Latest / The Operator | Healthcare Business / Called to Care Spotlight: AI Gave Clinicians Time Back. Who Gets It?

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Called to Care Spotlight: AI Gave Clinicians Time Back. Who Gets It? · The Operator | Healthcare Business

0:05
Benz and I'm excited.
0:07
We're here going to have a fascinating
0:09
conversation with Alex Bandersky and we're
0:11
really going to try to approach Called to
0:15
Care.
0:16
This is the Called to Care podcast to
0:18
promote the book and all the elements of
0:21
the revised and expanded edition.
0:23
And we're going to get to some areas
0:25
around AI in the areas where Alex is
0:28
an expert in,
0:29
but I want to kind of do it
0:30
in a little bit of a circuitous route
0:32
here.
0:35
In, there's a lot of stuff we added,
0:37
had to add to call to care since
0:40
the, uh, around topics, AI,
0:43
clearly virtual health was just becoming,
0:45
this is at the initial period of COVID.
0:49
And one of the things I talk a
0:50
lot about in the book are some concepts
0:52
that actually came out of the customer
0:53
service industry, um,
0:56
primarily through call center research,
0:58
which is where a lot of research has
0:59
done.
1:00
And it's the concept of what is called
1:02
calcification.
1:04
which effectively says that repeated
1:06
exposure to very routine negative clinical
1:11
detail numbs you to the humans in front
1:13
of your eyes.
1:14
So in other words, what happens is
1:17
a natural tendency is we dehumanize and
1:20
turn a three dimensional person into a two
1:22
dimensional.
1:23
This is natural.
1:24
This is normal.
1:25
It happens to good clinicians and it
1:27
happens slowly over time.
1:29
Typically when you get a little more
1:30
fatigued or you get into a routinized
1:33
situation,
1:34
if you had a lot of productivity for
1:35
that day, for example,
1:37
Decalcification is any ritual that
1:39
restores the connection.
1:41
And a lot of what we talk about
1:42
in call to care is restoring connection.
1:45
So the surprise of that chapter though,
1:47
is that AI,
1:49
can be a decalcification tool by allowing
1:53
you to maintain the connection fuel loop
1:57
with a patient.
1:58
That's what Alex is going to get into.
2:00
A quarter of a provider's time,
2:03
according to surveys, and in some cases,
2:05
if it's a Medicare patient,
2:07
has nothing to do with the patient,
2:08
has to do with documentation.
2:10
So we give that time period back and
2:13
you've created space for the thing that we
2:15
got into this for,
2:16
human connection and being called to care.
2:19
But only if we use it that way.
2:21
And I'm already seeing AI not as an
2:25
instrument to get humanity and humanness
2:27
back,
2:28
but a way to get more productive and
2:30
a way to have more time at home,
2:32
which obviously we want people to have
2:34
more time at home.
2:34
So that's the backdrop.
2:39
to this podcast today.
2:40
We're going to eventually get there.
2:42
And I'll start out, you know,
2:44
really in a more, you know,
2:47
big picture way, you know, Alex,
2:50
what would you,
2:52
how would you kind of characterize the
2:54
state of AI and rehab therapy?
2:57
What's real?
2:58
What's not real?
3:00
What's hype?
3:01
You know,
3:02
what's somebody saying they're building it
3:04
or built it, but hasn't really been built.
3:06
And from your perspective,
3:08
as you've done your deep dive.
3:09
Yeah, thank you, Larry.
3:10
And first, truly a pleasure to be here.
3:14
And thank you for everything you have done
3:15
with the book and with Charity.
3:18
Truly amazing how much you are just doing
3:21
for our community.
3:23
And in terms of AI,
3:25
so we treat AI as novelty because AI
3:28
is omnipresent,
3:29
but it's availability heuristic.
3:32
Artificial intelligence as a science is
3:34
seventy years old.
3:36
close to almost eight years.
3:38
The construct, the design,
3:40
the theories have been around for a while.
3:43
The reason why we're much more sensitive
3:45
to it now is because it's available to
3:48
us, but I think it's also,
3:49
it's finally maturing to the point where
3:51
it becomes table stakes.
3:52
Artificial intelligence at this point is
3:55
not a novelty,
3:56
but it's consistently something that is
3:59
available and present in every part of our
4:01
life.
