In this episode, Owner and Founder of Velocity Physiotherapy, Erica Meloe, talks about the business of physical therapy.

Today, Erica talks about her previous career, how to foster motivation and commitment in patients, and addressing company culture. What does it mean to be out-of-network?

Hear about the biggest lessons Erica has learned in her career, the importance of mentorship, and get some valuable advice, all on today’s episode of The Healthy, Wealthy & Smart Podcast.

 

Key Takeaways

  • “Being an entrepreneur, you need to be able to know what your strengths are, and really work with those strengths.”
  • “I learned over the years to delegate out what I don’t like to do or what’s not in my strengths.”
  • “Practice makes permanent. It does not make perfect.”
  • “If you put a computer between you and your patient, you decrease the outcome by 50%.”
  • Some important definitions
  1. Co-pay. This is a fixed amount that’s generally used for an in-network model.
  2. Co-insurance. This is based on a percentage of the bill.
  3. Balance-billing. This is balancing the bill up to what you typically charge.
  • “Lately, a lot of plans are being reimbursed as a percentage of Medicare.”
  • “A lot of being an entrepreneur is mindset.”
  • “Why reinvent the wheel when someone else has done that?”
  • “Be unapologetically yourself.”
  • “We need to find joy in our life, and whatever that is, we need to do more of that.”

 

More about Erica Meloe

Erica Meloe Erica Meloe is a board certified physiotherapist in private practice in NYC. After a decade solving financial puzzles on Wall Street, Erica took her MBA and her problem solving skills into the clinic. She specializes in treating patients with unsolved pain and her mission is to raise awareness of the physical therapy profession to a level like no other.

Erica is co-host of the podcast “Tough To Treat. A physiotherapist’s guide to managing those complex patients.” She is also a thought leader in the profession and helps her patients as well as her colleagues empower themselves to lead and live with purpose.

Erica’s book “Why Do I Hurt? Discover the Surprising Connections That Cause Physical Pain and What To Do About Them” was released in June of 2018. She has also been featured in Forbes, BBC, Women’s Day, Better Homes and Gardens, Muscle and Fitness Hers and Health Magazine.

Erica is also fluent in Spanish and loves traveling!

 

Suggested Keywords

Physiotherapy, Therapy, Health, Motivation, Commitment, Consistency, Practice, Entrepreneurship, Culture, Mentorship, Business, Mindset, Healthy, Wealthy, Smart

 

To learn more, follow Erica at:

Website:          https://ericameloe.com

https://toughtotreat.com

https://www.velocityphysiony.com

Facebook:       Erica Meloe PT

Velocity Physio NYC

Tough To Treat (Podcast)

Twitter:            @EricaMeloe

@VelocityPTNYC

Instagram:       @toughtotreatpodcast

Pinterest:         @emeloe

LinkedIn:         Erica Meloe

Velocity Physio

YouTube:        Tough To Treat

 

Business Round Table on July 27, 2021 at 8:00 PM EST 

 

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Read the Full Transcript Here: 

Speaker 1 (00:04):

Hey, Erica. Welcome back to the podcast. It is always a pleasure to have you on, so thank you for coming back.

Speaker 2 (00:11):

Thanks. Thank you Karen, for asking me, I can’t believe it it’s been, I remember our first podcast was probably 10 or 11 yeah. Years ago.

Speaker 1 (00:19):

So yes. So long ago, like way way, the beginning of healthy,

Speaker 3 (00:23):

Wealthy and smart. You were

Speaker 2 (00:27):

On the second street. I was just, so I remember taking a car going up in the elevator and sitting there in the office. Oh my God. Yes. It’s a pleasure to be back on again. Thank you so long

Speaker 1 (00:37):

Ago. Gosh. Yeah, that was a long time. It was like 10 years ago. And now this month we are talking all about the business of physical therapy. So I thought who else to have on who better to have on than you, who is a successful physical therapy entrepreneur business owner here in New York city. So before we get into your, what your business structure is like and how you run your business, I would love for you to remind the listeners a little bit of your background. So just so people know, Erica had a career before she became a physical therapist. So talk about that and how that career prepared you for your role as an entrepreneur.

