The Money Talk – How To Handle A Patient’s Money Conversations In The Clinic With Dee Bills Of Front Office Guru

The money talk can frequently overshadow the great work physical therapists do. No matter how great the person at the front desk sells and schedules physical therapy. Yet, they can’t collect everything owed with the service. In this episode, Dee Bills of Front Office Guru emphasizes the need to hire and train their personnel to become comfortable with the money talk without sacrificing the financial welfare of the clinic. She shares how to handle and talk with teams about the conversation and upsets about money. It starts at the top, confirming the value of the service, addressing the “baggage” that people bring about money, and ultimately doing what’s best for the patients and clinic. Optimize your front desk with Dee Bills!

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In this episode, I got multi-time guest Dee Bills, Owner of Front Office Guru , joining me again. Dee, it’s good to see you again. How are you?

Nathan, thank you so much. I always love these conversations. I am doing well, focusing on my program and platform. I enjoy myself.

You’re making a lot of changes. We’ll talk about Front Office Guru and what you’re doing here in the near future. I love having you come on because you’re the one person I can talk to that is immersed in the front desk. There’s always something to improve at the front desk typically. Everyone’s dealing with it but not a lot of people are talking about how to resolve the issues at the front desk and what we can do.

I highly recommend people look back into our past episodes so you can learn a little bit more about Dee and where she’s coming from. She is a physical therapist by trade and is focused on Front Office Guru for several years. I’ve been doing shows for years and you’ve been a part of it. If you don’t know much about Dee or Front Office Guru, look at her website. In short order, Dee focuses on improving the front desk at every physical therapy clinic across the country.

That is the goal. My mission is to help you to help more patients. That’s where this comes from. As a PT, helping more patients has always been my focus and goal. When I can help your front desk to manage people better, then they can help more patients. You don’t have to suffer the effects of that empty schedule or lack of collections.

Some of the important topics that we’ve discussed in the past episodes have been important KPIs surrounding the front desk and how to find the right front desk person with the right personality, characteristics and traits. Do you remember what else we’ve covered?

I don’t know. I had that open because we were doing some work on the website. I was like, “What was it that Nathan and I did?”

Those were the last two topics. They were super important.

Those were the two big ones. I don’t see it. I had just it open. In 2022, it was finding the ideal person. We did another talk on hiring or maybe managing your staff. It was something like that.

It was probably something managing, like how to manage them.

I don’t know. Go check it out. It’s pretty cool. We always have so much fun. That’s my favorite thing here. I always have so much fun doing these talks with you. We should do more.

I’m open to it. I get excited because I always like talking about money. At the front desk, so many transactions are happening. The money is not passing hands between providers. It’s not passing hands between the owner and the front office manager. The techs typically aren’t involved unless they’re helping at the front desk. There is so much that can happen simply because we’re talking money that at the front desk, those patient care coordinators or whatever you want to call them have to be capable to have solid conversations around money.

With the way you put it, there’s a button for everyone. There’s something emotional and psychological. This isn’t musculoskeletal. There’s something around money that has to be addressed first with the front desk so that they can handle it appropriately and then with everyone else on the team. That’s why I’m excited to talk to you about money and how to handle money at the front desk. Where do you want to start?

Think back to when you were a PT and you were treating. You were a new grad. Did you come out of school like I did? You were there to help people. You were so excited to help. I don’t know about you. I know when I graduated a million years ago, I had this belief that I’m there. I was like, “You should come to me because I can help you.”

I was the opposite. I was so scared someone was going to figure out that I had no clue what I was doing. I was there to help. I looked at other providers. I’m like, “You guys are amazing. You help people. I’m a sled that’s trying to get by.” I was so scared to see a new eval on my schedule. I then started getting results and I’m like, “Maybe I do know how to do some stuff.” When patients had positive results, I was as surprised as they were.

Don’t get me wrong. I remember being a new grad. I’ve been around for a long time. It is probably almost 30 years as PT. As a student, it is 35 years if I look at my career as PT. The biggest thing that’s changed is the conversation around money. You’ve got inflation at its very highest. You have reimbursements that are probably at their lowest. You have patient responsibilities also at, in most cases, the highest it’s ever been.

We could do a whole conversation on how corrupt the insurance system is and my passion for that but it is a button. Anybody could push your button on money. Anybody could push my button on money. When I say button, think of that big red button that causes a physical, mental and emotional reaction that a patient or someone else could have around money. Money elicits multiple emotions. Think about it. If you find $100 in your back pocket, how are you going to feel?

It changes my plans for the weekend.

