talked about this in our first episode, if I’m not mistaken but if it wasn’t in the episode, I know it came from you but we talked about the importance of setting a strict plan of care and saying, “Is it 2 or 3 times a week?” You have to decide. You are the doctor now. The patient is looking to you for an answer and not some wishy-washy, “Could be 2 or 3. It doesn’t matter.” Patients will bring up their financial concerns, and some therapists, I included back in the day, would say, “Maybe we can get away with one time a week.” What is it?

I’m talking to myself, and I’m talking to a lot of owners who are reading, “Is it 1 or 3?” What doctor in their right mind is going to say, “Here’s a medication for you. I want you to take it three times a day,” and they say, “That’s an expensive pill.” “Okay. Just take it one time a day.” Why didn’t you tell them one time a day from the get-go?

It’s unethical to back off of a plan of care that they have to perform to get results. You cannot go backward. You are expected to be the expert, and we are the experts but we don’t act like it and don’t have the confidence to do it. Backing off that plan of care for financial concerns is something we talked about a long time ago, and it’s going to be a continuing issue because therapists don’t like to confront that stuff.

It is, unfortunately. I wonder what this particular profession would be like if there were no insurance at all. There are the guys that made it in cash. They are making more than they made at the hospital or something like that, and maybe they built a good enterprise. The bigger practices are in the insurance model, where they go out of a network and play that model. I’m seeing more of that. You have insurance companies that by the time they pay you and deal with all your expenses, you would be better off. Give the patient $20 and ask them to stay home or come out ahead, or more ahead.

Some people don’t have an insurance plan but have an insurance card because there’s no coverage. With all of that said, we have to be better at selling our plan care. When we talked about that subject, if you’ve got good insurance or whatever, “I’m going to see you three days a week.” If you have bad insurance, “Let’s do 1 to 2 times a week.” You still have to have integrity. “I didn’t sign up for your insurance plan, Mr. Smith. You did. This is what it takes to get better. Your body doesn’t heal any faster than anyone else.” If 1 to 2 is okay, then why isn’t everybody treated 1 to 2?

I’m with you. The thing that I look at a lot is when people do things that they aren’t comfortable doing. They believe they have to be somebody that they are not. When you are disciplining staff, you feel like you can’t talk in your normal manner. You have to get serious, “I need to talk to you,” or whatever you do. I always find it hilarious. Two of my very best friends are former employees who I fired. I love the people that I work with but they have a job to do. If they do it, great. If they don’t do it, they don’t get to be on my team but that doesn’t mean they can’t be my friend.

When people do things they aren't comfortable doing, people believe they have to be somebody they're not.
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What happens for some of us as clinicians are that we anticipate the reaction of the patient, and we react to that versus delivering the communication and recognizing that it might be uncomfortable. It’s like, “You need open-heart surgery.” “How expensive is that?” It’s every penny that you have in your entire life. “Is there a way we can do a cardiac cath and handle it that way?” “No, it’s your heart.”

When it comes to what we do as clinicians, we have to sell what we believe in, and sometimes it makes me wonder how strong we believe in what we do and what we say we do but do we do it? When you are in practice, you are very good at making clear expectations and what the plan of care is all about, and you crushed it. Some people will go into the negotiating on the plan of care. Even if you want to see the patient three times a week and they go into a big sob story, “I don’t have any money and I couldn’t even pay it over time. I’m living in my car or I’m living in a van down by the river,” or something like that, you still don’t change that and expect them to come three days a week.

The plan of care is the same, no matter what the financial situation is.

They might not be able to make it but you don’t alter that because they can’t make it. That’s still the expectation.

That’s something that comes up. I have to talk to owners as you do about how to present this to their team. The other thing that you have to be wary of, and I have to talk them through this, is either they have a fear of or experienced some pushback in terms of, “You are all about the numbers. You don’t understand the personalized or individualized care that we give to each patient. It lines your pockets if these numbers improved.”