Speaker 2 (01:24):

Yeah, that’s a great question. I, it’s funny, I’ve gotten much more involved during this time being at home a bit more during COVID with the whole wall street and and, and the whole, the financial markets, cause I’ve had more time to look at it, but I graduated just in brief. I have an MBA from stern school of business at the NYU stern school. And after graduation, I ended up working for an investment bank, a global investment bank and international foreign owned bank, literally starting in Karen, when I tell you and I’m dating myself, but I started like just before the market crashed. Okay. Like the 87 crash,

Speaker 3 (02:05):

I was going to say, you have to, you have to be more specific. There’s been a few. So,

Speaker 2 (02:12):

So that was, and I started off in research and, and that was all great, but I ended up going on to a trading floor and it’s, it’s a, you know, like a huge trading floor with a lot of seats and it’s an open, open area and mostly selling and trading international bonds, futures and options. And I, I really, I loved it. I loved, I really enjoyed working on wall street and I think that it was a different time back then, way different than it is now. And, you know, somebody asked me recently, why did you leave? And I was like, I didn’t want to retire on a trading floor, which was the truth. You think God. Right. But I, I, I often think about why did I like it so much and how can I take that, that part of the business into anything else that I do.

Speaker 2 (02:58):

Right. And I liked it for many reasons. And one of it was, I was part of a team, you know, and I think the team of people, you know, we talk about collaborating in our, in our, in our world. I do very well with people, with a team, people who are team players. And I think for me, that’s why I think in physical therapy land, I’ve been, you know, in the profession going on. Yeah. Committee’s trying to run for different positions because I like being part of that team. It’s just an, and we all have a lot in common too, I think as well. So it, and that’s, you know, I got to talk to people on the phone a lot. I was, it was very much, it was back in the old days where we actually had to pick up the phone and call people and not, and it wasn’t all computers.

Speaker 2 (03:42):

So that’s the point. I think for me, I enjoyed the most and, and also figuring things out and problem solving. And as an entrepreneur, I mean, we have to figure things out all day long. Right. I think for me, it’s, it was being a team player was definitely the main thing why I miss it. But I also liked the, the fast pace and, and, you know, yes, we’re in New York, we all liked the fast paced and certainly not as fast as it used to be. That’s for sure. But I enjoyed making those quick decisions and, and, and talking to clients and analyzing with them to solve their problems. So it’s similar to physical therapy, right? I mean, we deal, we see patients, we try to, we talk to them, we try to figure out, you know, what, what’s going on, what’s going wrong with them or what their problem is.

Speaker 2 (04:33):

And, you know, I did recently a a paper for I’m doing part-time some courses and I did something on the therapeutic Alliance and the therapeutic Alliance, the quality that is the most important is really being, being a good listener and like listening to your patients, listening to your clients. So that’s how I’m when I was on wall street. I, I really, this is when we had great expense accounts. Peter I’ve waited, you know, I flew to Mexico city for, for lunch one day with, for the central bank and came back. I exploited, I mean, that’s the life I loved and I, to this day, I do miss it. I’ll be, be honest, you know? And I, I was able to fly. I didn’t, I didn’t, I only covered a few international clients was mostly of domestic, but it was establishing those relationships, maintaining those contacts.

Speaker 2 (05:25):

I know you talk about like the concierge I read your article actually in an impact magazine. It was excellent. And it’s about, you know, it’s that extra service it’s that, it’s that developing that relationship. It’s going that for mile. And, you know, I was one of the top sellers on the desk. And when I left people, some of my top clients were like, we liked you, or, you know, the, what if they use the word like, but they were like, you never shoved anything down our throats. I never shoved the deal down their throat. I never shoved anything down their throats. It was a, and I think that’s, what’s, I’ve taken a lot from that, you know, in a nutshell that, that whole experience, you know,

Speaker 1 (06:05):

And as an entrepreneur, where, where does that sort of plug in? Where does that fit? How did that help you grow your practice? Because you have a thriving practice in New York city. It doesn’t happen overnight.

Speaker 2 (06:20):

Oh no. Oh no, no, no, no. And to be honest with you, I think as entrepreneurs, we are lucky in the sense that, you know, since we don’t work for somebody, we work for ourselves, right. We have a little bit more leeway to discover things about ourself and what we want to do to grow the business. Right. and I think that what has from taking from the wall street experience the ability to that, what’s the word I want to use. It’s almost like being an entrepreneur. You need to be able to know what your strengths are and really work with those strengths. So when I first started out, I knew that my strength was I did the strength finders 2.0, you know, everybody should do that. It’s, you know, and I’m like a learner achiever. You have to be a connector. I swear you have to be a connector.

