Establishing Bonus Programs That Incentivize Productivity With Tracy Bond, Coach Of PPO Club

[00:00:00] If we get no's, we have the therapist call and say something. Johnny was here last week and he was working on, I'm a speech pathologist, so ours, and he was doing a great job on those. I hate for him to miss a week and possibly slip back a little bit and just have to learn all this over again. I would love to get him in. I know he was proud of himself. We were proud of him. I have appointments this time and this time. Which one works for you? So the therapists are responsible for filling their

[00:00:29] caseload to and making sure those cancellations and no-shows are rescheduled. Welcome to the Private Practice Owners Club. Your hosts and coaches, Nathan Shields scaled his practice and exited for millions while Adam Robin went from working 60 hours a week in one clinic to scaling to multiple clinics while working less than four hours per week remotely. This podcast is meant to share with you exactly how they did it and how you can build a business that supports

[00:00:58] the lifestyle that you truly desire. And don't forget to join the Private Practice Owners Club community on Facebook, where we are obsessed with providing even more resources that help owners just like you win the game of private practice. Hello and welcome to the Private Practice Owners Club. I'm Nathan Shields. And today I've got one of our great head coaches of the Private Practice

[00:01:26] Owners Club coaching program, Tracy Bond. And she's also the owner of... The Spot Clinic. The Spot Clinic. It's speech PT and OT, however you slice it. So spot, however. And you do pediatrics. Yes. And you've got three soon-to-be-five clinics in Alabama, right? That's right. Couldn't tell from your accent. Yeah, right. Well, this is why we love to have you is because obviously you have three clinics and

[00:01:56] you're going to five clinics. And now, just so everyone knows, Tracy kind of has nothing to do with her clinics at this point. She stepped aside and let the leaders take over. And that in and of itself should tell you a lot about her capabilities as an owner and the experience that she brings to a conversation like we're going to have today. So thanks for taking the time and being willing to talk to me, Tracy. Absolutely. Looking forward to it.

[00:02:20] Yeah. As I talk to potential guests, the question that I ask them typically when we're trying to decide what topic to speak on if they don't come prepared with one is what lights you up? What gets you excited? What are things that you like talking about you could expound upon and not feel like it's taking a lot of brain energy to do so? And I was excited when you said that you wanted to talk about bonus programs and maybe highlight your bonus program. Because thinking back,

[00:02:47] I don't think I've had an episode. I mean, I'm trying to think through 300 episodes, but I don't think we've had an episode dedicated to some examples of bonus programs that owners are sharing with their teams. We've talked about it in different episodes, but to spend an episode on it is really cool. And so I'm excited to hear what you've got and what you can share. And I'll share what we had. Yes. And go from there. But to start the conversation, tell me a little bit about when

[00:03:15] did you decide that you needed to start a bonus program? Did you have this idea from the very get-go before hiring your first person or what kicked it into gear? I didn't when I hired my first person, because at that point in time, I was flying by the seat of my pants and I did not start coaching until about a year in is when I got a coach. You hired a coach a year into ownership? Yes. And I opened in 2019. Oh, wow. So that's pretty recent.

[00:03:42] Yeah. December of 19. Congratulations. And then of course COVID hits. Yeah. Kind of hurt. But I didn't just because I didn't, I really didn't think about it, but it was just all of these things are ever evolving and I add things and I change things all the time. So that's a good point to make is anything. And then the other thing that's ever evolving is job descriptions because you change job descriptions for people all the time. So just a

[00:04:10] side note, but I was probably about two years in before I started bonusing. Biggest reason is because we want to make sure the company was viable. So our bonuses are there as long as the company is making money, making profit and a viable company. So that has been stressed to employees. Luckily, knock on wood, we have not had to cut bonuses up to this time. Hopefully we won't see any Medicaid

[00:04:38] changes that will cause us to do that, but we don't know right now what's going to happen. Knock on wood. Yes, exactly. We're just going to keep it as is for the time being. Yeah. So did they approach you about it or were you seeing a drop in production that you needed to incentivize or did you through coaching just recognize this would be good to incentivize them to produce more? Yeah, that was it. And because the coaches gave me some guidance on