That’s unfortunate that they go there but they tend to default to that thinking pattern. If the owner hasn’t connected, increasing these numbers strengthens our purpose and helps us live our purpose better and is in the best interest of a patient. Patients get better when they come to physical therapy more often. As statistically proven, they have to come at least twice a week to so show significant progress in their condition. If they don’t make those connections to both the purpose and mission of the clinic and also how this ultimately benefits the patients more, then that default is going to be there, and the providers will always get back.

It’s a mindset you got to get through but what happens is it’s the sales job. If you are an owner of a company, you are not getting your staff to write you a check but you are selling an idea or concept. You will have better outcomes. You are not asking the therapist to see the patient for 50 visits. That would be a crime if they don’t need it. It’s the same number of visits. I say this sometimes to people, especially I do a lot of workshops and go to the guys’ offices, and they are like, “Get the staff onboard, and then we do the program.”

One of the things that I look at is like, “Would you like to have your salary over an 18-month period or over a 12-month period? You will still make the same amount of money. We are going to pay you in eighteen months.” We do that when it comes to physical therapy. “You have a high copay, so I’m going to see you once a week and not get a result, and you will probably quit after six visits but you will feel better about that copay every week.” We are stretching out the care. It’s the same amount of money. It’s just if you can get it sooner. Someone did a payment plan for your services, and it was a payment plan that was six years but you are going to finish your service in six months. You would be out of business if you did.

I don’t know if I want to do that. It’s not effective.

We are all talking the same talk. It’s a very real thing. A lot of times owners need help delivering that message because you, as an owner and me, know that there are two major things that will knock you on your heels. Somebody is saying that, “This will affect the quality of our care,” because that hits you right in the gut, and then the second thing is, “It’s all about the money, isn’t it?” Those two things are the things that make us wimps as business owners. It’s always about the patient but it’s also about financial stability.

You don’t shy away from them.

In my practice years ago, I had how much money we had in the company on the wall on a graph every week. People saw it. They knew that if I was very financially solvent, they have a good future with my company. I do find this too, I don’t know about you but some of the guys that are having some challenges are sharing their financial challenges with their staff. They are telling them.

They are basically broadcasting their insecurities. If you are a PT in private practice reading this and having some challenges, find somebody else to talk to. Don’t talk to your staff about it. You might talk to your staff about getting the numbers up and being more productive and efficient but, “We barely made payroll this week,” isn’t the best message to share.

One of the other things that I find also is that it makes it hard because, as an industry technologically, we are usually a decade or two behind. Simply tracking this one statistic takes some effort.

It does.

I like Prompt . It is more cutting edge when it comes to management reports that you need. They can get you this number but it’s not the major player in the industry.

I got guys on Prompt, and they can get it.

All the other ones you have to manually track. We are talking 80% to 90% of the rest of the industry that isn’t on Prompt. That can be difficult for an owner to say, “Do you want me to track that stat? It’s going to take more footwork. I’m already treading water.” It’s hard to get them to do that manually.

You are right. Back in the days of me doing my notes on a shovel with a piece of coal, we did all that manual stuff. We grinded it out, and you probably did a lot more manual back then than we expect technology to solve our problems. There’s no button to push. It might take twenty minutes to get that number but you might need to get it. Sometimes it’s not worth the squeeze but if any of you guys are Prompt people or might be reading this, you can get that number for the clinic but you can’t get it by a clinician.

To my knowledge, someone can correct me. If you can get it by a clinician, then you can go say, “Joe, you are averaging 1.3.” The Prompt will tell you the visits and discharge for the clinicians, and that data is pretty good. I don’t think that they can give you the unique patients, which is something I made up but it’s unique individuals that represent the total of the patient visits for that week. I don’t think they can give you that data per practitioner.

To get a little bit detailed about it, you simply bring up all the individuals that came in that week divided into the number of visits you had, and you get that frequency.

I have 300 patient visits, and you have 150 people. That’s a 2.0. I have a client that I’m working with up in Brooklyn, New York. He’s got good practice. It’s 600 to 700 visits a week. I have been grinding on this guy on this statistic. He’s like, “We are working on it.” “You are not doing anything. I’m looking at your stats every week. It’s not moving.”

