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[JOE]:
Are you still doing your own billing? What a waste of time. You could be doing counseling or any of the other things that you’re really really good at. My friends over at Practice Solutions are amazing at billing. They’ve collected millions and millions of dollars on behalf of their clients, counselors, just like you. Katherine and Jeremy, the owners, are this amazing couple that has built such a crazy, awesome team. A team that will go after the bills, that will get them collected, and you only pay if they collect. As well, they can help you with credentialing. Take this off of your plate, put your time into something that really matters. I want you to head on over to www.practicesol.com and reach out to them. That’s www.practicesol.com, and let them know that you heard about it on the Practice of the Practice podcast.

This is the Practice of the Practice podcast with Joe Sanok, session number 494.

Welcome to the Practice of the Practice podcast. I’m Joe Sanok, your host, and right now recording from Practice of the Practice World Headquarters in Traverse City, Michigan, but actually, I batch recorded this and we are in Colorado – at least that’s the plan – when this goes live, kicking off Killin’It Camp. And so right now, Killin’It Camp is going on. If you didn’t get tickets, make sure you do over at killinitcamp.com. It’s just so awesome. We have so many great speakers. Also, episode 500 is right around the corner. Would you take thirty seconds to just leave a message of how this podcast has impacted you? Who are you? Where are you from? How has this podcast impacted you? Take thirty seconds to do that over at practiceofthepractice.com/voicemail and just leave us a message; it would be so killer for you to do that.

Today, we have Dr. Robert Moss who has done all these different things to optimize a physical therapy practice. So a little bit more of a medical model, but the things that he talks about are so applicable to what we do and what we think in our world as well. So without any further ado, I give you Dr. Robert Moss.

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[JOE]:
Today on the Practice of the Practice podcast, we have Dr. Robert Moss. Robert, after spending years as a physical therapist running a small practice, shifted to focus on streamlining his processes to give him more time to spend with his family. Out of this shift sprung a passion for helping other business owners to do the same, while also maximizing their profitability and customer satisfaction. Robert, welcome to the Practice of the Practice podcast.

[ROBERT]:
Great, Joe. Thanks for having me here. It’s a pleasure to be here, I’m excited.

[JOE]:
Yeah, I always am excited to find people that are in the private practice space, but that aren’t therapists or counselors, that kind of have this mindset that we value at Practice of the Practice, but are applying somewhere else. So physical therapist, it seems like you’re really doing things in a very similar way to what we do. Take us through a little bit of that story because when I hear the line in your intro that says ‘to spend more time with his family, that’s a hundred percent me, like, I value my family, my friends, my free time, all of that. What was that shift like? And how did it happen?

[ROBERT]:
Well as most people, there’s usually some type of pain point in the story, and mine was no different. I’ve always been kind of a busy guy. But back in 2006, when I opened the practice, I was finishing up my doctorate at that time frame, and opened the practice and was studying for clinical certification, and working on a fellowship project and all those sorts of things, and didn’t really know anything about opening a business – I just knew I didn’t want to work for anybody else. So as we started to kind of organically grow – we had a lady that pretty much started out with us running the front office – and as we just got bigger and bigger, she just took on more and more tasks, and not knowing how to build systems or even just record what we were doing on a daily basis. We’d look up and several years later, we’ve got several staff members and another licensed therapist, and at some point, she comes to me and says, well, I’m having some marriage issues and I need to leave, and I need to leave within two weeks. And so you can kind of… If you’ve ever blacked out, and the room starts to spin, your vision goes, you know, tunnel vision, and you’re like, everything just kind of flashed before my eyes, like, oh my goodness, like, basically all my front office knowledge sits with this lady, it’s in her head.

And so I’d already been reading… I’d read Michael Gerber – EMyth, and read some other books and thought, well, all right, we got to build these systems and I guess the best thing to do now just does this massive brain dump. Let’s get everything out. So I’m like okay, from now on, like, everything you do for the next two weeks, not only do you have to do it, but then you have to write down what you’re doing. And we got to make sure we have all of our logins, and all of our passwords, and all this sort of stuff. So that right there just kind of sent me on this tailspin of like, I don’t really have a business. I just have a job where I’m just super busy all the time and managing people.

And so from there, I found Work the System by Sam Carpenter, which kind of takes EMyth to a new level, of really kind of how to build those systems and how to put those things in practice. And so I went on a journey to kind of learn a little bit more about that. And that was really… that was probably 2014, 2015 when we started to move forward and build more systems in the practice. But that was my initial pain point. But back to your original question about spending time with family, I was, you know, I’ve got three kiddos now, and we’re learning to play the guitar, and I like to ride my bike and do all that fun stuff. And when I looked up, I’m like, I’m still working fifty, sixty hours a week, I’m working on the practice at the house, this really isn’t what I had in mind when I opened my practice back in oh six. So I knew some things had to change.