Speaker 2 (07:14):

Right. You must, right. I’m a learner achiever like maximizer input and responsibility for those of you who have done that. So for me, the way I work best is when I play to my strengths. And I learned over the years to delegate out what I don’t like to do, or what’s not in my strength. Like, I it’s just, why would you, do you, you know, we have the ability to do that. So playing to your strengths is that one of the first things I learned early on, because, you know, people say, oh, you can be a generalist physical therapist. You can treat everything, but what makes you different from the person down the street? Right. And for me, it’s like, and I’m still, I still hone this to this day. This is all a work in progress. But you know, it’s the problem solving. I love to figure stuff out.

Speaker 2 (08:06):

That’s just basic. I love to figure stuff. I look to look at a trade when I was on wall street to figure it out, how can you make money? How can I make you money? Because if you make money, I make money. Right. And you know, if you feel better, if I can make the patient feel better, I do make more money. Cause they’ll refer their friends and family. So it’s very similar mindset. I think that was the hope. That was the answer you wanted, but it’s, for me, it was really honing on, on what I did best. And then more recently, Karen, I looked at patients who I really like to treat. And what was the common thread, right. Wow.

Speaker 1 (08:45):

You knew what was it? What was the common thread?

Speaker 2 (08:49):

The, honestly it was being motivated and coming in consistently and being committed to going the full pro the full, raw, the full round. Don’t come for two visits and don’t come back. You want to, you’re, you’re literally, you are committed to having someone look at your entire body from the brain to the foot and looking at the connections in the body and be willing to commit some time to getting yourself better. That was the commonality,

Speaker 1 (09:15):

But, and they were athletic. But here I have, I have something to say about that. So was that the common thread they innately had or was that something that you helped to foster in them when you first see them, those first one or two visits?

Speaker 2 (09:34):

Yes. I helped to foster that. How

Speaker 1 (09:37):

Do you do that? How do you do that? How do you help to foster that? So,

Speaker 2 (09:41):

So when people phone initially, I’ll backtrack a second. When people like this recently I had someone come in to sit, you know, she said, I’m seeing a well-known therapist in New York, blah, blah, blah, et cetera. What makes you different? And I was like, this is what makes me different. And I start off and I say, everybody says, they treat the whole body. You know, it’s everybody treats differently. But what I do is I look at the connections in the body of the relationships of the regions, of the body, to each other. And I don’t just treat your symptom. I look at your impairment and I look at their relationship with the head to the PIP, the need of the foot. And I tell them a story. I say, I have a patient recently. She had a pet issue in her pelvis, low back pain.

Speaker 2 (10:18):

And her driver was her foot. And I explain a little bit about why I do that. And I do that with patients when they first come in, this is what I say. I say, look, I don’t want say, look, I basically tell them it’s w I try. I listened for quite a bit. And then I basically tell them that it’s, this is a relationship. And we’re trying to change your movement patterns. If learning is very important, and I need to know how you learn best practice makes permanent. It does not make perfect. So you need to be able to come in and I’ll say this to them. I need you to come in consistently at the beginning, once a week, I generally don’t treat twice or three times and they start a surgical. But I’ll treat for the hour. And I’ll say, you know, minimally once a week for, let’s say three weeks, I need to front load the visits because I’m trying to change strategies and trying to train your change, your brain.

Speaker 2 (11:11):

And I need to do that with a lot of input at the beginning of the treatments of the treatments. And if you want to space those out after I’m fine with that. And if patients can’t do that, I basically say for whatever reason, if it’s financial or Trey or vacation, I tell them that that’s okay, but you won’t get the same results. It will take longer. And the people who come in at the beginning, who front-load them get results quicker, and those are the people. And I looked at that list and that very true. They were coming in consistently and front-loaded, but I tell them that, but you know, it’s based on the assessment and if I can give them, like, I don’t want to say a wow, but if I, if they get what I’m trying to say, I can make a change in the first visit.

Speaker 2 (11:55):

Then they are more convinced of coming in more frequently. And I think because I do a lot of listening and I ask questions that not many people ask. I mean, we’re similar. You and I, but I think that they don’t get a lot of that outside of, of medicine, traditional medicine. And I think that when I explained to them, I’m trying to change your movement pattern. I’m trying to change your strategy. You’re, I’m trying to work with you. You know, I’m trying to change how you move about your nervous system, your neuromuscular recruitment, things like that. And I, I, I work with them. I’ll have the move and I can see I can. And I take P ever since COVID started, I’ve been with that Darla health. I’ve been taking more pictures in the office because I can really, I mark them up on my apple preview. And I’m seeing things that I never saw in the clinic before. And then when I show them this, they’re like, oh my gosh. Wow. And I think their brain starts to change immediately when they in the first visit. And I think that that’s important to get that buy-in at the beginning a little bit to help them come more consistently.

