IndeFree Miami 2009

IndeFree Miami
October 17-18, 2009

d a t e ] t h e
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Automation: reproducible quality, care, and profit where you are never putting out fires. Goals need to be clearly defined Goals are dreams with a deadline Courtesy referral is another channel of revenue Response is the key to their attitude (what theyre feeling) Not dependent on one referral source
[ P i c k t h e d a t e ]
Decrease level of dependency = decrease size of doormat Get staff to do what you are doing
P UTTING O UT F IRES ?
Fireman = owner putting out fires Fire = do now or get burned Dont hire employees who create fires Anyone can open up a private practice, but it doesnt mean that it will be independent and free
A UTOMATING P RIVATE P RACTICE
Automated private practice is where the business run without you having to make it happen Automate and duplicate 1st step is focus on $300/hr tasks Focus on automating practice Treat 20 hours a week or less Do storms come? Turn foundation into rock If you left for a month your practice would collapse The goal is to only be working 2 hours a month
Then you know if you really want to treat Until youre automated, you dont really know if you want to treat You dont know whats fun until you dont have to do it
E VIDENCE O F A UTOMATION
Automatic Without effort High quality High revenue People who need you have access to you
Ability to offer affordable services will determine how much humanitarian work you can do Different fee schedule than clinic Do the right things, people will bring in family Separate fee schedule for James If you want to see James this is how much its going to cost To see our staff therapist this is how much its going to cost Which would you prefer?
Non-automated practices plateau by year 5 and then goes down No tool Simple task becomes impossible
A UTOMATING P HYSICAL E NVIRONMENT

Automating procedures Automating teams Team builders Automating self New You = New Principles
S UBCONSCIOUS S ELF -S ABOTAGE
SSS = easy, redundant, we do them, things, because were trying subconsciously to fail We want to pay for past mistakes. Until you let go, you pay for your suffering Today, not judged by past, but by ability to trust another human being Allow for mistakes Expect them to make mistakes Let it go Become a new you that embraces new principles
Daily basis Make decisions at $300/hr level Rule as CEO Live at $300 level Most business owners live at $40 or $15/hr level Apply it!
T EAM T RAINING
Team trainings from 12 to 2 pm every other wed Talk for 15 minutes
S TAFF T RAINING
Training staff should be automated too Use training videos 4 week reviews = review everything A year is too long to know if someone is good for their position Reviews happen automatically No one has perspective you do Keeps admiration and respect for you
T OOLS F OR A UTOMATION
Employee punch clock
FIND IT AT: http://www.vertitatasksoftware. com Steady stream of business
W EBSITE
Everyone must have a website Business must have internet presence Need internet hub where staff can click in
T EAM H UB
Important for automation
D AILY P RODUCTIVITY S HEET
How often should you know how much profit you made? Every day Let administrative assistant or receptionist do it Have them email productivity sheet to you Hate storage units with patient charts We scan our stuff
PPO & H IGH D EDUCTIBLE

What do you say? Point of contact
Biometric employee punch clock Punch in with thumb
D OING T HE W RONG T HING

Most people do the wrong thing because its easy to do it Most of us will do the wrong thing if given an easy opportunity Dont make business that makes it easy to do the wrong thing THE INSTANT They Do Something Wrong Against You, They Sabotage You In Other Ways
P.O.S S YSTEM
Get rid of hand written receipts Get rid of cash box Stop spending money on copy machines and toners
NCR F ORMS
Sublease for first year How do you get those out there? Success is in the follow up No one sleeps with you on the first date Train marketing assistant this way
Use metaphors that help people remember $12/hr task = ordering US gel Sits in your mind and clutter it Genius knows what not to remember Have enough space for the unimportant things Successful practice knows what not to do Petty bank account with an ATM card So you dont have to do it Let the employees do it
The way your paperwork looks leaves an impression Entire company system online for employee access
W EBSITE C RITIQUE
Whats the biggest thing on this page? No one care about your logo (ego) Until they get to know you Left hand list Its all me, me, me Things below the fold dont matter
If you dont get them up there you lose them Whats here for me? What words are here for me? Phone # on every page You want them to call you Logo needs to be modest or small Video testimonials Common causes of pain Coupons Be wary of
Self help Adding foot massage = thats smart Do the right things = you will succeed
M ONEY M AKING A TTITUDE

Volume = human resource Think of growing before shrinking How do I make more vs how do I make less Economys down, I need to cut, cut, cut 70% close
How do I make more money? Run promos on Fridays This paper productivity sheet is easier What did I do to allow this to happen? I failed to have this system Cant delete or void mail
H ANDLING C ASH D EPOSITS

