Leveraging The Podcast To Increase Reimbursement Rates And Change Clinic Culture – An Update With Steve Edwards Of Achieve PT

The potential of your clinic begins with the knowledge to elevate reimbursement rates and the courage to revolutionize your culture. It’s not just a podcast, it’s a pathway to transformation. Welcome back to the Physical Therapy Owners Club podcast, where we’re thrilled to have Steve Edwards return with an inspiring update on his journey. Join us as Steve shares the strategic masterplan he’s employed to elevate his clinic’s average reimbursement rate and the lessons he gained from previous podcast episodes to orchestrate a profound shift in his clinic’s culture and performance. In this episode, you’ll discover how the podcast has been a catalyst for remarkable changes in Steve’s clinic. From enhancing the patient experience to boosting provider satisfaction and refining his leadership skills, the ripple effect of these transformations is undeniable. Tune in to learn how Steve has skillfully leveraged the collective knowledge of past podcast episodes to navigate and successfully implement these transformative changes.

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I’ve got a returning guest. Old coaching client. Good friend. We had him on the show before. I got Steve Edwards from Achieve PT in Las Vegas. Steve, thanks for coming back.

Nathan, my pleasure.

In the episode that we had with you earlier in 2023, I think it came out in January, you talked a lot about your plan and your strategic plan to drop certain insurances to increase average reimbursement per visit and increase profit margins effectively, you name it. I recommend people reference that episode because you shared a lot of technical and the lead stuff about what you were doing. Thanks for doing so. That was awesome that you were willing to share that.

No problem.

Now, we want to talk about a couple of other things, but we can’t get into the other things until we ask what’s the update. Tell us how things are going in terms of your fight to increase average reimbursement rates. Have you dropped any more insurance? Do you plan to drop insurance? Give us an update on where you’ve been and what you’re looking forward to doing?

Again, thanks for having me on. I’m excited to talk about this as well. 2023 has been a great year. I feel like we’ve been at this now long enough. After dropping these insurances, we know what our reimbursement is going to be. We’ve seen the trends, whether or not people are going to stick around and come out of network, those that are or aren’t. We’ve seen not only our average reimbursement go up by somewhere around 40% or maybe a little bit more.

It’s more. It’s like 60% or 70%.

We talked about attorney liens. That was one way to supplement it. It’s about 18% to 19% of our business. Those take the life of that lien to finally get settled. I think the average is right around 22 months. You’ve been taking on that for about two years, and we’re coming to that point now. We’re starting to get paid on those somewhat regularly. That increases that reimbursement quite a bit. We’ll drop those low payers, substitute them for 20% of our business with these that are reimbursing at a much higher rate and then our reimbursement’s going to go up quite a bit percentage-wise.

Things have stabilized. Tell me a little bit about your experience regarding people who are now coming to you out of network. Are you seeing a handful of those? Are people open to it? What was your experience there?

It’s interesting. One insurance in particular that we see quite a few out of network with. As you’re going through the benefits, it’s Blue Cross Blue Shield, actually. They’re the ones that those patients tend not to have too big of an issue with out-of-network benefits. It seems like their in-network isn’t too far off anyway. Some of the other insurances we dropped, I think they’re dramatically different within network and out of network.

Generally, they’ll try to find an in-network plan or a network provider if they can. Those that are staying with us, those out-of-network, it’s interesting. I’ll look at their benefits and I’ll see some of them have no deductible, very low deductible, and met their out-of-pocket max. When they hear the words out of network, they don’t even want to play.

You’ll see different mindsets from people. Other ones, they’ll have a fairly large deductible, maybe it’ll be $3,000 or even $4,000, and they’ll not have an issue with it coming out of network. You’ll never know. Look at the patient. I look at it and I’m predicting in my mind, “These are definitely people that are going to come. No issue at all.” It doesn’t always work that way, but it seems like our percentage for those out of networks has stabilized and stays about the same.

Are you looking forward to dropping any more insurance in the next 6 to 12 months?

I think we’re pretty set with where we’re at. Where we are, our numbers are good. Numbers continue to actually go up. We hit our highest ever after dropping. We’re pretty much what we were prior to.

