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Transcript

What's Your Average Length of Care? · 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 Puddle, and this is Pelvic PT Rising.
• 0:53
  Speaker 2: Hey guys, welcome back to another episode of the Pelvic PT Rising podcast with Jesse and Nicole Cozine.
• 0:58
  Speaker 2: Hello, hello, love to some of your guys' responses to our episode earlier this week all about asking more questions.
• 1:06
  Speaker 2: Some of you guys found that really helpful, really challenging.
• 1:09
  Speaker 2: It was really cool to see.
• 1:11
  Speaker 2: So if you haven't checked that out, make sure to go back and take a look at that one.
• 1:15
  Speaker 2: But, nicole, we're going to dive into this one today.
• 1:17
  Speaker 2: Speaking of other questions, what is your average plan of care?
• 1:21
  Speaker 1: I feel like, if you have to use the words about, it's bullshit.
• 1:27
  Speaker 1: You don't know and you need to know and we're going to go into this podcast on why you need to know why it's not bad if your boss is asking you about this and what steps you need to take in order to make sure that you're practicing within your ethos on this.
• 1:48
  Speaker 2: So I've noticed this and I don't know what this is.
• 1:50
  Speaker 2: Maybe you can shed some light on it, nicole, I feel like you guys, as public rehab providers, have this major aversion to metrics data tracking, almost like commoditizing patients, maybe that's the thing is like, oh, you're losing the personal thing.
• 2:09
  Speaker 2: I don't know what it is, but I don't feel like we've met very many of y'all who are like super stoked to be tracking stuff.
• 2:16
  Speaker 1: Totally.
• 2:17
  Speaker 1: I feel like there's two things.
• 2:18
  Speaker 1: I feel like we're never taught how to track anything.
• 2:25
  Speaker 1: I feel like we sort of abdicate that responsibility as a staff PT a lot of the times and then we immediately will translate somebody talking about how long we're seeing a patient as, oh well, that's all they care about.
• 2:41
  Speaker 1: They only care about the metrics, they only care about the business, that kind of stuff.
• 2:46
  Speaker 1: I also think it comes from and I can speak from just being in PT school.
• 2:51
  Speaker 1: I think that, for whatever reason and I actually quite don't understand this, because I personally think that a lot of chiropractors are great when we refer to a decent amount of chiropractors for our patients, especially pregnancy and postpartum but I feel like we have this villainizing of that type of practitioner where and I used to say it myself, oh, I don't want to breed a chronic patient, that's all they do they get people just to come back in over and over and over again, and I feel like this ends up, coming from a place that I think honestly is insurance driven and overutilization of care driven, when we're learning in PT school about the longer you see somebody, the worse PT you are, or, conversely, the shorter you see somebody, the better PT you are, the faster you get them, better the better.
• 3:46
  Speaker 1: I feel like there's a lot of things that are commingling in our brains about this, and so I hope that this podcast helps you all to think about it a little bit differently, but I do.
• 3:57
  Speaker 1: I think that we do have a collective aversion to talking about how long we're seeing a patient, because I feel like we have this oh, each person's so individualized, and whatever we're going to tell ourselves as to why we don't think that that's a valid question.
• 4:17
  Speaker 2: Right, but knowing on average how long you work with somebody is not an unreasonable thing to know.
• 4:26
  Speaker 1: It really isn't.
• 4:26
  Speaker 1: And I think that now that I've been a business owner and I really had to sort of grapple with what do I really believe about how we should be treating patients?
• 4:37
  Speaker 1: What do I really believe that my role is in this patient's life?
• 4:41
  Speaker 1: How else are we going to track?
• 4:43
  Speaker 1: What am I practicing, the way that I feel like I should be practicing, like we have to at some point?
• 4:51
  Speaker 1: I mean, the thing is, it's like what's so funny is that SPTs are so into objective data most of the time and then, as soon as we talk about it in the macro with like how long you're seeing a patient for we're like man.
• 5:04
  Speaker 1: Don't talk to me about that, even though we're like man they have 42 degrees of internal rotation.
• 5:09
  Speaker 1: I'm trying to get it to 45.