4:02
And so I think one of the biggest
4:05
issues
4:05
things for us as a community to do
4:07
is to start to dig deeper into what
4:09
do we mean by artificial intelligence and
4:11
AI and what is behind the statement?
4:13
And is it artificial intelligence in terms
4:15
of better data processing efficiency?
4:18
Is it artificial intelligence in terms of
4:20
better rule logic?
4:22
So we become more logical in our ability
4:24
to conduct ourselves?
4:26
Or is it artificial intelligence in terms
4:28
of how this data gets
4:31
us to learn more.
4:33
So it's machine learning,
4:34
but it's also human learning that's based
4:36
on machine learning.
4:37
But overall,
4:38
I think artificial intelligence follows
4:40
the same trajectory of humanity using
4:43
tools to extend our ability.
4:46
It uses a rock to smash a nut.
4:48
We use cars instead of horses.
4:50
So now we use algorithms to process large
4:53
amounts of data to make us
4:56
better at what we do.
4:57
So my stance is highly optimistic.
5:01
And in essence, don't trust the hype,
5:03
but do allow yourself exposure to this
5:05
technology as it emerges and as it becomes
5:07
more present.
5:08
No, that's interesting.
5:10
And as you look back on your twenty
5:12
three years,
5:13
you've really been on a path of digital
5:15
health for quite a while.
5:19
You had to change your mind somewhere
5:21
along,
5:21
anybody who is an adopter of digital
5:23
health has had to.
5:27
And help us understand where your
5:28
viewpoint is now and sort of where PT's
5:31
real problems are.
5:33
Yeah,
5:33
so I think it's like any good technology,
5:36
the operator is the culprit,
5:38
the operator is the bottleneck.
5:40
And so PT as a world in an
5:44
ideal way should be the clinicians and
5:47
administrators should be the innovators.
5:49
They should be the ones that have a
5:53
position at a table where decisions are
5:54
made.
5:55
And so from the design of this technology
5:58
as it emerges,
5:59
you need equilateral
6:01
power of clinicians shaping this
6:04
technology into the maturity that it's
6:06
entering.
6:07
And so when changing the mind,
6:09
I think I have been involved in some
6:12
form of health technology for close to a
6:13
decade.
6:15
And the biggest culprit was the
6:16
technology.
6:17
The biggest difficulty was actually making
6:19
technology operational.
6:21
And now we're at a point where technology
6:22
is operational, but the human factor,
6:24
we need the operators to gain better
6:27
mastery of how to best use this
6:28
technology.
6:29
So to reference your prior point,
6:32
um this ai can be a great liberator
6:35
of power a great liberator of knowledge
6:37
and intelligence only one designed to do
6:40
so by the clinician or it could steal
6:43
away from your energy if you are
6:44
preoccupied with the operational side so i
6:48
i think we need to start shaping
6:52
clinicians to become clinician
6:54
technologists clinician innovators
6:56
clinician entrepreneurs essentially
6:58
Yeah.
7:00
And, you know,
7:01
the work that you're doing at WebPT,
7:02
tell me a little bit about how you
7:05
are integrating these thoughts and where
7:09
sort of WebPT draws it in there.
7:11
You know,
7:12
how do they make product decisions based
7:14
on native AI, augmentative?
7:17
ancillary, built into the product,
7:19
integrated.
7:20
How do you think about all those things?
7:22
Yeah,
7:22
so I think I have a true unique
7:25
luxury of being associated with this
7:27
wonderful organization.
7:28
And this is the organization that brought
7:30
technology into the physical therapy space
7:32
in two thousand.
7:34
So at the foundation, at the start,
7:37
the technology was essentially
7:41
operationalized by YPT.
7:42
That was the first name of the brand
7:44
that was available.
7:46
But now we're at a point where we
7:48
have technology at a state of maturity
7:50
where we can build the architecture of a
7:53
platform.
7:54
that works on this next stage,
7:57
next phase of tech, this agentic AI,
8:00
this process where you have multiple
8:04
independent entities that operate based on
8:07
closed loop system with goals in mind.
8:10
You can have an infinite amount of these
8:12
agents that allow you to create this
8:16
larger operable efficiency, which again,
8:19
agent is one of the labels,
8:20
but think of anything that needs to be
8:24
redundantly outsourced to this tech.
