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You're Not the Arbiter of Your Patient's Finances · Pelvic PT Rising

• 0:02
  Speaker 1: In the last 10 years, our field has gone from an unknown specialty to a household name.
• 0:09
  Speaker 1: This brings unprecedented opportunities, but we need to rise up to meet them and give our patients the care that they deserve.
• 0:17
  Speaker 1: In order to help others get better, we need to be better.
• 0:23
  Speaker 1: This podcast will help you to become more confident with your patients, more successful in your practice or business and a leader in pelvic health, and we're going to have some fun along the way.
• 0:36
  Speaker 1: Join us as we rise together.
• 0:39
  Speaker 1: We're Jesse and Nicole Cozine, founders of Pelvic Sanity Physical Therapy and the creators of the Pelvic PT Huddle, and this is Pelvic PT Rising.
• 0:54
  Speaker 2: Hey guys, welcome back to another episode of the Pelvic PT Rising podcast with Jesse and Nicole Cozine.
• 0:58
  Speaker 2: Hey, nicole, hello, all right, talk in a day about being the arbiter of your patients finances.
• 1:04
  Speaker 2: We're going to get into where that topic came from.
• 1:06
  Speaker 2: Some of you guys who have been OG listeners might recognize it.
• 1:09
  Speaker 2: Before we do, nicole, pelviccon tickets open up in less than two weeks.
• 1:14
  Speaker 1: You guys, PelvicCon 2024 is going to be out of freaking control.
• 1:20
  Speaker 1: When I look at the speaker lineup, I cannot believe it myself.
• 1:24
  Speaker 1: Jessica and I were talking about it and we are on this little walkie-talkie app called Voxer, One of the things we were just like.
• 1:33
  Speaker 1: Can you believe that we got all these people that comes to speak at our conference?
• 1:38
  Speaker 1: This is out of control, Absolutely.
• 1:41
  Speaker 1: So let's go through, In case you've been living under a rock.
• 1:44
  Speaker 1: Who are the 2024 PelvicCon speakers?
• 1:49
  Speaker 2: Yeah, I feel like you and Jessica, basically, are now putting on PelvicCon just so that you can hear all of the people that you admire at respect and can't wait to listen to.
• 1:57
  Speaker 2: It's like your excuse to get everybody out here, especially considering the international.
• 2:01
  Speaker 2: When we talk about world-class speakers, I mean only two of our eight speakers are actually from the United States.
• 2:07
  Speaker 1: Yeah.
• 2:08
  Speaker 2: We're flying people in from Australia, from Ireland, from Scotland, from Canada.
• 2:12
  Speaker 2: This is going to be out of control.
• 2:14
  Speaker 2: So our three returning ones from last year Michelle Lyons, teran Hallam and Yenny Abraham.
• 2:21
  Speaker 1: And at PelvicCon 2023, we actually had a who would you like to hear most from?
• 2:26
  Speaker 1: And a lot of these speakers are actually on from that list, but the people that were already speaking at PelvicCon that got the most votes to come back were those three.
• 2:37
  Speaker 1: So of course, we wanted to ask them back and they said yes, and we were so excited.
• 2:43
  Speaker 1: So Michelle Lyons, Teran Hallam, Yenny Abraham friggin awesome Speaking about different topics, by the way, which is also really interesting- yes.
• 2:52
  Speaker 2: So next we have Shanae DeFour, who is world famous as the person that we all quote when we say that 95% of people with low back pain have pelvic floor issues.
• 3:02
  Speaker 2: She's like the author of that study.
• 3:03
  Speaker 1: Yes, totally, and she's done way more than just that, but that is probably how you know her the most and she is just amazing.
• 3:11
  Speaker 1: She's done a ton of work on pelvic girdle pain, getting people back to exercise and also some stuff on virtual care and just leading the field in that way, so this is really great.
• 3:21
  Speaker 1: We're so happy to have Shanae Grania Donnelly, who, together with Emma Brockwell, created the return to running guidelines Someone else that's like, oh, you might not know her name here in the United States, but she sure has hell know what they've done and so she is one of the authors of the return to running guidelines, which was awesome, awesome, awesome.
• 3:42
  Speaker 2: Bill Taylor, and this is a name that actually might not be as familiar to some of you guys, but this is like a PT's PT Like you.
• 3:48
  Speaker 2: Look over his resume.
• 3:49
  Speaker 2: He's like taught literally everywhere it's insane with the primary physio for a ballet company for years, so has a ton of experience with dance, medicine, hypermobility stuff.
• 4:01
  Speaker 2: I mean, narrow down what he could talk about and literally he could lecture on anything to anyone, anywhere and it would be just going.
