Healthy, Wealthy, & Smart Episode 350: The Anatomy of a Cash-Based PT Start-Up
Karen Litzy talked with Dr. Josh Payne on episode 350 of Healthy, Wealthy, and Smart. During their discussion, they discuss how Josh began his concierge physical therapy practice. Josh started his practice after getting tired of the traditional PT model.
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Welcome to the Healthy, Wealthy and Smart podcast. Each week we interview the best and brightest in physical therapy, wellness, and entrepreneurship. We give you cutting edge information you need to live your best life, healthy, wealthy and smart. The information in this podcast is for entertainment purposes only. It should not be used as personalized medical advice. And now, here’s your host, Dr. Karen Litzy.
Hey, everybody. Welcome back to the podcast. Today’s episode is brought to you by Net Health. So if you’re looking for an EMR system to literally do everything, except take the patient notes from your brain and type it into the computer for you, then check out Net Health. They are ReDoc powered by xfit, which is a cloud-based, fully-integrated EMR and billing solution. Plus, you can opt into completely outsource billing services. That’s the best way to optimize revenue. Imagine PT billing, coding, and compliance experts taking the back office work off your hands and reporting directly to you. To learn more about ReDoc and the complete revenue cycle management services, check them out at nethealth.com/healthy.
All right, onto today’s episode. This is one that is near and dear to my heart. I am happy to have on the podcast this week, Dr. Josh Payne. We are talking about the concierge cash-based practice that he started in Denver, Colorado. So he’s doing the same thing I do, just in Denver instead of New York City. So what do we talk about? We talk about why Josh decided he wanted to open his own private practice, and how he laid the foundations for his business. His top referral sources he used to build his patient caseload. Some mistakes along the way while growing his practice. We all make them, I think I’ve talked about mine extensively, and what the future has in store for his company Freedom Physical Therapy.
So it was so great to talk to Josh and I just love hearing what other people are doing out there in the country that are doing the same thing that I’m doing. So if anyone is listening to this and you’re doing the same thing, you’re building up your concierge physical therapy practice, get in touch with me. Reach out to me on Twitter @karenlitzyNYC or on Instagram, Karen Litzy, because I want to hear what you’re doing and maybe we’ll have you on the podcast and kind of talk about some of the struggles that you’re experiencing and see if we can work them out together. So I would love to hear from you. And on that note, everyone enjoy today’s episode with Dr. Josh Payne.
Hey, Josh. Welcome to the podcast. I’m happy to have you on.
Thank you for having me on, Karen.
So today we’re going to talk about how you started your own concierge practice, how you were able to grow that practice over the past year and a half or so, right?
And where you think you’d like to take it in the future. I just threw that in there, just because I’m curious to see where you want to take it in the future. But let’s start all the way back. So in the bio, we said you graduated in 2013. So what led you from graduation to working in some outpatient clinics to now doing your own thing? Can you give us a little background?
Yeah, yeah, absolutely. So I graduated from Texas Tech in May of 2013, and then I had quite a few jobs in Texas. What happened was I went into outpatient, just like most of my friends did. I thought I was meant to be a sports physical therapist and that’s what I wanted to do. And that’s where I had my eyes set for, and that’s what I went after. And I quickly realized maybe that wasn’t my path. I went into actually home health for about a year. Also, most people who do home health know that the paperwork, the OASIS documents, they’re insane. I quickly found myself kind of in a position where I just wasn’t extremely happy with anything that I had found so far in physical therapy.
I think it’s a good point to bring up because I’ve talked to a lot of physical therapists that feel the same way as me. Really in around 2014, 2015, somewhere in that area, I really just kind of found myself really not feeling great about the physical therapy profession as a whole and wishing man, is this … It’s that kind of feeling of man, is this it? Is that all that I have to look forward to? So my wife and I decided to move to Denver, Colorado, and I was doing some home health and some outpatients on the side as well, but I just saw an opportunity for the really active population here to do something different.
Actually, Karen, this is around the time when I reached out to you through email. I was sitting up late one night. I was doing OASIS documents on like a Tuesday night. I still remember this night and I’m sitting in this office in our little apartment building and this is the only office I could find. Sitting there doing OASIS documents, just grinding away on those. I was just so kind of almost just depressed about my situation. I looked up because I always had the idea of maybe going mobile or concierge. I heard that about a year and a half, two years ago and I just did a quick search and I eventually came up on you on Jarod Carter’s podcast.
