Episode 9: Addressing the 90% Problem

Richard: Welcome back to Agile&Me. A Physical Therapy Leadership podcast. A podcast devised to help emerging experienced therapy leaders learn more about various topics relevant to outpatient therapy services. Today's podcast is titled Outpatient Physical Therapy, addressing the 90% Problem. Our guest is Scott Hebert. Scott's the director of product Management for Web PT, the nation's leading rehab therapy software platform, and the co-founder of Strive Labs. Welcome, Scott.

Scott: Thank you, Richard. Glad to be here.

Richard: Before we start talking about what is the 90% problem and how we address it in outpatient therapy, would you be so kind as to perhaps give our listeners an introduction of yourself?

Scott: Yeah I'd love to. As you said, my name's Scott Hebert. I work right now at Web PT, working on our product team, working on our patient relationship and management product line, and working with our product managers to solve complicated problems in rehab therapy. It's been a blast. Before that, I was the CEO and co-founder of a company called Strive Labs. We were the first patient relationship management software built specifically for physical therapy. And that company joined WebPT about four years ago now. I started that company right outta college, actually with a colleague of mine, Ryan Kle. Both of us went to physical therapy school in Hamden, Connecticut at Quinnipiac University. Both got a doctor of physical therapy, though neither ended up practising in clinical care for all that long as we kind of transitioned into the software. So I've been looking at the gap between clinical care and technology for the better part of the last 10 years. And specifically looking at as a profession how we better engage patients and by doing so, drive better outcomes and improve physical therapies placed in the broader healthcare ecosystem.

Richard: I've heard a few times the concept of the 90% problem, and first off the listeners, we've got to really define what that is before we can even attempt to understand how we can address it. What exactly do you mean or do we mean when we talk about the 90% problem?

Scott: Yeah, it's probably the biggest problem that I feel like our rehab therapists, physical therapists, and occupational therapists don't even realize that we face. So we've started to use the term, the 90% problem. Here's the simplest gist of it. Today, musculoskeletal conditions are the most prevalent health condition in the United States. So one in two adults every single year will develop some form of a musculoskeletal injury. And what's staggering about that is we think about some of these broad disease categories like diabetes or hypertension or cancer and we don't realize that actually as therapists, we treat the most prevalent health condition in the world and the most costly. We actually sit in this incredible position from the ability to drive value in the healthcare system, physical therapy, and occupational therapy. We sit at this perfect place within broader healthcare. Yet we are woefully underutilized, and that is what the 90% problem is. We've realized that every year despite this massive number of folks that develop conditions that we can treat really well, 90% go untreated by physical therapy. And only about 10% of those patients end up walking through our doors. And so this problem boggles my mind because we've seen study after study of the value of physical therapy across so many areas of the Musculo scale, and yet we continue to be so poorly utilized. So when we say the 90% problem, that's it. It's 90% of those of over 150 million folks that develop musculoskeletal injuries every year. They never actually end up seeing us. So that's what we're, we're out to try to do.

Richard: I can accept the idea that the general public doesn't necessarily seek out care even though a significant proportion of them have MSK issues ongoing or it might even be acute each year. But what I truly don't understand is the fact that even healthcare professionals don't really accept or understand or acknowledge that there is the 90% problem. Do you agree?

Scott: Yeah, I would and I'll tell you that I think it's changing, and I'll give you some data points for why I think that's starting to change, thankfully. But yeah, it's been the most frustrating part of the problem. And depending on whether you want to be an optimist or a pessimistic, we can go down a few different paths as to why it's become the way it is. But you certainly.

Richard: I have as a clinician, I would go and market and I would connect with various types of physicians and I'd walk into certain family physician offices and the family physician would say, oh, well I don't use physical therapy. And I'm thinking to myself, how, how could you not use physical therapy for your patients? Given the fact that, as you say, one in two adults have a case issue each year.