• 4:07
  Speaker 1: Jessica and I were talking to him when we were asking him to be the speaker and after he said yes, and we were making all of the like what should we speak on which we're not going to share yet?
• 4:16
  Speaker 1: We have to keep something secret, you guys.
• 4:18
  Speaker 1: But literally, like, we talked to him for like 45 minutes about all the things that he could speak on and that he was interested in or that he has spoken on in the past, and so I'm so excited.
• 4:29
  Speaker 1: If you don't know who he is, I'm so excited for you to get to know him and his work.
• 4:33
  Speaker 1: If you do know who he is and you know what a freaking legend he is in the men's physio world and also the pelvic girdle pain world and everything, so it's awesome, Awesome.
• 4:43
  Speaker 2: Next we have on that list Alex Hill.
• 4:45
  Speaker 2: She's going to bring some interesting topics.
• 4:47
  Speaker 1: Dude Alex is one of the few duly board certified folks in pelvic rehab, so she has her WCS and her oncology board certification and we're just really, really, really excited to have her.
• 5:01
  Speaker 1: She was another one where she was like I can talk about all of these things, and we were like, oh my gosh, I don't even know what yet, and one of the things that Jessica and I really want to make sure of is that we have a broad range of topics as well, and so it's going to be really interesting when you guys hear about what they're speaking on.
• 5:17
  Speaker 1: So, yeah, it's really exciting.
• 5:19
  Speaker 2: And last but certainly not least, all the way from Australia, Joe Milios.
• 5:23
  Speaker 2: I mean, you guys know that name.
• 5:25
  Speaker 2: That is somebody who has literally changed the entire game for men's pelvic health.
• 5:30
  Speaker 1: Yeah, man.
• 5:31
  Speaker 1: So Peyroni specialist prostatectomy, male urinary incontinence.
• 5:36
  Speaker 1: Like if you treat men, you know who Joe is.
• 5:39
  Speaker 1: If you don't treat men, you will find out who she is.
• 5:42
  Speaker 1: She is so rad and, interestingly, she's from Perth, australia, which is even further than Sydney, pretty much one of the most far you could possibly be from the United States.
• 5:54
  Speaker 1: So we're just so, so thrilled to have all of these people.
• 5:58
  Speaker 1: It's going to be so out of control.
• 6:00
  Speaker 1: If you guys do not come to Pelvicon, I don't know what's wrong with you.
• 6:02
  Speaker 1: Seriously, you got to get on the wait list.
• 6:06
  Speaker 2: Yeah, let's talk about logistics then.
• 6:07
  Speaker 2: So we have had 250 of our tickets were snatched up by people at Pelvicon 2023 before they even left Atlanta.
• 6:14
  Speaker 2: So make sure that if you want to come, or even thinking about coming, get on the wait list.
• 6:20
  Speaker 2: That is going to give you priority access.
• 6:22
  Speaker 2: It's going to get you all of the information about the conference and if you're not on that, we honestly don't know if there will be tickets still available.
• 6:29
  Speaker 2: So you can do that at Pelviconcom.
• 6:31
  Speaker 2: It's just getting your name and email on there.
• 6:33
  Speaker 2: We'll send you an email to confirm you're on it, but you'll get all of that stuff and have access.
• 6:37
  Speaker 2: So it is the time that's going to be coming out on Black Friday.
• 6:41
  Speaker 2: So don't have that little Thanksgiving food hangover.
• 6:44
  Speaker 2: You better be ready to rock and roll on Black Friday.
• 6:47
  Speaker 2: All right, anything else on Pelvicon, nicole, before we dive into this.
• 6:50
  Speaker 2: So Nope, I'm good, okay, cool.
• 6:53
  Speaker 2: So a little bit of a backstory on this.
• 6:55
  Speaker 2: So we did a series way back when the podcast had first started, in 2020, in and around giving everybody updates on Coronavirus, as we called it back then.
• 7:05
  Speaker 2: First of all, you can't even get to those.
• 7:07
  Speaker 2: We've done so many episodes.
• 7:08
  Speaker 2: Now you came and find those on Apple podcasts.
• 7:10
  Speaker 2: But we had some other thoughts on that.
• 7:12
  Speaker 2: It's been more than three years.
• 7:13
  Speaker 2: We were kind of shocked to see and I think this is a hugely important topic and for my money pun very much intended our money mindset as a field is probably the single biggest thing that prevents people from getting better.
• 7:27
  Speaker 1: Jesse coming in with the big assertion, Can you elaborate on that?
• 7:31
  Speaker 1: What in the world do you mean?
• 7:32
  Speaker 2: Nicole's wondering that because it's not in her notes, but it's something I have been thinking about, like our collective issues around money, and that goes back to the way that you guys were all brainwashed in school about skilled care and overutilization of services and not using all of their insurance benefits which, by the way, is just a bunch of bullshit to design to save insurance companies money.