Speaker 1 (13:00):

Yeah, absolutely. If you don’t have buy-in in the beginning, then they’re not gonna, they’re not going to be that patient who you said this common thread is they’re motivated and committed. But I think that yes, if people are coming to see if they’re seeking out a physical therapist, they’re somewhat motivated, maybe committed, but it’s, you who’s educating them and listening and going that extra mile, making them feel comfortable, making them feel heard. And that’s why you have motivated and committed patients. Correct. So it’s a combination of the patient and what you do. So don’t say, oh, it’s just these motivated people.

Speaker 3 (13:43):

Good point [inaudible] I

Speaker 2 (13:47):

Know. And it’s so funny because the, the, because we spend so much time listening, that is the form of communication, the best therapist or the best communicators. I mean, when I was doing this paper for therapeutic Alliance, you look at the, there’s a like different pieces of the puzzle, listening and communication where like 70% of the outcome. I mean, maxi, Missy acts, she’s a researcher at a McMaster, right? She says, you know, you walk into a treatment room, I’d say for somebody who’s, you’re, you’re the fifth person you walk in there, hypervigilance, you know, distracted, you’ve exerted a no cebo effect on your patient before you even sat down. And they’re not coming back after that. Right. So it’s so important. And to, to know that, and I think that that’ll help them make, make changes. You, if you go in there, you can be the best therapist ever and, and try to get them to be more motivated and committed. But if you’re distracted, that doesn’t work.

Speaker 1 (14:43):

Yeah. I mean, just put yourself in their shoes. That’s all you need is, is like just a smidge of empathy, you know? Cause we all, you don’t have to be like an empath. You just need a smidge because like, we all know what it’s like, like when you go to the doctor and, and you’re trying to like spill your guts to them. And they’re like on their commute computer. Aha. And you’re like, well, nevermind. I don’t feel like telling you anything.

Speaker 2 (15:10):

I know. I know. And you literally, if you put a computer between you and your patient, you’ve decreased the outcome by 50%. Wow. That was an interesting statistic I found. And so now people are looking at me and this is extra work for me. And it’s something I’m working through, but I literally barely write in the first part of the interview. I’m just listening to them and looking them in the eye. And I’m like, I’m trying to remember, and I have a good memory, but I’ll write a few things down, but I’m listening to them. And I’m just passive, to be honest, if they don’t give, I don’t get what I want. I will ask other questions. But I think that that writing that paper on the therapeutic Alliance, even as an entrepreneur, because yes, we have the, we have the ability to make it, make our own schedule.

Speaker 2 (15:54):

Right. Have the freedom to do that. We have the, we have the freedom to tell people we don’t want to see them. You know, I literally someone said to me recently, I don’t know what you think about this is that you should have an application process to have them become your patient. I was like, Ooh, that’s interesting. I’m not sure I’m there yet, but that’s an interesting concept. You know, how business coaches do that a lot, you can apply for the program, right? I’m not sure I’m there yet. I can, you know, I can talk to somebody on the phone and get an idea of who, if they’re right for me or if they’re not, I’ll say maybe there’s somebody else, but I don’t like, like a formal application process to do that.

Speaker 1 (16:32):

Qualifying people. I mean, I guess you can, but I, I mean, I think that you’re doing that in that first visit by saying, you know, I, I really want you to be committed to this process. Is that something you think you can do? Yes. Right. how do you learn best? Because I want to make sure that my teaching style matches your learning style depending on who you are and how you do things. And, you know, what’s interesting is you know, there’s StrengthFinders, there’s all these different things. In the Goldman Sachs class that I’m taking now, we used one called people styles at work, by Bolton, Bolton and Bolton second edition. And it basically it’s 18 questions and it splits you up into four different kinds of learning styles or leader, sorry, leadership styles. But you can use that even with your clients and with, if you’re an entrepreneur, let’s say you have multiple people working for you.

Speaker 1 (17:31):

You can have them take these take this test or quiz if you will. And if someone is more analytical, maybe you want them doing this kind of work. If someone is more, there’s four different kinds, there’s analytical, which I think you are which would be less assertive. But some of these, I, I don’t agree with that. I mean, it’s, they’re not all perfect, but less responsive to others, task oriented, precise, and attentive to detail, prefers to work with procedures and symptoms motivated by the right way to do things I, and, you know, we sort of fall into things that might be a little analytical, a little expressive, but there’s our analytical, your exp you could be an expressive and amiable or a driver.