Scott: Yeah, it's the second or third most common reason people walk in the door of their primary care doctor. Right? It's tremendously common that those are staggering. My cousin, just as a data point of one, but just a good example, um, is a primary care doctor. She's come to me multiple times saying, Hey, what I was trained around musculoskeletal was woefully inadequate to provide help for my patients. I need to understand better the role of physical therapy, right? I think in our primary care training, there's a lot that needs to be rethought in terms of the ways and how we can educate to hopefully, to hopefully help these other providers through the care continuum. The value that physical therapy can bring.

Richard: I think it is the fact that if a physician misses the yes idiosyncrasies of what's causing a specific knee discomfort, they get away with that rather than those conditions that are life or death. So I must give them a bit of strength.

Scott: It is very, very true.

Richard: There are definitely patients that can benefit from our services. Don't get them for whatever reason or don't understand that we can help as a profession, alleviate symptoms. Why do we believe it's 90%?

Scott: I think there are a few broad categories when we start to look into this and so you have to sort of just like you would think about your marketing efforts right? I like to think about this conversation in terms of a funnel. And so there are your foundational aspects of awareness, I think you can find, I'm sure you may have had other folks on your podcast, or you could listen to another podcast in the physical therapy field where we compare ourselves to chiropractors. But I think there's a valid point here, which is that chiropractors have done an excellent job of branding around a specific problem set. People associate back pain with chiropractic and the power of chiropractors for doing that, right? People associate your teeth with the dentist and so on and so forth. I don't think physical therapy's done that as well. Right. I don't think we've articulated the problems we solve as well as some of these other professions. So we have just a foundational awareness problem.

On the other side of it though when you get past the awareness and you start to look at some of the referral pathways, there is some fascinating data around utilization and utilization patterns. And again there are many here but I think some of the more interesting ones focus around. What alternatives are provided instead of physical therapy? I think this has been the area when, when I said before there are some positive signs that this is changing. Groups like Optum and United Healthcare have done as they've looked at their referral data patterns. What they found was that a lot of times for injuries that physical therapy could have treated very well, you saw people entering referral pathways that led them to specialist visits, imaging, pharma, pharmacological, and prescription, and because of all of this, they got pretty crummy outcomes and they drove up a ton. I think that there's a major element to how we look at our higher-level sort of referral pathways and the impact that those referral pathways can play on utilization. I think you can see that in many areas of health, but Musculo scales are certainly no different.

And then I think there's a final area that I need to also mention, which is this idea around cost and value. And so they found that especially with the rise of high deductible health plans, the cost of physical therapies continues to rise, or at least the patient. The patient's responsibility, in terms of cost, has had a negative effect on the utilization of modalities like physical therapy. I do think that that is problematic and that's why you've seen some players change their model, right? Where for certain things like low back pain, there's no longer a copay because they don't want financial barriers driving folks. So there's definitely many more, and I'm happy to get into some of the weeds of this, but I think those are kind of our broad areas as to what we look at today. We'll continue the conversation after a short music break and advertisement. The world around us is changing at a rapid pace, and so is our preference for how, where and when we choose healthcare. That's where Agile virtual care answers the call. Agile virtual care is a comprehensive telehealth. Revolutionizing physical therapy by making PT convenient, safe, and accessible across the entire country for providers and employers looking to offer employees different options for preventative and continual care. Agile Virtual Physical Therapy delivers the comfort and convenience that patients want and the quality care they deserve. From experienced licensed therapists,

Richard: Welcome back to Agile&Me. It's as if the physical therapy profession is keeping this best-kept secret. We seem to be our own worst enemies, don't we? In regards to, oh, I don't tell him we can help you because otherwise we'll be inundated. Now I kind of joke it's somewhat, but it does feel like that sometimes, doesn't it?

Scott: It is so true. As we look at this, I try to explain this 90% problem to people and show them the data behind it. The key here is we've also become tremendously competitive with ourselves. And that's the most frustrating thing in my eyes is that we spend so much time competing with the PT practice down the street, but in reality, we're fighting over peanuts. There's 90% of an addressable market that we can go out and get and we have to find a way to do that. The other area I'd again be remiss if I didn't mention is that I think we're also too frequently we're kind of what I would think of as an end node provider in a referral network. We're like specialists. People will refer to us, and that's sort of the end of the transaction in medicine. Referrals are currency and I don't think we look at the opportunities where we can insert ourselves higher up in the funnel of patient care. Therefore kind of have what might be thought of as reverse referrals back to a doctor and how we can continue to demonstrate our value.