I like to hold cash All deposits come to me via mail Sending cash in priority mail envelope
Dont want money sitting around for a week I dont like to deposit cash
N O -S HOWS
Identify those days you dont make money Cant make decisions if you dont know No shows = 3% No shows is an indicator of how well your staff is doing in maintaining customer satisfaction and loyalty % no shows = employee performance
How well staff is creating perceived value No one should know how much employees make Outside book keeper does payroll If I see 3% no shows in same week I work my staff to pick it up How do you prevent no shows? Now shows cost a lot of money Its what you staff does in their interaction that decreases no shows
Maintain same eye level What you think is not If patient sits, you sit etc. #1 thing patient hates? Waiting If you dont track it, staff will be taking patients back late 3/100 taken back late >10 min late = wait for next appt If they dont have to wait it helps to increase perceived value Dont want book keeper to know my staff
Pay him $20/hr for 2 hours a week Quick books is of the devil Give all receipts to accountant
P UNISHING E MPLOYEES
Employee discipline form Critical to automation Punishing employees is important More important than rewarding Most employers dont know how to punish Poor attitude gets written up
Poor attitude is cause for dismissal My employee files is right next to my desk Only owner has access to employee files Warning Monetary penalty $5, $20, $100, up to a weeks pay Dock in pay until they earn it back Suspension Termination
Hostile response to being approached Get off my back! Are you sure you want me to get involved? We have an open door policy if fired Are there any questions? Were only going to talk about this once It was like a cloud was lifted It was almost like you removed a piece of cancer What James says, he does
Stabilizing effect when you punish If theres any grounds for firing Giving you a chance to correct something And they respond with Get off my back Indifference leads to love dying Get off my back = biggest offense Confrontation = opportunity to make things right Judge by their response, not the mistake itself
Might get what you ask for Any employee can write up anybody If youre not going to own up to it, Im going to get James involved Staff works it out amongst them selves Staff does hiring and firing You have to set that example Everyone is an authority of their position Physical Therapist cant go up to the receptionist and tell her what to schedule
Receptionist is the authority of scheduling Everyone is an authority in their role Technician can wrist up a therapist when therapist doesnt have documentation completed on time Trend of violation leads to a pattern of behavior Never write up for just one thing No shows are high in one day, I ignore it Cant jump to conclusions Give them benefit of doubt
C OMPLAINING V S . C OMMUNICATING
Do not complain in public What a complaint is A complaint is Im tired, or Im hungry Can I go lay down? Thats communication Complaining is grounds for termination Her teammate confronted her She said, Leave me the hell alone
B IOMETRIC E MPLOYEE P UNCH C LOCK

You only pay 8am to 5pm They have to sign for it Never shows if they punched in early But it shows if they punched in late Allow receptionist to be up to 45 min past close
S CHEDULING P ROFILES
40 mins face to face = comprehensive (1/hr) 20 min = intermediate (2/hr)
5-10 min = limited (3/hr) Hi and bye = brief (4/hr)
P.O.S. C ASH R EGISTER S YSTEM

Go to nurol.com Get cash register and roll paper CRE cash register express software Touch screen monitor RECEPTIONIST Out And About Talking To Patients About Everything $500 touch screen monitor
Have a system that manages money well When you have the right tools its easy to go to the moon
NCR F ORMS
New Client Registration
K EY T O L OYALTY
Will they break the rules? Yes. Gives you an opportunity to exercise forgiveness & compassion Key to loyalty How do you know your spouse is loyal?
List of things that are given Never give loyalty until its earned I will sacrifice my needs for you I will die for you Hard to cheat on someone who has shown you forgiveness? Yes. Have to outline the wrong in the rules Theres nothing you cant forgive at least once Have no right to expect or demand loyalty if you havent shown forgiveness
P HYSICAL E NVIRONMENT
Front desk Phone systems Fax systems Go to http://www.phonepeople.com
A CTIVATION S PECIALIST R OLE

Activate and Convert It cant be the receptionist Handling the people already in the system 8 min on phone
New people need time Only reason they put up with you is Because the MD referred them to you First impression is the most lasting Front desk phone for returning patients How does somebodys poor attitude reflect on you? You never told them its bad To them, all they know is poor attitude
Assume responsibility Never make assumptions Like youre talking to a 6 th grader
C LINICAL A REA /G YMS

Have 15 bins for per 1000 sq. ft. Will save you millions Follow the path of that patient until they walk out Make the path very nice, warm, and unobstructed Dont have ice when they first come in Walk right into the gym
Make it feel like a factory assembly line Place bins next to each station Chart goes in the bin
C HARTING C OUNTER
Spot where you can see the most Find the geographic center in the clinic Patient needs to see that you are there Patient loves interacting Physical Therapist has to be standing
Computer Solutions To be completed bins How automated are you going to get? If you dont have the right tools You cant pound a nail into the wall Wait 2 weeks = oh they must be good Create good energy in your facility 1,000 sq. Ft. = $40,000 collections/month
C OMPUTERS
For every physical therapist Unless net work 3 computers minimum or laptops 1 physical therapist = 4 computers Front desk computer Private room computer Gym computer Should not buy a server and get an IT guy Servers can get stolen, broken, etc.
Servers are vulnerable 1 tera byte hard that is net work capable for backup
P AYMENT P LAN P OSTER