If I pull a purse off the shelf and there’s $20, I’d be like, “It’s party time. I found $20 I didn’t know I have.” It can also elicit a negative reaction. Think about a time you got a bill that you weren’t expecting. How did you feel?

I was like, “Not again.”

That is probably the lightest reaction. For some people, it elicits the feeling of fear and tears. If you’ve ever gotten a healthcare bill or a car repair bill or you came home from vacation like Mike and I did one time and your refrigerator decided that was the moment that the hose on the back was going to leak all over your brand-new hardwood floors into your basement, it can elicit an absolute ruined feeling finding out that you have to pay for something that you didn’t think you had to pay for or maybe yet, you didn’t think you needed to pay for. Think about that negative reaction. That’s the one that most of us worry the most about when we’re talking to patients.

I recognize as I had to look for front desk people, it starts with that front desk person being confident enough to talk about money. If they have buttons and triggers or whatever you want to call it regarding money, then you know that they’re going to handle it in kind with the patients for whom they’re asking money from.

Think about it. Across the country, it varies but let’s say you’re paying someone $20 an hour. They have to look a patient in the face and tell a patient that that patient has a $100 or $50 even per visit charge that can come into play. We spend so much time at the front desk, all of us, worried about what a patient’s going to do or say when we tell them that we’re out of network or that they’re going to have a $4,000 deductible. Yet, the biggest thing we should be looking at is our staff because that’s where this conversation starts. It doesn’t start on the receiving end with the patient. It occurs from what comes out of your team member’s mouths. They have to feel good about it. They have to leave their stuff at the door and not bring their emotional reactions to this discussion.

Think about what it does for the negative effects of not being able to handle the money conversation at the front desk. Copays and deductibles aren’t getting collected at the time of service. The front desk personnel will think, “We’ll collect it on the back end.” You and I both know that you’re getting dimes on the dollar for every collection that doesn’t happen at the front desk. It gets worse over time as that goes on. It not only affects the front desk but also the providers. They’ve got a button themselves. If you’re like me as that new grad, I don’t know if I’m worth the $50 copay for each visit. I honestly could see myself questioning that as a young therapist. Thus, I’m going to change my plan of care.

You can’t afford it so you’re like, “I’m going to go 1 time a week instead of 3 times a week with your plan of care.” We all know that one-time a week physical therapy does not create significant changes in most people’s lives in the musculoskeletal. It changes plans of care which then negatively affects the patient. Their patient recognize that physical therapy has little value because my plan of care was less than it should have been. It’s all because we couldn’t hold the money conversation.

There’s a huge impact on the ability to handle money as a staff member. As owners, we have to have a strong belief and comfort around the topic of money. What are we worth? It doesn’t matter if you’re in-network or out-of-network or cash pay. Money becomes this thing that sits there. Think of clinical. One of the policies we have in our practice is you cannot alter your integrity and education for what a patient says. If you, as a provider, tell me, “It’s going to be fourteen visits,” you have to stick to that belief.

You cannot alter your integrity and education for what a patient says.
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That’s in spite of any objections and the financial situation. That’s what’s in the best interest of the patient.

That’s the other good thing. I’m glad you said that. That’s the button kicking in. If I have a button on money, the objection I’m going to throw at you is, “That’s so expensive. I can’t afford twice a week.” I could, at that point, say, “I don’t have enough time to do twice a week or three times a week,” so then it carries over across all of us. If your clinical staff alters their plan of care and they’re like, “We’re going to drop her down because she can’t afford it,” and they don’t handle that objection or they’re not comfortable handing that objection, what happens is they fall into agreement with that patient.

As you were saying as a new grad, you worried about your worth. One of the things we see a lot with PTs is where they fall into that agreement of, “We’re going to do twice a week.” They fall into that, “Three weeks in, we’re going to put you on a maintenance plan because you could probably do it at home.” They start to agree with the home exercise program. That’s where we get muddied as to what we do as providers.

I got this from Shaun Kirk. He said if overtreating is unethical and you know the plan of care should be 14 visits or 3 times a week and because of financial objections, you cut it down to 1 time per week, that is equally unethical. If you know their best results are going to come from 3 times a week or 14 visits and you sacrifice that because of money, you are practicing unethically because you are going against the best practices that you know of. That’s what’s in the best interest of the patient.

Your job is not to say, “I can do it in fourteen visits.” It’s not to negotiate. You’re not there to negotiate, “Maybe I was a little bit too high. Maybe I could get you in eight visits.” What is it? Is it 8 visits or 14 visits? If you sacrifice the patient’s capabilities to improve and get maximal results by treating less, it’s an unethical decision that you’re making.