Richard: The issue of the healthcare system which we're operating adversely influencing the perception and utilization of therapy is something I find really interesting. So for instance in England, there's been direct access to physical therapy since the early 1970s, and physical therapists are seen as a primary providers of care rather than secondary providers. But the American system, It's changing slightly, but it still is really dominated by the fact that therapy is usually referred to as that. That will change, I believe, in the long run, associated with direct access. But certainly, that's still dominant, isn't it? And I think that hasn't helped us until the consumer and even other providers see therapy as a primary intervention. I think we'll never quite address this 90% problem. Will we?

Scott: So I'm on both sides of this. Yes. I do think that that is a major factor. But I also don't know how optimistic I am to think that we've got the clout and ability as a profession to be able to reposition as primary care providers or as a primary providers. I mean, I agree, I love the model that the UK has utilized, but I think it's gonna be hard in the Americanized health system for us to do that. And I think that there are maybe alternative pathways for us to get there.

Richard: Going off topic slightly, I talk about there are obviously multiple stakeholders in healthcare and the issue is not all stakeholders are aligned in a similar way, are they? I think that doesn't necessarily help us as a profession.

Scott: The hardest problem we have in physical therapy is this idea of the economics of the principal-agent problem. So is American healthcare. Falls apart because the individual receiving the benefit is not the one that's paying for it. In a traditional insurance model. Now you can argue with some of these higher deductible plans, but that's changing. But because people aren't making the same rational cost value or value-based sort of price question, they're asking themselves that same question. When it comes to healthcare, you see some really kind of behavioural patterns, and I think it makes it really challenging for physical therapy

Richard: As we've talked about, there's really a small proportion of people with MSK disorders that we are seeing. It's funny, you talk about fighting over the crumbs, it's as if we're, we are trying to. Divvy up the scraps, whereas the table next to us has a Thanksgiving feast, isn't it? But the reasons why I think personally, we only see a small proportion of those that benefit. First and foremost a lack of general awareness and education about what PT can offer, and then also really a lack of perceived value by potential patients. Do you think I'm being unfair?

Scott: Here's the tricky problem I have a hard time a hundred per cent agreeing with the statement you just made. When we look at, so Richard, right? One of the main things that we do and the software we provide is a tool that can measure patient loyalty. I say loyalty over satisfaction. We use the net promoter score. That's sort of what that's measuring. There are hundreds of studies that have looked at NPS and its role in terms of its ability to project revenue. Forecast, churn, things like that. And they've all shown positive indicators that there is a correlation between higher loyalty and larger purchase prices, things like that. Which have at least a correlation with value. And physical therapy is fascinating. We're sitting on top of the largest NPS dataset and physical therapy in the world that I'm aware of and what the data shows is the net promoter score in aggregate for organizations across the United States is about an 84. And to remind those that may not be as familiar with the Net promoter a positive 100 is a perfect score. A negative 100 is a perfect negative score. So when you look at that, compared to other industries, we are far in a way an industry that drives tremendous brand loyalty.

So I always have a hard time saying that when somebody, that physical therapy doesn't demonstrate its value, because I think if it really didn't, I think that that score would be a heck of a lot lower. I think we'd have challenges. I am mincing the question a little bit because I think those that have experienced physical therapy, can demonstrate our value tremendously. Well, For those that have never, I think we still have room to grow, right? And so I think that that's key here is how do we change the perception or help build on the experience of what is physical therapy and how can physical therapy help specifically for those that have never experienced it before? I think for those that have experienced it, I think we actually do a tremendous job living up to our brand promise.

Richard: I agree. It's remarkable the number of times that patients either have no awareness or some negative perception of therapy in there, but once they've received therapy, there convert, aren't they for life. Yes and it's just a shame that we aren't able to give therapy to literally the entire population. And then, then there'll all be converts and we'll address the 90% problem over.

