Mistakes To Avoid In An Add-On Cash-Based Service With Stephen Rapposelli, PT Of StretchPlex

[00:00:00] Those little things all have to go in how you teach physical therapists, support staff,

[00:00:08] and then your cash based providers on how to speak to people.

[00:00:13] Because in this world of AI and in this world of Amazon, you will win every time because

[00:00:23] of your people skills and soft skills that can never be reproduced.

[00:00:31] Welcome, you've entered the Physical Therapy Owners Club podcast where your host Nathan

[00:00:36] Shields and other successful PT owners and leaders share their experience and insights

[00:00:40] on how to build successful PT businesses.

[00:00:44] They'll share the stories of their paths to success and show you how you can also

[00:00:47] obtain greater freedom and more profits from your business.

[00:00:51] That's what the PT Owners Club is all about, greater freedom and more profits.

[00:00:56] There's plenty of room for you as well so come on in and join the club.

[00:01:01] Hello, and welcome to the Physical Therapy Owners Club podcast.

[00:01:06] I'm the host Nathan Shields and got a frequent flyer back on one of our favorite guests

[00:01:12] in the past, Steven Rapacelli, the CEO of StretchPlex and owner of Performance Physical

[00:01:17] Therapy Clinics in Delaware.

[00:01:20] Steven, it's awesome to have you back.

[00:01:21] Thank you so much for having me, Nathan.

[00:01:23] It's always a pleasure.

[00:01:24] Yeah, it's been cool to speak with you over the last few years because you're not only

[00:01:29] a big fan of the podcast, which I really appreciate, but you also have been able

[00:01:33] to share with us some of your growth as it's related specifically to StretchPlex.

[00:01:38] If people who are listening haven't heard our episodes with you explaining StretchPlex,

[00:01:44] I recommend they go back and listen to that because you developed this cash-based

[00:01:48] program specifically for your company and it's been going on for what, about three years?

[00:01:54] Yes.

[00:01:55] Three years.

[00:01:56] And so we've been able to watch you, you explained it, you talked to us a little bit

[00:02:00] last time about what the benefits of it were and how you made it successful.

[00:02:05] But this time I'm excited to have you on because you will be talking to us about

[00:02:09] some of the lessons that you've learned over the past three years.

[00:02:13] And I know that you're bringing this from a place of, hey, if you're looking at any

[00:02:17] cash-based service, if you're looking to do some add-ons to your physical therapy

[00:02:21] clinics, these are some of the things to consider.

[00:02:25] And so, well, at least I'm assuming we haven't really talked about what you're

[00:02:28] going to present, but this could extrapolate to other cash-based services as well, I

[00:02:32] assume.

[00:02:33] Yes.

[00:02:34] Good.

[00:02:35] So let's talk about it, man.

[00:02:36] Let's talk about...

[00:02:37] Let's give people a little bit of an idea, just give them a one minute summary of

[00:02:42] what got you into StretchPlex, your cash-based service, and then we can get

[00:02:47] into some of the lessons you've learned over the last three years.

[00:02:50] I want to start with the early days of aviation, the early days of aviation.

[00:02:58] Now in the early days of aviation, obviously there was a cockpit and

[00:03:02] those cockpit head walls to it.

[00:03:05] And in the cockpit was a throttle.

[00:03:09] And those throttles were pretty basic back then.

[00:03:13] It was basically a stick with a ball at the end of it.

[00:03:16] And to go faster, you would push the throttle forward, you would literally

[00:03:23] go balls to the wall, which means you're going to go very fast.

[00:03:28] So in this podcast we're going to go balls to the wall, but now you know

[00:03:32] the meaning behind that phrase, that cliche.

[00:03:36] And I say that and I start with that, not only to get your attention,

[00:03:40] but to really remind all of us that you need to check your understanding

[00:03:49] of what you think reality is.

[00:03:50] Because believe it or not, a lot of people think that both of them

[00:03:54] mean something else, but it really means pushing the balls of you

[00:03:58] to the throttle to the front wall of the cockpit to make the plane go faster.

[00:04:02] So what story are you telling yourself that may not be true?

[00:04:09] One story might be that physical therapists just do physical therapy.

[00:04:13] Another one might be I don't have time or resources or talent to do something different.

[00:04:20] A story might be I can't increase my profit margin.

[00:04:24] So I wanted to come back on this podcast to be an example, not a warning,

[00:04:29] but an example of a physical therapist who decided to open up his mindset

[00:04:37] and see what could be done.

[00:04:39] And I've proven that it can be done by physical therapists, right?

[00:04:43] And as you know, I like to make fun of us a little bit as physical therapists

[00:04:48] and I can because I'm a physical therapist.

[00:04:50] So I have every right to make fun of us.

[00:04:53] And we have that Peace Corps gene in us.

[00:04:55] Oh, totally.

[00:04:56] Where it seems like we just want to give it all away,

[00:04:59] even if it's a therabandah, I just take it.

[00:05:01] Our bleeding hearts.

[00:05:02] Right. Or bark at the moon because some other business is taking away

[00:05:08] what we think is our turf.

[00:05:10] Right. Right.

[00:05:11] And to try to put that on on its head and say, well, you know what?

[00:05:15] I can be that grouchy old man or woman where I can do it and do it better

[00:05:20] and let's see what happens.

[00:05:22] And hopefully your listeners will come away and say, well, if I can do it,

[00:05:27] I can do it because you can't. Right.

[00:05:30] So it all happened with me when I was at Graham's sessions.

[00:05:34] I think it was 2018 or 2019.

[00:05:35] I wish I knew the guy and I like to tell the story of the guy said, hey,

[00:05:39] it was 200 pts there.

[00:05:40] He said, every pull out your phone.

[00:05:42] I want you to type in stretch lab.

[00:05:44] And we're like never heard of it typed it in up comes a website

[00:05:48] and 200 pts Jolls dropped open, including mine.

[00:05:54] And let me tell you, man, we were upset.

[00:05:58] Right. How dare they?

[00:06:00] This is what we're doing. This is what we should be doing.

[00:06:02] How can they do this?

[00:06:04] All these things, right?