It devalues us as providers. It creates confusion. You’ve got this patient that you told 14 visits, 16 visits or whatever it’s going to be and then you start to allow them to barter with you. We’re not in a bartering system. I went to school to be a master of my craft. The minute I allow a patient to tell me what they’re going to do, I’ve pretty much sacrificed my integrity, business or work ethic. I will be the one that suffers the effect of it. The patient too that’s quite obvious but I will suffer the effects of that.

The financial effects.

I don’t know about you but I didn’t learn any of that in PT school. I learned it from the school of hard knocks. I am the type of person that will handle it with patients. For some PTs, like the new grad you described yourself as being, you have this question of worth but you still want to make $90,000 or $100,000 a year. The PT has to understand their contribution to that but they have to feel comfortable saying to a patient, “This is what it is.”

Here’s another part of that. Let’s say I’m evaluating you and I tell you it’s going to be fourteen visits. You’re like, “I can’t afford that many. There’s no way.” I hear this a lot in practice. They’re like, “What if we start with six?” As the provider, I barter with you. I’m like, “What if we start with six visits? We get you to a point and then continue.” As a patient, how many visits did you hear this is going to take?

This is going to take six visits.

We get to visit 5 or visit 6. What happens around visit 5 or 6? What goes away?

Some of their pain.

As the pain’s going away, what is this patient thinking? They’re like, “My pain went away.”

They’re like, “You said six visits. I’m done, right?”

They’re like, “I’m almost at six visits. My pain has gone away.” It does predominantly go away between visits 5 and 6 for most orthopedic patients. You’ve got this patient whom you bartered for 6 even though you said 14. They forgot about 14 because they only scheduled 6. The patient gets into this conundrum. It doesn’t matter if it’s your front desk that has to have this conversation or the clinical or both. The objections go through the roof. They’re like, “My pain went away. I don’t need any more visits.”

They’re like, “I can do all these exercises at home. I’ll keep stretching and exercising. I’ll get that range of motion back. I know what to do next. Maybe you give me the next few exercise progressions and we should be good.”

You have a PT who didn’t handle the objections upfront that sets themselves up down the road to have more objections to handle. There is a psychological part to that evaluation that you do have to show this patient. It’s not just evaluating a patient. There’s so much behind that. They can’t just evaluate you.

We’re using the number fourteen only for example purposes. You’re not picking the number fourteen out of mid-air where you’re like, “Let me pick a number between 12 and 16. Fourteen is right in the middle.” You have to show there’s reasoning behind it. That’s where you come up with your whiteboard, knowledge or pictures and explain, “This is why.”

Patients have a reason to buy in. Patients don’t care about their range of motion. As a PT, you evaluate me. I’m only at 90 degrees of shoulder flexion. You know where you got to get me. I don’t care. What I care about is I want to be able to pick up my grandchild. It could be I want to be able to go play lacrosse with my son outside and get that shoulder back. At fifteen and I know you probably have teenagers in your household, they hit that stage where they stop talking. You have to find a PTS to find a reality point. If they don’t, they got to talk about money. They’ve got their objections to money. Maybe they think they’re not making enough.

I’ll tell you. I have a $4,000 deductible. In 2023, Anthem decided to add a 30% co-insurance to that plan and raise our rates. I have my financial nightmare. Two of my children are on my insurance so we have a $4,000 per person deductible. That is a button that bugs the crap out of me with the whole health insurance thing. You got patients who have that.

We can’t alter our integrity and what we do. The minute we agree with somebody else’s choice even though we know it goes against our own, as providers or front desk, that’s our ruin. That’s where turnover happens. That’s where so many PTs became dissatisfied. I can almost guarantee you why so many PTs became dissatisfied with outpatient orthopedic PT. It’s a failed purpose.

This is the number that I use all the time in these talks. If I can’t get you to do fourteen visits, I start to barter. I sacrifice my integrity there. I get to those patients that I haven’t shown the purpose of doing these exercises with me so I fall into that agreement of, “You could probably do this at home.” Eventually, you become dissatisfied with what you’re doing. There’s a case of ruin around not being comfortable handling that. It’s such a far-off topic.

You focus on the front desk. We can start there. Let’s get down to brass tacks. How do you start this conversation with your front desk to be more comfortable around money conversations?

There’s a lot in that. The first thing is looking at them and finding out what their comfort level is and what their button is on money like you’re hiring. A great hiring question is to talk to somebody about, “How do you feel talking about money to somebody? How would you feel telling me that I have a $4,000 deductible and a 30% co-insurance? You’re in that moment telling me based on reimbursements that I’m never going to hit the point where the insurance kicks in.” You have to have that conversation.

