The Future Of The PT Industry – Post-PPS Conference Reactions With Will Humphreys

APTA’s 2022 PPS Conference was held last November 2-5. It is a great place to run into people and catch up with other PTs. In this episode,  Will Humphreys , the founder of the  Healthcare Business Academy , joins the podcast to discuss our impressions after attending APTA’s 2022 PPS Conference. Will any group, or anyone, take a stand to change the direction of the private practice PT industry? What can owners do to stem the tide? Tune in to this episode to find out!

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I got my good buddy, Will Humphreys , back on the show with me. Thanks for coming back.

Thanks for having me. I appreciate the invitation to be back.

It is always good to have you. You are always more than willing with your time to come back on. We talked about this while at PPS and understood that we built up PPS 1 or 2 times over the past years leading up to it. We do have to have a follow-up on PPS and what we thought about it. Let’s start there. What were your general thoughts about attending it, and what you took away?

I love networking. When you talk to people down there, that is the number one thing. It is always great to run into people you know and catch up on what they are up to. That alone is the greatest value. For me, it is being around people. You and I got to hang out a few times, and we always run into people who are looking for answers to certain problems. That is always a great place to be.

Sometimes we can help, sometimes we know who they can get help from, and sometimes we don’t know. It is a lot of fun to be down there. The event itself was crazy for me because I was running a few events there and was running for office, which didn’t go well, but that is all right. It was still a good learning experience. Overall, it was worth it. What do you think? What were your thoughts about it?

I’m the same way. The networking part of it is what gets me excited. One of my core things is networking. Greater than going to PPS, networking, in general, is a core of mine. That fulfills a purpose. Hanging out with the people that I like and love and reconnecting in a way that I have never been able to over the past years is huge. It allows me to be a benefit to other people, especially as I’m coaching. I can say, “I know an owner who has that same issue or has done that thing before.” That gets me fulfillment. I enjoyed that.

I didn’t go to any of the presentations. I didn’t go to any presentations, but I know that a couple of the guys in my peer-to-peer network were enthused about the presentations on direct-to-employer marketing to reach out to these self-insured companies. You can address them and set up contracts with them independently to see that not only their employees and workers comp situations but also for any other health issue, including the employees and their families. There was quite a bit of talk about that. I know my course field has been on that horse. I’m not surprised that there were more presentations on that. I know other people got some value out of that.

That is a great concept. It is not the long-term solution, but it is a step in the right direction to start finding ways we can circumvent the reimbursement system to get better payers and start making more money for not working as hard. At the end of the day, one thing that unites all PT entrepreneurs is that everyone is getting sick of working as hard as they are for what they are making. There is a discrepancy between employers and employees. The employees somehow think there is more money out there. They are even more burned out in some cases because now they are coming out of school with $150,000 of debt, and salaries haven’t changed in several years.

Inflation has gone up, and reimbursement has gone down. I don’t blame people for wanting to jump out of the industry when they are making $72,000 after $150,000 in debt. Their only hope for making a sustainable living is to open their own practice, which even has its own pitfalls and challenges. It is nice to see that we are starting to find some ways to circumvent the main problem. Even though it doesn’t address it, it does help find some oxygen in little pockets where they can grow.

Part of the disappointing thing is there weren’t any groundbreaking new ideas from my perspective. That is a relatively new idea, but it is not going to change the direction of physical therapy as a whole. We will only go so far. Our conversations were more along the lines of things that have to change. Unfortunately, we don’t have all the solutions.

What we talked about in our previous episode is it got to start with taking a stand. We believe, and I don’t want to speak for you, but based on our conversations to our discussions, we are along the lines that we have to stop taking some of these lower paying insurances. Even if there is a reason why they might be justifiable financially, in a larger scope, it is a detriment to the profession.

Dropping it isn’t necessarily going to hurt you. There are ways to improve your bottom line, frankly, by dropping those insurances. It is pretty obvious that something like that needs to be said even though I don’t think the APTA has the guts, or can they without incurring some wrath from someone somewhere to say that? That is what I took away from it, and that was our discussion towards the end there.