Speaker 1 (18:22):

And it’s, it was very interesting to look at that, even from a client standpoint. So as you’re talking, you can kind of guess like what the, what maybe your client is and how you can. So if they’re more analytical, maybe you’re going to want to hit them with your facts, your figures, your numbers. If they’re more expressive, maybe you’re going to want to hit them with the things that sort of tug at the heartstrings. If you’re more amiable, if you think they’re more amiable, then you’re gonna maybe want to challenge them a little bit. So they’re not always just yessing you all the time. You know what I mean? Yeah,

Speaker 2 (18:58):

Yeah, yeah, absolutely. That’s, that’s a great that’s a, that’s a great tool. I have to look into that. It’s funny because I sent out some questionnaires ahead of time as well. I do the CSI questionnaire and the DAS questionnaire, and I get a good idea of, of just what their personalities are by looking at those. And some people I see them and I look at them, their questionnaires and they’re like completely different people, you know, honestly. Right. But that gives me an idea of just their, just their overall persona. And then I explained to them, you know, I explain how I assess and I just say, and they’re like, well, why are, you know, why are your hands in my armpits type thing? And I’ll cause I’m well on the thorax, the head had the feet and I’ll say, well, I’m, I explained the rules of the game.

Speaker 2 (19:39):

I said, I’m just gonna explain the rules of the game. Cause we don’t know the rules we can’t play and they all laugh and it’s fun, you know? Cause I think it’s just a way to make people feel at home. And I think it’s funny because when I weirs ago and when I was working for other people as like a staff PT, yes, I’m older now, but I, I feel that as an entrepreneur, you can, you can express yourself differently and you have more freedom than if you were to be with, you know, sort of in the confines of a culture, like a corporate culture, like on wall street. For me, I wasn’t confined in the sense because it was all about getting the deal done, making the money is pretty driven by money, right. So there were kind of no limits at that point back then.

Speaker 2 (20:18):

So you did what you felt, whatever you, whatever you do, you get the deal done. And we didn’t really have, it was just, we had limits obviously, but it was very different. We weren’t reigned in so much, you know, and then we were able to sort of be ourselves a little bit. And I, I always believe that things happen for a reason. I believe that I was meant to cover central banks are meant, I was meant to cover other banks at other different hedge funds because of the analytical style that these people have. You know, I think, you know, people say you find patients, I think patients find us, you know?

Speaker 1 (20:54):

Absolutely. Yeah, absolutely. And that’s where, you know, your website, your wording, your copy, all of that can reflect that. And you hit on something that I want to touch on quickly too. And that’s company culture. So how did you, and you have a partner and he gal, how did you guys address your company culture, the culture of your clinic, where you sort of very what’s the word I’m looking for?

Speaker 2 (21:31):

Like, did we have like something

Speaker 1 (21:33):

Like, was it purposeful, did you sort of purposefully, like this is going to be our culture, this is, these are our values and what we want to reflect on our business. Yeah.

Speaker 2 (21:45):

I mean, we didn’t do that formally. But we certainly, if it evolves over time, because it naturally the types of patients that would, that would come into the office would be those ones who sort of have been elsewhere or have, you know, really wants I don’t even want to say hands on approach anymore, but more of a, of a, of a whole person approach and that it naturally evolved that way. And that sort of like when we did at one point when we were gosh, I think this was when we first started, we actually had to go up to Columbia university to speak to the student center up there. And, you know, we did a little PowerPoint and in that PowerPoint, it was, we talked about, you know, why the, you know, the hip is related to the foot. And, and so it evolved over time that, that whole, that whole culture and, and, and we were out of network from the get-go all right, because we knew that in order to treat this way and certainly New York rents, you know, you know, they’re changed now, but back then, it was you, you could not at least in New York state, cause we’re like, like the lowest reimbursed state in the country, right.

Speaker 2 (22:55):

I mean, you cannot maintain a business in New York city on an network network, unless you see, you know, five patients an hour, which is unacceptable to me. So that is not the way I’m I treat. And even, you know, it’s funny when I graduated PT school, I called up a lot of places that I was going to interview at and see how many patients they saw an hour. And if it was four, I didn’t go for the interview. And I had, I was lucky I had a career change. I had some savings, so I could be a little bit choosy, but I, I, it’s very stressful working in that kind of an environment.

Speaker 1 (23:25):

Yeah, absolutely. So let’s talk about the structure of your business. So you said you’ve been out of network from the beginning. So what does that mean? Can you explain to the listeners what that means?