8:26
is outsourced and you have a thousand
8:29
experts working on your side to help you
8:31
deliver better quality of care which is
8:33
what we do as clinicians so this is
8:35
where ypt is ypt is building a product
8:39
that is going to shape and serve rehab
8:41
community for the next decade and beyond
8:44
based on availability of this technology
8:47
that wasn't available twelve months ago
8:49
and so it's really an exciting time to
8:51
be a clinician because this is going to
8:52
be a game changer
8:55
Yeah,
8:55
do you think about the intended or
8:59
unintended effects on things like clinical
9:01
reasoning?
9:02
Does an AI node or a scribe node,
9:04
can it facilitate or kill clinical
9:08
reasoning?
9:09
Yeah, I think it's a wonderful question.
9:10
And I think about it a lot because
9:12
I think it's,
9:13
we as clinicians have been guilty of
9:15
templatizing our clinical reasoning for a
9:18
while.
9:19
So the protocolizing and templatizing,
9:21
we create templates and create protocols
9:23
so that we don't have to think,
9:24
we can just follow.
9:25
And I've always have been conflicted,
9:27
especially on the clinical side.
9:28
So having my students or having residents,
9:31
if you're following a protocol,
9:32
you're not really making it patient
9:34
centric.
9:34
You're making it a protocol centric care
9:36
process.
9:38
But at the same time,
9:42
scribe is a scribe,
9:43
which is a generic term for something
9:47
that's a little bit different,
9:48
where an ambient sound delivery and
9:51
reception as a tool.
9:54
is brilliant because it captures a lot
9:56
more data than our human ability has the
9:59
capacity to do.
10:01
There's something that I would call data
10:04
exhaust.
10:05
Even in a typical exchange of information,
10:06
you and I right now are talking and
10:08
all we're doing is we're using words and
10:09
language as a way of delivering content
10:12
and information to each other.
10:15
And your ability to receive my language or
10:17
my ability to express this language is
10:19
being hamstrung by our organic capacity.
10:24
And this ambient scribe technology has
10:27
maximizing capacity to capture this data.
10:30
But then that's step one.
10:31
Once you capture it,
10:32
what do you do with this data?
10:33
And that's the key is that a smart
10:36
scribe solution doesn't just capture
10:38
sound.
10:38
It makes it operational.
10:40
It actually makes the clinician better at
10:42
understanding the perspective of how this
10:45
information is being delivered from the
10:46
patient side.
10:47
And that's where we are.
10:48
So it's great to capture maximized data,
10:51
but then
10:52
What's next?
10:53
And how do we make this operational?
10:54
How do we make clinician empowered to
10:56
deliver a more comprehensive care?
10:58
Because now I have better understanding of
11:00
the client or a patient that I'm treating.
11:04
Have you seen a clinic adopt AI
11:10
documentation?
11:11
I mean,
11:11
the advantage you have is you've been
11:13
around the block for, you know,
11:14
twenty three plus years as a PT.
11:17
and you understand the human part of the
11:20
connection and the visit.
11:23
Have you seen a clinic adopt this type
11:25
of documentation actually get worse at the
11:28
human part of the visit?
11:29
So I wouldn't call it worse,
11:32
but there's inefficiencies.
11:33
So there's optimal and suboptimal
11:36
adoption.
11:37
And optimal adopters are adopters that
11:40
actually have a structure and have
11:42
logistics behind this adoption.
11:45
So optimal adapters know exactly what to
11:49
do with it.
11:49
They also have champions and ambassadors
11:51
that are associated with this technology.
11:53
And champions are the ones that gain
11:54
mastery of this technology and are able to
11:57
train others.
11:58
And ambassadors go beyond mastery.
12:00
Ambassadors are the ones that tweak with
12:02
this technology and actually shape it to
12:05
better fit the workflow that is presented
12:09
to them.
12:09
And so that optimal adapters will have
12:12
human factor that is already associated
12:14
with this tech.
12:15
And suboptimal adapters are the ones that
12:16
are essentially just trying to jam it in,
12:18
that are trying to plug and play.