[00:06:05] Your gut reaction, including mine.

[00:06:08] Well, after I got over that, I said to myself, well, you know what?

[00:06:11] Why can't I do it?

[00:06:13] I shouldn't I do it?

[00:06:14] Why couldn't I do it?

[00:06:15] Then we went ahead and we did it.

[00:06:16] And this also came from years of feedback from my patients who said,

[00:06:21] oh, honey, I would pay you just to stretch this knee replacement

[00:06:24] out after you discharged.

[00:06:25] And I'm like, Betty, come on.

[00:06:27] That's silly. I can't do that.

[00:06:29] That's not licensed physical therapy.

[00:06:31] Yeah, that's all. Come on, Betty.

[00:06:33] Let's just get through our session here.

[00:06:35] And, you know, after about 15 years,

[00:06:38] it finally dawned on me

[00:06:39] hearing that that maybe ladies got something.

[00:06:42] And then as a PT and telling me if you know,

[00:06:45] if you never feel this way,

[00:06:47] profit margins start going down,

[00:06:50] reimbursement isn't going up, but everybody wants to raise.

[00:06:53] And you're like, oh, boy, man, I'll learn

[00:06:55] if I'm on a sinking ship here.

[00:06:58] And well, if you do nothing, it very well may be a sinking ship

[00:07:03] or you can do something about it.

[00:07:05] You can become a smith of your own fortune,

[00:07:07] a maker of your own fortune.

[00:07:10] So we started this and I'll be honest with you.

[00:07:14] Everything is basically I made up the name.

[00:07:18] We made up what the people who do the worker called

[00:07:21] half the things are just our creative side going crazy.

[00:07:24] It's probably how they make South Park.

[00:07:27] So what we wanted to also avoid is

[00:07:30] the frustration of us not being the gatekeeper

[00:07:33] as much as we would like to be the gatekeeper in health care

[00:07:36] as physical therapists and all that.

[00:07:39] It's just not happening.

[00:07:40] And I don't know if you've ever heard of where a patient called you back

[00:07:43] said, all the doctors said I didn't need physical therapy anymore.

[00:07:46] So I'm I'm discharging myself.

[00:07:48] I mean, can you imagine you imagine you see somebody who's seen a rheumatologist

[00:07:53] and you say, oh, you don't need to go to the rheumatologist anymore.

[00:07:57] You can just discharge yourself from them.

[00:07:59] I think that doesn't happen or an orthopedic surgeon.

[00:08:03] They do that to you, but you don't do it to them.

[00:08:04] So a little frustrating not being the first one to get that human

[00:08:10] and take care of them.

[00:08:12] Well, once we started doing this, we discovered that it's now the opposite

[00:08:16] and it started growing very quickly.

[00:08:18] We started with one clinic just within our four walls in one room.

[00:08:24] And that's probably how everybody starts.

[00:08:29] Or at least they should because I think a lot of people have this idea.

[00:08:33] Well, I need to find a 1500 square foot space or I need to find,

[00:08:37] you know, they need to start big and have it fully

[00:08:41] delineated instead of just try the product first in a room

[00:08:46] and see if it flies first, right?

[00:08:48] And then go from there. It does simple, simple scales, fancy fails.

[00:08:53] So what's the least you can do to see if this stuff works for you

[00:09:00] in your town because this doesn't work everywhere.

[00:09:03] Right. You got to have an audience who values what you're doing,

[00:09:08] who's willing to pay for it.

[00:09:10] And this is cash based service.

[00:09:11] So people are opening up their wallets.

[00:09:14] I kind of like it.

[00:09:15] It's different from physical therapy.

[00:09:17] In fact, many things about this are the exact opposite

[00:09:21] of what you're used to as a PT owner.

[00:09:24] So it's kind of it wakes up new parts of your brain.

[00:09:27] Well, within about four, I'm going to say four months, maybe five months.

[00:09:32] We had four of these separate studios.

[00:09:37] Four of them, which leads us to how we were dumb.

[00:09:41] Part one, do not do that.

[00:09:44] Right. Because we saw I'm a classic visionary.

[00:09:48] I've never met an idea that I didn't like.

[00:09:50] So you talk about squirrel, squirrel.

[00:09:53] I'm like, there's a great spot. Let's put one there.

[00:09:56] There's a great spot. Let's put one there.

[00:09:57] And totally I could justify it. I could talk you into anything.

[00:10:01] Right. So all of a sudden we went from maybe 600 square feet

[00:10:06] to probably 4,000 square feet in total.

[00:10:10] In these four studios, which comes with

[00:10:13] staffing and expenses and rent and everything was upside down.

[00:10:21] Everything.

[00:10:23] So growing too fast in this business is a real,

[00:10:28] real problem. You have to guard yourself against them.

[00:10:31] That's how we were dumb.

[00:10:32] Part one, it's taken us quite a while to recover from that

[00:10:37] because it opened up some other dumb things that we discovered

[00:10:41] that we did and didn't do, which I'm happy to be vulnerable

[00:10:46] to your audience and let them know because if they go down this path,

[00:10:50] they can create their own wounds or an unforced error

[00:10:54] if they don't think things through.

[00:10:57] Here's the next one.

[00:10:58] And now it's funny because as you listen to me,

[00:11:01] see if it also applies to your PT business.

[00:11:04] Very interesting. Here's the next big mistake

[00:11:07] that will make you kind of wince a little bit when you hear it.

[00:11:11] We didn't have systems and procedures in place.

[00:11:14] We thought we did, but we didn't.

[00:11:17] I think it's a mark of being an adult

[00:11:20] when the idea of policies and procedures

[00:11:23] to some degree maybe excites you a little bit

[00:11:25] because there's safety in how do we do this?

[00:11:29] Oh, here's how we do it.

[00:11:30] We have a document that says this is how we do it.

[00:11:33] Right? This is what we do.

[00:11:34] This is how we do it.

[00:11:36] That's the operations manual and the employee and book.

[00:11:39] It's simple if you want to keep it simple.

[00:11:41] But if you don't have it, trouble happens.

[00:11:44] Trouble happens and you're not ready for it.

[00:11:46] So we didn't have systems and procedures in place.