• 7:54
  Speaker 2: But that's the reason that people have limited number of visits.
• 7:57
  Speaker 2: That's the reason that we don't push for more.
• 8:00
  Speaker 2: That's the reason that we allow some of these things, these hangups, to dictate people's care.
• 8:05
  Speaker 2: I think it's a massive reason that people don't get the outcomes that they want, and it's something we don't even think about.
• 8:11
  Speaker 2: It's not at the top of mind.
• 8:12
  Speaker 2: If I said what are the reasons that people don't get better, no one would be like well, it's actually our collective fields money, mindset issues.
• 8:19
  Speaker 2: Yeah but it's actually a pretty big deal.
• 8:21
  Speaker 1: You know, I mean, if you wouldn't be broadening it out, and I would be interested to hear what you think about this.
• 8:24
  Speaker 1: Jesse, I would say that we have such deeply rooted money mindset issues, just as a society as well, that it also comes from a patient's end to with their money mindset issues on what's expensive, what's not, what they're willing to spend money on as well, and then so I feel like sometimes, when they're coming into us now we have this confluence of our money mindset issues as a profession, their money mindset issues personally, and now we're in this big clash of who's going to win out essentially on that.
• 8:55
  Speaker 1: So what do you think about that?
• 8:56
  Speaker 2: Well, who's going to fail out?
• 8:57
  Speaker 2: Basically?
• 8:58
  Speaker 1: Well, fail out yeah.
• 8:58
  Speaker 2: Because that's the that is an interesting point is that we collectively are not, I would say, very financially savvy, as just human beings, and that's not always making intuitive sense.
• 9:10
  Speaker 2: But I mean, I've said this quite a few times before but for my money, is there anything more valuable than having somebody who can fix your problems with peeing, pooping and sex Like?
• 9:19
  Speaker 2: What else are you spending money on?
• 9:21
  Speaker 2: Like, I know that bag is cute, but you're going to be using it to like hold your adult diapers.
• 9:28
  Speaker 1: Oh man, coming in with the fire.
• 9:31
  Speaker 1: Today it's a Saturday morning.
• 9:33
  Speaker 2: Now we're rolling here, but I get fired up on this because I do feel like it's a little bit interesting having a more of a patient perspective on this.
• 9:41
  Speaker 2: This is one of the things I kind of like about our dynamic here, nicole, you know, as a patient, you're going into a medical provider for their medical advice and a lot of times what you're getting is their medical advice interspersed with their financial concerns about how much things are costing.
• 9:57
  Speaker 2: And I just want to point out that, unless some of you guys are like moonlighting as certified financial planners or CPAs, your expertise is in what you have your degree in, not in finance.
• 10:09
  Speaker 1: Yeah, this is something I feel like that when you reduce what we're doing by inserting our opinions and they are opinions on what is expensive and what isn't for that patient we really run into some big issues because you're not an expert in that and, quite frankly, you're probably not even an expert in it in your own life.
• 10:31
  Speaker 1: I mean, we talk about, we talk to a lot of very, very smart business women in this field that run their own businesses and they're way more financially savvy now than by going through rising business mentorship and stuff like that.
• 10:46
  Speaker 1: But it's rare to find somebody that's like super personally financially savvy.
• 10:52
  Speaker 2: Super confident in it has.
• 10:54
  Speaker 2: You know all of that stuff, so we're not experts in that.
• 10:56
  Speaker 2: But then we immediately just assume that there's a problem with the patient's finances, and we'll talk about how this manifests.
• 11:02
  Speaker 2: The real question for you is is asking yourself how often are you thinking about your patient's finances?
• 11:08
  Speaker 2: And if the answer is more than when the patient brings up their finances, then you're having this problem.
• 11:15
  Speaker 2: Are you actively thinking in the course of your day?
• 11:17
  Speaker 2: Think back on the patients you saw today, yesterday.
• 11:20
  Speaker 2: Did you ever stop to think, wow, this is expensive, this must be expensive for them.
• 11:24
  Speaker 2: I'm not sure what I can recommend because of their financial situation.
• 11:28
  Speaker 1: Or I don't want them to think blank about how expensive this is If I say that they need to come here for more visits.
• 11:35
  Speaker 1: And so in your head you're having this conversation with yourself about what they can and can't afford or what they might do.
• 11:43
  Speaker 1: If you say that they need to be here for a month longer, we're letting our own opinions about what someone else's choices are or can be and infiltrating that into your medical advice.
• 11:58
  Speaker 1: And that is like I would even go and say that's just irresponsible, because not only are you not an expert in finances, just in general, but you're also not an expert in their finances, and you don't have all of the information.
