Tag: physical therapy

What to know about the No Surprises Act and Good Faith Estimates. How to prepare for medical audits.

No Surprises Act, Good Faith Estimates, And How to Prepare for Audits

In a recent podcast episode, Breakthrough Founder Chad Madden, MSPT speaks with Mary Daulong, PT, CHC, CHP, President at Business & Clinical Management Services, Inc. (BCMS). Chad and Mary discuss what you need to know about the “No Surprises Act” and Good Faith Estimates. Mary and her team have worked hard on providing resources to help PT practice owners comply and thrive in the new regulatory landscape. 

Who is Mary Daulong?

Chad: Mary is the Queen of Compliance. She has more than four decades of private physical therapy practice experience. And I want to compliment and thank you for keeping us legal, compliant, and ethical.

Today, we’re talking about the “No Surprises Act,” which became effective as of January 1st, 2022. It’s being discussed in all of the online group forums at essentially every physical therapy or healthcare provider website that I’m on. There’s a lot of confusion about this new legislation amongst owners. Can you give us a summary of what it is?

Part 1 of No Surprises Act: Disclose Out-of-Network Charges at In-Network Care Facilities

Mary: Well, the “No Surprises Act” was a surprise, right? When it was first contemplated, it really was to protect patients from having “surprise” bills. Say they went to an in-network hospital for surgery, but there was an assistant surgeon or maybe an anesthesiologist there who wasn’t in-network. And as a result —surprise — the patient gets billed at out-of-network rates. That’s what part one of the “No Surprises Act” addresses, and I’m in favor of that. But it has kind of ballooned from there.

Part 2 of No Surprises Act: Application to Private Physical Therapy Practices

Mary: The idea in itself is good, but the dispute resolution system really doesn’t lean towards the provider. So if the patient complains about the bill in this process then you have arbitration, where someone decides what the fair amount is that the patient should pay. And that doesn’t always turn out to be favorable for the provider, as you might guess. Also, we have a lot of PTs who are out-of-network because they accept cash, and we don’t have any clarification about whether this will implicate them, but it could.

On “Good Faith Estimates”

Mary: This is the part where we’re all pulling our hair out and saying, you gotta be kidding me. Recently, I got a text from one of my dear clients that said, “I’m just going to sell my practice. I provide the services, I do the billing, I do all the administrative tasks. I can’t add this to my things to do.” And we’re hearing this all over. People are very frustrated. 

So, what does it mean? Basically, therapists have to tell patients who are uninsured—as well as those who are insured but choose to self-pay—what our best estimate is for how much the service is going to cost. And because we have repeat services, that makes it very, very complicated.

How to Make this Information Public

Mary: One thing we do know absolutely for sure is that we have to post a notice with all the information about good-faith estimates, timelines, and dispute resolutions. And that’s the easiest thing we have to do. The notice needs to be posted in your clinic in a prominent area, where a patient would be likely to see it. It needs to be posted in areas where you collect for services rendered or do billing. And it needs to be posted on your website. (CMS provides a standard form for good-faith estimates here and details on what should be included in the notice here.)

Chad: What exactly does the notice need to say? 

Mary: The notice is for people who are uninsured or who were not using their insurance—with the exception of federal payers. It basically says that we’re required to tell them what the services for episodic care are expected to cost. I’d suggest basing it on a plan-of-care period, because you might change things at that point. And you can certainly charge them less than that. But you have to tell them that if the estimate is exceeded by $400, they have a right to dispute it. And you have to tell them how to dispute it, and who to contact. So it’s a simple notice; that’s the most clear thing. What becomes unclear is it doesn’t apply to patients who have benefits with federal payouts.

So as healthcare providers, we have to post this notice in all our clinics. It should be in the waiting rooms with licenses or certificates of occupancy or something like that, in prominent display. If you’re an owner and you don’t have it, you can contact BCMS for a template. Medicare also has a template on its website. So you can go to cms.gov and they have a “No Surprises Act” webpage and their own template as well. Number one on everybody’s checklist is we have to get that done.

How to Train Your Staff on the No Surprises Act

Chad: The next thing is that we really have to train our staff, especially reception. If somebody asks how much this is going to cost, we have to be able to tell them.  Regardless of whether they’re in-network or out-of-network. Is that true?

Mary: That’s right. First, we ask if they’d like to file insurance. If not, we’re required by federal law to give them a good faith estimate for the services that we would render for this condition.

Chad: At my practice, we’ve been doing cash pay. I’m guessing our rate is exactly $100. It might be $104. And we’ve always said, $100 per visit. Is that sufficient? Or do I need to say, you’re coming in for an ankle sprain, and that’s likely going to be six visits, so $600. Or: you’re coming in for a whiplash injury or something like that, and that’s going to be 16 visits, so that’s $1600.