[00:11:51] And it's taken us a long time to have the right person

[00:11:54] develop those to make things run the way they should.

[00:11:58] So can I ask you about that a little bit?

[00:11:59] Please do.

[00:12:00] You thought you had some policies and procedures in place.

[00:12:03] Was it that you just hadn't detailed them enough?

[00:12:07] Or what was missing that didn't allow for you to follow the systems?

[00:12:11] Where was the disconnect there?

[00:12:12] You thought you had it.

[00:12:13] What were you actually missing?

[00:12:15] Well, here's one of the secrets

[00:12:17] that I tell other owners that they should use because

[00:12:22] I think that I may be the laziest person on the planet.

[00:12:25] So what I did is a PT owner is I said, wait a minute.

[00:12:29] I got policies and procedures.

[00:12:31] It's called performance physical therapy policies and procedures.

[00:12:34] Oh, so you took your PT. Yeah.

[00:12:36] I'll just use that.

[00:12:38] Yes. And just moved it right over.

[00:12:40] Change the title from performance physical therapy

[00:12:43] to stretch planks and keep everything the same. Right? Exactly.

[00:12:46] Oh, OK, I see what you're doing because, you know,

[00:12:49] who looks at those things, right?

[00:12:52] But then you see how it's different.

[00:12:54] And then you see and then you'll, oh, yeah, that's problem.

[00:12:58] So you think you got it.

[00:13:00] Now, the other beauty of that is

[00:13:04] it also makes you look at your PT business differently

[00:13:08] because you discover, oh,

[00:13:10] there's no really strong accountability chart here.

[00:13:14] We better do that.

[00:13:16] So if you venture into a cash based business,

[00:13:20] it's going to make your PT business better

[00:13:22] because you were going to take some of that already.

[00:13:25] Why make the doughnuts over again if you can help it?

[00:13:28] So you just look at it, but then you have to look at it

[00:13:30] and you see where you really probably need to

[00:13:35] tighten up operations over on your PT business side,

[00:13:40] which is a good thing, isn't it? Yeah.

[00:13:41] So that's a good thing.

[00:13:42] And I think you're going to get to this point,

[00:13:44] but at set a point where it's at the top of my mind

[00:13:47] and I have to ask because we had the same thing.

[00:13:50] We started a separate venture in our physical therapy clinic.

[00:13:55] We got into diagnostics and it was great for us,

[00:13:59] but it didn't survive well

[00:14:02] until we made it its own organization.

[00:14:06] Like we tried to stuff it into the physical therapy

[00:14:09] and make it work within the physical therapy organization

[00:14:13] and it didn't go well or it wasn't gaining any traction.

[00:14:18] It didn't gain any traction until we made it a separate LLC

[00:14:22] with its own organizational chart,

[00:14:25] its own policy and procedures.

[00:14:26] And sure, we could steal from the other one

[00:14:28] with its own KPIs, with its own reports,

[00:14:32] with its own chart of accounts in QuickBooks.

[00:14:35] We didn't commingle funds between the two anymore.

[00:14:38] We were tracking them separately, different billing and collections accounts.

[00:14:42] You know what I mean?

[00:14:43] Even though we use the same people.

[00:14:45] That is golden nugget.

[00:14:46] OK, so I didn't know if you were going to go down that route.

[00:14:49] But that's what we noticed is that it didn't

[00:14:52] it has to be separated and treated as a separate business.

[00:14:55] And it makes total sense and it should be that way in the beginning.

[00:14:58] But it's kind of like your child coming back home

[00:15:00] after they graduate from college.

[00:15:02] It's like, yeah, it's just not it's not working here.

[00:15:06] Yeah, it doesn't work.

[00:15:07] There's too many.

[00:15:08] Now we got too many adults in this house.

[00:15:10] And that's what you find happened.

[00:15:12] The staff is fighting for literal physical space.

[00:15:17] Your customers are confused.

[00:15:19] And I'll get here's a tiny little story,

[00:15:21] which was as a physical therapist embarrassing.

[00:15:24] We had somebody who wouldn't come to the stretching

[00:15:29] because it was in a PT clinic and they had been to a PT clinic

[00:15:33] in the past and had a bad experience.

[00:15:36] And like, oh, oh, that hurts me in my heart.

[00:15:40] You know, because you like to think as a PT that everybody does great work

[00:15:43] and everybody has great experience.

[00:15:45] But but there's something that you never thought that people have

[00:15:49] do have some preconceived ideas of our profession.

[00:15:53] And that can be a barrier to really free unrestricted flow of service.

[00:16:00] Yeah, if you're not careful, those same employees,

[00:16:04] if they are pulling double duty for both organizations,

[00:16:07] they can get distracted.

[00:16:09] So especially if they have if they've caught the vision

[00:16:12] of this new fangled thing, or maybe they're similar to you

[00:16:15] and that they get distracted by the shiny new object,

[00:16:18] which is the new cash based program.

[00:16:20] And they're sitting at the front desk.

[00:16:22] Well, maybe they're letting their authorizations slack a little bit.

[00:16:26] Maybe they're not making the calls to canceled patients

[00:16:30] or no show patients like they used to because they like this new thing over here.

[00:16:35] And we're trying to get that.

[00:16:36] I thought you wanted me to get that up and going and help you out with that.

[00:16:39] They could get distracted from their true KPIs,

[00:16:41] which are in the physical therapy organization.

[00:16:43] That's right.

[00:16:44] And there's a lot in what you just said,

[00:16:45] there's a lot to unpack there.

[00:16:47] You go in a lot of different directions there.

[00:16:49] And one that I do want to touch base on because I'm sure

[00:16:52] there's some people out there who were pulling their hair thinking

[00:16:57] you're just waiting to be sued.

[00:16:58] And that is very clear.

[00:17:01] This is not physical therapy.

[00:17:03] They're customers.

[00:17:05] They come to a studio.

[00:17:07] They're not patients.

[00:17:08] They don't come to a clinic.

[00:17:10] Right.

[00:17:11] There's no physical therapist touching somebody.

[00:17:15] They're separate people, separate.

