High-Performance Practice Series, Ep. 5: Is Your Biller Keeping You Broke?

[00:00:02] 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 the lifestyle that you truly desire. And don't forget to

[00:00:27] 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. Hey, it's Nathan. Quick heads up for all the private practice owners who are listening. If you've been listening to the podcast for a while, you know that it took me at least 10 years of

[00:00:53] grinding in my own clinics before I finally figured out how to scale and sell my four practices for seven figures and about three times the national average. The biggest shift wasn't some secret marketing hack. It was how I thought about profit, systems, and actually my role as the owner. That's exactly what we're going to be working on together with you at the High Performance Practice

[00:01:18] Conference this fall in San Antonio, Texas. From October 15th through 17th, Adam Robin and I are hosting a three-day hands-on event for PT, OT, speech, mental health, peds, pelvic floor, and medical practice owners who want to build clinics that are profitable, scalable, and best of all, don't depend on them 24-7. We'll dig into simple profit and KPI frameworks, real leadership and culture

[00:01:46] work, and practical systems you can take home and plug in with your team. So if you're doing roughly six to seven low figures a year and you want your clinic to feel more like a real business and less like a job slash cage, I'd love to see you there. Frankly, I'd love to see you bring your leadership teams as well because we will have breakout sessions for them too. You can get all the details and grab your seat at the link in the show notes. All right, let's get into today's

[00:02:14] episode. Hello and welcome to the Private Practice Owners Club. I'm your host, Nathan Shields, and I got my partner Adam Robin on with me. How are you doing today, man? Good, man. Good. Grateful to be here. You seem more energized today. I'm practicing gratitude right now. I'm practicing gratitude and yeah, all that stuff, you know? Well, it doesn't look, I'll just say it doesn't look like a forced smile, so you do have a little bit more energy. I'm choosing great gratitude.

[00:02:44] Possibility and gratitude. That's what I'm choosing right now. That's the season I'm in. Let's do it. Well, for those who have been following us and joining us today, we're on episode five of the High Performance Practice series, all leading up to the High Performance Practice Conference in October. Our third annual Private Practice Owners Club Conference is going to be in San Antonio October 15th through 17th. Go to ppoclubevents.com. We're going to do amazing

[00:03:10] things this conference, different than last conferences with breakouts, people outside of the industry coming and talking to us in terms of speakers. We're going to have opportunities for your leadership teams who join you and you bring to divide and conquer, get more value out of it so you can train up your leadership teams as well and provide them value. So check out ppoclubevents.com.

[00:03:33] That is the High Performance Practice Conference. But in today's podcast, what I think last time we spoke about negotiating contracts and pair relationships and stuff like that, right? In the same vein, the idea behind being a high performance practice is to make it as profitable as possible, as efficient as possible to develop freedom and some of the visions and goals that

[00:03:59] you have as an owner. Managing builders is a unique topic that we've talked about frequently, occasionally, I shouldn't say frequently, occasionally on the podcast. But it's one that is, can be, man, it could be a pain in the butt when billing's not going well. Just like front desk. Front desk can be a huge pain in the butt if it's not going well and affects so many other things

[00:04:24] downstream. But when you're talking about billers, man, you could do a ton of good work, see all the visits, get your marketing right in line, charge well. And then if your billers aren't doing well on the back end, it's like all for naught. You're big. You're still broke. You could easily go broke no matter how well you're performing your therapy services. That is also, I frequently say it, that's a weak spot for owners. Would you feel like that was an uncomfortable

[00:04:53] place for you to oversee, manage, supervise your billing team? You've always outsourced them, but did you have that go through that as well? Like I'm kind of waiting for them to tell me what's going on instead of me really owning and supervising them. I think that ignorance is the most expensive tax you pay. You know what I mean? So we're all ignorant, especially in the beginning and we get

