Squeezing More Profits From Your PT Clinic – FB Live Event With Nathan Shields And Adam Robin

With declining reimbursement and the effects of high inflation, it is getting more and more difficult for PT owners to squeeze substantive profits from their clinics. Thus, they have to be more diligent about monitoring and optimizing their cash lines—over-the-counter collections, average billed amounts, collections efforts, etc. In this episode, a recording of a recent Facebook Live event, Nathan Shields and Adam Robin of the Physical Therapy Owners Club discuss what owners must do to increase cash flows. Should owners implement some of these changes, they will see substantive changes in their company and its bank accounts. Stop struggling with squeezing profits from your business and start increasing cash flows today!

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Welcome to the Physical Therapy Owners Club podcast. I’m your host, Nathan Shields. I have my good buddy, Adam Robin joining me today. How are you feeling?

I feel supercharged. I had some extra cup of coffee today, so you guys are in luck. I live in South Mississippi and we had a cool breeze this morning, so I’m fired up. Fall is coming.

I’m feeling good getting back into business. I spent some time out on the river. I caught a couple of silver salmon with my good friend Jacob from here in town. I got to enjoy Alaska. We are getting into it. Let’s talk about money. As you said, I love Will Humphrey’s quote, “Profitability unlocks possibility.” It’s worth talking about in the physical therapy space because a couple of episodes ago, I had our good buddy, Dimitrios Kostopoulos join me. He shared some of the data from APTA about not just reimbursement rates but also profit margins decreasing among physical therapy clinics nationwide.

Not just mom-and-pop physical therapy clinics, but profit margins for the publicly traded physical therapy clinics as well are decreasing. That’s a first in a trend. They were never quite increasing significantly over time, but this is the first time we have seen a precipitous drop. It’s important that we talk about money because some people maybe in academia or the theoretical sphere want to demonize the profit goals that companies and individuals might have. If we don’t have the money and the cashflow, we are not making any difference in the world. It’s hard to do that. We can’t all serve like Gandhi and expect to make significant changes in our community. It doesn’t happen that way. At some point, people need to eat and achieve some goals. To provide our services, we have to get that exchange

We need three things to run a business. We need a lot more than that, but my framework is you need people, purpose, and profits. We have to build a company, an organization, or a team that serves people. In this profession, we are in the relationship business. If we are not focused on people, then we are in the wrong business.

The purpose is the emotional driver that unites us and the profits are the fuel, the gasoline, or the coal that you put into the engine that pushes the engine down the road. Without profits, you are not going anywhere. If you are a practice owner and you are running a profitable company, you are probably one of the best business owners in America because the margins are so thin and you have to watch every penny. Congratulations if you are doing that, but if you are not doing that, you can make money in this game. You just have to be very intentional about it. You have to measure it and know where it’s at and how to focus your attention on getting it.

It’s interesting that you brought up purpose, profits, and the connection between the two. It was from a podcast a long time ago and I know it’s one of Eric Miller ‘s presentations about what to do in a cashflow crunch. All of a sudden, your bank accounts are dwindling and you don’t know why. It will go straight back.

The first thing you do is to reengage with your purpose. What is our purpose? Get the team bought into that purpose and you have to start there from a foundation. Are we on the same page? Do we all agree on blank that this is why we are here and that we want to make a change in the community? Do we all agree on that?

Now we can move forward. Now you can start inspiring people. You can start talking to them about what needs to be done next to create a greater impact in the community, how that translates into greater profits, and how that benefits them financially if they are living that purpose to a greater extent than what they previously were. You can then move forward and start monitoring your cashflow lines. The people who are touching the money lines and your connection to revenue have to be monitored on a regular basis. How long have you been in ownership, Adam?

Five years.

Have you experienced maybe some dubious employees who have taken advantage of siphoning money off of your clinic yet?

