Strategies to Combat Low Reimbursement & the Staffing Crisis with Dr. Dimitrios Kostopoulos

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We received a letter from an insurance carrier that they were cutting reimbursements for physical therapy from hundred and forty dollars down to sixty.
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So um and that was the letter that changed everything.
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They gave us at that time an ultimatum stating that hey, if you do not if you are not gonna accept this um by January 1st, that the rate change, then you drop we drop you from the network.
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Yeah, it was an ultimatum.
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So see, many times we talk about cause versus being effect, and at that time I felt that I was the effect, not not cause.
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But we had to do something to change it.
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Well, Demi, I'm so excited to be with you today.
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It's been a few months or years since I've seen you.
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It's been very you're someone I've known for a very long time.
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And man, I sure appreciate you spending some time with me today.
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Uh, likewise, it's it's it's been a long time, and um you have um uh a tremendous evolution um since the time that I have met you, and and you have uh, besides all the other business endeavors, you have you have an amazing podcast right now.
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And uh um I'm I'm very excited to kind of uh share this uh podcast with you now, from my podcast to your podcast, from your podcast to my podcast, and and uh it will be awesome.
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Well, and it's such a cool moment for me because um you, as I was a physical therapy practice owner, as my audience knows, and maybe yours doesn't, but I was a PT owner who was really wanting to make a big difference in the industry, and that's when we found you.
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And we the the we found you through um a common connection in Florida.
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Oh, um I'm forgetting which which of our which of our referrals it was, but he was at a miserable solutions conference.
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I think it was Dan actually.
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Dan, it was yeah, Dan Sage.
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So, Daniel, thank you so much, buddy.
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We wouldn't be here without you.
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And he was talking about this EMG thing and diagnostic ultrasound and how not only was it higher reimbursing, but more importantly, it was totally changing how patients were getting healthcare in physical therapy, and it made us diagnosticians versus being, you know, healthcare providers that get referred out to like a prescription.
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And so when we met back and it was 2014, I think it was 2014 or 15.
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Yeah, I think 14 or 15, yeah, you're right.
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Yeah, I mean, who'd have thought that we would have evolved the way that we did?
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I I know we were the sixth, I think, client of yours.
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We were in the first 10.
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I know that early the early days, yeah.
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And how how many companies are you partnered with now?
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Ish?
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Gosh, um, we have right now, I think about 65 companies, 245 locations.
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Wow.
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Um, like I think 31 different states.
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So that's yeah.
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Amazing.
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You know, for my audience side of things, can you share why you decided to do hands-on diagnostics?
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Why are because you're a medical doctor, like I'll say in my intro, and a physical therapist.
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You have both of these like combined talents.
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What was it about the industry that had you want to jump into it?
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Yeah, look, uh uh, I mean, definitely uh, first of all, I was involved in uh uh electrodiagnostics from the early days of my practice, like uh Costas and I, my business partner, um, we opened the first physical therapy office back in 1992.
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Wow, very early.
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What how old were you, Will?
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I was I was um 16.
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I I I had that number.
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I had that number in mind exactly.
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So anyway, um we opened that uh office and and we did very well.
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We grew um rapidly and uh um right around um 1996, 95, 96, I was like, okay, I want to do something more, I want to do something different.
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Meanwhile, I had a bunch of French um physicians who were performing electrodiagnostic studies at that time, and I did see um a flyer advertisement about these guys from the US Navy that they had physical therapies, that they had studied electrodiagnostics and they were teaching others.
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And I joined at that time my very good friend uh Rick Nielsen um and uh we did some training with him, and I started very, very slowly um doing electrodiagnostic studies.
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But the point that uh pushed me and to develop this as a real business is actually the same challenges and problems that physical therapists have right now.
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It was about reimbursements, it was about reimbursements that yes, on the one hand, we could see back then some uh clinical utility, some clinical importance, clinical significance of electrodiagnostic testing, but uh we could have never fathomed how to take this and create a business opportunity with it so until um we started facing some of the industry uh uh challenges.
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You know, when I talk to people, actually Will many times I say um you know that we received the uh letter that changed everything.
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What letter was that?
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What letter was that?
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I'll tell you exactly that it was um two days before Thanksgiving of 2002.
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Meanwhile, we had really expanded our practices.
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We had opened, I think at that time we had 13 um uh physical therapy locations, and we received a letter from an insurance carrier that they were cutting reimbursements for physical therapy from$140 down to 60.
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So um, and that was the letter that changed everything.
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They gave us at that time an ultimatum stating that hey, if you do not if you are not gonna accept this um by January 1st, that the rate change, then you drop we drop you from the network.
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Yeah, it was an ultimatum.
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So see, many times we talk about cause versus being effect, and at that time I felt that I was the effect, not not cause.
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So we had to do something to change it.
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It's interesting that this is a story that still exists today, that people are experiencing this, maybe even more so.
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But that was the same thing that you said that started this whole journey for you to go, wow, reimbursement for what we do is not representative of the value that we bring.
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And you were and you had a choice.
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Could I be at the effect of this or could I be at cause over this situation?
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So it sounds like Hods was your way of being at cause.
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That was that was that was a way of of of being of being.
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Yeah, but let me ask you this.
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Like you you speak some people, right?
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You you speak to you have your podcast, you have your uh consulting clients, you have your um uh conference and and and and events that you put around the country.
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What do you see what what are the common themes that that physical therapy, especially private practice owners, come to point and and and complaining about or seeing as challenges?
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What's the common theme themes that you see?
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You know, there's an there's an overarching singularity, and then there's the subcauses.
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The subcauses look like recruiting.
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The one thing I hear in my world, since I spend a lot of time consulting on recruiting on how to hire physical therapists or how to develop people, they're the most overwhelmed when it comes to that initially.
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And that just might be how they show up to me directly, although I know it's an industry problem.
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The second thing is reimbursement.
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Reimbursement between those two things alone, they just that becomes the singular issue of just not feeling in balance in life.
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And it's that's a horrible word, balance, because you know, I don't I don't really truly believe in balance.
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But what the better way of saying it is that they don't feel in exchange with their own business.
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They feel like their business takes way more out of them than they get back in return.