[00:05:04] how to do it. And I started out just bonusing therapists and then kind of went through the whole gamut. And about a year ago, I started bonusing all the staff members, except our techs are not bonused. We always had a hard time coming up with a real KPI for our techs. Yes. You know what I mean? Because they're so intricately involved. We actually kind of judged the tech's capability to get the therapist out of the clinic approximately the same time that the

[00:05:33] patients walked out of the clinic at the end of the day. But how do you bonus that? I don't know. So I know what you're talking about, but I'm glad that you highlighted something that if someone's starting a bonus program, I wouldn't expect them to cover bonuses across the board. If this is your first dipping your toe in the water with bonuses, you might want to just stick with providers and let's try to smooth that program out before we spread it across the clinic, right?

[00:05:59] And do a very small bonus. Just because mine may be higher than yours doesn't mean that's what you need to do. Most people I have found are glad to get anything. It just shows them that their work is valued. So I would not start out with a big number. You want a number that you can grow into. Now, so as people are considering, you brought up the amount in which you have bonus and I'm sure there's tiers to it. How did you fall upon that number? A lot of it was calculations. We had to

[00:06:29] look at revenue per visit was to make sure that we were covering salaries, covering overhead. Well, benefits. Yeah. Well, you had to cover your, you had to know your cost per visit. Yes. Right. Know your cost per visit, know your reimbursement per visit on average, right? Yes. And then man, I can imagine the calculations you went through because you had to figure out, okay, based on our average provider salary that we currently have, what are they producing?

[00:06:57] And what is the breakeven point, right? And breakeven covers all the expenses plus 10% to make sure you're generating something. And then finding that for us, it was a per week visit number. So many visits per week. I don't know how you did it, but we knew what that number was. And then we knew if they went maybe 10% above that, which equated to like five visits more per week,

[00:07:23] then we were willing to start bonusing. Does that sound familiar? Or did you do something different? I have heard people that do that. I played with this for a long time. And to be honest, I knew nothing about statistics until I started coaching. Yeah. That's pretty typical. I was just surviving. So learning statistics was a big thing for my company. And it made a big difference, I'm assuming.

[00:07:49] Oh, huge. Yes. Huge difference. So the way I bonus all clinicians is, and it's a convoluted way, but I'll kind of explain the why first. I had one clinic that was always a lot more productive than the other two and I paid hourly. So if they had a cancellation, they didn't care. They could talk to somebody else or be on their phone or whatever. Okay. So they still got paid if someone canceled. Yes. Got it. Understood.

[00:08:15] The only time that they didn't get paid is if the first one of the day or the last one of the day canceled. So they come in late, leave early. Yeah, I get it. That was when they get paid. Otherwise, yes. So looking at that, I saw my clinic that was 80% productive overall versus my clinic that was 65% productive overall. And I was like, they're getting paid the same amount. I've got to do something. And I had started a bonus structure

[00:08:42] kind of similar to yours. And it was so stinking complicated for me to figure. Okay. Again, I'm not a numbers person. I'm learning the stats as I go. So when I started looking at it, I started doing the same thing, looking at productivity and that kind of thing, and then

[00:09:05] didn't feel like the bonus I was giving was good enough for those people who were performing well. So I went down and tried to think of, okay, how can I change this so that everybody is getting paid based on their work? So I, like I said, I looked at all of the data and saw exactly what we

[00:09:28] needed to cover everything and profit. And then also added in a little bit for growth. They're going to be asking for raises and they're going to be asking for a bonus increase. So I also figured in, I think about 15% for that one. That's how I started. And then I said, okay, I know how to do this. I mean, I know what I want to do now. How do I do it? So that's when we came up with those numbers.

[00:09:56] So do you bonus on a, like I did a number of visits per week or a number of units per week or a total amount charged per week or something like that? We do units per week. Units per week. Okay, cool. And do you include, so some physical therapy clinics might, like we didn't include modalities as viable units. I'm assuming you're the same. No, we can bill everything. We're one-on-one with our kids.