[00:17:18] And you have to be very clear about that,

[00:17:20] which is another huge tick in the column for get it out of your clinic

[00:17:26] as soon as you can and make it separate.

[00:17:29] I get it.

[00:17:29] That's a big leap of faith.

[00:17:31] And I'm talking about step five.

[00:17:34] Think about step one, which is totally fine.

[00:17:37] But step one may not last very long.

[00:17:40] It actually might only be months before you're like, OK, that's nice.

[00:17:45] We've had enough.

[00:17:46] We're really even now.

[00:17:48] The other part of your statement that is worth noting is that.

[00:17:52] And I'm talking right now, hopefully, to PT owners or PTs at least.

[00:17:58] And that is you have to make a decision

[00:18:01] what role you're going to play in that new entity

[00:18:05] because it can be a full time job.

[00:18:10] So if you think, I'm just going to do this as a side gig a couple hours a week.

[00:18:15] That this one room is just going to be fine.

[00:18:18] And we'll just not divert a lot, not spend a lot on it, not really.

[00:18:23] You know, we'll just Joe is good.

[00:18:24] He's a PTA and people seem to like him.

[00:18:27] And we'll just have him stretch out Nancy after she's been discharged.

[00:18:31] You have to be very, very clear in what your role is

[00:18:36] and what you're going to play in it.

[00:18:38] It's a new baby.

[00:18:39] It's a new baby and you will be as successful

[00:18:44] to the degree that you devote some of your bandwidth to make it go.

[00:18:50] Some guys and gals want to be operators.

[00:18:55] Some want to be owners.

[00:18:57] Be really clear on which one that you want to do

[00:19:00] because if you're going to be an operator and I get it,

[00:19:03] I don't have to do notes anymore.

[00:19:05] I don't have to worry about insurance.

[00:19:07] I'm leaving it all behind.

[00:19:09] It's still going to take up a significant portion of your time

[00:19:13] if you're going to operate these services.

[00:19:15] And it really doesn't matter just because I offer personal training

[00:19:18] and stretching and compression.

[00:19:20] I'm talking about anything.

[00:19:21] It could be chanting, burning incense and tarot card reading.

[00:19:25] It's what your people, your customers want.

[00:19:29] And if they ask for it and you provide it,

[00:19:31] then you have to be really clear on what your role is going to play

[00:19:37] and kind of stick to it.

[00:19:38] Yeah, you want to be really clear.

[00:19:41] Are you going to be the technician?

[00:19:42] Are you going to be the person that's doing all the hands on work

[00:19:45] or are you going to be the owner who hires the technician to do all that work

[00:19:48] and you're going to oversee?

[00:19:50] Eventually, you want to work your way out of that technician position

[00:19:54] to the owner slash administrative position,

[00:19:57] which is the same thing you should be doing in your physical therapy clinics,

[00:19:59] by the way.

[00:20:00] But if you don't have the time,

[00:20:03] if any of these new projects you think are going to take a few hours a week,

[00:20:07] then I think you're kind of kidding yourself because you should be going into it,

[00:20:12] developing a marketing strategy, building out policy and procedures.

[00:20:16] This is how we get a customer.

[00:20:18] This is how we treat them.

[00:20:19] This is what we say when they first make the phone call.

[00:20:22] This is how we approach them when they come for the first time.

[00:20:25] This is how we collect.

[00:20:26] This is how we say goodbye.

[00:20:28] This is how we keep them as a customer.

[00:20:30] So marketing strategy, customer service strategy.

[00:20:33] How are you going to provide the product that they're creating?

[00:20:36] And that all takes time.

[00:20:37] And speaking of that,

[00:20:39] I like to say that your business's love language is quality time.

[00:20:46] And so if you are having a hard enough time

[00:20:49] giving that quality time to your physical therapy clinic,

[00:20:52] and now you think you can just shove in a couple more hours for this new venture.

[00:20:57] If you really want to make it work,

[00:20:58] it's going to be hard if you don't have the time to carve out

[00:21:01] and provide the time that it needs.

[00:21:03] Absolutely. Again, every time you speak,

[00:21:06] there's like so much within that one little soliloquy

[00:21:08] that can be pulled out that I'm like, oh, you're right.

[00:21:16] Before we jump into the next episode,

[00:21:17] let's talk about something I think we'd all like a little more of,

[00:21:21] and that is money.

[00:21:23] As a PT owner,

[00:21:24] I know how hard it is to increase your revenue without spending more

[00:21:27] on marketing or trying to attract a flood of new patients.

[00:21:31] And let's face it,

[00:21:32] you're already stretched thin trying to run your clinics.

[00:21:35] But what if there was a proven way to increase your revenue 10%

[00:21:38] in just 30 days with minimal effort?

[00:21:40] Better yet, how could you use the additional revenue in your business?

[00:21:44] Maybe you could hire another PT.

[00:21:46] You could start saving to open a new location or my personal favorite.

[00:21:50] Invest in yourself by hiring a business coach.

[00:21:53] Regardless of how you choose to spend it,

[00:21:55] a 10% bump in revenue can have a huge impact on your business.

[00:21:58] And that's why I created how to increase your revenue

[00:22:01] 10% within 30 days.

[00:22:03] A free guide to help you boost your clinics revenue

[00:22:06] and see big changes to your bottom line by tracking just one simple statistic

[00:22:10] in your business.

[00:22:11] And here's my big promise.

[00:22:12] When you follow the three steps I lay out in the guide,

[00:22:16] you're going to see up to a 10% increase in revenue in 30 days.

[00:22:21] This revenue boosting strategy is the same one I teach inside

[00:22:24] my one on one coaching program for PT owners.

[00:22:27] But it's my gift to you just for being a listener to the show.

[00:22:30] So head over to PTOclub.com to download your free copy of how to increase

[00:22:37] your revenue 10% within 30 days.

[00:22:39] And again, that's PTOclub.com.

[00:22:42] After you download it and implement it, feel free to reach out to me,

[00:22:46] schedule an appointment with me on the same website,

[00:22:49] schedule an appointment with Nathan and let me know how it went.

[00:22:52] And we can talk about next steps.

[00:22:55] That's PTOclub.com.