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So, like in terms of time and money that they invest in, what they get back in terms of time and money is so skewed that we use industry, you know, common words like burnout or um, you know, the fact that people are leaving the industry more than entering it.
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There's this massive exodus.
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And it's so interesting, Dimi, because as you know, there is such a demand for what we do.
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Like that's right, this is this is the opposite environment where those events should be occurring because there is so much demand for it.
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But it comes down to, and those two issues of recruiting and reimbursement are so interlinked.
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If we had more money, we could hire more.
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If we could hire more, we could make more money.
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But it it comes back to your core reason as to why you started the hands-on diagnostic seminars because at the end of the day, what we get paid per visit by the insurance is the driving force.
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That's the in I that has to be the first thing that's causing all this.
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Because if that was triple what it is now, people would be staying in the industry.
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We could pay people more, we'd have more profits the whole nine years.
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And and and and we see the application of this actually right now in the relationship between private practices and hospital organizations.
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So you're talking about about recruitment, right?
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Right.
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Uh, and although the numbers change from year to year a little bit, but we are producing about 5,000 less physical therapies every year than what the industry really requires, right?
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So 5,000 less up to now.
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Now, moving forward, this is going to become even more challenging.
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And I care less about the um uh political persuasion of anyone who is watching the podcast, your podcast, or whoever I talk to.
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But it is a real challenge.
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Private practice, physical therapists who in larger metropolitan areas, they were recruiting therapists, foreign-trained therapists from other countries, from India, from the Philippines, from Australia, from various places like that.
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Now, a private practice has to pay$100,000 application fee to apply for someone to come in uh with an H1 visa, provided that they can't kill that killed what I thought was the only viable solution.
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Because when we had, I was just in my coaching world about six months ago, we were really trying to figure out because there's already some challenge around that.
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You've got to the person has to take the the boards in the United States.
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So you're flying people from the Philippines, for example, to the to Hawaii.
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And so you're looking at about a$20,000 to$25,000 cost that has some risk already tied to it, and then the government threw a hundred thousand dollar uh penalty or whatever it is, like fee to in order to do that.
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So that killed the only viable solution, which for me I loved.
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I loved bringing people in from other countries and to solve that problem for us because then it would increase our profitability.
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I mean, look, uh I came to the country uh initially as a student with an A-sponsored visa.
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I didn't know that in the past, yeah, in August of 1987.
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World were you both?
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Okay, so we were both younger, that's for sure.
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We I always think of us as the same age, and for what it's worth, you look better at your age than I do at mine.
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Like, I'm looking the whole time, I'm like, where are his wrinkles?
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Anyway, so yeah, I I get it.
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You were here on a visa, and that's like the whole point of this thing is is that we're able to take the I not just the country of America, but the idea.
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I mean, there's again, I'm not I don't want to get into a political thing.
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People have all sorts of views about the border control, but getting people in legally through visas who want to provide health care.
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No, those are people we have to want to support.
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We want those people.
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So so so here is what I I am going to advocate.
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I got actually the agreement of the HADS group to advocate.
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And I am asking you also if you got it, agree on this to join me in this advocacy, advocating to the American Physical Therapy Association to utilize their lobbyists to advocate for an exemption of the$100,000 H1B fee for professions where there is a significant need in the United States, such as physical therapy.
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Because let's get this now.
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If who is gonna afford$100,000?
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Private practitioner is not going to, but the either larger national organizations or hospital organizations, perhaps they'll be able to afford the hundred thousand dollars with a contract that they'll stay with these organizations for the the employee will stay for five years or so.
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So so but but that is a problem for the uh private practice small business owner.
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So I'm advocating that the APTA utilizes their lobbying resources to actually lobby that there is an exemption for specific professions, specifically for the profession of physical therapy for um for the H1B visas.
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Um, yeah.
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Yeah, I'm in.
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I we are 100% supportive of that.
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I think that's makes so much sense because I don't know anything outside of my narrow scope.
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So, like if the$100,000 thing makes sense for legal or for other professions where that money is a little bit of a sting, but it's not a big deal, okay, great.
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That brings us more money, whatever.
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But for physical therapy companies, I love the H uh B1 Vs or H1V.
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I'm always dyslexics, whatever.
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H1B, those visas are so vital because they allow us to the high overseas, and it it's not even a smooth process without the$100,000 thing.
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So if anything, I would love to find ways to simplify that while, and it's not the long-term solution, in my opinion.
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I would love to hear yours.
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Um, I don't think that's the long-term solution because we're still fighting a diminishing game with reimbursements, but at least it provides us with some space to be able to get profitable, to organize and fight, because we don't have time as the private practice sector is what's going to save our industry or transform our industry.
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And right now we just don't have time to go lobby or like if we're too busy treating crazy hours or running around trying to hire full-time.
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What are your thoughts on that?
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All right.
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So, my thoughts on that.
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Um, first of all, um what will really create a significant difference is a positive difference, is parity.
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Parity in reimbursement between hospital organizations and private practice private practices, private practice physical therapy.
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So here is what happens right now when it comes to commercial insurances, uh hospital organizations they are able to uh retrieve significant multiples of reimbursement compared to a private practice physical therapy, and there are websites where you can go, because this is now public information, where you can go and see the reimbursement precipity code.
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But I'm gonna give you a very simple example.
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For uh let's say a visit on a patient where a private practitioner receives$85, for that same visit a hospital organization will receive more than$300.
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This is not only limited to um commercial carriers, it extends also to uh um Medicaid and Medicare Advantage, not the straight Medicaid, not the straight Medicare, because there there is um you know a little bit of difference, but not significant difference.
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But the advantage plans they have also three or four times greater reimbursement with hospitals.
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So what happens now is large organizations um in private practice who own five hundred facilities, six hundred facilities, a thousand facilities in various regions they collaborate with hospitals so the hospital rates extend to those private practice organizations.
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And they are able to have those significant rates, and then we have competition for the small private practitioners, small business uh physical therapists.
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We have competition not only by the hospital itself, but also by those larger organizations that now their reimbursement increases significantly, and they have to and they can compete for um the same physical therapy talent, but paying them a lot more because they can afford to do that.
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It's interesting to me that these groups are actually getting increased reimbursement because that shows that there's there's a battle that's being won, of course, by the bigger companies, but they are winning.