Now you’ve got this higher reimbursement rate and you’re back to the similar total visit numbers that you were before. Is that because you’ve pushed your marketing strategies in different areas? Do you think that’s a matter of time? What happened to bring it back up?

I think it’s more of our marketing. We’ve done more for past patients. A lot of our email programs, we are hitting the past patients consistently. We’ve even done some to-consumer. We haven’t done a whole lot of physician referrals marketing, but more to-consumer and past patients. That’s where we’ve seen our numbers come up primarily.

We talk about the four buckets of marketing. It’s current patients, past patients, direct-to-consumer, and physician relationships. The more you can put energy and effort into current and past patients, those are high-leverage opportunities. There’s less effort with a greater return. There’s less investment. It costs significantly less money with a greater return because these are people who already know, like, and trust you. You don’t have to convince them to come in the first place. It’s just an invitation that they come back. It’s cool to see that you’re leveraging those.

These people already know a plan of care. They recognize what physical therapy is. They know what your clinic is, what it has to offer, and the experience they’re going to get there. It’s not like you are trying to convince somebody or a doctor’s trying to convince somebody to come to you. These past patients and current patients are some of the greatest referral sources for us.

These past and current patients are some of the greatest referral sources.
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Have you found yourself tapping into some of those current patients or even the past patients who might have family and friends that they refer over to you? Are you tapping into that a little bit more, too?

Yeah, 100%. We have a little reward system for current patients who refer a friend or family. We also do a couple of little things like free consults for friends and family. Our email system has it set up, so it’s going out several times a week. This is what we’re doing this day, so that they’re consistent. Patients are seeing them. If there is something, maybe a past patient is thinking about therapy, they get hit once. Maybe you need a call, then they get hit again. Maybe by the seventh time, they’re like, “Let me give them a call.”

Just to get into the weeds a little bit for the benefit of those who are tuning in, are you generating some of this content? Do you have a vendor that’s helping you generate the content and send it out on a regular basis? I agree with you. They are only successful if they are routine. If these are just one-off emails you send once a month, I doubt you’ll get much traction at all. What are some of the specifics of your email campaigns?

Since we’ve been hitting it, it was all in-house generated. We would meet and say, “Why don’t we do this on this day? Let’s do this on a Wednesday and that on Friday.” I went with a software vendor that has a number of different programs or the other thing we send out as an option.

They’re going to bring content with them? That makes it awesome. That’s great.

It comes with video.

Combining some video in there would be great as well because the open rate is greater. That brings me to the other part of the conversation I wanted to have with you. You unsolicited sent me an email appreciating one of the episodes that I’d done. I thought that was awesome. Thank you for doing that. I don’t get a lot of feedback about the show, so it’s good to hear some positive stuff like that.

One thing about you is I know that you’ve listened to podcasts and implemented what I’ve talked about or what the guest has presented in the past. I think that’s important to highlight because we can continually be learning all these things through podcasts or books. Yet, if we’re not implementing, why bother? I think that’s a real strong suit that I want to highlight in you.

The reason why I wanted to bring you on the show is for those who are tuning in, if you’re just tuning in for the sake of, “That’s a good idea. That’s cool that they’re doing that,” but not taking advantage of what you’ve learned, implementing them, and gaining some wisdom from them, then it’s wasted time and energy. The point specifically is the fact that you listened to my interview with Sturdy McKee about going out-of-network contracts. How many times?

It had to be more than ten because then I would stop it and I would write down exactly what he was saying and how he was saying it. Even though he wasn’t giving full information, but I’m like, “I can use this with my front office on what we’re going to say on the phone and how we’re going to say it.” What it was for me, not to get off of that, but listening to that very first episode or maybe the second episode with you guys talking about being so deep into the business, not finding a way out. Me feeling those same feelings and then seeing a pathway out, I was like, “These guys know how to do it. I obviously don’t know how to do it, so I’m going to listen.”

To all these guys you have on here, they have a path. They’ve got the recipe to get out of here. I don’t have the most original thoughts or ideas, obviously, but if I copy what they do and it’s already working, then why can’t it work in my office? It was Sturdy McKee, that dropping insurances. We talked about it the last time. I was scared, I was fearful, and I was operating from fear. The more information I could get on how to do it and the experiences they were having, it was one more step for me to feel more confident about dropping them.