The mindset around it is what makes me concerned because I know there is a lot of willing and wanting PT owners out there to make a difference and change. When you start asking them to drop their lowest-paying insurance, that is where the rubber meets the road. How committed are they to greater change? You were telling me there was even someone out there saying, “You want to take all those low-paying insurance because why not fill your available slots or whatever bull crap that is out there.” We have to change our mindset first to some degree.

The thing where having a rally and cry around dropping your lowest-paying insurance is what wakes people up. Maybe we are like, “You got to drop your lowest paying insurance.” You and I both know people who have the courage to drop their lowest-paying insurance. Guess what happens to their whole life? Their margins improve. They are not working as hard. Go figure that there are all these fear-bound industries of ours of, “I’m afraid of losing a doctor referral because if I stop taking UnitedHealthcare and they are used to giving me everything, maybe they will stop giving me everything because I don’t take the crappy insurance.”

I don’t know about the laws. There is a debate on the APTA, which is why I ran for office. I didn’t want to formulate an opinion based on what other people told me. I wanted to work in some service-based capacity with leadership to get my own opinion before I complain about it. Unfortunately, I still can’t do that. I don’t even have an opinion on that piece other than to say that if it is what we have for now, at least it is a good central place to meet.

We have to be a lot more aggressive. That is the big thing that you and I were talking about. When I got on the plane, I was thinking, “We have to get more aggressive.” I don’t know if it means we got to start getting angry. If you could turn all that fear into anger or whatever emotion suits people to take a stand in the way that means something like dropping the lowest paying insurance, that is when we would see results. We were in discussion of doing it together. This is where I don’t know about collusion laws, but what if there was a group out of Arizona that did that together?

If we could turn all that fear into action, if you could turn all that fear into anger or whatever emotion suits people to take a stand, that's when we would see results.
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I’m not meaning to get political, but it exemplifies the point. That is one of the reasons you get a Donald Trump personality. You were talking about anger. There are people who said, “We tried with John McCain and Mitt Romney, who are nice guys, and we are not getting through. Let’s try something else.” The pendulum swung the other way. Not that it is necessarily good or bad, but something like that has to happen. Could it have happened with a different personality type? Maybe.

Things are going status quo. Medicare has come out. They are going to drop their rates by 5%. If you look back over the past several years, it is dropped almost 10% in total. It is going the wrong way, considering inflation. Something has to change. Those same people who have dropped their insurance that we know mutually, their lives have gotten better. I haven’t met someone who has dropped low-paying insurance yet that has seriously regretted it.

Every time they were scared, and it went great, they were like, “I’m such a dork for not doing it.” They end up running way better practices because they change their mindset on it.

The people who have done it, their mindsets are different. Sometimes, it is a step-in faith, but believing that, number one, we are more valuable. We deserve more. You almost have that conversation and talk yourself into that. If you do, that is fine, but do it and recognize that is where you are. Sometimes, those words give you power, especially as you express them more. Dropping them sometimes can be difficult. You have to come up with a letter, but you also have to come up with a plan. What are you going to tell your patients? What are you going to tell your doctors?

That is where the fear stops people. They were like, “I don’t know what the doctors are going to do. I won’t do that.” Let’s face that fear. Once they face that fear and have conversations with the doctors, typically, 90% of them are going to say, “I understand, but we are going to provide great services still, and we are still here. It is just that 5% to 10% of our patient load isn’t going to be seen anymore.” That is what it is.

When you are talking about your lowest payers, it is not 30% of your business. Sometimes, it could be. I do have a friend. It was 30% of his business. He still did it, and things went great because he shifted his mindset, and it took him some time. I was trying to talk him into dropping this insurance for a year and a half before he finally did. He finally shifted his mindset. Things got painful enough that he needed to shift his mindset, but he figured out what the conversation was going to be with his doctors and patients. He made the change, and things turned around for the better within six weeks. It is a simple process if we simply take the time to address the fears that are stopping and limiting us.

This might be a fun theme for us to talk about in a future episode, to bring on somebody who has done it and talk with the three of us about that. Have you done an episode like that?