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Like if they're increasing, it really kills that that individual who's just dreams of hanging their shingle one day and having their own practice.
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But it the only positive I really hear from that is well, at least some groups are able to get with insurance companies and fight.
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It just puts us in a position of like, well, how do we do that?
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How do we do you have thoughts on how we as a group so look?
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Here is King, right?
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There are three things that somebody can do to um increase um their bottom line.
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They cut our expenses, and they can increase our revenue from their existing business, and they can add additional revenue from related businesses that can be incorporated within their organizations.
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Now, the very first thing cutting expenses is probably the easiest thing that somebody can do with only short-term result and low yield.
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Because what are you going to cut?
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Can you cut your rent or mortgage?
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No, because that is what you pay.
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You probably have a lease, you probably have a mortgage.
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It is what it is, right?
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At the end of the day, you have to have the space to see your patients.
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Are you gonna cut salaries?
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How are you gonna compete in the marketplace if you cut salaries?
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You're not gonna be able to.
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And your uh uh the towels that you use in your office?
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Fantastic.
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You did it, you saved$55 a month.
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Great win.
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Let's go have a beer.
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Uh beer, by the way, costs$55.
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Yeah, the round of beers cost$55, but yes.
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So it's it's it it's it's a low-yield um uh type of activity to decrease expense.
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Now let's look at increasing income.
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Increasing income from your specific service line of physical therapy can be done by um negotiating rates with insurance carriers.
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Okay, you may be able to join some IEPA and join forces with other physical therapists, and then you can go and try to negotiate those those rates to a relative success on your region.
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Um, you try to go cash also in some cases where pay uh um you can uh manage to get some better reimbursements uh directly from patients, or then you add services that uh where you are able to uh receive much higher reimbursements, and those services can be quite a variety.
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You can have some cash-based services where they are unique in nature, uh, where no other therapists offer those services around you, where you have an incredible marketing plan um and approach where you are able to recruit patients who are willing to pay$150 to$200 for that.
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Or you add um reimbursable services by insurance company that have a multiple of what you pay for PT, such as diagnostic testing, EMG, ultra pay three to ten times more than what PTV is.
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And and this pretty much at the math unfortunately will by 2028 it is anticipated that 50% of the existing physical therapy private practices will be acquired by larger corporations.
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How what percentage was that again?
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50%.
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50% of all physical therapy, outpatient, private practice will be acquired by larger practices.
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Correct.
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That's that's what the number is right now by the year 2028, the estimate.
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Um if we if we ate the entire output of physical therapy, the entire physical therapy, inpatient, outpatient, private practice, large entities, 34% of the entire PT is being delivered uh by private practices.
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Okay.
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So imagine that um when larger companies take over half of that 34%, so you're gonna have only 17%, the entire PT industry being served by private practices, small private and medium.
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But that scares me for so many reasons, and I think you know this as well as I do is that what makes any uh unique physical therapy practice successful is the passion and the creativity of the individuals who are giving care.
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And you can't find a more passionate or creative group than a private practice because they are they are the ones who hung their shingle, they're the ones who put the risk up.
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They care arguably more about the patient experience in general.
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Now, you'll get some standardized care with larger groups for sure, but I worry about that devaluing what we do to be more of this service that gets referred out to, and we only focus on routine care items versus becoming doctors in our community and having those deep emotional relationships, which is what drives you and I.
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What we care about is the body and soul of each patient.
00:25:46.079 --> 00:25:49.039
And and people go into physical therapy for that, don't they, Deanny?
00:25:49.119 --> 00:25:57.759
Where absolutely yeah, I mean, look, the people who get into physical therapy school, they are the ones who are in a very interesting niche.
00:25:57.920 --> 00:26:18.000
They're they're definitely intelligent enough to go to a MD type program, but they choose to go this route usually, not all, but usually they they are, and they choose to go this route because what they really care about is the connection with the individual, combined with the fact that they love anatomy in a way they get to work with it more over time.
00:26:18.160 --> 00:26:20.480
But in exchange of that, they give up their profit.
00:26:20.640 --> 00:26:22.000
I told my wife this, Dimi.
00:26:22.240 --> 00:26:25.440
I remember when I became a physical therapist, the day I got my license.
00:26:25.599 --> 00:26:27.440
This was in the early 2000s.
00:26:27.599 --> 00:26:29.279
My wife and I didn't have any kids.
00:26:29.440 --> 00:26:30.799
I was in my 20s.
00:26:31.039 --> 00:26:38.319
And I remember turning to her and saying, Man, honey, um, we we're not gonna be wealthy on any level.
00:26:38.480 --> 00:26:39.759
I just want to prepare you for that.
00:26:39.839 --> 00:26:45.519
We're never gonna be wealthy, but I am gonna be happy because I'll be serving people.
00:26:46.079 --> 00:26:52.400
And that is, I think, a great you know, example of what most people feel when they become a physical therapist.
00:26:52.480 --> 00:26:55.200
They're looking, they, they, they're driven by those same things.
00:26:55.359 --> 00:27:01.359
And I was I was wrong on both counts, by the way, but it's one of those things where I'm just kidding.
00:27:01.519 --> 00:27:14.960
But it's one of those things where it's it's really it's unfortunate that we would get our basically our our our whole industry, the vast majority save that 17% by 2028 is gonna be standardized in these large groups.
00:27:15.119 --> 00:27:25.759
And again, I'm not gonna badmouth the large groups completely, but there is this something about the heart and soul of our industry with the private practices that drives so much of what attracted me to the industry in the first place.
00:27:26.720 --> 00:27:40.400
Look, uh, there are large groups that are very ethical and they are that uh the patients uh uh and the therapists value their therapies absolutely uh the same people.
00:27:40.880 --> 00:28:05.680
Um, they all have um shareholders or um uh board of directors, and and they they have sometimes people who are a bit uh further away from the delivery place, uh, and they cannot see what the frontline PTs can see when they uh deliver the service and they are um interacting with their patients.
00:28:05.920 --> 00:28:16.720
And uh look, I I don't know if you are aware of that, but um I've I've talked about this both recently at the HUD Symposium and and also in uh uh my podcast.