• 5:10
  Speaker 1: It's like why, all of a sudden, are we not data driven and objective measurement driven?
• 5:16
  Speaker 1: You know, when we're talking about like how long on average are we seeing somebody?
• 5:20
  Speaker 1: Like?
• 5:21
  Speaker 1: That matters.
• 5:22
  Speaker 1: It should matter to you, and I don't care whether you're just a staff PT somewhere, I don't care if you're a new grad, I don't care if you're a business owner, I don't care who you are.
• 5:31
  Speaker 1: If you are in pelvic rehab, you need to know the average plan of care that you are bestselling upon a patient.
• 5:40
  Speaker 2: And that's actually so interesting, nicole, that you probably didn't know that for a good chunk of your career and I feel like part of the aversion comes from people have had a negative experience in some form or fashion with somebody who was either pushing them to see people for longer, pushing them.
• 5:55
  Speaker 2: I know, nicole, when you were running a hospital program, people were pushing you to see people less often and get them out the door faster, and you really had pushback against that too.
• 6:05
  Speaker 2: So I could understand a little bit of reticence if you've had a business owner or a practice that felt selfish around this, but at the end of the day, like this is, you really are just asking yourself am I practicing what I preach?
• 6:21
  Speaker 1: Yeah, and I just want to go back to that for a half a beat because I think that I don't really know what like the don't shoot the messenger, whatever that type of a thing is.
• 6:30
  Speaker 1: I feel like just because you didn't like your boss and they were asking about this or they did it in a poor manner, doesn't mean that that the whole question was irrelevant.
• 6:43
  Speaker 2: Don't throw the baby out with the bath.
• 6:44
  Speaker 2: Yeah, that's right, there's some idiom here that we're going to get to idiom.
• 6:49
  Speaker 1: Is that what that is?
• 6:50
  Speaker 2: Yes, Okay great, wonderful.
• 6:53
  Speaker 1: In addition to Jesse's FDA stuff, jesse also was a writer.
• 6:57
  Speaker 1: Do people know this?
• 6:58
  Speaker 1: He wrote a book called my grandfather's war.
• 7:01
  Speaker 2: We need to put a lid back on the personal stuff, Nicole, because I feel like y'all are going to know me a little bit too well after all of this.
• 7:10
  Speaker 1: He's like a writer, so he knows about all these like literary terms, even though he was a physics major.
• 7:14
  Speaker 1: Like such a complex human, I married.
• 7:19
  Speaker 2: True Renaissance man.
• 7:20
  Speaker 1: Nicole, as my mother would say, you're lucky to have him, oh yes, she would say that she very much she very much was that we're going to have a whole nother podcast episode on this bullshit.
• 7:28
  Speaker 1: So guys we digress.
• 7:32
  Speaker 2: We do digress.
• 7:33
  Speaker 2: That's been one of our worst digressions here, at least for me.
• 7:36
  Speaker 2: So, thinking about how long you're seeing on people for an average, really, what we're coming down to here is we want to know two different things.
• 7:45
  Speaker 2: One is what you think it should be, and then what is it actually?
• 7:50
  Speaker 2: And is there a delta between those?
• 7:53
  Speaker 2: Is there a big difference?
• 7:54
  Speaker 2: Because if there is, then maybe you're not practicing or able to practice in the setting that you're in, the way that you believe that public PT, public OT should be done.
• 8:04
  Speaker 2: And so I know, nicole, when you talk about this with folks at the clinic, when you train this in the accelerator program on the more business slash, clinical side.
• 8:14
  Speaker 2: But what do you think it should be with your ethos, with your setting, with your patient population, with your expertise, with your belief in wellness, with what you think about your role in people's lives?
• 8:28
  Speaker 1: Yeah, and you know, I feel like to just FYI if anybody's thinking about business mentorship with us like we dive deep into this conversation, both in our one-on-one stuff in our mentorship program and the accelerator program.
• 8:43
  Speaker 1: It's at some level in every single one of our through lines for business mentorship.
• 8:47
  Speaker 1: But we also talked about the pelvic sanity clinic quite a bit and I think it's helpful really to think about what your role is in your patient's life.