Yes. Money is such a dirty word. It’s such a mean thing. I’m recalling so many stories I had in the past with such employees. Especially new grads come out of school and they have been taught for three straight years that you must protect your license. You must protect and guard it with your life and save it in a safe place. Don’t do anything risky because if you do, you are a bad person. Some of that is valid.

They will also use the refrain, “If you are in this industry to make money, think again.” Did you hear that one?

“We didn’t become PTs to make money.” That’s a hard thing to combat as an owner because you have a team who now believes they are trying to guard everything they do to protect their license. They are not willing to do anything “risky” according to them. They are always going to shy on the conservative side of things, which makes it very challenging.

They understand the negative implications of overbilling or over-collecting because that’s unethical and you can go to jail. That could be considered stealing. That’s all true, but nobody ever talks about the negative implications of underbilling or undercollecting. Nobody wants to have those conversations, but the truth is we devalue our profession. When we undersell our service, we have less buy-in from our patients. We are robbing the company of profitability to help support the vision and purpose. It’s a challenge for business owners.

We devalue our profession when we undersell our service.
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I love that concept that you bring up because when you are talking about grifting, siphoning, and “stealing,” there are the front desk people who might slide a twenty here and there. They are out of the copay drawer or the copay box. When you bring that up where you are losing most of your money is not from people taking cash here and there and putting it in their pocket. It is from providers who underbill.

I had Shaun Kirk on a few years ago and he talked about it, and I agree with him. If you are doing these two things, you could consider them unethical as well. That is if you know as a doctor of physical therapy that this person needs 3 or 2 times a week physical therapy and if they came 2 to 3 times a week, that would get them better and faster, yet they put up some kind of financial concern and you alter the plan of care to come in one time a week. You know they would do better at 2 or 3 times a week and you might not even be able to make as much of a difference in a shorter period of time if you did one time a week.

To go with one time a week is unethical because you know better. You are the doctor and you need to hold them to 2 to 3 times a week. What they do with it is up to them, but you can’t adjust your plan of care, which is in the patient’s best interest to satisfy their financial concerns. A doctor cannot tell a patient to have their prescription medications and expect the same results because that would be unethical. In the same vein, physical therapists who don’t sell a plan of care that’s appropriate for the patient to get better and faster are unethical. That’s number one.

Number two is they give away free services by not accounting for every minute that they provide skilled care to that patient. They are not accounting for it all and documenting appropriately for it. That also is unethical because who are they stealing from at that point? They are not losing any money on their salary. They provided all the services, but they were unwilling, lazy, naive, and ignorant. Maybe they are stealing ignorance, but the fact is that they don’t know how to bill appropriately and support their billing with proper documentation to support the care that they provide.

Err on the short side, and as you said, bill conservatively to keep their license. We are going to cheat the owner and the business to make us feel better. That’s unethical as well. Let’s provide the best care that we can, but bill for it, document it appropriately, and be strong and confident in what we did. Let’s not shortchange anybody.

Let’s get paid the most we can possibly get paid.

You can’t bill conservatively and then complain that reimbursements are going down. You can’t bill $85 per visit and then complain, “Why did my reimbursement rates go down from $192 a visit?” It’s because your providers are underbilling. They are saying that that’s not what their services are worth. At some point, you have to stop and take a stand, train your team inappropriately, and get them up to speed on appropriate sales of the plan of care, which you and I discussed right here in the last few episodes of how to sell a plan of care and mastering that skill, but also how to bill and document appropriately for their services.

I’d love to hear your feedback, but most of the owners that I talk to understand that’s important. They understand that billing is important and getting their team behind that is important, but they are too fearful to have open conversations about it directly with their team. They don’t want to be perceived as a person who’s just after their money. They haven’t figured that piece out.