Mary: Right. They created “required elements” for the good faith estimate form. So what you have to do is tell them how much it’s going to cost. If you’re flat-fee, or if you do fee-for-service, or whatever, you’re going to have to make sure your estimate gives you enough latitude to not go over by $400. On the form we have, it will give you some options. The thing is, you have to identify what you’re doing. This is the hidden consequence that we’re going to have to deal with. For years, we’ve tried to discourage third-party administrators and payers from saying they’re going to authorize X number of visits or X number of CPT codes. Are we supposed to always have a crystal ball to know exactly how we’re going to treat them? We don’t, so that’s problematic for sure.

Good Faith Estimates Should Mirror Your Plan of Care

Regardless of how you’ve set up your estimate, you’ll have to do some prognosticating about what you’re going to need from the patient. So the more inclusive you are, the better. But the important thing is that the good faith estimate really mirrors your plan of care. If they’re going different directions, that’s a problem. And if you decide the patient isn’t responding well, and you want to change things dramatically, then you have to go back. But if you’re under your estimate, that’s not a problem.

When you evaluate somebody, that’s when you determine how you’re going to treat them. So it necessitates two good faith estimates. There’s one for the evaluation, and then you have to create another one because you have to give it to them in advance of treatment. Now, is there a consequence for not giving it to them in advance? If the patient says, “I want to be treated right now,” then it shouldn’t be a problem. Also, we don’t know yet what the penalties are because they’re not anywhere to be found. We don’t know if it’s fines, penalties, or administrative sanctions. But it’s the law, so we have to comply.

Show Intention to Comply

Chad: In your SIPA summary, you mentioned the importance of the intention. As business owners, we need to show that we’re attempting to comply with the law. What do you mean by that?

Mary: Well, there are some providers who totally defy what’s logical. When HHS tells you what should be in the notice and you choose not to include it, that’s pretty purposeful. You have to tell the customers that there’s a dispute resolution if it goes over by $400, and that applying for this costs $25. Those things have to be in the notice, or else you’re not compliant.This is especially for all of those who have been audited or are thinking that they want to protect themselves.

Green Envelopes: What to Do When You Get an Audit

Chad: So let’s switch over to the Supplemental Medical Review Contractor (SMRC) audits. What is that?

Mary: The notice comes in a notorious neon green envelope. Typically, it comes in the middle of an episode of care. It’s not uncommon for auditors to request one day to service records, maybe 30 or 40 charts. We’ve been flooded with people asking what to do for their initial evaluation.

Chad: Got it. So I get one of these fluorescent green envelopes in the mail. What should I do?

Mary: First, pull up all the resources in the SMRC packet. It tells you exactly what to do. We have one that says how to respond to a payer’s request for records. It’s quite lengthy, but it has some graphics, so it’s not terrible reading. Do not throw the envelope away. Read the letter, then read the letter again. Look at who’s sending it to you. Go through the SMRC packet step-by-step. You want your submission to be organized, legible, and easy to follow.

At BCMS, we produced a template for a table of contents. We have a template cover letter and a form for identifying the billing personnel they asked for. We also have provided some clips from the Medicare benefit policy manual that says we don’t have to have long-term goals. If you need further support, you can email Alicia at [email protected].

Chad: Mary, Alicia, and the BCMS team have put together other training sessions for you that are highly recommended on billing and coding, and also on documentation. So if you’re looking for any of the resources that we’re talking about, you can email Alicia and she can set you up with that. And if you  contact Alicia, they’ll also get the FAQ for the SMRC audits, which is pretty extensive.

What’s Changes Can We Expect in the Future?

One final question for you here. And thank you for extensively reviewing the good faith estimate and also the SMRC audits, because I know a lot of owners are paying attention to those two things right now. Is there anything else in store for us as private practice owners in 2022 that you see coming down the pipe? Is there proposed legislation or anything like that on your radar right now?

Mary: Well, we all know the PTA payment differential is a killer, but I want to tell you, it’s not going away. Sorry if I’m the fun sponge on this, but our colleagues, the nurses, PAs, all of them have been dealing with this for years, if not decades. So it’s going to be very hard for us to say, “hey, this shouldn’t apply to us.” 

So let’s put our endeavors where we’re gonna get the least resistance. Let’s get rid of the plan of care certification. Let’s get general supervision across the board. Then we won’t have problems with somebody signing something that they’re not enrolled in. I’d encourage everyone to look at some of those important things. That’s my little soapbox.

Chad: I appreciate the look into the crystal ball, Mary, and into what’s coming down the pipe for us in the future as private practice owners. Another quick reminder: if you’re looking for any of the resources that Mary mentioned in this episode, you can email Alicia Mahoney, at [email protected]. You can also check out the BCMS website, BCMScomp.com. 

