• Why Your Practice is Losing Money w/ Dr Lyn Dteffes

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    Joe: Hello everyone, welcome. This is Doctor Joe Simon from the private practice business academy. On our call today we have Doctor Lynn Steffes, who is the owner of Steffes associates and consulting. Lynn was gracious enough to get on the phone with us today and talk to us about her journey as a physical therapist, as an entrepreneur. Lynn, good morning.

    Lynn: Good morning, Joe. Thanks for having me.

    Joe: It’s great having you, Lynn. Let’s introduce you to the audience and let them know a little bit about yourself and what you do.

    Lynn: Okay. I’m a physical therapist. Graduated in 1981 from Northwestern University, and then practiced for about 16 years in a private practice setting where I was initially functioning as a pediatric clinician, and then within about two about two and a half years had a leadership and management role where I opened some private practice outpatient clinics, pediatric and adult managed hospital contracts, school contracts, just did a variety of things
    I did that for 16 years, and then the entrepreneur got the better of me and I decided to break away. At that time I believed that I was going to be a pool therapist. Within about 30 days folks that I had networked with in the PT community started calling me and saying, “Jeez, I hear you are not working full time. How would you like to do a project for me?”
    That was really the genesis of my consulting business. When I was actually in a private practice I did a variety of things in a variety of settings, so that gave me a fairly rich experience, and I also was able to network with wonderful colleagues, and a lot of them gave my opportunities to work within their businesses. So I have been doing that for a long time, went back and got my doctorate, it will be three years ago through [inaudible 4:46], their executive management program. So that’s my background.

    Joe: Great stuff. A couple of things strike me. You have obviously been doing this a long time. You have seen a lot of changes take place. We have a lot of new grads that are coming onboard. They are looking at jumping right into the entrepreneur set up immediately. What kind of advice would you give them? Would you expect to,say, get a day job first or work in a hospital or work at a private practice first, or do you think they should just start right away and get out there and try it? What are your thoughts on that?

    Lynn: I’m sure that everyone is different, and their readiness for entrepreneurship is different. I do know that some folks who come from families that have their own businesses and have kind of an entrepreneurial environment feel more comfortable jumping in quicker.
    Typically my advise for those folks that come to me, and I actually teach at [Five] university, so I work a lot with students and new professionals. When they say to me they are interested in private practice, my primary advice for them is to get a job in a very good, high quality private practice, and be transparent about your interest in developing management skills.
    Look for a practice that is looking to develop someone to actually either partner with, or profit share with, or that they would enable you to spin off. There are a lot of practices out there, and when you are in that practice get your hands dirty. Jump in. Volunteer to do more than just the clinical work, because I believe that that really gives you the best insight into what entrepreneurship is.
    There are advantages to being in hospitals and large systems or corporations. One is that some of those have very formal leadership training and management training, and there are larger committees you can get engaged or involved in. Another advantage would be to network with physicians in the practice, but I still think that the people who do the best right out of the gate are those folks that worked in great private practices and learned what it’s like to be an owner and a front line person who cares about the whole product line, who isn’t just managing a portion, just managing patient care or just managing a portion, but actually managing everything.
    So I think that can be pretty important.

    Joe: That’s great advice, Lynn. It’s very true. A lot of students that have come into my clinics in the past, you can see right off the bat the tones that want to really get their hands dirty and the ones that are just here for, you know, to pass their affiliation or pass their clinical and just get a day job.
    It’s very important to see that, and it’s great advise. I wasn’t sure if a lot of universities and colleges were advising the students to do something more on the business aspect. Obviously when I was in college we didn’t get the business training at all. I think it’s changing slowly. I’m hearing a little bit different. Not much, but I’m hearing a little bit of a change with the college programs and university programs, and what they are doing with the doctoral programs.
    So that’s good. The networking that you brought up, that’s something I want to stress. Who did you network with, and who did you think helped you progress as an entrepreneur?