Sends a good message Owing money puts a dark cloud over someones head
W EBSITE D ESIGN
Gentle Compassionate Caring Doesnt that sound nice? Solutions Dont like structured
Like gently guided Whats special about your Pilates program? Put info into one word Precision & Pilates dont go together for common lay person Gentle yet effective pain relief Dont like the flashing Getting the info you need to get across No where do you see me, me, me Everything is about you
Things you can use Make it more about them first then they will want to know about you Secondary page Dont need to scroll Not drawing out too much emotions Need to draw out more Need more connection Strength/flexibility program Picture of someone that looks really happy
No one will buy until they can get a discount Nice pictures in bio Increases perceived value for patient Photoshop your picture Make you look gorgeous I want you in top 5 on Google How do I get to your website? Already Im leaving you and going to someone else Have a picture of someone having a great time
http://www.absoluteptf.com Im not sure Im crazy about the name Its creating some confusion What a name shouldnt do Doesnt cause confusion Doesnt conjure up wrong associations Absolute Physical Therapy Tagline Pain Free Solutions And Fitness Make some changes in your identity
Why absolute? Where did that come from? In todays business dont need to alphabetize All of you should have a tag line Personalized Pilates Program IndeFree Physical Therapy & Pain Center Add pain center at end of name People will come in off the street Do you sound like what they need?
Tag line: empowering independence and freedom Would it screw up a lay person? Wheres your fitness? Names says fitness We know? No one needs or wants physical therapy They need and want solutions They want pain relief We know youre in pain We know what its preventing
We know your suffering We care We know you tired of drugs Theres nobody smiling in the pics Subliminal message They feel smiling is not associated with you CHOICE Is A Very Emotional Thing Let them know what it is that they want Flashes 3 things but they can click it
PAIN, Is It Preventing You From Enjoying Life?(6 Words) Connect with them This, I dont connect with Where does it hurt? Click on body Decrease size of body picture Biography: what you like about job They need to feel a connection with you Automate Marketing Cant define who you are
What youre offering Self actualizing process Whos really good for what you offer? Very introspective process MARKETING Is About Caring About Who You Are And Caring About Who They Are And What They Need Pregnancy Program Post Natal Program R & D: survey your area Fingers on the pulse of your community
10-15 mins to do quick survey MDs love talking about what they know Now they are doing something they enjoy Let the MD talk Lets start a total knee class You become more the expert $12/hr task, pay someone to do it How many live in your area? How many females? Top Industry
Demographics Help you better understand where you live & what the needs of the community are Advertisements Sending messages Promotions Fun, exciting way to get message out 1 hr Free Clinic How many $5,000 programs do you want to sell a month? Why dont you have one?
You dont get $5,000 because dont have one With high deductible they can opt to take this $1,000 program Sounds better than this program over here Use 52 modifiers to lower the price of any codes Super bills dont work Use fee flips Save you on an audit They cant try to take money back Trei and Rachel from Florida
Can have a $10,000 program There are people who will pay If you write out the value of what you do, they will pay you Train a marketing assistant Give them the tools to introduce you to the community Public relations Whos going to meet and greet? Put a face to the name $15-20/hr job They have to be likable
Speak with good articulation You have to enjoy talking to them Are they an appropriate extension of you?
U NLAWFUL P OSTERS
Nice gift to send to MDs Its something they need and want Helps collect co-pays Front desk is a physical environment Phone system
Fax system Activation Automation Know what to say to get that HMO as a patient Tap into the 97% of the community that needs what you have to offer Use a training video to walk them through Never hear them say Welcome To
H OW T O R ESPOND T O FAQS
Tried to better understand whats wrong with me so he can give a focused answer
Try to understand their needs People dont like a manly man answering the phone Good gay guy can convey warmth and compassion Use people and tools to accomplish goals Some of you should pay someone to meet MDs Ego to ego is not good
A CTIVATION
Everyone needs to hear $40 $10 tx, $90 tx
HEARD The Possibility Of $40 Got them in the door 8 visits, $40/tx for financial hardship Im going to activate the patient Whats wrong? What do they hear? See? Think? BASED OFF What You Told Me Whats the . Not now too available
SOUNDS Desperate Subliminally Medium, little, or a lot (Pain) Where can I call you in the next 30 min? Call them back We have an opening in 30 min due to a cancellation Go straight into Whats Wrong With You? You sound like a great candidate for this program Based off the complexity of your condition
Always ask: Do You Want To Schedule? ACTIVATE That Person This is how good you can get Receptionists position is crucial More important than physical therapist for developing loyalty #1 reason why they bring in family & friends New receptionist AUTOMATE By Training Somebody To Do Their Task With The Right Training And Tools
Check whose birthday is coming up Birthday cards mean a lot to people Simply do it for the consideration Someones got to manage and update Have a marketing assistant to do those things
H OW T O R EACTIVATE
End of year promotions Benefits about to renew Remind them
Send a letter in September Send via post card Dont combine with newsletter Something they can stick on the fridge How much money did you make with that brochure? Good tools pay off Automate supply
B ANK A CCOUNTS
3 bank accounts Main account
Payroll leave $1,000 cushion Keep clean payroll Expense checking account 4 people with ATM account & online access $300 or $100 limit Limit cash withdrawal Max daily purchase set Team building never develops because you do everything Less than $50, I dont need to know >$100 purchase, email me
P URCHASE O RDER S YSTEM