I was going back and forth with a client’s nurse manager/patient care coordinator. They’re out of network. One of my questions to her was, “How do you feel when you have to tell somebody that they’re going to be out of network and that they’re going to be paying $150 or whatever it is for a visit?” I’m waiting to hear back from her. She did message me back. I’m going to listen to it later. It’s helping them to look at that. That’s one.

I’m glad you brought that up as part of the hiring process because you don’t want to have these conversations post-hiring. Most of the people reading have already hired the people but you can start having a conversation like this. If you’re in the hiring process, I love this as well because I would have the same conversation or the same question for the candidates that I’m interviewing. I would ask them how they handle asking for money.

There are two personalities and you can add to this, that seems to have done the best for me in collecting money at the front desk. Number one is the person who’s able to objectify it. She keeps emotions out of it. She’s like, “This is your plan. You signed up for this. This is what you have.” It’s not a reflection on us so she is able to put it outside of herself.

She’s like, “This is not me. This is you. I’m telling you your plan benefits as a courtesy. What you have if you’re one to receive our services is blank.” She is very flat about it. She has no emotion. She communicated the data and that was it. She was awesome about it. If they didn’t pay or didn’t want to pay, she said, “You owe this. This is what your plan is. Take it or leave it,” is where she went with it.

This is the second personality type. I love these front desk personnel because they thought that what we were doing in the back office was straight-up miracles every day. They were so bought into physical therapy and physical therapy that we did particularly. Sometimes, they were past patients of ours that came back around or had physical therapy in the past.

They believed that physical therapy was straight-up magic. It was the best thing in the world and everybody needed it. They couldn’t understand why you wouldn’t pay for it when you would pay for your kids to do it. You’d pay for your dog to get the therapy that they needed if they were injured but you won’t pay for it for yourself. They were over the moon excited about the services we provide. Those are the two personality types that I’ve found worked best for me.

It goes along with all my training and other things I do. Number one, how do you feel about leaving your beliefs at the door? That first person you mentioned, he or she could be like, “I may not be able to pay that. I don’t bring my worries into that conversation.” That’s something you see very commonly. We can talk about what you will see as an owner when somebody’s uncomfortable talking about money. That is one of the things you see when people bring their baggage. If I bring my crappy deductible, co-insurance and nightmares to the conversations I have with a practice owner, a patient or whatever I’m doing, it’s like I’m creating a barrier right here before I ever get started.

In the second person that you mentioned, you brought up another great question that you can ask somebody that you’re hiring for your front desk. “Have you ever had physical therapy before?” You don’t stop there. You don’t go with a person who goes, “I had physical therapy before.” You got to find out how well that physical therapy went.

If they weren’t a patient of yours and you can’t follow that process of, “She had the best experience ever. She refers 80 people to me,” and it’s somebody coming from somewhere else, we could go into a whole conversation about that. There are a lot of factors why people stop physical therapy. It’s not that the PT sucked but you can bet that’s the story you get from that patient or that person at that moment and you won’t know.

It’s always good to say, “Tell me. Have you ever had physical therapy before?” They’re like, “I have.” You’re like, “Tell me about that. How did it go?” They’re like, “I had this ACL tear. It was the worst thing ever. I didn’t think I was ever getting back to sports, life and this and that.” They were kings. That is exactly what you’re saying. It’s not that they have this innate belief. You can also find out, “Have you had PT before?” Here’s another one, which is, “Have you ever had an injury that you didn’t handle?” Think about it. It’s the reverse of that too.

Here’s the thing. I’ve had people that worked in my clinic at my front desk years ago. They would come in with a back problem or a hip problem. We’d be like, “Free care. Schedule yourself an hour. I’m telling you as an owner, put yourself on the schedule.” If you’re a crappy patient or you keep complaining about that problem and you are not handling it, you’re not going to handle somebody else on that problem and show them. There are a lot of ways you can get super creative on this. There’s a psychology behind it. For those of you PTs like me that hated your psychology class at the time, it’s going to do you some good here.

If someone at the front desk can’t handle the money conversation well, collect the copays and coinsurances when they’re supposed to, collect the deductibles upfront, have the conversations without giving in on the plan of care based on financial issues that arise and can’t have that conversation but do a lot of other things well, would you let them go?