    Lynn: I’m just naturally a networker. It wasn’t intentional right away. I will say that. I believe that as soon as I was in a facility I began networking immediately with administration, with other staff, other professionals in the facility, so I think a lot of times people think networking with other PTs, which I think is just as important, if not more so.
    But I want to say that no matter what setting you’re in, your intentional networking with other folks is really important. So even though I started in a private practice and I was a contracted therapist into a school district for full time, and then I worked some evenings and weekends in a private practice clinic. Even though I was a school based therapist I already started going to physician appointments with some of the kiddos and families, and began networking with physicians and PAs and their extenders.
    I began calling when I had questions. I considered myself, I think from day one, and I think some of it is just personal, but I believe that Northwestern University is my alma mater. When I went to school there we were actually based in the rehab institute of Chicago, RIC, so we were surrounded consistently by patients and families, physicians, nurses, OMPs, all kinds of individuals, and I found that to be really helpful.
    I do believe that networking across discipline is important. So I will say that first because naturally I believe that working with other therapists, getting involved in the professional association locally, nationally, going to meetings, all of those things really made a difference, and then I think another thing that I did that was a little bit unique is, I became an advocate for children with special needs and started working a lot with the parents on the payment side.
    That networking has actually led a lot of my career along, because there are so few PTAs that have integrated into the payment system, as ugly as it can be, such tat you can have a conversation, help people solve problems, etc., so I think networking, going to events, participating, I have done virtual networking, participating in a virtual summit, working across discipline and then within our profession, all of those things create a rich opportunity. They really launch you as an entrepreneur.
    Now whether or not you want to be a consultant or own a practice or whatever, all of that is important.

    Joe: Got it. I’m going to bring up what’s almost a touchy subject. Lately on LinkedIn I have been watching a couple of comments about the APTA come up. Obviously there are a lot of PTs that feel the APTA is not doing enough, and then there are some that strongly support the APTA.
    Years ago when I was a therapist, when I was working for somebody else, and this is my own opinion, I had to pay the fees, which were pretty high. It was probably one paycheck for me at the time. It was one paycheck to pay the yearly fee, the membership fee, and you do it right after college because as soon as you graduate everyone, you know, the first thing you do is join the APTA.
    You join up and you’re, like, “Wow, the fees are expensive.” But then the first year goes by and you see, well, what did I get for that? That’s the question that I get from a lot of students that come in. They ask my opinion on it and I always say, “You pay for what you get and you have to take advantage of it.”
    If there’s something there take full advantage of it, and at the time I did not take advantage of it. But lately the conversations have been coming up that the APTA is not helping as much. It’s a struggle. It’s almost a 60/40 or almost a 50/50 struggle between PTs. If you ask anyone it’s a different day, different story.
    What are your thoughts on the APTA and where they are going with private practices? This is only for private practice. I’m not talking about APTA in general. It’s mostly towards private practice and reimbursement and where the next year will take us.

