IndeFree Las Vegas 2011

We suck in business Were not meant for it The studies show that people who go into medicine, dentistry, PT We all share the same qualities We are all cut from the same cloth We suck at business We dont know how to do business Who starts a business before knowing how to get paid

We invest $175,000 in business before we even know how to get paid We believe that we deserve better We believe that our patients deserve better Without the money we cant do it better Startup cost is all the money you spend until you open the doors for business Unless youve gone through it you wont know Patient satisfaction doesnt mean squat You want to implement this into the relationships you have with people If they are just merely satisfied Theyll go somewhere else

Theyll be someone elses best friend Get your mother wanting to be your mother If you know how to create loyalty then youll create relationship where people want to be with you What are you here? Do fools learn from their own mistakes? Even foolish people learn from their own mistakes The wise learn from the mistakes of others You dont have a lot of friends when youre failing I decided to do the opposite of what led to failure

Before I went door to door all the time This second time when I started over I said Im not leaving my office My first practice it was on ground floor with 2200 square feet My second practice I was on the third floor of a building in the corner Paint was chipping off the walls That practice was 800 square feet As opposite as I could get from what I first had is what I wanted People would never do what I did in my second practice Because I had nothing left to lose

So lets try this Within 8 months I had to knock down walls to expand I was making so much money I was golfing 3 day a week What happened in those 8 months is what Im going to share What happened in those 8 months is the foundation of success I would have never have thought of doing those thing in those first 8 months unless I had failed in my first practice Its a certain mindset I can give you tools and you can still fail

You can be the best biller and the best marketer and still have to close your doors Whats in your mind will dictate your actions Certain actions lead to failure And certain actions lead to success But those actions that lead to success many of us do not do or do not think of Most of us are form the same generation Most of our parents raised us a certain way We are the product of our environment in which we were raised Is it fair to say you have to do different things to get more money, more authority

To get to that new level is it fair to say you got to do new things Or can you just do the same things you are doing and something will magically appear In order to do new things you have to actually think new thoughts or acquire new thoughts What Ive come to find out there are are some very talented people Ive come across But they cant get over this glitch They have all the looks Theyre very articulate They have all the intelligence But they cant just get over this thing

It requires them to keep praying every night for more money We all have it Its called SSS We have it like the plague Its called self-conscious self-sabotage Whats crazy is our kids dont have it But we have it Im going to show you how my first practice was plagues by SSS It was my mindset in thinking that led me to success in 8 months

I wish could really talk to you about mindset and action If you have the right mindset youre going to succeed You can succeed if you have the right mindset It doesnt matter if you have all the skills and all the intelligence If you dont have the right mindset you wont succeed Nothing is for certain until you make a decision The person behind the front desk is the princess You can only implement so much at a time You need to come back because you have SSS

You keep shedding SSS every time you come here Its your mindset thats going to lead you to success or not Your minds set is like 70% of your success Its that mindset that led to a different set of action Im giving you a literally handmade Rolls Royce If you use it properly youre going to reap the rewards You must do one thing within 30 days If you fail to do implement thing in 30 days youre not going to reap any benefits

830 Laser is a micro vasodilator in the capillary bed Subcutaneous capillary bed Laser and then ice Will laser spread active cancer? Cancer Treatment Centers of America Once you get into the science of lasers You understand how wavelength interacts with tissue Exicmer wavelength: photochemically debonding the cells in the cornea 830 nm get about 2 inches into the tissue Its nonthermal to the tissue

This is a class 3B laser Doesnt provide any heat to the tissue Studies are showing can sometimes increase the tensile strength of ligaments Can literally become stronger than before the injury After I failed I didnt know what to do There was a certain mindset going into my second practice How your mindset is today? How it compares to what Im about to show you My mindset in the first practice that failed Im going to share with you from my life

When I started over It had such quick immediate success How did that happen? How do I within 8 months do I turn this practice into this mega clinic #1 my definitions in my head changed In my first practice money meant happiness to me When I didnt have it I was really sad I grew up with parents who fought when we didnt have money Subconsciously money meant happiness to me

Can I be happy again right now even though I dont have it? Yes, I want to be happy without money What does money mean to you? Off the top of your head Dont think about the answer When you dont have money you feel unstable If money means freedom The problem is When you dont have it what are you? Youre a slave If you say money is happiness

Then when you dont have it you feel miserable You start making decisions in that state of mind I ran out of money after 3 months Because money meant happiness to me I was quickly becoming unhappy And I was making decisions from that unhappy state of mind What else was there? What else happens when you start losing money? Panic, desperation I was making decision in that state of mind

When I started over I had nothing I am not going to allow money to make me desperate, panic I started making decisions from that state of mind and that is what led to success Money means a unit of choice Nothing more or nothing less If you have 2 million dollars to buy a house how many choices to you have? This is a daily definition It becomes a part of you It does not govern you It does not give you happiness

Its about being able to sleep at night Its about being able to be loved and love others Do you want to be on this path? You think the private practice is the vehicle thats going to get you there? But this vehicle may take you somewhere else? It can enslave you It can become your ball and chain What will get you there is your mindset This vehicle wont get you there This practice wont get you there Do you want to ge ton this path?

You dont have to go through what I went through to get there I told myself money does not mean happiness with me I refused to let money be happiness to me Bill Gates said, money is a unit of choice You dont have to wait You can get on this path today Im going to tell you step by step how to get on this today I learned very quickly that its not my money Who owns money? Its the government

What do I mean by I dont own it I cant take it with me when I die This is the dynamic of money Your spending of it has to be done in the frame of mind where you know that its not your Youre spending this money because youve been entrusted with it You start making different decisions with money You will be entrusted with more It comes with a lot of responsibility You must make decisions Most of us are not decision makers

We would rather wait till the last minute where there are no other options left and were forced to go a certain path We come from that generation that ruins ourselves #1 reason why my first practice failed Indecision This is the phrase I thought in my mind in my first practice Ill wait and see There were so many great opportunities Failure gives you opportunities to avoid it Its when you respond to opportunities with Ill wait and see that will kill you

Indecision equal death I can tell you those moments where I had opportunity to avoid that failure I just hoped I thought faith means praying and doing nothing I waited until I had no choice If you want to be successful do you make a lot of goals? Do you achieve a lot of goals? If you dont know what it is you probably dont get much of it Whats a goal to you?

I thought a goal was wishing to have a multimillion dollar practice Thats wishful thinking Everybody wants to have millions of dollars Here whats make you different This is your definition of a goal A dream with a deadline I want to have a multimillion dollar practice by December 2012, thats a goal The difference between success and failure hangs by a very thin thread Try it You might not believe me

Start putting deadlines to things Third definition I had to go through in my second practice I had to ask myself Who am I? I am worthy of success Who are you James? I had to come to grips with that But who are you? Am I worthy of success? I am worthy of success today

The whole time I did not believe I was worthy because I had mistakes in my past where I had failed people, where I had hurt people I didnt believe I had the worthiness to actually to have this level of enjoyment I believe this is from SSS Its a horrible product of my parents generation We have this SSS from our parents Until you know that you are worthy You are not going to succeed in anything This is how you frame it Stop jumping down peoples throat Stop judging others by their worst mistake

Their worst sin Or their worst trespass against you Stop judging them by their worst sins You will soon be able to not judge yourself for your worst sins or mistakes When an employee makes a mistake dont write them off You wont make yourself suffer for your own sins if you stop judging others for theirs Stop judging Let them back into your life Quit beating yourself up You will be able to say I am worthy

Only then Todays a new day How I respond today despite my past sins and mistakes is how I am judged by others That is what they are waiting, watching, and hoping for, that I will respond with forgiveness Allow yourself to be forgiven because you forgive other, you will succeed These are the 3 definitions that helped me get through my 2nd practice Until you do that for you employees, your children, your spouse, you wont be able to do it for yourself I want you to become a decision maker

Ill wait and see in making my decision Full freaking crap Whatever decisions I confront Im going to make it right then and there If the words Ill wait and see start creeping in my head I will make a decision right then and there This test Does this decision help make my business more simple? Yes or no Does this opportunity help make my business more focused?

Will this decision help my business become more automated? Less work This is what youre literally deciding for yourself Even though theres a path I can take that makes my business and life more simple Im going to go in a direction that makes my business more ambiguous and broad Im going to go in a direction that makes me suffer more and give me more stress That is sabotage at its finest When I saw front desks to put into my practice they all had corners I was like no corners for me

Corners are like piercing arrows of negative energy No patient has ever said you have to go to James because he has no corner sin my office Do you want your life to be a business? You wake up and theres not fire to put out Nothing has to be done that day You can go in if you want to Isnt that a nice business to have? Isnt that the kind of business you want to have? Indecision equal death This is what I mean

When Im going down the road of life When you come to the crossroads you got a decision to make Once you make a choice you can start moving again This is your business If you stop moving, you die If you stop making decisions, your business will die You can kill it by no making decisions When we say the lack of movement equals death, the opposite is truth Movement equal life

Decisions equal life We promote life Its a privilege to promote movement and life to those who need it most Who is better? Who has the expertise and the compassion to promote life to those who need it most? Do something else that you love If you remember this you will begin to treat differently Dont bring inconvenience into your life Signs of SSS Keep doing whats familiar

Keep doing whats comfortable If you did that which is uncomfortable it would make your life so much better Doing that which is familiar I was losing money and yet cleaning my facility Im like in a middle of a financial windstorm and Im worried about the paint What the hell was I doing? Dont be doing stuff when there are things you got to do to make your life better Theres a problem in that stack of mail Whats the problem? Youre indecisive

You can tell a persons potential by how they handle their daily things Dont keep saving coupons until it expires If you cant be decisive with your mail you wont be decisive with your business Youve got to fix your mail When I was failing When I had no money left I could give a damn about the mail I just threw everything away Even the bills, because I didnt have any money Three things you do with your mail

#1 Throw it away Coupons, throw them away Unless you were going to buy that today Dont let it take up physical space in your life and mental energy in your head #2 Save for later reference File it for future reference #3 You do it there right now What do you do with mail? Pay it now Do not try to strategically pay bills Hold the bill until 3 days before its due

Do not think youre holding onto money by doing that Its just wrong, just pay it Just do it, get it done, and forget about it Thats what you do with your mail Your life will begin to change All you know is your life is getting better You seem to have less stress and more freedom I dont like paper things I dont like mail You have to remove all negative things form your life

Things you dont like to do Thats a negative thing Whatever you dont like to do, pay someone else to do it I grew up where my parents had me do everything I have somebody else do those things I dont like standing in line ever I hate it The reason why you feel so bad is because youre doing something youre not supposed to If your life or business telling you something? I felt sick in the pit of my stomach

I went to school for 7 years and spent all this money to knock on doctors doors How do I feel at that moment? Sick Now I know why I am not leaving my office It was my mind, body, heart, and spirit telling me theres a better way When your bodys trying to tell you something dont suppress it Youre not doing anything wrong but it is wrong Theres a better way Remove all negative things from your life

Your job is to make decisions Not control the outcomes I thought I could control how much money Im going to make I thought I could control the outcome The best you can do is make the best decision you can Dont get a big head So be it Move on Be ready to respond with dignity and grace no matter what the outcome is

That is how you get on the path to independence and freedom Your employees will look at you differently You become decisive Youre always wanting to move forward Youre never losing ground Resource allocation is another action I was not cleaning I was not fixing things I was not standing in line I was not open M-F I cut my days and hours

I scheduled my time to define who I am and what I really like, and who I really like The name of my clinic was spine rehab and therapy I also liked adolescent kids I created fax fliers and started faxing doctors Resource allocation is basically is where you do the $300/hr tasks and let someone else do the $12/hr task It increase perceived value It increases their healing potential Squeeze as many patients as you can into this hour Having an assistant increases perceived value

You cannot treat full time You got to pay your dues You have to do the $300-$1,000/hr task first before you treat patients Any practice that I start I will not treat for the first 12 months No more than 20 hours a week Hire a PT or PTA to take over the treatments Why is it they have their own business and they only make $40/hr We suffer from the same disease We think we can treat 40 hours a week and grow the business, and raise a family, and

It doesnt work Just like you would not pay a PT $50/hr to clean the clinic In the same way you are supposed to be $300$1,000/hr captain of this ship You should fire yourself Because eventually your ship is going under Build up your business for 12 months first But until you build your business, you cant be treating patients Einstein said the only difference between a genius and nongenius is the genius remember what not to remember

The only difference between a successful business owner and a unsuccessful one is that the successful one knows what not to be doing You have to learn how to achieve Did you school have a class How to Achieve 101 Theres no such class To have a successful practice you have to know how to achieve What does it mean to be an achiever? How do you make that practice happen? This is what I mean by an achiever An achiever will tell you exactly how to make that happen

When do you want it moved by? How much money do you have? I will come back with a proposal and I will make money out of this deal I want you to become an achiever Who here would like within 90 days would like to be making an extra $5,000 a month for your business Have you ever in 3 months jumped to another level of $5,000 or more in your business How did you do it? But you did something to get there, right? How would you like to do that at any time of your life

And at 90 days make it happen every time A dream is something you never had or done Duplication simple A goal only has to do with something you have never done or never experienced First of all, how you become an achiever is the same way as how you move a mountain You have to break it up into pieces Is it possible? Yes The only way possible is if you are an achiever What an achiever does is they break it down into manageable parts This is how you live your business

This is how you live your life Or else it will overwhelm you It will bring up on you anxiety, depression, and insecurity It will bring upon you experiences you have never experienced Manageable pieces I love repetition I love hearing what Im supposed to do I love hearing is repetitiously Until I do it doesnt stick Think about are you actually applying it or not

How many would benefit from something of value that you have to offer How many out of a hundred random people would benefit from what you do as a PT How many of you are actively involved in a physical therapy program right now? How many would raise their hands? About 4% How did you get the wherewithal to know that you needed PT You are beginning to realize when a PT opens a clinic right next to you why you want to stab them That small piece is what most practices live on today

So you just sit and wait Do you sometimes get a chance to talk with the doctor? Will you sleep with me, right? Who has been on a blind date? Did you sleep with the person on the first date? Why did you not with the person on the first blind date? You dont know them well enough for what? When you sleep with somebody you are giving them something It is sanctified

Do you think just because you go and knock on their door uninvited and unannounced the doctor is going to sleep with you Should you expect them to say yes, I will sleep with you? Its not a good healthy thing to do Do you want to wait around for that 4% Or do you want to tap into the 96% If you tap into the 96% and 4% there is literally no pie You will not have to worry where your patients come from How do you tap into that 96%? Its not as hard as you think

This is the first year that Im actually sharing everything Since 2002 I was only sharing 80% Youre the third class thats getting everything Guys dont like going to doctors Do guys have problems? Too many to count Should you have a program for guys? Yes What kinds of problems do guys mostly have? Low back problems

So if youre going to do a low back program are you going to have a female on the picture? Who else doesnt like going to the doctor? Young kids Do you know what Im talking about? Do you like taking your kids to the doctor? What do they do when you kid is complaining about neck pain Doctors dont like messing with kids problems Also kids dont like going to doctors A lot of kids have scoliosis You have to have a kids program for scoliosis

Adolescent sports injuries Wound Care Focus on the largest segments of the population Fall Prevention Arthritis Program You have to show results in the first session or else guys wont pay you for it Guys dont want fluff Let all the doctors know you have golf program A lot of small businesses do not get health insurance

Should you have a program that targets noninsured consumers? Should you say theres a special program for you if you dont have health insurance? Small Business Owner Promotion You get a special package If theyre trying to live with pain they dont have to They can find fast acting revolutionary techniques What other group do not go to doctors typically? #1 Alternative = Acupuncture Yoga, massage therapy, chiropractor

In order to gain access to these people They hate the medical How do you get them to want to come to you Chiropractors are outside the medical mainstream You are in the medical mainstream How do you get them to come to you? What comes to mind when you say modality to the person on the street? Blank stare When I go to the person on the street and I say rehabilitation what are they thinking? Drug Rehab

Got to be careful of the words you use Just like you disconnected with that Chinese chemistry professor Theres a communication barrier When you use words that people dont understand you disconnect What words I use is very important You have to connect on that first contact Cant use words like rehab, orthopedic Im going to tell you what you have to say What is therapy? The best answer

Ask a question more deeply Word it a different way Whats wrong? How can I help? I would have love her say, how did it start? Do you have medium, a little bit, or a lot of pain? Words connect to a person or disconnect Are you having any problem sitting, standing, sleeping When she asks me about these things, its about me

Shes determining the urgency of this persons problem I activated them Physical Therapy Yeah, you guys have a leg press machine Well, whats your name? Have you ever been here before Welcome to physical therapy How did you hear about us? Why do you need a let press machine? Whats wrong? When did it start?