Kudos to you for recognizing that a large majority of the guests that I have on are owners that one time or another felt stuck. They felt like, “I don’t know what to do next. I’ve got 100 different things that I know I need to do, but I’m not moving forward as I feel like I’m working on them. I’m not gaining traction.”

You get that feeling. They all came up with something.

Yeah, and they got through it. Whether it’s the vehicle we’re talking about, the topic we’re discussing in that episode or something else, they got through it somehow. You can lean on them as people who have been there, done that, and they’re willing to share away a path. Kudos to you for taking that step because I know people who have read all the books and seen all the podcasts and all the YouTube channels, yet they’re still in the same space they were years ago. You’re in a much better space implementing a program that you started years ago. It took some time.

It did. It wasn’t quick at all.

You’re in a much different space psychologically, financially, and professionally than you were years ago. I’m correct, right?

Yeah. We talked about this before, but you know exactly what I was thinking. If there was a way for me to drop this business altogether and be done, if somebody would give me an out, I probably would’ve taken it. Now, it’s the complete opposite of that. It’s funny. My wife and I were talking about this again. We’re talking about the constant worry that you have. You walk into a patient and you’re like, “This patient is not paying me anything. How much time can I spend with them?” You then want to feel better about what you’re doing, so if you can even engage the patient and talk to them about how poor their reimbursement is, that’ll make me feel a little bit better.

You’ll walk out of the room and you’re like, “Good. I was able to get that off my chest. I feel a bit better.” You get that little dopamine rush, and then you realize that you didn’t solve anything. You go into the next patient. Maybe you can talk about it with them. You then walk out of the room and realize, “Did they benefit from the visit? Did I benefit from the visit?” You’re doing that over and over. You’re in that worry cycle with coming up with the same question, “What am I going to do? How can I get out of this?” There’s no resolve to it. The coaching is what got me going and then recognizing this show helps break that worry cycle and say, “We can take care of this. There are several options here.”

You actually saw a light. There’s a light at the end of this tunnel. Sturdy McKee was one. I want to highlight a couple of the others to show how you’ve taken episodes of the show and made a significant change in your business. What’s another one you would highlight?

One of the first ones, I tried to go back and find it again because I wanted to take some notes on it again, but I believe it was a therapist from Australia. You talked about the recommended treatment plan. I came up with a recommended treatment plan. I came up with another sheet that we could give to the patients, what to expect with physical therapy, the things we’re going to go over on the first visit, and give the sheet to them. When they go home, if they have any questions, it’s already here and we’ve explained it on the back as a graphic showing what physical therapy is going to look like throughout the process. It’s going to take dips, but eventually, we’re going to get there as we go through these different stages of healing.

Recommended treatment plan, I love that idea of writing down and explaining to the patient, “Here’s the process. Here’s what I recommend in terms of your treatment. We’re going to do three times a week. In the next six weeks, I’m going to sign it. We’re going to walk it up front and hand it to the front desk. I’m going to introduce you to the front desk. This is what I’m recommending,” and then have them get scheduled. I felt like one plans of cares weren’t being completed. Patients were falling off. There was no accountability for where they were other than trying to call them.

This increased not only plan of care percentage for those completing their plan of care, but I felt like it helped the patient recognize, “This is what the plan is. It’s not just a visit physical therapy. Here’s the plan. Help my therapist recognize, “We’ve got some accountability here for the patient. This is what we’ve talked to him about.” I love that episode and how he explained it. I’m sure you know who I’m talking about.

You’re talking about Paul Wright . He’s the only guy that I’ve brought on from Australia. I still get his emails every week, so I love the guy.

It seemed like it was one of the first few episodes.

I believe it was within the first six months, I’m sure. It was way back then. You started implementing that. Plan care completion percentages went up. Overall patient engagement, I’m assuming, went up. I don’t know if cancel rate might’ve gone up, but at least people were more engaged and willing to stay on a plan of care because they said, “Here’s my prescribed treatment plan. I should expect that I’m not healed in three visits. It’s going to take some time.”