[00:05:17] hopefully a little less ignorant every year. So I don't necessarily think, yeah. So to answer your question, yes. Like at the beginning, you don't know what the heck you're doing. Yeah. And you're relying on them. Like they're the experts. They're just going to tell me what to do and what's going on. And so you're like, okay, go ahead. So you think it's all, I think it's all passive and things are going to go well. I've never had that strategy work ever. Well, you can get lucky every now and

[00:05:44] then, you know, if you have like that one rock star, whether it's a biller or an employee that's just like, man, that was a great, that was a great bet. But usually that's not the case, right? That big bell curve. It's like the big majority of that is not going to be the case. It's, I have said this many times before, things never got better until I got better. And what the first step in getting better is, I think is understanding, right? Is, you know,

[00:06:13] that first stage is like the education stage, the orientation stage where you got to know what good looks like, right? So that you can ask the right questions. You can hire the right people and hold a good standard. And until you know that, until you're in that place of knowingness, you're going to kind of be in the dark a little bit, right?

[00:06:39] Yeah, exactly. I know the thing I went through all the billing situations for over a decade before I finally landed on a decent biller myself. And it wasn't that I knew how to suddenly manage them. It finally became a situation where I had the person in front of me and I hadn't asked this of my bills before, but I told her, I said, you need to teach me how to read these reports,

[00:07:05] know what good is, what to expect out of you. And because I had the right person, she would train me because she had plenty of experience before. And we were, we always had not always, but prior to that time, we had done our billing in house most of the time. And so she could bring up the reports and I was started getting serious. Like, okay, we need to have number one, monthly meetings. We're going to have some back and forth during the month, but we are going to have a scheduled sit

[00:07:31] down meeting where we wrap up the previous month. We look over the previous month, what went well, what went wrong, what went, where did you spend your time? Where are you having hiccups? And what can we expect in the upcoming month? Or where are you going to put your energies, right? So monthly meetings with an agenda, and this is an opportunity. And I've shared plenty of times before for them to report to you. And when you had your initial billing company, you were out, you've been outsourced

[00:08:01] most of your ownership. What was the default setting in terms of communication? Was it like, they'd send you an email with the reports kind of thing? Or have you always had a relationship such that they wanted to meet with you? Well, I actually, the first biller, we had a monthly meeting, but I didn't run that meeting. They kind of just said, Hey, here's what's going on.

[00:08:27] Right. Yes. And I was just like, all right, I guess we're good. Like, you know, like I was not the, you know, it's like the person with the, what does I say? The person with all the knowledge gets all the money. They had all the knowledge. And so I was like completely out leveraged in that relationship. Like I had no control over the outcome or direction of my company, basically.

[00:08:57] You know what I mean? I saw Jeff Bezos one time. He said, uh, if you don't understand the details of your business, you're going to get smoked. I didn't know the details. I didn't know. I saw some numbers on us. Like, what does this even mean? So the one thing that triggered kind of the first red flag was I just saw the AR number just getting a little bit bigger every, every month on the AR aging report. Right. And I was like, what is that? What is that? That keeps going up. And I don't think

[00:09:27] like, is that good? Is that bad? Like, what does that mean? I started getting things like, oh yeah, well this is pretty standard. This is kind of like, this is how it always worked. This is a blah, blah, blah, blah, blah. Right. And then that's kind of the point where I started working with you and you were kind of like, actually, that's not good. Like that's actually real bad. Yeah. And I was like, what do you mean by that? Right. And so like, that was kind of my journey. Right. I had to like learn from Nathan and like learn. And that's kind of how I got hooked up

[00:09:54] with Will and in the black and they did a great job. Right. And I, that was my first, I was like, oh, this is what good looks like. Right. And it just becoming a student of that revenue cycle really changed. Yeah. I look back and I was going to ask you the same thing, but how much money did we lose for billers? Right. Could easily say hundreds of thousands of dollars over the decade plus that I didn't have good billers. Right. It's hard, it's hard to swallow. So for those of you who