Is it medium, little, or a lot We do have specialized program for back pain Sounds like youre a good candidate We have a special program for those who dont have insurance They realize what they can do and be a part of as an activation specialist That person upfront is the point of 1st contact for prospective service But exactly what are you going to do? Essentially what we do is use fast acting, revolutionary treatment, that increases your bodys healing power and decreases pain, at a significant rate, and most of our patients love it

Now Im going to say I would those words verbatim After 50 patients a week your receptionist is not capable of doing a proper activation I think whoever is answering the phone should learn those words but communicate it in a very genuine way and embrace it Thats what PT is to me I had to start asking patients why? Whats wrong with him? They cant explain it Theyre trying to go in fix and leave What they dont understand

That is not your job You dont fix things Youre not a mechanic We dont fix things What do we do? If you dont understand what Im saying If you dont engage the patients mind and heart, their body wont heal Where they are connecting with you Where they feel like you are the solution to their problem

#3 Reason, why a patient will leave and never come back, they simply dont feel like you are the solution #2 Reason, financial ambiguity They dont know what its going to cost Or they dont feel like they can afford it #1They dont like the front desk person Actually, they hate the front desk person Even though they love the doctor They will leave and not come back because they hate the front desk person What should you do about it?

There is no right person until you make the position right You have to train it, train it, train it No one is going to walk in and know how to do it Make sure they know how much exactly its going to cost They should feel you are the solution they need Its so important you know what to say and embrace what therapy is The therapist is responsible for patient improvement Does the receptionist contribute a lot? Yes

Does the admin, the billing support clerk, contribute to the patient improvement? Yes Thats the only way What percentage does your receptionist and staff contribute to the patients improvement outside of the therapist? What is the placebo effect? Placebo effect is not a negative thing Placebo effect is a very positive thing Demonstrates in scientific terms the power of the mind and heart What percentage does it have to exceed to prove its not placebo? 42%

Almost half of that patient is going to get better from the receptionist and the other staff Your therapist is not king There is no king They are all one body You are going to tap into the patients 100% potential improvement What is therapy? You cant just say the 1st visit is going to cost In their head theyre thinking am I going to have to come in how many times a week? I wouldnt have minded if she had asked whats wrong

1st thing she should have done Certain things to do correctly This is how powerful it is The instant theyre off the phone they come in and they say my pain is gone The instant they found a solution they start healing And it happens even before they walk in Goal is to have every patient walk up to you after evaluation and say I already feel better without you even touching them They actually start the healing process Im going to show you how to get every patient to bring in 6 more patients

Thats how I built my second practice How do you build your business without leaving your office? Every patient that came in, I made sure they brought in another patient What would you rather have, $1 million dollars right now or 1 penny that doubles for 30 days? This is what I mean by being decisive Why the penny? The penny in 30 days turns into: Day 30: $5,368,709.12 CEO needs more accountability than anybody else

For the price of a low level employee we will partner with you for 12 months Includes marketing, advertising, promotions, website, software Why partnering with us is so effective Its not out of a book The definitions of therapy Take the phrase I just gave you and take the phrase that you have been saying to describe physical therapy Take those phrases and ask 1,000 patients here are the 2 definitions of therapy which one would you bring a family member to? 99% are going to bring you a friend if you use the words I tell you

We focus group test You are acting towards success Now I want you to BE a successful person When I started over this is how I spend How you spend your time? Spend your time with people Unsuccessful people are extremely busy people They feel like they have no time Yet at the end of the day, they dont feel like they accomplished a lot Successful people spend time with people They make time for people

So when you are kind of at a cross roads because somebody asked you to do this Not quite sure what to do? What should you do? Spend time with people Spend time only on that which you enjoy doing If you dont like cooking If you dont like cleaning Dont do it, pay someone else to do it If you dont want to do, you dont have to do it All I want form you are the things I cant pay someone else to do

Support me in my dreams Encourage me when Im low Make love to me I want your affection, your love Things I cant pay someone else She and i have an awesome relationship When you move all the negative things out of your life the relationship you have with people blossom Energy How do you spend your energy? You dont spend your energy how youre going to take care of your kids

How youre going to put food on the table Those things are taken care of, you dont need to worry The more you worry about those things, the more you are going to suffer Do not spend time worrying about these things You will have the energy to create To be creative Create those messages to make them want to do business with you You have to get that place where you can say I will be ok, I can rebuild, they can take ti all away, and Im still ok

If you can get to that place without having to suffer first, all the better Just go to apply it Also, money, how do you spend your money Only that which brings a minimum 3x the return within 6 months I wont spend even $20 I know its going to bring 60 back Some of you need to move out of your big house and move into a smaller house Put your money into investment that will bring back 3x return Theres are other ways to spend money Cable for example is worth every penny

Got to watch TV My internet bill is worth a 100x to me Some things have a high value but no monetary return I guarantee youre going to be noticed If you want to impress Dont be like everybody else Be the person who leaves messages, people will remember you If you just go down the middle of the road they are not going to love you You cant please everyone Youre going to be hated by some

But loved by others You should be sleeping 8 to 10 hours a day If you cant sleep 8 to 10 hours a day then something is wrong Allocate your resources appropriately You have time to enjoy the journey A house does not bring money back Dont teach kids that money mean happiness Spend top dollar on cookware, shoes, and a bed Whenever anyone asks you for it, spend money on that request

Remember, its not yours, its just something entrusted to you for you to make decisions with Lastly, let it all go Be prepared to have someone take it all away Be prepared to respond with dignity and grace It takes faith not to worry about you mortgage It takes faith and confidence to start over again Making decisions form that mindset will change your business Do the unfamiliar, take risks Do that which you have never done and your life will be different

Your also losing a cost associated with each prospect = $50 for each interested person who calls in Should you activate everybody whos interested? Yes Youre like, whats wrong, how can I help? Collect up more cash up front Do you want cash flow? Collect more from insurance companies What should be the profit margin for a PT practice? Ideally, 60% You want to be in the 50% range

If you are working as the owner 30 hours a week, should you pay yourself? You should be paying yourself what you deserve, not extravagant, not top dollar Issue yourself a check even though you may not draw upon that check You can cash it later when the company has enough money to pay you That way you truly begin to run it like a business How to revolve everything you do and say around the #1 important thing about a practice Your loyalty rating How many patients are currently actively scheduled?

How many of those have actually physically brought you in another patient? Most practice dont know because they dont actually track this The national average is around 2% Only 2 out of 100 have actively brought in another person Thats a horrible loyalty rating Loyalty is actually someone who brings people in You ask them to Will they do it if you dont ask them or tell them to? No

The majority of people in our society will not act unless they are told When they come in what should you say? Are you attracting new patients? What do you do? What is your sex appeal? What is the one thing about you that attracts the opposite sex? Your business is a living breathing thing That identity is an extension of your identity That responsibility is up to you Make sure that everybody notices it

Put out there what is great What you really enjoy Make sure everybody notices it Thats part of attraction I made a mistake there calling it spine therapy rehab They start sending me knees and shoulders When youre good at one thing they start thinking your good at other things Have program names I also prefer a tag line You want to be attracting

Theres a certain type that you want to attract You dont put out messages in certain places You have to define who youre trying to attract I knew who I was trying to attract: parents I just want to connect directly with the parents What is the greatest commodity in health care today? What makes a patient think a doctor is good? They would choose that practice because it has commodity/value What has commodity today in healthcare? Information

The practice that teaches a patient something he doesnt know has the greatest commodity in todays healthcare system The doctor wont tell them the information What do you have to do to be the go-to place? You have to disseminate valuable information What kind of information do you want? When it comes to musculoskeletal pain and stuff The most popular answer was: They want to know how to treat to themselves on their own #1 what could be detrimental to them if they treat themselves

They want to know the common causes of their problem They want to know whats wrong with them and what causes it You cannot share this with somebody This is secret This is information that is only privy to those who come to this course No one is going to tell you this stuff This is what people want You have to start arming yourself with good information Be wary of excessive use of electrical stim

But parent dont know it But when they see it they are so glad That excessive use of EMS can interfere with bone growth in their children Your role as the captain of the ship What is your role? #1 is to bring patients in the door Thats no one elses job You cant let your employees do it #2 training staff Making sure your staff knows what to do with that business that comes in the door

This is your job for your facilities all the time You are always the one that everyone know what theyre supposed to do and how to do it The captain has to determine what messages they are going to be sending out Whats a message you want to get out to the world? Do people care that youre the best? Whats more important than the best? Affordability A better message right now is that your affordable How can you send out the message that youre affordable

Let them know about your special programs for the uninsured, high deductibles, and financial hardship Let them know that you have payment plans Doctors are sending less to therapy because they know patients cant afford it Doctors are being a little more paternalistic these days Doctors need to know you are affordable Do a fax blast every 2 weeks to doctors Youre going to get 4% of doctors saying dont fax to me Should you stop faxing to everybody because 4% asked you to stop?

Advertising is timing Marketing is timing They sent me a patient because I take cash Cash programs with financial discounts Another exciting message Should you be somebody who is associated with somebody who is charitable and giving to the community You think that message is important to the community Positive association with charity is important People are choosing to spend money with those who they feel are charitable

Also seasonal promotions Ever season is another opportunity In spring offer a weight loss program 70% of people are overweight Whats the best way to lose weight? Whats the best way to increase your BMR? Lean muscle mass is the most influential to your BMR BMR is most essential to losing weight and keeping it off Whos the best at increasing lean muscle mass safely?

You know more about physiology, nutrition, safe joint movement and flexibility Who should be the authority on losing weight safely? PT Offer a weight loss program to shoe with joint problems You need to tap into the weight loss business As long as youre getting people to think about you, your business will keep growing Other exciting messages is offering free classes to the community Holding classes at the clinic In the summer should you target orthopedic programs? No

Target it right before the holidays Everyone wants to get the surgeries down before the holidays Open clinics are where you give people a taste of what your programs are Show them how to prevent injuries Show them how to throw better, faster, stronger Kids got results They became star athletes I dont like to say we do exercise because they think were glorified trainers We use revolutionary techniques that increase your healing powers and decrease pain fast

If you say massage and exercise, they say I know what that is Why is it they know what that is? Theyve had it before You want them to get what they had before? No The fastest way to change your life, to change what you begin to experience, to change the way people respond to you, to change the path you are on Change the words that come out of your mouth If your employees improve will you organization improve? Yes You cant say unfortunately You cant say no

How did you feel when the lady said on the phone said No! What should she have said, asked She should have asked in a small tone, are you undergoing any financial hardship Would I have felt different towards her? Do you want me to connect with you and come in Its the words that come out of your mouth Dont try to sound like youre trying to sell Whats the better way? Are you undergoing ANY financial hardship? It would be appropriate to say this

You have to do this right You can get every health care consumer to come in You got free screenings Why not come in and find out what the problem is Everyone should come in and meet me Does everyone who meets you fall in love with you? I want you to become a therapist that everyone who meets you falls in love with you Should you have a fast acting pain relief program? Yes

Up to 8 visits, half hour treatments, over 60 days Another program you should have is an arthritis program #1 cause of pain in our country Do you not go to the grocery store? Where do parents go to in your community? Put your ads there Theyre give aways Things everbody wants They have a high percentage program These are high impact ads

Whats the greatest commodity today? Information It will take you 60 minutes to make one It will make you millions of dollars How to Guide How to treat themselves If youre the one telling them what they need to know, they will think you are better than everyone else Website is the #1 most exciting tool today They dont think youre good They dont think youre credible if you dont have a website

If youre not on search engines youre going to lose out on business Why did you choose IndeFree over other options? You have to have videos on your website Because it speaks louder than words If you have the right tool its not hard to succeed The greatest tool available today to build a private practice, to automate new patients coming in #1 tool is the E Guide This is so doctors dont have to sit there and explain what physical therapy is

Make a doctors job easier they will be loyal for life Another important tool is a flip chart of the hand so they can explain to patients whats wrong with the hand If you help them to do their job easier Its the only way to get doctors to refer We give you a flyer version of it Anywhere where people are standing These fliers are a free guide on how to do something Well also give you a media kit version of it You got to know what to say when they call in to convert them into a patient

It doesnt have to look fancy It just has to be done appropriately And it will work Get your messages out A $1,000 a month If you have these guides, these messages of open clinics and classes If you have these available You wont do it, get the message out there If youre not getting this message out, you cant complain that youre not getting any new business

If you have a marketing assistant out there doing these things you will get a return on your investment Start out part time 10 to 20 hours a week at a $1,000 a month Purchase the marketing success kit This is the easiest position for someone to od the wrong thing Youre not looking over their shoulder Should you put advertisement on their car? Should you make the car payment should they choose to wrap their own car? Yes Offer $300 to a month to the employee who would wrap their car for advertisement

Youre going to get people seeing your advertisement The marketing success kit is video that you can watch You can download the tools and forms online Who would like a marketing assistant success kit? Take control of your schedule Who here has a practice that would like to see it grow? What day are they going to have the highest no-show, cancellation, reschedule rate? How do you think that post-op patient is going to feel?

Do you want post-op patients? Post-op patients arent going to like your schedule Close down 2 to 4 half days The owner has to completely cut out 2 to 4 half days out of their schedule to focus on selling packages, training the staff, putting together eguides What are you in the business of selling? It would seem you are selling PT services But youre not actually selling services Did you know that? You guys are in the business of selling cars

If you buy a car and you sell it, is there a cost to the car? You have a retail price When you sell the car, you get your money The difference is your margin What happens if you dont sell the car? Nothing You can always sell it the next week Problem with our business is What are you buying? Youre buying time slots Youre buying appointment slots

Is there rent? Are there fixed expenses? For every slot you offer There is a cost to offer that slot If they no-show does it cost you money? How much money? Can you go to your employee or receptionist and say sorry the patient no-showed, I cant pay you this hour? Do you still have to pay Jackie? I thought when you first start your business that you have to offer all these appointments All that money is gone

You dont get it back If you dont get this concept, go sell cars Your goal is to offer minimum appointments as possible so you can focus on building your business Not sitting in the office waiting for that next patient You have to control your schedule Fastest way to get new referrals from physicians #1 Shadow physicians What does shadowing mean? For ever week for 52 weeks for an hour, you go in at the same time and you learn

You go in and say you want to learn Shadow because youre going to develop a relationship Your job is to make the best decision you can, not to control he outcome Shadow somebody; youre going to learn as well There are certain things that they want and thats how you send them reports Can you see the patient, send a status note to the doc, and ask for more visits, and if he signs and sends it back, can you use that as a script Should you see a patient without a referral? You should not require a referral to evaluate a patient

Send a note to the doc and have them sign and fax it back You should never say to a patient that they require a referral You should always communicate with a medical profession You only need a referral to get paid by a third party payer to treat a patient If they have a medical diagnosis in CA already determined Do you currently have or were ever told you have any medical condition? If they write down they have arthritis You have the legal right to treat because theres a medical diagnosis

If they write down no Your right is to evaluate, but you cant treat So long as you get a medical diagnosis and a doctor signs it, you can treat Its just so desperate and lacks focus to say I just want any patients How do you decide which one you need more of? Pick the one where you get the kind of patients that you enjoy Ever channel has the potential to collect money Which is the best paying channel? Personal Injury

What you bill at facility rates is what you get paid Should you get some personal injury and motor injury cases? Yes Should you tap into this? Yes Should you tap into the best paying 3rd party channel in the industry? Yes They call you and then you refer them to the attorney Im not joking All the attorneys are doing it One of the fastest ways to get physician referral is to have a patient fill out a thank you postcard to the doctor for sending them to you

Because they love you You will get more patients form your referring physician because you have your current patients thanking their doctors for sending them to you I do want the patient telling the doctor how much they love me Thank you for sending me to James, because he is amazing Theres a critical discharge visit where they dont need you anymore 3rd visit is the best time to get them to sign a postcard Whos been in practice less than 2 years?