Well, Mary Daulong, Queen of Compliance, thank you very much for being here and helping us as private practice owners.

Looking for more resources to help you manage your practice? Visit Breakthrough’s Resources Hub for free content on marketing, hiring, financing, and more.

If I could show you a simple question to ask during the Initial Exam, that would improve your Physical Therapy Patient Graduation Rate by 10%, would you be interested? 

This is Part 4 of 4 in the blog series on Workshops

Specifically “How to Host Direct Access Physical Therapy Workshops” if you missed it.

So far we’ve talked about solving the first big problems.

Which is how to fill the room.

IMG_4424

Then, after you have a room filled with skeptical onlookers and hopefully affluent back pain and sciatica sufferers, converting them to an appointment. Again if you can read the first post here, “How I got 21 Patients from a One Hour PT Workshop”  on the second post – “How to Convert the Most Skeptical Audience Member into Motivated Paying PT Patients” here.

So now that we’ve accomplished that.

How do we make sure we convert that IE, Initial Exam, 97001 to a full Plan of Care?

Where the person comes to all of their visits,

On time

And does their home exercises

And achieves their goals?

What We Ignore Is Killing Us

If you would’ve asked me 10 or 12 years ago, when I first started in Private Practice, ‘’How many of your patients graduate and complete their plan of care?’’

And I would have answered, “Almost 100%.”

And like most other Practice Owners I’ve talked with.

We’re both in SEVERE Denial!

SEVERE.

The truth is most of us guesstimate this number.

And we tend to give ourselves more credit.

But, if you’re super brave and willing to get a dose of reality (that quickly will pay HUGE dividends),

Then here’s what you can do.

Calculate Your Graduation Rate

  1. Pick a month at least 3 months ago.
  2. Make a list of every single patient you or your PTs performed an IE, or 97001 on.
  3. Then right the number of visits each was seen.
  4. After that, go through the actual notes or EMR and notate why that person stopped coming to PT.
  5. If they met all of their goals, indicate “Graduated”.
  6. If they stopped for any other reason, including financial, illness, travel, forgot appointment book, etc., mark “Incomplete”.
  7. Now take the total number of “Graduated patients” and divide by the total number of IEs.

Less than 40%?

We call that a “Discharge Machine”.

More than 80%?

All-Star.

So after studying this for years,

AND having lived as a recovering “Discharge Machine”,

AND from the in-the-trenches experience of having “Discharge Machines” AND All-Stars work in my Private Practice,

I can give you a 7 Step Exam that will drastically improve the rate at which your patients graduate.

But here’s the problem…

I only share the entire 7 Step Killer Exam in my Killer Marketing class.

And we prescreen those Owners ahead of time.

And your simply reading my blog so you could be anybody.

So I can’t give you all 7 Steps here but I can give you the best, most important step.

Alright, enough of that.

So here’s what I’ve got for you.

The Single Best Question You Can Ask Your PT Patients During the IE Which Will Improve Your Graduation Rate at Least 10%

(There’s a good chance you’re not going to believe me when you first read this but it’s very true)

Here’s the Question…

“Have you ever had Physical Therapy before?”

Now, the patient can say two things:

“Yes”or “No.”

Now, they may perceive other conservative care experiences as “Physical Therapy” including:

  • Chiropractic
  • Personal Training
  • Athletic Trainers
  • Massage PTs
  • A manipulation from their family D.O.
  • Inversion tables
  • And even online exercises
  • Or my favorite, P90X

So, if the person says “Yes”, here’s the all important Second Step

You say, “Ok, tell me about it.”

Now the Killer to our profession isn’t the person who had PT on their knee in high school and did amazing.

It’s the person who had a BAD Experience.

And it will kill your Plan of Care before it starts if you don’t uncover it.

You’ll become one more “I tried that and it didn’t work.”

So after the patient tells you that she went down the street and the last guy “cracked her back” and she couldn’t walk for 3 days,

You don’t have to disparage or make less of that clinician.

You don’t have to make the patient wrong for doing that treatment.

(In fact, if you do this: just shake the patient’s hand and let them know it was nice to meet them and you doubt you’ll see them again because you probably won’t.)

What you do, is simply listen, acknowledge and restate.

“OK, so 3 years ago, you had back pain.  You went to the chiropractor down the street, they cracked your back.  You couldn’t walk for 3 days and you were very upset.”

That’s it…

No knock on the chiropractor (you don’t know their version).

Just acknowledge and restate.

Don’t tell them you’re different.

Just show them.

Show them what you can do and aim for a meaningful improvement on Day 1 – today.

So that’s it.

For Your PT Workshop, Your Action Plan Is To…

  1. Fill the seats
  2. Convert your attendees to an IE either a Free Screen or a paid Initial Exam
  3. Then convert the IEs to a full plan of care.