Probably not. I have talked to Sturdy McKee about it on the episode, but I have a few friends in mind, especially my friend in Las Vegas, who more than likely do it. Steve could talk about the members. I had another client in Tennessee. It was a big headache for him to drop UnitedHealthcare, specifically because he couldn’t find the right person to give the termination letter to.

You can’t fire us if you can’t find us.

He got sent to 4 or 5 different people. He was like, “I’m going to start giving it to everybody but let it be known.”

That reminds me of Ryan Hamilton’s bid on quitting his gym. He has to quit the gym. He is trying to get rid of the gym membership. They were like, “If you want to quit, you either need to come down or you need to mail a letter.” He was like, “No. This is me telling you.” You quit, but you had to go through this process of writing a letter. It is hysterical. You got to check Ryan Hamilton out.

That is how insurance companies operate. My billing company is hysterical. With certain companies, we will send out the claim and the next day immediately send out the corrected claim with all the exact information on it because we already know whatever insurance is going to deny it, saying that it was missing X, Y, and Z, 100% of the time.

PTs usually operate from such a clean, integrity place. They are trying to do what is right, but they end up ruining their whole lives, trying to be everything to everyone, but the insurance companies are taking advantage of that, and they are laughing. I’m not saying the person you call, but somewhere at the administrative level, they were like, “They are willing to take it. We might keep doing it to them because they don’t even say anything about it except for this one guy out of Tennessee or Las Vegas.” When everyone starts doing it, and we all start banding together, like the orthopedic surgeons, they are going to stop laughing and start going, “How are we going to solve this problem? We are going to have to reimburse higher.”

It is funny because he got sent to 4 or 5 different people at UnitedHealthcare and found out he shouldn’t be going through UnitedHealthcare. He had to go to Optum. He finally found the person at Optum. The person at Optum gave him the original 90-day notice. He didn’t change the dates, but on day 89, they finally called him and said, “This is the deal. We are willing to pay you this much.” That raised $15 a visit. He was like, “I took it because I’m going to see what happens.” There were four different UnitedHealthcare plans that you could drop. He is sharing this with me.

This might be regional to Tennessee, Florida, or whatever, but there is UnitedHealthcare, Medicaid, UnitedHealthcare commercial, and Medicare is one department, UnitedHealthcare Workers’ Comp, and UnitedHealthcare VA. He was like, “I keep VA because they paid all right. I dropped Medicaid, and the worker’s comp paid all right. The commercial bumped up $15 a visit.” He said, “I will take it.”

The fact that he did it, you could tell that that gave him a little bit of confidence. He was like, “I’m going to see how this goes. If it gets better and doesn’t give me a hard time, maybe I will keep it or not. I can also drop them now because I know how to do it.” That makes things a little bit easier. Giving that power back to the owner is infectious. They gain more confidence in themselves as an owner, like, “I’m doing what is best for the business. Why didn’t I do this several years ago? I’m going to do more of it now.” That can be helpful. Maybe it is the solution or not, but it is, at least, the stand, and it gives some power back to the owners.

You and I were talking about this concept of purpose and power. When we are on purpose, but we are not getting enough power, which directly relates to influence, i.e., profitability and possibility. What is powerful about money is that when it is taken in the right way by the right leader, it unlocks the possibility to create more good for others as well as their own family and self.

When we talk about PT owners, what a wonderful purpose-driven group that couldn’t want to sell their businesses faster. I did a masterclass at PPS called How to Sell Your Practice for 2 to 3 Times the National Average. I have to be mindful of who goes into that dinner because there is a large percentage of PT owners who are burned out. They were like, “Take this thing off my hands. I want more money for it,” and all these things.

It is because they haven’t had enough power. They haven’t been empowered in their day-to-day career of owning a practice long enough to be able to feel like they can make a difference without sacrificing time from home. To your point, every decision we make that increases profitability increases power and helps us enjoy the purpose-driven work that we do.