Speaker 2 (23:34):

Yeah, so we don’t contract. So basically we don’t contract with an insurance company. So we have, we take Medicare. We are what we call par for Medicare. So that’s con that’s a contracted in New York city rate. And, but other than Medicare, we are out of network, which means that if your client has out of network benefits, we can do one of two things. You either build the insurance company directly. We charge them the co-insurance and then we get paid. So we get paid or the patient pays us directly. And then they submit the claim themselves, or we can submit the claim for them. So the majority of patients now have no out of network benefits. So what we end up doing is just billing the patient directly. And there are some insurances that we don’t take it all. And so even out of network, so what we’ll do is we’ll just, the patient will pay us directly and then they’ll submit on their own. We just give them a receipt, but out of network. So long-time patients of ours. We will bill the insurance company for them and wait for the insurance company to pay them, pay us, excuse me. And we’ll charge them the co-insurance and that’s gotten much less lately.

Speaker 1 (24:51):

Yeah. And can you explain what a co-insurance is?

Speaker 2 (24:55):

Yeah. So there’s the co-pay and the co-insurance, the co-pay is a fixed amount. That’s generally used for an in network model. So you have a 60 per dollar copay when you see a specialist. So co-insurance is based on a percentage. So for example, I work for, you know, large company, a here in New York, I have Cigna, my benefits are 70%, 30% Cigna will pay 70% of what’s reasonable and customer in 30% is the co-insurance that 30% of the co the co-insurance is based on what you bill out of network. So you bill $400, the co-insurance can be 120 bucks, or it could be lower. We generally drop it lower. Okay. But we’re because we’re not contracted with, with any insurance companies. So a lot of people lot of lately, a lot of insurance companies have been sending patients letters like you, just so you know, you’re seeing an out of network, I’m using this in air quotes, out of network, physical therapist, just so you know, they can balance bill you. So they’re doing a lot of these sort of nefarious practices to get the patients saying, well, I don’t know if I want to do an out of network practice, and they’ve been doing this for a while now, but in my patients know better. But recently someone brought in a piece of paper and it was not, was not a bill. It was just a statement of fact we’ve received charges, you’re out of network, just, just FYI. They may balance bill you, which is, you know, they never did that before.

Speaker 1 (26:21):

Yeah. And balanced billing is

Speaker 2 (26:24):

They’re going to build. So I’ll use a simple example. Let’s say $300. We charge, for example, let’s say that’s the number the patient’s covered at 70%. Assuming. So let’s say that it’s, that would be two 10. That’s usually not what they pay. Let’s say they pay one 50. The co-insurance we charge was 50 bucks. That’s $200. We can bill them to a hundred. That’s a balanced bill means you balance you balance bill up to what you’ve charged.

Speaker 1 (26:48):

Got it. Got it. Yep. Just so people understand what all the well, because we’re throwing out a lot of terms here. I want to make sure people understand, because this is all about the business of physical therapy, right. This whole month. So this is, this is literally the business, right.

Speaker 2 (27:04):

And I will, and I will. Yes. And I will tell you lately, a lot of plans just for anybody who’s wants to do an out of network and bill and accept what they pay. A lot of plans are being, being reimbursed as a percentage of Medicare, which as we know is not great. So more often than not, you do not know that upfront. Sometimes they’ll tell you, we do mostly electronic right now. And they won’t, if there’s nothing on the site that says patient is reimbursed at a certain rate, so you’ll get paid. And then you realize, oh no, this is not enough. And so, you know, and that happens a lot of times after the fact. And so we have to, we have to you know, make the different part of the difference up in the co-insurance. So it has to, it’s just, we have to, because of the, you need, we deserve caring.

Speaker 2 (27:51):

We deserve to get paid. This is what I say every night or every morning I write in my journal, my work is of high value and worthy of massive compensation because it is yes, we deserve to get paid. And and patients accept that now a lot more than they used to, a lot of patients now do not have out of network benefits at all. So they just pay and that’s that, and that also comes down to your ideal client, right? Who, you know, you want, do you want somebody who’s just going to like, you know, ask you to drop your rate or cause they, they will do that. They will ask you to drop your rate. And I generally don’t do that anymore. You know, it’s a special situation of course, but because those people are not sort of going to stick around, right?