• 8:59
  Speaker 1: Are you a coach?
• 9:00
  Speaker 1: Are you a facilitator?
• 9:02
  Speaker 1: What are you?
• 9:04
  Speaker 1: I truly believe that our role in our patient's life is a person that should be there throughout the lifespan.
• 9:12
  Speaker 1: I really feel like pelvic rehab should be a part of someone's life throughout their life, no matter who you are.
• 9:20
  Speaker 1: And if that's the case, then then I feel like there's two really great ways to think about.
• 9:28
  Speaker 1: This is number one what's the minimum amount of your plan of care?
• 9:36
  Speaker 1: What is the absolute minimum number of visits that you feel like somebody with very minimal symptoms, just off the street you're meeting somebody at a dinner party and you're like come on in, I would love to check your pelvic floor, because y'all know we do that weird shit like that.
• 9:57
  Speaker 2: But like what is we just declare by not at the dinner party.
• 10:00
  Speaker 1: Correct, not at the dinner party.
• 10:01
  Speaker 1: Make them come into the clinic.
• 10:04
  Speaker 2: Kick and sense we gotta guys, thank you For somebody.
• 10:07
  Speaker 1: I feel like it's helpful to think about all of the things that we can impart on somebody with all of our knowledge, and all of the things that we need to check, all of the things that we know affect pelvic floor function, both from a pelvic floor foundation so nutrition, stress management, movement, sleep, all of those things.
• 10:30
  Speaker 1: And then also what are the orthopedic things that we know affect the body, the movement analysis, the hip, the spine, the thoracic spine, the biggest nerve all of this stuff right, and then we have the pelvic floor itself.
• 10:47
  Speaker 1: And then we have how you're managing pressure and how your abdominal is and how you're you had a baby or whatever way you had that baby matters and what surgeries you have.
• 10:58
  Speaker 1: We have so much knowledge to impart on even just the average person.
• 11:02
  Speaker 2: It's like two visits.
• 11:04
  Speaker 1: Not two visits.
• 11:05
  Speaker 1: It's what you're saying Right, guys.
• 11:08
  Speaker 2: And I feel like this is like when a doctor asks you how many drinks you have a week and they just double it.
• 11:11
  Speaker 2: Take whatever your initial thought.
• 11:13
  Speaker 2: Here is from a patient perspective.
• 11:15
  Speaker 2: Times about like five.
• 11:16
  Speaker 1: And double it right.
• 11:17
  Speaker 2: Because patients and speaking lovingly because I'm a patient patients are idiots and you guys have so much.
• 11:23
  Speaker 2: I'm constantly blown away by all of the different ways that you guys can help.
• 11:28
  Speaker 2: And if you really start with that framework, how can I help this person, even somebody with literally no pelvic floor issue, coming into your office, like think about all the different things that you can do.
• 11:39
  Speaker 2: Like I am a human being with no confirmed pelvic floor dysfunction?
• 11:43
  Speaker 2: Well, let's not say that.
• 11:44
  Speaker 2: But right, who's not complaining about public floor issues?
• 11:48
  Speaker 2: But I guarantee you could spend a lifetime trying to put the pieces of me back together Totally.
• 11:53
  Speaker 1: I mean all of it and I'm not even going to tell you on this podcast what I think the minimum should be, because I feel like it really is an individual number.
• 12:00
  Speaker 1: So I want you to think about what the minimum number of visits that you would impart upon your patient that has little to no symptoms, what do you think that you can talk to them about their pelvic floor health for their life?
• 12:12
  Speaker 1: So that's number one.
• 12:14
  Speaker 1: And then number two is think about, for each of the different types of patients that you see right, some that's pregnant, some of this postpartum, someone that has a chronic pelvic pain condition you know what is the average number of visits that you feel like that group should see and really honestly, if you don't even have to complicate it that much, it's just like pregnancy, postpartum is one group and chronic pelvic pain is another group.
• 12:38
  Speaker 1: What do you feel like, on average, you're doing for those folks?
• 12:44
  Speaker 2: And that minimum helps you with that, because if you know that, that's what you would do for someone with little to no symptoms, and now you've got somebody with a five-year history of pedental neuralgia coming in the door, right, you're adding that minimum on top of all of the things that you have to be doing.