[00:10:21] are listening, it is worth a lot of money to get a control, get control and management over your billers. And so that you are competent and start the work now. So you don't lose any more in the future. But like I said, number one, having an agenda, these are the reports that we need to go over. We're going to review, I don't know about you, but we would review purpose and values because these were in-house employees. We're going to review our purpose and values just like we do every

[00:10:50] other meeting. And we talk about that and where we can improve, talking about calendar items coming up, who's going out of town, what billers need to, if a biller is leaving, what do we do in the meantime? But then going over the reports, man, we would go over what was projected for last month versus what was projected versus what was collected, right? Is one for us. Go over the denial rates, where the denials were coming from. We'd look over our aging reports as a whole and by payer,

[00:11:18] right? I think some billers will present dates of service outstanding metrics. I didn't lean into that all too much and I understand it, but that wasn't an important one for me. I really wanted to see those three that I mentioned. And that is what was your collections versus expected? What was the first pass denial rate? And AR aging. Does that sound about right for you? Is that what you're looking at?

[00:11:46] I would say it's exactly what I think. I think those are the, I mean, I would assume like there's a few different, there's no, I think the main principle that matters there is that you have a meeting, you have some metrics and you're, you're discussing them and having some expectations around what is the minimum expectation around each of them. And then you're not expecting perfection. You're just expecting that when things do happen, because they will, that we are putting all

[00:12:13] of our talents and resources into fixing it and bringing it back into a place of stability. And nobody is going to create that environment except for the owner, right? Like you're the person with the standard, like you have to make, to create that standard. So I would say that managing your biller is no different than managing any other employee in your team. It's the basic fundamentals of HR and organizational structure, right? Ideally like having an agreement, have some type of

[00:12:43] job description for them. Right. With some expectations, with some policies and procedures in place, with some KPIs and a meeting rhythm for accountability. And you got to bring, you got to bring that to the table. Oh, and that, and that's whether they're in-house or outsourced. 100%. They've got to know what the expectations and they got to know, they've got to understand your communication level, your expectations in terms of communications, right? Correct. Yeah. And I think outside of that, like you said, like becoming a student

[00:13:13] of the revenue cycle, like what does that mean? How does that work? Can you break that down for me exactly? Why is that important to me? Like these are the types of questions you should be asking so that you can understand how it works, the whole revenue cycle, right? Well, as you were explaining your, or as you were sharing your story, like some of those red flags are, oh yeah, this is very normal. You know, that we kind of expected

[00:13:39] this, you know, you don't need to worry about that. We're going to take care of it. Those would be red flags for me. Like I want answers. And as we're going into this meeting, you're having a great experience right now with the biller that you're working with. And the reason I gather that you're happy with them is because they saw the problem in the reports before you did. Totally. And they had solutions for those problems before you even asked. And so when you did ask,

[00:14:08] or if they didn't already present them, when you did ask, listen, yeah, we saw it too. This is our plan X, Y, Z. This is how we're going to knock it out. Or these are the communications that we've already had about it. And we're waiting for a response. They're not coming to the meeting, looking at those reports for the first time with you. Right. I'm expecting they have gone through those reports with you and they know the metrics and they know their KPIs and they know where they fall short and they know where they did well and they

[00:14:38] know exactly what the comments and notes and communication levels are for the issues, especially the outstanding balances that are large. I expect them to be coming with answers. Right. None of those should be the first time that they see it. Yeah. I think it's important to have like in those meetings, there should be a level of intensity in a meeting, I believe. I mean, I'm not, don't be too intense, but like this is business. Right.