Every decision increases profitability and power and helps us enjoy our purpose-driven work.
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Sticking it to the man. It is a common phrase, but in this case, there couldn’t be something more true. There is nothing more suppressive on this earth than insurance companies. Their whole point is to do as little as they can as possible without looking like jerks. When we allow them to take advantage of us, and that is such a big complicated system, it is hard to even point your finger. Going back to your initial thought, “What if the thought was to drop your lowest-paying insurance?” we are not singling one insurance company out, but as an industry, we are reclaiming our power back by saying, “We are not going to take it anymore.”

These guys and girls are owning practices who are reading this blog right now. They don’t even know that they are afraid of the wrong thing. What are they afraid of? They are afraid of everything that I used to be afraid of. I’m afraid of being exposed for who I am, and I don’t know what I’m doing as a business owner. I’m afraid of getting sued by a patient. All these things are legitimate threats, but they are individually not that hard if you are being ethical, you have insurance, and you do the best that you can.

They are worried about getting home in time to see their kids play sports. The big one I hear in coaching is that they are afraid they are never going to have enough time to exercise and take care of themselves. They are afraid of the wrong things. They should be afraid of the fact that where the industry is going right now in several years, this thing that they have killed themselves to build isn’t even going to be an option. If this keeps going the route that we are in for several years, the mid-2030s, there will not be physical therapy private practices that are standalone month pass that can succeed that aren’t cash-based.

Going to Danny Mateo, he is going that route the right way, but it is not going to solve the problem. I talk to those guys all the time. They are super on purpose, profitable, and powerful. It is not going to pivot the industry. It will help. We have to get a full-rounded solution around this. If we were afraid of the right things and if we thought for a hot minute that we were leaders and we could say no to these insurance companies and reclaim that money, there is a way to solve this on the micro level. If enough of us solve that, we could start shifting things on a macro. It is interesting that this is a purpose and power and how money’s about power. PTs are messed up. We are all typically screwed up about how we think about money as an industry.

It starts back in PT schools because if your focus is on profit, you are evil. It plays into our personalities because, as a collective, we are compassionate givers. We want to help. We want to be people pleasers. We want to give out of our altruistic nature of ourselves, and hopefully, we get rewarded because of it. We are not going to claim our treasures on the backs of people who are hurting type of attitude.

We shoot ourselves in the foot because these companies that we are “working with” are collecting $1 billion in profits on a monthly basis. UnitedHealthcare supposedly put out their financials. They made $1.2 something billion dollars in the first quarter of 2022. They made $24 billion in 2021. They are doing pretty well on the back of our caring natures.

We keep taking it, but we don’t even realize that we are taking it. What we think we are doing is surviving because we are busy from day to day that all we can work on is a show like this on the way to work or coming home. That is as much as we can do. It is not a judgment on that busy entrepreneur who fights the fight every day. They are the heroes.

The problem isn’t that they are not heroes. The problem is that they don’t think they are as they are driving to work. They think it is selfish to say, “I’m a leader. I’m a hero. I can change things for the better. I can stick it to the man by rejecting my lowest insurance.” I have heard this from others. It is selfish for them not to recognize that they’re heroes in their own universes. If they deny their own power, they deny all of the parents, teachers, and family members who supported, loved, and helped them become who they are.

When they say, “I am strong enough to make a stance here. I have done the unthinkable, which has opened a low-margin business that rides on my back as an owner. Maybe I can do even more,” they honor those people as they get their profit lineup. It starts in the school system. It is insane. We have our profession led by educators, and by the way, I love educators. They are essential to this journey. Without the right balance of education and entrepreneurship, where are we? All we have is this wonderful standard of doctorate level, which is valuable and important, that is raising the debt to our students $150,000 ahead, who are now leaving the industry in droves.

Without the right balance of education and entrepreneurship, where are we while we have this wonderful standard of doctorate level?
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We are going to get to a point where there won’t be people to hire because no one with a decent head on their shoulders is going to continue in this profession. If we, as entrepreneurs, can take a stance for our practice, if every one of your readers drops their lowest paying insurance, never mind more profitability for their business, more time with their family, and fewer headaches dealing with crazy employees. Every time they do that, they are improving the profession.