Another positive byproduct of it was that the patient recognized that the whole team was here together for you. Therapists will walk up with the front office that we’re not separate, taking you to the front office, introducing you again to our scheduler, making sure you’re set-up and you don’t have any more questions and all of that. It flows a little bit better. As you said, it did help with cancellations as well. You see your cancellation as well as your arrival rate increase.

Paul is awesome. He’s so good.

I loved that episode. It was incredible.

Tell me any other episodes that you feel transformed your business a little bit.

I worked for about a year on having a clinic based on positivity. I think it was Steve Line out in Nebraska. The Feel-Good Experience . I read the book, took notes, gave it to my administrator, and had her read it. He focuses so much on the five senses, creating positive vibes with those five senses. I then wrote a policy and procedure on that in terms of our treatment. What we want patients to feel. I love it. Immediately, when they come in, visually, they need to have a positive experience with what they’re seeing. Lobby, face. Audible-wise, “Hello, welcome to Achieve.” He said scent, so we have some essential oils. Mint for taste. He goes into the appropriate touch and all that. Three senses.

One of the things that I liked is he’s like, “You can be a good PT, but do you know how to be a great PT where you are putting aside basically your thoughts on what needs to happen right now in this treatment so that you can listen to the patient, make sure you’re getting that therapeutic alliance, and make sure you’re doing something to help them feel good?” You’re trying to gain some trust here. Something that’s going to help them feel good and get out of the clinic feeling much better so people aren’t leaving in pain.

They’re going to have those positive experiences. He talks about how compassion releases dopamine and oxytocin. You’re getting this connection when you’re being compassionate with a patient, so they’re getting that positive vibe. We took it for a year, studied that book and tried to implement everything we possibly could into our clinic.

That’s something that you did as a team. This wasn’t just Steve deciding, “I’m going to read this, implement it across the board, rearrange the front waiting room area, and implement an essential oil candle.” A lot of these ideas sound like they didn’t come from you because you read this together as a leadership team.

First of all, it was all his ideas, 100%. I’m great at talking, but the team put it. We trained the staff. Staff is on board. They recognize. We talk about the wording being very specific when somebody arrives. I want it to be more than just, “Are you so and so? Is this your first visit?” It’s, “Welcome to Achieve.” I know every clinic has their way of how they want to greet.

We want to make sure that ours is unique as well, so the people feel that they actually are welcome. They’re having a different experience than what they would maybe have at another doctor’s office with the glass. You want to open it, slide it, and close it again. They’re doing everything they possibly cannot to have contact with you. We want to be the complete opposite of that.

To get an idea for those who are tuning in, some of these episodes might not call to them, and that’s fine. What was it about that episode or even the other episodes that called to you about, “I need to implement this?” Was there something that was missing in your clinic that these episodes brought up in you? What happened there?

With him in particular, I would try to explain to my PTs in our training and stuff my thought process on what I wanted the clinic to be. What are the questions I wanted to be in a therapeutic alliance when you’re trying to build this relationship of trust with people? I talk to them about, “Don’t worry so much about getting what it is.

You know the best way to treat this patient. Recognize that they need to feel comfortable before we can necessarily attack that.” I had these thoughts, but I couldn’t necessarily put it in my own words. I wasn’t sure how to explain that. I read that book and I was like, “This is exactly what I’m thinking forever. It spelled it out so much better than how I was able to do it myself.”

You were very specific about the wording that Sturdy McKee recommended. You took notes, obviously, and read the book from Steve Line. Also, what we learned from Paul from Australia. Do you feel that after implementing these things over the past couple of years, you’ve started to create a culture significantly different from what you had before amongst your team?

Yeah, it’s funny. I was actually thinking about that. I feel bad for my therapists, who were with me for a long time leading up to COVID and during COVID. They left for one reason or another because I felt like they didn’t have any structure. There weren’t any boundaries. There weren’t any expectations other than, “Guys, stay with me here. Keep your head above water. We’ll get there eventually. I know something’s going to turn here. I don’t know what, but something will happen and something’s going to change here. I’m sure.”

I appreciate how hard they worked, but I also recognize that they didn’t have the direction that they needed from an owner for them to be able to have their expectations met or to be fulfilled in their job. I feel like these things now are filling the gaps to provide for my team members or for my employees to give them opportunities and what they’re looking for in the job.