It depends on what your staffing looks like. We have levels at our front desk. If we’re fully staffed, we have multiple levels. If you’re a new hire, there are things I’m going to get you through. My ultimate goal is that all of my staff would be level three. Meaning, you can handle everything. You have to look at, very often, if somebody can’t talk about money. In many ways, they end up being their destruction. It’s like the conversation I said.

Do you mean it starts showing up in other things?

It’s like a failed purpose even as a PT. I look at things in reverse. I want my front desk or your front desk to be superstars. I want them to feel as good as I would want my clinical staff because they have a huge role in helping people.

You want them to love the job and that they align with the purposes.

They do have to not only leave their issues at the door but also be very comfortable talking about them with a patient and not becoming the effect by whatever the patient throws at them. In PT practices, we don’t have that witch behind the window. We legitly have people who are very caring and fit our vision. We have to be careful with that as well. I don’t promote the witch behind the window but we have to have a balance.

They could be too compassionate and that’s where we get bit in the butt. That’s what we’re talking about. You sacrifice the 3 times a week for 1 time a week because you care enough to take that into consideration. That compassion hurts everybody. Physical therapists like to be people pleasers.

Part of it is that true care and desire, we have to separate the two. I can love you and care about you but I have to look and keep my true purpose, which is to help you recover from that injury. Your front desk has to have that belief as well. Here’s another great question you can ask an interview or current staff. In my training, I talk about this.

Think about it this way. I don’t care who it is in your practice, whether it’s clinical or front desk. If I allow you to not schedule and arrive and it is an allowed thing because there is a way to handle everybody to keep them from canceling and all of that, but if I allow you to do that and I’m giving that up to you, you stop seeing the value of PT.

Also, it almost becomes a fail because I know I’m supposed to schedule you three times a week. It’s also the money conversation. If I allow my money issues to come into play, it’s the same thing. I don’t handle your upset or whatever about money but it is doable. Think of it this way. If you don’t get the help you need from us, where are you going to spend your money? Think about it.

I was at a boat show with Mike. We were wandering through, having a fun afternoon and dreaming of these million-dollar yachts that happened to be there. There was a dude there with the massage guns, the powerful ones. He’s like, “All of you boaters that have back pain, I got this $150 product I’m going to sell you.” The thing people have to understand is somebody will always spend money to solve their problem. They are going to spend it. They can either spend it with you where you know you can help them or buy a bunch of crap that sits on a shelf that may make them feel good for five minutes but doesn’t solve their problem. Most front office staff say that.

I like the verbiage on that. How do you handle this issue with the front desk person to start with? How do you train them to handle that button?

The first thing you have to do is to listen to them. Be up there. Be present. Better yet, you pretend to be a patient. Have them explain the cost of care and benefits to you. Before you even role-play, it truly is listening. Stop and listen to your front desk. I sound pretty confident. I’m pretty confident in myself but let’s say it’s not me. It’s somebody else and they’re like, “We verified your benefits with Anthem. According to Anthem, you have a $4,000 deductible and a 30% co-insurance. The good news is you don’t have any authorizations or anything that you need but it’s going to cost you between $100 and $132.52 per visit for therapy.” Did you feel the problem in my voice right there?

Listen to your front desk. Be up there, be present, or pretend to be a patient. Have them explain the cost of care and benefits to you.
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Yeah. You assumed I had an issue with it right off the bat. Here’s the other thing. A lot of people don’t know the difference between deductibles and co-insurances. If it’s me coming to you, I’d be like, “Tell me what I got to pay.” I know what the verbiage is. Most patients might know what a deductible is but they don’t know what the co-insurance means and how that affects them and that kind of stuff.

I love what you’re saying. If the front desk doesn’t know how to explain the difference between a deductible, co-insurance and co-pay effectively like you’re being confident about and then they’re assuming right off the bat, “This is going to cost you a lot of money and I don’t think you can pay it,” that’s how you came across.

That’s the baggage coming out of their mouths. You are a CEO. This was very real to me years ago. We had this guy. He came in. He needed it three times a week. His doctor was adamant. The dude needed shoulder reconstruction. We were going to start with him from day one passively. He didn’t care. This was how it was going to be.

I tell this accolade to other people. It’s my little story. He gave my front desk this whole whiny thing on, “I can’t afford this.” They jumped to, “What if we do a payment plan?” I don’t recommend that either because the minute you become a payment plan, you become the bank. I don’t know about you but the last I check with PTs, we can’t afford to be the bank either. Not only do we have to listen to our staff but we also have to give them the right scripting and the right education for handling those objections to money and being able to recognize it.