Local newspaper for older book keepers http://www.paycycle.com Do from home Billing liaison In vs. outsource make more money Hands are in the billing too much For the time & money, its not worth it You shouldnt be looking at bill to make sure its accurate
Losing money for the time spent Put a $5,000 program together & sell that Focus on selling expensive programs Tapping into the community Maximize reimbursement Who was sent a collection letter? Who was sent to collections? Get those appeal letters sent EOB Explanation of Benefits
Responded too, need 2 nd level appeal file bin Pending file bin Need letter file bins Condition of being a member, have to help other members http://www.paytrust.com Use for personal & business Only $12.95/mo Use for paying bills Anything you dont like to do, pay someone else to do it Why be unhappy?
Things I cant pay for Encouragement, sex, uplifting me Focus on things you like to do Simpler is much nicer Buying solutions that are better Paytrust.com dont know your bank account Automation is not common sense Do it one at a time DO THINGS That Stand Out Appealing right away to get paid
Learn more, implement more Self, tools, physical environment, procedures, team Team See the next step Get to next level Dont need to see the whole picture Job description (standard & officers) Orientation critical development step Check off each statement
I will represent my team well by never complaining in front of them or others Stand the test of audits these descriptions Make enough money they will audit you Recruiting Dont know how Can waste money and time Add a phone call Group interview face to face Group interview is the most important step
This ad produced the best candidates This produced good pools of receptionist I had one receptionist who made mistakes, but was so lovable no one cared Put this on Craigs list for nonlicensed staff Youll get a good number 20-200 Do a phone screen Group interview give an option of 2 dates and times to attend Do about 10 people
See who responds and how LOOKING for Who Do You Like? Who do I seem to like here? Different mind-set when they work for you FIRST Impressions Are Everything Nothing will cost you more than having the wrong person in a position Try to narrow down to 2-3 who you really like Its a heart and mind decision
Ask, I want to give opportunity to give feedback in this group setting This is what I liked about you This is what I didnt like It sets the tone They leave with a totally different impression If you dont get picked, call us in the future For physical therapist advertise on monster.com Costs $400
Recruitment post cards and brochure Advance PT for therapists and assistants 1-2 years of solid performance = % of shares Anyone who would like to talk in private? Its very respectful to allow them to do that Never hire on the spot One on one interview Staff gets to ask them questions What did you like or not like
First impression lasts forever Your business becomes a vehicle for producing great people Hiring who they work with Sends a powerful message This is my team Hire via email or letter Congratulations. Thats how you bring a person on Do they want to bring this person on? Whats the opposite of love?
Indifference You care enough to notice What you didnt like I dont like working with people who dont have an opinion Everyone has to give an opinion Review orientation checklist Each section done by different staff members Compensation Little things go along ways Team building
O FFICE R OLES
Officer role position Human resource officer Liaison to you Logs and records absences You managing employee scheduling is non-productive; just busy work Approves or denies time off Human Resource Officer is a technician Someone has to be assigned to hold people accountable
No queen bee mentality; everyone is an authority Facility Improvements Officer These office roles are a privilege Do you care about your organization? What is the company? The people in it They may be asked to perform some officer roles Physical Therapist is the Patient Care and Loyalty Officer Makes sure that ultrasound gel gets stocked and ordered
Lost respect for the pesky owner When they do it amongst themselves it runs like popcorn If you dont delegate officer roles then you have to do the work 4 months are peer & competency review Create rewards & bonuses based on their ratios Start peer reviews tomorrow Review Officer What people are saying about you
Peer review is powerful Owner review is so negative They dont have the right to review the owner Always have an open door policy But youre not part of this review process Patient chart review A patient shouldnt sit in room for >20 mins Physical Therapists should make themselves available Physical Therapists need to manage patients and techs
This helps produce a team thats very together and competent 300 pt/wk = 1.5 therapist + 1 assistant + 2 techs Limited & brief & intermediate patients = 90% CVAs, Bells palsy = 40 mins face to face Patient limited tasks defined by you Medicare wont define it for you Time based bill law What I would imagine. Its got no legs to stand on
Be able to justify why you do it that way Medicare auditors are trained to come back with money Really define what patient related tasks is Its not a science, not an art Laurie Feinberg wrote the law That sounds logical to me Theres no law that specific on it >2 or 3 bill as group for Medicare Only bill MT and TE and gait Collect cash for laser tx
No modalities: no ES, US, HP, ICE Standard joint mob or STM Im still going to bill a unit If it takes me 5 mins to do a joint mob and reduce their pain, should I get paid less than a new grad who take more time but with less results? Document I did Manual Therapy and their pain went from an 8/10 to 3/10 I cant get paid even though Im better and faster because of a therapist who cant do better
W ORDS O F W ISDOM
First 30 min. of every Monday morning 10 min words of wisdom Whats that mean to you? Need to look at your opportunities differently Apply new principles How can we apply that this week? Need to let go of these things: billing, book keeping, ordering What went good, how to increase that
What went bad, how to decrease that? Last 10 mins general announcements Every other Wednesday 12 to 2 pm Review codes Review things & train, train, train 2nd Monday of each month Review stats of last month Only number from me is payroll A healthy organization is made up of healthy group of people
Wont assign officer roles until 3rd time at class In 24 hours how many hours was spent on training? To be the best, have to allow for training Create stability & consistency for Tuesdays and Thursdays In the beginning open Monday, Wednesday, and Friday Market on Tuesday and Thursday Break it up so were busy on Tuesday and Thursday
N O -S HOWS
NO SHOWS Are The Poorest Reflection On Your Staff No shows are very disrespectful
T EAM (C RITICAL P OSITIONS )