That’s where you have to finally stand up as an owner and take leadership. There’s not a lot but there are resources. Rick Gawenda is probably the main resource in this regard regarding billing and documentation appropriately for plans of care. I came across Anthony Maritato on YouTube. He has a library of videos on billing for physical therapy. I reached out to him a few days ago. Maybe we will connect and do something on the show as well, but there are resources out there. There’s not a lot, but there are compliance programs. BCMS, how to bill documents appropriately. They will audit your charts. You name it.

It’s at that point where if there’s a concern and you know you can do better, hopefully, either by listening to the podcast or working with your coach, and if it’s us, we are going to tell you that’s where you have got to spend the time as an owner with your admin time to learn this stuff. Maybe you don’t have to learn it. You don’t have to be the expert yourself.

You need to know your way around things, but your job is to find the resources. Correct me if I’m wrong, but in a situation like this where you are training on billing and documenting inappropriately. Honestly, we are trying to get providers to up their charge per visit or up their charges on a regular basis. That could have come across poorly because providers could think you are all about the money.

I would recommend finding the Rick Gawenda and Anthony Maritato videos and letting them do the teaching. Get the third party to talk about it. Help them understand. 1) Find the resource to get a third party to do it, and 2) Make the connection between how increasing our charges per visit feeds into our purpose as a clinic or as a profession.

I love what you said about step one is to get agreement around the purpose. If you read the book Crucial Conversations , they will talk about this a little bit because this is a crucial conversation. It’s a risky conversation. You are about to have an uncomfortable conversation with your team about money. It’s a delicate space.

If you read that book, they talk about the first thing that you need to do or one of the first things that you need to do is you need to create an area of common ground. You need to create an agreement that we can leverage as context. We are going to create this agreement first before we move forward. That agreement is that money matters. It’s important to what we do, and we have a responsibility to provide the value that justifies the amount of reimbursement that we get.

Can we agree on that? Can we agree that money matters and that we are willing to provide the value that’s needed to justify maximum reimbursement? You have to get that agreement first. We have to have people who say, “I agree with that.” Once we have that, we can move forward with how we are going to do this together. Tying that to the purpose is important. It’s a scary conversation to have the first few times you have it, but once you have it and you create that culture, you only have to have it a few times.

I remember having a guest and I forget his name. He said, “Sometimes we lose sight of the fact that the patients that come and see us are sacrificing a lot to come to physical therapy, a lot of the times.” There are plenty of people who don’t have a lot going on in their schedule and so physical therapy, they have the time to do it.

Number one, they would rather be doing other things. We should understand that and that their time is sacred. There are plenty of our patients who don’t want to be there. Their time is sacred in that maybe they are taking time away from family, friends, hobbies, work, and childcare to get to physical therapy on a regular basis.

We have to understand that they are sacrificing all of this to come to physical therapy 2 to 3 times a week. They want to get better, but most people would rather take a pill than come to physical therapy. No one wants physical therapy. They are doing all this to come to physical therapy. Maybe not in the best mindset to even get there the majority of the time. In that mindset, it is our responsibility as physical therapists to provide as much value as possible in every single visit in which they come.

That’s demonstrated by not only the results that they get but also by the charges that we bill for. We should be providing and appropriately billing for as much physical therapy as we possibly can provide because that’s in the best interest of the patient, and also be respectful of the time that they sacrifice to come.

I cannot agree more. We have to agree to that.

I got off a call with Travis Robbins of Next Level PT. A good guy. I have known him for a couple of years and they are starting to do some collections and billing stuff. He said, “Without a doubt, the owners that know their average reimbursement rate per visit and know their average build units per visit are usually miles ahead of all the other owners in the room.

Correct me if I’m wrong, in your experience as you are coaching PT owners, but mine is they are not sure about the first number. They have a ballpark idea. It’s somewhere between $80, $90, or $95 per visit. When you ask them, “What is your average build per visit?” That’s a tough one. They don’t know that one. They assume, “Somewhere around $400.” When they see it, it’s somewhere below $300 or just above $300.