12:20
Plug and play, it's like, you're right,
12:23
I'm old enough where we used to have
12:24
a VCR that had a blinking twelve o'clock
12:27
screen that it probably took us two years
12:29
to figure out how to change it because
12:31
we were suboptimal adapters.
12:32
We just lived with this blinking twelve
12:34
o'clock screen.
12:35
But we don't have to be there.
12:38
Interesting, you know,
12:39
when I when I hear how you I
12:42
like your framework of suboptimal and
12:45
optimal.
12:46
And it really lends into something I've
12:48
been thinking about for a long time,
12:50
which is, you know,
12:52
I see AI enabled on virtually everything
12:55
these days.
12:56
And when I see that,
12:57
it's a marketing gimmick, right?
12:59
But when I see it in relationship to
13:00
physical therapy,
13:04
is it a measurable difference in a
13:05
clinician's day to day?
13:08
So it could be and it should be
13:10
when you have clinical intelligence
13:12
associated with it,
13:14
which there's organic clinical
13:16
intelligence, which is experiential.
13:18
And then there's inorganic clinical
13:20
intelligence,
13:20
which is a construct of
13:23
optimal clinical guardrails,
13:25
like the guardrails that shape your
13:27
delivery process.
13:28
And those guardrails are static based on
13:30
emergence of empirical evidence to support
13:32
your output of clinical care.
13:35
So the organic part is what it is,
13:39
but the inorganic part, actually,
13:40
these clinical decision support tools,
13:42
clinical intelligence tools,
13:44
that are built into operating software can
13:49
help align us to deliver a better
13:52
concordant care, a more aligned care,
13:55
while still giving us enough agency to
13:58
deviate if we want to.
14:00
You don't have to substantiate.
14:02
And that's why we deliver evidence-guided
14:05
care, not evidence-based care.
14:07
The guidance is from that technology that
14:09
helps shape the guardrails.
14:11
But then the evidence itself,
14:13
it's my choice as an agent to apply
14:15
this evidence or to listen to the patient
14:17
and do what is necessary for the patient's
14:19
needs.
14:21
That's a great way to frame it up.
14:24
I want you to help me understand,
14:26
does AI get this kind of debate with
14:29
large practices, small practices?
14:31
And there are some that look at this
14:33
as an equalizer to some extent.
14:35
So do big documentation gains,
14:38
for example, show up in large system?
14:40
Or does AI kind of widen the arc
14:43
or the gap for small practices?
14:45
And the reason I ask that is it's
14:46
always been my observation that the
14:48
innovators are
14:50
in technology adoption have primarily been
14:52
private practice bts as opposed to large
14:54
systems but ai is not a simple investment
14:59
and it's not a cheap investment so what
15:01
is your what is your um take on
15:03
all that so there's there's the business
15:06
side the revenue side uh which is pretty
15:09
much a table stakes because if you don't
15:12
have artificial intelligence or smart
15:14
systems we'll just call them smart systems
15:16
guiding your revenue cycle,
15:18
then you're bringing a knife to a gunfight
15:25
because the payers all have optimal
15:27
systems designed to authorize or
15:30
invalidate your delivery process and your
15:33
revenue stream.
15:34
So on the revenue side,
15:36
you cannot afford not to have smart
15:38
systems supporting your revenue flow,
15:40
especially if you are more than just a
15:42
single provider cash business where
15:45
On a clinical side,
15:48
there's a lot of complexity actually.
15:50
There's an amazing amount of complexity
15:53
within the construct of physical therapy
15:55
delivery cycle,
15:57
which never ceased to amaze me about just
16:00
the vast amount of complexity in terms of
16:03
diagnostic factors,
16:05
in terms of clinical factors,
16:06
in terms of recovery trajectory factors,
16:09
which if I have to keep all this
16:12
knowledge inside,
16:14
I don't have enough energy or bandwidth to
16:15
actually provide optimal clinical product.
16:18
In a way,
16:18
I can outsource some of the stored
16:21
information into the tech sector and help
16:25
the technology guide me along the way
16:26
because I still have my cognitive
16:28
emotional factor being part of my entity
16:31
as a service delivery personnel.
16:35
That's the key is that there's some parts
16:37
that can be outsourced to technology
16:39
because my working memory is limited by my
16:41
organic computer.