    Lynn: Good question. I agree with you. It’s contentious, and people are on different sides with it. I guess I have always been a person that believed if you didn’t like something you have to be a part of the change, so I have been involved with the private practice section. I was on the board of directors, served a three year term, came off last November and am still involved.
    I can tell you that the job is large. It just kills me when a practice says, “Well, APTA is supposed to market us.” There is a level of marketing and PR going on, although it could always be more. But I believe what the private practice section has been trying to do is to create tools to empower practices to market promote themselves, work with pairs, and I think if you watch the media and you follow health care reform and Obama care, whatever side of the aisle that you live on, you know that the problems are incredibly complex. No matter how right you are on an issue, ti doesn’t’ mean that you get your way.
    I can tell you that from an insider’s view, without the APTA and PPS working on our behalf, things would be worse. Now, does that make it any more comforting that things aren’t better? Definitely not.
    A lot of payment is local. Medicare, and some of the challenges with Medicare that have occurred, have occurred largely because outpatient Medicare part B has grown at a level that outpaces the growth of the Medicare population. It has grown at a level where we are way on the target. They are looking at us and saying, “How can you be growing this fast?”
    We are of course making the argument that it’s a good thing we’re growing this fast, as opposed to surgery, or as opposed to inpatient admissions or whatever. So maybe PT is becoming a logical solution. But we have to demonstrate our value, and I have to say that we don’t always do that. Because I work in the payment area I have a position in Wisconsin where I am the payment specialist. I spend a fair amount of time in both private practices and hospitals, and I will tell you a couple of things.
    Number one, most therapists do an amazing job and they are very committed. They love their patients, they are dedicated, they make a difference. They are busy, committed people. But a lot of them don’t do a good job of capturing that information in the way they document and the way they bill, and unfortunately that is all that parents see from us. They don’t come and watch us.
    I would love for them, for PT month to be a month of blue cross blue shield sitting in our office, or whatever. But I believe that we have to continue to do a good job on our own, and I also unfortunately see a level of over utilization and things that I think border abuse that put us in a position where we get policed at a higher level by Medicare, Medicaid, third party payers.
    I think it’s a mixed bag of tricks. I definitely believe very strongly that we should be contributing to the profession. There are a lot of people working on behalf of the profession. When I was on the board of directors I estimated that I put in somewhere between 10 and 15 hours a week purely as a volunteer, in addition to writing checks, working for the profession.
    Now, the whole profession benefits. So I guess the argument could be made that you could sit out and just watch, or you could complain or carp about the fact that we aren’t getting everything done that we wanted. But the bottom line is that jumping in and participating and contributing, whether it’s time or money, that’s how we’re going to make a difference.
    The APTA and PPS aren’t perfect. There are other organizations that have risen that can fill some voids of that. There are certain things that a professional organization can’t do on behalf of practices. We can’t do anything that would be considered price fixing.
    So there are other organizations that are important as well, but I do believe that participating is essentially to being a true professional. We are a doctoring profession.
    So I have pretty strong feelings about that, but I also respect that some people feel they can’t spend the money, they don’t have the time. I can tell you right now that I work 40 to 50 hours a week, consistently and more often. I raised a family. I took care of elderly parents, and I still managed to find a check at least annually for the pack, and also spend some time working on something that I think is of incredible value, and that’s on our profession.

    Joe: Absolutely.

    Lynn: I don’t think any profession has been able to secure the kind of payments that they want. I think physicians would tell you the same. I think everyone is struggling.

    Joe: Absolutely. I agree with you on that. It’s across the board from every scoop of practice that I have consulted with. The arguments have always been the same.
    It’s funny, I have worked with many physical therapists in the last couple of years. It was the same arguments, and I did the exact same thing you said. If you’re not part of the solution, you’re part of the problem.
    So I would tell people, “Stop complaining. Let’s figure out a way to solve these problems.”
    As I stretched out to the other professions I found out they are doing the same thing. They complain as well. So I said, “Hey listen. It’s all the same. It doesn’t make a difference.”
    Obviously that growth, that’s a great thing. The growth of PT has become the logical solution, which is amazing, as we see as more and more people are obviously learning about PT. I think the biggest argument you get from private practice owners is an issue that they do not know how to market their practice correctly, and they rely on the APTA to do it, and the APTA marketing nationally will not help your local practice.
    That’s what you try to explain to a lot of practice owners when I consult with them. A national campaign is just like building a brand. It’s not going to build your office right off the bat. That doesn’t have the exact connection to your exact niche, your exact office, so good point there.
    You also brought something up about documentation. Now, with all of the EMR companies that are popping up, documentation, you know, in some of the offices that I partner with, I see the issue with the therapists.
    All the therapists, we all say the same thing. Every therapist that works for me or works for you, they are great therapists. But the biggest problem that we see is their notes at the end of the day, or their notes is they get tired, pretty much suck. It gives the insurance company every right in the world to deny that note.
    Is there any EMR company that you support and that you say, “Hey, they are doing a great job.” Do you see a solution for basic note taking, or getting that point across to the insurance company?

    Lynn: Wow. Loaded question.

    Joe: It always is.