[00:23:02] And one thing that really stands out to me, Nathan, is and I think it resonates

[00:23:06] with just about everybody who's listening to this podcast.

[00:23:09] You know, nobody thinks they're average as a physical therapist.

[00:23:12] You think you're great, right?

[00:23:13] And we all have our groupies.

[00:23:16] Believe it or not, there's actually there's a cohort of people out there

[00:23:18] who think that I'm great.

[00:23:20] And so you start believing that after a while, you're like, hey, listen,

[00:23:23] once I start seeing this patient, they're mine forever.

[00:23:26] There's a steel cage around them.

[00:23:28] They love me, but et cetera, et cetera.

[00:23:30] It takes humility, which is again a core attribute of a leader.

[00:23:35] It's humility to say, OK, whatever the Steve magic is or the Nathan magic,

[00:23:41] I can probably operationalize that.

[00:23:43] And if I thought about it long enough, I can make a checklist of how

[00:23:48] on my initial evaluation, I create people, they will come back the next time.

[00:23:52] 100 percent, they will not cancel.

[00:23:54] And you wind up identifying these soft skills.

[00:23:58] I look people in the eye.

[00:23:59] I call them by their name.

[00:24:00] I shake their hand.

[00:24:01] I say, hello, goodbye and thank you.

[00:24:03] I explain what I've done.

[00:24:04] I make sure that they can anticipate that something's going to happen the next time.

[00:24:08] I tell them how they're going to feel so that when they do feel it,

[00:24:11] they're going to be like, that guy's brilliant.

[00:24:13] He knew that I was going to be sore after this.

[00:24:15] Right? Those little things all have to go in how you teach physical therapists,

[00:24:21] support staff and then your cash base providers on how to speak to people.

[00:24:27] Because in this world of AI and in this world of Amazon,

[00:24:33] you will win every time because of your people skills and your soft skills

[00:24:38] that can never be reproduced.

[00:24:40] So you spend your time teaching everybody below you how to those little differences,

[00:24:46] those little turn in phrases, make all the difference in the world to people.

[00:24:50] And we train a lot on that.

[00:24:53] Then we revisit it.

[00:24:55] Yeah, so you went from, OK, you grew too fast.

[00:24:59] And then you also took on what sounds like a lot of expenses too quickly.

[00:25:05] Right? Instead of keeping it slim, didn't have policies in person.

[00:25:09] You know how easy it is to spend money? Yeah.

[00:25:11] Yeah. You don't like those tables.

[00:25:13] Let's get new ones. Right.

[00:25:16] You don't like that color.

[00:25:17] Let's get a different color. That's right.

[00:25:20] That's right. Absolutely.

[00:25:21] You didn't have policy and procedures in place and you had to work on that.

[00:25:26] Here's the next one. Ready? Here's the next one.

[00:25:28] What's it?

[00:25:29] Lack of accountability, lack of follow up.

[00:25:33] So I think that that studio should look, sound and smell a certain way.

[00:25:41] I've told you how it should be.

[00:25:43] I've shown you pictures of it.

[00:25:45] Then I go about my business of being a physical therapist

[00:25:48] and run a physical therapy practice and kind of let you handle it.

[00:25:52] And then I come back.

[00:25:54] This is the actual thing that happened.

[00:25:56] I walked into one of those studios and they were playing Ozzy Osbourne

[00:26:01] and the body coaches were wearing baseball caps, looked like thugs

[00:26:05] and the lights were off.

[00:26:07] Now you think this guy's got to be exaggerating.

[00:26:09] I was not. I walked in.

[00:26:12] I looked around and I walked out.

[00:26:15] I said, I can't believe what I just saw. Right?

[00:26:17] So the lack of follow up, lack of accountability is critical

[00:26:23] when you start to branch out and you start to let others into your sandbox.

[00:26:29] Right? So just because I've written it down as a checklist,

[00:26:32] you got to follow up on it, make sure that it's always like that

[00:26:36] because you get to have it whatever way you want it to be.

[00:26:39] But you have to make sure that it still is.

[00:26:41] And I'm like, how come that studio isn't doing well?

[00:26:43] How come visits are dropping in that studio?

[00:26:46] And we walked in and we found out that's not welcoming to people.

[00:26:51] 70 year old Betty is not going to like listening to Ozzy Osbourne and ACDC,

[00:26:56] even though the people that work there liked it.

[00:26:59] Right? So you got to ensure accountability

[00:27:03] and that means you got to follow up.

[00:27:04] You have to make sure that everything is just the way you want it

[00:27:07] for the people that you delegate that to follow up on it.

[00:27:11] Same thing with PT, isn't it?

[00:27:13] It is. I like the first thing that you did is observe.

[00:27:16] So in my training in the past, if you see an issue in a certain area,

[00:27:21] as it is being reported to you by the KPIs.

[00:27:24] So you're seeing something go down in the wrong direction on a graph.

[00:27:29] According to the KPI, I think one of those first things

[00:27:32] is to just observe the situation.

[00:27:35] If KPIs are getting low at the front desk,

[00:27:39] if KPIs are low for someone for a provider

[00:27:44] and their cancel rate is high,

[00:27:46] compared to the other providers in your clinic,

[00:27:48] I think one of the first things you need to do is simply observe.

[00:27:53] You know, I really like using analogies and this is where

[00:27:56] and the analogy is really true.

[00:27:58] And they call it a dashboard and just like the dashboard of your car,

[00:28:02] the check engine light comes on.

[00:28:04] All that means is you better go check your engine.

[00:28:07] It doesn't tell you that your spark plug is bad or your distributor's

[00:28:10] all messed up or you left your code under the hood or something.

[00:28:13] It doesn't tell you any of that stuff.

[00:28:15] It just says something's not right.

[00:28:17] And just like in your PT business,

[00:28:20] you should get to a degree of intimacy with your KPIs

[00:28:26] that you may not know at first blush what's wrong,

[00:28:30] but you know something's not right.

[00:28:32] Like I know that if claims submitted are at a certain amount,

[00:28:35] the two weeks later, revenue is going to be a certain amount

[00:28:39] based on visits that were a certain amount.