[JOE]:
Yeah, it’s amazing how those disruptions, it’s never easy at the time, but it forces you to kind of grow up as a business owner.

[ROBERT]:
Most definitely. And I’ve talked to several other business owners, and people, and it’s funny, everybody has – almost everybody – has some type of story like that or some type of pain point. Because if I come to you, and I say, hey, we need to build some systems in your practice, we need to document what your staff is doing. They’re like, yeah, okay. You know, like, they know they need to do it, but it’s not…

[JOE]:
That sounds good, but I’m not gonna do it right now.

[ROBERT]:
Right. But it’s like, wait a minute, how about what do we do on social media? How do we market this? And it’s all about something different until the fire gets so big, then it’s like, oh, my goodness, like, I really don’t have all this stuff. And when a key person of your team leaves, that’s when it really gets to you.

[JOE]:
And for you, what did those, say, first few months after she left – what did that look like? What were kind of the low-hanging fruit systems that you took care of? What was most essential? How did you think through that? Because it feels like to untangle all of that, when you’ve had this trusted person for so long, it would just be like, what do I even do first? So take us through kind of like what you had worked on in your own business, and then we can kind of transition into talking about other people’s businesses.

[ROBERT]:
Sure. So first thing, cash is king. So, cash flow. And luckily, we were pretty profitable up to that point. And I was kind of like a squirrel, stashing money aside, so we had some money set aside for a rainy day fund, but getting our billing and our collection systems dialed in from that point was crucial for us. When you bill healthcare, as I’ve said, the insurance companies, they don’t care if they pay you or not. And even if you send in a bad claim, they’ll wait as long as possible to come back and tell you, hey, you forgot to put a social security number here. And so making sure that we had someone that could do the billing, to step up, and then also working on our collections process as well. Those were the two big things starting out because we already had some marketing and some good word of mouth going. So the volume of patients that were coming in was still consistent, but it was making sure that those bills were going out and that they were also getting collected.

[JOE]:
Yeah, I think a lot of times people think, oh, we have to automate all these different things. But when it comes down to it, you’re a business. And so if the flow in, or the flow of money isn’t there, like, everything else needs to pause till you get that going and get it cleaned up. Because it doesn’t matter if you have a hundred patients coming in if half of those claims aren’t being paid because you don’t have a good system for it, then you have half as many clients as you think you have.

[ROBERT]:
Exactly, yeah. Collections, cash is king. And jumping ahead briefly just to this COVID issue, not only did our volume drop, but then also the collections slowed up because a lot of these claims adjusters and people that work for the insurance companies are working from home. And so there’s been an increase in delay in our overall payment here recently. And so volume-wise, we’re getting close to where we should be on track for the year, but just coming out of my meeting before this podcast, our collections, and our income, is still down. And so instead of running within twenty to thirty-day payment cycles, we’re looking at thirty to forty-five days. But guess what? The staff still wants to get paid.

[JOE]:
Yeah, of course, they do. So the idea of kind of streamlining things and moving away from a job, I think there are so many therapists that can relate to that, because their direct amount of money they make is dependent on them, during COVID, showing up on the screen or outside of that, showing up in the sessions. How did you start to shift differently, to really increase that profitability and work less? Because that’s the code that I think a lot of people struggle with, like, how did you do that?

[ROBERT]:
Right. So the big thing is that I really just kind of looked and said, what do I want? And at that point, my daughter was probably about twelve and my son was nine, and then most recently, we had a surprise little toddler. So you now have this third child running around the house. But I just kind of looked up and I said, you know, by the time I see patients for forty hours a week, five days a week, then I’m spending time on my management and stuff over the weekend, I’m really not able to develop and grow my leaders within the practice because I’m burnt; I don’t have time at the end of the day. So that was kind of that sticking point for me. And then I just kind of went on this journey of, okay, what would I like to look like? And now I’m transitioning out of practice entirely, we’ve got a new therapist that’s coming on board next week. And it allows me to now not only coach and kind of lead our team that we have, and do some weekly training with our therapists and our front office staff, but also to now step out with other business owners and share my experiences and knowledge with them, and hopefully be able to coach and kind of help them along, so maybe we can shortcut and reduce their, their feelings of pain and frustration with someone that has experienced it, then say, hey, look, this is what I’ve done in the past. Let’s not go down that road for you, and here’s a way around it. And so trying to help people see that you don’t have to have pain to make a change in your business or your lifestyle.