Those owners that are measuring their financial key stats are the ones that are usually doing pretty well because that which gets measured and reported improves exponentially. If they are measuring that, they are probably measuring a lot of other good factors and key indicators in their company. For those financial metrics, those guys are usually doing pretty well.

I knew we were going to get to the measuring part eventually. I also find that some people don’t want to know. They think they want to know, but once they realize that they have a problem that needs to be solved, now it’s objective. Now they are accountable, but it takes some discipline to measure these stats because the stats tell the story.

I tell my directors, “Manage by the metrics. Stop being emotional about the decisions that you make and make objective decisions consistent with our values.” If you are not measuring things, then you are making emotionally-based decisions and you are not clear on the outcome that you want. You have zero control over the outcome. Measuring skilled units is an important stat. Not only that but measuring your over-the-counter collections because that’s another window in which money is generated throughout the revenue life cycle.

Stop being emotional about the decisions that you make and make objective decisions consistent with your values.
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Something that shocked me when I ran a statistic is the percentage of gross income that is over-the-counter collections. It’s north of 20% in my practice. Twenty percent of income is collected over the counter. That is a chunk of change. That is huge. Some people try to look at that as a tip. It’s like, “You did a good job. Here’s a $20 tip.” That’s part of the piece. If you don’t collect that 20%, you are not even making a 20% percent margin in your practice.

If I was running a physical therapy practice, which I am, I would be looking at every single penny that comes over the counter. I would want that reported to me every single day. I would want to know exactly. It’s not that hard. You look at your schedule. There are ten patients. You add up all the over-the-counter collections for those visits, and then you measure what’s collected versus what was expected to be collected, and you will have a percentage. It should be 100% every day. If you are at 60%, 70%, 75%, or less, you are looking at thousands of dollars that are missing from your bank account at the end of the month. It’s very important. We don’t have the flexibility to be flexible at that touch point. We have to collect every dollar that’s owed.

It was a billing company that shared with me a long time ago that for every dollar that’s not collected at the time of service, you are losing immediately within the first month $0.35 on that dollar. If you don’t collect it within that next month, you are losing 50% of that dollar. It’s imperative to get it at the front desk. That means your front desk person has to be dogged, detailed, and good about having financial conversations with the patients and it’s not emotional. This is an agreement that the patients have with their insurance company.

Not you. You are just a conduit. They need to be clear to say, “You have a $20 copay. How would you like to pay? Can we possibly collect the $20 copay? Would you mind paying that today?” It’s not a yes and no question. You don’t have an option. You are paying it or not. “You are paying for it. How would you like to do that?”

Most owners know that. They know that they should be collecting over-the-counter. If you ask most owners, they will say, “We collect it,” but do you measure it?

How well are you collecting it?

I bet you are not collecting as much as you think you are collecting.

You are right. There’s so much I learned over the years and I’d gone at least ten-plus years without measuring the day-to-day over-the-counter collections.

It’s hundreds of thousands of dollars.

I don’t like to think about it anymore.

Could you imagine where you would be now?

Seriously, there’s so much money. It’s a simple spreadsheet. You have a template. You have the patients that are coming in that day. How much is their copay, co-insurance, and estimated deductible per visit? Figure out their estimation. Collect the deductible upfront per visit. Please do it. Do whatever you have to do to talk to the patient and train the front desk, but collect it upfront so you are not chasing money on the backend. You are losing money as you do it.

If I’m not mistaken, most EMRs have the capacity to keep credit cards on file at this point. There might be a few out there that are struggling. If your EMR does not do that, then there are third parties that will help you do that. Merchant service accounts that will save the credit card information on their software. There’s no excuse to not keep credit cards on file. As you do that, it’s easy to collect the copays, co-insurances, and deductibles. You just say, “You are here. I’m going to charge your credit card on file.”