Scott: Well and that's the thesis though Richard of the software that we built, right? Which is that a lot of people said, well, why didn't you build a referral management software to help us go after Doc? However, why I care so much about what we built with a tool like Reach is that it really was designed to help say, okay, let's capture and understand who's had a great experience. And let's make it really easy for them to share that information or to increase the likelihood that they come back, should they get injured again. And we do believe that over time, right, that we are gonna chip in through, through some of these, you think of viral dynamics, right? The more people that we can convert, the more they'll tell their friends and family, and physical therapy will ultimately grow. And I am still bullish about that. I think we've seen the beginning stages of a lot of that work over the last few years.

Richard: We've mentioned very briefly chiropractors, but what I'd like to ask is why do you believe that the general population doesn't have the same perception of physical therapies of other providers such as dentistry, podiatry, chiropractic, et cetera? All those entities have patients that really are the continual consumer. I believe that based on a lot of musculoskeletal conditions that really are chronic in nature or certainly intermittent, I've never really understood why we haven't developed those long-term relationships, like the other providers. Do you have any thoughts on that?

Scott: Yeah, well my short answer is I'm 100%. I think that if we were to re-look back at this conversation we're having right now in even 10, 20 years, I think we'll see things differently. I'm certainly hopeful we do and I think it's always important to remember we are still, relatively speaking a very young profession, and so I think a lot of maturations a lot of our ability to grow and build a more established service model, I think are still gonna continue to develop over the years to come. So I think that there are a few things I think on the dentist side, what you've seen happen tremendously well is the proliferation of these dental practice management roll-ups. That has treated the business of dentistry in a much more effective way.

And while we can argue about the value of similar rollups in the physical therapy field, we also see this happening. I think what comes from that degree of sophistication, I think comes an improvement in the ability to retain a customer base. So that's things like reactivation. How do we reach out to past patients and remind them that we can still provide value? How do we continue to build this brand image of a provider or resource for life? We're starting to see a lot of practices, especially on the enterprise scale. These larger roll ups starting to do very effectively and that's why I think we'll start to see this change in therapy. The other challenge though that we have, that I think chiropractic has done well is they've niched down to a very specific set of conditions. And I think you and I both know that chiropractic does treat a very wide, actually breadth of conditions, but the general public doesn't, and they think about chiropractic in terms of back.And they're kind of niching down to that specific market, I think as a differentiator that has served them well relative to physical therapy.

And I think one of the biggest challenges we have is just the breadth of, of types of physical therapy that exist today. We treat athletes and infants and geriatric populations and we treat them across all sorts of condition types, neuro to orthopaedic and everything in between. I think that does put us at an interesting place in terms of explaining, well, what exactly is physical therapy? We'll continue the conversation after a short music break and advertisement. Most orthotic manufacturers take a one shape fits all approach to solving lower body pain and symptoms. They focus on arch support for temporary pain relief which can end up leading to inefficiencies in injuries. That's where Bio Correct is different, more than just an insert bio. Correct is a fully customizable foot orthotic system engineered to address and treat biomechanical imbalances of the entire body and we're backed by more than 25 years of experience. To learn more, visit us at www.biocorrect.com

Richard: Welcome back to Agile&Me. It's interesting you talk about a business mindset, I think as therapists a lot have, and still many do perceive the term business as almost a dirty term. Particularly when you talk about sales and marketing. You see therapists' eyes kind of glaze over, but the way I see sales and marketing is really improving the patient experience and clinical outcomes eventually and talking primarily profitability, it, it, it has to be framed in the clinical sense, doesn't it?

Scott: To be frank I had the hardest time trying to figure out what to call the software we were building at the time cause we were building marketing tools, but we couldn't call 'em marketing tools because there was a stigma against marketing and healthcare and it's a fascinating problem, but I totally agree. Our profession has this opportunity for what I like to think about as a double bottom line, which is that we generate revenue through providing services to individuals that need to recover and reach a better health outcome. And we get paid to do that. It's an amazing profession, and so you have this great opportunity to both improve outcomes and the quality of life of the people we treat and make money while doing so. And if you can do better. A colleague of mine always says there's no mission without a margin. And I think it's such an important mindset to have.