Personal Assistant Administrative Assistant Marketing Assistant Critical for your success Mail, book keeping, dry cleaning, oil change So you can focus on $300/hr jobs Posting EOB payments
Research local area Start at 40 hrs/wk Need $20,000 with sublease $30,000 start up for commercial space Receptionist/technician Monday am Tuesday off Wednesday am Thursday pm Friday am Fixed schedule
If you dont schedule time for advertising, marketing, promotions, it will not get done Physical therapist treats 20 hours or less until reach = 50/wk Hire assistant or therapist @ >50/wk @100/wk hire a therapist full time Do activation for first 3 weeks Then train assistant how to do it Knowing what not to remember (definition of genius by Einstein) Know what not to be doing
NO MANAGER; Everyone Is Their Own Boss No right person until position is made right with the right training and tools Small things matter JUDGE Not The Mistakes But Their Response To Being Confronted Every other Wednesday 12-2pm staff eats together 2x a month Be considerate of peoples feelings Find things you should not be doing
For now, whos going to be responsible for that? YOURE Valuable For Creative Things ITS HOW You Make People Feel That Matters Most We have a way of discounting someone Even though you say its all right, you make the person feel small FORGIVENESS Is Not Just Saying I Forgive You ITS Making The Person Feel Forgiven Xerox 272 documate
Hi speed scanner Scan card feature Important tool for front desk automation Refer a Friend Poster People dont like being bought Dont give something too big Working on self Attaining the tools Start automating my environment Start automating the procedures
Team set up that self-sustaining, self-caring, self-learning, selfmanaging Nothing will cost your business more than hiring 1 wrong employee
C ODES F OR C ALLING I N
Urgent post-op = 0-48 hours Urgent impaired = 0-72 hours Can wait up to 2 weeks if not urgent The way you deliver it is the way people receive it Does perception create the reality? Yes.
Humans ruin things Receptionist can ruin things So be wary! Perception is everything Preserve the quality of it Requires training What I do, patients love, they benefit, etc You are an extension of the quality I provide You have to talk to you employees and tell them
W ORDS N OT T O U SE :
Im sorry Unfortunately I dont understand Youre a diamond This job is a circle This doesnt fit you Dont cut corners during hiring, screening, etc #1 thing employees hate most When they feel they are not well trained or prepared to do their job No one likes feeling like a fool
There are some things people are willing to forego in order to work for you Team meeting
D EFINE C ONFRONTATION
Its not what you think Whats the opposite of love? Indifference You know what, I dont care Its not worth it You need to Confrontation = opportunity for improved relationship
When I confront you, then youre good If you dont have this conversation with your employee, they will not accept criticism Whats going on, whats with the behavior? Do you care about the organization? Yes. IF ONE Person Fails Its A Linked Effect. HOW They Respond Is How You Judge Them Poor response, poor attitude, not willing to take responsibility are grounds for dismissal
Your business, your people are not automated if youre not able to walk out of your facility and have things still run smoothly EMPLOYEE TRAINING = creating a culture of rewards and punishment, of teams, of a group of authorities, confrontation and forgiveness, accountability What they like most about working at IndeFree #1 answer: I love my be job because theres no one looking over my shoulder I am the authority of my position
Employees are given ownership of their roles This leads to a high caliber of performing I want them to feel: Im becoming a better person Im growing Im holding myself to a higher level Money will come and go BUSINESS Is A Vessel For Making Great People That vessel is what made a difference
TAKE ON People & Show Them What It Means To Be Accountable, To Forgive, To Accept Criticism, To Be Compassionate If you going to give yourself a task, its not going to happen A New You BETTER Understand If You Want Something Done, Assign Someone Else To Get It Done THATS Letting Go THATS Working On Self I never say this is what the job pays
What do you want it to pay? Its all so subjective Words are so very important You can never pay a person what theyre worth We want to know what your needs are? What are you looking for? What should you do? Is that going to change you? Is that going to change their perceptions? No.
Keep in mind, you like this person Youre offering them $38-42/hr; they want $45/hr The moment of control with your employee Do you want to be in a position where that employee is over you because they are coming in at lower pay but with higher expectation Youre willing to let go someone you like for $180/mo? Youve been chosen under 1 condition Bring in me one new patient a month on your own effort
Store the info under the folder of that perspective Change the angle of sight, you create a new folder Market who you are What your message is What you are offering Who your best customers are Always go back to square one Mold the mind of your therapist Paperwork molds and conditions their thought process Paper Work = Thought Process
YOU Can Forgive Someone, But They Never Feel Forgiven; Doesnt Mean Squat Clinical Excellence ITS How You Make Them Feel That Counts Without this you will never have clinical excellence Its not what you think it is ITS CARE That Inspires A Patient To Unlock The Healing Power (Potential) From Within that results in family and friends being brought to you THEY Cant Unlock The Healing Power Within
Nothing you do will get them better HOW Do You Give Them Care That Inspires Them To Unlock The Healing Power Within? GOAL OF EXAM is to hear this: Thank You, I Already Feel Like Im Getting Better IF THEY Feel Like They Are Getting Better What are they getting? Getting better We are so clinical Thats our mentality