    Lynn: First of all, I’m going to say what I always say, which I think is the crux of all of this. Physical therapists believe, and I often hear them say, and I’m sure you have heard this as well, Joe, “We just want to treat patients.”

    Joe: Absolutely.

    Lynn: “We don’t want to have to do paperwork.” But the bottom line is that if you just wanted to treat patients you should have become a physical therapist assistant. That’s what technicians do. Technicians apply their trade, and a physical therapist’s assistant doesn’t have to apply clinical decision making. They don’t have to research and decide on what ICD 9 and eventually ICD10 codes are going to be.
    They don’t have to determine how to communicate with a physician on complex diagnostics to alter a diagnosis that is not appropriate. If you just wanted to treat patients you should have become a physical therapist assistant.
    That’s probably not a popular thing to say, but that’s what I believe. I believe that as doctors of physical therapy, we are health care practitioners. We don’t just treat patients, we manage patients, and in managing patients we have to take responsibility for end to end. That means that we have to market and communicate to the community and referral sources, and individuals who would benefit from the value of APTA.
    We have to deliver customer service. We have to do excellent differential diagnoses and capture that component of what we do in our documentation, because that is the place where I believe there is a huge gap.
    I had an ah-ha moment this fall. You know I have been working on marketing PT for years, first at a practice level and then as a marketing consultant. This is primarily what I do. I have worked with practices in 40 states, do a lot of training on marketing and customer service, teach marketing in a number of programs, including doctoral programs, and I believe that we all have good ideas. You do marketing stuff too, Joe, and you do a great job of capturing great information.
    I think that what we haven’t done a good job of, and I had this ah-ha moment in September, is actually teaching people that we are diagnosticians. Every fall one of the things I do with my DPT 6 class at Marquette University in Milwaukee, is I have them survey five non PTA folks in their lives. So it can be people in the university, but I also ask them to survey either relatives or friends that are not at Marquette.
    One of the five questions that I asked is, “Can you go directly to a physical therapist for care if you hurt yourself, or if you have an injury?” It surpasses me. In Wisconsin we have had direct access forever, and we have lots of payers that pay for direct access, but it surpasses me that a lot of people say, “I think you can. However, wouldn’t you want to go to the doctor first to find out what’s wrong?” Or, “I think you can, but only if the doctor has already determined what’s wrong.”
    I believe that we have built a marketing campaign where people know what PT is. There’s no way PT would have grown, outpatient physical therapy would have grown at the level that it has, which is tremendous, without some marketing and branding presence in the greater community.
    Not just the medical immunity, but the community at large. But I believe the reason that direct access, and us as the practitioner of choice, continues to lag, is we haven’t done a good job of marketing our diagnostics ability.
    We haven’t done it with payers, either, because some of our evaluations just look like a checklist that a personal trainer could do at a club. There’s no synthesis. There’s no solid clinical reasoning demonstrated in the assessment portion and the recommendations. It just looks like I said, like a personal trainer does at a health club who assesses you to develop a program.
    Some of the programs just look like a personal training log. We get ourselves into trouble with that. I don’t mean to be a naysayer, because I think PTs are super smart. I think so often we are the ones that uncover the real problem, not just shoulder pain, but that this particular shoulders has a rotator cuff strain, weakness in the serratus, problems with scapular humor rhythm. We are much more detailed in what’s going on bio-mechanically, but I think we’re selling that and I think that’s a challenge.

    Joe: Great point, Lynn. You brought up something amazing you just said. Years ago there was someone that said that if you went out into the streets and you asked 100 people what physical therapy was, only four of them would have a real concrete answer of what actual physical therapy was and what you were dealing with.
    Once I heard that stat, and this was a long time ago, and this is my own clinic, this is something I did for my own private practices back then, I stopped advertising for physical therapy and started advertising towards the pain of whatever that pain may be, if it was back pain, shoulder pain, and that worked so well for me. I still see it to this day. I see practices that will just say physical therapy. It’s tough.
    It’s exactly what you said. Wisconsin had direct access probably way longer than New York and new Jersey has. I think we have only had it for four or five years, and I might be off on this, but maybe five years in New York. But I remember that shift was pretty tough for people to grasp it. It’s amazing to hear a state that has had it for so long, and people still didn’t really know that they could see the PT first.
    This is something that we could help the audience with right now. What would you say to help PTs out there right now, someone starting their own practice, just starting out, what would be a great marketing campaign to start off with?
    I basically threw an example out there. I would target the pain of the community, whatever that pain may be, if it’s a back pain for pregnant women, if it’s shoulder pain for tennis players or golfers. What do you think could be a marketing campaign that would help get someone through the froth door?