Here’s the other thing. It’s not just how I explain it to you. I have to sound confident. I’d be like, “We went ahead and verified your benefits with Anthem. According to Anthem, you have a $4,000 deductible. The good news is you’ve met $1,000.52. According to Anthem, you don’t have any authorization required so we’ll be able to treat you for this problem and get you the care you need. I do want to let you know that we will be collecting at the time of service. We’ll be collecting somewhere between $100 and $132.50. It will be based on the plan of carrier provider creates and what they do with you during that visit to help you and your problem.”

It’s the difference between uh or um, which is very common. It needs to be a good relationship. They need to sound confident. I didn’t give you a problem there. It’s like your first employee. I smiled. It wasn’t a problem. It was a little bit of a party but not in an obnoxious way. I gave you the data. I can’t stop there even though I was confident with what could happen to you as a patient.

There could have been any range of reactions.

Your front desk has to learn what it means for money to be a button, not just for themselves. They’re like, “I got these employees. They don’t have a button on this. They have no problem talking about it and collecting it.” They have to be able to recognize when the patient in front of them is having a moment. Some people get quiet when it comes to money. Some of us have to wander to the waiting room for a minute and think it through.

I had this happen when I blew a tire on my car. They told me I had to replace all four. The blood drained from my face. I looked at the young lady and I was like, “I’ll be right back.” I wandered outside for a minute, took a deep breath, looked at what I could do, walked back inside and we were good to go. Often, the minute a patient has a reaction, if they’re not well-trained, the front desk takes a step back. They panic with the patient. They’re like, “What do I do with this person,” or maybe their objections or worries start kicking in.

They either backpedal or get defensive. Either one is bad. The last thing you want for them is to get defensive in an argumentative.

There has to be this happy medium. They have to know what to watch for and wait for. You cannot solve a problem. Think about a time you’re in a panic. I don’t care what it is. Think of a time you’ve stubbed your toe or burned your finger. What’s your first reaction when that happens?

It’s anger.

Does everybody in your household rush to solve your problem right at that moment? Do you want them to?

I’ve got a bunch of teenage boys. They don’t care.

They’re sitting there and texting. You don’t want them to solve your problem. Let’s say you burn your finger. You don’t want somebody rushing to you and solving your problem. You need a moment to have a moment. Why do I say that? That’s what the patient’s going through. Their staff has to know the symptoms, what to recognize and when and what to say next. It’s not like, “Let me rush to offer you an appointment plan. That’s what you got to pay.” There’s a happy medium there. That’s part of sales.

The leading part of sales is relationship building, which is another thing I teach. I teach how to develop that relationship so they are more on board with you. There’s that big money objection of, “How do I recognize it? What do I do to handle it? What don’t I do?” I never go, “You have to pay. Let me give you a payment plan.” As owners will tell you, there’s a specific reason why when you bill on the backend, it takes so long to get paid. Do you know what it is?

What’s that?

Think about it. If you get billed a month after you finished care, what have you forgotten about?

The value that you received.

You might be happy with the clinic. Nobody’s saying you’re not. You get this bill. What do you do with it? You pull out your drawer, stuff it in it and get to it when you have money. You’re not pressed to pay like you would be as you’re seeing benefits. Let’s say you’re a patient who dropped out of care because you weren’t happy for whatever reason. Often, it’s the patient’s compliance that’s the problem. When you dropped out of care, what’s your attitude when you get a bill?

When I get an $800 bill, I’m like, “I didn’t even go.”

You’re like, “Forget them,” and that bill takes forever if you get paid on it. We’re not even talking about the people who are masters at getting out of collections, payments and stuff. All of that stuff plays into how your front desk has to understand all of it. It’s not like, “Collect money.” They have to understand that they might have a reaction and to watch for it. They have to be comfortable watching for agreements they might fall into.

Better yet, they have to know how to present the cost of care and be prepared to handle your objection with the right tools because that is not a think-on-your-feet kind of thing. The average person and this is owners and staff alike, does not think well on their feet when a person boxes at the cost of something. There’s that too.

I was going to ask that. The training that you provide I’m sure helps because you have scripts and that kind of stuff on handling these kinds of objections. That training shouldn’t be relegated to the front desk. There needs to be training and conversations like this with the providers because they’re going to see the same objections.

Many times and you’ve experienced this as well, the front desk gets all the blowback from the financial conversation. When they come back and see us, they’re like, “What’s happening?” It’s a party. It’s like nothing happened at the front desk. They get crapped on all the time, especially because they have to deal with things.

