From:
Topeka Kansas
Thursday, 8:14am
Dear Colleague,
My name is Paul Silovsky. I’m a physical therapist and practice owner. I’ve sent you my photo because it’s as close as I can get to coming down to your office and paying you a personal visit.
I’ve been meeting with other practice owners in my area and a lot of them are worried. They don’t quite know what to do about all of the upcoming changes in healthcare. They tell me that if reimbursements keep going down, they might not be able to stay in business.
They are sick of seeing doctors being pressured to refer patients to the physical therapy department of the hospital that bought them out despite the fact that the therapists there are already booked up 2-3 weeks solid.
To say that it is frustrating doesn’t begin to describe the type of pressure you’re under when you are trying to run a private practice. It’s almost as if someone out there on Capitol Hill is expecting us to work for free.
For a lot of business owners, private practice is ceasing to make good business sense.
I don’t blame them. I mean, let’s face it, if being a therapist means having to treat 4 patients an hour just to break even, then maybe it’s time to find another profession that isn’t malignant with bureaucracy.
But it doesn’t have to come to that.
You can have a practice that steadily grows and is profitable each year despite declining reimbursements.
It’s totally possible to have an ever-increasing patient load without spreading yourself too thin or sacrificing your quality of care. You can be a hero to your patients, valued by the doctors, and respected by your staff.
On top of all that, it doesn’t have to take a lot of endless hard work to achieve it.
I know this because I have done it.
I have grown a small practice into two clinics in my hometown with a total of just over 21,000 sq ft. of space. Just last week, we treated over 600 patients and over 300 cash-based Wellness and Sports Performance clients. I have over 42 employees, excellent quality of care, and a good profit margin.
I built all of this despite the fact that reimbursements had been going down the entire time.
As a practice owner, I eventually learned that there were, in fact, three certainties in life:
• Death
• Taxation
• and lower reimbursements.
To try to fight that was to try to push an avalanche back up the mountain. No matter what I did, what congressman I wrote to, I single-handedly wasn’t going to be able to control the reimbursement rates for my state.
While the injustice of this fact aggravated me to no end, I decided that I wasn’t going to let it stop me from having a successful practice either now, or twenty years later.
I took and long hard look at the way things were set up and I figured out the only way I could make this work was if I was able to increase the profitability of my practice faster than the rate at which reimbursements would decline.
I didn’t know exactly how I was going to do that, but that’s what had to be done. I needed some kind of engine, a little motor of a business model, that was going to steadily chug along and get me to where I wanted to go.
Now, I had no interest in running a PT mill that just churned and burned through patients because truly helping people with physical therapy was important to me. And I think you would agree that profitability is important, but job satisfaction is paramount.
So whatever I ended up doing, it needed to stress a high quality of care. On top of that, I wanted a practice that wouldn’t work me to death. It had to be, at the very least, a controlled chaos. Something that maybe got rowdy, but always got its work done without overworking us or stressing me or my staff out.
I began looking at how my practice had been running.
It generally went through phases like this:
• I’d go out and do some marketing.
• After doing that for a bit, business would pick up and we’d be swamped.
• Sometimes we’d get so busy that we didn’t completely follow through on the full plan of care and we’d discharge patients early.
• I would hire more staff to handle the increased patient load.
• Then after a while, many of the doctors I had talked to stopped referring.
• Pretty soon, I’d hardly have enough patients to keep my staff busy.
• I would immediately cut back on expenses and reduce some of the staff hours.
• Then I would go back out and visit doctors and do the whole thing all over again.
This had been going on for several years!
I was stuck in this continuing cycle…better, worse, better, worse, better, better, worse, worse. That was a startling realization for me. I wasn’t much better off than I was 5 years earlier and I had been working my guts out.
Frankly, I was sick of it. I couldn’t do it anymore. I wasn’t getting anywhere. I hated stressing over payroll. I hated not being able to put anything toward my retirement. I hated telling a good employee that I couldn’t pay them more for their hard work. I wanted things to get better and be able to build on that with no relapse.
I didn’t really have a solution and I was starting to burn out, so I just tried to forget about the whole thing for a while. Just went through the motions and didn’t get too worked up over anything.
About a week later I was playing catch with Cody, my English Springer Spaniel. I’d toss the ball and he’d jump up and catch it. I’d toss it farther and he’d run and fetch it. We did this over and over again and Cody loved every minute of it.