Speaker 2 (28:36):

You want a lot of people who have no problem paying and it, depending on what your rates are, they will stick around and they will have no questions asked. And that, you know, as, as an entrepreneur, you will hone that ideal customer avatar over time. But speaking from experience, it is very frustrating when you, you, you treat an hour an hour and 15 minutes sometimes with people in any insurance company, out of network reimburses you at a percentage of Medicare, that’s a joke. So you and I would get angry over it. And so at a certain point, you know, I, you know, a lot of I’m happy that we don’t have out of network benefits a lot of the times, because it will save me that frustration and anger and the patient can just get reimbursed themselves, you know, pay me directly. But once again, as a new PA, if, if we have people who are just starting out or they’re five years in the business and they want to start their practice, they may have to do that. And you’re going to learn over time that the reimbursement changes from between insurance companies in between dates of service. I mean their insurance companies who we bill out of network will pay different rates for the same codes. It’s just ridiculous. It’s ridiculousness. And, you know, we have a small practice, someone who has a large practice like that, who’s getting hurt like that. You need to almost hire us, hire like an advocate or somebody who can negotiate for you, you know, because that that’s, that’s a full-time job.

Speaker 1 (29:57):

Yeah, absolutely. And, and I think that it was really important to go through all of that, because that can be really confusing, especially for a new physical therapy entrepreneurs who want to start their own practice, who are on the fence. Should I take insurance? Should I not take insurance? I always tell people, call insurance companies and find out what they reimburse in your area. Yeah. Because it may be worth it to take an insurance, take one insurance and not take the others because there are insurance companies that may reimburse 120, 150 a visit. Hey, that’s not bad.

Speaker 2 (30:33):

I will tell you there’s a couple of patients. And if it’s planned dependent, because there’s far and few between, like I can count on one hand, the amount of patients I have who have like the platinum insurance plan. Right. And you will get paid more than your direct rate, which that number is dwindling. I’ve had people therapist asked me recently, should I? Because of COVID because of the financial stresses people are under, should they start billing out of network for their patients? And I basically tell them what I just told you. It’s, it’s, it’s a great service you can offer. But if you don’t have an assistant, you will be on the phone way too much than you want to be on the phone. Okay. so it just misses out your priorities. Yeah. Yeah.

Speaker 1 (31:16):

And actually my next, that was going to be my next question for you is if let’s say a, a budding physical therapy entrepreneur comes to you and says, gosh, what, what was one of the biggest lessons you learned when in the course of either starting or now continuing to run your business? What would that be? Hmm. I think

Speaker 2 (31:47):

With regards to, I would say being willing, being open and being open to collaboration, being open to like expecting the patient to do the right thing. Because a lot of times we can say, oh, their patients never got going to pay. They’re not going to do this. They’re not going to do that. And I think that a lot of about being an entrepreneur, and this is one of the biggest lessons is, is your mindset. It’s the vibration that you have. And it may sound woo woo. But trust me, it works. You know, 80% of this is mindset. 20% is execution. You know, you can sign up with an insurance company, you can do the billing, you can put the codes and you can do the evil, right. It’s about minds. If you expect people not to pay you, or if you expect people to, you know, B B be difficult with, with regards to where, if you expect with insurance, we expect to have a difficult time.

Speaker 2 (32:44):

You will have a difficult time. And a lot of it is mindset. That’s the biggest lesson I think because the technical stuff can be, can be taught, you know? And when I first started out opening the practice, I was looking for a mentor in our profession and, you know, Karen, I still, I couldn’t find one. And it was very frustrating because I was I was, you know, did have an MBA, but the school of entrepreneurship didn’t was not open at stern. And when I was there, right. So I was coming from a corporate culture, transitioning to an entrepreneur, an easy transition in terms of mindset, but not an easy one in terms of logistics of, you know, what does it take to be an entrepreneur versus working for a corporation or corporate it’s very different. You have to really advocate for yourself.

Speaker 2 (33:32):

You have to know who you have to know who you are treating. Your marketing is huge. You have to really learn a lot about that even before way before you even, I mean, I w I wouldn’t say learn that before you start your business, because most people, if we did that, we would still not have a business. You know, I would just start and go and you’ll learn, you know, but, but the mentorship is huge. I think because why reinvent the wheel when someone else has done that? So talking about the 80% strategy, why, why reinvent the wheel, find somebody in our profession who can mentor you, right. That can help you do that. And the 20, the mindset is stuff is, is, is you, you can learn with mentors or finding somebody outside of our field to help you with that. But that’s, that is important.

