Disturbing PT Industry Benchmarks, Declining Reimbursement Trends, & How To Combat Them With Dimitrios Kostopoulos Of Hands On Physical Therapy And Diagnostics

Recent changes in reimbursement trends have been negatively affecting businesses in the physical therapy industry. Based on a recent APTA industry survey, the recent reimbursement trends are more dramatically negative than we’ve seen in at least six years. Dimitrios Kostopoulos from Hands On Physical Therapy and Diagnostics shares how his organization successfully dealt with reimbursement challenges and grew its business. Adopting a strategic marketing approach boosts revenue and also fuels business growth. Dimitrios stresses the importance of being deliberate and focused on financial and marketing endeavors, resulting in significant improvements to profit margins. Take advantage of Dimitrios Kostropoulos’s expertise, and tune in to today’s episode!

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In this episode, I’ve got a longtime friend and returning guest, Dr. Dimitrios Kostopoulos. He is the Chairman of the Board of Hands-On Diagnostics and Cofounder of Hands-On Physical Therapy and EMG Testing in New York. Dimi, it is great to have you back. Thanks for joining us.

Thank you, Nathan. Thank you for bringing me back. Thank you for everything that you are always doing in helping our profession get the information that all of us need to improve the conditions for our profession and our lives too.

If people don’t know much about Dimi, you can go back to our previous discussions. We’ve had you on the show 4 or 5 times by now. If you can tell by his accent, Dimi’s not from here, but I consider him the freak of physical therapy. He has had all kinds of leadership positions and has all kinds of relationships and an amazing network in the physical therapy industry.

He knows everybody and has had a little bit of influence on everything. Go back and read those previous episodes. Now, we want to talk about some concerning data that has come out from PPS/APTA KPI studies from the respondents who at least turned in their information because there’s a concerning trend that’s happening since 2022 and into 2023.

Before I even go to that, I want to mention that we see that on a much larger scale now, insurance companies complicate the physical therapy processes, especially when it comes to reimbursement with the purpose of managing to deny claims, ask for additional information, and prolong paying for these claims. It’s because the longer they keep their money, they can take this money and put them now in high-yield money market accounts. They can put them in high-yield US treasuries.

If they pay you three months later than they are supposed to pay you, they have already gained 5.5% in a three-month US Treasury bill that they bought for millions and millions of dollars. They end up making a lot of money like that. The hottest news of the press that we received both from the APTA headquarters as well as from PPS/APTA is the new development with UnitedHealthcare.

UnitedHealthcare released a bulletin through which they require 1) Time in and time out from patients to specifically indicate when the patient arrives in the practice and when they leave. 2) They require very specific information to be listed in the initial evaluation and reevaluation, which is not that bad to list that information. The most important part, which has significant consequences, is the fact that they are now requesting for the provider to get a signed plan of care before they see the patient.

I’m not talking about Medicare plans. I’m talking about general commercial UnitedHealthcare and Oxford Plans. They started requiring now a signed plan of care before you see the patient. What this does is it negates right away what physical therapists have accomplished in the past decade, which is direct access. It’s because if you have a requirement for a signed plan of care, right away, they are denying us direct access.

The only reason why Medicare still requires a signed plan of care in order for you to start physical therapy is that direct access is not applicable yet to Medicare. Medicare is not recognizing physical therapists as direct access providers. That’s why they require signed plans of care. We have made significant strides in the past decade across the whole country winning state after state direct access, which now is being threatened because of this situation. At the same time, I must add that both the APTA and PPS/APTA are in negotiations and conversations with UnitedHealthcare to try to reverse this new development, but that’s very interesting.

It’s disappointing simply because I know the third-quarter profits that UnitedHealthcare posted were somewhere around $25 million in a singular quarter, and they’re making it more difficult to pay us pennies on the dollar. It’s difficult to swallow that. It is the question I have at this point because we’ve addressed it a few times in this show over this year, specifically about dropping some insurance. You hear information like that and you hear about the profits that they’ve made and how they’re going to make it more difficult for us. They haven’t increased flat rate payments for decades in most situations. What is the reasoning behind even keeping that insurance plan at this point?

I think that every provider must sit down and make a very important evaluation in regard to their cost per session and evaluate how they treat and deal with each insurance carrier. I will tell you something that we have done in our practice. Although most of our practice is in New York State, which is one of the states with the lowest reimbursement, at this point, we are in the upper percentile of average reimbursement per session. We have increased our reimbursement from $60 to $65, up to at this point, the mid-$90s, which is a very significant increase in average reimbursement.