16:42
But the synthetic computer will do a good
16:44
job cuing me into what is necessary for
16:47
the patient,
16:48
cuing me about what the patient's
16:49
preference is, cuing me about, like,
16:51
we know physical therapy is a longitudinal
16:53
cycle, so it's not a single visit entity,
16:56
right?
16:57
There's an episode of care.
16:58
But I don't have to keep it in
17:01
my working memory,
17:01
what happened three episodes ago or five
17:03
episodes ago.
17:04
Technology can help me shape a more
17:06
consistent output product based on the way
17:09
it's built.
17:12
Yeah, it's fascinating.
17:14
You know,
17:15
there hasn't been a lot of data out
17:17
on this yet.
17:18
But the one study I'm familiar with,
17:20
there was a six health system and it
17:22
was like two hundred sixty plus clinicians
17:25
across, you know,
17:27
various types of clinicians.
17:29
And they saw, you know,
17:30
pretty statistical difference in burnout
17:33
from the adoption of AI.
17:35
Fifty one percent was fifty two percent on
17:37
almost thirty nine percent or below thirty
17:39
nine percent.
17:41
What they found was that the time savings,
17:45
you know,
17:45
was at least ten percent in sort of
17:48
face-to-face clinician,
17:50
twenty to thirty percent in cuts to after
17:53
hours, what they call, you know,
17:55
pajama time in an observational study.
17:58
I would think with physical therapy,
18:00
because we tend to have a heavier
18:01
documentation load, we just do,
18:03
our profession is piled on over the years,
18:06
and there might actually be bigger upside
18:08
here,
18:09
but my fear is that
18:11
It doesn't allow the clinician back to
18:13
connection time with the patient.
18:15
And you have to understand,
18:17
I'm from the age,
18:18
I've been practicing for years.
18:19
We had paper,
18:20
we had a card of paper templates.
18:23
Those went on forever.
18:24
We hand wrote it.
18:26
Then we had a PC.
18:28
Then we had a little mobile device.
18:31
Then you could argue, well,
18:32
you don't even have a phone now.
18:35
You have a scribe that listens.
18:38
All of these over time have taken away
18:40
have now given back time to your patient.
18:43
But my fear is that we're not doing
18:45
that.
18:45
We're doing it to promote more
18:47
productivity and to promote more billable
18:49
units.
18:50
And the very thing we're trying to
18:52
correct, we're actually, to some extent,
18:55
if we're not careful,
18:56
the unintended consequences,
18:57
it could get worse.
18:59
How are you thinking about that with the
19:00
advice to clinicians that are adopting
19:02
this?
19:02
And how is WebPT as a company approaching
19:05
it holistically?
19:07
So it's so interesting that you and I
19:09
have the same frame of reference.
19:10
When I started practicing,
19:11
I had a three-pager like that.
19:13
You write yourself, right?
19:15
The top page goes to the chart,
19:17
the middle page goes to the biller,
19:18
and the bottom page,
19:19
you say for the record your thoughts.
19:21
And then we had those gigantic shredders
19:23
that would shred all this information at
19:25
the end of the month,
19:26
like the ones that wasn't necessary.
19:28
It's interesting design.
19:31
The handwriting is actually a better way
19:34
of conceptualizing information.
19:36
There's not evidence that shows when you
19:38
are using your pen and paper,
19:40
you're working through a problem
19:41
differently than when you're using a
19:43
computer because it outsources your mental
19:46
ability or cognitive ability.
19:49
On the other note,
19:51
I think that natural evolution of
19:53
technology that you've described,
19:55
from paper to computer to wearable to now
19:59
ambient sound reception,
20:03
the method of data capture is important.
20:06
What you do with this data is so
20:08
much more important.
20:09
This is where the design and architecture
20:11
of these systems comes into play.
20:13
With WebPT,
20:14
I think that there's been so much energy
20:16
and so much effort
20:18
given to designing and creating the
20:21
optimal architecture for this or for the
20:24
platform so that the architecture reflects
20:27
what a clinical workflow should look like,
20:29
what does look like,
20:31
and the end user in mind,
20:33
essentially the clinician,
20:34
is the primary recipient,
20:36
the primary person that the system is
20:38
designed for.
20:39
And so the question is,
20:41
would the clinician want to use it?