“If you have a cancellation policy, I am going to have to charge you the blank amount for not giving us 24 hours’ notice.” You don’t even have to say it, but you charge the credit card on file. If they have a balance at the end of the month, part of your financial policy should be, “We charge the balance that’s left in your account at the end of the month to your credit card.” That would do wonders for your accounts receivable. Honestly, it will do wonders for your bank account. All this money that you are hoping to get, all of a sudden now you have got some immediate cashflow. It’s a lesser portion of the overall amount, 20% in your case. Now it’s there and you don’t have to wait 30, 60, to 90 days to collect it. It’s there.

I remember being brand-new to practice ownership. I had so many fears about collecting over-the-counter money. I’m sure you did too. Everybody does.

Everyone has some hesitation about the money talk.

Especially in the beginning, you are like, “I need some patience in this door. If that tells them it’s going to cost money, then I’m risking losing the patient.” We are scarred. The profession is scarred. Trust me when I say that that’s just one of the many mindset challenges that we have to overcome as a profession, especially as practice owners. If you are bold enough and brave enough to push through that discomfort for a little bit, you will realize that it doesn’t affect your practice at all in a negative way. You won’t lose patients. Even if you do lose them, you are going to lose them anyway.

You are going to lose the patients who don’t want to pay their bills.

If they are not willing to pay $20 to see a doctor, they are not ready for your care. They don’t value what you are doing. It will make an enormous difference if you are willing to do that or tough it out for a little bit. You will make a huge difference in your practice. You will have patients who are more bought in and who are more committed to you. You will have more money in the bank. You will be able to get bonuses and raises, buy new equipment, and provide new opportunities for your team. Lean into that discomfort.

If they have a large copay or something, they are financially incentivized as you are collecting it to get better and faster themselves. They might cut out, but are they going to get the results they want? Maybe you have that conversation with them at some point or the front desk does. It’s not only about the patients valuing your care. One of the mindset issues is we question our value.

Maybe they are not convinced. Maybe they don’t have the confidence in themselves that their services, the PT owner and the providers themselves, that our services are that valuable that require a $50 copay per visit. There’s a lot of those out there. That’s maybe an equally if not greater mindset challenge to overcome.

It blew my mind. I remember when I was set free of this mindset and it was so great. I used to think to myself, “How am I going to charge this woman $100 to come in here and do quad sets?” What I didn’t realize is this lady has no idea what a quad is. You don’t know how much you know. You don’t realize how much you know.

How many times have we had patients who come in and say, “I have got a torn rotary cup?” They have no idea. Not even a close idea of what you know. We take for granted that there are four muscles in the rotator cuff and this is what they do. This is how they work. This is the quads. This is how they work. They extend the knee. Those things are so elementary to us and we assume that the patient should understand that already, but they don’t. That little simple knowledge is worth $100. Convincing yourself of that and selling yourself on that idea is a good way to set you free from that fear.

As we are looking at the money aspect of this, you can see the different areas of your practice where as they tie together, profit margins can significantly improve. Let’s start measuring some key data related to money and the collection of revenue. Let’s see how we are doing at the front desk. Are we collecting 100% of the expected copays, co-insurances, and deductibles every day? Are they reporting that every day? Who do they report it to? Are they reconciling it? When they are not doing it, who holds them accountable if it’s not at 100%?

Do we know what our billing and collections team is doing on a regular basis? Do you know how to hold your billing and collections team accountable? Do you know how to read the billing and collections reports and your AR agings? Do you know what your collections team should have collected this month? Are you doing some forward projections?

I have talked about these on the show and I’m not going to get to them in detail because we have talked about each one of these things probably in the past six months. As we said here, talking to your provider team. Are you tracking the metrics to see how well they are billing and providing services for each and every visit and holding them accountable to the expectations?

If you are going to keep a patient there for 1 hour and 15 minutes on average, you can’t be billing 2 units per visit if you are on timed codes or something like that. If you are on a $65 capped rate and flat rate plan like your typical UnitedHealthcare, every minute over about 45 minutes, you are giving free services at that point. You have to be okay with that.