00:28:17.039 --> 00:28:32.559
As you know, uh hands-on organization that Kostas and I developed, um it has a physical therapy component, the diagnostic testing component, uh as well as the uh consulting and education component, right?
00:28:32.640 --> 00:28:33.920
The HUD component.
00:28:34.559 --> 00:28:54.400
So, you know, looking at conditions, um in especially in the state of New York where the hands-on organization is, uh Costas and I made a decision to actually sell our physical therapy component of our organization, and we did as of uh as a few months ago.
00:28:54.480 --> 00:28:56.319
Uh oh my goodness, I didn't know.
00:28:56.480 --> 00:28:56.880
Yeah, yeah.
00:28:56.960 --> 00:28:58.079
We well, yeah, that's correct.
00:28:58.160 --> 00:28:59.200
So I'm breaking the news.
00:28:59.359 --> 00:29:00.880
Breaking the new congratulations!
00:29:02.079 --> 00:29:03.200
Thank you, thank you, thank you.
00:29:03.440 --> 00:29:09.279
That's wonderful because you've had that for decades and you've grown a beautiful business there, but you've recognized the opportunity to help.
00:29:09.440 --> 00:29:13.359
You're you're it sounds like you're going all in on helping the industry, is what I hear.
00:29:14.079 --> 00:29:22.640
Yes, uh, plus we we sold our physical therapy operation, but we did not sell our diagnostic testing operation.
00:29:22.720 --> 00:29:32.000
So we have currently in New York 35 locations where we perform electrodiagnostic testing and musculoskeletal ultrasound.
00:29:32.160 --> 00:29:59.839
So that part we kept because we believe that that is where um the future lies, and uh, and of course, HUDs where we can create an impact in the industry and and in practices around the country, and uh uh putting putting more of attention on those two areas, I believe it will uh yield better, uh, not only for us, but also for uh all the people that we care around uh our the PTs.
00:30:00.240 --> 00:30:02.880
And the patients in need, you know.
00:30:03.119 --> 00:30:05.759
So that's so beautiful that you guys are doing that.
00:30:05.920 --> 00:30:15.599
And again, you know, obviously your podcast people already know this, but for me, for my end of it, you know, the electrodiagnostic journey has was a beautiful part of our growth.
00:30:15.680 --> 00:30:27.839
When we joined Hods and we brought it into our four locations in Arizona, that increased our reimbursement, but it also spawned uh a new business in Alaska that Nathan Shields took off and started and grew.
00:30:27.920 --> 00:30:32.480
And then we ended up selling uh to a physical therapist who had become a key hand.
00:30:32.640 --> 00:30:36.799
So it was it's a very it's a powerful, there are things out there.
00:30:37.039 --> 00:30:48.240
And you know, there's like you said, it kind of boils down to cutting expenses, which really there are I until some I'd love to see the business that shows up and says, We're here to help you make money by cutting expenses.
00:30:48.400 --> 00:30:59.359
Um, well, I guess except for mine, which I'll talk about later, but but in terms of like your regular expenses, like your lease and that stuff, but then increasing reimbursement is one.
00:30:59.519 --> 00:31:01.759
And I'm really hoping Nathan will take that on.
00:31:01.920 --> 00:31:10.960
He's got a program I know he's been working on for a while to help people get more reimbursement just through like you know, tactical support through negotiating and that kind of stuff.
00:31:11.119 --> 00:31:21.519
But then there's your company that helps you get more reimbursement in a way that creates additional value that actually supports the industry in terms of autonomy and just straight up marketing.
00:31:21.680 --> 00:31:35.839
Like when patients and other MDs start seeing physical therapists as the musculoskeletal experts because we're doing diagnostic works, is the day that our industry as a whole benefits because we're no longer some medication that gets referred out to.
00:31:36.000 --> 00:31:38.799
We become equals in the referral process.
00:31:39.680 --> 00:32:04.720
And I'll give you actually um, if you want to put uh in your in your in your podcast podcast website, yes, please have you a copy of a white paper that I wrote recently that compares actually physician electronistic residencies with what physical therapists have in place right now, and yes, it's like a side-by-side comparison.
00:32:04.880 --> 00:32:07.759
So um our listeners can can take a look at that.
00:32:07.920 --> 00:32:25.039
But tell me something from from your viewpoint and the things that you are doing, what are some meaningful ways that you have put together that physical therapists can save money right now in their practices?
00:32:25.519 --> 00:32:33.519
Yes, so my audience can tune out because they understand this point, but it's um my journey, as you know, I had a medical billing company to help fight that piece of it.
00:32:33.599 --> 00:32:35.759
And then I started coaching across the board.
00:32:36.000 --> 00:32:42.000
I started hiring virtual assistants for my core business back in 20 in 2001.
00:32:42.319 --> 00:32:46.400
And I had clients Demi that were working with me on multiple levels.
00:32:46.559 --> 00:32:49.920
They were coaching for recruiting, they were getting their billing done, all these things.
00:32:50.079 --> 00:32:54.640
And I had a handful of really close friends say, Hey, can we try that VA thing?
00:32:54.799 --> 00:32:56.640
And I said, No, leave me alone.
00:32:56.720 --> 00:32:58.000
I've got four other companies.
00:32:58.079 --> 00:32:59.279
I'm I'm dying.
00:32:59.519 --> 00:33:02.480
And so they they just asked, they said, please can you help me?
00:33:02.720 --> 00:33:05.839
And so I ended up hiring virtual assistants for them.
00:33:05.920 --> 00:33:07.680
And recruiting is my favorite thing.
00:33:07.839 --> 00:33:16.160
So we started hiring virtual assistants, and they came back two months later, this was years ago, and they said, This is the best thing you've ever done for me.
00:33:16.400 --> 00:33:20.880
And so very quietly, we added that business line into what I do.
00:33:21.119 --> 00:33:25.599
And now it's 99% of what I do now, and it's been that gap for a few years.
00:33:25.759 --> 00:33:31.680
We we have 150 clients across the country, um, somewhere around four to five hundred locations.
00:33:31.839 --> 00:33:33.920
We have hundreds of VAs that we work with.
00:33:34.000 --> 00:33:35.119
It's really scaled.