[00:10:23] Well, we use like electrical stimulation and ultrasound and stuff like that. And those wouldn't count towards your units billed per week. Okay. Yeah. All of ours is anything that's billed, we count. Okay. Gotcha. And so you, they have to meet a minimum number of units billed per week in order to get the, well, I'm sure there's a baseline level to justify their job, but then there's another X percent more in order to get the bonus.

[00:10:50] Yes. What I did was I had all of my staff tell me how many hours I wanted to work. Could be 20, could be 40, 30, whatever. Tell me how many hours a week you want to work. That is set in stone. Unless you come back and change it and want to change it for the next payroll, it's set in stone. So once everybody told me that, I went to their hourly rate and cut everybody's hourly rate by 25%.

[00:11:18] So did we not have an uproar for a while? But the way I explained it was with this bonus program, the more productive you are, the higher your bonus is going to be, and you're going to actually make more. So what we did was if somebody worked 40 hours a week, they had to be 50% productive. So they had to bill 20 hours a week for a base pay.

[00:11:46] So justify their decreased salary. Yeah. Yes. Yeah. So for example, if they made $40 an hour, then now they're making $30 an hour. And then after that 50% for every unit they bill above that, they are bonused. Oh, okay. And this is all depending on everybody's numbers. Everybody has to be different.

[00:12:09] But for speech, it might be $20 because we're untimed. So 30 minutes is a speech session. And then for OT and PT, I think PT is nine and OT is seven. And again, that's based on reimbursement and that's per unit. So that's times four. So the way we did that was when I announced it and had all

[00:12:36] of these people up at arms, I decided, okay, I'm going to give you six months to fill your schedule and you don't have to do it for six months. Well, my productive clinic said, wait, wait, wait, we want to try it now. We'll be your guinea pigs. Oh, that's cool. So they actually started it two months after I announced it, but we gave them a spreadsheet on that spreadsheet. They could put in how many hours they were scheduled, what their previous

[00:13:05] hourly rate was, and then it would calculate their old hourly salary per week. And then it also, then you put in, well, it calculates what your new salary will be, new hourly rate. And then what the current base is, how many units they need to hit 50%. And then they could go in and add their

[00:13:28] units that they build for the week. And it would tell us how many units did they build over that 50%. And then over that 50%, they would get the bonus. But what we wanted to do with this and why we let them do this was because we wanted to prove to most of them that they would be making more if they increased their productivity. And it has worked very well, extremely well. So we turned that out in June

[00:13:58] of 23 was the deadline. The first clinic started in February. And then oddly enough, I had all of my therapists other than two go to the bonus structure before June. So they all saw how much they were making. And some of them were making four or $500 a paycheck more, but I can afford to pay them that because they're 90% productive. Right. Okay. Yeah, exactly. I was going to ask you what kind of

[00:14:25] productivity changes you saw. Huge. The 60% productive clinic went to what? What are they averaging? I think they're about 83 overall. Great. Great. And the, it sounds like the 80% clinic went to 90. Yep. That's amazing. Yep. That is so cool. And I'm assuming that going along with it, like when sometimes when clinics are running hot like that, they're like 90% productive.

[00:14:52] There's a lot of complaining or whining, if you will, and we're so busy though. I can't keep this up or that kind of thing. But when they know that their paycheck is tied to their production, some of those complaints tend to fall by the wayside. Did you see the same? Yes, I sure did. Because what we told them is we're going to let you have some autonomy in this. You're going to be over what your hours

[00:15:19] that you want to work and whatever productivity you want. You have to be there that number of hours. If you want to build 20 hours out of 40 hours, you can get your base pay. You get your base salary. That was 75% of what you had before. Yeah. Yes. But if you want more, you just have to work for it. Wow. So you did a little bit of a hybrid there. And when I say hybrid, it's a smaller base salary

[00:15:44] and on the backend, a greater reimbursement rate, either via bonuses. It's not an eat what you kill model, which is completely based on production. And I've had that interview before in the past with some owners, but they took the same approach that you did. And that was, they didn't say this starts tomorrow. They said, we're going to show you what the benefit is over time. You can opt in whenever

[00:16:09] you want, but we're going to show you based on your current production levels and what you could produce more, how that would affect your take-home pay. And that tended to turn a lot of minds when they, and some people were just like, yeah, I know I can make $200 a week more. I just like the security of the salary. I mean, some personalities are like that. What are you going to do?