Speaker 2 (34:17):

And I believe that the, the, I know we’ve got a lot of business groups out in our field right now who charge very large sums of money to, to, you know, to up to, you know, and they’re great programs, but I will throw out an option. You know, there are a lot of great physical therapists out here, you know, who have business backgrounds, who are entrepreneurs, who have successful businesses like you and me, we, we could all easily help out people, you know from a mentor program. And, you know, we need to grow the profession. We need to grow our physical therapists. And I think it’s important that we give back and, and it being, and, and learning one of the main things I’ve learned as side’s, the mindset is learning to be a mentor and learning the importance of mentorship. Because I didn’t have one when I first came on and I still don’t have one yet. I’m still looking, but, you know, that’s why I have a team and collaborate with people like yourself, you know, cause we learn. But I do think that people should like you and I are like on the front lines, so to speak, right. We’re, we’re, we’re, we’re seeing patients, we’re, we’re actually doing it, we’re running a business. And I do think that is important when people look for programs out there. Right. Because I think it’s, it’s, you know, we’ve done all the hard work. Why reinvent the wheel? Yeah,

Speaker 1 (35:41):

Absolutely. I couldn’t agree more. And I think that’s great advice for any upcoming entrepreneur in the physical therapy space. And before we jump off, where can people find you, if they want to ask you questions, if they want to know how you do things, where’s the best places for people to reach

Speaker 2 (36:00):

You? A couple of things, we have a podcast with the wonderful Susan Clinton and myself it’s called tough to treat. Yes. we’ve got our a hundred, our hundredth episode was last week kind of

Speaker 5 (36:11):

Crazy. Right. I was so proud my God.

Speaker 2 (36:14):

So there’s our website, tough to treat.com and I’ve got a bunch of website, our business, the website, but I’ll give you like the way to reach me is all my handles on social media are at Erica mellow. And my email is erica@ericamellow.com.

Speaker 1 (36:31):

Perfect. And your website, Eric

Speaker 3 (36:33):

And mellow.com. Yes, yes, yes.

Speaker 2 (36:37):

Yeah, no, I’m thinking more philosophy. Physio. One is being redone right now. So that Erica mellow.com is a,

Speaker 1 (36:42):

It’s a good one. Perfect. And we’ll have the links to all of that at podcast dot healthy, wealthy, smart.com and the notes for this site for this podcast. And I know that you’ve answered this question before, but I’ll ask it again because you know, more advice from you is not a bad thing. And that’s, what advice would you give to your younger self? Maybe like fresh, forget, forget you your first job out on wall street, or even your MBA. How about like fresh out of undergrad?

Speaker 2 (37:18):

That’s a good question. And you asked this of everybody, right? I, I know this, I know you do. I think that, and, and I’m saying this now because I’ve experienced so much throughout the life, I’ve lost loved ones and things like that, but be unapologetically yourself. You know,

Speaker 1 (37:39):

I know don’t we waste too much time being somebody else. Yep.

Speaker 2 (37:44):

Yep. It’s at it is. Yes, we have. We do. And I think that if we are Susan always calls me my podcast. CO’s a confronter, I’m like, I’m not really a confront her, but I do, you know, have opinions. And I think that we that’s the advice just, you know, open your mouth basically and be up, be yourself.

Speaker 1 (38:09):

Excellent advice. Because like, like you said, we waste so much time trying to be somebody else and trying to conform to what people think we should be instead of just being who we are.

Speaker 2 (38:19):

Yes. And I, and I think that if I were to give an like other advice, because there’s so much burnout in our profession now is that, you know, we need to find joy in our life and whatever that is, it varies for everybody need to do more of that. And this is a practice that I’ve done. So I recently went to a polo match gesture day. And so I have every year I have a thing called magical moments. And if I have a magical moment like that, I write it down. So it can be like, you know, spinning at soul cycle and Hudson yards during a pandemic, you know, or, or, you know, going to the, met with my niece or going to a polo match or Disney when I, and so at the end of each year or new year’s Eve, I’ll look at that. And I’m like, oh, I actually did have a nice year because I think we don’t write those things down, you know? And I, and I think that’s good for, for, for us to do.

Speaker 1 (39:10):

I love that. I love it yet. Another great piece of advice. Well, thank you so much for coming on the podcast and we will see you again at the end of the month on Tuesday, the 27th of July for our business of physical therapy round table talks, I’m really excited. And for all the people listening, you can find that out in the show notes as well, how to get more information on that round table. So I’m looking forward to that. So thank you so much, Erica, for coming on

Speaker 2 (39:45):

Again. You’re welcome, Karen. Thank you. And, and to all

Speaker 1 (39:48):

Of you guys listening, thanks so much, have a great couple of days and stay healthy, wealthy and smart.

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©2019 Karen Litzy Physical Therapy PLLC.

©2019 Karen Litzy Physical Therapy PLLC.