00:33:35.200 --> 00:33:45.920
And the reason I bring it up isn't to promote, but because whether you use me or somebody else, um, one thing that people can do immediately is look at supporting their non-clinical team with virtual assistance.
00:33:46.000 --> 00:33:48.480
It's the second fastest growing trend next to AI.
00:33:48.720 --> 00:33:48.960
Yeah.
00:33:49.039 --> 00:33:51.759
And I I totally agree with that.
00:33:51.839 --> 00:33:54.799
Uh and and yes, you should promote it.
00:33:54.960 --> 00:34:16.079
And and and and yes, uh, you know, especially from someone who comes from the physical therapy industry, you can trust that will recruit individuals who really can pay more attention to the proper to a physical therapy practice.
00:34:16.320 --> 00:34:20.639
So absolutely, please promote that's that's oh, I appreciate that.
00:34:20.800 --> 00:34:27.840
I I think you know, and I appreciate that because um, of course, I'm going a bri a business, but you and I are both are are pushing a movement.
00:34:28.000 --> 00:34:33.519
What we're really are at the end of the day, what you and I are aligned in and always have been is our passion.
00:34:33.760 --> 00:34:45.440
And and I and for my audience sakes, and I I don't say this often on my podcast ever, if ever, but Demi is in the top one percent of the best human beings I've ever had the privilege of working with.
00:34:45.599 --> 00:34:48.880
He can be trusted in every way if you're looking at diagnostics.
00:34:49.039 --> 00:34:53.519
So for me, what we're doing together is the same thing, it's just in a different way.
00:34:53.679 --> 00:35:01.599
You're trying to get re increased reimbursement and more awareness from the industry of our professionalism and our expertise.
00:35:01.840 --> 00:35:04.559
I am trying, I've been trying to help the industry in some way.
00:35:04.719 --> 00:35:15.119
When this came around, it was like, oh, not only am I using a talent that I have that I love, but we're doing it in an immediately impactful way that increases profit and time.
00:35:15.360 --> 00:35:20.079
We have less than a 2% churn, meaning 98% of the people who hire us never leave us.
00:35:20.239 --> 00:35:28.000
And it's because when we can have good people supporting us, then we can make decisions like how do I hire professional help or how do I do this?
00:35:28.159 --> 00:35:42.079
And and so they all these pieces need to come together for the ultimate battle, which is fighting the insurance companies for reimbursement, or as Brandon Siegel says, if you know who that is, that he's a good guy.
00:35:42.239 --> 00:35:47.119
He was telling me he's he's like, you know, I believe that he's not a clinician like us.
00:35:47.280 --> 00:35:48.480
So he has a different perspective.
00:35:48.639 --> 00:35:58.079
He's like, he goes, I think it's crazy that PT OT and SLPs keep doing the same business model despite these horrible conditions versus changing the business model.
00:35:58.159 --> 00:35:59.679
And that's where Hodz comes in.
00:35:59.920 --> 00:36:04.000
That's where some really cool cash pay services come in that are going to be really powerful.
00:36:04.239 --> 00:36:07.039
Um, he's like, you guys should have created stretch labs.
00:36:07.280 --> 00:36:10.239
You guys should have, you should have owned that space and you still can.
00:36:10.320 --> 00:36:43.199
And so if we came, if we had a little bit more profit and time and if we organize better, which is where Hodds does it better than any organization, in my opinion, is that we get people together to talk about how we can change the industry, then we can move the needle globally for all of us, like a rising tide, so that we all have because here's the funniest thing is Dimi, you and I both know if all the people you and I work with tripled their profits, they would use those profits to like better the patient experience and maybe take a vacation for once in their lives.
00:36:43.360 --> 00:36:48.719
Like they like the selfish return on that would be so unselfish from the outside looking in.
00:36:48.880 --> 00:36:53.440
And everything else would go into the industry, and then we would start preventing surgeries more.
00:36:53.599 --> 00:37:00.480
We'd stop opioid addictions, like the the cascading effect across the human experience in terms of health would be significant.
00:37:00.639 --> 00:37:10.000
And so it's it's interesting because we all know that within the industry that if we just had more profits and time, we could shift healthcare globally really dramatically.
00:37:10.239 --> 00:37:14.960
But my word, we stink at marketing because we just don't have time, we don't have the business training.
00:37:15.039 --> 00:37:23.519
So yeah, I think guys like you and I just feel very called and very fortunate to be in a position where we might be able to help organize and educate a little bit.
00:37:23.840 --> 00:37:24.719
Absolutely.
00:37:24.880 --> 00:37:48.159
Uh uh and and definitely the the the solution you have provided um of a lower cost of very highly capable individuals uh as virtual assistants that can that can help in many functions in in an organization is is absolutely extremely valuable.
00:37:48.320 --> 00:38:08.880
I mean, we are using uh both in HADS and in my uh the hands-on emg testing, our local diagnostic company, we do use virtual assistants for certain things, and the best uh experience I personally have is my personal executive assistant.
00:38:09.599 --> 00:38:16.719
She is a virtual assistant, and she is oh my god, absolutely incredible.
00:38:16.960 --> 00:38:20.559
I don't know what I could do without her.
00:38:20.719 --> 00:38:23.280
Um, she is very valuable to me.
00:38:23.679 --> 00:38:24.559
What country is she from?
00:38:24.800 --> 00:38:26.719
Kenya, Kenya.
00:38:27.119 --> 00:38:30.079
Do you know I I leave for Kenya in two days, Dimi?
00:38:30.639 --> 00:38:33.679
You you you're I'm going to Kenya in two days.
00:38:33.920 --> 00:38:34.480
Nairobi.
00:38:34.880 --> 00:38:36.400
Nairobi specifically, yeah.
00:38:36.559 --> 00:38:37.440
Oh wow.
00:38:38.639 --> 00:38:45.599
I'll I'll I'll give you the information so you can maybe uh meet up for some Kenyan coffee.
00:38:45.840 --> 00:38:50.159
Yeah, send me her, send me her, do an introduction in WhatsApp, and then I'll reach out to her.
00:38:50.320 --> 00:38:51.119
I'm in Kenya.
00:38:51.280 --> 00:38:55.199
And um, I'm so excited because like I love that you've had that experience.