That’s a 50% increase.

I will tell you how we did it. There are two ways that we implemented it. You know our involvement with diagnostics, and I’ll talk a little bit more about that at the end. What we implemented was the establishment of three tiers of insurance, tier A, B, and C. The first thing we looked at was what our cost per session is. We established that first. We then went and identified what is our reimbursement rate per insurance.

Can I ask you what your cost per session is? Are you willing to share?

It varies from time to time, but I will tell you that our cost per session now is in the mid-$60.

If I were to guess, that’s about right. I would think that’s about average, maybe even across the country. It depends on demographics, salaries, and whatnot. Even in Arizona, which is quite a distance from New York and different payer mix or whatnot, I believe that we were losing money on that $65 flat rate payment that UnitedHealthcare provided us by about $3 or $4 a visit. I don’t think I’m far off if I’d said that most of the industry is somewhere around there or maybe even into the $70s a little bit.

We are in the low $60, maybe $62, $63, or somewhere around there now, but here is what we did. For insurance that would pay us more than one standard deviation above our mean, I will calculate what our mean is and the standard deviation. If an insurance, for example, would pay us $80-plus, that insurance, I would put it in tier A. I would have insurances that are just above the mean as tier B. Insurances that are hovering at the mean or below, I would put them on tier C knowing that if I see that insurance, either I break even or even maybe I will lose a little bit of money from that.

You’re not making a profit.

Exactly. What was the mechanism for this? As an ethical business, we did not discriminate. We did not say, “If we accept the plan, we have to see a patient.” However, what we did was this. We identified what percentages we got of tier-A insurance from referral sources or other avenues of marketing. If these 20, 30, or 50 physicians refer patients to us, the preponderance of their patients that they refer to us tends to be tier A, so we intensified our marketing to those physicians.

Hands On Physical Therapy And Diagnostics did not discriminate as an ethical business. We did not say if we accept the plan; we should see a patient.
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We then looked at what is our marketing strategies like social media or direct-to-consumer marketing. We identified, “What age populations, what specific demographics, what financial brackets of people, and what areas that people leave would give us the most tier A referrals or patients?” and we loaded our marketing towards those areas.

What happened then is instead of having the vast majority of patients, either tier B or tier C, we started having the vast majority of our patients, 75% or 80% of our patients on tier A, and then the remaining patients were tier B and tier C. That’s something interesting, and that’s how we increased significantly our revenue per visit.

The transition from $60-something on average to greater than $90, what was that timeframe? How long did this take you?

It did not take an awfully long time, but I would say a bit over six months that the conversion was made.

You didn’t drop any insurance at all?

No.

You focused your marketing efforts only on those higher payers. Did you essentially eliminate marketing towards the tier Cs then?

Exactly. Eliminate marketing or a patient would have to wait for two weeks before they came in because, simply, our schedule was full. There was no availability. Let’s take an example. Dr. Smith sends us 80% tier A patients and 2% tier C patients. I don’t want to go through the process where I say, “Dr. Smith, by the way, we no longer accept this plan, that plan, or the other plan,” because I don’t want to disappoint them.

Instead, I will continue seeing that 2% of tier C plan patients, but maybe they’ll have to wait longer to get into the schedule, especially if all of our marketing fills the schedule with tier A patients. It’s a natural change that happens in practice. You don’t do anything unethical or something. It’s that you see the numbers changing because of where you put attention on.

Would you give those tier-A patients preferred eval times? Maybe they can get in a little bit faster than the tier C patients?

Not necessarily. We did not want to follow a discriminatory policy in our practice. If there is a physician who sends you tier C patients and you stop going to visit them, some other physical therapist will go visit them. Also, they will start sending patients to the other physical therapist. I am very happy if other physical therapists are very busy with tier C patients. I have no problem with that, but in our practice, we do anything possible to get more tier-A and B-type insurance.

Because of our marketing efforts, some other physical therapists will start sending patients to the other physical therapist.
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It was all about your intention with your marketing strategy. Number one, you had a marketing strategy, or at least you had some marketing efforts happening. You then were taking that marketing strategy and pouring gasoline over on this section and not the whole thing. It’s not a matter of volume at that point to everybody, but volume directly and specifically focused on that tier-A demographic.