Richard: It's interesting that you struggle with naming your product because you didn't want to use the word marketing. I have a funny story where I was heading up some operations for a medium sized PT company and we were designing or writing a handbook. I said to the person who I was working with, we mustn't use the word marketing in this entire handbook. And it was really, really quite entertaining trying to think of creative words apart from marketing.

Scott: It is so true, it's been so hard. In recent years we've stopped, right? We've given up and we said, no, we're gonna be okay talking about this in marketing. Cause we have to mature, the industry has to mature. We have to get okay with this and we're starting to see improvements there.

Richard: The biggest threats to the profession I perceive are the design of the healthcare system. I think it's flawed and we won't necessarily ever fully address healthcare until we change it further. But I'm also a realist and understand that that's unlikely to happen. But the pressure's on reimbursement too, and that can be argued to be part of the health system we're operating. I believe that a large threat to the profession is actually ourselves, therapists. We seem to spend more time focusing on our energies, on creative ways of preventing or changing or minimizing it, rather than embracing the changes and perceiving them as opportunities. Do you see that as a problem as it pertains to addressing this 90%?

Scott: Oh 100%. I actually would argue, I think those two that you discussed, both the health system design and our fear of change, I think are coupled. I think they're actually, in some ways they become the same problem. I'll give you guys sort of an example of I think to me what I see as one of the broader existential threats right now and how it relates to both. So as I started out talking about the 90% problem. It's become abundantly clear that the cost of managing musculoskeletal care is now the square centre of the bullseye of how we reduce costs in healthcare. I think we're at a tipping point moment because there are two paths we could go, right? When you look at the broad picture, what you realize is the clearest day. When we say groups like United Healthcare are seeing this, Optum seeing this, I mean at the payer and largest provider level, they're, they're realizing the problem is not physical therapy. The problem is opioid prescription. The problem is imaging. The problem is speciality surgery when surgery is unnecessary. All of these are the real cost drivers, but yet what do we see? Fee schedule reduction in physical therapy. We see a reduction in physical therapy visits or higher pressures put on utilization management. I think part of our problem is we are unwilling to adapt our service model. And so we keep just taking these punches, right? We keep taking 'em and taking 'em and taking him instead of starting to get out. So one thing I'd love to talk to PTs about right now, cause I think it's, it's one of these issues that's just going largely unnoticed. Richard, are you paying attention at all to groups like Hinge Health or Omada, Sword or Kaya, any of these startups Ring a bell?

Richard: Absolutely. In fact, they're in some respects, a competitor to our business, Agile Virtual Care. But yes I'm well aware

Scott: Yeah. Which is great to hear. I talk to every PT owner I talk to and a lot of 'em still tell me, I've heard of 'em, but I don't really know what's happening there. So just to inform this audience, there have been just over a billion dollars raised for these technology startups over the last better part of the last four or five years, and what they have all realized is that managing musculoskeletal conditions in a digital way has a huge opportunity to reduce costs to self-insured employers and to payers. And what are they doing? They're just changing the delivery model, right? They're looking at how we utilize virtual means. How do we intervene early? And they're doing tremendously well. And I think that this is such an important moment because these companies, what they're becoming are just large physical therapy companies. They just don't have physical brick-and-mortar real estate. I think this is such an important lesson to us, which is they're not waiting around on the reimbursement from a payer and taking the fee schedule reduction. They're not waiting around with some utilization management company that's saying you need to get authorization every three visits. What they're doing is they're saying, no, we're just gonna change the whole model. We're just gonna go direct to employers. We're gonna provide a combination of tech. We're gonna leverage technology to provide a better scale. We're gonna hire physical therapists. We think physical therapy is part of the equation. We're just gonna deliver it in a different model. And I think this is one amazing, I think it's awesome. I'm so happy to see the success of these companies, but also I think it represents physical therapists and I agree. I think it's an aversion to change. I think it's part of our mindset, and so I'm fascinated to see how these companies continue to do in the coming years and how physical therapy adapts in the face of this change.