[00:16:33] But you know what? You want to feed your tigers and more than willing to pay them more and let the other ones just get what they get. We implemented a policy. I always have a mantra every year for my staff. And this was in 23. So my 2023 model or mantra was own your own caseload. So then we trained the therapist when they had a cancellation or no show and the front desk can't reschedule them.

[00:17:00] It's their responsibility to call and see if they can get them rescheduled because every cancellation is money out of their pocket. So we kind of have a script. Front desk never asked, do you want to reschedule? It's always, we have appointments at this time and this time, which one of those work for you? Sometimes we still get no's. So if we get no's, we have the therapist call and say something, Johnny was here last week and he was working on,

[00:17:25] I'm a speech pathologist, so ours. And he was doing a great job on those. I hate for him to miss a week and possibly slip back a little bit and just have to learn all this over again. I would love to get him in. I know he was proud of himself. We were proud of him. I have appointments this time and this time, which one works for you? So the therapists are responsible for filling their caseload too and making sure those cancellations are, and no shows are rescheduled.

[00:17:52] I really like how you gave them control over their caseload because I think the default mentality for most therapists is patients come to me. I can't control it. If they cancel, what am I going to do if they're sick? And so-and-so went to the hospital. Okay. Or like bring me the new patients. If we're not getting new patients, that's like your job. Where's the marketing department? They need to bring me

[00:18:16] new patients. But giving them ownership of their caseload changes the dynamic, changes the mentality and the attitude towards that such that now they're thinking, oh, I giving them control and giving them responsibility for the product, i.e. their paycheck. Now they could say, oh, if I step in now and really take control of my schedule, they will see benefits. But I know the conversation was around that.

[00:18:46] But it's also part of telling them when you step in and control your schedule, your patient's results get better. And so when you roll it out, it sounds like you didn't necessarily tie it to patient results, but have they recognized that over time? We haven't tracked that simply because with pediatrics, we see these kids for a year, years, whatever. Yeah, I can see the difference. Yeah. So it's hard to

[00:19:12] really have a track on that. The other thing that helped with us getting the therapist on board was we just pointed out when you are talking to parents and trying to get them back on the schedule, it shows them you care and you care about their plan of care and you want to see them to make sure that they're coming in. And also it hurts another child if we've got a waiting list and that child

[00:19:39] can't get in. And it also hurts the therapist, their bottom line. So there's three little branches off of that. So it worked. It worked well for us. That's huge because I've seen the same thing either with personal experience or those of others that I've talked to that when the provider makes the call, the patients really appreciate it, frankly. And those providers that take that call seriously tend to have lower cancellation rates. I agree.

[00:20:08] Right. And it's all in the scripting. It's how they say it. They need to come across with care. They need to come across with a focus on patient results. But some of it is like, Hey, remember at the initial evaluation, we agreed to this plan of care that was such and such frequency over such a period of time. And if we're not able to agree to that and stay true to it, then I cannot guarantee you the results that you're hoping for. Exactly. And so we need to be bought in. We need to be on an agreement on this together. If there's some kind

[00:20:37] of conflict. Yeah. And like one of the nuances is not when do you want to reschedule? That's like the worst possible. I hated when my front desk answered, asked that question. When would you like to reschedule? But rather we have days and times available here, here, and here, which one would you like to take? Right. And we got in the habit of saying, do you want to reschedule? So all that is a yes, no question. And I was like, yeah, that's not working for me. No, that doesn't work

[00:21:05] because people will typically default to no. Yes. That's what I told them. That's exactly what I told them. Show me your friends and I'll show you your future. Hey, it's Adam. I'm serious about one thing, growth, personal and professional growth, because everybody wins. When you get better, one of the most powerful ways to grow is by surrounding yourself with people who

[00:21:33] challenge the way you think. That's exactly why we built the private practice owners club, Facebook group, but this isn't just another random group. We're intentional about creating a space for growth inside. You'll find weekly live trainings, all of our free resources, access to our entire coaching team for your questions, plus connections with industry partners, digital marketing, billing, legal, EMR, compliance, and more to support you every step of the way.