20:42
And so this is my position right now
20:44
as the head of clinical innovation at YPT.
20:46
But beyond,
20:47
it's my position as a clinician who loves
20:49
technology and sees it as the only way
20:51
for us to improve our efficacy and not
20:55
supplement for what we do.
20:57
Because given the right design and the
20:59
right system,
21:01
it democratizes your time and your ability
21:04
to actually spend time with the patient.
21:06
And it democratizes your time and your
21:08
ability
21:09
to think through problems.
21:10
When you're referencing in a typical
21:13
clinic,
21:13
if you have a higher patient roster,
21:15
a higher patient load,
21:17
you have very little time to devote to
21:21
critical thinking because you are just
21:23
thinking through process of patient
21:26
development, next patient, next visit,
21:28
next.
21:29
If we can democratize even five minutes of
21:31
time to critical thinking because you no
21:34
longer have to document,
21:35
you no longer have to sit in front
21:37
of your laptop and stare at your laptop.
21:39
I think that's wonderful.
21:39
That's five minutes of time that the
21:41
patient will benefit from because now I
21:43
get to use my twenty three years of
21:45
clinical experience to better understand
21:47
how to reduce the barriers to recovery
21:49
that you are facing and how to apply
21:51
some of the skill set and knowledge base
21:53
to help you achieve your goals.
21:55
So I think we are absolutely thinking
21:58
about that.
21:59
No, that's great, because I think, again,
22:03
all these things have trade-offs,
22:05
and you've got to be careful.
22:06
I mean, you know, everybody, every day,
22:10
everybody's asking about the existential
22:11
crisis of AI,
22:12
and you're going to be eliminated.
22:14
And I'm old enough to remember when they
22:15
said the same thing about a fax machine,
22:17
and then they said the same thing about
22:18
the Internet,
22:18
and then they said the same thing about...
22:21
early days of LLM models and now it's
22:23
agentic AI.
22:25
I think you have to have a rational
22:26
strategy.
22:27
As you said,
22:27
there's business purposes and then there's
22:30
all the things around the clinical
22:31
encounter.
22:34
Now we're going to flip it around here
22:35
a little bit, Alex,
22:35
and allow you to ask a couple,
22:37
I always ask my guests,
22:38
they want to ask me a couple of
22:39
questions to finish things off.
22:43
Fire away at me.
22:44
Well, I think it's wonderful.
22:46
So first,
22:46
and this is a little bit off the
22:48
script,
22:49
but what is your view and what is
22:51
your reflection of how, in a neutral,
22:55
non-positive, non-negative way,
22:57
how this technology can actually shape the
22:59
output of our clinical deliverables,
23:03
our clinical process, our clinical flow?
23:04
You know,
23:07
my honest answer is that I fall back
23:11
to
23:13
leadership, that it's a decision
23:17
And AI and all the other things are
23:18
not necessarily a software feature.
23:21
If AI hands a clinic clinician,
23:23
I should say, you know,
23:24
fifteen minutes back on a visit and the
23:27
owner just stuffs another patient into it
23:29
or say, oh,
23:30
go take a walk in or somebody who
23:31
showed up.
23:33
All we've done is we've sort of automated
23:36
the calcification.
23:37
Right.
23:38
And that's a choice.
23:39
You know,
23:39
I've run thousands of clinicians across
23:42
now two industries.
23:44
And the operators who win long term treat
23:46
that recovered time as clinical capacity.
23:50
clinical reasoning, as you mentioned,
23:52
connection, you know, tracking things,
23:55
becoming engaged and retention actually in
23:59
outcomes actually gets better.
24:01
And here's the strange KPIs that matter.
24:04
Those who connect the best get better
24:06
clinical outcomes.
24:07
That's been demonstrated.
24:07
We know that because the soft skills are
24:09
hard skills and that all works.
24:11
But the other factor that shows up is
24:14
that the patients refer more friends,
24:16
family,
24:17
and former patients,
24:18
which lowers your lead generation costs
24:21
and your customer acquisition costs.
24:23
Your therapists tend to stay longer,
24:26
so that retention number.
24:28
In dentistry,
24:29
your clinical case acceptance goes sky
24:31
high because you're connecting better.