[00:28:41] And if one is really crazy, like everybody in the leadership team goes,

[00:28:45] well, something's going on there.

[00:28:48] Now, in the beginning, we didn't.

[00:28:49] And the same thing will happen when you have a cash based business,

[00:28:52] only you won't have any history to know.

[00:28:56] Right? Like right now, we're at the level of we can predict

[00:29:00] and we have it all out leads, conversion rate,

[00:29:05] booking rate, follow up plan of care booked.

[00:29:10] We can see it the whole way and we know any one of those,

[00:29:13] but you won't know initially on the cash base side.

[00:29:15] It's real simple in the beginning.

[00:29:17] It's do I have more money at the end of the month

[00:29:19] than I did in the beginning of the month?

[00:29:20] And that's OK.

[00:29:21] That's OK for a couple of months to think that way.

[00:29:24] And we all did that.

[00:29:25] I did that for probably the first 10 years.

[00:29:27] My KPI was my checking account balance.

[00:29:30] Anybody else?

[00:29:32] Right. And now you're like, wait a minute,

[00:29:33] that revenue per visit dropped a little bit

[00:29:36] and look at the charges and look at the units.

[00:29:38] If you're 26 year old self heard you today,

[00:29:42] they wouldn't even know what you were talking about.

[00:29:44] So it happens. It happens over time

[00:29:46] and you develop a new nomenclature for this side business.

[00:29:50] So the next time

[00:29:53] letting the wrong people in now,

[00:29:57] if anybody has the key to unlock

[00:30:00] the ability to know 100 percent of the time

[00:30:03] who the wrong people are, I would like to know who you are.

[00:30:07] Right. And we could probably spend the balance of this podcast

[00:30:12] talking about funny stories of the person who was all that in a bag of chips.

[00:30:16] And the first day they were late because their car was booted.

[00:30:20] Right. Those kind of people, you know, you're like, oh, boy, I didn't see that coming.

[00:30:23] But letting the wrong people in and then to add insult to injury

[00:30:28] using time, energy and resources to train them

[00:30:31] when they're the wrong person is a huge, huge mistake,

[00:30:36] particularly when you're growing fast because you need people.

[00:30:40] Hey, man, I need people.

[00:30:42] If I don't have enough openings, I can't do the business.

[00:30:44] We all get that same as P.T.

[00:30:47] But if you let the wrong person in and if you don't have a framework

[00:30:51] and a procedure to try to at least weed out the obvious bad ones,

[00:30:56] this is going to go really bad fast

[00:31:00] because you're not going to be able to you're going to have to give up

[00:31:04] some control to be able to do the things that you need to do.

[00:31:08] So finding the right person is critical.

[00:31:10] Now, you've had many guests on your previous podcast

[00:31:14] because I've listened to them on some really cool ways to evaluate that.

[00:31:20] And I think there's good advice in some of your previous podcasts

[00:31:24] on how to do that, lots of books to read.

[00:31:26] I think that there's there may not be one that's the absolute best,

[00:31:32] but something is better than your gut.

[00:31:36] And that's a hard part for most physical therapy owners

[00:31:39] is because we weren't trained to weed those people out, right?

[00:31:45] We're just trained to be physical therapists.

[00:31:47] We weren't trained to even be business owners.

[00:31:50] So like you said, about two or three episodes ago,

[00:31:53] Adam and I talked about how to interview people well.

[00:31:57] And that's a big part of the weed out process, right?

[00:32:00] Is to ensure that there's value alignment to begin with the shadowing process.

[00:32:05] As I'm a huge believer in job shadows for at least a couple of hours at a time.

[00:32:10] That helps weed people out.

[00:32:12] References are huge, of course.

[00:32:14] That is something that just has to be learned

[00:32:16] because otherwise our interviews devolve into, well,

[00:32:18] tell me a little bit about yourself and what makes you great

[00:32:21] and why are you excited about physical therapy

[00:32:24] without getting to the nuts and bolts of are they aligned with you or not?

[00:32:29] Yeah, one data point can have a slope in any direction.

[00:32:33] Right? So having other people other than yourself

[00:32:37] be part of that sourcing process is helpful.

[00:32:41] And then compare notes.

[00:32:42] Hey, did you see that?

[00:32:43] Did you see when it's written?

[00:32:45] You get the same thing.

[00:32:46] Oh, no, I didn't or yes, I did.

[00:32:48] So just having somebody else is helpful.

[00:32:51] Right. And then different platforms we use online.

[00:32:57] We use phone.

[00:32:58] We use in person and we use, like you said, hands on.

[00:33:03] Those are four different different data points that help you come to the conclusion

[00:33:08] whether the person gets it, wants it and has capacity for it.

[00:33:11] I love the stuff that you're bringing up

[00:33:13] because it's totally applicable to physical therapy clinic, right?

[00:33:16] Oh, yes.

[00:33:18] Well, all the stuff that we're talking about is the exact same thing

[00:33:20] when it comes to opening up a PT clinic.

[00:33:23] Yeah, you just got to recognize that

[00:33:25] you've got to do all that over again for a cash based business.

[00:33:29] You can't just think that you're past it now and I can open up this cash based

[00:33:33] business because it's a great idea.

[00:33:36] That's right, gravity.

[00:33:37] One. Yes.

[00:33:38] The laws of gravity still apply.

[00:33:40] You know, if you step off the balcony, you will drop.

[00:33:43] There's no doubt about it.

[00:33:44] So you can't forget that.

[00:33:46] And then the final, because I can keep going here, I think the final big

[00:33:51] and I'm not going to call it a dumb mistake because we didn't commit this,

[00:33:55] but I'm going to reverse it.

[00:33:57] The best thing that we did.

[00:33:59] No doubt about it.

[00:34:01] Coaching Tiger Woods as a coach.

[00:34:05] Why the heck would that guy need a coach?

[00:34:07] Tiger Woods.

[00:34:09] I need a coach.

[00:34:10] You need a coach.

[00:34:11] Everybody needs coach, right?

[00:34:13] So and what you want to do when I quote my buddy, Alex,

[00:34:16] where Mosey, who I love, get a coach from the person

[00:34:19] who's two or three steps above you, who's done it.