[00:15:05] And I'm expecting us to have a level of focus and seriousness around the problems we're trying to solve here. Right. So if you're at a meeting with your biller and they're like, oh yeah, everything's fine. Everything's good. And it's like very, it's too casual. It's like, why aren't you urgent? Like you're dealing with health insurance. Like surely there's some type of problem that we could be solving. Right. Hey owners, quick pause in the episode, because I want to talk to you owners who are listening and

[00:15:34] feeling trapped in your clinics. Every time you hire a provider, it feels like chaos instead of increasing capacity where you're stuck treating full-time and constantly putting out fires, or you're not able to find the right providers to join your team. If you refuse to stay stuck in your clinics and you really want to grow and expand and experience the freedom as an owner in your business, you need to join us at the high performance practice conference happening October 15th through 17th in San Antonio, Texas. That is, this isn't just generic advice and fluff.

[00:16:04] Adam and I are bringing together PT, OT, speech, mental, medical clinic owners for real taxid tactical execution. You'll walk out with a clear 90 day plan to boost your profits and reclaim your freedom. Bring your clinic leaders as well. So you can be aligned from day one, lock in your registration today at PPoclubevents.com. That's PPoclubevents.com. And we'll see you in October in San Antonio.

[00:16:31] These are numbers. We need to get serious. And so to break down some of these metrics a little bit, a little bit more, I'll go into that, but just to add one more thing, if you're not currently collecting payments at the time of service or automatically charging credit cards on file for outstanding patient balances, reviewing the patient AR balances would be another thing to

[00:16:57] add to the agenda. So right now we have maybe four or five items to go over the agenda, but to break it down first, we're looking at projected versus collected. We know what to project. So in the month of, so we're sitting in August right now, we're looking at July numbers, the projected collections for July are usually the visits in June time, your average reimbursement per visit is what would be collected in July. Okay. Did you hit that metric? It's not going to be perfect, but you should be

[00:17:26] within five to 10%. I know you like to be closer to 5%, but if it's close to 10%, then okay, maybe there's some reasoning why we had to hiccup with XYZ insurance company. It should approximate that, right? Secondly, we are looking at denial rate. If there was one cardinal marker, you didn't want to look at anything else, but maybe first pass denial rate should be less than 10%. And I know you

[00:17:54] again, want that less than 5%, right? You want that single digits. Yeah, man, I want it cleaned up. Get it cleaned up. Let's go. Third, you're looking at the AR aging reports, the benchmarks we're expecting our builders to hit it in that 80% of your outstanding AR being in the zero to 60 range, 5%, 60 to 90, 5%, 90 to 120, 10% and above. And that is, I personally don't, we would see some motor vehicle accidents.

[00:18:24] Some people call that no fault or personal injury or whatever. Those balances usually are two to three years old. So we usually exclude those from these numbers, but excluding those numbers, this is what things should look like in your AR aging report. And then, like I said, you can break that down by pair because some payers, you know, are going to have some hiccups and that's when you break it down and you're like, okay, Blue Cross with Shield is having a hard time. There's a lot of money out there in

[00:18:51] 120 and above what's going on. I think if your billers are keeping an acceptable ranges in those three things, wouldn't you assume they're doing pretty dang well? Totally. I think so. I think the way that I kind of think about it is I kind of always look at the denial rate as the leading, kind of the leading metric. Yeah. Right. Because if your denials are high, your ARs, it's going to bleed into your AR, right? So like, I don't even really like to rely on my average

[00:19:21] reimbursement per visit metric unless my denial rate is at a good rate. Because if it's really high, then I can't really go off of my projection really cleanly. Yeah, that's true. Because does that make sense? Yeah, totally. So I always think about like, okay, like clean in-house first, right? So like in your billing department, traditionally the way that I've always thought about it is everything that happens after the claim has been sent, right? Which may or

[00:19:46] may not be true is debatable, but that's just kind of the way that I think about it. Denial rate is going to be kind of like the entry level to how clean that's happening. And so how do we drive denials down? And there's really only a few, all of that happens inside the clinic. Right. All of that happens inside the clinic. That's on you. That's training stuff. That's on the owner. That's on the front desk. Right? So that has to be buttoned up. You can't

[00:20:13] blame your biller if your denial rates are 15%. That's on you. Or at least your biller needs to be holding you accountable. I was going to say, there has to be some communication from the biller side. The biller should know that KPI and say, our denial rates are 18%. I need to come in and sit in on a lunch and train you guys on what's getting denied and why. That could be just the front desk. It could be the providers or it could be the whole team, but they need to be proactive about correcting that number, right?