Pretty simple, isn’t it?

Leave me a comment below and let me know how you’re using Physical Therapy Workshops in Your Private Practice.

Hope this helps you,

Chad

PS- Looking for the full 7 Step Direct Access Exam?

Join This Free PT Online Training If You Want To Discover The 7 “Brain Dead” Simple Steps to Preventing No-shows, Drop-Offs and MIAs While Improving Outcomes and Profit

Grab your spot by clicking the link below

“How To Double Your New Patient Visits In Less Than 12 Months Without Working More Than 40 Hours A Week“

One of the alarming metrics I share about Madden PT (my Private Practice) is in 2009, we hit an all-time highest ever of 154 New Patients referred by physicians, in one month.

BUT…

Due to the changing healthcare environment (Hospital systems, POPTS practice come to mind), that number shrunk to 30 New Patients for us in March.

So we’ve gone on a progressive decline from 154 down to 30 in physician referrals.

Yet we’re busier than ever before…

Our income is better than ever before…

We’re seeing more ideal clients than ever before…

Our patient compliance and graduation rate is better than ever before…

And we continue to grow…

So What’s the Deal?

A month or two ago in the “Breakthrough Marketing Strategies for Physical Therapists and Owners” group on LinkedIn…another owner stated:

“We need referrals from doctors to stay in business… if we don’t have that, we might as well join them.”

(I’m paraphrasing, and unfortunately not giving the full context in the space provided here, yet I’m sure you get the point).

I’ll politely decline to agree with the comment, and here’s why.

In spite of operating in one of the most competitive healthcare markets in the U.S., my Private Practice continues to grow (we doubled profitability in 2013, over any other year in business).

So what’s the BIG Secret of how we continue to grow and expand in spite of shrinking referrals?

 

Acres of Diamonds

One of my favorite stories of all-time is Russell Conwell’s “Acres of Diamonds” (you can Google it and read it later).

In the story, a farmer sells his land and farm in Africa and spends the rest of his life desperately searching for diamonds, and dies broke and a failure.

Meanwhile the land that he sold, the farm, later was discovered to be on top of the largest diamond mine in the history of the world…

I’m not sure if the story is true or not.

It’s a good one though.

And it illustrates a point I believe many of us Physical Therapy Private Practice Owners miss…

We’re sitting on Acres of Diamonds, and don’t even realize it…

 

BIG Secret Revealed

In my Direct Access Marketing Training, one of the first things I share is the value of:

Your Past PT Patient List (Your Acres of Diamonds)

These people already know you.

They like you.

They trust you.

And now you’ve discharged then and maybe even encouraged them to never come back again…

M-I-S-T-A-K-E (and one I made for years).

In any industry, in any business, the #1 Asset of the business is the customer list AND the relationship of that business with their customers.

And as in other businesses, you can choose to:

  1. Ignore your patient list.
  2. Send them generic, meaningless B.S. that portrays, we hope, that we care about our patients…
  3. Or send them meaningful communication that allows that patient to continue to feel connected to us.

 

What Meaningful and Valuable Communication Can Do For You and Your PT Private Practice

Two weeks ago we hit an all-time high here at Madden PT, 17 Returning Patients in one week.

That’s 17 New Patients just from our past patient list.

Our team was pumped.

And you can do the same…

Staying in contact with your past patient list does several things:

  • Keeps you top of mind for their Physical Therapy needs…
  • Establishes you as an Authority, Celebrity and Expert (A.C.E.)
  • Makes it more likely they refer their friends and family to you…

And my favorite benefit, if you do this the right way.

They’ll come back years later and talk to you as though they’ve never left.

It’s pretty cool…

Like they’re part of your family.

(I cover step-by-step how I’ve done this at Madden PT for the past 10 years, in my Killer Marketing Training, only open to Private Practice PTs unfortunately, the enrollment period for the latest group of owners is closed as of this writing… we’ll be opening another Direct Access Marketing Course later this year).

***As an aside, by far your greatest Return on Marketing Investment (ROI) should come from your marketing efforts to your past patient base…NOT the unwashed masses of the general public.  Write this down…and reread it until it’s etched into your subconscious business mind.***

So How Do You Stay in Touch With Your Past PT Patients?

Well you have quite a few options when choosing how to stay in touch with your past patients…

If you’ve been following my blog, you know by now I’m a huge fan of Direct Response Marketers, especially Dan Kennedy.

For years, Dan taught a concept called “Market-Message-Media” match…meaning for your marketing to work, you need to match the right market with the right message using the right media.

So for our past patients and considering “Media”, here’s a few options:

  • Email
  • Snail Mail (including postcards, letters, and newsletters)
  • Facebook and other Social Media
  • Fax
  • Texting
  • Phone
  • Live communication, such as at an event…
  • Smoke signals…

You get the point…

So, which “Media” is most used by your past patients AND are they most likely to respond to?