[JOE]:
Yeah. I know, for me, having really aggressive boundaries around my time has forced me to really work on the things that only I can do. And so if I have a list of twenty things in any given week that I can work on, if I only give myself enough time for fifteen, either I have to work faster or I have to drop the ball. And obviously, the things that I’m not as suited for, or I don’t want to do, or that really aren’t a priority will be those last five things that I drop the ball on, which is a great opportunity to outsource or create a system. What kind of boundaries do you set up for yourself, or mindsets that you set up, to not get sucked back into, you know, just increasing profitability, but to actually keep working less? Because I think people like you and I, we have ideas, we have inspiration, we probably could keep working that forty, fifty hours and just keep doing it. But what kind of boundaries do you have for yourself that help you kind of stay reined in?

[ROBERT]:
Yeah, that’s a great question. Because yeah, just as you were talking, I’m like, oh, yeah, there are a million things that I could do, I could easily work a sixty-hour workweek. But some of the biggest things is (1) just when I’m at work, just to be present at work. I walk through those doors, it’s game on, it’s time to get work done. When I go home, it’s game on, it’s time to be dad, and hang out at the house and help with the chores or the kids or whatever. So kind of establishing that, and that’s just something internally that you have to just set and do for yourself. The other thing is, I’ve given myself permission to not feel like I have to get everything done, you know, within the day. So like you said, you’ve got this checklist. And I don’t know about your checklist, but mine is I’ll get one checked off and add three more. So it’s just a running list. But so what I do at night is I journal. And I’ll write down three things that I want to get focused, and attention on, and get accomplished for that next day. And as long as I get those three things accomplished, then I’m good. And so that’s allowed me to then really prioritize like you were saying is, okay, what are the three most important things I need to get done tomorrow, that only I can do? Not that I can outsource to somebody else. And once I get those accomplished, then anything else is just icing on the cake. And so that’s one thing where I’ve given myself permission to not say, oh, my goodness, and just feel overwhelmed by my huge list, but just focus on those top three things.

[JOE]:
Yeah. Now, when you’re coaching people, when you’re helping other businesses kind of shift their mindsets, what are some of the big challenges that people walkthrough? What are the mindsets that really have to shift to transform businesses?

[ROBERT]:
Yeah, I think one of the biggest things is the feeling, especially as an entrepreneur, that you have to do it all, that you have to… you’re the one, that only you can do it because you’re a perfectionist, and you’re going to make it right. And sometimes good is good enough. And if you can find someone on your team that can deliver the eighty or ninety percent result versus you thinking you can do the hundred percent, you need to let go of that task. And the owners need to focus on, you know, what are the key things that I can do? So maybe if you are creating some marketing content, maybe you can get a rough draft of your idea down, and then you outsource it to a skilled copywriter who can tweak that for you. Or if you want to teach your team how to do something specific, then you’re the one that’s going to do it. But all these other processes that are in place, your team is doing those on a daily basis. So those people should be the ones – if you’re starting to document your systems – those are the people that I would turn to say, okay, this is gonna seem tedious at first, but super important. You need to write down what you’re doing, how you schedule a patient, or how you build something in our computer system. And you get the staff to buy in that. So now they own part of that process. And it’s not like, oh, well, the owners come out of his office again, he has another task for us to do.

[JOE]:
Gotcha. Sweet. So I think that idea of, like, ‘nobody can do it like me’, that’s such a common mindset for someone that… I wouldn’t even say if they’re newer business owners, I see it with a lot of people that have been around for a while. I’ve found that it’s true, no one can do it like you, but sometimes someone can do it even better than you. Like, I think about my team now and thinking about, yeah, I would have done things a certain way. But then, boy, they really have developed their skill set to be able to do this differently. What are other kinds of things, as people start to systematize their private practice, that they need to consider?

[ROBERT]:
Yeah, I think that’s the big one, though, is letting the other team members kind of take over. And I think, another big thing that I see is, you really need to be open and receptive to change, which is hard for me. But if I have a staff member that is running my front office, and we’ve got something written out that, you know, a system that maybe we wrote months or a year ago, and they say, hey, we don’t use this phone system anymore, or this has changed, or I think we can do this more effective, then you need to be open to let those team members kind of run within their skill set, like you said. So maybe they’re better at organizing, or maybe they’re better at putting together Google Sheets, or whatever that is, and trusting in your team that they’re going to continue. But I think all of that also, it really comes back to setting that vision that you want as the owner, and sharing that with your team, and getting a good group of people around you that buy into that vision that you have set. Because if you don’t have a vision of where you’re going, then your team’s not going to come up with a vision on their own, and they’re going to just wander around aimlessly. So if you have that vision and you can get them to buy in, then I think it gets everybody moving in the same direction within the organization. And you also let them know, hey, it’s progress, not perfection. And so, you make a mistake, let’s learn from it, let’s fix it, and then let’s keep moving forward. I think if they’re fearful that, you know, they’re not going to be able to do something up to your standards, then a lot of times they won’t even try. But you need those people on your team to keep rowing the boat and moving forward and let them try, let them fail, help them up, and then keep moving forward.