The most selfish thing that we can do is to take these low-paying insurances that are selfish. It is so sad. I’m not any better than a $65 visit. None of my team members, none of the impacts of the thousands of people I have helped in the past, I am less than anything else. Every single time we say no, we are standing up for ourselves and all the other PTs in private practice.

It is almost like we, as a profession, have daddy issues. This blog is going to come out toward the middle to end of November 2022. Aren’t you doing something about save the profession?

I was going to bring it up.

Tell me what you are doing. This is going to post facto. How can they get in touch with you post facto if they want to know what you are doing?

What I’m doing is a start, stop, and keep the discussion with whoever shows up. I don’t know who is going to show up. I had a handful of people say they would be there. Let’s see if they have the time and the courage to show up. All we are doing is a town hall meeting as a profession. I have zero interest in trying to make this into a lead generation for one of my companies. My companies are busy enough. I don’t need more business. What I need is the industry to survive so my businesses can do something in several years. That is what I need.

I’m inviting all leaders to be there. I hope you will be there if you can. We are going to do a start, stop, and keep. We start doing as a profession, stop doing as a profession, and keep doing as a profession. I want to see who has the cojones to show up and have this discussion together. We can see who the leaders are.

Network is going to be vital to the net worth of this industry. I don’t think us meeting isn’t an invalidation of the other efforts. I had a chance to get to meet the PPS leaders. Although I don’t know them well, I was super impressed by the quality of leadership in those men and women. I have no show my speech at PPS, which is a big part of why I didn’t win. Look how arrogant I am. I honestly thought that if I showed up for sure, I was going to win. Isn’t that funny?

All I had to do was show up.

I give a crap in a way that I don’t think most people do, and I think it shows. I’m confident that if I had done it. I had this health thing that night before that was insane. I have never missed anything like that. I ghosted them. The way they were generous on the back end of that, I remember thinking, “We got some great leadership here.” Us meeting is about adding additional support to that. If you are a critic or a supporter of that, it doesn’t even matter. Let’s get together and start having this discussion more frequently because it is going to take a village to turn this thing around. I’m not willing to let it go after several years in this thing. I hit twenty years of being a physical therapist in September 2022.

We put many decades of our lives into this industry that we know changes people’s lives. Doctors and ER surgeons save the life. We change life on every level. A good therapist has the patient leaving, saying, “I had as much emotional therapy as I did physical therapy now.” That is what we do. I want to get together in a room of people like you. We solved how to save the profession that day at PPS before I left for the airport and you went to see your son. You and I like broke down all the things that would need to happen and stuff. I’m like, “That is not hard to see. It is going to be heavy lifting. It is going to take a lot of people to do it.”

A big part of it is that we are independently owned. That means you have to change the minds of tens of thousands of people instead of changing a few minds.

There are a lot of cool people who have that mindset, but there is nowhere for them to go. That is what I’m doing. I created this thing on Thursday. It is the PT town hall. It is 4:00 PM Pacific Time, 5:00 PM Mountain Standard and wherever else. I am inviting everyone who gives crap to show up. Even if you don’t say anything, you sit back and listen. Being there physically or virtually is the same thing as taking a stand. It is always the little stand that we take that makes the biggest impact.

Before we drop the insurance, that is hard for people. Those who are reading this were like, “How am I going to do that?” Show up at the town hall. Read this blog continually. Keep reading these because every time you have a guest on, that helps empower people with knowledge. They are getting a sense of power that will help them get the real power of that profitability layer. These little things we are doing are not little. If all they can have time for is a podcast on their way to work or home, that is still taking a stance. Be committed to doing more later.

This is going to be on November 17th, 2022.

Yes.

Are you going to record it? Is that something that you are going to share?

I’m going to throw it up on my YouTube channel. If you want to catch that, go to the Healthcare Business Academy on YouTube. That is my channel where I teach business lessons and stuff around that. I will be putting the information there.

Do you think you are going to have more town halls going forward? Are you going to get a sense of where things are initially?

The vision would be that we have this like kumbaya, rally, and cry. There are leaders with good ideas, there are tears, and someone says, “I didn’t know I felt this way.” We go, “Let’s do this every month.” I thought that would be cool. I don’t know. The calendar isn’t repeating yet because I want to see who is going to show up and what they are going to say. Let’s go to that point and figure it out from that point on.