Richard: What I would like to obviously point out is the fact if anyone thinks of virtual therapy first, obviously think of Agile Virtual Care before the competitors, please. I feel that the reimbursement challenges over a significant period of time have somewhat shackled them. I often think that PTs feel like a beaten dog in the corner and they've kind of given up fighting back or changing their behaviours because they've had so many. Whereas I think the only person that's really shackled them is themselves. But unknowingly there are definitely ways I believe of avoiding that victim mentality. And changing how we treat and the medium we use in order to not only improve value and reimbursement, but also enlarge our patient population.

Scott: Totally agree. There's this concept of the sort of fixed versus growth mindsets. I think historically many physical therapists, I would categorize into the fixed mindset. Things are the way they are and that's how they will be. I have to work within this framework and I think we can continue to go full psychoanalyst on this and say that's partly because we look at sort of our hierarchy of needs. There is some unmet security. Still but I do think it's important to start adapting towards more of a growth model and a growth mindset. Thinking about how can we look for opportunities to succeed and what efforts can we put in that will yield that success? I'm an optimistic person by heart. I believe that it can happen. But yeah, I think it's a transition we've gotta make. We'll continue the conversation after a short music break and advertisement. Agile EMR is a comprehensive all-in-one electronic medical records solution created by physical therapists or physical therapists. Features include everything you need to run your physical therapy practice in one place. To schedule a demonstration of Agile EMR, visit our website at www.agiletherapyemr.com

Richard: Welcome back to Agile&Me, A Physical Therapy Leadership Podcast. To address the 90% problem, do you believe that it will need a paradigm shift, or can we achieve change on an incremental basis within the profession, do you think?

Scott: That's a great question because paradigm changes are hard, right? I don't wanna underestimate the challenges of paradigm. I don't wanna think it's important to paint a picture. I do think we're gonna have to start doing some things differently to make that happen. So I think that we will see improvements in the 90% problem by doing a few small things. I think to really see a big change, we have to do big things. So let me kind of break them both down. I think on a small thing basis, we can make changes in the 90% problem by continuing to focus on retaining the patient population. We have provided amazing experiences and made sure those patients understand the value of sharing their experiences with their friends and their family members. By doing that, we set ourselves up on a scalable path to control the growth and utilization of physical therapy, and I think that's a really important piece.

Second, I think we have to continue to focus on advocacy. And I think that advocacy takes place both at the federal level and with payers. We need to continue to push forward the data around how the utilization of physical therapy drops, and the overall cost of healthcare. Some of these research papers that have been done by United Healthcare, Optum, and Intermountain, have all shown tremendous results for utilizing physical therapy and what that does to reduce costs. So I think those things, as we continue to push for them, will have a significant impact. To where we need to get to. I think the paradigm shift that we have to start being more thoughtful about is our delivery model, right? I think we need to start expanding. The view of therapy has to happen within four walls. By doing we have to think about patients as consumers and how there's been this shift over the years towards convenience. I did an internal talk at our Ascend conference this year where I talked about the convenience economy, and we think about today, I have groceries delivered to me. Barely ever visit a store. Cause I can purchase it on Amazon or I can have something shipped from a local store here in Phoenix where I live. And all of those opportunities, right? Patients are consumers and they're expecting a similar experience when possible. They want things to be easier. And we put a lot of barriers in front of providing therapy care. And so I think the paradigm shift that's gonna be most impactful to driving higher utilization and really cutting into that 90% problem is gonna be rethinking our service delivery.

Richard: It's interesting you bring up the concept of consumerism. I wrote a blog a while ago that was titled Needs Once and Wow and really it mapped out the change in healthcare delivery from a position of essentially, Delivering to the patient what the healthcare professional believed is what they needed to one where it was really addressing the wants of the patient. So instead of being focused on the clinician, it's become focused on the patient, but really it needs an additional shift to address the wow. What I mean by that is really anticipating the demands before and might even need that the patient doesn't even necessarily understand or can verbalize. And I think that that will really need to be the focus to really drive that shift.