I listened to the whole thing, was just like absolutely enthralled. I was like, I have to email Karen. And so that’s when I emailed you. I just asked you a few questions, but that’s when it all began. I was like, wow. If she can do it in New York, I think I can definitely do it in Denver with the population here. So that’s where it all began. It really kind of happened out of me just trying to find my place in physical therapy, and now I really couldn’t be happier. It’s kind of reinvigorated me as a physical therapist. Now I want to be the best again, but there was definitely a period there where I went through a time where I just didn’t really know where I fit into the whole physical therapy world, what was going to be my best niche. I’m glad I found it.
Yeah. Well, I’m glad you found it as well, because that’s so sad to hear after you went to school that you didn’t feel like you kind of found a place where you can serve others. Because we all go to physical therapy school because we have this desire to serve others and to be of service to people who need us. So it’s great that you have been able to find a niche for yourself where you can accomplish that. So now let’s take it back to how did you start? So you have an idea. You listen to a podcast. You reach out to me, what comes next? How did you start?
Actually, my first thought was I had no idea anything about business, so that was … Originally, my first thought was I need to learn about business. So we were new to Denver anyway. I was like, man, I need to meet some new people anyway. So I put myself into an entrepreneur class that was eight weeks long. I went through that, started meeting new entrepreneurs and talking to them about business, started to get more and more excited about this idea. That’s what kind of shifted my mindset a little bit in regards to owning a business and looking at it more as a business role instead of just that physical therapy role, where you’re just taking care of clients during the day.
And then from there, I just started really, the next step was just pure networking. I mean, I know Karen that you’ve talked about this in the past, but I just got out there and I networked with every possible person that I could think of. I mean, that’s kind of where I found my love for networking was, I mean, I went to every event possible, every networking group possible, some were better than other. That was my first initial kind of start, was just getting my name out there. Of course, after I made some basic business cards and websites and things like that.
How did you decide on how to incorporate or how to create that corporate entity? So did you have help from a lawyer or from an accountant? Or how did you get that? Because that’s the foundation of the business. So how did you get that foundational part squared away?
Right. Yeah. So, with all of those networking groups, I actually met a lawyer who had his own practice. He had a concierge type practice for himself, and we met for a few visits to just go over everything that I needed to get started and make sure everything was legal on that side of things. He suggested just an LLC for me, and so we filed an LLC through the secretary of state websites in Colorado. And that’s that. That’s just an LLC.
Great. So you did seek out some legal help. I think that’s important to note.
Yeah, because if you do it wrong, it’s a nightmare. So I’m glad that you spent a little bit of money, did it right the first time around and now you’re off and running, right?
So you create the LLC, you’re networking like crazy. How long did it take for you to build up a patient caseload? Because I know I hear from a lot of people, gosh, everyone said it, I would get patients so quickly and I’ve been doing this for a few months and I don’t have, I’m not seeing 30, 40 people a week.
Right. I do have kind of a rare case here because I met somebody that really kind of changed the course of my practice. So I was full within about eight months.
So who did you meet that changed your practice and how did it change it?
Yeah. I had heard from a lot of different PTs that were doing cash-based models. Oh, avoid the doctors, avoid the doctors. I eventually just said, you know what? Screw that. I’m going to actually try this. So I found pretty much the top five concierge doctors in Denver and in Denver concierge MDs are actually pretty … They’re kind of popping up all over the place. So it’s becoming very popular. So I kind of wrote down the top five and I was like, you know what, I’m just going to try and reach out to them through email.
I met with one of them. Luckily, he agreed to meet with me for about 30 minutes and hear what I had to say. And he said, “You know what? I don’t think you’re a good fit for my practice, but I think I’ve got a friend who has his own concierge practice who would be a really good fit.” This guy was a little bit older, and the guy that he referred to me to was a little bit younger. So he actually sent out an email connecting the two of us.
I met up with this new doctor and we just … I mean, he was a hundred percent right in that we just clicked immediately. I mean, since then it has been almost a flawless, the best relationship any PT and doctor could possibly ever have. I mean, if he has any musculoskeletal issue, he basically just sends it my way and says, I don’t know anything about that. Just give it to Josh. So he’s been incredible, and I still get a good amount of referrals on a monthly basis from him.
And so he was kind of instrumental in why I was able to build it so quickly. Other than that, without him, I think it would have taken at least a year or more to get completely full on my practice. But he made it a little bit shorter. So I guess for anybody listening, I guess one good thing to learn is don’t … Concierge doctors, it’s becoming a big thing, just like concierge PT is as well. I wouldn’t count them out as a possible referral source.