[00:20:41] Totally. So we need clean and accurate insurance verification and patient demographic information at the front desk has to be cleaned up, right? Because you know, if you don't put the P behind the middle name, the dot behind the middle name, it's going to get denied, right? So that's number one. Number two, you need your codes from the provider side scrubbed appropriately, right? So making sure that they're only using the codes that are approved by each insurance type.

[00:21:07] Yeah. We need to know that, hey, with this insurance, I can't bill 97140. It's going to get denied. There needs to be training on that. You got to be training on that, right? And you should be able to clean that up, right? And then lastly, the authorization side, making sure that your authorizations are on file, timed and cleaned up. Signed by the pairs. Correct. If you do those things well, your denial rates are going to be low. I'm telling you, if you

[00:21:34] talk to anybody in the revenue cycle, they're going to say, start on the front end of the revenue cycle. Start on those three things. It's the most important things, right? Things go so much smoother on the backend. From there, you can have a really accurate, a more predictable average reimbursement per visit metric. I see it. Right? Then you can start projecting month to month, right? So your denial rate is going to kind of be your day to day. Your projections will be kind of like your month to month,

[00:22:04] right? That should be closer to a hundred percent. And then your AR can be more quarter by quarter, right? Because if you have one bad month, your AR is probably not going to like take a huge shift. But if you have a bad quarter, that AR is going to start looking really rough. Yeah, exactly. And so that's kind of the way that I think about it. Because here's the thing, like if your denials are high, you got to think your biller, they're going to submit five claims for today.

[00:22:33] Right? And then next month, one of them is going to come back denied. So now I have to submit five more claims. Plus I got to work this denial. And then the next month, there's going to be another one that's denied. Now there's two that's denied. Now I got five claims and I've got three denials to manage. And so you could see how very quickly that can become over, it can become administratively impossible to manage on the backend. It can be hard to keep

[00:23:01] up if your systems on the front end aren't. Yeah. And your example carries even more weight if you just add some zeros. So 50 claims in one day. Correct. And 20 get denied. Correct. Or 10 get denied. Now we're talking overwhelm. Now it's a hairball. Yeah. Right? Exactly. Right. So yeah, that's why you need a good billing department. Or a good outsourced biller. I mean, I think, again, we just unfortunately don't know how to

[00:23:31] manage them, especially when they're outsourced because they usually come with five-star reviews and other people have recommended and they tout these great systems and they promote and market themselves well. So you expect them to do the job and kind of abdicate your responsibility instead of step into an ownership role of being in charge of your billing collections company or department,

[00:23:55] whether that's outsourced or in-house. Right? And so it's important to have that mindset and that they work for you. I think many times when we abdicate that responsibility, you almost start feeling like I'm working for the billing company. I've got to get them the information that they need so that get off my back, but rather you need to take control. Yeah. For those that are listening, there's a few pain points that you might be experiencing.

[00:24:24] Like if you're a smaller practice, maybe one location, you're just going to struggle with profitability. Like if you don't have a good billing department, right? It's going to be chaotic. Your front desk is going to be overwhelmed and you're just not going to be as profitable as you could be. I mean, you could lose like mega bucks. We're talking about like 5%, 10% profit from the revenue cycle. You can also see it during growth phases, right? Like if you're trying to scale

[00:24:50] up and trying to open up two or three more clinics and the volume that can really start seeing inefficiencies of the front desk and at the billing at the backend side becomes more critical for you to actually know how to do this stuff. And so if you're in that place of overwhelm, the good news is you don't have to learn it all in a day, just like anything else, right? It's start with just like, let's just start with one thing at a time. And if you can just learn a