• 12:59
  Speaker 2: It really just helps to pre-frame and get you to a number that you feel like is how Pelvic pt, pelvic ot should be.
• 13:08
  Speaker 2: Practice, right, that's what you know.
• 13:10
  Speaker 2: Nicole is a number in here and one a perfectionist.
• 13:12
  Speaker 2: Right, always think about what should be, what should be.
• 13:16
  Speaker 2: So what?
• 13:16
  Speaker 2: What do you think should be in an ideal world, in a world where you're not beholden to an insurance company or finances or whatever the limitations of your setting are.
• 13:27
  Speaker 2: Or you know, nicole, in your previous life as a running a hospital-based program, like the sheer volume of patients that were coming in with, almost forcing you to spread people out or Discharge earlier than you wanted to.
• 13:39
  Speaker 2: Right, get rid of all of that stuff and just say what do you think this should be?
• 13:43
  Speaker 1: Yes, I really believe that this is a powerful thing for you to do, whether or not you're working for someone else, whether you want to start your own business one day, whether you are yeah, just just quote-unquote a staff pt somewhere.
• 13:56
  Speaker 1: Like I really believe that this is a valuable thing for you to Decide.
• 14:01
  Speaker 1: It also helps to decide are you in the right setting for you to practice the way that you want?
• 14:05
  Speaker 1: That's a whole nother podcast for a different day, but like it really does help to match the ideal with what's actually happening and that, I feel like, is a powerful thing for us to be able to do.
• 14:17
  Speaker 1: And I also want you to think about or honestly not think about what you've been told, what you've been conditioned to believe, what you have not liked, about a boss that told you something.
• 14:29
  Speaker 1: I mean, just strip all of that away and think about the person that you literally meet for the first time and you're just like, oh, you hear them say one thing and you're like can talk for 45 minutes on.
• 14:42
  Speaker 1: It's like a session right there of all the things.
• 14:44
  Speaker 1: And also I want you to think about things like this is other stuff, like thought experiments that you can do.
• 14:50
  Speaker 1: Think about, like if somebody had a menstrual health symptom, how many cycles would you need to until you're really sure that that menstrual symptom was Eradicated like?
• 15:06
  Speaker 1: I feel like one of the other things that we pointed out on a different podcast is, of all of the interviews that we've done with really like top leaders in the field and pelvic rehab, pelvic pt, pelvic physio all of us say and act as if we treat patients for way longer than I think that the average person coming out of pt school does.
• 15:28
  Speaker 1: I really feel like you know Michelle Lyons, yanny Abraham, like all these people that are we're really talking about time with folks as if it's like Not even a thing you know, and so I really want you to to strip away any like preconceived notions you have about what, what someone else told you or Chiropractor they don't like or something like that, and just be like, if I could and still all of my knowledge on pelvic floor stuff with someone that barely had any symptoms, with someone that had decent amount of symptoms, with someone that had a chronic pelvic pain condition, like what would that look like?
• 16:03
  Speaker 2: and get it to one number, right, because, as we established earlier in this, about is a bullshit word, right?
• 16:11
  Speaker 2: So I don't need a range of.
• 16:13
  Speaker 2: Well, some people could be two and some people could be 47.
• 16:16
  Speaker 2: That's not a very helpful thing.
• 16:18
  Speaker 2: So come up with what you believe that number is, and don't worry for the perfectionist out there.
• 16:24
  Speaker 2: This doesn't have to be perfect.
• 16:25
  Speaker 2: We're not holding it to you.
• 16:26
  Speaker 2: No one's looking over your shoulder when you write this down in your little notebook, right?
• 16:30
  Speaker 2: But come up with a number.
• 16:31
  Speaker 2: And then now we're going to say what is the difference?
• 16:34
  Speaker 2: What is, are you treating the way that you believe that should be?
• 16:38
  Speaker 2: And I'm going to just talk about how easy this is to Calculate, nicole.
• 16:42
  Speaker 2: And then I know you've got some things to talk about this, but Make this easy.