Im going to give you online access to one of our training manuals for technical start up steps They will send you a link to that If you want to know what kind of equipment you have to have to start basic outpatient orthopedic clinic You dont have to have a hi-low table No patient ever said you got to go to James because he has an adjustable table But they have said you have to go to James because they have a Laser Where should you spend the money? My second time around, my patients were not judging me by the peeling paint

They were judging me by the quality of care I gave them Our philosophy is not to do anything at the clinic that the patient cant reproduce at home Must have a mat table Average patient visit is 5 $15,000 for build-out $8,000 for used equipment

Once they become prospect Once you connect with them what do you do? The importance of creating niche programs

The importance of creating cash programs Working with physicians Getting out into the community Spending a lot of time and energy trying o connect with their communities Most practices fail Think their advertising doesnt work because its not translating into more business Your front desk is literally your gate They throw in a minimum wage person who talks decent, looks decent In 30 to 60 minutes trains them

Greet everybody that walks in the door, collect co-pay, keep the lobby clean, and about 10 other things I dont care how you do it, just get it done It you dont train a person Theyre going to turn off people There are so many choices in todays market If they choose not to come to you They have the perception of you as a glorified massage therapist The studies are showing that they are going to person al trainers, massage therapists, acupuncturists, yoga, chiropractors, and medicine

Its cheaper What you need to do to make sure that point of contact is converted into a client Most practices lose 60% of the potential business that are calls coming-in, or walk-ins inquiring about services That is how ignorant how most practice owners are Every practice could literally be doing 220% more Lets say you saw 600 a month You could have been doing 15,000 a year Because you have a minimum wage person off the street running the front desk

Start with a topic you know a lot about Something that doesnt require too much research on our part What we have in our heads has the potential to be extremely valuable Your target population should be broad enough to cover a lot of patients The objective of your E-guide Create a real quick title Until you finish your content you wont cement a title for this guide How to throw better for kids Throw something down

Use words like you Try not talk in the third person What is something the reader probably wont know about this topic? Adolescent sports injuries are on the rise I would share some information that they might know The reason a talented child doesnt play well after high school is because they are not properly trained Their career can be cut short Make the reader feel like I need to take this more seriously With all patients you should be supersizing

They pay a little bit more out of pocket and get a massage, laser treatment, or exercise treatment Get one free first And youre making extra money Get known as someone who offers these kinds of things Are you doing is putting up a sign on your counter saying add this service for this price If you dont have that option available and make them aware of it, they wont take advantage of it Let them see a menu of service with prices Your supersize items can be any service not covered by insurance

If the patients wants it Hey add this and youll get this Whats heat pack bundled into What procedure is heat bundled into? There are certain codes that theyre bundling heat with that code Medicare is saying head and ther ex is the same thing So you can bill separately You cant unbundle What else is heat bundled into Her software did not have the capability of putting in the body part for ultra sound quickly

On her documentation it looks like she didnt try different areas Why did you try 8 US when the patient was not improving? Where did you document that? My software didnt allow me to do it What you did is over utilization Why do you keep doing something when its not working? Over utilization is this close to billing fraud She took it there How did she take it there?

Shes apply a procedure with no medical necessity because there is no improvement Shes doing it merely for the sake of reimbursement Thats billing fraud Every practice in the country is doing billing fraud There is a way to document so you dont get accused of billing fraud There is a right and wrong way of doing things Our documentation in IndeOffice is audit proof Were also super sizing them See them for 30 minutes and super-size them

2 hour workshops once a quarter Ergonomic assessment of work stations Every company wants these services So they can tell work comp care they had an outside company come in and do an ergonomic evaluation Show that you doing everything you can to lower the risk of injury You are the #1 solution to businesses across the country to a huge problem Businesses are going under because they cant afford their work comp insurance payments Executive ergonomic advisor to Circuit City

Who would like to treat all the fire fighters and police in you city? Go to the city and submit a proposal to treat all the city workers You have the ability to go in and submit an offer for that contract Most cities have an open season to accept proposals They cant show favoritism politically Make a proposal to treat the city If you can back it up They will send you all the city workers Find out when their needs are

Find out when theyre opening up for new contract proposals All government agencies must open it up to receive bids from the public Youre not doing physical therapy, youre doing wellness That is why you dont need a diagnosis They find out when the owners are not there They come in acting like theyre FBI Wed like to come in and ask a few questions and look at your documents Were from Medicare, thats what theyll say Get the hell out of my office

Im calling the police Make an appointment to see the owner If the employees are trained to do what theyre supposed to The PT boards act like criminal elements They want to prosecute They want to hurt you Because they did 8 Ultrasound and the patients did not get better They want to say thats billing fraud Billing fraud is trying to get paid for something they didnt do Billing for something they never done

If I send out a fax blast and the doctor knows Im coming When Im face to face what am I going to say? What do you say when your face to face with the doctor When you go face to face with the doctor You have the potential to have great energy around you When your energy starts to get confused it starts to repel Theres certain people I wont remember However, you have sometimes confusion that will repel Dont push

Stop pushing Be yourself Dont try so hard You have a nice spirit, but you try to hard You let that frustration fuel your action You have to act from a place where youre grounded, where you love nature Not from a place of desperation We just me Why be so desperate Cant relate to people who come from that place Very nice lobby

Who designed it? Talk like a real human being Dont talk like a desperate person Do you have any good solutions you feel for them I have something that might actually help you a little Its basically a guide that show patients how to do some of the things at home If theyre in more severe pain We have something for that Im not pushing anything

Start it with a real genuine person to person statement Everybody will divulge whats important to them Theres a little bit of anticipatory nervousness You want to present that as an equal footing You want to do the same things with physicians Everyone is showing me something today thats important to you I might comment on his apparel Just kind of throw it out there Everyone one of you will reveal something somehow You seem to care about how fit you are

Some people its the way they do their hair Nice hair You cant just tell Some people its in their jewelry Try to be sensitive and in tune of people around you Business is about getting people to want to do business with you We actually have to work hard at being likable Self-centered people are very hard to like Business is so much about not being selfcentered Notice the receptionist is nice

Comment on something Something for her to say I like you because you notice things Youll stand out I call it the sandwich theory Its a theory of how to get people to like you What it is When you acknowledge Its human nature psychology The best way is to have a positive statement Do you have any patients that require. Then you want to end it with positive

Heres a guide that might help you education your patients We also have a special program if they need elevated care Start to ask something about them You just want to be in tune End with something nice that is not about your business Its positive, negative, positive If you want your husband to clean the garage dont say when the freak are you going to clean the garage Have you been working out?

By the way, are you ever going to get to that garage? Guys need their spouse to respect them Tools that tell people who you are Like brochures #1 criteria patient is looking at to connect with How do they choose who they go to They want to know where you are Location is the #2 criteria in most cities #1 They want good information they connect with that they want to know more about #3 How much is it going to cost?

#4 They want to see who you are They want to see a picture of you They want to see a video of you They want to know what your hobbies are If they love dogs, they want to see pictures of you and your dog Theyre trying to make an announcement that is insignificant No one cares about whats below the fold Whats above the fold is all that matters Unless you can get their attention above the fold in 2 seconds they will leave the page STOP the Pain grabs their attention

Are there some links that are more important to the viewer than others I dont like that all the links are the same size It all blends too much I want certain links to stand out I want location to stand out Do you see the location>? #1 Variable that determines if patient chooses you or not once theyve connected with you You got to design the site for the patients What patients want or like is not the same as what you want or like Patients are coming to you for care and healing

99% of patients are in pain A person in pain could give a damn about working out Lets give them some healing pictures A person in pain wants to heal What do you think physical therapy is? It looks like torture You cant sell physical therapy People in your community dont know what physical therapy is Doesnt it look like an attorney website? I dont like to wear ties

It makes me unapproachable Name tags really help Have a nice looking name tag What words do people in pain want to see? Anyone who offers free transport is going to dominate Medicare Restore strength and confidence Patients like those words Results that last We can build you a website in 3-4 weeks if you respond to your proofs quickly It typically takes 5 weeks to build a website

Seniors are really ramping up Seniors are starting to go online Even for Medicare you should have website A website gives you credibility Our websites guarantee that patients will like it Its $79/hr with a 1 hour minimum We tested it with patients We know what they love Were not here to rip you guys off The most important tools are going to be brochures

That laser brochure has made me so much money Like how to guide Anatomy flip charts that make physicians job easier Use scripts to train your staff I want to know exactly what my staff are going to say Advertising 101 Message is exciting If you have the right tools that are designed well Building a business is not hard Website needs to look nice and be effective

Be wary of websites that dont look nice Graphic designers make $18/hr Web designers make $25/hr Advertising specialists make $200/hr Capable of building something that is effective Change from fear of falling to Fall Prevention Seniors dont like you asking them questions They would rather be told When you see this number ring you had better answer that phone You have to answer that phone For the activation person there is no vacation

If they want to count minutes with me I will count pennies with you If you dont count minutes with me, you will make more money Activating Prospects Ring, ring Its not even common sense for someone whos been in private practice for 7 years How is it going to be common sense for a minimum wage employee off the streets? How do most offices handle the first call? Most offices respond in a way that makes you feel that youre burdening them

6-8 minutes is required to make them feel like you are the solution If you dont invest the 6-8 minutes you are going to have a higher no-show rate That on first impression lasts an entire lifetime The typical receptionist dont have 6-8 minutes Phone calls coming in They go to clean Envision your front desk Think about what it looks like Are there post-its? Post-its kill your business

Willingness to pay will be dictated by that first impression They will go somewhere else if you dont do it right #1 thing you do Must determine their medical urgency Medium, little bit or a lot of pain Determine payment options Why is it important to know where they are medically urgencywise? Perceived value is one of those things If you offer employment to somebody who doesnt want it that quickly

Its all subjective Youve got to send the right message You do want to determine their medical urgency Should you have same day appointments for post op patients? Yes It sends the message that you care if you ask questions about their medial urgency Come back with scheduling First part of scheduling What times and days are best for you? Second part of scheduling Come back and offer them 2 slots

You conclude the conversation with APPLE Caller Profiles What is your name? Have you ever been here before? Welcome How did you do that? Are you in a little bit, medium, or a lot of pain Do not say great when they are describing how they injure themselves Activation person has to be real and compassionate You got to stop and say

Thats horrible you had to go through that You want to some compassion Are you able to sit without pain? Does it affect you sleep? Can you sleep through the night? Urgent Post-op She has not had a surgery When should I get her in by? 0-24 hours Urgent Impaired One of her basic life function is impaired Most important basic life function is sleep

If sleep is impaired they need you immediately If 3/5 of those are impaired and their pain is medium to high, get them in 0-24 hours, or else they are going to somewhere else Everyone else is standard Always 2-7 days out Never give a standard patient same day or next day appointments I want to get you in as soon as possible Is that what you want me to do? Can you get yourself here? Do you want to get in as soon as possible? How are you intending to pay for your services?

Well figure all that out when you get here So important to ask how you are going to pay right after you determine medical urgency Timing is crucial Ask how you intend to pay right after determining medical urgency Get that person in the door ASAP Let me see what I can do for you You want to walk away Have her wait on the phone Putting them on hold give me an opportunity to come back and say I have great news for you Do you have a pen handy?

These are the 2 dates and times available for you They fit the profile of somebody who always think theyve gotten the short end of the stick Youre just another one of those who crap on them too People take it the way you present it Great news, I can get you in, because youre urgent I got another patient to switch their appointment I am reserving that spot for you If you dont say those words They dont think youre reserving a port for them

And they take that appointment less valuable, less important I want to make sure Let me know Id like to let that patient know so we can get someone into that appointment Right this down Make sure to wear some loose clothing so that we can expose that area Do you have access to the internet? You can go to our website and download the forms and fills them out in the convenience of you home

So make sure to bring a credit card, check, or cash with you Lets figure it out when you get here Just in case, there might be some payment due for you, but lets figure that out when you get here We have a very strict late policy If youre more than 10 minutes late we may have to reschedule Make sure you arrive 20 minutes early so we can take care of everything Well see you tomorrow Thats an activation It takes 6-8 minutes

Its done very methodically Information today is the greatest commodity She thinks were very good She is sitting at home taking a big breath Healing has already begun Phonepeople.com for $29/month It allows you to have this phone system 1.6 to 2.4 of minimum wage for activation person PPO In-Network Whats wrong, how can we help? Versus whats your problem

The words you use are so important Are you experience a lot of pain, a medium, or a little bit Im sorry youre experiencing so much pain Let me see what I can do for you What kind of insurance do you have? Do you have your card handy? Do you see the 800 number on the card I want you to give them call Id like for you to ask what your deductible is for PT services The second thing is your co-insurnace

Bring those two pieces of information in with you Also bring some form of payment How do you guys feel about that? #1 priority that you evolve you practice around is what? Patient Loyalty What is patient loyalty? How does a patient demonstrate loyalty? They physically bring in another patient Just bring in patients from prior patients How does the patient feel?

How do you feel having that discussion with that patient? No ones asked your patients Patients think you are in cahoots with the doctor and insurance company 40% of the patients will do it 60% wont have it What does the receptionist do at that point? Do you have your card handy? Give them the phone What number does Ms. Jones call? The member number gets service much quicker that the provider number

Got to splice the relationship between that patient and the insurance company Insurance companies are of the devil Will the patient be loyal if youre delivering bad news? No Well Ms. Jones, are you undergoing financial hardship? Because if you need help, we will help How are you going to help? Payment options Well try to get them better within in 5 to 6 visits Well split the costs into a payment plan She can do the $499 program

Financial hardship form Can you still discount anyways? Shes technically a cash patient Shes eligible for 30% discount at cash rates If youre in network with that plan you cant apply a discount If youre dealing only with her then you could apply a 30% discount If you are in network, your fees will apply They have to pay cash because the deductible is so high If they are in network you have to go with the contracted rates

If you are billing their insurance at all, there is no discount So long as you dont have any of their insurance information on file, then you can give them a discount Discount only applies if you are not sending any information to their insurance If they fall below 2x the poverty level, you can waive deductibles or co-pays Patients always have to pay something I just dont think charity works It shows them that they have value Act like this patient didnt have any insurance at all

Dont be the deliverer of bad news When that patients walks-in dont be the one delivering the bad news Theres not loyalty there I hate putting my princess in an awkward position I want her to be a princess, not a combat marine Do the APPLE with me Go over the APPLE with me Patients dont mind filling out paperwork at home You add all these benefits to this person and their healing just starts growing

If they are out of network, what should you say? How do you intend to pay for you services? What do you say if they have a plan outside of your network? Wed be more than happy to help you If you are serious about this problem and you want to get the best care possible we are your best choice Only 10% difference for out of network versus in network The value is different Get better care out of network It may be cheaper in network

But the value is greater out of network Better than going to in network with full rates Standard amount of care youre willing to deliver for $75 Were allowed to super-size them ABN = I know these services are not covered but I want these service You should be selling wellness services Selling massage, weight loss, laser, just as an elective service Youre paying rent and expenses You should be selling that stuff Workers comp is really cool

If you can talk the adjuster into authorizing stuff you can make a lot of money You should be getting to know your adjusters You should be sending chocolates to your adjuster You should be sending sports tickets to them FAQ I saw your brochure; tell me more about your program How are you responding? Do you know anything about the laser? Can she activate me even though she knows nothing about the laser?