Either you make some changes or you agree that you are giving away services pro bono, or maybe you come up with a different idea regarding those flat-rate payers. I love that you said you measure things by metrics and not by emotion. Once you have the data that you can follow and track, you can start pulling some levers and figuring out how to improve each one of those points. Now you are talking about increasing your profits. Let’s talk about your average reimbursement rate, 5%, 10%, or 15% at least, and spread that over an entire year. You are talking tens of thousands of dollars. It’s not going to stop after one year, hopefully. After many years, if you are talking about hundreds of thousands of dollars by tracking some of these separate issues related to collecting money.

Not everybody wants to scale and grow an empire, but there are people who want to do that. There are people who want to do that.

They want to have their little kingdoms.

Nowadays, it’s hard to have a solo practice and have a nice financial income for the owner. You almost have to have multiple locations.

If you are going to be your typical practice, 2,500 to 3,000 square feet, and I have talked about this in the past with my buddy Shaun. There seems to be a sweet spot. You have got to have about 4 or 5 full-time FTEs and full-time providers. That’s where your profit margins seem to be the best in those situations. The expenses are fixed and you cover all your expenses with the first 2 to 3 providers, and then for the fourth and fifth providers, whatever they generate tends to go closer to the bottom line. There seems to be a magic sweet spot there. You could do it with one clinic.

You could do it with one clinic and you could have a nice and comfortable lifestyle, but if your goal is to open multiple locations. If you think about it, you are talking about the difference between opening up a location in 1 to 2 years versus opening up a location in 5 to 10 years. When you are saving tens of thousands of dollars year after year, you are taking an exponential because those locations generate additional revenue. Thinking about the long game. This is such a strong skill to have to have control of these touch points of your money so that you can maximize profitability in your business.

I want to say here that I learned about some of the stuff through stupid university and the school of hard knocks.

I have learned plenty of those. I’m still learning them.

Honestly, I didn’t hear a lot about it in the coaching that I received back in the day about this specifically. Will and I had figured it out over the years, but I had a podcast episode with my buddy Stephen Rapposelli and he quoted Alex Hormozi something to the effect of you hire coaches so that you can go through the same experience without taking on all the scars.

You can learn something without developing the scars as you talk to coaches and consultants. You don’t have to go through losing money for 6, 12, or 18 months before you see a turnaround. We have seen that in some of our clients. We have worked with them for a couple of months. I just had it. All of a sudden, I had it on a Monday. She’s like, “Before working with you. I lost tens of thousands of dollars last year.” Now 6 to 8 months into 2023, she’s had more profit than she has ever seen before and is able to workout and see her kids more often.

It’s the first time she’s done that in a couple of years because someone on the outside is able to look at your practice and say, “Pull this lever. Do this over here. Let me guide you a little bit over here and give you a different perspective and mindset. Now go.” The world opens up. Honestly, for this client, the amount of money that’s coming is scary. I don’t know what to do with it. That’s the problem you want to have. That’s a good money problem right there.

Coaching changed my life. It really did. For those who don’t know, Nathan was my first coach. I was about a year into private practice and I was at that stage where I didn’t know where my money was at. I was burning the candle on both ends. I was working late and getting up early. I was exhausted. I was unhealthy, anxious, and unhappy. Nathan took me in and whipped me into shape. What I didn’t realize was the beginning of a transformation. I became a different person after that. That was the start of it.

Since then, I have 3 locations within 5 years. I could have never done that without somebody there to show me, to help me recognize my blind spots, and to help me identify the priority and take massive action. I was sitting in my bubble just spinning like a dog chasing the tail. The tail is so important. I have to keep chasing this tail. I didn’t realize it but I was sacrificing my health and my most important relationships. If you are on the fence about coaching, I would highly recommend giving that a shot.