I would shower him with attention and he’d pay it back in spades. He loved nothing more than to bring me that ball. We had a great relationship, him and I.
I thought, why couldn’t I get that kind of love from my referral sources?
I’d take them to lunch and I would tell them all about myself and my techniques and afterwards they’d send me a couple of patients and then none. The lunch went well and I thought they liked me. Why did they stop sending patients?
That was when I realized that my entire business model truly lived and died by the doctor referral.
The doctor referral, the doctor referral, the doctor referral.
That was the problem or the solution depending on how you looked at it.
It seemed that if the doctors would keep on sending the patients after I hired the staff to help handle my patient load, then I would be able to bust out of this cycle.
But consistent doctor referrals just weren’t possible. I’d have to continue spending $484 a month feeding doctors and then drop it all to go treat the moment we got busy and I’d be right back where I started.
So I thought that if I could somehow supplement the doctor referrals with advertising then I could get some patients directly and not have to totally rely on the doctors.
But I really didn’t see how advertising would result in patients, much less provide a profit above what I had spent on the ads. So I scrapped that idea.
I then thought about switch to a 100% cash-based practice, but it was the same deal. How could I consistently get new patients by doing that? It would make doctors referrals even more difficult.
On top of that, physical therapy isn’t as well known to the public as dentistry or chiropractic, so I couldn’t expect a lot of walk-in traffic. While cash services looked promising, this route didn’t look immediately viable as my primary option.
I started to go over my schedule book and my checkbook to see if I could map out my cash flows. The one thing that became apparent was that having a doctor regularly sending you patients was lucrative. More so than anything else I had been doing.
Having someone out there selecting patients for physical therapy was the ultimate marketing tool because it did ‘t require my participation. The doctor just sent them our way.
I decided that I had to make that the integral component of the engine of my business model, I just needed to be able to count on that. I needed them to continue referring and not suddenly quit.
I remembered one orthopedic doctor, I’ll call him “Dr. S.” He used to send me his shoulder patients. I had gotten great results on those patients and then he just stopped sending them . I don’t know what it was that I did to make him stop, but if I was going to get all of this resolved then I had to find out.
I normally dreaded making these visits, but because I was on the hunt for answers I just went into his office and flat out asked him:
“Look, you don’t have to answer this question of you don’t want to, but I would like to know why you stopped sending patients to my clinic.”
I thought for sure that he was going to tell me that he found someone else to treat his patients, but he told me it was because he hadn’t done any shoulder surgeries in the past few months. So he didn’t have any patients to send me.
He had recently changed provider networks and had also reduced his office hours, so he only ended up doing a few knee and ankle surgeries each week. So then I asked him, “How come you didn’t send me those patients?” He said that he already had them on a program that basically consisted of a few hours of home exercises, cryotherapy, and some anti-inflammatory meds.
I told him that I could do much more than that and I started going on about my functional progressions, manual therapy, special taping techniques, etc.
My words were just floating in a vacuum.
He was listening, but I could tell by the look in his eyes that he wasn’t “getting it.”
Realizing that this was going nowhere, I asked him if he had a particular patient who was having difficulty recovering. He told me about an elderly woman with osteoarthritis that was still having a hard time putting weight on her knee. I asked him to let me take a crack at her.
He gave me the referral and wished me luck.
Now, I was glad to know the reason for the lack of referrals, but what troubled me was his superficial understanding of how I treat. I would explain it to him, but no matter what I said, he just had a limited view of what I could do for his patients.
I was beginning to think that the only thing that would work was if I showed him. It’s pretty hard to deny results.
I decide to make this woman my personal mission.
She came in, told me all about it and I got to work. I was going to do whatever it took to rehabilitate this woman. I called her at home and made sure she did her exercises. We even picked her up, treated her and drove her home a few times.
I kept it up until she should walk comfortably without her walker. Then I took her to see “Dr. S.”
When she walked in, he was surprised. She thanked him for sending her to me and said that I took real good care of her. He was impressed with the results and asked me what I had done.
This was the first time I had ever witnessed genuine interest in my treatment from a doctor. He really wanted to know. I explained what I had done and he replied that I done a good job and saw me out the door.
The next week I got two patients from him and their prescriptions simply said, “Evaluate and treat.”
I was utterly amazed.
Usually the doctors’ notes are specific, but this doctor was giving me free reign. And after I treated those patients I went back to Dr S and told him what I had done and my reasons for doing so. Because of that visit more referrals followed.