24:33
And in physical therapy,
24:34
the patients come in for more of their
24:36
visits.
24:37
And so these aren't just nice things to
24:40
do.
24:41
The soft sciences, positive psychology,
24:44
social neuroscience,
24:45
all of those things have very good
24:48
business purposes outside of the fact that
24:51
they're a very good thing.
24:53
And that's to a large extent why I'm
24:55
focusing a lot of my time in the
24:57
shift between skills and operations.
25:01
because everybody wants an ROI.
25:02
Everybody wants to understand the
25:04
implementations on the business stand of
25:06
it.
25:06
And the reality is we don't have enough
25:09
emphasis on operations only on third-party
25:12
things like productivity and metrics and
25:14
net promoter score and schedule
25:16
optimization and efficiency.
25:19
And what I think we have to do
25:20
is we have to flip that a bit
25:22
because the dollars when you have
25:23
shortages of PTs and when you have
25:27
patients that don't fulfill all their
25:29
treatment planning and you have marketing
25:31
dollars spending on new patients in an
25:32
environment where margins are getting
25:34
smaller,
25:35
I think you've got to double down on
25:36
humanity and the humanness factor and the
25:38
connection factor and the soft skills.
25:41
Because we know that in the absence of
25:44
those, the cost of turnover,
25:47
the cost of patients not fulfilling their
25:49
visits,
25:50
it's a lot easier to get your existing
25:52
patients to finish a visit than it is
25:54
to get a new patient.
25:55
And then you got the leaky bucket of
25:57
marketing and lead generation.
25:58
So I view all these as elements of
26:02
a well-performing operational approach to
26:05
the business.
26:06
Operational excellence is what I typically
26:08
refer to as.
26:09
Yeah, absolutely.
26:10
I think that there's interesting research
26:12
about that.
26:13
We see economics as only financial
26:15
economics,
26:16
but then there's time economics, right?
26:18
And time as an economic factor, we can...
26:23
spend time wisely or we could spend time
26:27
losing it.
26:28
Exactly.
26:28
So ROI should go beyond how many KPIs
26:32
you can hit and how many SFQs you
26:34
can actualize.
26:36
That's right.
26:37
In PT,
26:39
we have a real clinician shortage,
26:41
not just not enough clinicians per se,
26:44
but only about twenty percent on an empty
26:47
basis of licensed PTs are actually seeing
26:49
patients.
26:51
And I'm from a generation, granted,
26:52
I'm a baby boomer.
26:53
You tended to be with the same employer
26:55
your whole life.
26:56
And I'm not saying that's realistic,
26:58
but I'm seeing just the opposite.
26:59
I'm seeing migration and flight risk
27:03
daily, weekly.
27:04
I see PTs lasting at certain jobs three
27:06
and six months and moving on to the
27:09
next.
27:09
And I see employers adopting new comp
27:12
plans and then sign-on bonuses and all
27:14
these other externalities.
27:16
Whereas if I really think they invested in
27:17
the human capital side of this,
27:19
the talent management connection,
27:22
getting patient,
27:23
getting PTs more money based on what
27:26
they're actually
27:28
you know,
27:28
producing and revenue for a company rather
27:30
than being overmanaged by middle
27:32
management.
27:33
And I would have never said that six
27:35
and seven and ten years ago because the
27:36
margins were enough to get by on.
27:38
Well, they're not anymore.
27:39
They're not all of a sudden you're not
27:41
going to wake up and Medicare is going
27:42
to increase your fee schedule ten percent
27:44
or anybody else for that matter.
27:45
Well, sure.
27:46
And then the ten percent of zero is
27:47
still zero.
27:48
Right.
27:48
So exactly.
27:51
But it is interesting.
27:53
And I think what you just referenced,
27:55
I think that's actually a perfect point
27:56
where we as an industry need more Larry
28:00
Banzas leading our way because you were
28:04
able to change your construct and your
28:07
mental model from ten years ago based on
28:09
emergence of new evidence.
28:12
Why do you think we have fewer clinicians,
28:14
fewer clinical leaders?
28:16
changing this mental model as the new
28:18
evidence emerges?
28:19
How do we shape the industry to get
28:21
better?
28:24
Our industry just hasn't changed enough.