Anybody who is reading this, I want to caution them on how they calculate that because it’s not simply enough to say, “Insurance A pays me this much money more than Insurance B.” Let’s say that insurance A pays you $100 and insurance B pays you $85. Naturally, you may think, “I will take more insurance A patients instead of insurance B.” Instead of looking only at reimbursement from insurance A per session, I encourage you to look at reimbursement per minute.

Why? It’s because there are insurances that would pay you $100, but their policy and requirement, in order for you to make $100, you have to be with the patient one-on-one for 100 minutes. I’m trying to make it simple. We’re making $1 a minute. Let’s say you make $100 for 100 minutes, that’s $1 a minute. You also have another insurance that pays you $85, but let’s say the legal requirement for the time spent for that patient is only 30 minutes. When did you make more money? $85 divided by 30 is now $2.83. You made almost three times as much from that patient despite the fact you got paid less so you can fit more patients.

As you’re doing these calculations, was there any preparatory work done in terms of, “Were you confident? Did you trust that your providers were billing the maximum amount for the therapists for the services they provided?” One of the issues I see commonly with clients that I work with as a coach is that their therapists are underbilling. That’s the tendency of most physical therapists. I like to call it compassionate billing.

If they’re going to go one way or the other, they’re not going to try to maximize and document all of the services they provide. If there’s a question at any time, they’re going to cut the units down and get paid less. Was there any work done beforehand so that you were billing for everything that you could maximally?

This is an internal systems issue that needs to be corrected in practice, and even when you correct it, you cannot just let go. You have to continuously look at improving conditions in regard to that. It has to do with education and culture. I do not want unnecessary codes or billing done. I’m not talking about overbilling. However, we try to educate therapists to bill for all the things that they do.

You have to continuously look at improving conditions regarding the internal systems issue that needs to be corrected. It has to do with education and culture.
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What happens is that, for the therapists, it’s not that they don’t do enough stuff. They just don’t code right and don’t interpret right what they do in order for them to bill it. It’s not a matter of them doing the right thing or not for their patients. The vast majority of therapists do great things for their patients. It’s that they are not educated enough on how to write that in a proper manner.

If you take, for example, a specific exercise that has a balance and proprioception component, and you then end up billing it with 97110 as if it was a therapeutic exercise, which you are going to bill with anything else instead of billing it for 97112, it needs education there. It’s not education only selecting the proper codes. It’s education also on how to phrase or how to write the note of what you are doing and how you document it properly.

That’s why I liked the conversation I had a few episodes ago, and I know you shared it with the Hands-On Diagnostics Community with Prediction Health about how now, there is an AI system that can teach your providers how to document appropriately for specific exercises and code them appropriately. As you went into this effort to see, “What are my tiers A, B, and C?” you had a culture. You had confidence that your providers were billing well. You had provided that education. They knew the difference between certain codes and how to bill and document them correctly.

They also knew the difference between AMA versus Medicare billing rules. That was all already understood. I fear that some readers might look at this like, “I need to get into Dimi’s and follow Dimi’s program and find my tiers A, B, and Cs without doing that initial work”. It’s because I think there’s a lot of money left on the table. Probably at least a 10% to 20% increase in revenues and profits if they simply did that pre-work in billing correctly.

If you don’t mind, Nathan, I would like to share the KPI numbers that we’re talking about. This is from the KPI study of PPS/APTA for 2022. A big acknowledgment to PPS/APTA. I encourage every single person who is reading now, not only for you to become a member of the APTA and the Private Practice Section of APTA, which provides huge and amazing resources for your marketing and education on how to successfully run a physical therapy private practice. Also, I encourage your participation in the annual key performance indicator data that provides you not only KPIs for the entire nation but also, compares your individual data with your regional and national data.

However, you can see in the data that we’re going to focus on the average and the median. In terms of visits per new patient, the vast majority of practices are doing about 12.1 to 12.9. The average is 12.9. They do around 12 to 13 visits per new patient. What you were saying before is important. They are doing 3.6 to 3.7 procedures per visit. This would be your units per visit. I can see that for 2022, the median revenue per clinical hour was about $108. That’s the median. However, the cost per visit, which is the national average, is $91.59. This resulted in only a net income of 7.2%. The median was 7.2% net income.

That’s a horrible profit margin. You don’t want to be in business at 7%.

Absolutely not because of a hiccup from Medicare and a sneeze from UnitedHealthcare, all of a sudden, you are in negative territory. That is a big problem. You can see here that practices that were on the 75th percentile and above had a better number at about 15.9% to 16% of profit margin. Also, the practices on the lower percentiles were down to 1.8%.