    Lynn: It’s a loaded question because I don’t think it’s the same everywhere, and you said something that was really important, which is addressing the community. In terms of working on a marketing plan, I will say a couple of things.
    One is that with healthcare, and in particular physical therapy, it’s a competitive business these days. A lot of people think that PTs compete with PTs, but PTs compete with – actually, our biggest competition is pharmacy, right?

    Joe: Absolutely.

    Lynn: Absolutely. PTs compete with chiropractors, we compete with DOs, we compete with acupuncturists, personal trainers, athletic trainers, docs. There’s a lot of competition and there’s a lot of choices for consumers where they get their care. I guess the one thing I would say is that if you’re starting a private practice, so that’s an important part of your question, I would suggest that in this health care climate you niche your services. I believe that private practice right now is going to be charged by the ACO and the consolidation environment with hospitals and systems, and large physician practices in most markets. Therefore, I believe that small practices, which I would consider startups being, would do best to [inaudible 29:20] niche.
    So to go after target markets. For example, I have had clients of mine, I have open clinics very specifically working on female sports. They work on the female sports continuum. They are working with young female athletes, adolescents, women who are exercising and older women, and then they provide that continuum of care with that as a niche.
    They target women, which of course, when you do a great job with a female, especially a middle aged female in a family, they are going to come back to you and they are also going to refer their family members, friends, etc., because women are the health care purchasers in our society. So that’s a great target.
    I had a clinic open up that just did baseball and softball. That’s all they did. Very strong niche practice. Obviously someone who had a lot of skill and a lot of connections. I have also had other clinics open up in rural areas where they position themselves as a family practice clinic, just like a family practice doctor, and they really market for, your whole family can come for anything.
    I want to interject something, and I know it’s not part of your question, but I think it is important. That is that earlier when I said networking across disciplines, I have also have really tried to study across disciplines in health care which disciplines do a great job, and I would say that the dentists do an awesome job. They have established themselves as family practice in many ways.
    No, of course there are pediatric dentists that niche, and there are orthodontists that niche, or whatever. But they have established themselves as someone who you go to throughout your life. Most families, if one person goes to a dentist, the whole family goes to that dentist.
    Most dentists will schedule regular checkups. They do wellness. They do intervention. They do education. They consistently stay in touch with their patients through post cards, through follow ups. They have referral programs. Physical therapists should look more towards the dentists and their independent practice than they should look towards doctors, I believe.
    Niching, I think, looking at yourself as providing care over a lifespan, and having that relationship, is key.

    Joe: Lynn, as someone that has done a ton of marketing for dentists over the last four years, the big difference that I see, and this is something I brought up at a PT conference I just went to recently, when someone approached me to ask me for my services and the differences in professions that i work with, and I said the differences between professions isn’t reimbursement based. I said, “It’s because dentists will spend more money for their marketing.”
    They know that if they spend one dollar they will get two dollars back. I said, “They have understood that concept.”
    this is another reason why you see a lot of marketers in the dental space, but the dentists do a great job. Absolutely right. Dentists and chiropractors, actually, and I have learned a lot from chiropractors in the years past because they are another group that spends a lot of time with marketing, and they send a lot of time training their staff.
    To explain that to a lot of physical therapists who have relied on referrals from doctors for years, it has been a tough battle. That’s why I’m hoping this platform will open some eyes up and say, “Look at your local dentist. Look at what they do. It works so well. They have such a following.”
    That same patient will not leave that dentist and just jump to the next dentist, but their entire family goes to them. If PTs could grasp that concept, it works so very well. You’re absolutely right. The dental profession, they do a very good job marketing. They spend a lot of money on marketing, trust me. I have seen that across the board.