[00:34:22] Right? He said, I can't coach you on a billion dollar business

[00:34:26] because I don't have a billion dollar company.

[00:34:28] I can coach you one up.

[00:34:30] Hundred million dollar business because I have a hundred million dollar company.

[00:34:33] But that's what you go to, right?

[00:34:35] You go to somebody who's done it, has experience doing it

[00:34:39] so that, you know, you get the lessons without the scars.

[00:34:43] Yeah, that's been my mantra since I started, right?

[00:34:47] There's three steps.

[00:34:48] It's reach out, step out and network and reach out is a guy.

[00:34:54] Right. And how many and I'll tell you, you don't do it,

[00:34:57] but I'm telling you, most people are like that.

[00:35:00] Yeah, yeah, yeah.

[00:35:01] I'll think about the other.

[00:35:02] I don't need that.

[00:35:03] Yeah.

[00:35:04] But yes, you do.

[00:35:06] You really do.

[00:35:08] So we're probably going to go past a million this year.

[00:35:12] Way to go. Nice job.

[00:35:13] Yeah. In cash-based services.

[00:35:15] I don't think I don't consider it a secret,

[00:35:18] but that's for studios.

[00:35:19] And that's with systems in place and exceptional people.

[00:35:24] My COO is probably one of the most extraordinary young men I've ever met.

[00:35:30] He is everything that I am not.

[00:35:33] Couldn't do it without him.

[00:35:34] He's the horsepower.

[00:35:36] It's good to find those kind of people, but I'm saying that simply

[00:35:40] because we're not talking about a thousand dollars difference.

[00:35:44] This is.

[00:35:45] It's going to be.

[00:35:47] At least to me, it's a significant amount of revenue.

[00:35:51] Nothing to sneeze at.

[00:35:52] And where's the limit?

[00:35:54] I don't see one.

[00:35:55] You have.

[00:35:57] I know you have a model to get stretch plex throughout the country.

[00:36:01] Are you in other states at this point?

[00:36:03] Pennsylvania and Delaware.

[00:36:04] Nice.

[00:36:05] Pennsylvania and Delaware.

[00:36:07] But I'm saying this because you can do this as a PT.

[00:36:11] You should be doing as a PT.

[00:36:13] Again, if you decide to offer infrared, cold plunges and CBD oil.

[00:36:21] Now, I know I get it.

[00:36:22] There's people who are like that is an affront to my professional

[00:36:26] sensibilities and it's totally unethical.

[00:36:29] You can say that all you want.

[00:36:31] You can say it all you want, but I'm going to still be here.

[00:36:35] Right? I went to get my car wash and I'm looking at the display

[00:36:39] inside the car wash.

[00:36:40] You're selling CBD oil.

[00:36:42] Now, why do they do that?

[00:36:44] Why do they have if somebody is not appropriate to sell CBD oil?

[00:36:49] It should be a car wash for God's sakes.

[00:36:51] And I'm worried that that I shouldn't be selling TheraBand

[00:36:54] or I shouldn't be selling a pillow.

[00:36:56] Right? There might there might still be people like that.

[00:36:58] But but again, I'm also going to offer the services that my

[00:37:02] people want me to sell to them.

[00:37:05] And I want to try to make it as valuable as possible

[00:37:08] that solves a problem that they have.

[00:37:10] And part of the problem that we have as physical therapists is

[00:37:15] there's sure is a lot of obstacles to get to us.

[00:37:18] Right? A lot of obstacles to get to us,

[00:37:21] whether it's insurance, the doctor, this, the paperwork,

[00:37:26] I'm sorry, again, I'm a P.T.

[00:37:28] So I can say it.

[00:37:29] But the business that solves the problem

[00:37:33] with as little friction as possible to the customer wins.

[00:37:36] Mm hmm.

[00:37:37] So that lady who looks good in a bathing suit on Facebook

[00:37:41] and it's selling her exercise regimen for eight hundred dollars

[00:37:45] and she doesn't know what an Ilyassoa is versus a TensorFlow Sholada.

[00:37:50] She doesn't care, right?

[00:37:52] Neither do the buyers.

[00:37:53] That's right. She wins. Right.

[00:37:56] So again, I just want everybody to think about opening up your mind.

[00:38:01] Think about saying, hey, listen, I got like a built in advantage here.

[00:38:07] I have a built in advantage as a physical therapist.

[00:38:11] Are you kidding me? Yeah.

[00:38:13] And and I see people coming into these studios.

[00:38:16] One guy said, oh, I overheard him say, oh,

[00:38:19] I'm getting a double hip replacement in a month.

[00:38:21] So I came here before I was getting my hip replacements,

[00:38:24] my hips replaced, then I'm going to come back afterwards.

[00:38:27] And I'm like, oh, I'm like, no, that's great that you're here before.

[00:38:31] Fine.

[00:38:32] I think if you get your double hip replacement,

[00:38:35] you should probably see a physical therapist.

[00:38:37] Oh, by the way, yeah, I happen to have a great one.

[00:38:40] Right. I just won.

[00:38:42] You're the first person that they get

[00:38:45] and you have a good experience with them.

[00:38:47] You have a relationship with them.

[00:38:48] They're not going anywhere else but your PT place.

[00:38:51] Why would you do that?

[00:38:52] What are some other cash based services

[00:38:55] that you've seen that you've been impressed with?

[00:38:58] Like there aren't.

[00:38:58] There are some out there that I'm like, I don't know about that.

[00:39:02] I don't know about that.

[00:39:03] As you've looked at it, are there some that you're like,

[00:39:05] that could fly or that's really cool?

[00:39:07] Well, not to be crude, but there's a butt for every seat.

[00:39:11] And you see it on your Facebook feed or your social media feed

[00:39:13] that there's people who they love infrared.

[00:39:16] They love sauna.

[00:39:17] They love cold.

[00:39:19] They love now me personally.

[00:39:21] I don't want anybody taking their clothes off.

[00:39:23] I don't want anybody getting wet.

[00:39:25] I don't want any of that.

[00:39:26] I'm no none of that.

[00:39:28] In fact, that's what one of our customers said.