The difficult thing, and you and I come across this a lot, is coaching is not cheap. For my first coaching bill, I had to commit $80,000. I was willing to pay for it and I’d pay for it again. It completely changed my life like you. Our coaching isn’t $80,000 upfront in case you are worried about it, but there is a price tag to it.

I’m trying to say this the right way, but you and I know that as clients come in, a lot of the work that needs to be done is mindset work. Maybe perspective. Maybe think about it this way, or maybe you are focused on the wrong thing. Maybe your focus needs to be over here. We are guiding. What clients want to see is how are you going to make more money.

Where’s the money going to go?

We know that but we also know that you need to get there by doing a certain number of things, and it will pay off rather quickly if you implement those things. What they are saying in wanting to gain control of their business or learn how to run their business better is, “I want to make more profit because that expands the possibility for me and as a business. I can expand more. I can do more personally. I can bless my team better if I have more profit.” All those things are possibilities. It’s difficult because we are trying to say, “You can’t see these purchases, whether it’s coaching, bringing on a physical therapist or another member of physical therapy to your team, or hiring a front desk person when you don’t have one now.”

These aren’t expenses. These are investments that will pay off as you invest in them. The immediate return is not transactional like, “I saw that patient. Now I know I collected $94 because that’s my average reimbursement rate.” It’s not transactional like that immediately, but you invest this money. You are going to 2X, 3X, 5X, or 10X your return on that money as you listen and implement appropriately. That’s where we have to get people to understand. Get out of the scarcity mindset. Get out of the small business mindset when it comes to money, that there are things that you need to invest in that will generate significant returns for an ongoing period of time.

You have mic-dropped it. You did it. I couldn’t agree more. It’s a scary thing. I remember I had to pay you some money when I first started coaching. I was like, “What’s going on? What if it doesn’t work?” What I found is that I used to search for the marketing program that would save my business or I need the right biller and the biller is going to solve my problem.

It wasn’t until I realized that nobody was going to run my business for me and that you can’t outsource being a CEO. You have to learn how to be a CEO and it’s not by treating patients, hustling, and working your fingers to the bone. That’s not how to be a CEO. It wasn’t until I realized that my focus and my decision-making ability was the limiting factor in my business. When I can get crystal clear on where my business is at and I can be more strategic and confident in the decisions that I make, things move very quickly. As opposed to being consumed with chaos and anxiety and just going on Google and YouTube trying to figure it out on my own. Our ability to get out of that mindset and take massive action quickly is the key. There are no other gimmicks. That is the key. The answer is right in front of you.

When you learn something, it needs to be implemented quickly. If you learn something and you take 6 to 12 months to implement it, then you lose power in that thing that you learned. That’s the benefit of making quick decisions. You gain power by not having all of the data, but having enough data to make a decision knowing that you can always redirect and go to plan B.

There’s always an ability to put the car in reverse. “I went down the wrong path.” Put the car in reverse. “Let’s go the other way.” Sometimes people think that making money decisions is a dead-end street. “I’m not going to go anywhere, and their clinic is going to fall off the face of the earth.” That’s typically not the case.

As you are making money-based decisions, do as much as you can with the information that you have. Make a quick decision. If you need to do a little bit of fear setting, and that is what’s the worst possible scenario that could possibly happen? Figure out if you are okay with it or not. What are the likelihoods that’s going to happen? It could happen. Maybe there’s a 2% chance that it happens.

Is that going to be the worst thing? What would I do if that 2% occurrence came up? Have a battle plan around. Make a plan for your fears. That’s what the military does. In the worst possible scenario, we need to have a plan C and then move forward quickly. Quick action on decisions is important, otherwise, you become stale.

Your team gets jittery like, “Are we going to do this or not?” You get jittery. It clogs up your mind and your brain space because you have these lingering decisions to make and you can’t think clearly. When it comes to money, focus on recognizing where your money decisions are investments versus expenses, and where you can expect to get a greater return from that.