Scott: Yes. I couldn't agree more and I think it's such an important trend to be following and paying close attention to realizing that this is not a byproduct of entitled millennials alone this is the shift in behavior and consumer behaviors is happening across all demographics and to really be thinking like you said, where those wow experiences can come in and how, how we can do that. I just received physical therapy for a back injury that happened while I was playing pickleball, I'm not that old. I still did injure my back while playing pickleball. And I'll tell you, I mean, I knew the value of physical. But I was able to basically recover from crippling low back pain to the point where I was, could not walk in a matter of a week and a half with some great physical therapists. That was a wow moment for me, and I knew the value so we are sitting on the precipice of having the ability to deliver these types of experiences, but we're doing so in a model that had a lot of annoyances, whether it was insurance reimbursement or intake or, um, the process of having to drive to a clinic.

Richard: Excited to see that shift. I'm very glad that therapy was able to help with the injury. However, what I would say is probably you need to change your story and just change out pickle pickleball with something more thrilling and exciting. Obviously, the podcast is geared towards clinic owners, aspiring leaders, and clinic directors, and I always like to, Be able to give them tangible, actionable items that they can take away to improve their practice. So what would you say are the tangible things that clinic leaders and owners can start doing to address this 90% problem now?

Scott: Such a good question to ask. So before I said a couple of times now, I think the foundation of solving the 90% problem is understanding the impact of the existing patients you treat and understanding their role in driving you, new patients. I ask almost every practice we've worked with, what is your strategy for growth? And they'll all say word-of-mouth marketing. And I ask them, okay, well what are you doing to support that? And they go, ah, good question it's a strategy built on hope.

So the first place that I'd like to say is you can operationalize word-of-mouth marketing and you can put systems in place to drive it. And so a super important element to consider, right, is how are you going to monitor patient loyalty? How are you going to reach out to patients after they're discharged? How are you gonna ensure that those patients share their excellent experiences with you? And how are you going to continue to work with your community to ensure that, that you're, you're highly visible and a provider of choice in your area? And so there are a lot of tools to do that we mentioned today. I always love to tell people, if you aren't measuring Net Promoter, you should start doing that today.

The second piece is understanding how you can leverage Net Promoter to understand and improve your visibility in your local area. And that is something as simple as helping your practice generate online reviews and so we talk all the time about it, but Google is the number one place that people still search for local services. If you are not ranking high on Google, especially within Google Local, you have to come up with a strategy for how you're gonna solve that. The best recommendation I can make for you is to measure Net Promoter and of those loyal patients, send them a link to fill out a review online. It's super easy to do and can drive some really great outcomes in terms of your practices, and online visibility. And while small, it definitely can play a role in terms of making you more visible, making it easier to.

And then the third and I'll say this is more aspirational, but I need people to be aspirational here, so this will be my final recommendation, is really think about your patient's journey. Think about it from the first moment that they get injured, all the way through to how they're gonna discover and find your service. How they're going to experience your service the first time they pick up the phone and call or request an appointment online. What their experience is gonna be like when they first walk into your practice or, or how they're gonna be treated. Maybe they don't come into your practice for the first time.

Then what is that journey gonna be like throughout their process of recovery? I think by exploring the patient journey and looking at those points that provide friction, figuring out how you can reduce and eliminate that friction, you're taking your step closer towards some of those wow moments that you described by doing so, you just increase the likelihood that you're gonna improve this word-of-mouth marketing. That you're gonna drive more patients into your practice because of these, these wonderful experiences. So certainly I'm not gonna sugarcoat it, it's a hard challenge to solve, but one that's well worth it.

Richard: Those are practical things that clinic owners can do. So thank you. Unfortunately, we're running outta time. I could talk all day about this subject. Thank you, Scott, for what you've contributed to the profession through the tool that you provide.

Scott: Awesome. Thank you, Richard. I'm really happy to hear that. This podcast was brought to you by Alliance Physical Therapy Partners and Agile Virtual Care. For more information, please visit our websites alliance ptp.com and agile virtual care.com. Make sure to follow us on social media and LinkedIn. Where you can learn more about Alliance Physical Therapy partners in Agile virtual care.