Go into the activation Its the same thing Whats your name? Have you ever been here before? Welcome Whats wrong? What can we help you with? Go through the activation When did it start? Is it little bit, medium, or a lot Are you having difficulty sleeping?

Medical urgency Shes going to forget about her question She will most likely schedule without getting her question answered Do you care about my problem? Do you have a solution? She doesnt want to know the technical aspects I feel good that you care I feel good that you have a solution How much is it going to cost me? Can you tell me around how much its going to be?

Do people want to know? This is the answer We have several different programs, however, its going to cost anywhere between $40 to $90 per session depending on the complexity of your condition AND most patients gets better within 8 visits They need to hear that range We recommend the $499 program that gives you up to 8 visits over 60 days Trying to get you away from selling session by session I want you to sell packages People like packages better

They dont like the idea of getting sucked into something that is endless Theres no confusion What will determine if its more towards the $40? If its recent injury Very local area affected Pretty clear cut More towards the $90 if chronic in nature Multiple areas affected May want to do the $799 program Just giving you a structure to go by

$799 up to 16 visits Theyre not buying the visits Theyre buying the results What will you do? Are you like chiropractors? Are you going to crack my back? Youre in the business of selling PT Dont go we are going to do massage, EMS, modalities No one wants to buy those things People want to buy the ability to hold their grandchild

So if you tell them were going to do ultrasound and MFR Theyre like, do I even want that? Is that what I need? We going to use some revolutionary technique to help your body heal quicker and pain relief quicker Out patients get well quicker and they love it There are certain words that patients want to hear There are certain words they want to hear but they dont know it You need to start doing whats revolutionary

You can get a patient better 42% without touching them Because you have a team where people say the right things Those are healing words Thats horrible what you had to go through 42% of a patients - healing is going to come from the words you use, making them feel like you are the solution to their problem If youre doing some of the fast acting techniques Theyre revolutionary They drop in pain from and 8 to a 1 Increase your bodys healing potential quickly

Can you work with me? I lost my job What do you say? Do you like doing business with people who say no? I dont like being friends with people who say no too often The word NO is not allowed What should that girl have done? Can you waive my deductible? Well, are you underdoing any financial hardship? If you qualify.

If she had responded that way I would have felt totally different about her Intake is what? Intake is when that patient shows up for that first appointment Now that you did your advertising and promotions And now that youve activated that patient Now youve reserve a spot for them Now that the patient knows that slot is valuable Let me see what I can do Ill try to get you in right way

We really care about you Were going to do the best for you They will trust you They will believe you Do you anyone suffering from arthritis? Do you know anyone suffering from neuropathy? After 50 tx sessions per week Press 0 to speak to an operator Call Prompts Press 1 to route the call

It should go to a company cell phone to the activation specialist How that receptionist takes the baton How that receptionist take over from the activation specialist Those words are very healing Should the receptionist be trained? What should they be trained on how to do? Do you have to train somebody how to greet? Greeting is not common sense 80% of the practices I walk into dont greet me Train them to greet

The typical receptionist in a facility Its about how you do it Thats what makes you good or not What the role of a receptionist in a typical facility Youre trying to revolve that business around customer loyalty Theyll leave and never come back if the front desk sucks The role of the receptionist is to create and maintain loyalty Thats their job Their job is not to schedule patients

If they understand what their role is, they will do this differently Receptionist do not spend too much time on one patient Get them out I see too many offices suffering In most offices that are suffering, the receptionist is spending too much time on the computer Most of the time what I find is the time is spent scheduling them and changing their schedule Do not schedule more than 3 appointments at a time Train your receptionist to notice people

Sense of mind to notice whats important to people They cant do this if they are running around ragged You want patients to have the perceived value where they are asking for more appointments We dont call to remind patients Stop reminder calls We got to treat them in a way where the patient perceives the value of that time You have to train your staff to get the patient to perceive value in the treatment If you start to shadow physicians you will hear what patients say about you to the doctor

Most patients will tell their doctor, I feel better for a couple of hours, but then it comes right back

Thats such a big reflection You wont see a lot of fancy equipment in our facility Most people dont have access to fancy equipment We want people to stay better The PT are like salesman If I miss one appointment, there are like 8 messages on my phone Theyre too desperate

Are you guys profiling medical urgency? Theres a reason why patients are bringing in other patients Do they love and respect you? Are they really loyal to you? Get a better perceived value Give a better perceived value Do you training on those days when its slow like Tuesdays Its peace and harmony Bored one day Overworked the other days

I dont like being overly busy So I dont like my employees being overly busy Dont try to completely fill every day Thats short term thinking I like steady growth You really enjoy the journey Apply what Im telling you Try not calling anyone You have to do certain things correctly though Stop reminding people Have to train to greet

How do you greet? #1 Stop what youre doing #2 Eye contact You will see a persons soul only through their eyes #3 Use their name Say their name How do you know the name of a new patient? Hello, would you happen to be Mrs. Jones? How did you know it was me? It was a very nice impression #4 Smile

Do you like being fake? What if you dont feel like smiling? Tell your employees why and how to smile What it means Is an authoritative person Its got to be a female Or a left handed person Its a female, gay guy, or lefty Do you want to make more money? Do you want to give better care? Do you want people to get better faster?

To do what your job it even though you may not feel like it Thats performance means If youre going to contribute to the success of the organization you have to perform If youre sick You show up to work Thats not your decision to make Thats the culture of our organization Thats performance at its best You cant have patients coming in and they feel like they have to take care of you #5 Make a personal statement

Pia I like your shoes A question you should never use How are you? Never say that You also want to hold the team accountable Whats the problem? It was her response when he confronted her Whats the opposite of love? Indifference is when you stop caring Hate is a god given emotion thats appropriate to feel Indifference is when start to die

Be careful what you ask for because you might get it Confrontation equals an opportunity to make things right When someone confronts you theyre giving you an opportunity to make things right If you get defensive and start making excuses Eventually that person is going to say, shes not worth it The way they handled it I love them better than before they made the mistake How you handle that moment is going to make that patient love you or make that patient tell everyone not to go to you

Two things patient hate most when they see their doctor #1 Waiting #2 Paperwork Whose job is it to make sure the patient is not waiting too long? The receptionist Go to the therapist Excuse, sorry for the interruption Can I speak with you? Receptionist is the princess They are given the authority to kick the therapist in the ass, hard

#1 Tool in the practice = Fee Slip More than website, more than brochures #1 Fee Slip is the most important tool in your entire practice 3 parts Every patient brings this up to the receptionist Does Medicare have co-insurance? Yes, 20% Your data is backed up through 5 different computers Back of express registration form are a list of policies Important to clarify expectation in a relationship

Why? Is it important to say, honey dont ever tell me to shut up in public If you dont say it Will there come a time where they will say it in public? If you dont clarify expectation, people wont know they did anything wrong These rules and policies are clarifying your expectation Rules are not meant to justify punishment But rather to create opportunities to exercise compassion and forgiveness

If they dont know they did anything wrong, there is no room for forgiveness Only way I know how to create loyalty in a relationship Its very difficult to cheat on a person who has forgiven you Without forgiveness you cant expect loyalty Your receptionist is the one to earn the loyalty of all your patients Receptionist are empowered with the greatest authority to exercise compassion and forgiveness And with that develop loyal patients There is no sin that cannot be forgiven

Assignment of Benefit Form Insurance company paid the patient What do you do when that happens? You have the right to request the insurance company issue you another check and they go after the patient They authorize you to file a complaint to the insurance commissioner on their behalf Gives you a lot legal leverage 2 signs the patients has to see Dont Break the Law $10 Fee for being late Will they break these rules? Yes

Is there any way you can see me? Do you want to be seen today? Clearly understand, never tell me to shut up when Im in public with my friends Punishment has to be fair Even rich people will respect a $10 fee When they break it You have to enforce it You have to make them pay it If the punishment is excessive youre going to lose loyalty Why should you collect patient portions upfront at the time of service?

There is one thing that will ruin everything That is, they get a bill after discharge, they never expected, that you never told them about They will hate you The will never come to you again I like to collect a little bit more each visit than what the patient owes 2 weeks after discharge you send them a check Can patients pay a $400 unexpected bill? #1 answer Patients get better faster If they pay a little each time they come in

You want to get patients better faster You have better cash flow If you get them out faster you can get 3 more in Less expense with collections Less likely to get sued Less likely to get accused of malpractice Have a cloud over their head If they owe you money Common denominator among lawsuits 80% owed the doctor money Oh, I forgot my wallet?

Give them this form Its a request to be seen Pay their payment plus a fee What does the receptionist do once? Forgive them As theyre filling it out what should the receptionist do? That fee there, Ill waive it this time This is how you build loyalty Its just nice to create this kind of loyalty Were going to have to schedule you for the next time

Reinforce it That will send the message that coming in late is breaking the rules Once you do it It sends a message They might be upset that moment That night as they lay down to sleep they will respect you more You have to make a good faith effort to collect their deductible or co-insurance Always want to send the message of are you undergoing financial hardship Are you undergoing any financial hardship?

I always ask them this question Is it important they know that? They have friends who need a financial hardship discount who could benefit from your services Must make less than 2x the federal guidelines for poverty You should have a credit card account that automates monthly payments How would you like to take care of it? Send them to olddebts.com When you owe somebody money that is justified Do you have a grey cloud?

Does it hurt your ability to sleep? I dont want you to put a grey cloud over someones head Give patients the opportunity to feel that Do them a favor Make them pay Theyll actually come back again to you for therapy If you dont, they will never come back to you You put that grey cloud over their head Make them pay it back Can you bill for manual traction and manual therapy on the same day?

59 modifier on both or one? Got to put it on both Indicates that each procedure is distinct and separate Is it important to set your fees correctly? If you give someone a cup of soup and charge them $25 how will they feel? What am I talking about? Do patients see the EOB? As consumers are they looking at options and becoming more educated? It will hurt their impression of you Indefreept.com and look at price list link

Those prices are good for any state People will pay that without feeling like your overcharging them Hes a nice guy and he sounds smart, but Im not saying that Practice the way you need to practice Do what you need to do Practice the way you need to practice and as long as you can justify what time you are spending I would say transfer training If you want to bill that You have to document that you did transfer training

I dont want you guys to get scared Make a lot of money so if anyone screws with you Verbal cue and tactile cue is expert intervention Practice in a way where you can sleep at night Outsource your billing Automate your patient flow GP is PT Anything offered by PT you have put GP modifier behind it If you dont add GP they dont pay GO is OT

GN is speech KX is When do you need to apply the KX? Do you know when you are beyond the cap? How do you know? How do you know when they are coming close to their cap? You dont have to be exact Just throw the KX on their when you feel like its getting close to the cap Whos contacting the Medicare Intermediary? Re-evals need the 59 modifiers

If you dont add the 59 modifiers, they will pay for the treatment but not for the re-evaluation Medicare will consider the re-eval payable if there was a significant change in function that required a change in the treatment plan They will justify a re-eval if there was an incidence and reinjured themselves Try not to ever use two lines If you used US on neck on shoulder Dont use US on two separate lines Put it on one line and use the 59 modifier for 2 units of US Does anyone use L codes? Start thinking about doing orthotics

Employee and Front Desk Training (Sunday) What does it mean to be a part of an organization? Even if there are only two of you Whats the difference between being an employee and being a team member? An employee doesnt care A team member and team might be holding hands working towards a common purpose Theres no person that is not unimportant That person is either going to add to and contribute to the success of the entire body The captain is the head of that body

It really does work like a body Theres nothing benign Every person will either contribute or take away from the successfulness of the organization No action is benign Every action you take will either contribute to the organization or take away from the successful of that organization When you walk out of here What do you walk away with? Some of the pitfalls and temptations of being an employee What you do, does it affect who you are?

Theres some people in the world that will say thats not who I am, thats just what I do I used to think that This is not who I am This is what I do I do physical therapy Im not defined by that I also do sports, but Im not defined by that Im a husband, but Im not defined by that The question is then who are you? What you choose to do makes up a big part of who you are

How I do it will define who I am Thats why you are here I want to make sure that you are somebody who is going to grow Accept some of the seeds that are being scattered So that you an individual can grow Because thats what life is about Its not about can you do STM Its not about can you do an intake properly Its about what can you take with you when you die You cant take statistics

How you developed your character How you did you job Not for the money Not for your boss Not for you co-worker Do it for the character For those of you who dont have much character Do you want to be a person of character when you die Thats all you can take when you die, the love of people, the memories, and your character

What I want you to walk away with is the skill to make more money Because if that what it is to you Then when you dont have it what do you become? Unhappy Money is about units of choice I want you to walk out of here with the skill to make more money You can have more choices in your life You can choose to have those nice things You can choose to take those vacations You can choose to hire a therapist

If you dont have money you cant choose to do anything How do you spend it? Spend money on other people On anyone that asks you for it Youre entrusted with it The greatest way to spend money is to share it with people You want to continue to work a job? Just over broke Pay just enough to get buy but never enough to get ahead

The captain of this ship is trying to create an organization A demonstration to make an investment to no longer have jobs in the organization They want success in a team and opportunities and they want to give it to you If you just want to punch in and out and have a paycheck then go work for McDonalds I want you to walk away with the skill to make more money I want you to understand why your captain brought you here They had a different point of view and I would get upset

I realized what communication and confrontation mean What is confrontation you guys? When they say something that throws you off balance, thats confrontation Confrontation is an opportunity to make things right Theyre giving me an opportunity to better that relationship you have If you respond in a way that makes them feel like I better not bring up this topic again You making that person say its not worth it Next time they want to approach you with it, forget about it

Opposite of love is not hate Opposite of love is when you say its not worth it Forget about it So captain dont respond to them in a way that forces them into indifference Welcome every comment How will you achieve the skills to make money? One of the ways is to build the best relationship you can with your captain, with your team Build the best relationship you can with your captain first Your fellow workers second

Your patients third Your internal mission I will do whatever I can to create the best environment for my team so that we can successfully reach our goals First and foremost this mission You cannot break this mission You cannot make decisions that break this mission You never break this mission It doesnt matter if you sick It doesnt matter if you have a headache You come into work

It burdens the rest of the team if you call in sick Do you want to be loved? Then you dont break this mission Thats how you build character It builds character You can take that with you when you die Members of the team Stop talking the talk Stop thinking the thoughts with intention Start doing You become a doer

You go back and apply it The big picture Revenue vs. Cost Did the company really make $110? You got to pay rent Rent is typically $3,000/month How much is that per day? $150/day Lets say you offer 20 appointments per day How much is that per appointment? $7.50 per appointment

Do you have to pay the receptionist Lets minus that too How much did the company make Minus the cost of internet, insurance, marketing, advertising, payroll If that company is somewhat efficient Out of that $150, that company made $40 Do you want to be a contributor to the success of your team Stop thinking the owner is a money hungry work you like a donkey person Its not the case

Theres a reason why they ask you to do certain thing Making money in health care is very tough to do Did you ever ask the captain why did you ever start this business? The #1 thing they will not say For the money Because if it was for the money there would be easier ways to make money Much easier They didnt do it for the money Try to create the best relationship you can with your captain

Definition of therapy Youre part of a business, a team that sells physical therapy What is physical therapy? Should you know what it is? Is it important to know what it is youre offering? Do your parents say where do you work? So what do you say? So what do you do? They have misconceived notions about it What is it to you?