I’m grinding on him pleasantly. You got to work with the willingness, and then I showed him the spreadsheet like dollars and cents of what it would make in the practice. He went from 720 to 860 in a week. He went from 1.5 average frequency to 1.99 in 1 week. Sometimes you have to show the numbers, and then they even disagree with it. It’s simple math. Use your own calculator, and you can come to the same conclusion.

People reading are going to say, “What did he do? How did he flip that switch?” What did you do? Do you remember?

It sounds simple but it takes some courage. First, we got an agreement. I did do something with the group on that to get an agreement that it made sense. When you take a new patient, as a rule, the first 2 full weeks that they come into therapy, see them 3 times a week. If you start at 2, your average frequency will be below 2. Some people start at three. I’m not saying if they had a hangnail, “I want to see you three days a week,” but, in general, every new patient is seen three days a week.

They all agreed, and then nothing changed. “Joe, you are going to have to look at every new patient that comes in the next day and see that they are scheduled 3 for the next 2 weeks. If they aren’t, get the therapist to get on the phone and fix that.” If you say you did that on Monday and the therapists already agreed, “Get on the phone and fix that,” and then he has to get on the phone and fix that. On Tuesday, he’s going to have the conversation with maybe most of them.

With all of his new patients.

By the time Friday rolls around, “I figured out my chops and knew what to say. I can get this thing done.” I said, “You have to make the penalty for non-compliance to grow some enforced. Heat and pressure make a diamond. It’s not comfortable. There are two things I always say you get agreement first before you get cooperation. If there’s disagreement, handle the disagreement but once you got an agreement, then let’s get it done.

You have to make the penalty for non-compliance and enforce it. Heat and pressure make diamonds.
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It’s easy to hold them accountable after that.

Another thing is that all changes are met with resistance. If you weren’t tough enough to tolerate that, you are in no business to be a business owner. Every time you want to make a change, someone is going to go. “Do we have to? Does it apply to me because I only work part-time?” “If you got children, you understand what I’m talking about.” It’s everything you want to do differently with your kids. It’s not always sunshine and rainbows.

I’m thinking about teenagers. That’s how you have to work with them. It comes down to if the owner is not set in their mindset. “This is what I’m expecting. This is what is in the best interest of our patients and will ultimately be in the best of our business.” If they are not firm in that mindset, then you are going to be weak like the other therapists are in initial evaluations. “If you do it, it would help, so thank you guys for being a team player.” That’s not the mindset you need. “This is what we are going to do.”

One of my more successful clients told me after having the conversation that he was successful because he was determined and had certain goals, and wasn’t scared. He told me after the fact, a few months, and decided, “We are a three-time-a-week clinic. If you come less than three times a week, you are the exception, not the rule.” There needs to be clinical reasoning behind that. It’s not financial reasoning. Everyone schedules it three times a week at the initial eval and not week to week. He blew up because of it.

It’s so easy but everyone thinks it’s the right Facebook Ad. That would make all the difference in the world. Not to dig into all of that but there’s more to it than running a business and then backing a bus up. I see and run into it all the time. As a matter of fact, you can have that transition where the therapist could say three times a week, a patient goes, “Yes, that makes sense.” The patient goes up front and says, “I can come twice next week,” and the receptionist goes, “Okay.”

What I always recommend is if I’m talking to you and I get you to agree on the plan of care and the frequency, I walk you back up front, and I go, “Nathan, did you meet Patricia?” “Of course. She’s the best receptionist we ever have but she will rip your face off if you start missing appointments.” She goes, “I will.” It was always like a lighthearted thing. “I want to see Nathan three times a week. Is that Nathan?” I would make you say yes. It’s a verbal yes like sitting in an emergency room. I then pass that to the front desk.