• 12:10
  Speaker 1: And I can't tell you enough about the person that comes in with a Louis Vuitton bag.
• 12:18
  Speaker 1: You have no idea whether or not they can actually afford that.
• 12:21
  Speaker 1: You don't know whether that's a drop in the bucket for them to have or if they got all of their life savings together and decided to splurge.
• 12:29
  Speaker 1: And even if they did, who the hell are you to judge that?
• 12:32
  Speaker 2: You're not asking them to bring in their tax returns.
• 12:34
  Speaker 2: You don't know if they have somebody who's helping with medical bills.
• 12:37
  Speaker 2: I mean, if you really want to dive into this, then yeah, have them bring in their tax returns and their paystubs for the last couple months and you can sit down and do a whole financial analysis with them.
• 12:45
  Speaker 2: I'm guessing that made a lot of you guys uncomfortable to think about.
• 12:49
  Speaker 1: Yeah, and so it's like I want you to just to think about what you're actually doing when we are bringing into the conversation your opinions about what is and isn't expensive into this conversation.
• 13:04
  Speaker 1: And also and not only, I think, is it irresponsible, but it's also pretty disrespectful because the person that's sitting in front of you has a huge problem that you're an expert on.
• 13:17
  Speaker 1: They have a prolapse.
• 13:19
  Speaker 1: They're peeing themselves when they're running and their exercise is affected.
• 13:23
  Speaker 1: Their sex life is affected because maybe it's painful intercourse, they can't orgasm or a combination of all the above.
• 13:31
  Speaker 1: Someone can't sit.
• 13:32
  Speaker 1: You're sitting, burning vaginal pain and or feeling like they're sitting on a freaking golf ball and you are then telling them how important that should be in their life based on what you think About money, and that's just so disrespectful to the person sitting in front of you.
• 13:52
  Speaker 1: It's like they have a huge problem.
• 13:55
  Speaker 1: You are the expert and now you're getting a ton of like weird information In the thing that you're supposed to be an expert in yeah, as a patient, that is Condescending, it's patronizing, it's kind of the opposite of what everybody wants to be with.
• 14:11
  Speaker 2: Giving people informed choice Like that is.
• 14:14
  Speaker 2: It ends up being my decision as the patient is is it worth coming in and doing this?
• 14:19
  Speaker 2: And I don't, frankly, need somebody who doesn't know anything about my personal situation Basically giving me unsolicited financial advice.
• 14:28
  Speaker 2: And then the last piece is I think that we do this when we train our front desk as well.
• 14:33
  Speaker 2: We talk about this with our staff at pelvic sanity, but it's not looking at the big picture.
• 14:38
  Speaker 2: Because even if you're talking about all this stuff and you feel like it's expensive or it takes time or whatever your rationale is for some of the things we'll talk about examples how this manifests in a little bit but you're not looking at the big picture.
• 14:50
  Speaker 2: You told that person with prolapse it was fine to come in once every three weeks, even though you thought it would actually be better for them to come in twice a week at the beginning.
• 14:57
  Speaker 2: They didn't get better.
• 14:58
  Speaker 2: They were sick one of those weeks.
• 15:00
  Speaker 2: Now it's six weeks.
• 15:00
  Speaker 2: In between they ended up dropping off the face of the earth.
• 15:03
  Speaker 2: What happens to them?
• 15:03
  Speaker 2: Their prolapse doesn't go away.
• 15:05
  Speaker 2: They go back to their OB-GYN.
• 15:07
  Speaker 2: They go and get a surgery.
• 15:08
  Speaker 2: You know that that surgery has a 60 to 70 percent chance of failing within the first five years.
• 15:12
  Speaker 2: So what do they do?
• 15:13
  Speaker 2: They go back and to get another one that cost them both of their full deductibles in both of those years.
• 15:17
  Speaker 2: That was $10,000 a pop plus all the management stuff in between.
• 15:20
  Speaker 2: You just cost that patient $25,000 because you weren't willing to recommend what you thought was clinically necessary.
• 15:26
  Speaker 1: Let that sink in.
• 15:28
  Speaker 2: So who's the arbiter of their finances?
• 15:30
  Speaker 2: Are you even doing a good job?
• 15:31
  Speaker 2: If you're an arbiter and I love this Definitions a lot of times we'll look up and actually define some of these.
• 15:36
  Speaker 2: Nicole, an Arbiter is someone who has ultimate authority in a matter.
• 15:40
  Speaker 2: Right, a judge is a typical thing.
• 15:42
  Speaker 2: You go before and you do arbitration.
• 15:44
  Speaker 2: They are the ones who decide.
• 15:45
  Speaker 2: Does that feel good?
• 15:47
  Speaker 2: Does that sit well to think that you have ultimate authority in a matter of the patient's choice?