I could not agree with you more. That is one of my biggest pet peeves is people saying, well, we don’t need doctors. I mean, you do need doctors and they need you.
It’s a two-way street. You’re not going begging for doctors to give you referrals. You’re going to doctors saying, “Hey, this is the service I provide. I really think I could be of service to you and your patients.”
Not please, please, please send me patients. But this is what I do. I’m really good at it. I think we could have a great partnership. I think we can have a great relationship. And FYI, that’s how you work with everyone, but you need doctor referrals and they need you. That’s how it should be. You’re all part of a team.
Right. And if you don’t mind me expanding on that just a little bit.
Because I just had a PT ask me about this not too long ago. I think it’s really important for PTs when they are approaching docs, whether it’s concierge or normal, to approach it exactly like you just said with confidence and that we’re trying to build a relationship here and not just one sided type of relationship like I think a lot of PTs do try to approach it. But really come at them as, “Hey, I want to learn about your practice. And I’d love to share about my practice too.” And let’s see if we can create a spark here, some kind of relationship where you can create a good relationship with a doctor, because I think when you find the right one that gels with you, it’s an awesome relationship.
I mean, it’s still ridiculous. I mean, I call the guy on a regular basis and I’m just like, “Hey, doc, I’d love to talk to you about 10 or so patients I’m seeing right now.” He’s just like, “Yeah, stop into my office.” We pop in the office. Sometimes we eat lunch together and we’ll just talk about the patients then I’m off seeing more patients. And it’s like, I do think there is opportunity for us as PTs to have a relationship like that with doctors. It’s just, I think we’re going about it the wrong way sometimes.
Yeah. Yeah. And it doesn’t mean that you market exclusively to doctors because you should never have just one referral source. God forbid this guy picks up and moves to California on you.
So the referral wheel has a lot of spokes to it.
And doctors and physicians are one of those spokes for sure. So, okay. So you filled up your practice, you’ve got a good network for doctor referrals. Where else are you getting your referrals from, speaking of those spokes of those wheels?
Yes. So the majority of my other referrals now come from word of mouth. Obviously that takes a little bit while to grow organically, but it does if you are doing good work. So patient referrals, patient to patients. I see lots of patients that I start to see, I end up seeing a lot of people in their same families. So that’s a really easy transition as well. And then also I have had just a few reach out to me from other like chiropractors in the area that I know, a massage therapist that I know in the area. And those are basically the main two that I can kind of count on that are kind of talking me up as well and want their patients to see me as well. So I know you’ve talked about in the past, those are really important relationships to have too, so reaching out to massage therapists in the area or the chiropractors or-
Or other physical therapists.
Yes, yes, absolutely. Absolutely. Yeah. Correct.
What I would love to see more of is people maybe in the concierge space or the home health space, not your traditional home health space, but kind of like what you and I do is reaching out to those acute care therapists, because they’re seeing patients, their patients are getting discharged.
That’s true. Yeah.
So why not reach out to those therapists that are in acute care in big hospitals in your area? Because they’re seeing patients.
If there’s a big orthopedic wing or something in a hospital near you, I think that’s another great people to reach out to, and you can again create like a positive relationship with this therapist and then guess what? You have great transition going from inpatient care to outpatient care, which is really hard to do.
It is, but it’s definitely needed. So yeah, I like that.
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Okay. You’re a hundred percent cash-based, you’ve got … That’s correct, right?
It is correct. Yeah.
Okay. You’ve got good referral sources coming your way. You’ve been in practice for eight months. You’ve got a pretty good patient caseload. What does that mean? When you say you’re full, how many visits are you seeing per week? Not individual, like if you see a patient twice a week or something, I mean just straight up visits per week.
Straight up visits per week. So actually, I had some experience with this because of my home health background. I always told myself if I were to start a business like this, I never wanted to see over 30 visits a week. So that is my cap and anything over 30, then I schedule them out and that’s just simply because I just feel like I’m a better therapist when I stay at that cap. I’m more energetic. I enjoy every single visit. I don’t want to get burnt out. I know other concierge therapists I talk to that are doing like 35, 40 or upwards. And that’s awesome if you can maintain that. But for me, I just know myself, 30 is my cap.
Are you around that each week or does that vary?
Yeah, of course it varies, but generally on average I’m between 25 and 30 visits a week.
Okay. Great. That’s awesome. I like the fact that you are setting some boundaries for yourself because as an entrepreneur and a business owner, I think it’s important to set those boundaries. Did you have…I know you said kind of working in home health, you got a dose of what you can handle. Did you have an incident where you were doing too much that led you to say this is going to be my absolute boundary when I have my own practice?