What they offer is manual therapy, exercise, estimulation What you are offering is essentially this Essentially what we do is we use revolutionary treatments to increase the bodys healing power and decrease pain at a remarkably fast rate That is physical therapy Some of the tools we use Some of the procedures we use are electrical stimulation, but that is not physical therapy What he does is create art He creates beautiful things for us to look at To remember, to symbolize

He creates those things He doesnt do penciling He uses those tools to create And our patients love it If your patients dont love it, lie If your patients dont love it, then you better confront your captain Never forget you are part of one body Never forget you can add to or take away the successfulness of that body There is no such thing as this is my job I dont know what they do

I dont care what they do I just work here You better care what the parts do Does it affect you? Yes it does What someone else is doing affects you One of the only way to create more money is to be sensitive to you environment When someone is not doing what theyre supposed to do you give them an opportunity to make things right Hole them accountable We all work together

Thats the next step In acquiring the skill to make more money 1st step youre going to take as a team The current patients you have When they reschedule, cancel, or no-show does it cost the business money? You are not getting those things because patients are canceling or no-showing When Im making more money I give them more money Do you not give more Do you not share more

The kind of people 82% of us are exactly the same Were all anal Were all not likeable Were all meticulous Were all very intolerant of human incompetence Were all not very forgiving We all are very generous We all care immensely for the human soul We all will give and give We all care too much

We all think too deeply The captain of the ship is not what you think If the organization makes more money, all the members make more money For patients that are established in the system is there a way to get them to from no-showing or canceling How do you show compassion? Do employees contribute to a patients unlocking of their healing power? 42% of a patients improvement will come from you and how you actually send messages to that patient The other 58% will actually come from the clinical care of the therapist

The way that patient connects with you The healing begins the instant when they hang up The therapist needs you just like you need the therapist #3 reason Why people no-show, cancels, or reschedules Theyre not getting better Theyre not improving If theyre not improving they dont consider it important #2 theyre not sure about the exact financial costs

They start getting concerned about how much is this going to cost me #1 they dont like the front desk people The receptionist, the admin assistant, the billing person They will still leave not want to come in because they do not like the front desk Where are they going when they no-show or cancel? Theyre going to massage therapist, acupuncture, hot springs, yoga classes Theyre going into Walgreens to buy medicine They no longer think you are the solution to their problems

This is how you as a team can eliminate noshows #1 Every time the patient comes in for their visit The first part of your job is what? Whats at the top of the list when you go over the job description for the receptionist? Why? Why you even want to greet the UPS driver When they know you, they will tell other people about you But if you treat them like theyre insignificant they wont tell anyone about you Your job is to greet and not selectively

I dont care if someone walks in by mistake, you greet them Receptionist, your job is to greet everybody Your job is to create the tone of the entire facility That means the way the face looks, thats the way the rest of the body feels The way you greet your teammates will make them feel better The way you greet the owner will make them feel better How do you feel about that? To smile even when you dont feel like it Does anyone feel fake when theyre smiling?

Who likes being fake? Smiling when you dont feel like has nothing to do with being fake If he didnt try, would my 1 year old son ever walk? We call that failure to thrive Do you want to make more money? #3 to make money is to not fail to thrive When you dont feel like smiling, you try You try to make yourself feel better Because if you dont try, you are failing to thrive When you walk through that door

You are the most beautiful, confident person you know If you fail to thrive, you wont grow Make eye contact Say their name Smile, even if you dont feel like it #4 Give your full attention to that person that walks in Make sure you implement something that makes it easy for them to detect somebody walks in Nothing is more important than that persons sense of welcomeness into that facility #5 Now were going to the clinical staff

You have to tell that patient before they start treatment You have to give them their comparable sign measurements Whats a comparable sign for R should tendinitis? What I want you to do from now on is hand behind the shoulder This is too hard to measure improvement What is reliable is reaching behind the back Reach as high as you can See the difference Whats the difference?

Whats the deficit? Very reliable, every time they come in, do the same thing She actually needs therapy 6 inch difference Capsule on right shoulder is very limited What will that lead to? Arthritis Its going to lead to calcification of the tendon It can lead to neck problems She needs to address that

Im going to do a really quick pressure point release Little, medium, or a lot? One little quick treatment and you can improve She needs to hear that every time Her range improved that much in 2 minutes They need to hear improvement at ever treatment If they dont hear it, they wont value their treatments as much You have to get improvement every session Thats just the bottom line If theyre not getting better

Is it only the therapists fault? Its everybody the interacts with that patients 42% of the patients improvement comes from you, the receptionist #6 Teach them something new every session Something they didnt know before A new thing for home exercise A new thing for changing their environment Let her know she needs to buy a new bed For every $1,000 spent on a bed it will last 3 years before it is actually harmful for your body Most of you spend a third of your life in your bed

Im going to tell her its time for a new bed And Im going to tell her why Can you explain to somebody what I explained to her? You start creating resource pages Its the aides and assistants job Every time she comes in Im giving her another resource page for the shoulder Every time they come in, one page, theyre learning something new If you left it up to the therapist if wouldnt get done Its not the therapists job

Is it only the receptionist who makes eye contact? No, everyone should be doing it Do you feel any connection with the person on your left? Look at the person in the eye and not break the gaze until I say stop Look again Do not break the gaze Why are you looking away? When you look into someones eyes do you know why you look away? Theres only way to see a persons soul

When youre looking into someones eyes youre looking into their soul You know what that means? What does it mean and you cannot look into someones eyes and let them look into your soul You do not feel worthy You are still judging yourself by your past sins, mistakes, and failures And you dont believe yourself to feel worthy Do you want to improve your life? Do you want a better life Only way if you can get yourself to a place where your worthy to have it

You will not allow it subconsciously You will sabotage it How do you become worthy? Stop judging others Stop jumping down their throats Stop judging others by their worst sin, mistakes, and failures Stop holding anger Confront and communicate with them Give them an opportunity to be connected again Stop judging them by their worst sin, mistakes, and failures

Stop thinking in your head what an idiot Stop responding this way to others mistakes, sins, and failures You can look a person in the eye and never let go because you have worthiness in your soul Only then will youre life improve Only then will you grow Only then will you have happiness Performers are people like artists, athletes Thats why theyre successful People want to be like them What does it mean to perform?

You do what is expected of you even though you dont feel like it No one should know youre hungry, hung over, or that you have a headache Why should they not know? They come to you for healing power Because what % of their healing power comes from you? 42% Is this direction of healing correct? You cant let people know This is all about performance, integrity, and character

Its doing your job so you can be a person of character Its so you can grow Its so you can acquire the skill to make more money People think success just happens Completely untrue The reason why you never win is because you do it for everyone else Do it for yourself Thats performance Become a person of character

How many of the calls or walk-ins do you want to activate Its possible to have every single person that is interested to come in If you apply what were going to go over What is your current conversion/activation rate? Anyone who makes a step coming towards you Anyone who has shown interest How many were those? How many actually scheduled an appointment? Most of you dont know Tendency to block out of their mind those failures

Part of your job is to track every contact you make while youre at the clinic Why they called Outcome of it Name Time Submit this with all the other forms This is not about you making yourself look good to someone else We look at his log and were able to help you get better If youre not honest we cant help you improve and make more money

Start this immediately As soon as you get back You start this Activating all prospects Its within you control to make the outcome Why do most receptionist try to get people off the phone as quick as they can? Captains, its so important Your receptionist will fail if you are seeing over 50 patients a week You cannot expect the receptionist to invest 6 minutes into a prospective patient if you are seeing over 50 patients a week

It is too difficult when someone is standing there watching them on the phone You cant share it like its scripted You want to address their question Thats not readily available You have to know the words, not script the words You can even use your own words, but do not make it sound scripted I want you to own the definition of what your company is working for and what youre offering You have a great energy And you sound great

Do you feel like you want to get in right away? Doesnt require many questions to determine medical urgency I actually welcomed him Find out who they are Find out if theyve been there before You actually want to say welcome Dont pause too long Its a little awkward So whats wrong? How can I help? How did you hear about us?

What caused it? When did it start? Is your pain little bit, medium, or a lot? Youre trying to determine patient category Urgent Post-Operative You have to offer an appointment within 0-24 hours Urgent Impaired Medium to high pain 3/5 problems with sleep, stand, sit, bathroom, eating, walking, 3/5 basic functions impaired

Standard Patient Not in that much pain Always confirm did you want to get in right away? Find out Confirm it When they tell you about the mechanism of injury should you listen? How if that was you going through that injury, how would you feel? That is absolutely horrible that you had to go through that Its a skill

Youre not born with it Your ability to put yourself into someone elses shoe is not something that youre born with Its a skill you have to develop Let me see what I can do for you I will try to get you the best appointment for you On hold music Ive got great news I have an appointment available at this date and this time How do you intend to pay for you care? Do you happen to know what it is?

If you feel like whoa, say whoa Are you undergoing any financial hardship Just so you know, if you feel lie the financial cost are too burdensome we have some special program available Is it important to him to know that we offer these things Theres always somebody he know that needs to get some kind of care but they feel like they cant afford it Its just a good message to send Call that number and ask for you deductible and co-insurance Bring those two pieces of information in with you

Do not worry We can help make it affordable APPLE write this down Since it is your knees Make sure you wear shorts Nobody told me I needed to wear shorts or that I needed to get into a gown Do you still want to be evaluated today? We need to expose the knee in order to evaluate it Sent a note to the docs right away Refused to get into a gown

Offered several times to get into a gown Let the doctor know right away Patients really appreciate being told what to wear Most of our patients find it convenient to download paperwork Got to www. Fill it out at home So bring your checkbook, cash, or credit card Depending on the complexity of your condition Financial unknowing You cannot say it all depends

Financial ambiguity, thats why they wont show It will range anywhere from $40 to $90 per session But I also have some special programs available for those with high deductibles $499 programs, up to 8 visits, over 90 days They need to hear the $40 Because thats all people can afford They understand they are an exception to the $40 Insurance patients, only evaluate Should do a short treatment on those without insurance

You should not create pain in the evaluation You should not evoke pain in the evaluation Comparable signs isnt something you do with every patient when they walk in the door Its something you do before you apply treatment This guy is good If you want you can say our first visit is typically between $90 to $150 dollars And most patients get well within 6-8 visits If you say 6-8 they can calculate in their head The reason why I didnt write this down for you If you write it down yourself

Youll remember and apply it more readily You have to apply it I actually want you to remember it This is a good time to say If for any reason at all you feel like you need some help We have some special programs to help make it affordable Is this problem something significant that you want to take care of? How important is this to take of? If theyre too much trouble, dont try to hard sell them

If youre in a high income area You should make changes according to where youre at Typically $40-$90 is affordable You might want to increase it in high income areas Just so you know If you find you deductible or your costs to be too much We do have payment plans available They may have friends or family Even wealthy people, they will judge you for the quality of who you are by the way you handle

that activation call and how your advertising material and identity present themselves Every business should have business card and brochures that look very nice My business physical environment is not a personal extension of me You advertising materials have to be an extension of you Rich people care about the identity you present Theres never any options presented to them It catches their attention Heres a program for high deductible This is untapped gold mine

If you dont activate like this, they wont schedule with you We have a strict late policy If you are late, most likely we will have to reschedule Come in 20 minutes early If there are any issues with your insurance or paperwork We can take of it before your treatment begins Did you have any other questions? Youre all set Im going to go ahead and reserve this spot just for you

But if anything comes up please let me know within 24 hours in advance This gives us time to give it to someone else who needs it Make sure you say let me say what I can do for you When you come back say you have good news I have this available and this available Think about articulating your words more clearly Become a person who enunciates more Sometimes you can sounds little lazy I want the receptionist to start enunciating your words more

Lets do somebody who does not have insurance Lets do cash Lets do low income Cash, low income, LBP, standard profile What did she miss? Say words like: great David Those are good words that people like to hear Start using different words that people like to hear It will change how people respond to you You did it 2 or 3 times; you did it too much

Anyone who ever says they dont have insurance You want to come out and ask are you undergoing financial hardship Missed the second P of APPLE Make sure to bring check, cash, or credit card with you More you talk about finances on the phone more likely theyre going to come in prepared to pay If there any issues with their paperwork Come in early why? You might open up a slot Take them in earlier

Make sure theyre early What else did she miss? Typically sessions are $40 to $90 Your first session may be a little bit more You may want to give them a free screening You want to be able to use that wildcard We have a special free screening for you If you ever feel some apprehension from that appointment Offer a free screening to come in and find out whats wrong

You cant be someone you pull off the street, pay them minimum wage, and throw them into the front desk They need to be able to detect apprehension and make the appropriate offer A free screening is like a mini evaluation An evaluation is comprehensive Some of these insurance patients youre going to do a free screening and then later do the full evaluation Theyre not quite ready to come in and pay for a full evaluation Apply a small treatment And send a note to their doctor

Now you can do a full evaluation and charge the insurance Free screen form Patient and doctor still feel like youre taking care of them Once you get the authorization you can do a full evaluation There are some words Main thing you have to think about Words youre using or not using Dont worry, were going to make it affordable Whats wrong? How can we help?

Those are very healing words to people Those words work very well What are some of the things she did do well? End it with medical urgency Are you having any difficulties sleeping? Are you having any difficulties walking? It conveys a lot to a person in pain First you got to say whats wrong? How did it start? When did it start? Are you having difficulties with the basic functions?

If they cannot sleep, they cannot heal You cannot repair without sleep High deductible, not actually schedule, end with Ill think about it and call you back, standard patient with knee problem Suggestion: do comparable signs over the phone Additional level of phone screen What didnt she do? Say his name 3 times His condition wasnt trauma Its insidious onset Its part of your thinking of what to say

Youre going to be very conditioned to jump back into what youre used to saying Conjures up different emotions and feelings Whats wrong? How can I help? Totally different message Sounded like he was concerned about cost What could she have said? What should you do when they say that? Well, you know, we have a special right now, where you can come in to find out whats wrong, theres no strings attached At least try to ask them Reword it

Why would you want to come in? At least find out whats wrong The way I would like you to do it is We do have a free screening Would you like to come in for a free screening to at least find out whats wrong, there are no strings attached Why would I think about coming in for a free screening? To find out whats wrong I like that proposition People who are concerned about deductibles/costs

I want to change the words a little bit So at least you will know whats wrong The words you use are that critical You find out whats wrong You find the root cause of your problem Well let you find out whats wrong Why you are having the pain This is learning You have never done this You have never said these words Your ability to recall these words when somebody says Ill call you back

5% theyre going to actually call you back You do not want to let them off the phone without at least one offer Towards the end you started talking about how YOU can fix it Im not sure you are the solution I dont like you throwing it in there so we can start helping you get better Im not sure I want you yet Thats the whole reason why they call you back Thats the whole reason why they dont schedule I do like her voice

Her spirit is there I liked how she asked for the appointment Would you like to go ahead and schedule the appointment? She went into the financial hardship You have to ask for the appointment Call you with a mystery shopper Sometimes our recommendation is to fire the receptionist Put her on an intensive program Make sure she says this in every call Sometimes our recommendation is to let her go

She did not show any indication that shes capable of changing or wants to change Shes not capable of changing I think you can become somebody who Understand you can make or break your business Theyre judging the entire body by the face Its not fair I get judged by the color or my skin You have to understand that and get through it That person is judging the rest of your organization based on you What you say and what you do or dont do Turn to page 23

Talk about patient loyalty Who here are working with patients now Would you say you patients are satisfied? How do you feel about that? You feel good that they are satisfied? Is your husband satisfied? Do you want them to be satisfied? Or do you want something more? Is there a difference between them being satisfied and being loyal? Satisfied people are there because you are the best option at that moment

The instance something better comes along they are going to leave And youre wondering why theyre not going back to where they had therapy before Im here because I love I dont care about any other woman Im here to stand by your side They dont care about anyone else Do you have a loyal girlfriend? Do you have a loyal wife? How do you know shes loyal? Can someone act like theyre loyal and they cheat on you?