[JOE]:
Wow. So then, describe the kind of people that tend to work with you, and maybe kind of a practical case study that we could apply to therapists.

[ROBERT]:
Sure. So part of our hiring process is I’m a stickler when it comes to attention to detail, just from what we do, and it has to be. So we’ve got to make sure the T’s are crossed, that the I’s are dotted, especially when you’re billing insurance and you’re doing that sort of stuff. And so part of our interview process is we start with a phone interview. And this is from, I think Jeffrey Smart is who wrote the book, it’s called ‘Who’, and it really has a great system to kind of walkthrough and things to look for with the hiring process. But so that’s kind of some things that I’ve tweaked to use in the practice. And, you know, we’ll do a phone interview, and I’ll kind of grade that person. If I think they’re A material, then we’ll bring ’em in for an on site interview.

At that point, we start to talk about our company, our magical core values – I like Disney stuff and so we’ve kind of made it an acronym. So it’s magical, it’s making a difference, its attitude, gratitude, integrity, customer service, attention to detail, and then leadership. And I kind of watch their face and see if they chime in, or if they get a spark when they start to hear that sort of stuff. If that’s the case, then they start to buy-in. And then we want people that are going to take the training that we give them and then just start running with it, and come up with new ideas and as I said, make a difference and just really have that attention to detail and work to serve our customers. Those are some of the big things that we look at in our hiring process, and people that work around me. And we’ve had people that we thought they had those qualities, and they work for a little bit and they select out. They’re like, nope, you guys are a bunch of nuts. I’m not working for you. And they’ll take off and leave.

[JOE]:
Yeah, yeah. Now, when you think about your next steps as the owner, and kind of what’s going to help you personally grow, but even the business grows, your consulting grow, how do you determine, for yourself, here’s what I’m going to work on next?

[ROBERT]:
That’s a great question. So, weekly, I’ll sit down, and I’ll kind of look at, you know, plan out my week. But that goes off a bigger plan that I’ve set down back in January. Of course, this year is a little bit off track, right? But I kind of set some annual goals. I’ll break those down into quarterly to try to help accomplish those annual goals back down to monthly, and all the way down to weekly, and then into the day. And so I’ll look at that and say, okay, what do I want to accomplish for the coaching services that I’m offering? And get on some podcasts, start to produce some more content for people, work with some other therapists and local businesses here in our community. But then also, within our practice, it’s looking at, okay, we have a new therapist that’s coming on, making sure that we are consistent with her training, as well as our other front office staff, being able to automate a few of our other tasks to allow the front office some more time to spend on the phone with the patients, especially people that are coming in. And so it really, it kind of varies, but it’s all based off that larger annual goal that I set back in January.

[JOE]:
Gotcha. And how do you keep kind of pushing yourself to get to that next level beyond that? Because I know that, like, whether it’s the book, ‘The One Thing’ or other business books, they all have their way that they do it. That idea of what’s that next big thing that’s gonna make everything else easier? Are there any mantras or techniques that you can share with us that are kind of the practical step by steps?

[ROBERT]:
I think it’s just staying focused. I kind of, every once while having that little shiny squirrel syndrome, you know, something else dings or pops up. And it’s really, it’s closing the extra web browsers, it’s looking at your calendar, or looking at… for me, I’ve got my three wins that are kind of listed out, you know, what am I going to do for the day and knocking those things out first, I think that’s part of it. And the other is not letting the other time vampires, so to speak, the people within your organization, that are always knocking on the door, saying, hey, got a second. Having the guts, so to speak, to say, you know, I’d love to help you but it’s going to have to be in an hour, because I’ve got to prep for this thing, or I have to finish writing this document. And be okay with telling people ‘no’ at the moment. I don’t think that’s disrespectful. I think they’ll respect your time. But they need to understand that you’ve got to, you know, hunker down and focus on tasks just like they do. And just because they have a moment, that doesn’t mean that that’s the right moment for you as well.