You’ve provided some structure. You’ve provided some leadership. What do you think it’s done for your team?

When you think about boundaries, whether you are a kid, an adult, or an employee, if you know what your expectations are, you know what is required of you and what you shouldn’t be doing, then you feel much safer in your environment. I feel like it’s created almost, in a sense, that people know what is expected and what they can get from me as well. There’s no coming and going, “What’s today going to be like? Are we going to see him? Is he going to be so engaged with patient care?” It’s that doggy padding trying to keep your head above water so you’re not drowning as opposed to now having some structure.

If you know what your expectations are, what is required of you, and what you shouldn't be doing, you just feel much safer in your environment.
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You’ve taken the lead on a lot of changes in your clinic and you’ve implemented some things and you’ve received some coaching, so you’re implementing and you get some coaching and whatnot. What do you see in yourself? How are you different as a leader nowadays?

I can think about leading. I can think about future goals. Whereas, not to keep harping on the past, but I would write out a goal or several goals at the beginning of the year, but I would have no idea how I was ever going to accomplish those goals. It goes back to that same worry cycle. You’re asking the same question over and over. “How do I get out of this? What am I going to do here?” There’s no solution to that because I don’t have the answers. I don’t have a pathway here.

Now, there are answers. There are goals that are attainable. You’re not so constantly overwhelmed. These not only create structure but allow for success. Business, personally for my team members, they create a pathway for success that I didn’t necessarily know how to do on my own. I obviously didn’t because I’ve been doing this for a long time and couldn’t come up with the solutions because I’m stuck.

I know you were out of treating for a while and now you’re back in it because you had some people leave the clinic, but you have a pathway to get out of it again. You’re like the rest of the world. You’re looking for a PT and a PTA. However, you seem like you are mentally from a leadership perspective in a different place when it comes to bringing on another provider and stepping away from patient care. Talk to me about how you’re a little bit different now compared to before.

It’s interesting. I talked to one of my PTs about this again. As soon as we hire a PT, then I’ll be stepping back, but I was typing up the onboarding plan and what we’re going to do. How their day will be spent with me doing the onboarding, talking about policy and procedure, what I expect in terms of therapeutic lines, and recommended treatment plan. All those things. They will then spend 3 or 4 hours with you doing hands-on and seeing how it works. It gives me an opportunity to come up with ideas as opposed to feeling stuck. When you’re working from that part of your brain where you’re constantly stuck, “I don’t know how to get out of this.”

Reactionary.

As opposed to the creative side, it allows you to do much more. When you’re working off creativity, I’m obviously not the most creative because I’m copying everybody, but that’s okay. It works for me and hopefully, they’re fine with it. It allows me to come up with so much more in terms of what I can offer these new people coming on, their experience, a mentorship, a pathway into a clinical director, a pathway into profit sharing, and those kinds of things. That’s not an option before.

I’m assuming your providers didn’t have an onboarding process in the past.

Right. I’m going to have you follow me for an hour and a half, and then you’re on your own.

Significantly different in that one step alone because you actually came up with something. Maybe we don’t need to get into it in detail, but other episodes that you thought were highlights that you came across?

Front Office Guru. We ended up using Rockstar Recruiter. Steve Rapposelli , how he talked about his Cash Stretch Flex.

He’s doing Stretch Flex, but he talked about developing cash-based programs.

We developed some cash-based programs in our clinic. We’ve got those going and those are doing well. I’m hiring a PTA to oversee some of the cash-based program stuff and then do patient care as well. Every episode seems like there’s a little nugget or something you can get out of it.

How do you listen to a number of episodes, maybe week after week, but still focus on the one episode, Steve Lines, The Feel-Good Experience ?

Usually, as you put one out, I’ll listen to my way home. If there’s something in there that sparks something in me. Maybe it’s something I’ve been concerned about, maybe something that we’re missing in the clinic and somebody happens to mention something. I’ll listen to that one again, take some notes on it, talk with my administrator, type some things up, and maybe we’ll come up with a policy regarding it. I still have the projects that I’m working on over here. In my spare time, this is what we’re focusing on. This is what we’re going to do training on.