• 15:52
  Speaker 2: Probably not.
• 15:54
  Speaker 1: Yeah, I would go back to something that, jesse, you said, that that's not the feeling that we want, exactly contrary to the feeling that we want somebody to leave with at an appointment, like we want someone to feel empowered and All of the positive, positive words.
• 16:10
  Speaker 1: I don't think that you would want somebody to leave with being like, wow, they're the old, that's whatever they say, I have to do, and then on top of that, remember you don't have all the information so to say something's expensive expensive is such a Relative term to everybody like it's just so ridiculous that we're even bringing that into the Conversation before the patient's even saying anything about it and this does manifest more, I think, for people who are working in a cash-based practice or who own a cash-based practice and have to come to terms with some of these money mindset issues.
• 16:47
  Speaker 2: But it is just as much of a problem in insurance based programs.
• 16:50
  Speaker 2: Sometimes it's easier to see this as an example of other people who do this and it infuriates us.
• 16:55
  Speaker 2: But has anybody had an example where a patient was told by their OB, for example, that yeah, maybe you could do pelvic floor physical therapy, but it's pretty expensive.
• 17:04
  Speaker 2: You might not want to try that.
• 17:05
  Speaker 2: I guess you could if you wanted to right.
• 17:07
  Speaker 1: We go up in arms about that.
• 17:09
  Speaker 1: We rail on Instagram.
• 17:10
  Speaker 1: Don't tell our patients what to do Duh duh, duh, duh, duh.
• 17:13
  Speaker 1: Don't make decisions for them.
• 17:15
  Speaker 1: Let them go if they want.
• 17:16
  Speaker 1: I mean, we're really good at Advocating for when someone else is doing this to our patient and we need to frickin turn the mirror on ourselves.
• 17:25
  Speaker 1: Sometimes.
• 17:25
  Speaker 1: It'd be like are we also doing this in some ways?
• 17:29
  Speaker 2: So for an insurance practice.
• 17:30
  Speaker 2: And again, we think that this comes back to a lot of the brainwashing that happens early on in career, which comes back to more insurance.
• 17:37
  Speaker 2: You know rationale and reasons here, but just the whole idea that the shorter the plan of care, the better.
• 17:42
  Speaker 2: Get them out the door.
• 17:44
  Speaker 2: They should be their own therapist.
• 17:46
  Speaker 2: Like how quickly can we get out?
• 17:47
  Speaker 2: Can we make sure we don't over utilize their insurance which, by the way, they've been paying for for the last 10 years and haven't had any problems at all and all of a sudden they have something that they can actually use their insurance for and we're so worried about saving Blue Cross, blue Shield money that we usher them out the door before they're better.
• 18:05
  Speaker 1: Right, or in that world.
• 18:07
  Speaker 1: It's like oh well, you know, if they get a certain amount of visits per case, like I don't want to use up all their visits on their frigging pelvic floor issue just in case they have another issue later on.
• 18:19
  Speaker 1: It's like number one what if that doesn't happen?
• 18:21
  Speaker 1: Number two I would argue that any public floor issue is way bigger of a deal than I'm so sorry.
• 18:28
  Speaker 1: If your big toe hurts in November, I think you're going to be okay.
• 18:31
  Speaker 1: If you are frigging, can't poop in February.
• 18:36
  Speaker 1: I feel like that's a big deal.
• 18:39
  Speaker 2: Yes, and this comes in two when just stopping a plan of care or having your plan of care just align completely with what their insurance benefits are.
• 18:47
  Speaker 1: Yeah, that's so frustrating.
• 18:48
  Speaker 1: It's like, oh, they have 12 visits, oh, miraculously, that's what I'm going to recommend.
• 18:52
  Speaker 1: It's like it doesn't work like that.
• 18:54
  Speaker 1: What in the world is everyone doing in that same way?
• 18:58
  Speaker 1: You are the arbiter of your patient's finances.
• 19:00
  Speaker 1: It's just manifesting in insurance benefits in that way.
• 19:05
  Speaker 2: And not sending them off to a cash practice.
• 19:07
  Speaker 2: Even if you can't work with them because of the way that your insurance thing is structured, at least letting them know that, hey, you're not really done.
• 19:13
  Speaker 2: There's more stuff to be done.
• 19:14
  Speaker 2: There's people out there who can help you, I would tell you.
• 19:17
  Speaker 2: I mean, it's one of the more things that is frustrating about the just the interaction between insurance-based practices and cash-based practices.
• 19:24
  Speaker 2: I would say cash-based practices are probably the single biggest refers to insurance-based Pellow PT practices.
• 19:30
  Speaker 2: We send so many people to our local hospital program.
• 19:33
  Speaker 2: I have not yet gotten a call from somebody who said you know what?