Not to belabor the point, but we did it out in physical therapy. We spent how many tens if not hundreds of thousands of dollars on physical therapy school with no guarantee that we were going to pass the licensing board and become full-fledged physical therapists with a big enough salary to pay off our school loan debt.

We are willing to put tens and hundreds of thousands of dollars into that scenario, but not invest in ourselves at a smaller amount by hiring a coach and by bringing on a support team that could consistently expertly work in their role outside of you like other physical therapists and front desk people, billers, and collectors that have great experience and capabilities. Hiring experts in those other realms only supports you and makes your team better, which helps you generate more money. It’s making quick decisions on those. I love that you brought that up.

I learned a ton about money here.

Money is good and that’s why I have Eric Miller on all the time. I love talking about money and there are many different aspects to discuss about it. As a physical therapy owner, the one thing that I remember Eric saying at the beginning of one of our episodes in the last six months was that you should demand to make a profit. You have to demand a profit from your clinic. It doesn’t just come naturally.

You have to demand the profit. That’s why you got into it. If you are lazy about it, you will not make as much profit as you could. You are losing money if you are not focused on it and you could have a greater impact. You have to demand your clinic to generate a profit and in doing so, you have to be very intentional and specific in your actions.

I remember, Michael Hyatt said one time that your business will spend to the degree of the boundaries you set on it. If you don’t have rigid boundaries, then you are going to fill it up with expenses, inefficiencies, and inconvenience. It’s about being able to set firm boundaries around things that are important and being disciplined enough to hold the line. When we could do that well, there’s money in the bank at the end of the month. We have to do it every single month. Show up every single week and month with discipline, intentionality, direction, and focus. That’s how you run a business.

Set firm boundaries around things that are important. Be disciplined enough to hold the line.
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Some owners are like, “If I’m not treating full-time, what am I doing?” Let’s start with a half a day. Maybe preferably two half days, but this is one of those things. You are reviewing the daily collections over the counter. You are looking at your key financial metrics. You are meeting with your billing and collections team, not just from the emailed billing reports every month, but talking with them through the billing reports every month.

Working with your providers and maintaining a high level of skilled units per visit appropriately. These are some of the things that take time. This is one of your jobs as the CEO or as the owner of a small business. You can’t give up. No one else is taking that from you. Those are the things we are talking about in terms of getting those parameters in tight. Once you get tightened those things up, now you can talk about, “Now I’m going to bring on another physical therapist. What do those financial metrics look like?” Now you can trust and plan for growth and expansion. Thanks for joining me. It’s been a great event.

We will jump on again in a couple of weeks.

Do you know the topic for that one?

I don’t. Not yet.

We will do some surveys. We will start doing some research and see what are top priorities, but we will get it out there. If people want to reach out to us, PTOClub.com . You can book a connection call with me and or Adam and see what we can do for you. See if we can help you out. Nathan@PTOClub.com . We finally got Adam’s email going, Adam@PTOClub.com . I look forward to our next event Facebook live event. Thanks for joining me.

Yes, sir. Peace out.

He continues to work closely with business consultants to continue to grow Southern to be everything that it can. During his spare time, Adam enjoys spending time with his family and friends. He enjoys challenging himself with an eager desire to continuously learn and grow both personally and professionally. Adam enjoys a commitment to recreational exercise, and nutrition, as well as his hobbies of playing golf and guitar.

Adam is inspired by people who set out to accomplish great things and then develop the discipline and lifestyle to achieve them. Adam focuses on empowering and coaching his team with the primary aim of developing “The Dream Team” that provides the absolute best patient experience possible. He believes that when you can establish a strong culture of trust you can create an experience for your patients that will truly impact their lives in a positive way.

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The post Squeezing More Profits From Your PT Clinic – FB Live Event With Nathan Shields And Adam Robin appeared first on Physical Therapy Owners Club.