(That’s what I would use, and what I share in the Killer Marketing Training).

On the negative side I dropped my Twitter efforts years ago, because my Target Market is not using Twitter.

 

OK, You Picked Your Media…Now What Do You Put in There?  What’s Your Message?

Again, due to the limits of space and time, I’m going to touch on this briefly…

I can tell you what your message should NOT consist of, at least from experience.

100% PT Jargon-filled, condition-related advice…

You know what I’ve found to work best?

Yes. Donkeys.

Seriously.

Recently in a bulletin we sent out to our past Patient List (a touch over 7,000 people), we did a cover story on the 3 Mini Donkeys we have on our farm…and the story of how one ends up with 3 Mini Donkeys: Haley, MoonBeam and Peppermint Patty (who is expecting in August, so make that 4 Mini Donkeys).

A little quirky…

A bit different…

BUT Crazy effective at building long term relationships with past patients (aka customers) who already know, like and trust us…

And WAY outside of the box of typical “marketing” you’d get from your PT.

At this point, it’s in your court…

Are you going to continue to rely on physician referrals 100% to grow your practice?

Even though you KNOW they’re being bought up by the local hospital system…or may be opening their own POPTS clinic in the future?

Or are you going to start working your past patient list?

Warming it up?

And eventually seeing them after their TKR, for your PT, even when the orthopedic surgeon says he wants them to go to the PT in his basement because they “communicate better” (even though we really know it’s because the ortho owns that clinic)?

So what’s it going to be?

If you’ve been following the full Patient Funnel…then you know we’ve covered 5 Steps so far:

  1. Lead Magnet
  2. TripWire
  3. Core Service
  4. Upsells and Cash Pay Services
  5. And now, the Return Path

Next time, I’ll be covering “Referrals”, and how we just hit a Highest Ever for New Patients referred by other patients in one week: 14.  (That’s for one clinic.)

That will be my last blog covering the Patient Funnel…

Do you have something you’d like to read about regarding Private Practice PT Marketing?  Hit the “Like” button and leave a suggestion below…

Also, as I mentioned earlier, my Killer Marketing Training Enrollment is closed as of this writing, and won’t open again for likely another 6 months.

BUT in the mean time, I do have a few tools I can share with you IF you’re a Private Practice PT or Private Practice Owner.

I put together a “Fix Your Funnel” package which includes:

  • “My Greatest Promotion Ever”…which is the step by step guide to a single day promotion we used at Madden PT which resulted in 65 New Patients in one day (October 29, 2013) and 50 New Patients PLUS a Waiting List (on November 4, 2014).
  • The Killer Testimonial Machine…which is how we’ve collected over 4,000 Patient Stories and Testimonials from our patients…this includes the “What to say”; the template we use…and what we do with the testimonial once it’s written by the patient.

Go here to check out the offer:

www.breakthroughptmarketing.com/free-training

I’ll leave it up at least through the next month.

Hope this helps you,

Chad

breakthrough pt business courses

If you want to attract more PT patients to your practice, you can use this 6 Step Patient Experience Funnel:

  1. Lead Magnet
  2. TripWire
  3. Core Service
  4. Upsell and Cash Pay
  5. Repeat Patients
  6. Referrals

And so far, we’ve covered Lead Magnets and TripWire offers… (If you have not read those, you can click them to catch up).

Now we’re on to the Core Service.

If there’s one part of the above 6 steps that we Private Practice PT Owners know inside and out, it’s this: the Core Service.

This is where we’re providing our PT service, our IE’s or 97001, plus the manual therapy, exercises and other modalities to help our patients achieve their goals and complete their plan of care.

And frankly when most of us think about our Private PT Practice business, we envision it, or at least 99% of it consisting of the Core Service.

This is where we try to make all of our Profit…

It’s the way I thought for years…

And the only way I ever heard another PT talk about their business.

“It’s all about New Patients, New Patients, New Patients… If we have more referrals, then our business is bigger and better.”

Contrary to popular belief, this thought process is a colossal mistake.

There’s a lot more to Private Practice than getting referrals, POCs, and Discharges.

That limited tunnel vision can financially cripple a practice…or any business.

But before I rail on about my mistakes and limited vision, and how it nearly cost me my private practice… twice…

Let’s talk about the Core Service and how to make it better.

3 Keys to Creating a World-class, 5 Star, Disney-like Physical Therapy Patient Experience

disney

Did you ever have an amazing experience in another health care professionals office (doctor, dentist, etc)?

Did you ever have a lousy experience?  (all of my lousy experiences seem to involve an Emergency Room)

Have you ever taken your children to an appointment?

Or a parent or other family member?