If you remember, for the whole of 2021 and part of 2022, whenever I came to your show or I gave other webinars, I was always discussing the whole situation about Medicare, the changes in reimbursement models, the reductions of Medicare, and other insurance carriers that followed reductions. Here is what I’m going to share with you, which is very staggering and worrisome.

I have a net income history nationwide from 2016 to 2022. In 2016, it was 13.6%. Yes, I understand that in 2017, it went to 10.6%, but then let’s look at 2018, 2019, and then 2021. In 2020, there was no study done because of the pandemic. In 2018, 2019, and 2021, the net profit was averaging about 12% to 12.5%, and look what happened in 2022. It’s 7.2%. We had a drop of five percentage points.

If you multiply that by what it represents in terms of actual dollars, it is very significant. This is why it is very important for physical therapists to make the right choices about what insurance they accept, to make the right choices about what patients they accept, or what billing their staff members are doing but also, look at how to expand in other practice areas that can be significantly more profitable than just their PT.

It’s a disturbing trend because you would imagine that there were between 100 to 200 respondents in the survey. You would imagine that those are probably the better owners.

They are the cream of the crop.

The numbers are probably skewed in a positive direction because of the surveyors that are churning in data. The ones who don’t have good numbers are probably embarrassed, don’t have the time, or are too busy to turn in that data. They’re probably skewed upwards, firstly. Second, I was way off. I thought maybe $70 cost per visit would be the national average. That data shows me it’s $90 to $100 per visit. Even the 75th percentile clinics, I noticed that their average cost per visit was over $100, but they combat that by getting revenues that are averaging $114 per visit or something like that.

You can see that even in 2023, the first quarter financials that were released with some of the big physical therapy publicly traded companies like ATI and USPH, you are going to see that some of them had negative margins. Those who had positive margins were in the 3% or 3.5%, and that is also worrisome.

I’m thinking there’s this confluence of the effect of issues that are coming down on the physical therapy industry, and we’re not alone in that. Whether it is inflation in and of itself or the cost of team members, there’s been a rush out of the industry of 20,000-plus physical therapists from the industry, so it’s hard to find a therapist. If you’re going to do so, you’ve got to pay more significantly. Also, the insurances are making it more difficult as evidenced by UnitedHealthcare’s stance, and this confluence of issues has made it more difficult to generate a profit.

Definitely, and I will tell you that one of the bigger problems is, on the one hand, you have that reduction of reimbursement. At the same capacity, you have increased payrolls. That is a very important component. If companies used to spend for payrolls 55%, 60%, to 65%, and now, they end up spending in the mid-70% on their payrolls, that is very significant.

Seventy percent of your gross revenue is going towards payroll and I can see where your profits get lost, essentially.

I want to give you more specific data. In the first quarter of 2023, payroll expense as a percentage of income for USPH was 68%. It was nearly 70%. This is pretty significant.

For those owners who are reading, what we’re talking about is a key data point in your profit and loss statement that you might want to review with your bookkeeper or CPA. You told me what your number or your target is for this. If we could get our payroll numbers, including benefits, paid time off, or salaries, and everything related to payroll to 50% to 55% of gross revenues, then we were doing well. We were generating a nice profit. That was a sweet spot. If you got below 50%, you had an amazingly productive month. We aim for 50% to 55%. When it started getting pushed towards 60%, then we saw a serious squeeze on our profits. Do you see the same targets for your company?

I’ll tell you that when it comes to the retail industry or other non-service-to-consumer industries, their payrolls are about 33% to 35%. With the pandemic and all that happened, they went up from 40% to 42%. In a service-oriented industry, service delivery is always somewhere around 50%-plus. With the pandemic, these numbers went higher. In the physical therapy industry, we’ve had a massive exodus of physical therapists from the profession.

There was not enough physical therapist produced every year and, at the same time, a tightening of the immigration policies that allow less physical therapist to come into the United States. There is a great demand for staff and payrolls have gone significantly up. You asked for our figure. We are in Q1 of 2023. We were at 57.16%.

Our numbers are a little skewed because we are 57% payrolls compared to income revenue, but our revenue is the combined revenue of physical therapy and diagnostic testing. It’s not only physical therapy. Our average reimbursement is significantly higher if we combine the diagnostic testing revenue together with the therapy revenue.