[00:22:03] So stop what you're doing and check out the show notes. Click the link titled Facebook group to join today. We need people like you to help us build an even stronger community of passionate practice owners, especially the ones committed to growth. I love how you laid it out and I wish we would have done the same, but this was so long ago just to say, Hey, you're seeing, you guys are busy. You're doing your thing. This is what it's going to be like. Ours was just simply a bonus program. And I like how yours was tied

[00:22:33] to increased production, but we tried to help them understand that we wanted to recognize their increase in production. We especially wanted to recognize when maybe they took on a few extra patients because someone was on vacation. So if you're going to put in the extra hours to see the extra visits, then we want to bonus you. I'll tell you what else that's helped with. If somebody comes to us for a raise, we look back and see what their bonus has been for the last year

[00:23:01] and what their average productivity has been. So if they've been on average 80% productive, then we say, okay, let's figure this out. If you were 85% productive. So why don't, you know, I want you to control your own salary. I want you to make as much money as you can make. Don't leave money on the table. So this year, let's see if we can get you up to 85% or 83% because you'll make X number of dollars more, which is equivalent to, or more than what you're asking for anyway.

[00:23:31] So we haven't given raises in a couple of years. Oh, really? Because they can just control it themselves. So when they're asking for a raise, are they asking for a raise on the base salary or are they asking for an increase of the benefit per unit? Bonus. Yeah. They're asking for increase in bonus. Oh, okay. Gotcha. So they want to be bonused more. That's hard to do if they're stuck in the 60, 75% production range, right?

[00:23:56] Yeah. If they're 60 or 70%, they're probably not going to make as much as they did last year. Not last year, but when they were on the old salary and bonus structure, they pretty much have to make 75 or better percent. At 75%, they kind of break even a few dollars here in there. But by 80, they're seeing a difference in their paycheck. And I even had some at one point

[00:24:22] in time that were 95% productive because she was trying to buy a house and she was trying to get as much money as she could. So she would get off the clock to do notes and do all of these things that she could do off the clock. And I actually had to put a cap on it and said, we're capping at 90%. Because the other thing that she did was she would say, well, I don't have time to call patients and

[00:24:50] I don't have time to clean and I don't have time to do this. And I said, well, that's part of your job. And we've got to have everybody participating in those things too. So let's cap it at 90%, unless there's extenuating circumstance that your manager can determine from there. It can always override, but there's a conversation that's planned. Everyone knows ahead of time, right? It's approved, et cetera, et cetera. Especially if vacations and sick days come into

[00:25:16] play. Yes. Yeah. When you know, it's huge to pay them every paycheck. I was just doing the bonuses quarterly. That was why it was taking me so long. So doing it every paycheck. So they see that money, that extra money coming in every two weeks. They like. Yeah. We had the same thing. They, they got bonus per week, but it came in, but that bonus just accumulated over the two week payroll period, right? And got paid every paycheck. I have had

[00:25:46] some people that do just fine paying quarterly. We had David on the group call on Wednesday who said he allows them the opportunity to track their bonuses on a regular basis. But when he pays out, he pays that quarterly bonus, whatever works for you. Right. I mean, there's nothing set in stone here. And I think what's really important is to not get too complicated and just tell me if this is,

[00:26:11] if your providers are able to, but are you, are they able to track what their bonus is going to be at the end of the week? Like it's, it shouldn't be rocket science. You show them the formula you get, or you hit this number, you get X amount of dollars, or you hit this many units, you get X amount of dollars. They're able to track it themselves. If they're not able to do that, then the bonus is just like this ethereal thing. They're like, maybe I get a couple hundred bucks next week. You want to make it available to them so that they understand exactly what they're going to make when that paycheck