We think its good enough just to do a technique Its not #1 way to reduce malpractice for MDs Two words: Sit down What you think isnt Sit down and get eye level with patient Even get below them (for those with low self esteem) Never bring a computer to the exam
Get eye level, make eye contact Use a tone of voice thats authoritative yet gentle and calm Use words that are inspiring Stop asking like that; have you ever had physical therapy? Instead, ask have you ever participated in a physical therapy program? You are going to take control Go to the active with words Actually want to touch the patient
You want proximity, physical proximity Place diplomas right behind your head in the most expensive frame you can find Poster that conveys you are going to be active again Every therapist should have their exam room TO UNLOCK The Healing Potential Within, It Is A SomaticSensory Experience ITS Tactile, Auditory, And Visual They view you as someone who is caring and compassionate
You send the message You can let it go Trust me to get it done Subliminally gets the message, this person can help me Exam Patient role sheet Patients dont like seeing a new face Our job is to teach and guide Their job is to go and do Comprehensive = 40 min Intermediate = 20 min
Limited = 5-10 min Brief = hi and bye Ability to recognize who needs you more, those who needs you less Let the patient know they are not going to see the therapist much They will be working with a tech Thought process for exam Determining rehab potential PROFILING The Patients Motivational Levels
Thats when you should do the rehab potential from the profile Most therapist approach the patient this way Whats their rehab potential? Next visit: better, same, or worse Tell me whats going on, talk to me Comfort them YOU MUST Give Rehab Potential Based On Their Motivation To Get Better REHAB Potential Is Not Based On Diagnosis
ONLY Limiting Factor Is Their Desire To Get Better Or Not Identify motivating level What you learn in school is not FOCUS On Profiling That Patients Motivational Level PATIENT Is Not Getting What They Need To Become Motivated PROFILING Is Critical To An Exam PEOPLE Are Good At Deception And Manipulation
Most common cause of no improvement, but they are motivated WHAT They Are Not Doing On Their Own At Home Spend 2% towards getting better, will they get better? No. Tell them to do this and they do = clinical skill When do you start to think about what structures are at fault? I dont even care what structures are at fault FIND The Patients Motivational Level For Getting Better
WHATS In Their Work, Play, Or Sleep That Is Interfering With Their Restoration? Not allowing destructive elements to enter POTENTIAL For Destructive Forces That Will Interfere With Healing Environment Husband, wife, their attitudes toward injury Assessment WHAT Are Those Destructive Forces? IT MIGHT Be The Bed, Their Stress Levels, Their Shoes, Driving A Car, Poor Attitude
IDENTIFY Destructive Forces You want to educate: but not too much BLANKS Or Question Marks On The Pre-Exam Form Indicate They Are Not Motivated IF THEY Write Too Much = Mental Issues WHAT Are The Potential Destructive Forces In This Persons Life? DO NOT Allow The Subjective Or Objective To Change Your Profile Too Much DONT Allow The Patient To Focus You
THIS Person Is Still Going To Try Things And Overdo It PATIENT Principle #1 = They Will Overdo It = Destructive Force Do you think patient education is a biology or anatomy lesson? Thats showing off IF PATIENT says, Thank You So Much For Teaching That To Me Be wary What that means is: you just screwed your relationship with your referring MD Patient thinks what a freaking idiot this MD is
They Google it and take it back to the MD MD will never send you another patient again MD will call you and yell at you Do you want confrontation? Yes. They still love you The society, learn wrong things about confrontation Confrontation = an opportunity to make things right First of all, thank you for bringing this up
They were not going to expect you thanking them WHAT Can I Do To Help Make It Right? Words are very important Educational part of exam DO NOT Educate On Anatomy Or Pathophysiology Cant do it in 5 minutes (teach anatomy) How does it relate to outcome? FEAR Is Not The #1 Way To Gain Compliance
DOES Scaring Them Unlock Healing Powers? No. EDUCATE Them To ID Destructive Forces THE Word Is Issue NEVER Say Tear Conjures up too much fear USE TERMS Like Muscle Issue, Joint Issue, etc Patient Roles Tell them to write this down This is how you care for you Define their roles
Do's and Donts No excessive walking on uneven surfaces Always be definitive Every 20 mins get off feet Every 20 mins stand up Every night ice for 15 mins Why twice a day? Get up and go to sleep Never say 3x a day Cant do things 3x a day
2x = get up and lay down to sleep DONT Set Someone Up To Fail GUIDE Them Through A Program For Success, For Healing Clinical excellence is not common sense FAILURE Turns Off The Healing Powers BASED On Those Things (The Destructive Forces) WILL Determine How Much Time I Spend With Them Discharge (D/C)
Why D/C necessary if unable to remove destructive forces? CANT Follow Any Part Of His Program No chance of success UNABLE To Remove Destructive Forces On Affected Structures WHY Walk Into A Pit Just For The Sake Of Moving Forward MINUTE They Feel They Are Failing, The Healing Power Shuts Off At least he knows what he needs to do to get better Cannot cut corners
Match it up with bodys healing process Restoration Process This paperwork will pass audits PAPERWORK Will Take Staff Away From Patient Care Sequence tx in the flow sheet Within 6 visits should progress or change once Design tx plan right after exam System is not training them to be quick decision makers BE WARY Of Changing Tx Too Quickly Or Too Soon
TRUST Your Initial Instincts Grades for STM Forgetting it because youre not doing it Starts with reference number of 3 = 50% into tissue 1 = myofascial layer 2= 25% 3= 50% 4= 75% 5= into the bone Infraspinatus Pressure Point Release
T RACKING T HEIR P AIN