I should note you are treating, but I’m assuming you’re still setting aside admin time to work on some of these things.

Yeah, I’ve got several hours a week where I can still focus on the business.

For those people who haven’t considered that, can you explain what your schedule is? Do you take a Friday off? Do you take two half days? What are you doing?

Two half days, Tuesday and Thursday. I’ll then use time at home. If I’m watching a game on weekends, I’ll have a computer in front of me or something like that, but I try not to do much of that.

Two other things, then. Has there been an episode that you’re focused on now? Maybe it’s not related to my show, but maybe it’s related to a book you’re reading. Is there something in particular that you’re trying to implement in your clinic right now?

I’m looking at different things that will help me with marketing to go straight to the consumer. I want to be completely independent of physicians. I think I talked to you about this. In the past, we had two other clinics. At one point, we were three clinics. Miserable. I think we talked about that. I got out of that. Now, I’m looking to do a second clinic within the next 12 to 18 months and then we’ll kind of build off of that.

I do not want to have that same experience and go knocking on physicians’ doors going, “I’m new. Can you please send me?” Walk out and go, “I hope that was the person.” All those thoughts that we’ve had for years, I don’t want to experience that. I want to see if we can be a little more independent in terms of marketing specifically to the consumer so that when we open doors, 75% to 80% of our referrals are coming from that.

I’m sure you’ve listened to him because you listened to most of the podcast, but the one episode that comes to mind is an episode with Mike Bills from a few years ago. I think he gave me an astounding statistic at his clinic. He said that 10% of his new patients are from physician referrals. That’s where you’re heading for, right?

I would love to have that ratio.

What did he say? He and his team spend 45 minutes a week role-playing and asking for a referral from current patients. I’m like, “Wow, that’s crazy.” Maybe it’s worth a re-listen, but that’s the one that comes to mind. Tell me, what books are you into or what books have influenced you in the last 12 to 18 months?

I ordered one, Who . I think it talks about an interviewing process.

It’s not Who Not How by Dan Sullivan and Benjamin Hardy. There’s another one called Who. I know it was recommended to us a long time ago, but it’s about top grading, the interview process, and the hiring process.

Talking about ten different areas that you need to have in your business for staffing, hiring, and retaining. I want to read that and see if I can’t create those ten specific areas.

Especially because that’s a big goal for you. It’s to bring on a couple more providers. Who knows? Maybe bring on more, especially if you’re looking to open up another clinic or you’re going to want another provider as well.

I want to make sure that that is set and stable, that part of a business. I heard a few people talk about that book and thought, “I need to check that one out.”

Thanks for sharing your experience. It’s awesome to have you on and talk about the growth that you’ve made over the past few years. I’m, of course, pulling for you being an ex-coach of yours. It’s cool to see where you’re at now compared to back then. Is there anything else you want to say about what you’ve learned from the podcast or recent books or anything like that?

I will put a plug in for coaching. Specifically, if anybody is out there, even on the fence, whether or not they should do it, time-wise, financially-wise, just know you need some accountability and you can’t do it on your own. If you could, then you would already be there. You need somebody to question your thoughts, your actions, and others to look at your business, your clinic, and your ideas from a completely different perspective. If anybody’s even thinking about coaching, do it. Contact Nathan, get in touch with him, and he’ll set you up right.

If you are on the fence about whether you should do coaching or not, do it.
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Thanks for the advertisement.

My pleasure.

I heard a good quote. It was, “If nothing changes, nothing changes.” If you’re not willing to change what you’re doing, then nothing changes. You can be very comfortable there, but you can’t complain because you’re not willing to make any changes.

That’s the other thing, too. If you’re like, “How do I know if I need coaching?” If you find yourself complaining constantly about your situation, there’s an old quote out there talking about, “If you complain to two people, you’re just letting them know about the situation. If it’s more than that, then it’s complaining.” You’re looking for somebody to justify and somebody you can place the blame on, so you don’t have to internally feel it. At that point, it’s time. Just do it.

If you complain to two people, you're letting them know about the situation. But if it's more than that, then it's just complaining. You're just looking for somebody to justify.
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Thanks for joining me, Steve. I appreciate it.

My pleasure.

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