If I walk away and you go, “I can only come twice,” she goes, “I’m sorry but I have to schedule you three times.” If she can’t get it done, she goes, “I will be right back.” She goes and gets me. Imagine that if you got the courage up to do that 100% of the time, and the receptionist would go and grab me and I’m like, “I’m on my next patient, and I’m very annoyed.” I would get better at the skill because the penalty for not doing it is too uncomfortable for me. I need a verbal yes. You walk over and pass off the plan care. Some people will do something where they write a little ticket, and the patient hands it to the front desk.

They will have an agreement. It’s almost like a contract. “This is my plan of care.” I sign it, and they sign it, and then you take that to the front desk.

Whatever that does, it seals that potential hole where they can slip through. Do whatever system works for you. You have to fix it.

Do you find that a lot of your owners do well as they roleplay this more often? Does that get the providers to be a little bit more comfortable with the wordage?

Yes. I do see that. When you drill something, you become good at something. We should all bow our heads and pray for the first 100 patients we ever treated because we didn’t know what we were doing. As you treat more patients, you do the drill. You get better at doing that. When you have an ad that comes in for a free exam or something, if you can’t close, don’t waste the lead. Drill how to close the plan of care before you waste this guy who needs your help. Drills bring about an awareness of how to do certain things.

When you drill something, you become good at something.
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I did some drilling with a case manager in a different type of practice that I worked with. It’s more of an integrated practice. She goes, “I hate drilling.” I’m like, “I know but we are going to do it anyway on a Zoom call.” She says, “I feel I could do better in a real-life situation.” I go, “No. We are doing the drilling because you are not doing very well in a real-life situation.” You don’t have a would-be-patient that you are trying to close on a plan of care. As they are walking out, I’m like, “Allow me to critique your sales process. What I noticed is that you weren’t listening to me when I was talking,” and that type of thing. Drilling is how you get good at something but again, agreement and then cooperation will allow them to sit and do the drill.

Back in the day, we would say all these things, “This is our expectation.” We would give examples of what could be said, but they didn’t feel comfortable with the conversation until we role-played and hated it. We would simply play off that, “It’s everyone’s worst part of the meeting. We are going to do some roleplaying.” “I don’t want to do that.” “You come up here. We are going to focus on you. I’m you, you are me, and we go through the roleplay.” We get everyone’s feedback on how it went but going through that 2, 3 or 4 times allowed them to come up with their own words, so they could own the narrative or the story and thus feel comfortable than approaching people with whatever they are talking about or confronting any issue.

You don’t want to load their lips. I want to make sure that this concept is presented very well as I talk about a four-phase approach to care when it comes to rehab, so the patient doesn’t think, pain relief is the only thing they need. The therapists will sometimes assume because the patient is in therapy that, they want to rehab. They don’t want to rehab. They are not interested in rehab. They are interested in pain relief.

If you haven’t painted enough pictures of what the phases of care look like and what the phases the patient was in like when you see a patient, Phase 1 is pain relief. Phase 2 is mobility without aggravating symptoms. Phase 3 is strength, the core stability. Phase 4 is aerobic. As you are doing something with a patient, you go, “This is a Phase 2 activity to improve your range of motion. This is a phase three activity.” They keep hearing it all throughout the clinic, phase 1, phase 2, and phase 3, and see the posters on the wall. You walk in, and the receptionist goes, “Nathan, what phase are you in?” “I’m in moving into Phase 3.” “Awesome. High-five.”

You are selling this concept that physical therapy does not end up with pain relief. If you are sitting at home and you no longer have pain, you at least know there are three more phases that you got to get through. Finding a way to say that that feels comfortable and natural. From working with me in the past, when you have somebody go out who beats the streets and talks to doctors, and a doctor says, “Can you tell me about your back program?” You go, “We have a four-phased approach to care. The first thing we do, doctor, get the pain under control.”

If it was good enough for a doctor, it surely is good enough for your patient. You find your way to get those concepts across. Drilling is super simple. Sometimes I’ve talked about this selling that plan of care concept and the frequency and all that. I will drill the therapist, and the therapist goes, “This is what I do and I go, “I know what you do. How’s that working out for you?” “Would you be willing to try one thing?”