This was going real well.
I had erroneously thought that my quality of care would speak for itself. I was wrong. It could speak for itself only if I properly displayed and presented it. Soon, every opportunity this doctor could he’d send a patient my way.
I began going through the same process with my other referral sources and I started to get a steady stream of new patients. I hired more staff to handle the new patient load, and after 6 months I was flush with patients. I had more than I ever had before and they kept coming.
I had finally done it. I had consistent referrals.
That was the missing piece because after I had done the doctor visits everything fell into place. I had something that worked. I had my engine.
I began reviewing the process and this is what I discovered; doctors get all kinds of people wanting to talk to them all the time.
Drug reps, insurance reps, medical equipment reps…they all try to razzle-dazzle the doctor with how great they are, what they can do, how much of a savings they can provide, etc.
After a while, they all sound the same. And I had sounded just like them. The doctor has to protect his sanity, so he will often just be polite and “tune out.”
If you want him to listen, then you can’t just walk in and start educating him as to how wonderful you are. You have to show him. You’ve got to demonstrate it.
To him, you might be a delusional egomaniac; you might say anything to get his patients. He doesn’t see you as any different from all the other people who walk through his door wanting something from him.
Therefore he doesn’t have any reason to believe anything you say. Your job is to give him a reason.
If you would just assume that every doctor you talk to is from Missouri and that he is going to challenge every claim you make with “show me,” then you can’t go wrong.
He might not believe you, but he will believe his patient. If you can skillfully accomplish that, then you cease to be a faceless marketing rep and you will become a colleague in his eyes.
This entire process is called “referral development.” What you are trying to do is influence the doctor’s decision-making process.
Don’t make the mistake in thinking that this is the gift of the gab. It is a skill, no different than any therapeutic technique you have used to treat a patient. But there is one added fact…
IT IS THE MOST IMPORTANT SKILL
YOU COULD LEARN AS A PRIVATE PRACTICE OWNER
If you do not have the skill to systematically enlighten your referral sources on a broad basis, then you are totally dependent on their limited understanding of your professional. And the number of patients they refer will never increase beyond that.
Acquire this skill and you will have the means to develop an ever-increasing patient load.
How powerful is it?
I have used it to go from 125 patient visits a week to over 600 PT patients and another 300-400 in our wellness program.
It is the ultimate leverage.
You can build a practice that is free from the frustration of the struggle. You can steadily grow without suffering the pangs of trial and error. Never again will you have to visit that dark place you fall to when everything goes wrong.
It reminds me of this quote:
“Give a man a fish and fee him for a day. Teach a man to fish and you feed him for a lifetime.”
I care about this profession. I care about you. And I wouldn’t want you to have to go through what I did to finally get things on track.
With all of the upcoming changes in healthcare, I know that things seem tougher than ever. But with the right skill set you can overcome them. Knowing that I could make it easier for someone else would be a great joy for me.
If you dread talking to doctors, if you sound like a salesman or feel like a beggar, then I want you to know that there is a better way…an easier way. Look, a lunch date isn’t going to cut it. You have got to be different than the rest of those reps. You have got to be real.
You have got to follow this sequence:
1) Build rapport
2)Demonstrate results
3) Enlighten
A step-by-step guide to how you go about this is more than I can accomplish in this letter. Remember, this is a skill which you must develop and I can tell you how. With this skill you can get definite results within a matter of months.
So, this is what I am going to do. Next week, myself and a few other practice owners are going to be holding either a conference call or an online meeting.
I want you to be part of it.
Together we will discuss the most effective ways to develop doctor referrals. We’ll go over a variety of strategies and brainstorm on any peculiar circumstances someone might be facing.
I’ll be holding more than one conference call to accommodate different schedules. I may even have time to talk with you personally.
Please do this:
Follow the link below. You will enter your name, e-mail and address, and the best number to reach you at. Then I’ll have Melanie, my assistant for this conference call reach out to you and schedule you for the call.
[LINK HERE]
I do have one favor to ask though–I know how busy a practice can get, so can you please do this now? It will just take a few seconds. I don’t want this to get forgotten about and then we miss the chance to talk.
All the best,
Paul Silovsky. PT
P.S. If you lost half of your current patient load what would you do to replace it?
If you had mastered the art of getting doctor referrals, you would know what to do. In fact, with a broad base of referral sources I doubt that this could even happen to you. Attend the call and I’ll tell you how to maintain what you have and to build on it.
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