Be careful of putting 0/10 Critical d/c visit most prime to send a friend How does patient feel about you here? (At time of d/c) They think you are awesome Point at which they will refer family Find that pain never let it get to 0/10 Become predictor for D/C Say, How is therapy going?
Are you ready to start managing this at home? 2 comparable signs check it every day NEVER Let The Reason For Caring Reach 0/10 Have you found that measurement to be reliable? HBB With Thumb, Right Versus Left Tight Posterior Capsule Very reliable Important for patients perception of you
BECOME A Master Of Developing Comparable Signs GET The Difference In Measurement IF YOU Dont Tell Them What Their Progress Is They Wont Realize It HBH with middle finger what can they touch? Patient cannot cheat this test Single leg hop Side to side Front to back Diagonal
Run 10 mins on even surface LOOK At Proprioception ABILITY To Control Limb In Space SINGLE Leg Hops Is Very Comparable Functional Sign
K NEE C OMPARABLE S IGNS

Single Leg Bridge on Heel Tests hamstrings and posterior knee Minimal, moderate, severe
VMO F IRING /R ECRUITMENT

Tests anterior knee
Tone is 25%, 50%, 75%, or 100% compared to good side To bike: single leg squat without pain; 110 degrees knee flexion = you can ride up to 5 mins Is 110 degrees knee flexion extreme? Yes. Its the last 30 degrees of the range Yes (100%), no, and why? If you say go ask your MD they lose respect for you L/S (hinge from anterior to posterior)
S QUAT O N H EELS
How far can they go? Pain level at that range
S PINE M ECHANICS
T/S hinges from side to side L/S hinges front to back Flexion/extension; thats the direction its supposed to move C/S hinges in horizontal plane
T HE M EANING O F P AIN
Dont make them in pain Never leave worse; always better
Dont need to inflict pain to discover root cause (rule of thumb) Treatment is always painless, always You giving them pain sends the wrong message Pain means = there must be something wrong with me If youre good at one thing, your good at everything
T HE D ISC C ONTINUUM
Everything starts in the spine, everything Does it make sense?
Its always the disc At what stage is the disc? Disc lost integrity = facet problems In children: 99% with low back pain have no disc herniation 1% congenital basis of herniation Describe a moderate DDD? This is why we dont own the community market How do you open up spinal foramen? Transverse abdominal type stuff
Disc Continuum WNL 25%= mild DDD 50% = mod DDD; radial tears; disc is mushy Spontaneous restabilization as body starts to dump calcium to protect the nerves Patient starts getting better at restabilization all of a sudden Lay down every hour for 2 mins Get them on board 75% = bulge/herniation; brittle; severe pain
Should you walk with belly button in? 100% = sequestered/stenosis; broken up into pieces; got to separate it; fusion 5 years scan chart and throw away ICD-9 list on fee slip Doing great, great; if not, why not? Always have signed plan of care If MDs are looking at your progress notes, youre communicating
If use IndeFax, then dont need land fax line Patients perception of you as clinical excellence #1 complaint at most facilities = paperwork 45 min eval (apple in activation sequence) Pre-exam form & subjective (do both = 10 mins) 70% straight forward sprain/strain stuff 20% challenging stuff 10% crazy stuff
Face to face = 15 mins Dont give any tx usually Indefax = 2 min In exercise log record no shows or reschedules See DN = daily notes Adjust goal once a week for Medicare Lumbar a exercise log Prone press up Prayer SL Bridge
I= instruct on next visit 5th visit = critical d/c visit 4 th tx Tx program done after eval D/C few quick tests Ask! Do you know of anyone who might benefit from our services? Give the cards and brochures Best memory Teach exercise Hold them accountable Show me what you are doing at home
Continue at home for next two weeks Do I need to teach bridging one single limb? No, have techs teach it Were not a gym You do it once, do it twice Now do it at home Teach 1 exercise at a time Get better doing 1 or 2 exercises well every day at home for next 2 weeks I dont type up an exam and send it when the MD ask for it
They only want progress notes
CAIR T HOUGHT P ROCESS