[00:26:38] hits right. That spreadsheet that we provided them to show the difference between their old hour, hourly rate and their current one with the bonus. They can do that every week if they want to. Yeah. So they're doing the same calculations you're doing. And I think that's super important and important to highlight because you don't want to make it super complicated, something that they understand. Right. Exactly. And they can figure it out themselves. That's great. I love how you did it

[00:27:05] because it incentivized things. We saw the same thing when we bonus with visits per week, they still had to meet a certain number of skilled units per visit. Yours inherently does that because as they max out the units, they're going to get a higher bonus. Ours was visits per week, but they still had to hit a minimum average of skilled visits per week. You couldn't see the number of patients that we wanted to see and just build two units for an hour of care. That doesn't work. Going back to your thing about

[00:27:35] it has to be viable for the company in order for this to work. And to get back to something that you said before we push record is you're presenting it like we plugged this in and then it just worked for the last two years. You told me you've had to go through a few iterations of this to get it right, right? Probably more than one hand. So over time it's changed a lot. At the beginning, it was only bonusing

[00:28:01] therapists and it was quarterly and it was completely crazy to keep up with. And then it evolved a little bit to we were paying hourly and this bonus was just teeny, teeny, tiny. And it was still, then we paid monthly. So now it's evolved to the weekly thing that works better and it's working, but that's for my clinic. Everybody has to do, like you said, everybody has to do exactly what's

[00:28:30] best for their clinic. These are just examples. Without using these words, how did you tell them that you reserve the right to change the numbers and the bonus structure at any given time? How did you get that across? That's part of the policy. So it's in the policy. That you have the wherewithal to change this at any given time, that they'll be given plenty of notice, et cetera, et cetera, that kind of thing, right? Yes. So they're like, wait, I'm getting whiplash. You're making all these

[00:28:57] changes. And we're like, well, this isn't perfect. And I started putting that phrasing before we changed any program towards the end of my ownership was like, we're going to try this out. We're going to see how it goes. All right. We want to make sure it works for everybody. If it doesn't work for me, I reserve the right to change it. If it doesn't work for you, then we'll have a conversation and we can change it again. Are we clear on that, that this isn't perfect? We're just going to try it. And we can say that for any program we're going to roll out, right?

[00:29:26] And we let them know that the company has to be viable. And the only way the company's viable is for them to put in the hours and see as many kids as they can and help as many families as they can. But that goes for everything. And it's still, after five years, still ever evolving. So we always tell, here's the policy as of now, but there could be a change. We implemented a staff initiative group

[00:29:52] with all the disciplines. And what we were finding is we put out a policy and then we'd have all these complaints back. So we decided to put this committee together to be able to look at each policy. So instead of sending one out, that was kind of like a rough draft and we'd have to send it back. We looked at them coming in. They came in once a month. We changed all policies that were new to go out once a month. So at the beginning of the month, they would all go out. But in that meeting,

[00:30:22] we would have all the staff members review the policy, ask questions, clarify anything that we needed to add so that when it went out, it was set in stone. And that just empowered our committee members to handle some of the questions and complaints. Because at that point in time, they know the why that we're doing this. They helped write it. So they're accountable too.

[00:30:46] Oh, that's a cool idea. So we talked about how to bonus providers. Give us some general ideas on how you're bonusing other members of your teams. Okay. Front desk staff in Alabama, they don't make a whole lot of money. So we try to bonus them a little bit and they appreciate everything. So what we do is for every person they reschedule in the same week, if somebody cancels on Monday,

[00:31:11] as long as they're in by Friday, they get paid $3 per reschedule. If they reschedule for a different week, like if they're on vacation and have to schedule the next week or whatever for makeup visits, then we give them a dollar per cancellation or reschedule. The front desk, they're always rescheduling 20 or 30 patients a week. So they can easily make an extra 60 bucks a week, which is

[00:31:37] good for them, but we can encourage them to own that caseload as well and try to get those people in. And although it was small, they appreciated it. Yeah. I think ours was, they had to hit a couple of metrics. Arrival rate had to be above a certain percent. Their over-the-counter collections rate had to be over a certain percent. Ours is a hundred. Nice. Everybody that walks in does not leave without