00:38:55.360 --> 00:38:57.679
Everyone needs to have that virtual assistant experience.
00:38:57.760 --> 00:39:02.239
And I always tell people don't go through an agency if you'd like to try doing it yourself.
00:39:02.320 --> 00:39:08.079
You can go if you're gonna hire one or two, go to through, like, you know, there's in in the Philippines, there's online jobs.ph.
00:39:08.719 --> 00:39:11.679
Africa has its own uh boards as well.
00:39:11.840 --> 00:39:13.679
And it just depends what you're looking for.
00:39:13.840 --> 00:39:20.239
Some people are now going more towards like Central America and South America because they're on similar time zones and they like the Spanish speaking.
00:39:20.400 --> 00:39:21.840
It just depends what you're looking for.
00:39:22.000 --> 00:39:25.920
But yeah, like for everyone who's listening, like don't you don't have to go through an agency.
00:39:26.000 --> 00:39:27.920
You can go try to do this on your own.
00:39:28.000 --> 00:39:33.440
I uh services like mine are for people who are looking to scale or just want to help people who don't want to do it.
00:39:33.519 --> 00:39:39.280
But Dini, like, you know, it's funny because the Africa, one of the reasons I'm going is because we're expanding into that country.
00:39:39.920 --> 00:39:48.000
And we we love uh I was in Mozambique a year ago with my family, and this is a cute story I just want to share because it's kind of related to the humanity.
00:39:48.239 --> 00:39:52.079
I took my four boys there, and you know, an American father.
00:39:52.159 --> 00:39:59.920
I don't think I really did a good job of like pushing them to challenge them and and make them work hard because you know, I'm I I don't know, I just didn't do a good job.
00:40:00.000 --> 00:40:04.400
So we took him down to Mozambique, which is one of the poorest countries in the world, hands down.
00:40:04.480 --> 00:40:07.920
It's usually tied in the top, the bottom five of the poorest.
00:40:08.159 --> 00:40:09.280
And it was rough.
00:40:09.440 --> 00:40:16.559
Like we're we're digging latrines for villages that had earned it through this organization, Care for Life, this non-for-profit.
00:40:16.800 --> 00:40:23.519
And my youngest son, Van, was 12, and he's big-hearted, and and and not I've never really worked him hard.
00:40:23.599 --> 00:40:25.920
And he was starting, he just started sobbing.
00:40:26.480 --> 00:40:30.079
And I said, Oh, buddy, are you just exhausted from the work?
00:40:30.159 --> 00:40:34.320
And he said, No, I'm happier than I've ever been in my life, and I never want to leave.
00:40:34.880 --> 00:40:43.599
I think that what we forget in our physical therapy worlds is that we have the power to help people with technology globally.
00:40:43.920 --> 00:40:56.480
We can serve you, we can serve people in so many ways across the the borders of our country, you know, whether it's an HB1 visa or whether it's a virtual assistant or whether it's just being really passionate about helping.
00:40:56.639 --> 00:40:58.719
I mean, it's really amazing.
00:40:58.960 --> 00:41:03.360
We feel such a scarcity sometimes in the industry, but we are in a position where we we we are blessed.
00:41:03.599 --> 00:41:05.519
At the end of the day, we really are abundantly blessed.
00:41:05.679 --> 00:41:08.639
Yeah, and if we just had a little bit more time, we could see it.
00:41:08.880 --> 00:41:09.679
Awesome.
00:41:09.920 --> 00:41:11.519
Yeah, oh my goodness.
00:41:11.679 --> 00:41:13.360
Um, let's see.
00:41:13.519 --> 00:41:18.079
Um, what is uh let's both of us answer this question.
00:41:18.239 --> 00:41:21.920
Uh take home message, take home message for for everybody.
00:41:22.159 --> 00:41:24.480
Yes, please watching or listening.
00:41:24.719 --> 00:41:25.760
Yeah, let's do that.
00:41:25.920 --> 00:41:26.880
Um, you you know what?
00:41:27.119 --> 00:41:31.440
If it's okay too, I also do a rapid fire at the end of my podcast for people.
00:41:31.599 --> 00:41:33.199
I asked I ask some questions.
00:41:33.280 --> 00:41:34.239
Would that work for you as well?
00:41:34.559 --> 00:41:34.800
Good.
00:41:34.960 --> 00:41:35.760
Do that, do that.
00:41:35.920 --> 00:41:36.960
Okay, let's do some rapid fire.
00:41:37.119 --> 00:41:39.280
Let's do that first, and then we'll do the the the take-home.
00:41:39.760 --> 00:41:45.360
I like that because yours could be like um, you know, our parting thoughts as we get into that that space of it.
00:41:45.440 --> 00:41:48.880
So let me just pull up these questions uh really fast.
00:41:49.280 --> 00:41:50.559
Oh, there we go.
00:41:52.320 --> 00:41:54.159
All right, okay.
00:41:54.639 --> 00:41:57.679
So these questions they're meant to go fast.
00:41:57.760 --> 00:41:59.039
So don't worry about getting them right.
00:41:59.119 --> 00:42:00.079
Just go as best as you can.
00:42:00.320 --> 00:42:01.039
Oh my god.
00:42:01.519 --> 00:42:05.199
Now I'm like, oh okay.
00:42:05.679 --> 00:42:08.239
Okay, so um, what's the insertion of the quadrice?
00:42:08.400 --> 00:42:08.960
I'm just kidding.
00:42:09.119 --> 00:42:10.320
Rapid fire, number one.
00:42:10.559 --> 00:42:15.280
What's the top book that you've read recently in the last couple of years that's blown your mind?
00:42:16.559 --> 00:42:19.760
Uh this is supposed to be a rapid fire.
00:42:20.079 --> 00:42:21.679
Oh, it's okay, don't worry about it.
00:42:22.079 --> 00:42:47.679
Um so um I'm gonna take in this case um you know, my spiritual journey is a little bit um um very specific, and um um I would say uh something like the 15th American ACC.
00:42:48.880 --> 00:42:57.039
Okay, um it's very ritual and uh so the title is 15th American ACC?
00:42:58.639 --> 00:42:59.199
Oh, okay.
00:42:59.679 --> 00:43:00.719
Awesome, love that.