C = control the destructive forces in work, play, and sleep (do's and donts) A = apply appropriate forces I = impose challenging forces R = restore maximal functional forces Dx = ankle fracture C = dont jump Do alphabet; dont let swelling increase; do use ice
A = stretching, closed chain isometrics I = single limb hopping or trampoline Baps board stuff, front and back R = running, figure 8s, up and down hills Running on side of hills, cats, zig zags, play soccer Treatment plan sucks no treatment plan progression No decent thought process At D/C ask can you do me a favor?
If you dont ask, they wont do If you ask at the right moment, they will do it The people they bring in listen better and pay more
D/C C RITERIA
S: 2/10 during ADLs O: 80% or better functional A: Self care/HEP independent Clinical measurement 80% or better Functional impairment 80% or better
Clinics have this thing where they subconsciously dont want to D/C Discharge certificate of achievement Fill out survey Dont underestimate For some, this is 1st time achieved goals Zero out account Get info to marketing 2-3 weeks after D/C, pt should get some money back for $12-18
Round up on collections send surplus back
A SSESSING P ROPRIOCEPTION
Sense of awareness of L/S and other body parts; holds all contractions Good test for Lumbar spine Flatten your back Toes up Squeeze knees Push heels down Breathe
Fair = loses it when they breathe Poor = cant hold it Contract and hold them while theyre breathing Notes when they lose it Push; hold it x 10 seconds (HEP) Use for comparable sign & HEP Pilates gaining awareness of the body in relationship to the other parts Yoga works good with bodys nervous system Bed lasts 1 year for every $100 spent
Anywhere you spend 8 hours Physical therapists havent addressed where we sleep C/S disc memory foam pillow with curve Right Infraspinatus is mod thickened near the spine of scapula PPR followed by stretch Low C/S and upper T/S Dont really need to mobilize C/S with C/S mob Have to get them into flexion
Stretch into flexion; use contract-relax Palm on cheek bone Opposite hand on temporal bone Its not fast or hard Push down Radial deviate and pull on ring/pinky finger for C/S pain (block wrist) Partial squat & stomach in a good for L/S firing gluts Side lying: hip abduction with knee bent Keep side off bottom hand
Keep waist off ground Psoas stretch extend arm up; ipsilateral lunge in standing Prayer stretch gluts on heel; feet flat (plantar flexed) on floor; finger walk forward; finger walk to side; hold belly button in

IndeFree Miami 2009

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IndeFree Miami 2009

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IndeFree Miami

October 17-18, 2009

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A UTOMATING P RIVATE P RACTICE

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A UTOMATING P HYSICAL E NVIRONMENT

S UBCONSCIOUS S ELF -S ABOTAGE

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FIND IT AT: http://www.vertitatasksoftware. com Steady stream of business

D AILY P RODUCTIVITY S HEET

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PPO & H IGH D EDUCTIBLE

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Biometric employee punch clock Punch in with thumb

D OING T HE W RONG T HING

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M ONEY M AKING A TTITUDE

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H ANDLING C ASH D EPOSITS

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B IOMETRIC E MPLOYEE P UNCH C LOCK

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5-10 min = limited (3/hr) Hi and bye = brief (4/hr)

P.O.S. C ASH R EGISTER S YSTEM

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A CTIVATION S PECIALIST R OLE

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Assume responsibility Never make assumptions Like youre talking to a 6 th grader

C LINICAL A REA /G YMS

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P AYMENT P LAN P OSTER

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