• 19:36
  Speaker 2: My insurance visits ran out and it was going to be prohibitively expensive for me to pay the outrageous cash rate at the hospital.
• 19:42
  Speaker 2: So my therapist said you know what?
• 19:44
  Speaker 2: There's a world-class facility right down the road and you should finish up your care there.
• 19:48
  Speaker 2: Still waiting on that phone call.
• 19:50
  Speaker 1: Still waiting.
• 19:51
  Speaker 2: Talking to you, Hogue.
• 19:52
  Speaker 1: Yeah, seriously.
• 19:54
  Speaker 2: Also, this can manifest in not recommending the tools, the supplements or a lesser version of things to save money.
• 20:01
  Speaker 2: I mean, nicole, this whole thing was brought up because you saw a post about someone who is recommending their patient crush up pills and mix it with coconut oil because suppositories were expensive.
• 20:12
  Speaker 1: Right, and it's just like okay, and I completely understand that all of us are seeing a wide variety of people with different financial situations.
• 20:21
  Speaker 1: I understand that and I understand that I do have a bias towards being cash based practice owner and all the things.
• 20:27
  Speaker 1: But I can almost guarantee that the conversation around oh my gosh, suppositories are so expensive and then like let's figure out this weird workaround that you don't know anything about Again like you don't know anything about this Do we know that it's safe for the vaginomycosa?
• 20:46
  Speaker 1: Do we know the absorption rate difference between a suppository form and crushed up pill form and coconut oil?
• 20:53
  Speaker 1: Do we know anything about coconut oil being okay for the vaginal microbiome?
• 20:56
  Speaker 1: Like all of the things we're trying to work around, instead of just saying like, hey, here's what I recommend.
• 21:04
  Speaker 1: I recommend a suppository of whatever it is.
• 21:09
  Speaker 2: And the benefits of doing a suppository.
• 21:11
  Speaker 2: I understand that it might be expensive, but I think it's really important because ABCND, right Like York, again medical expertise.
• 21:19
  Speaker 1: Totally, and ironically this is just a sidebar.
• 21:23
  Speaker 1: Ironically, you guys, the medications that you put in a suppository actually work on the brain and so there's actually no huge advantage to putting in a suppository, except for that it doesn't have the first pass effect and go orally because it has the same mechanism on the brain.
• 21:40
  Speaker 1: So we know that's like boom, oh my gosh, what just happened?
• 21:43
  Speaker 1: Like I know that we've said, oh, put it closer to the area.
• 21:46
  Speaker 1: But that's not how the medications work that usually go into them, like diazepam.
• 21:51
  Speaker 1: So also the recommendation there would be like okay, great, well, if we're going to put diazepam into a suppository and you think that his compounded medication is too expensive, then the next recommendation is to why don't you try an oral form of diazepam?
• 22:07
  Speaker 1: Because your insurance might cover that if you really care about that.
• 22:10
  Speaker 1: But clinical honesty and this is where we're going to go into, but saying something, to be clinically honest with your folks is that's what's most important and that's really the only thing that we can actually be an expertise, have expertise in.
• 22:24
  Speaker 1: That's it is.
• 22:26
  Speaker 1: What do you think this person would benefit the most from, based on your doctorate level education in the pelvic floor, pelvic girdle, muscles, nerves, bones, ligaments of the pelvis and how the patient's presenting in front of you right now what should be happening, what's in their best interest.
• 22:47
  Speaker 1: Is it coming in twice a week?
• 22:49
  Speaker 1: Is it coming in once a week?
• 22:50
  Speaker 1: Is it coming in three times a week?
• 22:52
  Speaker 1: Is it coming in once a month?
• 22:53
  Speaker 1: Is it?
• 22:54
  Speaker 1: What is it?
• 22:56
  Speaker 1: What do you feel like is best?
• 22:57
  Speaker 1: Is it buying a want?
• 23:00
  Speaker 1: Is it buying dilators?
• 23:02
  Speaker 1: Is it doing both?
• 23:04
  Speaker 1: If you feel like a wands and dilators are good for the patient for different reasons, then tell them that they need both, instead of being like well, you can use this dilator as a wand, but we all know that using a dilator as a wand is not as effective because you can't reach the muscles that you need to reach.
• 23:25
  Speaker 1: They have completely different uses, but you want to save your patient $50.
• 23:31
  Speaker 1: We don't even know why, because you haven't looked at their finances.
• 23:35
  Speaker 1: You don't actually know if they would deem that appropriate or they would think that that's expensive or not.
• 23:40
  Speaker 1: You just think that you might not pay $50 for that.
• 23:43
  Speaker 1: But you don't have a problem.
• 23:44
  Speaker 1: You don't have a pelvic floor issue.