Oh, absolutely. Yeah. I mean, I had weeks where I did 40 or up in home health, and it’s just, I knew I wasn’t giving everything that I possibly could, but I had just had so many visits that the home health company was cramming down me that I had to get them done. I had to figure out how to get them done. And the only way to do that was to shorten the visits a little bit. So I said the whole reason I’m starting a practice is because I want to give my patients what they truly deserve. So I can’t do that. It’s just number one priority, we got to stay below 30 visits. I don’t budge on that.
Great, great. I think it’s really important to have those boundaries and to have that mindset that you’re taking care of yourself so you can take care of others, which is really important. We’re in the present, your business is going well. Where do you see it going in the future?
Yeah. So I’ve had this question a lot recently. I do have a business coach and we go over this type of thing quite a bit. Currently, I have a very kind of a tight niche in Denver and very tight area that I see clients in. I’m growing a reputation there and currently I do not expect to grow in employees. As of right now, I would like to keep it as just a sole practitioner, kind of a small niche practice. Of course, as demand grows, I guess how I plan on controlling that is by increasing rates. But as of right now, I don’t have the need or the want to hire somebody right now. Because it’s very controlled and going smoothly, but that may change in the future, but I’m just looking at it as a small niche practice right now.
Great. I had this conversation this morning actually with a friend of mine, who’s an occupational therapist. She has a concierge OT business in Boulder. And we were talking about how you can scale a business in a lot of different ways.
So scaling a business doesn’t mean I’m going to hire a bunch of people to work for me, because then now you have to manage a bunch of people.
Right? And you have to manage a bunch of people going to other people’s homes. So what if something happens, what if they’re not doing things the way that aligns with your values? I mean, it is like, a lot of things can go right, and a lot of things can go wrong.
There are definitely a lot of other ways to scale a business. I don’t think that necessarily means hiring on a whole bunch of people to work for you. So I’m with you, I’m with you on that.
I figured you would because I’ve actually kind of looked at how you have done things and I like it.
The next thing I want to talk about is mistakes. Can you give the listeners some mistakes that maybe you made as you have been growing your business over the past year and a half or so, so that we don’t all make the same mistakes?
Yes. So I think particularly the first one that comes to mind is saying yes to too much and not being a hundred percent conscious of my time and my wellbeing, even though I just talked about that with how many clients I see. But to a certain level when you’re starting a practice or any type of business, you have to. You have to say yes to everything. But it got to a point where I was never home. I am married and my wife is a physical therapist as well. And most business owners can probably relate to this, but it definitely became very hard on our relationship those first probably eight to 10 months or so.
It wasn’t until I took a step back and really said to myself, okay, I need to stay focused on the big things that really matter, not just these extra networking groups that aren’t doing anything for me. I took a step back and I took away everything that wasn’t helping me go in the direction that I wanted to go forward with. That was probably the biggest mistake I made was just letting that get a little bit out of hand and having my wife eventually say, “Hey, this is ridiculous. You’re obsessed with this business.” And again, I think to a certain level, you have to be obsessed with it. But many of us have loved ones in our lives, and you got to be conscious of that too.
Yeah, I think that’s a very good advice. And sometimes it takes a little soul searching to be able to look into yourself and say, why am I saying yes to all of this? Like you said, is this furthering my goals? Or am I saying yes just to say yes?
Yeah. That makes a lot of sense. Anything else that you did, even something small that you were like, oh man, why did I do that?
Yeah. Well, it kind of ties into the last one and this one comes in more financially, but I was saying yes to everything, I just have all these ideas. And I was like, man, this was right when I was really just getting a good patient load. I heard about this guy that was coming to town that was helping entrepreneurs and business owners expand their voice by helping them write a book. I was like, “Yes, that’s going to be awesome. I’d love to write a book.”
What were you going to write a book about?
I wanted to write a book really, and actually this is still in the works, but it just wasn’t the right time for that. I think that’s the lesson here is I was trying to do too much, but I wanted to write a book about my experience and how to start a concierge practice. I’ve been writing that on the side about my experiences and marketing and things like that, but it just wasn’t the right time. I guess the mistake I made was I ended up paying this guy $2,000.