I want to talk about that, but I also want to highlight your focus. You started this focus on marketing towards tier A, B, and C a few years ago. Since doing that, you had a focused expansion strategy targeted around this as well in such that you’ve opened a number of clinics based on this strategy. Tell us about that a little bit.

What we ended up doing is since we had identified those tier-A insurances, before opening a new clinic, we started looking at the demographics. In specific areas, we were looking at opening clinics to match the demographics of people having tier-A insurance. This way when you open in a new location, we have two advantages. 1) The new location is in an area where we’re going to have a greater percentage of tier-A insurance. 2) From day one, we implement diagnostics in that new location. If from day one, my average reimbursement per session will end up being $130 something or $140 per session, if I combine the diagnostic testing and PT, then you break even much faster than if you did it without a strategy or a method.

That blew my mind because that was the first time that I’d heard about focusing on the higher payers. In general, when you talk to small business owners, you talk about the importance of focusing on the top 20% that provides 80% of your business. However, you took it a step further in your expansion. What was mind-blowing to me is that, “This is the demographic, and this is where they live. Why don’t we open up a clinic over there where we see more of those patients?”

Instead of doing things randomly, you can have a strategy. You can have a plan and implement that plan, so thoughtfully, you take action.

Instead of doing things randomly, you can have a strategy. You can have a plan and implement it so thoughtfully you take action.
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I have to ask because I’ve been a big proponent of simply dropping the lower payers. What keeps you from simply dropping some of those contracts altogether?

We have dropped some payers. I would say those were the payers where they were more than one standard deviation on the left. They are below our mean. I’ll give you an example. Let’s say my cost per visit is $62. There is insurance that will pay me $60 or $58 where I know I’m not going to make a profit. I’ll make it up from some of the higher plans. This insurance, although it’s not going to generate significant profit for me, I see that as an investment in the relationships I have with the physicians that I serve.

That would be under my tier C category, and I’ll see sporadically a few of these patients. It’s not going to hurt me, but if I have insurance that would pay $34 a visit, and believe me there are plans that pay $34 a visit, I’m going to drop that plan because it will require significant effort for that insurance such a lower payer not to hurt me. It will take up too much of the higher-paying insurance to make up.

What has been your success in negotiating for higher reimbursement rates? Have you gone that route as well?

We have, but we have not done enough of that. I am not going to consider myself an expert on that part yet, at least. When I have some better successes on this, I will report back to you. I do know a few people who have done that successfully. We’re in the process of working in that direction.

When you say adding diagnostics to your care or your episodes, in most situations, are you doing EMG, MSKUS, or both?

Here is a general concept. Out of 100 patients that you see in a general physical therapy clinic, I’m not going to say that does not apply if you have a practice that is 90% pediatrics, 90% stroke victims, or something like that. It’s not what I’m talking about. I’m talking about your general physical therapy practice, where you have orthopedic and pain management cases. You have sports injuries and elderly people too.

With that combination, with that general practice, out of 100 patients who come to your clinic, about 70% of them would qualify for you to perform a musculoskeletal ultrasound, whether to look at some muscle, tendon, joint pathology, or a neuro ultrasound where you look at the integrity of a nerve. For an ultrasound, the nationwide average reimbursement for two units of that will be about $180 to $200. It will take you fifteen minutes to perform that.

Out of 100 patients in your practice, about 35% of them would qualify for you to do nerve conduction and EMG study. For nerve conduction and EMG study, the national leverage would be about $500. You do the math. You have a patient that gives you $100 per physical therapy visit, and you do an average of twelve visits. For twelve visits, you make $1,200. Let’s say you added one extra visit where you did a combination of EMG and neuro ultrasound, that single additional visit will yield for you $700. All of a sudden, for a patient where you got in twelve visits $1,200, meaning $100 per visit, now for thirteen visits, you got $1,900, which represents $146 a visit here. It’s a big difference there.

Your average reimbursement goes significantly up with the incorporation of diagnostic testing. It is, at this point, our model that we are not opening new physical therapy practices unless we are able, from day one, to implement diagnostic testing in the practice. It’s as simple as that. If I implement the diagnostic testing, I’m going to be able to break even faster, and I’m going to be able to turn around and make a greater profit faster.

What’s the trend that you see with musculoskeletal ultrasound? As someone who knows the diagnostic side of things quite a bit, the barrier to entry for EMGs can be difficult. It’s not easy to become ECS-certified, as someone who’s been through it, but musculoskeletal ultrasound has a lower barrier of entry. You can implement it faster. They are faster tests to do in general. I’ve been saying it for years and it hasn’t caught fire yet, but it’s starting to in terms of the trend for musculoskeletal ultrasound in a majority of PT practices. What’s your feeling about that?