00:43:00.880 --> 00:43:01.199
Very good.
00:43:01.519 --> 00:43:05.440
Standing for um American clinical course.
00:43:06.239 --> 00:43:08.239
Okay, mind blow.
00:43:08.880 --> 00:43:09.679
Love that.
00:43:10.000 --> 00:43:10.960
Okay, next question.
00:43:11.119 --> 00:43:13.280
What's your top time saver hack?
00:43:14.960 --> 00:43:20.320
My virtual thing, I hope she listens to this.
00:43:20.480 --> 00:43:21.440
Me sure love you.
00:43:22.000 --> 00:43:22.880
She'll listen to it.
00:43:23.039 --> 00:43:24.000
She'll listen to it.
00:43:24.239 --> 00:43:25.039
Oh, I love it.
00:43:25.119 --> 00:43:25.840
Okay, number three.
00:43:25.920 --> 00:43:29.760
What's the one thing you wish you'd stop doing way sooner in your business?
00:43:31.039 --> 00:43:57.280
Um not taking advice that donated wrong statistics, but instead putting a lot more attention on how I felt about something, not about what the numbers showed.
00:43:58.000 --> 00:44:00.320
That's powerful.
00:44:00.719 --> 00:44:02.239
Because it's kind of an arc, right?
00:44:02.320 --> 00:44:09.920
Like we come in because of the passion, and then we don't know how to track the numbers, and then we start tracking the numbers because we have to, and then we start making it about the numbers.
00:44:10.159 --> 00:44:11.360
So it's a full cycle.
00:44:11.679 --> 00:44:12.000
Okay.
00:44:12.800 --> 00:44:18.079
What is the most time-consuming task that you secretly enjoy?
00:44:20.000 --> 00:44:23.119
Um secretly enjoy.
00:44:23.760 --> 00:44:27.440
It's kind of like a maybe like one of those um, what do they call those?
00:44:28.079 --> 00:44:35.039
It's uh one of those things that you do that like you know you probably shouldn't do, but you kind of love doing it, so you keep doing it.
00:44:35.920 --> 00:44:52.000
Um, you you you know what what um uh I enjoy um definitely having uh long uh um uh conversations with friends while wine tasting.
00:44:54.559 --> 00:44:55.199
That's a good one.
00:44:55.519 --> 00:44:58.079
Especially when it's more than a couple of glasses.
00:44:59.119 --> 00:45:02.880
More than a couple of friends and more than a couple of glasses come together.
00:45:04.079 --> 00:45:15.519
Okay, and then um what is if you had unlimited time, what would you focus on in your life?
00:45:17.280 --> 00:45:37.360
Um training somehow more than I do right now to create a larger influence in society in general.
00:45:38.000 --> 00:45:38.400
Yeah.
00:45:39.599 --> 00:45:42.559
Because your your passion's huge for that larger dynamic.
00:45:43.119 --> 00:45:43.360
Yeah.
00:45:43.519 --> 00:46:07.280
I mean I I if you see if you can definitely you can deliver stuff to a single individual and another individual, another individual, uh but if somehow you can deliver in someone who they themselves have can influence a bunch of other people, then your effect will be much larger, right?
00:46:08.000 --> 00:46:09.360
Yeah, absolutely.
00:46:09.760 --> 00:46:13.679
Like uh Okay, well good job.
00:46:13.760 --> 00:46:15.760
You answered those rapid fires very well.
00:46:17.599 --> 00:46:25.280
Okay, I I I I think this I'm gonna have to go uh triple, you know?
00:46:25.840 --> 00:46:29.440
And that will make my six shots for the day.
00:46:29.679 --> 00:46:33.039
So uh uh look, what time are we recording this?
00:46:33.119 --> 00:46:34.800
It's like uh almost one o'clock.
00:46:34.880 --> 00:46:36.079
I had three.
00:46:36.400 --> 00:46:36.960
Wow.
00:46:37.119 --> 00:46:42.800
Uh so uh the the three ones are now we've gotta go for the three afternoon ones.
00:46:44.159 --> 00:46:53.199
So wait, um, how about uh uh we'll do um take-home message, last words, or something like that?
00:46:53.519 --> 00:46:54.239
I like that.
00:46:54.400 --> 00:46:55.119
I like that.
00:46:55.360 --> 00:46:58.079
Um, do you want me to go and then you'll you'll you can finish?
00:46:58.239 --> 00:46:59.440
Yeah, that's fine.
00:46:59.760 --> 00:47:20.480
Yeah, my take-home message for everyone listening is the importance of recognizing that there's hope, that this is the best time in the history of our profession to be a leader or owner in the physical therapy space because we are at this kind of like I had to compare it to being like in the real estate industry in market around 2008.
00:47:20.960 --> 00:47:25.920
The best time in the history of real estate to get into real estate was 2008.
00:47:26.559 --> 00:47:34.000
You know, and so a lot of people who'd been through 2006 and seven wouldn't agree in 2008 if they weren't able to see the future.
00:47:34.079 --> 00:47:38.079
But when you look backwards, like, oh no, the beginning of great things was about to occur.
00:47:38.159 --> 00:47:39.679
We have so many things pivoting.
00:47:39.760 --> 00:47:43.199
So I just want to encourage everyone who's listening to never give up.
00:47:43.440 --> 00:47:51.840
Focus on on increasing reimbursement, be bold enough to join uh an event.
00:47:52.079 --> 00:47:56.159
The hands-on diagnostic symposium is one that I highly, highly, highly recommend.
00:47:56.239 --> 00:48:00.159
It has that symposium has a lot to do with why I have my own events.
00:48:00.320 --> 00:48:04.800
So if you have to choose between the two, go to that one because I wouldn't have mine without that one.
00:48:04.880 --> 00:48:07.280
It's a it's a networking opportunity on steroids.
00:48:07.679 --> 00:48:12.559
So just be brave enough to build that network, and that would be my parting thought.
00:48:12.639 --> 00:48:13.440
What about you, Dimi?
00:48:13.840 --> 00:48:19.360
Yeah, well, first of all, we have to make sure that our symposiums don't conflict in terms of dates.
00:48:19.599 --> 00:48:22.639
I scheduled mine intentionally not to conflict with yours.