Do you believe hes loyal? Why? Did these words ever come out of his mouth I will never cheat on you Can someone say I will never cheat on you and then cheat on you We live a society where theres a 50% divorce rate What you may not know In all relationships 75% theres cheating right now In 3 out of 4 relationship theres cheating

We live in a society that doesnt know how to cultivate loyalty What do you do to earn loyalty Lot of things are given in life Like respect, admiration I will admire you until you lose it I will love you unconditionally until you ruin it Something are not given I will stand by you Im here because of you I love you I love this clinic

I love your front desk person I love your care I love your service Im not even open to looking They will actually go out and get other people because thats how great they think you are So how do you cultivate loyalty in your spouse, your boyfriend, your girlfriend? If you dont know how to do it there you wont know how to do it in the clinic Clearly defining expectations Without it your practice will not reach its true potential

#1 start thinking about your loyalty rate? How do you calculate your loyalty rate? Look at how many patients are actively scheduling Out of those people who are currently active How many of them physically brought you in another patient? If two of those patients brought in another patient then your loyalty rating is 2% Everyone one of you should shoot for 2 loyal patients by the end of the month Demonstrate their loyalty by bringing in another person

Next month you want 3 patients to demonstrate their loyalty After 12 months youre going to get to 12 patients demonstrating their loyalty You think its doable Receptionist its your job to keep track who brought them in and when they brought them in You submit that log at the end of each month All you need are 2 names on that sheet of paper Yes, the clinical staff have a part to play Do you want your family to be loyal to you? Do you want your friends to be loyal to you?

Necessary Ingredients The activation has to be done properly To translate this to your spouse Every time when you first see your spouse Make it a moment Stop what youre doing and acknowledge them What the hell is so important that you cant acknowledge the person you love? Acknowledge that person Just go straight to them and acknowledge them Do not give bad news Whats bad news to the patient?

Its when you the receptionist says Heres the form to fill out, by the way, you have a $1,000 deductible Whats that mean? Well, youre going to have to pay today Well how much? The whole amount Thats horrible news A lot of patients think Those out of network patients that you never say anything about You let them come in

Then you break them the bad news then They get upset you didnt tell them before Arent you and my doctor teammates? Patients have no clue what goes on in health care How do you translate that into your relationship? Dont give you wife bad news Do whatever you can to not give them bad news Dont hide things from them Third, you have to collect patient portions at the time of service

They have to owe later anyways If you do everything correctly If 8 weeks after discharge they get an unexpected bill for $400 to $800 They hate you The loyalty is gone They can pay $15, $20, $30 at the time of service What they cant pay is $800 bill 8 weeks after discharge There are some words that you should use during the activation What are some?

Thats horrible! Whats wrong? How can we help? Welcome Your options are People like to hear that they have options People dont like take it or leave it Dont break the law poster You should send these to doctors Every doctors office want this Its a good gift

9 different reasons why collecting at the time of service is beneficial Tell me 4? No large bill Patients get better faster Send them a refund check later Good cash flow Less likely to sue you later Less likely to be accused of malpractice Those people who sue have a common denominator They owed the doctor money

When they dont pay it ends up putting a grey cloud over their head It prevents them from sleeping at night They have a less quality life and you put it there You got to do whatever you can they pay How do you feel when you pay off the debt? Give them the opportunity to get that relief Dont think your being nice Brushing the fee under the rug Youre doing a big disservice to them How do you translate that into your spouse? For me, I just personally think

If you have an issue, you do it right then and there As soon as you can pull him aside Guys dont like being made a fool I public That bothered me Dont give him the silent treatment Dont wake up doing all kinds of weird stuff Guys cant read your minds We dont know whats going on Just confront us Give us the opportunity to make it right to you

Youll have a lot less clouds over you relationship You must send the message of flexibility You must send the message that you dont say no You must send the message that you are the person who will try to make it happen You might have that intent But you never send the message because you never say it Just so you know If the cost of these services get a little too high We have programs to make it affordable

Receptionist you should make them know They might know somebody who cant get services How do you translate this into your spouse? If your wife asks you to go salsa dancing lessons Dont go like who me? Dont be so damn inflexible The fastest way to lose loyalty is to show no care or concern that interests the other person Send the message youll do whatever it takes to get their needs met Have to have rules

Have to have policies Have to clearly define your expectations Receptionist what are some of your rules? Call before they cancel $10 fee if they are late Co-pays are due upon arrival Will people fail? Will people forget their wallets? Why should you expect it? Rules and policies are not meant to justify punishment

But rather, create opportunities to demonstrate, to exercise compassion and forgiveness You should hope patients come in 20 minutes past their appointment You should hope that patients forget their wallets Because when they do Is there any way you can see me? Great news! At the very next hour we have a cancellation Hold on 10 minutes, were going to get you in Dont worry, Im going to waive it this time, because I like you

That act of forgiveness is the cornerstone to loyalty Its easy to cheat on somebody who loves you Its easy to cheat on somebody who does everything they can to make you happy Its hard to cheat on somebody who has forgiven you much Its important to say these are my rules Dont do this Do not do this Do this Make sure you have those signs up in your office so your patients know

24 advanced notice is required No shows are bad You lose money when somebody no-shows The chances of them coming back and getting back on the schedule Less than 60% chance theyre going to continue to be part of your system Thresh hold for no-shows is 3% If they go above that They get a memo from me that says STOP IT They know what I mean Do you still want to be treated today?

Well, no problem, fill this and let me see what I can do for you As theyre filling it out they will see the extension fee Dont worry about that Ill waive it today You dont have to pay Being forgiven is a magical thing Were not forgiving much in our lives, in our society You cant make patients sore on their examinations Do not provoke more pain

If youre the kind of person who evokes pain at the examination You have better use the patients role form You cannot make patients sore If you make a patient sore they will not come back Who believes in tough love? Who believes you should inflict some pain to experience true happiness? To this group of people in healthcare People who care are in healthcare For us, we need to send out less pain And send out less criticism

Send out less criticalness Send out less touch love We need to be more compassionate We need to be more soft We need to be complimentary Be more acknowledging of feeling Be more soft #1 thing is forgiveness You have to forgive Let patients feel that magical feeling of forgiveness

I hope you actually practice this in your personal lives first Then youll be better at it in the clinic Call them and talk to them Just be yourself By the end of that conversation Let them know youre sorry for being so judgmental Forgive them and also forgive yourself This is how the receptionist develops loyalty Step by Step how the receptionist can demonstrate loyalty Ask them, hows therapy going?

Wonderful, you guys are great Then you say, can you do us a favor? If you know anyone suffering from any of these ailments, problems, or injuries, give them this program, brochure, or voucher Anyone who is physically brought in by another patient is a VIP Actually 5 x more likely to listen to you 2x more likely to spend more money with you 4x more likely to bring in another person They are the types of patients you want They can come in any time without brining someone in, but they wont get the discount

They come in with them on their next appointment How to get patients better real fast 2 minutes treatments and theyre feeling great If they come in with them, youre going to waive that fee Otherwise its $49 Loyalty is not where they say oh you guys are great Loyalty is not word of mouth Loyalty is not someone who makes you a pie Thats a patient being nice and generous Your husband can be generous to you

You husband can do all these things and cheat on you Those things are not loyalty Dont be fooled into thinking A patient has to demonstrate their loyalty by bringing in another patient This is how you translate what I just said into your relationship He was asked Are you loyal to your wife? This man is a man of faith And he says, absolutely

In this day where so many men are not, how do we believe you? Well, my wife has shown me much compassion and forgiveness and as a result Im never alone with any other woman Youll never find me alone with any other woman Even the best will fall, no matter who you are How does the therapist cultivate loyal patients? Therapists, what can you do? What part do you play? Or are you going to sit there and say receptionist, do your thing Comparable signs

These are the things you do like the receptionist will smile How do you get that patient to bring in another patient Ask them to, when? Got to determine their critical visit When you determine their critical visit This is the patients progress These are the number of visits At what number of visits do you discharge? When do you actually discharge a patient? Put yourself in the mind of the patient

You come in for you first visit How do you feel? How do you feel at second visit? How do you feel at third visit? How do you feel about your visit by the 4th visit? How do you feel about your therapist by the 12th visit? I wonder why am I coming? Do they like my co-pay Why am I still coming? They are not spending as much time? They start questioning your motives

I know why you dont discharge them slower If that slot goes empty I have to go marketing This is what you do you guys You determine the critical discharge visit You determine which visit that patient is going to love you Typically its between 4 to 6 visits On that visit, you bring the patient back to your room So hows your therapy going? You guys are fantastic Are you ready to start managing this on your own at home?

Yeah, I think Im ready Ok lets have you come in one more time Why, is my insurance not paying? Why are you trying to get rid of me? Im doing great, but I still cant do this Well, how many more visits do you think youll need? How would you like to use them? You got it They love you Can you do us a favor? This is what I did at my second practice

This is what I did to get people to bring in other people Dont underestimate the power of duplication Now you say, do you know anyone suffering from these injuries, ailments, or problems? Who? You want them to actually think of a specific person Theyll think of that person Can you do me a favor? Every one of them will say absolutely They love you

Give them the voucher and say bring them in with you, well waive the fee Come in on their own and get his special discount promotion Theyre going to ask you that Do you have some more? This is one of the greatest skills you can acquire as a therapist The only thing I use to judgment How many patients bring you in another patient Are they loyal? Do they bring in someone else? This is what I want you to say verbatim

Bruce, hows your therapy going? Were doing a pretty good job? Do you feel like youre ready to manage this on your own at home? What is it you would like to do? How many more visits would you like? How you like to use these visits? You got it You need to sound like youre the authority Send them a quick memo to the doctor Sign it and fax it back

Doctors dont care so long as the patient is getting better Doctors dont care so long as youre updating them You have to do it the way you feel comfortable There are times where Im sitting in my chair looking down The relationship is where I am the authority I like to gauge that to who Im talking to This is just a limited time special promotion Most are going to be thankful that they can extend something of benefit to somebody else

Its pretty easy to get that authorization if the patient is making good progress but they havent reached that functional goal yet Theyre not paying for the visits Theyre paying for the results Dont just assume theyre going to pay out of pocket Your benefits are running Give them the option Youll be surprised You should be communicating these kinds of status notes How do you feel about IndeFax?

Do you get your status notes signed and faxed back? If youre not using IndeFax, youre probably not growing Reports in the templated way they want to see it with the information they want to see For the cost you cant get a better return on investment If youre not advertising to physicians and attorneys, youre missing out Im not going to leave my office That was my main way that I promoted my services via fax Doctors offices check their fax 20 times a day

3% may ask you to stop faxing They like interacting with you via fax If youre not sending a joke of the day or joke of the week Make them laugh They like it It works Do you want your business to grow? You have to use the tools to make your business grow Hows therapy going? Are you ready to start managing this on your own at home?

Revisit this page Read you notes on what to say Doing something you never done before Really expands your skills Clinical Support Assistants and aides How do they get patients to bring in other patients? Develop a very good rapport with patient Involved in clinical treatments as well Biggest thing they can do to develop rapport

Teaching them something new every time they come in Disseminating information When they have that rapport and they go up to the patient You circle the visit you think thats the critical D/C visit Once you miss it It drops off very quickly You got to catch that Have ready prepared some resource material about that particular ailment Hey on the next visit

I just pulled some information your cousin might want or need Have you aides say heres a voucher If you bring them in well take a look at them and we wont charge them that discounted fee How to get your employees to get loyalty from your patients Thats what were talking about How to get the employees to get loyal patients in How employees can get patients to come in Critical Discharge Visit The visit at which the PATIENT is most primed to bring in another patient

Have to work as one body, one organization If the receptionist is not doing their part and every month youre not having patients bring in another patient, youre not going to succeed Your captain is going to have to go out and market door to door Things youre going to do to get past patients to come in Get to the point where you dont have to market anymore You have to be an authority in that position There is no such thing as a manager who takes care of everything Anything that has to deal with scheduling has to go through me

Captains you have to train your staff and let them be the authority Its hurting your body of you doing the wrong job, the $40/hr job When you the captain are doing the therapists job You dont listen to him, the new PT He cant tell you what you can do Staff therapist, sorry for the interruption Patient is 11 minutes behind Need the receptionist to kick some ass Bring in patients from other patients Hold one another accountable

Everyone should be kicking everyone in the ass if youre not doing your job Make these available in your clinic Let anybody be able to write up anybody No one is exempt from being written up except the captain You cant write me up You havent earned that right You have to understand Im the hand The heart cant tell the head what to do The head tell everyone else what to do You are going to want me to do my job and do it effectively

You cant tell me how to do my job My job is to bring the business in and train you how to do yours How would you approach a team mate and say whats going on? Hey I need to write you up Poor attitude They got a chip on their shoulder Poor performance Theres whats called a complaint and then theres communication Thats communication and problem solving Oh, Im hungry, period

Oh, I have a headache, does anyone have an aspirin? Thats problem solving Thats communication Your facility officer will come to you and say we got a leak in the roof So why are you complaining to me? Thats like I have a headache Theres a leak in the roof I have 2 plumbers You have two options Their prices

Learn how to question your staff Every time they come to you for something Question your staff I want you to ask a question Not tell me what to do This is not common sense If someone comes and says hes really adamant about coming in today What do you think you should do? Get you people thinking Stop giving them the answer Stop telling them what to do

Do you want you receptionist to take authority up front Why? Then youll be just like me You wont have to step foot in your facility and it will continue to grow without you Everyone in that facility loves working in that facility Theres no one looking over their shoulder When they go to work, its their office It a group of peers, working together, achieving thing together Implement all the materials and tools

Three people who can actually cultivate loyalty Therapist, receptionist, clinical aides What does the receptionist say to get a patient to bring in another patient? Ask how therapy is going? Never ask hows it going I love you guys Thats the only time you can ask can you do me a favor Do you mind doing us a favor If you say it at the right time they are going to say absolutely Do you know of anyone suffering

Well, then bring them with you I do not want to many words This is a voucher If you bring them in with you well actually waive the fee They can get an idea of how they can get better with our services and care They can still bring this in at the $49 discounted promotion price You should not have said yes I prefer if you bring them with you on one of your appointments That way we know theyre VIP

Its enough for a person to say yeah thats true Its enough for that person to make an arrangement to have someone come in with them If you dont have something that looks nice, that has your map, that looks professional It doesnt exist Things spoken doesnt exist Its tangible Its a real thing Give them the voucher They will treat it as real They will think of somebody and bring them in

You have to use a fee slip Why? You cant collect at the time of service without it If they get a large bill after discharge it ruins everything Unlawful Sign Important policy sign that says copays are due at arrival They dont mind paying if theyre made aware ahead of time Payment Plan Posters Not going to think about bringing them with them

Make them aware Posters that say you have payment plans Policies and rules on back of express registration form Preparing for them to break those rules so that you can exercise compassion and forgiveness You cant have loyalty without forgiveness You cant have loyalty with your spouse until you forgive Theres no sin that you cant forgive at least once Dream with a deadline Get them implemented by a date

Empower them with the right tools Its another little thing that reminds them they are going to something today Have a brochure with a list of all the ailments you treat Top 10 Reasons Why WE are Your Best Choice Lastly Definition of loyalty Regarding a patient, physically brining in another patient Circle of Loyalty Your role is to empower

Greatest commodity in health care today is information Make sure you are disseminating it Your job to get materials for your facility Train your people how to use the tools Train your people how to treat the patients Train your people how to get loyalty Activation person asks whats wrong no matter what the caller is calling for Whats wrong, how can I help? Go over payment option and solutions You need to be the one talking to them about payment options

You reserve appointments You inform and prepare them for physical therapy The receptionist, they embody forgiveness Never deliver bad news Controlling the flow Have to control the flow Thats why they have to kick people in the ass The receptionist has to be the kind of person to knock on the door and say get your ass to the next patient Your patient is waiting, GO!

I love this, because she did it to me, shes doing it to everyone else Have to use the fee slip Theyre firm but theyre compassionate They collect everything from that patient Go after them like a freaking hawk and make them pay You dont want grey clouds over their heads One day they will show up in your clinic again Always getting resource materials together Produce great resource pages Show every patient something new each visit

Therapist, you embody progress Better show, demonstrate, document, patient is always getting better Every single session Patient has to know exactly how much progress Better do comparable sign every visit Know how to detect, handle, and execute critical discharge Internet phone from phonepeople.com Internet fax from myfax.com You belief systems have to be set up What is therapy?