• 23:46
  Speaker 1: They do.
• 23:46
  Speaker 1: So you need to just tell them what you recommend.
• 23:50
  Speaker 1: If you recommend wand and a dilator, then have them get both.
• 23:53
  Speaker 1: If you recommend the more expensive version of a foam roller because it lasts longer than the stupid one you can get at Target, then recommend the $40 one.
• 24:02
  Speaker 1: Like, please just recommend what you think and then wait and don't say anything else and see what your patient does.
• 24:12
  Speaker 1: Period, just wait, stop talking, because your insecurity about what they might think with your recommendation is the reason why you keep talking after your initial recommendation and it's usually something about money and then now you've placed that thing in front of their brain when it wasn't going to be there, and now they're responding to you talking about how expensive something is, and so now you guys are in a conversation about it being expensive, when you're the one who planted that seed in the first place.
• 24:45
  Speaker 1: May have been like, cool, I'm going to get the $40 thing, I'm going to get both wands and dilators, or I'm going to get the depository, because you explained why you think it's really important to pay the extra money to get it actually compounded for my freaking person that went to school to compound medications.
• 25:01
  Speaker 1: Just tell them what you think and then stop talking.
• 25:07
  Speaker 2: Yeah, I can't tell you how many times we've had people in our coaching programs.
• 25:10
  Speaker 2: Realize that everyone's talking about this.
• 25:13
  Speaker 2: If you feel like every one of your people is talking about money, it's because the common denominator is you.
• 25:19
  Speaker 1: You're the one who's talking to everybody.
• 25:22
  Speaker 2: What's the joke with that, nicole?
• 25:23
  Speaker 2: It's like a guy goes into the doctor and he's like man.
• 25:25
  Speaker 2: It really hurts.
• 25:26
  Speaker 2: When I poke my knee and when I poke my hip and when I poke my shoulder.
• 25:29
  Speaker 2: What's the common denominator?
• 25:30
  Speaker 2: You got a broken finger buddy.
• 25:31
  Speaker 1: Yeah, it's not.
• 25:33
  Speaker 1: You don't have a fireball.
• 25:34
  Speaker 1: You don't have a huge problem with some systemic issue of a broken finger.
• 25:39
  Speaker 2: And then this really manifests when, if and when you're working in a cash practice as an employee.
• 25:44
  Speaker 2: If and when you start a cash practice for yourself.
• 25:45
  Speaker 2: But just ask yourself are you spreading out visits because you're afraid for them to pay what the rate is?
• 25:52
  Speaker 2: So I mean clinically, if you, a lot of folks start off as like, hey, my baseline is once a week, but there should be just as many people who you're recommending twice a week to as every other week.
• 26:04
  Speaker 2: If you find that you're doing, hey, we usually have you come in once a week, but if that's too much, we can always spread that out.
• 26:11
  Speaker 2: If I'm a patient, I'm gonna be like yeah, of course, I'd rather spread it out.
• 26:15
  Speaker 2: What you're not saying is it's gonna take me twice as long to get better.
• 26:17
  Speaker 2: Totally Like, if you gave me that option, then I could make an informed decision.
• 26:21
  Speaker 2: But a lot of times we see people just putting that into the head of hey, oh, but if that's too much, we can do something else.
• 26:28
  Speaker 1: Oh yeah, I mean, you know, what also fries me is that every once in a while I run into somebody who's like oh yeah, well, I really think it's best to see patients once every three weeks, and I'm like once every three weeks.
• 26:37
  Speaker 1: That's a very interesting number of frequency of visits and I'm like every once every three weeks and inevitably, if we're talking about someone with a cash practice, if I really ask about clinically what's happening, there is no real reason why it's three weeks, because I think we can all assume that, especially at the beginning, we want to see people more often rather than less often.
• 26:59
  Speaker 1: And so when we get down to it after more and more questioning, it's usually because usually, if this is like a first conversation we're having, someone has bamboozled them into thinking that they need to charge more.
• 27:12
  Speaker 1: So now their price is super high, and now it's so high that they actually have a money mindset problem.
• 27:20
  Speaker 1: And so they're like well, if my fee is $350, then I'll just adjust the patient visit so that it all evens out.
• 27:30
  Speaker 1: And it's like such convoluted thinking there on a lot of levels and like but stop, there is money mindset issues on your side that is influencing what you're recommending to patients and you are not the arbiter and remember what that means the ultimate authority in your patient's finances.
• 27:48
  Speaker 1: You're not.
• 27:48
  Speaker 1: You don't have all the information.
• 27:50
  Speaker 1: You don't have any information, really, and all you know is that they're in there, your office, for your medical expertise, your expertise about what is going on with their pelvic floor condition and can you help them and how long it's going to take.