    Lynn: I don’t think it’s just money. I think it’s a consistent approach, and I think their expectations is that they do certain things within their practice with their current patients consistently, and I think that that is something that PTs don’t always get. I think we have spent a lot of time knocking on doctors’ doors.
    I’m not saying that, hey, I do referral stores. I onboard marketing folks all the time to do physician marketing. But I believe that there are things that, inherent in the way they run their practice, that they are sensitive to building their practice from the inside out.
    I don’t think it’s just throwing money at it. I think it’s a combination. I know you weren’t implying that, but I want to say that out loud.

    Joe: No, I wasn’t implying that. To a certain extent I was saying that when I spoke to a couple of physical therapists they said, “What would be the cost of this kind of a campaign?”
    I said, “Well, this is what it would cost anybody. This is what I spend on it.” They said, “Well, would you get that money back right away?”
    I tell them that if you’re looking at it from that perspective, that’s pretty tough to see. Look, I never went to dental school, so I couldn’t tell you if they get more training in this aspect when they are in university or when they are in dental school themselves. So I didn’t have that. But all of the dentists I have ever spoken to, they have always approached me and said, “Hey, look, I see a benefit of this service because it will help me garner more referrals.”
    Like you said, the PTs, a lot of places, have relied on the doctor referrals for a very long time. I see it changing now. I do see a big shift changing now, not only with the newer therapists, but practices that have been established for a long time are now paying more attention to their patients and asking patients for more referrals.
    It’s a big chance that I have actually seen in the last two years. A couple more questions. Obviously we touched on the documentation. We have touched on the changes that you have seen. What’s something that you see coming up?
    You did bring this up a little bit about the hospitals for practices to niche down. What’s something do you see in the next five years – not five years. Let’s say two years. Two years is easier to come up with. Something that you see in the next two years that will either be a big shift for the PT practice marketplace? Do you see a big win coming, or do you see it’s going to be a lot of hard work coming up for them?

    Lynn: Well, I’m glad you scaled it back to two years. My crystal ball has a hard time seeing much beyond that, at this point.

    Joe: I have a habit of saying five years, but realistically if somebody asked me five years I couldn’t tell you what’s going to happen by next week. I will even let you go for a year. The next year, I’m excited to see what’s going to happen for next year, and I say excited because I’m not a pessimist.
    I don’t want to say, “Oh, with Obama care.” Like you said, it doesn’t matter what side you sit on. You just have to figure out the solution. We know what’s going to happen in January, so no matter what happens there has to be a solution that you practice will have to take. So what excitement do you see coming up?