[00:39:30] They said, when I get stretched out, it's like a massage.

[00:39:33] But I can come in during the day because I'm not going to get all messed up

[00:39:36] and I have to change and shower.

[00:39:38] If I leave my clothes on and just stretch around, it's just like a massage.

[00:39:41] I went, oh, you just gave me a tagline.

[00:39:44] Thank you so much.

[00:39:45] You know, I just listen to the customers.

[00:39:47] So I think that there is great potential in those kind of things

[00:39:50] because there are people who really like that.

[00:39:53] It's not going to work in.

[00:39:55] I don't know.

[00:39:55] I'm going to probably get in trouble for saying, you know,

[00:39:57] it's probably not going to work in the hills of remote Kentucky

[00:40:01] somewhere just because that there's you got to be where the people are

[00:40:05] who are ready, willing and able to pay for that kind of service.

[00:40:08] Right. Right. Gotcha. Cool.

[00:40:10] Do you see this becoming so stretch labs for a time

[00:40:14] got some traction and I see it.

[00:40:16] I still see it.

[00:40:17] Do you see it continuing to grow or do you see branches of it forming?

[00:40:22] To me, it's absolutely a blue ocean.

[00:40:24] It is so underserved in all my travels that it's just

[00:40:28] any physical therapist should be able to do this and dominate their local market

[00:40:33] because you just add one or two elements.

[00:40:36] And here's how I advocate for small business.

[00:40:39] We just add one or two combination to our offer.

[00:40:42] And then we have a unique offer that no one else provides.

[00:40:45] You know, we do personal training and compression.

[00:40:47] Well, stretch lab doesn't do that.

[00:40:48] Stretch zone doesn't do that.

[00:40:50] So we are totally unique.

[00:40:53] And it's good to be the only person that does that your area

[00:40:56] because then it's not about price.

[00:40:58] It's about a valuable service.

[00:41:00] And then when you have that, you don't have competition.

[00:41:03] Then it's just a matter of you getting the word out.

[00:41:05] And as I like to say, if I have a bowl of ice cream,

[00:41:09] all I need to do is take that little scoop and say, would you like to taste

[00:41:11] of this ice cream?

[00:41:13] And then it's it's really that simple.

[00:41:16] And then when they go, oh, I like that ice cream, you go, you want a bowl?

[00:41:20] That's it.

[00:41:21] It's like in physical therapy.

[00:41:22] You say, do you want to go to toilet?

[00:41:24] Well, then I want to stretch that knee out after it's replaced.

[00:41:27] Now, I see it now.

[00:41:29] It comes with some pain and all, but it's not quite like ice cream,

[00:41:33] but they get the solution, right?

[00:41:35] It's not as fun as I think it's not as fun as I think we have great

[00:41:39] stories to tell as physical therapists.

[00:41:41] You want to talk about great stories, looking at clinics.

[00:41:44] I mean, there are just people who are their miracles.

[00:41:48] And we just need to be better storytellers.

[00:41:49] That's why I started with a story in the beginning of our podcast

[00:41:53] to just try to also illustrate that just tell a good story.

[00:41:56] You have it, and then you can tell it more with your cash

[00:41:59] based services. And why wouldn't they do it?

[00:42:01] It's like selling a hamburger and not selling the french fries.

[00:42:05] I'm OK selling the french fries.

[00:42:07] And if you want to tell somebody to go down the street

[00:42:10] to get french fries separately, you keep doing that

[00:42:13] and I'll keep selling the french fries.

[00:42:16] Why not?

[00:42:17] Well, thanks for so much for your time, man.

[00:42:19] Yeah, absolutely.

[00:42:20] It's fun to talk about this.

[00:42:22] More than happy to talk about all my mistakes.

[00:42:24] If anybody wants to reach out to me, they can certainly email me.

[00:42:27] It's simple to remember my name.

[00:42:29] It's like wrap it up and sell it. Steve, wrap a selly.

[00:42:31] Get it? Wrap a selly.

[00:42:33] Wrap it up and sell it.

[00:42:34] Just Google search.

[00:42:35] You'll find me sooner or later.

[00:42:37] A lot of people reach out and ask questions.

[00:42:38] Happy to do that.

[00:42:40] I even have some checklist that they can that I could email them

[00:42:43] about the evaluate whether their business is good for this or not

[00:42:47] because not all businesses are meant to do this.

[00:42:50] And not all owners should do it.

[00:42:52] Not all should do it.

[00:42:54] You know, you've got to be the right framework.

[00:42:56] You've got to be the right person.

[00:42:57] You've got to be ready to go and happy to help people.

[00:42:59] So sometimes I tell people don't do it.

[00:43:02] And some people are like, oh, this is going to be a ride for you.

[00:43:07] Happy to do it.

[00:43:08] Yeah, but imagine that those who it's not a good fit

[00:43:10] for relatively new owners that are still trying to build

[00:43:13] their first company, their first clinic.

[00:43:15] Right? Yeah.

[00:43:15] Don't get distracted.

[00:43:17] Focus on your clinic, dude.

[00:43:19] I know you want to increase your average reimbursement rate,

[00:43:22] but focus on getting solid policies and procedures in one clinic first.

[00:43:26] Then we can talk about some other things.

[00:43:28] Yeah, wait.

[00:43:29] And that's valuable to come to that realization.

[00:43:32] And that's where your coach comes in with the brakes on.

[00:43:35] Well, thank you so much for your time, dude.

[00:43:37] Nathan, as always, thank you so much for having me on.

[00:43:41] It's a pleasure.

[00:43:42] And again, nothing but respect for the quality of your podcasts.

[00:43:45] I always appreciate you having you on.

[00:43:47] I appreciate you sharing and being a little bit vulnerable.

[00:43:51] Everyone else can take a lesson from it as well.

[00:43:53] Absolutely. Sometimes I'm an example.

[00:43:56] Sometimes I'm a warning.

[00:43:59] Thanks, Stephen. All right, peace.

[00:44:04] Thanks for joining us today in the Physical Therapy Owners Club,

[00:44:08] the resource for stability and freedom in your PT practice.

[00:44:11] Reach out and join the network today.

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