What was most important to you?  What stood out?  What made you say “Wow”…they’re good, I’m coming back here” OR “I’d never go back to that place again.”

What have you chosen to create in your Private Practice?

I’ve surveyed our patients repeatedly over the years, and we’ve focused in on what  “Mothers and Grandmothers” want and need in a PT practice, and have worked hard to deliver that.

And the following are 3 tools you can implement to make your PT service different from the “run of the mill” place down the street…

1. All Physical Therapists (including you if you’re still treating) can use a systematic approach to your initial evaluation (we call it an IE or 97001).

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Why is a standard approach important?

Well, have you ever had a patient go through their IE, and first treatment, seemingly in agreement with all of the treatment and PT knowledge you just shared with them, and go out front to schedule, and they report they forgot their appointment book… never to be seen again?

Raise you hand if you’re guilty of having this happen to you…

Me too.

(If you didn’t raise your hand… there’s a name for your condition, it’s called, “DENIAL.”)

From studying Physical Therapists who have high drop-off (patients NOT completing their Plans of Care) and comparing them with PTs who have amazing patient compliance, super high attendance rates, higher than average frequency of return patients (patients who’ve been discharged and return for a plan of care for the same or different body part) and word-of-mouth referrals from other patients…

What would you guess is the biggest difference between the All-Star and the Discharge Machine?

Certifications?

Degree?

Years of Experience?

None of those.

At least from what I’ve seen and studied, a PT with a standard script, who is disciplined at touching all bases, easily outperforms the PT who does not have a standard script.

I know… I know…

“But I treat the individual…”

“And provide a super high quality of care…”

OK.

If there are key points that you miss in your exam though, it can absolutely kill your practice (kill in a bad way).

So, in our Private Practice, at Madden PT, all of our PTs use something we call “The 7 Step Killer Exam”.  (Killer here is used in a good way).

(As an aside, we train all of our PTs to do this… in their sleep… so they don’t miss steps.  We then record them, to help them see what areas are smooth and what areas need work.  I recommend you do the same.)

And what’s the 7 Step Killer Exam?

I don’t have time for the entire 7 Steps here, but I can give you the MOST Important Step…

And it’s the step that is missed the most often.

By adding this in, you are guaranteed to dramatically improve your Graduation Rate (Patients completing their plan of care divided by total number of New Patients)…

And here it is:

  1. Ask this question, “Have you ever had Physical Therapy before?

If “No…”

Then ask, “What about Chiropractic, Massage therapy, personal training, seen an athletic trainer or DO?”  (This is super important as many people in the general public confuse Physical Therapy with other interventions…including P90X!)

If “Yes…”

Then ask, “OK, Tell me about that…What happened?”

Then just listen.

Many times, the people who drop off have had a past bad experience.

And if you leave it uncovered, they’re done the second they walk out to schedule.

If you uncover it, then just listen.

Acknowledge they had a bad experience through restatement…

“OK, so you went to XYZ Physical Therapy down the street for your back…3 years ago.  They gave you an exercise sheet and told you to come see the PT when you’re done with your exercises.  You did that for 4 weeks…only saw the main PT on the first day…and it didn’t help you at all.”

Acknowledge through restatement.

You don’t have to tell them you’re different…

You don’t have to talk bad about another clinician…

You just restate it.

That’s it… seriously.

(If you’re interested in learning and implementing the full 7 Step Killer Exam… send me an email to [email protected] with Subject line: 7 Step Killer Exam)

2. Give them a unique experience…

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“What’s your receipt?”

I highly recommend you buy and read Jeffrey Gitomer’s Little Platinum Book of Cha-ching.

In it, he shares the story of John Patterson, one of the premier sales trainers for National Cash Register (today know as NCR), in the late 1800’s.

There’s no way I could do the story justice in the limited space here, but basically, John Patterson first failed at selling his cash register directly to store owners…

Until he created the demand for a receipt amongst the general public.

Then the store owners came running to him to buy his NCR cash register.

He went from trying and failing to chase sales (being the hunter) to having his ideal customers demand to do business with him (being the hunted).

All by changing the game.

You can do the same.

A few years ago, I challenged our team to do the same.

We wanted to do something unique around the home exercise instructions we were handing out…

We used to hand out this ugly green sheet system with up to 9 exercises per sheet.

And that had to go.

What we ended up creating was an Exercise Card System.

Every patient who comes through gets an Exercise Card carabiner, complete with full color exercise cards and simple instructions.

The sheets were lost constantly, so the Exercise Card System is a keeper.

Women hang it on their purse… and tell others about it.

It’s our John Patterson “receipt”.

3. A System for Your Patient’s Graduation Day

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Your patient kept their appointments…

They did their home exercises faithfully every day…

They’re pain is 100% relieved…

Their motion, strength and function goals are met…

And they made you a tray of brownies.

Awesome, right?