First of all, when Hands-On Diagnostics was created in 2013, the first thing we did at the beginning of 2014 was that we ran a nationwide study or survey where we surveyed physical therapists around the country about their knowledge if they knew what EMG and what musculoskeletal ultrasound was, and if they knew that the PT is able to perform these tests.

Ninety-seven percent of the PTs had no idea about that. Only 3% of the industry knew about that and the ability of PTs to perform that. In our HODS Symposium , I’m going to announce the outcomes of the new nationwide survey many years later. I can tell you that the difference is striking. Physical therapists now are a lot more aware of the fact that they can perform these tests and they can get paid.

Musculoskeletal ultrasound can be learned very easily. Hands-On Diagnostics has a fellowship in musculoskeletal ultrasound, which you can complete the fellowship within six months, and you do it in your practice. There are nine days of education that you do over a three-day weekend, and then mentorship and reports that you do with the help of a mentor.

It is very natural for a physical therapist with the knowledge they have of anatomy and all that to navigate towards musculoskeletal ultrasound. We see also that the APTA and PPS/APTA are embracing more and more the performance of diagnostics by PTs. I believe that very soon it will be one of the gold standards within the physical therapy industry.

I like to compare it to dry needling where dry needling, many years ago, no one had any clue what it was, and now it’s fairly ubiquitous across the industry. I have a feeling ultrasound could be the same. It should be the same, especially if we want to be primary care physicians or primary care professionals.

Especially if you consider that you can even do dry needling under musculoskeletal ultrasound as guidance, and there is a special code that pays physical therapists for the guidance of the needle. It’s greater accuracy and greater reimbursement too.

One of the things I know that we need to focus on as a profession is getting Medicare to recognize our ability and making that part of our scope. Do you think we’re close?

Do you mean on the musculoskeletal ultrasound side?

Yes.

At this point, there is one of the Medicare intermediaries in the country. I think it’s Noridian.

They’ll pay us for ultrasound up here in the West, but in the rest of the country, they won’t, and that’s striking as to why. I’m worried that the rest of the country’s going to put pressure on the West for Noridian to not pay it. “You guys should pay for it too.”

The opposite happens. Although I cannot speak of information, I know that is more on the APTA side. Perhaps at some point, you can have a guest from the Government Affairs Department of the APTA to talk about this. I have to tell you that the APTA is in the process of working towards the complete and full reimbursement of musculoskeletal ultrasound by all Medicare intermediaries across the country.

Dimi, we’ve spent a ton of time talking about some disturbing trends, but also how to combat them.

At the end of the day, these insurance companies play a game. In a game, the first thing you need to know is the rules of the game. You have to know the rules of the game in order to play the game right. Every game will have barriers and it will have freedoms too. Both of them are needed for the game of life. Without having some barriers and some challenges, we’re not going to have freedoms and wins on the other side. If you also consider that happiness, or at least one of the definitions of happiness, is the overcoming of known barriers in life, then we have to see these barriers. We learn the rules of the game, we play an intelligent game too, we win on the other side, and we’re happy.

Insurance companies play a game. You have to know the rules of the game to play the game.
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Thank you so much for sharing your knowledge. Thank you for all that you do in the profession, for standing up for it as well, and for what you’ve shared with the community at large. Thanks for your time. I appreciate it. What’s happening in the near future with you? How can people get a hold of you? Tell us a little bit about that, Dimi.

The first amazing thing is that on September 16th and 17th, we have the 10th annual HODS Symposium. Your readers can get 50% off the tickets for the symposium. The symposium is Physical Therapy: A Primary Care Profession – The Role of EMG & MSK Ultrasound Testing. It takes place in the amazing Clearwater, Florida at the Sheraton Sand Key Resort waterfront.

If your readers go to HODSSymposium.com and they plug in WELCOME50, they can claim 50% off of the ticket. People can also get in touch with me by going to CallWithHODS.com and they can book a meeting with me. Also, there’s a phone number there, (888)-447-6014. This is the contact info.

Again, thanks for coming on. I appreciate it.

Thank you. Take care.

He also serves as a Clinical Affiliate Professor at Florida Atlantic University. Dr. Kostopoulos is also an adjunct faculty member of Springfield College in Springfield, Massachusetts, where he teaches the clinical electrophysiology module.

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