[JOE]:
Yeah, that idea of kind of open-door policy, that to me does not necessarily breed productivity. For me, I even, in working at home now, I tell my kids, I’m going into monk mode, I’m going into my cave. And they know it’s time for dad to work. And so I’ll give hugs, right before I go upstairs into my office, and I’m going to work now. And then even if I run down for a glass of water, they ask, are you done with work? Or are you just between things? And so to even just be able to say, hey, I’m just between things, I’ll be done at four. Then it’s like, okay, I can clearly work on what I need to work on. I’m not gonna be even interrupted by the family, which I think is happening a lot with people that are doing therapeutic work, maybe it’s not their actual therapy sessions, I doubt that’s being interrupted as much. But when you’re doing a blog post, for example, to say, no, this is the time that I’m going to focus on my business and just get things done.

[ROBERT]:
Right. I think that’s key. And so whether I’m here at the office, or I have an office at the house as well, and letting the wife and kids know, hey, I’m going upstairs, you know, dad’s going to work for a while, and they know, it’s kind of the same thing. He’s essentially gone. He’s out of sight. And that allows you to focus on the thing, same thing here. And then in the office, you know, the staff is… I’ve worked with them, it’s like when the door’s shut, like, hold back the interruptions. If the building is on fire, notify me when there’s one wall standing and the fire departments already here starting to put it out, you know, or if I smell smoke, then I’ll come out. If not, just leave me alone and we’ll be good.

[JOE]:
Yeah, I feel like once you kind of get in that flow, you just want to keep riding that wave. Well, Robert, the last question that I always ask is, if every private practitioner in the world were listening right now, what would you want them to know?

[ROBERT]:
You got to put in systems in your business. It’s super, super boring. But I think it’s one of the missing keys that a lot of people don’t implement, especially early on. And really early on is the best because as you’re starting to learn and do things, it’s easy to write those processes down versus waiting, you know, ten, twelve, fourteen years later, and then you’re having to backtrack on that. And it doesn’t have to be anything elaborate. You could literally just use a Google document, which is what we use a lot in our practice, and just write down, you know, how you want to answer the phone, or how you’re going to hire somebody, or how you’re going to document your session. And you just start and then as times change, you need to have a way to go back and just review those on a frequent basis. And if you do that, then you’ll just continue to update basically your systems over time. And then if you have a key person leave, you don’t have to have the stress and the angst that I had years ago when I lost the key front office person with all of the knowledge sitting up in her head. I would have had it documented and it would have been an easier transition, especially on me.

[JOE]:
That’s so awesome. Dr. Robert Moss, if people want to connect with you, if they want to hear more about what you do, what’s the best way for them to connect with your work?

[ROBERT]:
Right now the easiest way is our springtownphysicaltherapy.com/practice – so we set up a page for your listeners – that’s the easiest way. It has my contact information on there. They can book a free discovery call. We just kind of talk about things going on in the practice, gives us some tips. That’s probably the easiest way to connect with me at this point. I’m also on Facebook, MOSS Rehabilitation Center, and then also on Instagram, which is @mossrehabcenter.

[JOE]:
Awesome. And we will have links to all of that in the show notes. Robert, thank you so much for being on the Practice of the Practice podcast.

[ROBERT]:
Joe, thanks for having me. I appreciate it.

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[JOE]:
Wasn’t that awesome? I mean, we can learn so much when we look at other fields and how they do things, and how they think through things. I would love to know what are you going to take some action on with this podcast? What are you going to do? Feel free to drop me an email at [email protected]; we’d love to hear what you’re doing with this information from the podcast. And also if you are still doing your own medical billing, you got to stop. It’s such a waste of your time. So often, you know, we try to bootstrap it so far past where we should be bootstrapping it. And I want you to head on over to practicesol.com, Practice Solutions. They are the best billers that we have found. It is amazing to see how much they collect and you only pay if they actually collect. And so if they don’t collect, you don’t pay. It’s really amazing. So check out Practice Solutions, head on over there today.

Thank you so much for letting me into your ears and into your brain. Next time we’re going to be talking about the ABCs of online therapy, a quick start guide for mom clinicians to take their practice online. So I’m really excited about that. Online therapy is something that so many people need to think about, even outside of COVID. It can be such a great lifestyle decision for you. So we will be having that on Thursday. I’ll see you then. Bye.

Special thanks to the band Silence is Sexy for your intro music; we really like it. This podcast is designed to provide accurate, authoritative information in regard to the subject matter covered. It is given with the understanding that neither the host, the publisher, or the guests are rendering legal, accounting, clinical or other professional information. If you want a professional, you should find one.