• 16:46
  Speaker 2: So we use this as an appointment to eval ratio.
• 16:48
  Speaker 2: If you guys have been through business mentorship with us, if you're an employee of pelvic sanity you've heard this term but basically all you're doing is to try to get a conception of this number.
• 16:58
  Speaker 2: It's not a perfect metric, but just look at how many follow-up visits you've had in the last three months, right?
• 17:05
  Speaker 2: Hopefully you can run something on your EMR.
• 17:07
  Speaker 2: Take a look, whatever it is.
• 17:08
  Speaker 2: Go back three months how many follow-up visits have you had?
• 17:11
  Speaker 2: And divide that by the number of evaluations, that is going to get pretty damn close to the average number of visits in your plan of care.
• 17:21
  Speaker 2: So if you've seen 100 follow-up visits and you've had 10 evaluations, your average plan of care is about 10 to 1.
• 17:29
  Speaker 2: If you've had 40 follow-up visits and 10 evaluations, your average follow-up or your average plan of care is about four.
• 17:37
  Speaker 2: That's how easy this is to calculate.
• 17:39
  Speaker 2: I don't want to make this really difficult and, yes, are there some imperfections with that?
• 17:44
  Speaker 2: Yes, if you want to talk about the margins.
• 17:46
  Speaker 2: But basically, if you look at it over a couple of months period, you're going to be pretty dang close to what your average is.
• 17:52
  Speaker 1: And I know you all right.
• 17:55
  Speaker 1: I know that immediately, most of you right now listening to this podcast have some form of yeah, but I understand what you're saying, but this doesn't apply to me.
• 18:08
  Speaker 1: I don't want to.
• 18:11
  Speaker 1: I am in a setting right now that I am not loving.
• 18:15
  Speaker 1: I know it's short, but I know it's not that many visits.
• 18:19
  Speaker 1: But now you're going to have all the excuses as to why that is and I'm like I just really want you to just cut the bullshit and just stop your inner monologue going on and just do the math and then do the exercise that we talked about first.
• 18:37
  Speaker 1: Then do the math and then just see, Just see, and then you can use that information if you want or not.
• 18:46
  Speaker 1: You can discard it if it does not serve you.
• 18:48
  Speaker 1: I don't really care what you do after that.
• 18:50
  Speaker 1: I kind of do care what you do after that.
• 18:52
  Speaker 1: But it's okay if you're like I'm not going to change right now.
• 18:55
  Speaker 1: I'm not about trying to change your whole thing on a one podcast, I am about trying to change it.
• 19:02
  Speaker 1: The whole industry like this for thinking this way.
• 19:06
  Speaker 1: But all that is to say is that just do the math and do the exercise and just see what happens and see how what that makes you feel like and see if that matches what you thought you were going to find.
• 19:18
  Speaker 2: Now we've been talking this entire time to clinicians out there.
• 19:22
  Speaker 2: Whether you work for someone else, whether you're a clinical director, whether you have your own place, whatever it is, this is applicable to every single person who treats public health.
• 19:31
  Speaker 2: I want to step aside now and I wish I had, like, another camera, another microphone to like go to Camera two.
• 19:39
  Speaker 2: Like we're going to head over to camera two and talk to the business owners now.
• 19:41
  Speaker 2: Okay, so business owners, this is one of the biggest changes that you can make in your business is getting the number of times you see somebody in actuality, in reality, to match what you believe that it should be.
• 19:56
  Speaker 2: And this is a massive thing and oftentimes, especially for cash based practice owners, there's a huge money mindset issue.
• 20:06
  Speaker 2: You are way feeling unconfident, feeling like an imposter.
• 20:11
  Speaker 2: You want to spread your visits out.
• 20:13
  Speaker 2: You want to get rushed to finish people.
• 20:15
  Speaker 2: You're telling them that they're good enough.
• 20:17
  Speaker 2: You're getting them out the door.
• 20:18
  Speaker 2: You don't feel confident telling somebody to come in for twice a week.
• 20:21
  Speaker 2: You don't feel confident telling somebody to come in for a two hour visit because that's so much money.