[00:32:05] paying. What's your secret? I didn't give them an option. Well, do you keep, like I've been really pushing people to put credit cards on file. That makes it super easy. Do you do that same thing or are they pulling out their credit cards every visit? We have one clinic that pretty much bills credit cards every day. Then we have one clinic that's about half and half. And then we have one clinic that's about 25% with credit cards on file. The two that are not a hundred percent say, well,

[00:32:34] people don't want to leave credit cards. So if that's the case, we use Square or Stripe and all this other ones, and we just run their credit cards. Some of them pay cash, some of them write checks, but they just have to pay something. And when the first of the year rolls around and everybody's deductible changes at that point in time, we also charge a little bit more to start with looking down that deductible. And then once their deductible is paid, they go back to whatever the copay is.

[00:33:04] Okay. Yeah. I could see that. Right. And if they don't come prepared to cope to provide their copay, they're not saying, okay, you don't let them back. That's a policy in our new client handbook. That is a policy in there. So they know you pay every single time you come in. When you go to the doctor's office, you pay and we're the same way. You're not walking back until you... The only difference is we can only see one patient at a time where doctors can stack patients.

[00:33:33] Yeah. Yeah. Yeah. Good for you. So yeah, we had some different metrics for the front desk. Are there, who else on your team gets bonuses now at this point? Our clinic managers are bonus. We look at metrics for them. We want them to make sure that the arrival rate is up there. So we want to make sure they're at 90% and they can follow up with their front desk and with the therapist to get it up there. We also look at the number of therapists

[00:34:02] that are meeting 75 to 80% productive. So 80% is for non-evaluating therapists and 75 is evaluating therapists. We plan to probably bump that up in the future. And most of them are doing more than that anyway. The number of cancellations and no-shows that weren't rescheduled, in-house referrals, and the average treatment charge pending.

[00:34:27] Oh, okay. So they get bonus on each of those metrics or do they have to hit all of those metrics in order to get the bonus? Well, if they hit three of those seven, they get this amount. If they hit four of these seven, they get this amount. Oh, okay. And that's just kind of a flat rate? Yes. Uh-huh. Yeah. Yeah. Because our clinic directors could not only get the visits per week bonus as treating providers,

[00:34:52] but as clinic directors, they also could get bonus. We had a profit sharing program, frankly. So if the clinic was XYZ profitable, then they could get a bonus for that. And that was usually played out. They could get the weekly bonus, but the profit sharing was usually a quarterly thing. Yeah. We probably need to share that or share a conversation about that because I would love to do that. So I may be picking your brain. Yeah. Because you want those higher level people,

[00:35:19] like your clinic managers, you call them, to benefit from leading the team, like financially bonus for leading the team and the team hitting certain metrics. And you want them to be a part of that, right? So I think that's really important as well, especially for your leaders. How do they get bonus? And if the people over their purview is a large group, then maybe they should get bonus on the production of that large group. Right. Our credentialing coordinator,

[00:35:47] what we want her to do is we want her to have all of the credentialing paperwork in from the day they sign the offer letter to six weeks after employment. So if we're able to do that within that six weeks, she gets $25 per new staff member and she stays on it. I mean, she's on the phone constantly with Blue Cross Blue Shield and Medicaid to make sure they've got everything they need and to see where

[00:36:14] where they need, she needs to follow up. So we have increased or decreased our amount of time that it takes to get credentialed significantly. And is your billing team outsourced or are they in-house? No, we do in-house. Yeah. And do you have bonuses for them as well? We do. So for intake, we've got ours kind of divided into three. We have front desk and then we have intake and then we have billing. Okay. So for our intake, we look at how many

[00:36:43] evaluations they scheduled within two days of getting the referral. If they actually show for evaluation, reminder, reminder, reminder, and then if they can get the paperwork in from the case history and all the paperwork they have to do on the first visit, then they get another bonus. Great. Yeah. So you're really bonusing them to speed up the process, right? To have everything

[00:37:11] available because there's power has an element of speed to it. And the more, the faster you can do something, the more powerful your clinics become. I agree. Our front desk, we look at advanced schedule. So we look on Friday every week, we look at the following week's schedule to see how many visits we have. Then the next Friday, we look to see exactly how many came in. And as long as it's

[00:37:35] a number, if somebody's canceled and they fill in that cancellation, it counts as a visit. So just the total number of visits. And they get a bonus on that? Yes. Nice. And then we talked about the copay bonus. What about your billers? Is that related to your AR aging or how much they bring in or average reimbursement per visit or denials? What are some of the bonuses you share with them?