00:48:22.800 --> 00:48:29.039
I scheduled mine in March, so I would never step over your your November, your November, October event.
00:48:29.360 --> 00:48:29.760
Awesome.
00:48:29.920 --> 00:48:32.559
Uh, is is yours coming up this month?
00:48:33.199 --> 00:48:33.679
It is.
00:48:33.840 --> 00:48:40.800
We have we we made the mistake of only giving a hundred seats out, and so we're almost already sold out for March.
00:48:41.199 --> 00:48:41.920
Awesome, awesome.
00:48:42.000 --> 00:48:43.920
What's where are you where are you hosting it?
00:48:44.159 --> 00:48:44.719
Phoenix.
00:48:44.800 --> 00:48:48.320
We have this really cool spot in Phoenix where we have a state, you know me.
00:48:48.480 --> 00:48:49.679
I need to be the center of attention.
00:48:49.840 --> 00:49:01.760
So we we have like a live band, and then me and my comedic partner get up on stage and we do comedy songs about physical therapy, but the whole event is about learning how to recruit, train, and retain talent.
00:49:01.920 --> 00:49:04.000
It's all about the people side of the business.
00:49:04.239 --> 00:49:07.840
And we have come most people come from out of state, ironically.
00:49:08.000 --> 00:49:11.360
Um, so we have people from across the country, and then we do something really fun.
00:49:11.599 --> 00:49:18.400
We invite all the local university students to attend one day to get interviewed, and it turns into an actual hiring event.
00:49:18.880 --> 00:49:24.639
And so um half of the Arizona students leave the state and want to go out of cut out of state, so it's perfect.
00:49:24.719 --> 00:49:27.440
People usually will hire, so it's fun, it's a lot of fun.
00:49:28.079 --> 00:49:28.800
Fantastic.
00:49:28.880 --> 00:49:35.280
And and and you you will give us also the link, so we're gonna post it also in our um uh podcast uh resources.
00:49:35.519 --> 00:49:36.559
And vice versa, please.
00:49:36.719 --> 00:49:37.199
All the links.
00:49:37.519 --> 00:49:37.920
Awesome.
00:49:38.159 --> 00:49:39.760
Okay, final thoughts, Debbie.
00:49:40.000 --> 00:49:41.199
Uh final thoughts.
00:49:41.360 --> 00:49:50.880
I mean, um, I totally agree with with uh what you talked about, uh uh and hope and and and I want to add to that action, yeah.
00:49:51.119 --> 00:49:51.440
Right?
00:49:51.519 --> 00:49:57.920
Yes, there is hope to do something, but we have to do it, we have to take action on it.
00:49:58.239 --> 00:50:09.599
And uh if nobody is gonna just give you the world, nobody's gonna just come and tell you all of a sudden we're gonna double your reimbursement just because you are cute.
00:50:09.760 --> 00:50:14.079
No, you gotta do something about it, you have to take some action.
00:50:14.320 --> 00:50:21.599
And many people they're like uh many times in a zone of indecision.
00:50:21.760 --> 00:50:24.960
They're like, okay, should I do this or I shouldn't do this?
00:50:25.119 --> 00:50:27.760
Should I do HUDs or I shouldn't do HUDs?
00:50:28.000 --> 00:50:33.119
Should I get a virtual assistant from Will or I should not get a well, you know what?
00:50:33.280 --> 00:50:40.320
The worst place you can be is the zone of maybe because indecision is actually a decision.
00:50:40.880 --> 00:50:43.679
So just indecision is a decision, right?
00:50:44.000 --> 00:50:44.480
Absolutely.
00:50:44.719 --> 00:50:46.079
Indecision is a decision.
00:50:47.280 --> 00:50:49.199
It's a decision of not doing it, actually.
00:50:55.599 --> 00:50:57.280
Yes, uh good.
00:50:57.599 --> 00:51:03.119
You're embracing the change, you are embracing the new, you are embracing the new opportunity.
00:51:03.840 --> 00:51:12.400
If your decision is no, uh at least you are freeing up your mind from being stuck somewhere in the middle, not knowing what to do.
00:51:12.480 --> 00:51:17.519
And and eventually you'll be able to put those attention units to something else that you want.
00:51:17.920 --> 00:51:22.239
Never be in the middle, never be in a state of maybe or indecision.
00:51:22.480 --> 00:51:25.840
Just make up your mind and do something.
00:51:26.719 --> 00:51:29.920
Okay, uh, Dami, it has been too long.
00:51:30.079 --> 00:51:32.000
I am so grateful that we got to be together.
00:51:32.159 --> 00:51:34.159
I sure appreciate you being on the show.
00:51:34.400 --> 00:51:36.480
I am honored every time I'm with you.
00:51:36.719 --> 00:51:37.039
Awesome.
00:51:37.199 --> 00:51:43.599
Likewise, and you know what I guess we should get our friend Nathan and Rio.
00:51:45.440 --> 00:51:47.039
That let's do it.
00:51:47.119 --> 00:51:57.760
I would do that'd be so fun the three of us to talk and share memories from the battlefields of me calling doctors and hanging up after introducing myself and as an electrician, like all the things, like we could do all the things.
00:51:58.079 --> 00:51:59.360
Exactly, be awesome.
00:51:59.519 --> 00:52:00.239
Thank you, Will.
00:52:00.320 --> 00:52:12.320
Uh thank you, Did you uh everything to do and appreciate uh giving the opportunity also for your audience to for me to share with your audience uh some of my thoughts.
00:52:12.480 --> 00:52:12.880
Thank you.
00:52:13.119 --> 00:52:13.920
Thank you.
00:52:14.320 --> 00:52:17.920
All right, so I guess we say okay.
00:52:18.000 --> 00:52:19.199
Well, Dimi, thank you so much.
00:52:19.280 --> 00:52:20.960
Let's stay in touch and please, I mean that.
00:52:21.039 --> 00:52:21.599
Let's stay in touch.
00:52:21.679 --> 00:52:25.199
I'll I'll send out all the assets and stuff, and then yeah, man, great to be with you today.
00:52:25.360 --> 00:52:26.719
I sure appreciate your time.
00:52:27.280 --> 00:52:28.719
Sounds good, likewise.