What would even make it more “awesome”?

If you could capture the appreciation they have for you and the high quality of care and service you provided.

And make a super good impression on the patient’s referral source (or family doc).

And attract more patients who were compliant, friendly, and respected you for the care you provided.

AND provide killer proof to the insurance company that your care was worthwhile.

How do you do that?

Well, create a system for your Discharge Day (we call it “Graduation Day”… and you’re welcome to do the same).

Here’s what our Graduation Day consists of:

  1. Normal full treatment
  2. Reassessment with full objective measures and discussion of comparison of Initial Evaluation numbers.
  3. Testimonial capture (we call this The Direct Access Marketing Testimonial Machine).
  4. A Graduation Day interview with Tammy, our Internal Marketing Representative.
  5. A goodie bag (we just had a Graduating Patient post this on FB… it’s free press!)
  6. A picture of the patient in their Madden PT T-shirt with the PT team who treated them.
  7. A hand-written note from the PT to the patient…

And it’s the same for everyone who comes through our doors.

Wrapping It Up

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So far, if you’ve been following my blog… we’ve discussed:

  1. Lead Magnets
  2. Trip Wires
  3. And now, the Core Service

Don’t be lulled to sleep thinking that there is no advantage to be gained here within your marketplace…

Put the work in.

Study what others are doing to create an amazing, 5-Star experience for their patients.

And model what they do in your clinic by implementing.

Your patients and banker will both be thankful you did.

Next up on our list is Step #4: Upsells and Cash Pay Services.

What is one thing you want to implement in your practice from this post? Let me know in the comments below.

PS. And if you have any questions on creating a world-class, 5 star, Disney-like patient experience in your private practice, leave a comment below as well. Happy to help.

And please be sure to check out some of our Direct Access Marketing Testimonials!

Chad

We use Tripwires now because early on in my Private PT Practice, I gave away a ton of free PT Patient screenings.

And I remember one couple specifically who came in…

They both had clear neck and lower back dysfunctions that would have been easy to treat.

Both were young and would have responded well to Physical Therapy.

(I think I may have even treated both, for Free, and both had immediate relief).

BUT – when we walked out front to schedule (after giving over one hour of time to them), the excuses started…

They wanted nothing to do with being a paying PT patient: they were “Freeloaders”, and just wanted Free stuff.

I store that experience in the same part of my brain with the receptionist who stole co-pays (cash) from me, or the 4 teenage gypsies who scammed me for $2 in Frankfurt, Germany.

And they’re pretty lousy memories…

So when someone responds to our Physical Therapy Patient Lead Magnet, they’ve raised their hand and said, “Yes. I have that problem. I qualify for your offer. AND I want the free stuff…”

What do we, the Private Practice PT with limited time, money and resources do next?

Enter the Tripwire Offer…

The easiest way to separate the wheat from the chaffe (the good part of the wheat from the not useful part) is to have a Tripwire Offer.

Take my Physical Therapy Marketing YouTube videos for example…

“Top 3 Exercises for Sciatica and Pinched Nerves” has been averaging 50,000 views per month for over a year now.

So that’s 50,000 people per month raising their hand and saying, “Yes, I have pain, numbness and tingling in my leg.”

Two out of three people watch the video to the end, so let’s assume that’s ⅔ of 50,000 (or 33,333 people) who watch the video.

Embedded in the video is an ad… my ad.

If they click the ad, they go to a “Squeeze Page”.

A squeeze page is an “Opt-in Page” where a person enters his or her name in exchange for other information – Classic Lead Magnet – and that information is FREE.

(I prefer to use information [ebook, report, etc] as a Lead Magnet, over Free services or Free products, for the reason that people who consume information tend to be better buyers, and better patients. Plus I’m not losing valuable time).

So once a person opts-in (I don’t know the exact number we have today, but we had over 3,000 opt-ins in the first 90 days), we can give them other valuable information relevant to what they raised their hand for. In this case “sciatica”.

Eventually, we want to see if that person is a potential customer… or a Freeloader.

And the way to do that is with a Tripwire offer…


What is a Tripwire Offer?

Think of a tripwire as an irresistible, unbelievable deal.

The goal for us is not necessarily to make money, nor a profit; it’s just to see if this potential patient, customer or client has a pulse and has the ability to buy.

Once they’ve established the ability to buy, then we can invest our marketing dollars specifically into that group of potential buyers.

In the YouTube example above, I sell an electronic version of my book, “Pain Free Motion for Your Lower Back” for $5.99…

In an odd, almost too good to be true way, YouTube gives provides a way for free lead generation: I pay nothing for having videos on YouTube (other than the time it took me to record and post valuable information), and Google (who owns YouTube) sends me a monthly check for videos I have posted… unreal.