The belief system is: does everybody contribute to that? YES Everyone contributes Everyone is holding everyone accountable Consumers vs. patient Thats another belief system You have to teach them something new each and every visit Have to acknowledge them as a consumer each and every visit Provide them with everything they want and need The one body approach

What do you believe therapy is? Make sure patients are always clear of what is expected of them If you believe it, you do it with friends If you have it in your personal life, youll have it in the workplace

Clinical Excellence Las Vegas 2011 What does Michelangelo do? He creates beautiful pieces of art that we can appreciate and cherish What is the kind of PT you do? #1 Using revolutionary Treatments No longer use ice, heat, US The future of therapy are not those things Shadow physicians to see and hear what patients say Most therapist dont ask it that way Is your pain same, better, worse?

So are you feeling better? Its a very guiding question A woman got raped on a train station and no one did anything about it How could this be? How could something like this be happening in front of people and no one did anything? No one stood up and told them what to do You have to tell people what to do in order for them to do it You have to actually say CALL Now in order to get people to do it Physical therapy is not something that you have done to you

Physical therapy is something yo participat in, you engage in, you take control over You have a role to play This is what your supposed to do If you dont do this you will undo all the revolutionary techniques Things that go to the root of the problem Things that heal forever Things that gets the patient to take control of their program Most practices dont do it Thats why its revolutionary Most practices dont do it

They just want to fill up empty slots Just using passive modalities to milk the insurance companies What age are we in? Information age People are now considered as consumers Its the baby boomers that are dictating that is being delivered to them This is what we want That is what driving production and consumption Theyre more informed Theyre more demanding

What are they more demanding of? #1 They want affordability/value They want convenience There was a time I never dreamed Id call 30 minutes therapy The days of 3x4 wk is gone Im believing that 3x a week for 4 weeks is overutilization You cant force the body to heal that fast You cant make it heal that fast ACL 3x a week for 36 weeks, thats overutilization You cant force the body

Become a practice thats exciting Thats doing revolutionary treatments Thats essential what youre doing To decrease pain Increase healing Unlock the healing power from within your own body At a remarkably significant fast rate Bonus is: everyone loves it You can be a facility where everyone loves it Stop being a facility that does heat, ice, and stim

What is clinical excellence? If you want it you have to know what it is What is it? Youve got to really define it If you want to have a successful practice, define it When do you want it by? You got to define it What is clinical excellence? Do you want it? We all start businesses without knowing how to get paid

What is clinical excellence to you? I want you to get away from clinical excellence I realize a lot of PTs how all these things work, the politics How the PT board with their function and their mission is, and their authority is And how you as a PT is actually affected and dont even know it by these dynamics in politics The PTs board function is not to be your friend or be your advocate Its not their job Their function is to keep the community safe In conjunction with consumer affair and to regulate you

Their job is to find as many PTs thats hurtful to the public and that they correct their behavior The PT board has been working harder and harder that their budget should not be cut or theyre going to lose their job Now theyre going after the small guy too I was very upset when I found out their function and objectives I always thought the PT board was our assistive support agency Theyre my opponent were going to play the NCAA tournament APTA has very little authority in anything They cant help you

Theyre job isnt to help you when you get in trouble What is their job? During those 8 years did I ever get a correspondence from APTA? No If youre not a member they dont care about you The APTA is not a governing body They just help their member try to interpret the laws They have no authority If you think you can go to the APTA for help, youre mistaken Theres really no place to go

Clinical excellence You have to stop thinking when the therapists gets OCS certification and evidence based practice Those people are the ones who are opening up practices and failing in todays day and getting so upset at the industry and blaming you who are being successful and choosing to be the representatives, the hired guns for the PT boards and Medicare to prosecute you Medicare is hiring PTs to spy Get away from thinking Theyre actually getting religious about it They think our industry has gone to pot How could I fail?

I have all these initials And I do treatments that are so evidence based Its not about going in and fixing things Its not about how well you fix things Also because of foreign therapists doing things for cheaper That is going to help fix our industry Clinical excellence is understand the rules under which you are playing These are regulations they have approved Theyre older They all have had practices that they have sold or closed

Its a specific profile They couldnt make it work Theyre blaming you Instead of themselves and their inability to adapt They dont use the fee slips They dont use the 59 modifiers They dont discharge on the 4th or 5th visit They blame you What date do you see there? Look at the billing sheet What date do you see?

Do you see any treatment that was done on Oct. 16th? Isnt billing fraud when you charge for services and procedure that were not done Then how is that not billing fraud Clerical error If you want to accuse this practice of billing fraud based on this evidence then you have to prosecute every practice in the country They did not try to bill for the 17th I dont see an intent to try to get reimbursed for services not getting done One time is not intent Religious fanaticism

Im going to show you what clinical excellence is You have to bullet proof To sleep at night you got to be bullet proof Clinical excellence is: 3 parts to clinical excellence #1 Patients physically brining you in another patient I cant tell you how many therapists think they are good You could be the bomb and have a failing practice Clinical excellence is required for a business to succeed

#2 Your documentation is bullet proof from insurance companies, Medicare, RAC, PT boards, consumer affairs #3 Your staff love the environment Thats clinical excellence That make sense? Exam Process How to bullet proof your documentation How to apply fast acting techniques How to streamline documentation Willing and wanting to do it is not enough Do one thing at a time

Be patient The mountain will be moved Can you be great with your hands, yet the patient doesnt get better? Patient doesnt like the front desk Theyre not going to heal 42% of their healing is not going to come Youre only working with your 58% How else does it happen? Financial ambiguity If the patient doesnt do what theyre supposed to do at home and on their own

Its not what you say or do but how you make them feel that matters most The power of the words you use Some of you have never used the word like revolutionary You never used the words great news When you start using those words your life will change The quickest to change you is to start using different words Its not going to church and praying Start using words like I love you Will you please forgive me

Words youre not used to saying Youre sweet Thats horrible When someone is sharing something traumatic Youre using words that you never used It all starts here Do you want another patient to bring in another patient after the initial exam? You can get a loyal patient on the first visit Whens the best time to bring in another patient?

Is it possible for your activation specialist to be so good that that new patients brings somebody in with them on their first appointment Is it possible? Yes I just want to introduce to you the possibility Having a patient brining in a new patient Thats duplication By the third visit if they dont bring in a new patient they cant be a patient Its a requirement he has I just want you to know the possibilities You can do it on the exam How did you session go?

The receptionist asks this of the patient Thats the goal of the exam Get every patient to say I feel like Im already getting better regardless of whether you did a treatment or not 1st step of profiling Typical evaluation You do a subjective Then you do an objective testing Then you formulate an assessment Then you do a plan which will indicate youre going to do heat, stim, US, and exercises Thats what you learn in school

So you also do the SOAP in your treatments That is going to get you into trouble in court Because thats all fluff Thats going to get you in trouble when the insurance company says I want money back Make sure youre doing things correctly If youre part of the 50% that get audited you are safe If a disgruntled employee faxes a chart behind your back If a student doesnt like how youre doing things and send the PT board documents A disgruntled employee or PT intern

#1 First thing you do is profile #2 Create a hypothesis based on that profile #3 Do an assessment to confirm the hypothesis #4 Then establish baseline data Only after youve confirmed your hypothesis Only then will you create baseline data Your comparable signs will be drawn from your baseline data That baseline data has to be very important Your comparable signs is important in court to prove medical necessity Comparable sign is like gold to you

Most dont every do it Youre vulnerable Youre not increasing the perceived value It comes from comparable baseline data #5 Now you educate Why do you educate? Not the kind of education that you think You cant pull the model off the shelf and educate The greatest commodity today is information You think youre trying to motivate this person by educating them

Theyre just staring at you Inside theyre thinking Im going to die Can you write that down for me? Who told you you need an MRI? Why am I learning from my therapist Im going to lose feeling in my legs? This doctor has two options #1 Call you and chew you out Are you a doctor? Do you like seeing my patients? Stop playing doctor Most doctors dont do that

They stop referring 6 months before you realize theyve stopped referring Cant educate like that Dont overeducate them and scare them 78% go to internet when theyre scared They dont say WHO told you you need an MRI Not WHAT told you you need an MRI #1 reason why theyll start working with another PT, they dont like the notes Too much jargon they dont understand #2 that PT played doctor

Told patient something that was contradictory to the doctor That referral you got from the doctor that said low back pain After they realize they have a disc protrusion Stupid doctor Low back pain, idiot Theres a reason why they put low back pain Doctors are very smart Whos going to actually going to get this referral They dont want this patients No saddle symtpoms

They know this patient is a conservative management patient No reason for this patient to know they even have a disc issue They know its a very appropriate candidate for you as a PT Thats why they put LBP What would the patient have done if they put down disc The patient would demand and MRI It will kill your business if you over educate You are preserving medical network dynamics You cant piss off the doctors or other medical personnel that you are part of

You should tell every employee Never bad mouth a referral source, physician, or patient because if it were not for them we would have no business Does that make sense? Do not overeducate! Define roles This is my role as the therapist This is what you do Patients has to know what theyre part is This is what you have to do or else this is going to fail

Will that program fail if the patient doesnt know what to do? How many hours in a week? 168 hours What 3/168 = 1.5% If thats all the time they put in towards getting better are they going to get better? Dont be foolish The patient has to do things at work, at home, while in bed, while theyre playing with children, while having sex, Define the roles Rehab potential?

Excellent rehab potential in my experience Quickly they get better 42 y/o housewife When did it start? ? Drawing up on past experiences Multiple areas Multiple diagnosis Not very specific Over amplify Dont respond to therapy very well What you just did was profile

You heart, mind, and body is already intuitively understanding this person Your intuition is the most reliable tool Once you meet this person they will deceived you They will lead you astray People like this are very good at manipulating and drawing you in It has nothing to do with you Racking your brains Intuitively knew based off the pre-exam Limiting factors are obesity, chronic things, diabetes, and heart disease. WRONG

Forget what you learned in school Are you going to help me or not! Im going to help him Window of opportunity has closed 5 years post stroke How are you going to pay? Ill treat you for 20 visits What are you going to give me? I dont know Your wife cleans 1x week 52 times I dont believe in charity

Everyone has value You gave me a rehab potential based on motivating factors, not on limiting factors His motivation is high 42 y/o housewife, you know she doesnt have motivation Her motivation is not as readily available for you to tap into I can tap into her motivation Mrs. Jones come here I have her sit up on the treatment table Im sitting below her Mrs. Jones, whats wrong?

My neck hurts I know, but really tell me, I look into her soul, I hold that gaze You have to probe a couple of times Whats going on? All of a sudden Flood gates of tears What can I do to help? Lets just focus one problem Then well move on to your shoulder Lets just take it one step at a time How to motivate them

Guide them to a place where things are manageable Demonstrating what she needs to do Take one problem at a time Im actually managing something Im actually taking control Greatest skill you can have is getting into a patients motivation How do I motivate this patient? If you can tap into their motivation center they will do everything you say They will try like the dickens to succeed Profiling for motivation level

Determining the rehab potential of motivational levels Throw away what you learned in school It doesnt work in the real world Medical necessity is based off of your objective findings and their functional losses, not their motivational levels This person doesnt appear motivated to make changes at home, work, etc. Physician has to know that this person is not motivated and heres why 42 y/o male, back pain, mechanic, meds I dont see a lot of motivation here See a lot of detail = motivation

See blanks and question marks or exaggeration in pain levels Motivation to get better is really limited This is what I want you to do I want to make sure you dont life anything off the floor Why do you say that? Well, can you maybe have someone else do it? Well, can you have someone else help you do it? If youre ever holding something in your hands dont twist. Maybe you can take work off for 2 weeks

In the doctors office Feels good, after therapy comes right back Seems very motivated What they hell is wrong with therapy They think youre benign Not very good Patients shows up at docs on time Therapys the problem Theyre not very good Doctor is going to send you far less patients Not capable of modifying work activities

Not able to avoid lifting 30lbs off the floor Unable to follow my treatment plan Unable to move from basic phases of rehab Rehab phases Controlling destructive forces Apply appropriate forces to stimulate healing Impose challenging forces To create strength Restore maximal functional forces To improve quality of life Those are the phases of rehab

I will see that they are doing A and I in the clinic Their treatment plans are all over the place Too aggressive before the patients ready Should be in the restoring maximal functional forces Still doing prayer stretches Prayer stretches are like applying appropriate forces Thats profiling To do examination efficiently you will need these forms Evaluation forms Fee slip is always on top only on new charts

Left side is flow sheet Why? Exercise log on the right side Always on top Nothing else goes above these two Not even the fee slip copies are on top If office manager says its easier for us to track how many visits are tracked Who should win? Admin staff or clinical staff? Clinical staff always win Want to save time for the $40 and $50 people

Therapist should not have to rummage through stuff to find what they need Everything else is admin stuff Admin stuff I always on the left side underneath the flow sheet Therapist is seeing fewer patients because they dont feel like they have the time or energy to see more because of the paperwork being disorganized Right side is all clinical stuff E page eval form 1st page of the eval form Pre-exam form Second page

Third page For outpatient ortho this is a good eval form Why? If you actually use this form youre going to be able to prove medical necessity much easier Minimally meet all the requirements Most of you have charts the wouldnt meet all the minimal requirements You could be charges with document charges Chart Recovery Sometimes you got to sleep with the devil to win the war You forget to pull them out during audits

Patient role sheet Directly underneath patient log sheet In order to maximize recovery Work together with rehab team to reach your goals They may sometime see somebody else If they dont know that they might see someone else they will get upset You got to tell them to do it What should they do? Let us know if ther are any things getting in the way of their recovery Dont lift anything more than 30lbs off the floor

Dont twist while holding anything in your hands Dont sit on the bed and sit straight up What do you think is better? Have the patient fill it out Give them a pen and clipboard Two part NCR Give them a copy One goes in chart What should you not do if you have a lateral dis protrusion Dont sit for more than 20 minutes Tell them exactly what they need to do

Dont run on uneven surfaces Can run of smooth, flat surfaces Dont drive more than 20 minutes without taking a 60 second break All your body needs is 60 seconds to recuperate from sitting Dont hold your breath while youre exerting when going to the bathroom Go likethen. What do people do on a daily basis? Work, play, sex This is for the next two weeks Do not have sex for 2 weeks

Its hard to get into the position for sex with a left L4,5 disc protrusion Dont hold breath during orgasm Dont sleep on an old mattress When do they blow a disc? The way they put on shoes Do not put on shoes, even when you are sitting Get a shoe horn Do not put on shoes that you normally put on shoes Dont bend over to pick up or pet your dog or cat Dont get sick

Sneezing blows disc Dont sneeze If you dont tell them things, they dont know Dont tell them this blows the disc Your condition may worsen if you dont do these things Dont dust or clean your room, kitchen, or bathroom Looking at the patient roles Take frequent breaks form sitting They should head before they do anything strenuous

Ice at the end of every night for 20 minutes before they go to bed Should do one or maybe two exercises at the most Pull their belly button in when theyre standing in line or sitting in their car Without holding their breath Do as frequently as possible Goal #1 What is it that you want to be able to do that you cant do right now? Put in quotes stating that this this what the patients wants Put in a long term goal and short term goal

Its is common to experience soreness We may have to provoked some pain If it doesnt return to normal within a few days please let us know If there is something that you redundantly do change it Thats how youre going to determine your critical discharge Whats patient code? Every patient that walks in the door you can categorize as a 4 How can I actually split and categorize everyone that walks in the door 22 y/o ankle sprain, why are they simple

Theyre not going to need a lot of one on one Thats what we mean by simple Thats one of those patients that you have a chance to catch up on other stuff Comprehensive is 40 minutes fact to face Post CVAs, complex patients, post-op patients with issues You got to do what you go to do Thats the realities of business Got to go where the money is Intermediate is 20 minutes face to face Limited is 10 minutes face to face

Brief is hi and bye, 5 minutes Is it important to categorize each person? Can you put 3 brief patients with you and an aide? Why is it good to have 3 briefs together? They actually like talking What do you typically do? You know if this is an easy patient or a comprehensive Your software doesnt allow you to do that To double book That brief patient

I dont like that that brief patient is having difficulty finding an appointment thats convenient for them This is an easy patient For the money, this person is really easy Wouldnt you like to put his name into the appointment and any slot is open What happens if the brief category patient finds it difficult to find a convenient appointment? Easy for them to fall through the cracks The comprehensives are the ones you want to fall through the cracks Requires so much work for the money You want to allow them to have freedom

Theres no one looking over my shoulder As long as patients are bringing in another patients My no-show rates are down Timeliness marks are good Money coming in is good New patients coming in is good I could care less what theyre doing Your comprehensive patients Youre scheduling 12 visits out where no one else can get those slots Everyone is treated equally

Give your time appropriately across the board Theres not software that allows you to do what Im talking about How does it allow you to do that? Every slot is given a value of 4 points Everyone is given a default value of 3 points That seems to be the default value What do we change to their point value when theyre a stroke? A 4 No one can ever double book What if theyre a brief patient? You go in there and change it to a one

But one you get to 30 a week You want to change You cant use a book after 30 visits a week It will cause a lot of problems for you The only system available today that allows you to do all this very simply All they do is pull a patient name and they know what slots are available Theres always a PT-assistant team or PT-aide team If you dont change anything theyre default level 3 Each slot has a value of 4

It increases your productivity by 40% You staff dont feel like theyre over burdened Theres a PT orders form MD request form if you want anything for the patient and you want a 3rd party to pay for, you need to fill this out and send it to the doc You should over communicate if youre going to err on the side of communication

You should do some classes Rather than trying to work with each on separately Have them come to a class

Disabilities recommendation form NCR form thats half page Do it all at one shot Can you give me a note for PE class? No running Professional way to fill requests from patients Its important for efficiency and increasing perceived value IndeFax is the best way to do it all If youre not using IndeFax youre wasting a lot of time and money What is this persons disability status?