There is a possibility there. You and I, back in the day, dealt with ASH coming into Arizona and wanting to represent Cigna. That was several years ago. Sean Miller said, “ASH came into Utah in 2021 trying to do the same thing.” Simply by him being there, he was able to share with the other PT owners, “This is what happened in Arizona. We don’t want to do this.” It made significant changes. Grassroots efforts in that regard can make a big difference within the State of Arizona and the State of Utah regarding one particular effort. That is the beauty of it. Starting in November 2022 could be something of a grassroots effort that could make a significant change.

When you say that, it makes me realize the bad situation we are in, and the bad news about where we are is that there are only 23,000 physical therapy owners in the country. That is a big enough number to have to influence but not big enough to where it has major potential. The good news is that there are only 23,000. We could realistically influence the majority of those owners because it is such a small group.

A way that we are going to change healthcare policy as it pertains to private practice is that we need a controlling majority of those private practices to be united in what they do. I got people on my line saying that we should unionize and all these different things. I’m not even close to that side of things. Let’s all have one conversation and create the time on our calendars to do that. We can figure out everything.

We will talk about the other things later.

You and I have ideas, but the path will be crazy, easy, and walkable if we can get everyone on the same step.

I wanted to thank you for joining us. Anything else that came from PPS that was like, “This little tidbit.” Anything else like that?

I do believe that there is more we could do with our industry in terms of these types of conferences. Greg Todd, for example, has one every May, and I love that. We need more stuff like that. It was useful to get people in the room. The content is secondary to me, even though that was useful for a lot of people. The big walkway is like, “We got this.” CSM doesn’t count at all for what this is. There are a couple of companies out there that run some stuff. I did my first in-person leadership summit in August 2022. There are different things that are bubbling up. We need more people stepping up, creating space for people to have talks and discuss this thing.

I haven’t been to these, so I can’t say, but hopefully, they are having these discussions and getting a little bit deeper into the weeds.

One of our coaches, a guy named Chris Smith, was the keynote speaker at Ascend. He loved Ascend. He thought it was a great event. This is a guy who speaks in various industries across the country. That is his main thing. He is a public speaker. He said, “Will, I have never seen a more asleep group of people in my life. I had never spoken to an audience who seemed so unattached and wanted to do the big things that are going to move the industry forward based on how they responded, not just when I spoke but afterward with the individuals who came up to me.”

He goes, “That is incredibly disappointing but also exciting because if you are going to disrupt a space or change it all, it doesn’t take as much energy for someone to step up and be loud because everyone else is being quiet. They are hypnotized by the beat of their own pencil hitting their paper for documenting their notes.”

If you're going to disrupt space and change it all, it doesn't take as much energy for someone to step up and be loud because everyone else is so quiet.
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My takeaway was that you guys are doing great things at Multiple Exit. You are helping owners and seller practices and coaching them up to get more value and, ultimately, a greater sale price when they do go to sell. You guys are doing a great job there between you, Scott, and Michelle. You talked about Healthcare Business Academy on your YouTube channel. Remind everyone what other offers you are providing and the many things that you are doing.

There are a few things going on right now, but the one I want to promote is Multiple Exit. We have had unbelievable success in helping our clients start to realize the true value of their life’s work. If anyone reading is even contemplating exiting their practice by selling it in the next several years, reach out to me. We can do a free assessment of the valuation of their company to give them a sense of what it is worth and what it could be worth.

That gives us a chance to show you a little bit about what we do. We have had a loyal group of clients in that company for several years. We are in a very exciting place to be able to continue to grow. If anyone reading was like, “I want to exit in the next ten years,” you don’t know what that looks like, give me a call. Have them reach out to you.

If they need to reach out to me, Nathan@PTOClub.com . You can find me on the Physical Therapy Owners Club Facebook group or LinkedIn . Connect me with me in any of those ways. I will be happy to make the introduction to Will.

If you reach out to me directly, make sure you let them know that you learned from me on Nathan’s show, please.

Thanks, Will.

Thank you.

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