[00:25:16] little bit every month, a little bit every month and study and study and study and listen to the PPO Club podcast and come to San Antonio at the conference, right? You can actually become an owner who can create real change in those problems. And I think that's going to be the real unlock is when you actually empower yourself to make that change. In your experience, we had some of this and I think we were able to work around it

[00:25:41] fairly well, but I heard about it from billing companies in the past. There tends to be friction between the billing collections team and the front desk. Have you experienced that situation? I would say, I think it's a culture just like anything else, right? So culture is the lubrication that communication flows through, right? So like making sure that you are working with a billing

[00:26:07] company or department that is aligned and that you have aligned people on your team, for sure. I think it's really important. But I think that if you have a bunch of performers on your team, that is probably going to go away. You know what I mean? If somebody is not taking accountability and that's the problem, right? So like what we want is everybody shut up and own

[00:26:32] something, fix the problem. Let's get in problem solving mode and not complaining mode. You know what I mean? So the situations that I've seen, where I've looked back at times when that dynamic wasn't as ideal, it's usually because there was like an expectation that we had of the billing company that they were like dragging their feet or my team is performing. You know what I mean? So it was

[00:26:58] rarely, it was rarely our fault, but I guess it could have also been like, maybe you had a front desk person that just wasn't really owning the front end of that revenue cycle the way they should or could have. And there could have been maybe a transition that should have taken place there. I mean, there are those front desk people that when you're trying to correct them, they take it personally and they get butt hurt and then they get defensive and you name it and start blaming. They need to understand,

[00:27:26] listen, if there's a dropped authorization and that's your responsibility, that's on you. You can't blame that on billing people, right? And so I'm glad that you brought up values because I think one thing that we're looking at when we're talking to billing companies is talk about values too much. Do these people align in our values? Because they are going to be representing you when it comes to the patient interaction. If there's a patient outstanding balance,

[00:27:54] they're representing you and you would like them to have the same values as they approach those patients as you do when you approach the patients. And maybe there's an interview process with your billing company about, hey, how do you handle outstanding patient balances? Imagine I'm the patient and I owe $250. How are you going to talk to me when we're on the phone? And honestly, have those kinds of conversations. If the front desk isn't getting some portion of the intake paperwork

[00:28:21] done, how do you expect that communication to go? Do you communicate directly with them? If it doesn't change, then who do you talk to? When do you get me involved? If I'm their supervisor, when do you get the supervisor team involved? And go through, walk through some of those scenarios because yeah, you'd expect them to ideally align in values. Yeah. And I think you can ask values-based questions without like specifically labeling the value.

[00:28:50] Like how do you practice integrity, right? You know, it doesn't necessarily have to be like that, but you know, one of the questions that I like to ask is like, what is a good, like, how do we become the best client that you've ever had? What would that look like for you? Right. And so like what you're really wanting them to describe is like, what are the characteristics that they value? Right. And so it's like, okay, like tell me about a time where you had a client that wasn't really a good fit for you. Like what are some of the things that really showed up that

[00:29:17] really got under your skin that could have been better? And what you'll find is like, you'll find the characteristics that they operate by typically, but I could tell you, man, I've got a great company right now. If you guys want to know more information, send me an email, I'll tell you who it is. But they, uh, man, when two rockstar people start working together, like a rockstar billing company and a rockstar person, like there is just a chemistry there that gets really exciting. So it's definitely achievable. You just got to know what it looks like,

[00:29:47] you know, things start flowing. So it's palpable the change in those meetings when you have people in tow. So anything you want to add to the managing the biller conversation? I would say, how do you like just a quick, like wrap up, what are the like top three things,

[00:30:09] top one to three things that I would ask you as an owner that would indicate, that would help us understand if you have a good, good control over your billing department, right? I would say the first thing is number one, what are your key metrics? What are the key metrics that you're measuring that are driving decisions in your revenue cycle month over month? If you can't answer that question, that doesn't mean you're a bad person. It just means you're not buttoned up, right? You need to know your numbers.