I can see at that initial evaluation and maybe even into it a little bit if they have large copays and deductibles, there’s going to be a point at which they say, “This is going to cost me a lot of money. What can we do?” Your training would be important in that situation not just for the front desk but also for the providers because they need verbiage and practice. This doesn’t come naturally. It’s one thing to be objective and emotionless when you’re presenting your plan of care but you care and you want to help. The immediate fear is, “If I don’t give in, I’m going to lose the patient. They’ll go somewhere else.” The knee-jerk reaction is, “I’ll take it in short so I can keep the patient.”

Both sides need that training. That’s one thing I learned in the school of hard knocks as a clinician. It was a blow to me for every patient I ever lost. It’s lost and not dead. When they didn’t want to come back to me, it would be a blow. I had to learn very quickly that it is about value. Your front desk is super important to your practice because they’re the ones that create the initial value to get a patient to show up for an eval. They got them to show up. They got to handle that administrative task. They have to be skilled and be able to identify.

Here’s another one. They have to be good at identifying when a patient’s going to drop out due to the cost of care or whatever other value points we’re talking about because they need the PT or OTs time to sit down with that patient. Your treatment can’t be like, “Let me provide this care and tell you these exercises.” Your PTs have to be focused on every treatment with a focus on value.

Value comes from patient goals. Who gives a crap about the range of motion? They don’t give a crap about motor control, strength or endurance. I’ve worked with every avenue of PT practice at this point. They know their COP is going to be there forever. They want to know, “Can I walk to the bathroom,” and make it there without dying or having to stop 84 times. From a PTs perspective, it is like, “Can I get back to playing a sport?” It could also be from an ortho perspective. PTs have to learn what value is to a patient. Value is not like, “Let me tell you about this exercise.” Value is tying this exercise to every goal you have. It’s not one visit.

Value is tying this exercise to every goal you have at every visit.
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I recognize that providers have to reiterate that each time they come in. They’re like, “Do you remember when you started and you couldn’t do that before? Now, you do this.” The patients have short-term memory loss. I see that sometimes. You have to remind them, “When you came in, you couldn’t feel that. Your pain was 8 out of 10. Now, you’re telling me it’s 2 out of 10 50% of the time. That’s a huge jump. It only happened since we started therapy.” You do have to show that to them on occasion. You have to not only provide the value but then, you also have to speak to the value in every visit.

All the time. If you want to keep them vested through a plan of care, your front desk has to manage them. You do need to get paid for that. You have to bring it back every single time like, “Do you remember when you told me that you wanted to be able to play lacrosse with your son?” They’re like, “Yeah.” You’re like, “How’s that going?” They’re like, “This weekend, I got it back but my shoulder is hurting today.” I have something to talk to you about that is related to our agreement point. That’s a sales point.

I love working with the front desk. That is all I do all day long. It is all about helping them to develop relationships and not have that lightweight conversation with a patient but manage patients and get the patient to believe in them and trust them. The clinical side has a big role in that as well when it comes to money and they might not want to. They don’t have to talk about money. PTs should never talk about money. As an owner, if you’re treating a patient, you leave it for your front desk. Train them well enough that they could handle whatever comes at them and not have to push it back on you as well. That’s the goal here.

I love that you stated that here at the end because I agree. The providers should not be negotiating their plans of care and the financial situations at the initial evaluation. Like a doctor prescribing a medication saying, “You need to take this twice a day for the next two weeks,” we should be prescribing physical therapy. We should be like, “You need to come and see me 3 times a week for the next 4 weeks.” No doctor is going to say, “You can’t afford it so take one pill for the next week and we’ll see how you do. Come back and we’ll maybe change things around.” You need to prescribe it like a medical provider so you give them that.

I love the way that you said they shouldn’t be having the financial conversation. If they have financial issues, they need to then go talk to the front desk about that. The front desk then needs to be prepared to handle that. A good front desk will be trained on the financial policies of the business, which means the owner has to have already laid out the financial policies of the business and what tools the front desk can use at the front desk to help those patients that have financial issues. I’m glad you shared that at the end that these conversations shouldn’t be happening in the treatment room anyways.

You need to focus on the patient’s goals. If you muddy those waters, it makes it so much harder to have that conversation. You’re like, “You’re concerned about the cost of care. I’m going to have you talk to one of my care coordinators. Before we’re done today, I’ll let them have that conversation. Let’s focus back on your goals today. How did you do with X?” It is all about their goals. The money is a reward.

Here’s an interesting way to look at it as a PT. The patient should be rewarding you in the practice for the good work you do. If you’re doing crappy work, I can understand why somebody’s like, “I don’t want to pay for that.” Any outpatient PTs that are private practice or smaller practice, for sure, are vested in their patients. I don’t know too many patients’ PTs that are crappy. It’s truly about help. You should stay focused on your patient goals because the payment is a reward for what you did. Look at it that way instead.