    Lynn: First of all I’m going to say that I believe one of the underlying definitions of being an entrepreneur is being willing to roll up your sleeves and work hard. That is a characteristic of most of our folks, of our target audience, Joe, whether they are PTs or other healthcare professionals who are in independent practice.
    I think they are used to rolling up their sleeves. I’m going to put that to bed and say that that goes without saying. But for physical therapists specifically, I think there are going to be emerging opportunities, and opportunities that we don’t necessarily naturally see ourselves in.
    Let me just discuss one of them. One of the opportunities that I see emerging for PT is, as of January 1st, and even now, with folks enrolling in greater numbers nationwide in Medicaid programs, with folks enrolling in the insurance exchanges, even with the stumblings that we have had with them, there are going to be an increasing number of people who have insurance.
    That population will have, in many cases, a stronger hard stop for therapy. So, for example, a lot of the exchanges have a 20 visit hard stop for PT. Sometimes a 20 visit hard stop for PT OT speech and combination. Medicare has its cap and threshold. Lots of insurance companies are going to be looking at scaling us back to more of a case rate, en episodic care, and that’s definitely what I’m hearing from the third party payers, who I feel like I’m talking to all the time.
    But I think our role, our emerging role if we step up to the plate, is going to be that of muscular skeletal primary care individual end case manager. So one of the models that’s emerging is the medical home, and the medical home is where a physician practice manages all the care for a particular patient.
    Let’s take, for example, a patient that might have, let’s say, arthritis. Say that person is in their 50s and they have arthritis, early arthritis, and they are going to that medical home. They are going on a regular basis to the physician in the current model for medication updates, for checkups, general health, etc. . But in my mind the PT, because these practices, a lot of them are going to be inundated with all these new insurers, and a lot of their new insurers will have pent up need. They haven’t been going for health care. They are not particularly healthily. They have chronic health conditions that haven’t been managed well.
    I think PTs will have a role to step up and be providing some of those visits. So if you see your doctor every three or six months, I think you might see the PT every other third visit just like a PA does now, to the opposite of that position, and then manage the care.
    So of course ask the patient about their medications, and report that back through whatever documentation or communication format to the doc, but then have a plan to manage that person to keep that person from needing the total joint replacements, to keep that person active so they don’t develop cardiovascular disease, etc. . So I think that PTs, I always say this and my daughter teases me – my daughter is 22, but I always say that we are the bomb. We are rockstars. We contribute incredible value to the health care system because we are good at patient education. We are good at teaching prevention, and we are good at the number one thing that keeps people healthy, and that’s keeping people active.
    No matter whatever their issues are. If you follow any of the AARP literature and you look a the silver book, which is a book at the aging boomers, which of course I happen to be a part of, you will see that by the time we reach 65 90% of us will have at least one chronic health condition. 50% will have five or more, so think about that. That starts a lot earlier than that 65th birthday.
    So there are a lot of things that we can do to keep people active. Almost every single diagnosis that currently costs the health care system money can be mitigated by exercise and activity. Yet as people get older they become inactive.
    Now, it’s not just because they have physical limitations. It can be motivational. Obviously, it’s lifestyle. But we have a chance to impact that, and I believe that the PTs that figure out how to step up and contribute value in that respect for that target population, we will carve ourselves a place in the health care world. Those people that just continue to function as technicians treating whatever, they will be okay too. We’re still needed across the board.
    But bottom line is those people that step up and figure out how to fill that value need are going to be in great shape.

    Joe: Lynn, you just gave away a golden nugget there, if anyone picked up on that. Anywhere between 50 to 65, this five or more chronic conditions, that is one hell is a niche, if anyone has picked that up, because (a) you’re not falling into the Medicare clients.
    They will have better paying insurances at that age because they have worked a job for awhile at that point, so that is a great niche if anyone out there wants to target it. Even the dentists that listen to this, or the acupuncturists, I think just targeting that age group, which, like you said, there’s a growing number of boomers in the marketplace right now and are willing to spend money to help them get better or feel better, that was a golden nugget. I hope everyone caught onto that. That was amazing.

    Lynn, let’s chat a little bit about your consulting firm, which you have been doing obviously for a long time. I have been looking at the LinkedIn page and I see eight years, 16 years, 20 years, so I’m just going to say it has been a long time Lynn has been doing this.
    Take me step by step. Walk me through this. If I was a practice and I come to you for help, take me step by step. How does it start? How do you work?

    Lynn: Okay. Well, first of all, thank you for carbon dating me.

    Joe: I’m sorry, Lynn.