When I have owners who say, “My staff is always coming to me. I don’t know what it is about me but I always solve their problems. I don’t know what to do.” “I’m going to give you a tip. We are going to drill it. Are you ready?” “Yeah.” “When somebody comes up and goes, ‘Shaun, I don’t know what to do about this one thing,’ and you go, ‘Okay.’ What do you think you should do?” They go, “I don’t know. That’s why I went to talk to you.” I would say, “If you did know, what would you do?”

I said, “If you figured out how to do that 100% of the time, you will knock down 50% of the time that people will try to dump problems at your door.” We would drill it. I go, “I will be the person.” I give the person a problem, and then they would say, “What do you think you should do?” “I don’t know.” “If you did know, what would you do?” When you receive it, the owners would go, “It puts me right on my heels. I have to figure out a solution.”

You taught us that, and I remember one person, in particular, would come back to my back office, knock on the door, “You got a second?” She would say, “We’ve got this patient.” I would say, “What do you think we should do?” She said, “We could do this.” I’m like, “Any other ideas?” “We can do this.” “Try that.” She kept doing it and I said, “What do you think I’m going to say now?” She’s like, “You are going to ask me what I think to do.” I was like, “Why do you keep coming back here?” “I want to do things the way you want them done. It’s your clinic.”

I said, “I didn’t hire you, so you could come and ask me questions all the time. I hired you so you could figure out your own solutions and then move forward because you’re smart enough and licensed. I’ve trained and trust you. You don’t have to come back to me. I hope you recognize that after coming back here the last few times, I trust your answers. If there’s a problem on you’ve implemented something and things have gone off the rails, talk to me but other than that, use your own intellect, and you will be good to go.” That helped a ton. It was great.

Sometimes what happens for staff members that move into VP level or exec levels within the group, the reason that they commonly move up is that they are good at problem-solving. They are good at fixing things but that’s the death of them as an executive because they are good at problem-solving. You go, “I got there by being a good problem-solving person. Now, I have to make people who can solve problems.” That’s sometimes the different switch.

I talked to somebody up in Canada who has an office manager person with exactly that problem. She’s like, “I jump in and help. Part of being a good leader is being willing to jump in and do the work with them.” “No.” Maybe in heavy traffic warnings or something like that but we don’t do their job with them for them. You got all kinds. How she moved up and how she got to be more valuable is that she could solve people’s problems. As you know and others have found out, that’s the trap. What keeps you from growing is that you got to make mini-mes.

Also, empower them. Help them understand that there is a solution. “When you are consistently coming to me, that means you are not thinking for yourself. I’m going to let you figure it out for yourself. If it becomes an issue, then you can come to talk to me.”

I have a very high faith in people. Sometimes I would say to clients, and maybe you’ve heard me say it, “I believed in you before you believed in yourself.” Over the years of working with practice owners, I see that they are having challenges and troubles. Now, you are doing it. Sometimes it’s like putting the key in, turning it, and suddenly, things change. They got to let you guide them toward that. If we can have that same understanding of practice owners, practice owners should have that same understanding of their staff. If they are willing, take the time and train them. If they are not willing, get them off your team. Simple as that.

Anything else you want to share in terms of production efficiency? We’ve covered a ton of stuff but it was good.

You know me, I can slap a quarter in the back of my head. I can go all day. Maybe another day. People are falling asleep and going unconscious. We are long gone, and they miss this part altogether. To recap, what would be important here as a practice owner is if your average patient frequency is low, fix it. Do whatever you got to do to fix it.

As a practice owner, if your average patient frequency is low, fix it.
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Start with yourself or your attitude and concerns about that. Some people justify it, “How am I going to make any more money?” You make your money sooner. If we stretch it out, it’s not like you are making more dollars per patient. It’s that you are getting paid faster, and getting paid faster makes you busier. We then focus on hiring and then recruiting because we need to.