So we have 33,333 raising their hands saying, “Yes, I have pain, numbness and tingling running down my leg”, searching for answers online, AND watching my short but valuable 4 minute video.

Approximately 1,000 of those viewers each month click on the ad within the video for more information.

AND enter in their name and email address on our “Opt-In” or “Squeeze” page. (It’s referred to as a “squeeze” page because it “squeezes” information out of a potential customer).

And 40 of those people buy my book in pdf format…

And potentially other offers.

So, the e-book (pdf) is the Tripwire.


How to Apply Tripwires to Bricks-N-Mortar Private Practice PT

The PT Industry trend, especially in Private Practice PT (and often in the chiropractic industry), is to offer a Free Screen.

No Lead Magnet – nothing offered that can be quickly and easily consumed WITHOUT taking time, money or resources from the PT.

So offer the Free PT Patient Screening, and “determine if the potential patient would benefit from PT” OR “a PT sales pitch”.

Then hope they sign up for a true IE…a 97001.

Then start the whole process during the 97001 for a full plan of care, or at least one or two more visits.

Since this method is so popular (and I did it for years myself semi-successfully) we’ll call it the “Old Way”.

There is a Better Way…The “New Way” to Use Tripwires

(As is always true with any marketing technique…you should always test, test, test. You’ll want to be scientific about what works best for your market. And gives you the best ROI: Return on Your Investment. If you’d like to read more on how to be “Scientific” in your Marketing, the same way you are scientific and using Evidence-based Practice as a Physical Therapist in the clinic, send me an email at [email protected], and I’ll send you a PDF copy of my favorite classic marketing book of all time… it is no longer in print so it sells for over $100 on Amazon).

Anyhow, where was I?

Oh yeah…Tripwires.

Over time, I’ve found that most true buyers, people who are willing to pay you for your services once they see that you are legitimate and are ready for help, will WANT to pay you.

That is important, so read that sentence again.

Most PTs (myself included) try to do too much free stuff up front…

You only need one Lead Magnet.

In another article on my 3 Favorite Lead Magnets of All Time, I shared how I use Lead Magnets in Private Practice PT to attract ideal patients.

The tendency is to stack them…

A potential patient comes to a Free Webinar on Back Pain and Sciatica…

In the past, I’d offer a Free Screening, essentially another Lead Magnet.

Now, we’re testing a nominal charge for the screening. We’ll ultimately test from $11 to $59.

And here’s the weird part that’s a little counter-intuitive for our science-based PT brains to handle.

Real, true clients – the kind we like to work with, they’re ready to pay the minute they know, think or have hope we can help them…

So why prolong the agony and the courting process?

A potential patient who consumes your Lead Magnet, and now is beyond interested in you and your services… do you know what they are?

They’re in H-E-A-T!

They’re hot to buy… they’re ready.

Be ready to serve them… now.

Case in Point… A Funnel for You to Test.

Here’s the model I’m testing now.

I’d love to hear from you if you’re a Private Practice PT testing out similar ideas. Please contact us here for more information on our PT Marketing Services and Solutions.

  1. Postcard driving to a Lower Back Pain and Sciatica Workshop. Presently this is no cost (although my best one ever had over 100 register at $10/seat). Free = Lead Magnet.
  2. Attendees of the Lower Back Pain and Sciatica Workshop are given a Worksheet to fill out with 5 key points I make in the hour or so. Those who complete it (90%+ do) get an offer to schedule an appointment to see what’s causing their back pain for $11. We’re testing this offer presently.
  3. If and when the person schedules their full plan of care the $11 or $19 or $59 (or whatever the amount is we’re testing at the time) is then applied to their financial responsibility.
  4. Full plan of care scheduled after IE. (not visit to visit)

This is a little more savvy and complex than what we learn (or don’t learn) in PT school.

The days of relying on physician referrals may be over for the average Private Practice Owner…

And a well-tested Patient Attraction Funnel is the way to go…

The end result is better control over the flow of New Patients to your clinic, less dependence on physician referrals, the ability to attract the type of patient you want to treat, increased patient compliance and a more financially sound Private Practice.

Big Point

It’s easy to waste marketing dollars in Private Practice, and frankly any business.

A Tripwire offer efficiently differentiates and discerns between your true buyers and those people who are just looking for something for free.

Put in a Tripwire, and distinguish who is willing to pay you, so you can focus your time, money and energy on giving them an amazing patient experience.


Want to Learn More on Patient Attraction Funnels for Private Practice PT…So You Can Stop Chasing Referrals?

I host frequent webinars, Free Tutorials, for Private Practice Owners.

The latest is “How to Magnetically Attract Direct Access Patients”. (The material also applies to PTs who do not have Direct Access).

Or to learn more visit our Physical Therapy and Direct Access Marketing Resource Center.

See you on the training and next on the blog.

Chad