28:27
If you view the world,
28:28
and I like to view the world this
28:30
way a little bit, into pre-COVID,
28:34
post-COVID,
28:36
And you view your management and your
28:37
leadership pre-COVID, post-COVID.
28:40
And you view the business model of
28:42
physical therapy pre-COVID, post-COVID.
28:45
And you say to yourself,
28:46
nothing's changed during those times.
28:48
What kind of leader, manager, clinician,
28:51
business owner are you?
28:54
and business models have to evolve to the
28:56
times we live in declining reimbursement
28:59
for the last several years higher
29:02
regulatory influence a shortage of
29:04
clinicians yet the demand for pt is
29:07
ridiculously high you know we still have a
29:09
significant amount of the population that
29:12
does not access pt for low back pain
29:14
only about twelve to fourteen percent and
29:16
probably growing a little bit
29:18
Now I'm in the dental world where forty
29:19
percent of the population never go to the
29:21
dentist, period.
29:22
They don't have a dentist.
29:23
And the sixty percent of the population,
29:26
one in eight avoid it because of dental
29:27
anxiety.
29:28
One in six have enough anxiety to go
29:31
there and they leave right away or they
29:32
cancel.
29:33
And that leaves one in five that actually
29:35
attend up or some bizarre statistic at
29:37
that.
29:38
And the way to handle it is not
29:40
better schedule optimization,
29:41
not more efficiency, not more technology.
29:45
The way to get it is to restore
29:48
what brought patients to you in the first
29:50
place, a relationship with somebody,
29:52
confidence they have in their clinician,
29:54
self-efficacy.
29:56
I believe that I can get better in
29:58
working with my clinician.
30:00
I have a lot of proxy efficacy.
30:01
What do I think of the clinician?
30:03
Do I think they're the best one for
30:05
me?
30:06
and the more we migrate away from that
30:09
you know this is not anything new alex
30:11
if you think about high touch high
30:13
technology you know nisbit they saw they
30:16
recognized that years ago that any time
30:19
you bet that you get into high tech
30:20
you better double down on high touch i
30:23
just think we're seeing another generation
30:24
of it but with the model of physical
30:26
therapy the those who are practicing by
30:29
the old model are driving clinicians out
30:31
of being clinicians they just are
30:34
And that's a shame.
30:36
And so we have to regain that.
30:38
Everyone's talking about alternative
30:39
payment models and risk models and this
30:41
and that.
30:42
It ain't going to matter if we don't
30:43
have clinicians that are engaged in really
30:45
looking at retention of their profession
30:48
for the long haul.
30:48
Yeah, absolutely.
30:51
Absolutely.
30:51
I think it's like if we can solve
30:54
this puzzle,
30:54
then we definitely have a much brighter
30:56
future ahead of us.
30:58
Well, that's a great way.
30:59
That's a great quote to end it on.
31:01
Alex, I really enjoyed having you.
31:03
If we can solve that,
31:04
you are absolutely right.
31:05
If we can solve this puzzle,
31:06
we have a great future ahead of us.
31:09
And it's a complicated puzzle.
31:11
And, um, I just want to continue to,
31:13
to listen and hear people, uh,
31:16
Or to have people get on their bully
31:18
pulpit and talk about fundamental changes
31:21
that have to happen at the clinician level
31:24
and really become back to a therapist
31:25
centric organization,
31:28
because it's not only good for business,
31:30
it's good for.
31:32
the profession, and more importantly,
31:33
it's good for patients.
31:35
Absolutely.
31:35
And you're absolutely right.
31:37
There's so much demand.
31:38
I think we're sitting at such an
31:40
opportunity to take a leadership role in
31:41
the U.S.
31:42
healthcare system.
31:43
If only under the right design,
31:45
we can be the leaders.
31:47
We can be the primary musculoskeletal
31:48
providers in the country.
31:50
No question.
31:51
Yep.
31:52
That's okay.
31:52
So we are the force multipliers.
31:54
Well, thank you again.
31:55
Thank you, Larry.
31:56
I appreciate it.
31:57
I appreciate you.
31:57
Keep on doing all the great work that
31:59
you're doing at WebPT and love your
32:01
LinkedIn posts as well.
32:02
They're high value posts.
32:05
So keep on doing it.
32:05
Appreciate it.