[00:38:00] We bonus per insurance verification. So we're supposed to verify insurance and get it back to our intake specialist to schedule within 24 hours. So if it comes to them and they get to the intake patient and intake gets them and can call, they get a bonus. The other thing is any denials that we get in, if they're resubmitted in the same day, they get a bonus because we want to make sure we're staying on

[00:38:27] that. Yes. And then luckily we can get rid of the one that says we have to collect because we collect on site, but that was something that was big because they would email or they would text back before we were doing that and they wouldn't get them. So we were like, you have to speak to a person. Yeah. You can't just text or email because they're going to say they didn't get it. Right. So you have to text, they have to talk. Yeah. I could see like the only thing that I could

[00:38:56] see might be an issue is yeah. What if I got the insurance verification in 24 hours, but I wasn't really good at it. Maybe I just guessed it. Cause I've worked with this insurance company a lot and then we get denied and I turned it in in 24 hours. Then they could get bonus on both ends. That comes back to training, training your front desk or intake and your billers to get everything complete. Yeah. I guess if this denial start stacking up and then there needs to be some

[00:39:23] conversations. Exactly. Yeah. I get it. I get it. Very good. Well, I love how you did all these things. I'm assuming you did calculations on all of this. I did. Yeah. Before you implement it, you're just like, you didn't just think, uh, $50 would be good here or $50 would be good there. Or $3 is good here. I'm sure you probably ran the numbers. Like if they hit these numbers, this is what, how it affect my profit margin. Right. I'm sure you did some of that.

[00:39:53] Yes. Just like for the bonuses, uh, the therapist bonus happened to come up with what it was per unit. Yeah, exactly. And is that something you did or did you lean on your husband? Cause I know he's a numbers guy or did you leverage your bookkeeper or accountant who helped you through some of this? I had my COO do it. She and I kind of talked through it and she came up with some numbers and got back to me. And then we talked through that and then finalized whatever we were going to do. And you probably took what a month or two to figure these things out before you even

[00:40:22] address them. Probably longer than that. It was probably three months. Yeah. Yeah. So you took your time. It's not like, let's figure this out today and run with it next week. Right. Now, when I first started, I did that guessing game. Oh, let's just give $20 here and $50 here. But when I first started again, before my coach, I live from my bank account. If I've got this amount in my bank account, I can spend this amount. So when I started looking at stats, I realized

[00:40:50] real quick, that ain't going to work. So I really had to analyze those better. Well, that's a great reminder to people, especially if you're considering a bonus program that you need to know your statistics and you need to actually run those numbers before you roll out any program. Absolutely. Feel free to take your time, but leverage people who know numbers. If you're not a numbers person. Yes. And I know a lot of speech pathologists aren't numbers people particularly. Yeah.

[00:41:17] I'm not sure about PTs. I would think they're more analytical, so they may understand numbers more. Depends on the person, but we didn't get into physical therapy because we were numbers people. That's for sure. That's how I am. Right. Well, thanks for sharing so much. Is there anything else you want to add to the conversation before we sign off? Not that I can think of. You covered a ton of stuff. So thank you so much for sharing. And if people wanted to reach out to are you available, whether email or social media?

[00:41:46] Yes. My email is Tracy, T-R-A-C-Y at P-T-O club.com. Or P-P-O club.com. Either one, right? Okay. Yeah. And then I also, I'm on Facebook as Tracy Hayes Bond. Okay. Awesome. Thank you so much for sharing again. I appreciate it, Tracy. Absolutely. Thanks, Nathan. Have a good weekend. Bye-bye.

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