[00:30:38] You need to know your numbers a little bit better, right? Number two, honestly, if the answer is, that answer is probably 90% of it. But number two, I would say, how often do you meet with your billing department? I was going to say that. What is your accountability rhythm look like? Yes. Right. And how do you know you have the right person in the right seat? I'd say if you answer those two, and then the last one would be, do you have a regular cadence of accurate insurance verification

[00:31:07] and authorization? Like, is there some type of department lead for those two buckets? At the front desk. At the front desk or in the authorization department? Right. And are they accountable to reporting something up with accuracy? Mm-hmm. If the answer is no, then you probably need to button that up. Those three things, I think, will get you 95% of the way there. Yeah. I totally agree. It's an accountability meeting rhythm. Know your numbers. If there was

[00:31:33] one thing that maybe we didn't cover that, not absolutely necessary, but I see a common personality trait in the good billing teams that I've worked with. And they are bulldogged when it comes to collecting money. They're confident too. They're confident. They're not afraid to ask for money. They will make as many calls as they need to make. They are not shy. And if it, if when they collect that last $21 check from,

[00:32:03] UnitedHealthcare that's been sitting out there for 18 months, they are ready to party. Yeah. They're competitive, right? Their mentality is us versus the insurance company. It's value. Yeah. Yeah. And when it comes to the patient, it's like they have empathy, but you owe this money because we did the work. This is your insurance, not ours. You chose the insurance that you have. You owe the balance. We did the work. You owe us the money. And they're not afraid

[00:32:33] I mean, I won't say it in those words, but they're not afraid to go after the money. They will trip over themselves so they can collect another $10, you know, is that kind of bulldogged mentality that kind of permeates the really good billers that I've had in the past. And because of that, they are, here's the cool thing. When they come to those accountability meetings, they're proud. Yeah. Yeah. We did some cool stuff this month and look how well I'm doing. They're like a golden retriever

[00:33:03] with their tail wagging, just waiting to get petted. They just, they're excited about what's moving forward and they're frustrated. They're like, Oh, I hate that company. I'm going to get them. And then they are tied up emotionally in their work in a good way. The other thing I'll add, because I agree with all that, but if you're going to outsource, I want, you want to work with a team that has good business acumen, right? Like what are their

[00:33:28] metrics that they track for internally? How often do they meet as a company to talk about their values and, and to measure performance and how do they hold their people? Like they, they need to be good at business if they're going to be good for your business. You know what I mean? So like, if you've got some like retired mom that's in her basement that we love her great person. But if you plan on scaling up practice might not be the best person to stick with long-term, right? Yeah.

[00:33:55] So that's something to get you off the ground, but if you want to really get somewhere, then you have to consider moving up, right? Correct. Yeah. Got it. Cool. Well, we will cover stuff like this and at the conference, ppoclubevents.com, check that out. The high performance practice conference. There is a worksheet tied to this and all the other episodes as well. As you look at the show notes, you can download a free worksheet to write down your notes. It's going to give you some

[00:34:24] questions on there to help inspire you a little bit to kind of figure out what next steps could be as you're working with the particular topics that we're talking about. So check it out, check out the previous episodes. We've done four others thus far, and we've got a couple more. The next one being staffing ratios with clinical and admin teams. And I'm sure we're going to talk about production in those departments as well. And then I think our last episode wrapping it up is

[00:34:51] going to be cash pin out of network services. I know people are looking that direction quite a bit nowadays with reimbursement rates going down. So look forward to those episodes as well. In the meantime, register for the event at ppoclubevents.com. We'll see you at the conference and look forward to seeing the next episode. See you later, guys. Thanks for listening to the Private Practice Owners Club. If you enjoyed this episode,

[00:35:17] would you mind doing us a huge favor and leaving a review? This helps us get the podcast out to more clinic owners to help them create greater freedom and profits so they can own their future. And visit our website, ppoclub.com to find more resources and connect with us. Thank you.