    Lynn: That’s okay. I’m just kidding.
    The one thing that comes with being my vintage, which is the word I like using for age, is experience and a network of wonderful people. Really, I work with start up practices, but I also work with mature practices that are rebranding and trying to take their clinic in another direction, that are trying to market, that are trying to determine where their position is in their individual marketplace.
    So I actually apply a process that I call differential diagnosis for your practices. What I actually do is just a data analysis, a look back at your history, what your practice is about, getting information, look at your demographics. I work with people individually on developing marketing plans and training marketing staff, but training all of the staff. I am such a huge believers in marketing from the inside out.
    Joe, you referred to that earlier as a philosophy that you have in working with clients as well. I think that a lot of people think that the fancy brochure is the answer, and that is way down on the list. On the top of the list is creating a great internal culture, so looking at your culture.
    I do a combination of diagnostics that we do via email and phone calls and Skype and sometimes FaceTime. I generally do onsite, where I will come and view a practice, spend a couple of days there, do some training before I leave, and leave with pretty comprehensive recommendations, everything from your signage to the decor to your marketing materials, your social media presence, and then make recommendations about how to move forward.
    And also make a plan, because the one thing I recognize, and I’m sure you see this as well, is that most practices don’t have a ton of resources. They don’t have a ton of money, they don’t have a ton of time. So they need to incrementally evolve their practice into having a marketing mindset. So with that I try to work on different elements of their practice, prioritizing and developing that over time. I work a lot on the strategy end. I work a lot on training and internal mechanisms.
    That really is my approach. Like I said, I have been doing it for a long time. I am still having a ball. I love to see young, newer consultants coming out and doing their thing too, because I think we all have ideas to share, and our practice needs that. I just think we so need to work together to elevate the profession.
    All health care professions, we need to stay ahead of the fact that people are holding tight to their pocketbook right now. They are very nervous about spending any money they don’t have to. You know this and I do as well. Baby boomers actually have the most disposable income out of our population, so that’s why it’s a good target. But the bottom line is that we have to keep informing people about why they need to take care of themselves. I think the pharmacy industry has done a good job of that, and everybody else is kind of limping behind.
    That’s where I think – I love to be part of that. I would love to advocate for PT, whether it’s with PTs themselves, unfortunately. Whether it is in the insurance industry, legislative arena or marketing. I believe we just need to take darned good care of the people that are aging, because we can’t afford to take care of them on the backend, because they didn’t have proper care as they were getting to that point.
    That’s it.

    Joe: Lynn, great information there. Another reason why I had Lynn on the phone call was because when I looked at the information that you put out there, I said, “Lynn presents herself well. She has some great information, a lot of knowledge, but she’s also someone that’s in there trenches. She’s actually doing what she says she does.”
    I have worked with the companies that are just business owned companies that teach marketing, and they help a practice with marketing, and exactly what they did was they offered a fancy brochure. Once I learned it myself that this was absolutely the wrong thing to do, I couldn’t believe that.
    It’s exactly as you said. I look to work with a lot of marketing people from all types of industries, and it just helps getting ideas from different places. You take one thing from one place and apply it to you rabidness, and you will be shocked at how it works.
    Like you said, the pharmacy industry does an amazing job with it. Just taking one nugget from them and applying it to your practice, you will be surprised how patients will respond to that.
    For everyone listening, Lynn has so much more information and we’re running out of time today. But we will definitely get another call down the road again to see if people have questions, and maybe we will just answered those questions. We have covered so many topics today, and even I’m having a hard time saying which one I want to go to next. I know there’s a lot more, but we are also running out of time as well.
    Lynn, how can someone get in contact with you and your company if they want to secure your consulting services?

    Lynn: I have a website. It’s www.steffesandassociates.com, and “and” is spelled out. They can also email me at steffbiz, S-T-E-F-F-B-I-Z @gmail.com. Those are probably the best ways to get a hold of me.
    I do attend and speak at most of the national meetings, so I will be presenting at the private practice section meeting in [inaudible 50:02] November of 2013, and then at a combined sections meeting and Vegas in February of 2014. So I’m around.

    Joe: Lynn is around. That’s great. And as everyone knows, I will make sure your contact information appears on our resource page as well, so if they need that extra information out of Lynn’s contact, it will appear there as well.
    Lynn, once again, great information today. Great discussion. We definitely have to do this again. I appreciate your time and knowledge today. Thank you so much.

    Lynn: Thanks for the opportunity, Joe. And good luck to you as well.

    Joe: Thank you, and for everyone, have a great day. This is Doctor Joe Simon from the private practice business academy. I will talk to you soon.

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