Stay focused on your patient goals because the payment is a reward for what you did.
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The last thing I want to say about it is you talked about value. Therapists have to recognize their value. The front desk needs to recognize the value that’s being provided in the back office. It starts at the top. We didn’t talk enough about how owners need to value what they’re providing to the community. If the owners don’t believe strongly that their clinics are providing great value to the patients and the communities that they see, it’s going to be hard to push that down the organization. If they don’t truly believe it, then the provider’s going to be like, “The owner doesn’t. He’s not collecting copays. He is treating people for free all the time.” They’re going to question the value they provide.

If the front desk sees that, then it’s going to be hard for them to toe the line. They are the front lines of the effort. It’s going to be hard for them to say, “You need to come in three times a week.” The patient has some kind of upset so they go back and talk to the provider like, “He’s having an issue with three times a week.” The provider’s like, “Maybe I’m not so valuable. Go ahead and make it two times a week.” Are you valuable or not? I can see how that question of value needs to start at the top and be pushed down into the organization. Hopefully, it’s not pushed. Hopefully, they all buy-in. They shouldn’t be forced on anyone.

When we talk push though, we’re talking more about how we’re pushing that message down, not shoving you.

It’s promoting what we’re doing through the organization as a value.

It can be hard sometimes because owners get a lot of stuff pushed at them. They hear from people, “I want to make this much money but I can only do this.” The owner can fall out of their integrity as well. I remember Mike hiring a PT one time. I was like, “We paid how much money for her?” Anytime there was a patient that needed to be seen and her schedule had an open spot, it was going to her.

You were like, “We’re going to fill her up.”

It wasn’t to be rude or disrespectful but we all have had those moments, I’m sure, where we’ve fallen prey to the, “I need somebody so badly. I’ll do whatever.” It does come from the top. You and I, in a lot of our background training, learned that the only way a business is ordered is if it comes down from the top. The owner, the CEO, the president or whatever you call yourself, you have to be the one that establishes and holds that in. That doesn’t mean you can’t hire coaches to help you to do that but at the same time, it still comes from you. If you’re giving a mixed message, there’s that as well. You end up with problems that you don’t want or somebody handing you their problems.

We could go on forever but we can’t.

I know we could. You and I have the best conversations. We land on these crazy tangents. Even though we plan at least an idea of what we’re going to talk about, we still get on crazy tangents of the best conversations. Thank you for that. I enjoy every minute.

We hit everything that we wanted to as well. Tell everybody a little bit about Front Office Guru and what you’re doing. You do handle these things with the training that you provide to Front Office teams. How do they find you? What are you doing?

Front Office Guru has shifted its model slightly to provide training across all different avenues for offices. I got started doing only one-on-one. There are a lot of practices out there that want something where they can stick even more consistency and use it from team member to team member. I have online virtual training for your front desk where you can get started right away. You can assign your staff seats to this course that I have. You guys can either focus on the entire path from start to finish from the first phone call through a fully scheduled out, managed, handled plan of care preventing drop-offs.

You can say, “I got to handle this one problem.” Cancellation is a big one. They jump to that first. There’s no control over it and no limitation but it’s consistency. If you have a staff member that leaves so what? Remove him from the academy and assign that seat to your next staff member. I don’t punish for turnover. That would be great for me but painful for everybody else. That’s not what I want to do.

The virtual academy is designed to provide a consistent message for your team and give them the training they need to handle. This is one tiny piece of what they have to handle every day. That’s what we’re here to do. They can check me out at FrontOfficeGuru.com. If you want more information on the academy, you can also look at FrontOfficeTraining.com. That is my baby.

That’s awesome.

Thanks.

It’s great to have you on again. We’ll be coming back to you again sometime in the future.

You know I love it.

Thanks again. I appreciate it, Dee.

Thanks so much.

These systems have provided our practice the opportunity to expand without Mike and I having to do all the work and spend endless hours working in the practice. My front office systems have improved new patient conversions, patient arrivals, schedule efficiency and collections beyond industry standards which has allowed him to focus on his dream and not on crunching numbers. ​ In 2016, I realized how much I missed helping others and I founded Front Office GURU. My mission is to help other private practice owners achieve similar success in their practice by training their front office staff and offering consistent systems to install in the practice.

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The post The Money Talk – How To Handle A Patient’s Money Conversations In The Clinic With Dee Bills Of Front Office Guru appeared first on Physical Therapy Owners Club.