I have a couple of clients who are super busy. They are tapped out. Their schedules are full, and if someone cancels bands, someone else is coming in. Their huge schedule book is full. Their frequency is in the 1.1s to 1.5s because they are so busy. There’s no room to put that new patient in three times next week. I want to get your thoughts on this. I’m telling him dropping out of healthcare or your lowest payer and say, “It’s because of shortage of staff. We are unable to take new patients in this insurance anymore,” that immediately opens up 10% or 15% of the schedule next week to put in higher payers that can come in more frequently.

I’m in 100% agreement. You have to look at the actual revenue per hour that you can generate. We have to confront that. I’ve got a client that’s in Canada, and they are podiatrists and do surgeries and stuff like that but they also collect toenails. When they look at their schedule, they line that schedule up from a revenue perspective like, “I need two surgeries. I need I did this and that.” They are all about hitting a revenue number per day.

In physical therapy, the range between lowest to highest isn’t such a disparity. However, when you got a United Healthcare $45 or something crazy like that, they know that, generally speaking, we won’t compromise our care. We will deliver the Cadillac service every time. “My therapist says it’s not fair.” “Let me make a payment adjustment on your paycheck too.” You got to get rid of them. There’s a certain range where you go, “That works for me. I can’t keep them if it doesn’t. You got to go out.” If you say something about insurance and you say United Healthcare, it fits.

It’s nationwide. This client, in particular said, “I’ve had that United Healthcare contract for probably 25 years now,” and it’s still $65 like it was back in the ’90s. $65 back then compared to what $65 is worth now is significantly less considering inflation. Normal inflation over time. Not what we’ve seen over the past few years. I want to say, “Your patients can get better care if you dropped the lower insurance,” and your providers might be happier, and your profit margins are suddenly improved by making that one move. It’s a scary thing.

I got one of my former clients who’s from New Jersey, but he sold his practice many years ago and lived down here, and we hang out a lot. He was out of network. He had a 37% profit margin. He wouldn’t play that game. He did have challenges getting new patients regularly, but he ran a 37% to 38% profit margin.

Not too bad.

He did fine. He will be okay and will survive. More and more years go by, and to survive, we have to be able to sell the value that we offer. As a coach, consultant, trainer or whatever you want to call me, what I look at in terms of this profession, is that the profession’s not as viable as it once was. Not across the board, as you know. There are guys that are building shrines with them holding goniometers out front. They are big. They built something, not PE money that they built it.

If we don’t get our heads around being better at running a business, we are doomed. I never had a primary care doctor. My wife says, “We should find a primary care doctor.” They are no longer acceptable because they are up to their eyeballs in patients. They are busy as can be and make no money. As a profession, to me, if you can’t sell your plan of care, this problem is going to get worse. If I were ever going out in private practice again, I would do cash because I can sell. When I go to hire Joe to work for me, can Joe sell?

That’s tough.

Yes, dump United Healthcare.

I’m dropping now. I believe it. Anything else you want to share or contact information if people want to get in touch with you, Shaun?

If you want to get in touch with me, go to PTPracticeSuccess.com. You can find me there. There’s a contact page there, and you send a message. I will see it, and we can set up a time to chat. When it comes to working with people, and you know this too, it’s a relationship business. It’s got to be a good click. I always want to talk to somebody first to find out if I care about their practice more than they care about their practice.

Thanks for taking the time. It was great catching up and talking to you.

You bet. Thanks.

Shaun sold his practice and for the next 20 years, he worked as a PT practice management consultant, directly helping thousands of practices succeed, with many winding up on the Inc. 5000 list of fastest-growing companies in America.

Shawn then took the position of VP Operations at a private equity firm where he helped PT practices grow through mergers and acquisitions. There he learned exactly what can hold down the value of a practice and what can rocket it to stellar heights. Despite leading the equity firm’s growth to 180 locations in 26 states, Shaun yearned to return to his true calling: helping PTs in private practice succeed. And so, he left the firm to start PT Practice Success.

Now Shaun and his team are ready to help you take your practice to the next level and far beyond.

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