• 28:03
  Speaker 1: That's what your job is to tell them that period and then stop talking.
• 28:08
  Speaker 2: Yes, and you know we see this with time-sucking non-sensor TSN.
• 28:11
  Speaker 2: This is another way this manifests for those in cash practices of sending summary emails and going over on time or doing a super long initial evaluation even though you're not charging appropriately for it.
• 28:25
  Speaker 2: All of that stuff really comes back to money mindset.
• 28:28
  Speaker 2: And then, like we were talking about earlier, Nicole, where you feel like and we've had staff clinicians who have had to work through this like every person is leaving because of costs, because of insurance stuff, and it's like, well, but they came in, they came in, they saw you and then they decided not to come back.
• 28:45
  Speaker 2: That wasn't a matter of absolute cost, that was a matter of value.
• 28:49
  Speaker 1: Yeah, and that's a really great point to bring up.
• 28:51
  Speaker 1: There is a big difference between what's actually expensive versus what isn't worth the value to somebody.
• 29:00
  Speaker 1: That's really important distinction to get down, because a lot of times what people are saying to you is it's expensive and what they're really saying is that I don't think you're worth it for the amount that you're charging Right, and those are two very different things.
• 29:19
  Speaker 2: And people don't say the latter because it's not polite right?
• 29:23
  Speaker 2: But that's really what they're thinking because, again they came in, they were in your office.
• 29:28
  Speaker 1: And especially for in a cash-based practice, we're already not getting the people that can't afford us.
• 29:35
  Speaker 1: We're already eliminating the people that can't afford us.
• 29:39
  Speaker 1: Those people aren't really calling our office.
• 29:42
  Speaker 1: Who is calling our office?
• 29:43
  Speaker 1: Or the people that can?
• 29:45
  Speaker 1: And now it's all a value proposition and it's not necessarily the absolute cost of the visit.
• 29:52
  Speaker 2: So I feel like that was a lot.
• 29:54
  Speaker 2: I think it's always interesting when we get fired up at different parts of our thing.
• 29:58
  Speaker 2: This is, I think, comes from I mean, this is just beat into folks from PT school from the way that the whole industry is structured, from the insurance model, and it really is.
• 30:11
  Speaker 2: If you are finding yourself in this, it really does come back.
• 30:15
  Speaker 2: And, nicole, I think you said a great and maybe we'd close with this, but it comes back to just getting back to clinical honesty.
• 30:21
  Speaker 1: That really is it, you guys, and if, if you lead with that and have that be your guiding light in all of your recommendations, your entire relationship with your patient will be improved and their care will be improved for it.
• 30:40
  Speaker 1: So I hope that this gets you all to think a little bit.
• 30:44
  Speaker 1: I hope that you remember what your true expertise is in, and that is the pelvic floor, pelvic floor conditions.
• 30:54
  Speaker 1: You just need to give your expert medical advice, and then it's their responsibility to go back and figure out and make their choices for them, what's best for them.
• 31:07
  Speaker 2: Awesome.
• 31:07
  Speaker 2: So I hope that gives you guys some things to be thinking about and working on.
• 31:11
  Speaker 2: Do you have questions about this or how this happens?
• 31:14
  Speaker 2: I mean, this is not usually just a one and done thing.
• 31:17
  Speaker 2: Hopefully this helps you recognize that this is an issue.
• 31:19
  Speaker 2: That's why you know we have a whole clinical excellence portion of you know our accelerator program.
• 31:25
  Speaker 2: This is something that takes a while.
• 31:27
  Speaker 2: This is a mindset that needs to change.
• 31:29
  Speaker 2: It's not just an opinion that you can, you know, change on a dime.
• 31:32
  Speaker 2: So hopefully this helps you be aware of that at least and start to be a little more self-reflective about that.
• 31:38
  Speaker 2: As always, we'd love to hear from you.
• 31:40
  Speaker 2: If you have this, remember, make sure to head over to Pelviconcom, get on the wait list.
• 31:44
  Speaker 2: You should still look a little bit more at those speakers.
• 31:46
  Speaker 2: There's a really cool sizzle reel of all of the highlights of 2023.
• 31:50
  Speaker 2: Give you a sense of what it will be like.
• 31:52
  Speaker 2: I literally can't wait.
• 31:53
  Speaker 2: I know it's forever away, but September is going to be here faster than you know and you guys are going to be stoked.
• 32:00
  Speaker 2: Who are able to make it?
• 32:01
  Speaker 1: Stoked.
• 32:01
  Speaker 1: All right, you guys.
• 32:02
  Speaker 2: As always, guys, we'd love to hear from you.
• 32:04
  Speaker 2: Keep this conversation going.
• 32:05
  Speaker 1: And let's continue to rise.