This is a form that you would use to do a FCE You can charge $300 for one of these evals You can also do pre-employment screenings Theyre starting to invest in pre-screening employees that are going to cost them less money in workers comp PTs do those You can actually offer that as a program of service to your local medium and large size companies at a rate than what their physicians office You going to be a very innovative practice Youre going to rule your region How long should I spend in the exam?

Typical outpatient ortho = 45 minutes One every 45 minutes Do the paperwork and evaluate the patients Thats the standard today The way we do it is half days There are 2 or 3 half days a week that is only new patient slots I will only see new patents that parts of the day Everything else is treatment slots I get into a groove This is much more efficient for me We just group new evals

You dont need an aide Versus the other way, always need an aide I dont like open scheduling Open scheduling is horrible You just got to create slots that are for evals The rest are treatment slots That same duration is when I jump on IndeFax If you dont find time to jump on IndeFax to send a quick report Dont fax your entire eval They want you to give them a brief narrative text, one page only

Theyre going to be there for an 1hr and 15 minutes Im literally face to face for 10 minutes I look at their pre-exam form I go in Look at it Did you get an x-ray Did they find anything? Dont see too much swelling Can you stand up for me Can you put some weight through that Does it hurt?

Check ROM Check ATFL Little medium or a lot more sore Im done If later I find out hes got a knee issue I dont want to find If I find out he has a knee issue Were all anal I will actually want to look at the knee One thing at a time Thats how you move mountains Now youre going to do another eval

This patients may have a potential meniscal tear Now you have two body part, two diagnosis, two patients in one If they have maximum, youre going to eat up the maximums quickly Youre going got reach that cap very fast You can have two patients in one You might spend an hour with Mrs. Jones, sweating when you come out and you get paid for one eval Next time you come in well evaluate your back You should get paid for both Its a different body part

50 modifier which says its bilateral Thats why youre doubling the units Only for the ones where you did both If you bill two 97140s it looks like over utilization Its only for Medicare where theres a time based coding For other insurance companies there are none of those rules Thats why you tell your patient his is related to your work injury Thats their policy to deny When you deny the appeal the squeaky wheel gets greased

Worker comp lien it These are the rules to see our patients 50 modifier states that it was bilateral If youre going to add something special you need to add the 22 modifier Which is more appropriate is the 50 modifier The 50 gets paid more readily than the 59 or 22 Bilaterally gets paid more readily Helps you communicate that you did bilaterally Determining frequency and duration Stopin doing 3x a week for 4 weeks

Youre are going to be more easily accused for over utilization Stretch them out Patients appreciate them more Patients dont have to change their life to come to therapy Go back to the patient role sheet Do you give 3 exercises? No One or two at the most How many times should they do that? Do not say 3x Have them do things that they can actually accomplish

Have them do it 2x a day Twice is the most you should ask them to do it When they fail they dont feel like theyre healing How many icd-9 codes should you determine? 2 treatment diagnosis for every body part Should you communicate with their physician even if theyre paying cash? Yes Do you remember before IndeFax what you did? Before you dial what you got to do? Look for the number While its faxing what are you doing?

Theres got to be a better way Whats the difference? All you do it sign in All its going to do is ask you choose your recipient You can have groups You pick a doctor Dont email it They dont want it emailed No cover sheet They dont like you wasting their paper or toner Put like PT status note

Put in patients name Spell everything out I have like a cheat sheet for reevaluation for audit purposes Makes the doctor to want to send you more patients Its not meant for an audit Doctors want to know how theyre doing in therapy Always understate how that person is doing I never put 0/10 pain If someone is sitting in front of me Any pain?

If they say no, no, no, no Im like Im going to find some pain Heres 5# dumbbell do it 20 times At the 8th rep with 5# dumb bell patient had pain It feels better after therapy But it comes back On the report says 0/10 pain You look foolish They dont even know where their patients at Compliance with appointments and home exercises Wont modify work activities

Existing impairments Lumbar flexion 60% restricted due to pain They want to know strength They want to know function Difficulty sleeping Wakes up every 4 hour due to pain Then your recommendations Discharge with a home and care program because patient is unable to control he destructive forces that are causing the pain therefore we are unable to elevate to the next level of rehabilitation The treatments that we did

Hit confirmation Look at you report Hit send report now And youre done In less than 2 minutes, thats all doctors want Search past reports Search a patients name or diagnosis Hit enter Its going to pull all the reports with that name on it Edit options and choose a different doctor Every fax you ever sent you can recall it

Search for it Dont have to back it up Backed up 3x deep We just charge you for the space and the fax cost $24/month Cheaper than a fax line Which typically takes up $80 to $100/month You can actually attach a flier and fax it to everybody Without tying up the phone lines It auto saves and auto logs off

Doctors will like you less if you send a cover page I want to see you succeed If you fail, then I fail also So thats how I want you to know that IndeFax Control destructive forces that healing can begin Dos and donts Posterior lateral disc is getting too much excessive forces Disc continuum Normal disc Pathologic disc

Describe me the name of the state right before the disc becomes pathologic A pathological disc is a sequestered disc What is a sequestered disc The disc is actually broken in pieces Right before a sequestered disc what do you have? You have severe DDD Halfway between DDD and normal what do you have Moderate DDD Halfway between the moderate and normal you have mild DDD

Lot of us therapists do not understand Critically important to actually understand this process Give me a one or two word adjective to describe a normal disc The actual characteristics of that disc Describe to me what it feel like if you were to touch it Gristle like Its the support structure of the entire body Describe to me a moderate DDD disc Use a one or two word adjective Mushy Disc

It begin getting mushy of the way from mild to severe begins to get very soft and mushy Thats when you begin to get HNP Disc is so soft You get circumferential tearing It bulges and extrudes After it extrudes it become severe DDD Those two segments are very unstable Is a nerve like rubber band or rope Its like rope It has no pliability

That nerve is literally like bouncing off the bone The nerve starts sending hyper-excitatory transmission to those structures? that is innervates Those structures that L5 S1 innervates What happens to those structures? Micro-excitatory transmission causes what? Contractions Chronic state of contraction Theres no blood getting in there Youre getting accumulated cellular waste products

Because those cellular waste products are staying there you start getting toxic Thats what a pressure point release does to the psoas Thats what the psoas does It feels light Severe DDD Youve lost all structural integrity the segments are floppy Your body starts going through a spontaneous restabilization What does that mean? Your body is always trying to protect what?

If you start irritating a nerve too much Its starts depositing calcium Thats why the end plates start to grow Your body is trying to stabilize Were going to try to put calcium there Youre muscle are not doing it Your muscles are not doing it You literally start fusing This is between severe and pathologic disc Once your body completes the spontaneous stabilization you fallen off the cliff We cant help you anymore

During the spontaneous stabilization phase how is the pain level? Its gone Starting to get stenosis because of the spontaneous stabilization The spinal cord has less foramina Because of the deposits in the face joint Nothing eases their pain but traction Then what you do, Fusion A normal disc to a mild disc Who has mild DDD? Does a 12 y/o have mild DDD? No

How about a16 y/o mild DDD? No Mild DDD is tenderizing of the meat A 16 y/o cannot get a mush disc You got to literally beat the disc You get some of these older persons Lets say a 62 y/o Can they have a disc protrusion? Most likely what do they have? Most likely they arthritis They been going through a spontaneous stabilization

When there really really active that pain come on What do they have? They have instability Once their muscle gets too tired Thats why they have to give them what drug? Flexeril or Soma They might have a disc protrusion that develop when they play too much and it starts infringing on the nural roamina The reason why you dont like it is because you dont understand it Everything else is related to it

Stop this instability Cant sit too much Now they can do what? Prpayer stretches Pelvis tiling Things to bring circulation to the area Now youre really stimulating rapid healing Now you start imposing challenging forces to make sure collagen is being laid down properly High tensile strength when laid down properly

Will collagen lay down in an organize matrix without appropriate forces? No Will it easily restrain or reinjure? Yes Imposing maximal forces Plyometrics where theyre accelerating and decelerating Have them do exercises with cables pulling and pushing at the same time sport specific movements Do all 4 of these overlap? Yes Do not let C overlap with the R Do not let C and R touch Flow sheet

I think theres going to be a video online under training Theres a video that will explain to you how the flow sheet works Use sequence You should be sequencing your treatments If you ever change your sequence You have a second column to put a line through it Now as of that date you are not following that sequence You should only change your treatment plan once in 6 weeks Your being foolish

Youre not giving your treatment time Trust your instincts The original treatment plan you originally designed Dont e so quick to change things I want to know exactly where I want to know for what purpose Therapeutic exercises for what? Are you trying to impose challenging forces for what function? Are you trying to impose maximal forces for what function? Joint mobilization for what joint?

Write this in here Youre giving quantifiable information Dos and donts cover controlling destructive forces You got modalities here This is an old flow sheet We actually dont use modalities any more We only have elective services Up here we have manual therapy, therapeutic procedures, More things you can do for cash = elective service Write down here subjective

Pain levels Sleep disturbed 4/5 nights weeks Put some kind of subjective that youre goin to track Pain in the right knee 7/10 Every visit what is the pain at the time of appointment Comparable sign 1 Comparable sign 2 Objective comparable measurement Look at the very end where the actual mobs are Its the last packet

Thoracic spine Aps Comparable sign for thoracic Lumbar mobs comparable signs Online videos that will show you what that actually is as a comparable sign I dont like to do comparable signs fro C/S Left posterior quadrant I dont like to do ROM too much for C/S Not very reliable Hand behind the head Hand behind the back I dont like to check ROM

I just want to be sure they can wash their hair Shoulder pressure point release Audit proofing Bullet proofing I guarantee you this documentation system will make you bullet proof You have to use a functional sign thats function related At what percentage of movement does he have pain? At 40% he has pain His squatting ability is impaired by 60%

You go to show progress every visit on these comparable signs These insurance companies can see functional measurement related to life or work CDN see daily note Patient had sex last night, husband came back from Iraq last night There is nowhere do you write tolerated treatment well There is no where do you write continue You have your subjective right here Their assessment is inherent in not having met their goals yet

Each one of these have exercise that we commonly do Description of it Repetition of it Who was there when they did it 4 sets of 10 and initial of person there when they did exercise For Medicare you actually put in the time The number of minutes STM is that a time based code Is it a one on one based code? Yes Is it a constant attendance code? Yes

If you can justify it you can do it The amount of time you put in to do that code All time based codes are according to the CPT unless otherwise noted Are for the duration as the CPT unless otherwise noted Meaning if you put two and you dont put 2x 10 minutes 2x means 2x 15 minutes Time durations are per CPT Does that make sense? Current procedural terminologies Then you can do what youre doing

Or you can write them in yourselves Shoulder Pressure Point Release Every pressure point Cross friction for 2 minutes Also determine the most sore area Put sustained pressure on the most thickened area for 1 minute as they lengthen the muscle Do a 15 second quick stretch You have regular trainings You can bill for that You can train aides to do that What does that indicate

HBB posterior capsule tightness Teres minor/infraspinatus Does overhead stuff Thats why he has some of that Rest his arm on your knee Like hes prone Medium, little, or a lot Cross friction up and down Stimulate some vasodilation Irritating it a little bit will increase blood flow Release some toxins

Stimulate blood flow As I hold it there Kind of move it toward my calf Have him lengthen it a little bit while I hold it there Do you have any more pain under my thumb? Now I do a quick stretch Youre not doing aggressive Shake your arm out Its hard to show you the infraspinatus Its very easy to find the infraspinatus Reach behind your back

Up, up, up, Same, but he could have gone up a little bit more To tell the patients when they first come You are at a 3 inch deficit Now they can do it Supraspinatus pressure point release Support it Go into that V, that fossa You can do it in that position to How do you do a quick stretch of the infraspinatus?

HBB elbow on my stomach, keep this shoulder down, do in this way, hug em Now youre only 1 inch deficit They can feel they can do it better Was that movement same, easier, or harder Quick stretch 15 seconds Subscapular PPR Have to have them supine Hard to hit in sitting You can hit it from this position How do you quick stretch the subscapularis? ER with flexion

Affects more hand behind the head Something you should do for frozen shoulder? Yes Subscapularis I do supine Hawaii is where we like to launch everything Its going to be audit proof Upgrading to 2nd version within 30 days Express registration form HIPPA form I dont put it on the website They sign it when they come in Pre-exam form AOB form

Not everyone is Medicare So I dont put it on the website I cant go to the bathroom and I cant clean myself How impaired it is That is what Im tracking under the flow sheet Critical discharge visit What is it? Discharge Criteria At which visit do you start to think about discharging 1st visit not doing too well

The reason why? How does the patient feel about the therapist here? Theyre like wow, this therapist is great Wow Ive come a long way I havent seen much change in the last 3 or 4 visits are they trying to milk my insurance I cant believe how much better I am, you guys are great You think youre ready to manage this at home Great, lets go and schedule one more visit and go over you home program If its getting worse, come back

If it doesnt get better, come back You mind doing me favor? Do you know anyone suffering from an injury? Give him a voucher I will waive that $49 fee He can come in on his later and pay that $49 fee Its regularly $150 value I want it to be from you They want to do something back for you Remember the girl who got raped if you dont ask or tell a patient to do something they wont do it

This is important policy to have is you get scrutinized If their subjective is 2/10 or less Primary objective impairment is 80% or better If their primary functional impairment is 80% or better Independent with home care and exercises Have to meet ALL criteria If you continue to see these patients and they meet all these criteria You may get charged to over utilization And you may get elevated to billing fraud

Ask for the policy that you are going to make your employees sign Do not let anyone access, outside of your organization I am not aware of any authorization to allow anyone on these premises I am required to have authorization from the owner due to HIPPA privacy laws They might actually scream in your face I hearing horror stories out there They may threaten your employees Call 911 I have a disturbance here at my place of business They wont come when you are there

It will never happen when you are there They know exactly who you are You have to train your employees They will stake out your facility They know when you are not there You will have to train your employees They must refuse to answer any questions unless they are represented by legal counsel You have to train your employees You will not go to court If you let them in beforehand

Then they will actually take the charts that they want Theyll get the one where they know they can incriminate you If your staff answers questions without your legal counsel They will pick out what will incriminate you Therapistsadvocacygroup.com We want to draw media attention to this Use this stuff Biggest charge against a PT