• 20:26
  Speaker 2: All of that stuff tracks back to money mindset issues.
• 20:30
  Speaker 2: But if you see people for closer to what you believe they should be seeing, if you treat closer to your ethos as Nicole would talk about it, you are going to get better outcomes.
• 20:42
  Speaker 2: If you see people for more time, you're going to be able to get them better outcomes.
• 20:47
  Speaker 2: You're going to get more reviews because you're getting them better outcomes, because people are going to get to know you and like you and trust you and refer people to you.
• 20:55
  Speaker 2: Word of mouth starts to become way bigger thing than the person.
• 20:59
  Speaker 2: You got kind of better after four visits and then discharge them.
• 21:02
  Speaker 2: You're going to be making more revenue.
• 21:05
  Speaker 2: Let's be totally transparent about it.
• 21:07
  Speaker 2: You're going to be.
• 21:08
  Speaker 2: If everybody comes in for more visits, you're going to make more revenue.
• 21:11
  Speaker 2: You're going to do less marketing.
• 21:13
  Speaker 2: You have less administrative work.
• 21:15
  Speaker 2: You have less bullshit phone calls.
• 21:16
  Speaker 2: You keep the people.
• 21:18
  Speaker 2: You build relationships.
• 21:19
  Speaker 2: You have a better business.
• 21:21
  Speaker 2: You enjoy it more than this constant flow of brand new evaluations in that you're constantly trying to sell something to.
• 21:28
  Speaker 2: So, as a business owner, everybody always talks about how they need more marketing help or business systems.
• 21:34
  Speaker 2: And, nicole, this clinical excellence piece of actually treating people and this isn't artificially prolonging people's care for nefarious reasons this is treating closer to the way that you believe physical therapy or occupational therapy for pelvic health should be done, and if you can do that, it will have the biggest effect on your business.
• 21:55
  Speaker 2: That's why one of the three pillars of the business accelerator program is clinical excellence.
• 22:00
  Speaker 2: Even though everybody says that they don't want that by the end of the program they think that's the most important thing you taught, because this will transform your business.
• 22:07
  Speaker 2: If you're a business owner, I promise you that it's the single biggest change that you can make in your practice.
• 22:12
  Speaker 1: Yeah.
• 22:12
  Speaker 1: So now that Jesse's off of his business owner soapbox, I mean, honestly, I really feel like if you don't have a business, if you never want a business, I really feel like this is still a thousand percent relevant for somebody that is a staff public rehab provider.
• 22:29
  Speaker 1: Like this is this is our jam, this is what you need to be doing is treating people the way that you think they should be treated, and not beholden to any person that's telling you to get them out the door faster, or any insurance company that's like your six visits are up Like none of that.
• 22:55
  Speaker 1: Nobody's saying like, oh, you can't treat the hip because that's not, we don't have a prescription for that.
• 23:01
  Speaker 1: Like I want you to strip all of that shit away.
• 23:03
  Speaker 1: And it's still going to be so transformative to the way that you treat your patients, the way that you talk to people, the way that you present what you can offer folks, like it's game changing.
• 23:17
  Speaker 2: Fire up Nicole.
• 23:18
  Speaker 2: So if you have questions about this, if you want to reach out, we would love to hear from you.
• 23:23
  Speaker 2: We'd love to hear how this goes when you actually do this exercise.
• 23:26
  Speaker 2: But think about what your clinical ethos is, what you believe and are you practicing according to that?
• 23:31
  Speaker 2: And again, like Nicole said, I know that can be a little bit scary to put some real numbers behind that, but it is just information, it's just a baseline, it's just a starting point.
• 23:40
  Speaker 2: It's exactly what you all do with your patients, by the way, and we don't always feel 100% comfortable telling you the answers, but knowing where you're starting from is incredibly important and seeing if there is a delta for you and how close are you actually treating to your ethos.
• 23:56
  Speaker 2: So we hope you guys have enjoyed this episode.
• 23:58
  Speaker 2: We are grateful for each and every one of you listening and trying to improve your clinical practice and treat closer to your ethos.
• 24:04
  Speaker 2: As always, we want to keep this conversation going and let's continue to rise.