Yes, to help me. And it turned out to just be garbage. I mean, it wasn’t a scam, but it wasn’t what I thought it was going to be. So I think another thing for young PTs just look out for those types of things. When you get in that business building mode, you just want to move, move, move, create more momentum. Sometimes it’s best to just take a step back, take a breather and say, as you know, is this really what I need to be doing? I’m definitely at fault for having shiny object syndrome and I kind of jumped at everything. So it’s a good thing and a bad, it’s a curse and a blessing at the same time. So just be careful with those types of things. It’s not always everything you think it’s going to be.
Absolutely. And what was one of the biggest…we sort of touched upon this in the beginning, what was one of your biggest mindset shifts that needed to happen for you to create the practice and continue to have it grow over the past year and a half?
So the biggest thing that changed was my shift in my confidence. So the main thing that once I established, and once I really realized that, man, I am a good therapist. I can build a business and I do have what it takes to really provide good care. But I think I was just limited a little bit because I have a lot of PTs that I know and a lot of PTs around me and they have all these initials after their name and they have all these certifications. I was very focused on what everybody else was doing and not myself. And so again, I took a step back and reflected and was like, man, I am a damn good therapist and I can make this happen.
Once I did that, my confidence just continued to grow as my caseload grew. I’m sure you can attest to this, when you have confidence with a patient and you really lay down how you’re going to help them, and they’re actually excited about it and they feed off your confidence. I mean, things change and people don’t want to let you go. They want to continue working with you. So I can definitely say the change in confidence was hands down the biggest thing that changed for me with owning a practice and what made my practice successful up to this point.
Makes perfect sense to me. And now, before we wrap up, what are, let’s say, maybe two or three big takeaways that you want listeners, especially maybe students listening to this interview.
Yeah. So, first, if you’re like me and you’re struggling to find your way in physical therapy after you graduate, try not to get discouraged and know there’s other people out there like me that go through the same thing. And sometimes it takes a while to find your path, but you will find it. So my biggest second takeaway would be, if you have an idea to start a practice and you have the experience and you have the confidence in yourself, don’t have fear in doing it. I mean, I think the biggest thing that a mentor told me, he was like, what’s the worst that could happen? You would have to go find another PT job if this doesn’t work out. Really, what is the worst that can happen?
I know that’s easier said than done, but once I started saying that to myself and saying, look, if this thing doesn’t work out, it doesn’t work out. But at least I tried it and I won’t have any regrets. So if you have an idea lingering in the back of your head, man, just do it. Karen, you’ve talked a lot about side hustles. You can definitely do this as a side hustle too, if you have ideas. So that’s definitely something, an option to do if you do have a lot of fear behind it, or you just don’t have the financial capacity to do it, but yeah. So definitely an option.
Awesome. And what advice…I feel like these two big takeaways might be advice you would have given to yourself as a new grad, but I’m going to ask the question anyway, because I ask everyone, what advice would you give to yourself knowing where you are now in your work and in your life? What advice would you give to yourself back in 2013 when you graduated?
Yeah, that’s easy again for me, it’s don’t be afraid to be different in the world of PT. I mean, I feel like in school, you start to almost get in these cliques of, oh I’m an outpatient therapist, I’m an acute therapist. I want to go into home health or I’m a pediatric therapist. There’s so much more to the world of physical therapy than I could have ever imagined. And that’s all being opened to my eyes now. If you don’t feel like you comply with one of those specific spots, don’t be afraid to be different and pave your own way.
Yeah. I think that’s great advice and definitely advice that I wish I had when I first graduated was not to be afraid to be different in the PT world. I think it’s awesome. So where can people find out more about you if they have questions, if they want to do what you’re doing, where can they find you?
Yeah. My email is firstname.lastname@example.org. And then obviously that’s my website as well. You can reach out to me there. You can also reach out to me on Facebook at Josh Payne, or even on Instagram, I’m Dr. Josh Payne on Instagram. So you can reach out to me in any of those areas. I’ve got people that do all the time about the concierge model. So please reach out to me. I love to help. I’ve helped a few people in Denver get their businesses started already. I don’t want anybody to be in the same position I was. So I guess that’s why I’m kind of passionate about it. So please reach out to me. I’d love to help you out, even if you have any questions.
Fabulous. Well, thank you so much for sharing the inception of your practice through the middle, to where you are now, and I’m sure there’s great things ahead. So thanks so much for coming on and sharing that with all the listeners. I really appreciate it. And to all the listeners, thank you so much for tuning in today. And if you’re a PT, if you are a student, definitely reach out to Josh, find out about how he’s doing what he’s doing and have a great couple of days and stay healthy, wealthy, and smart.
A huge thanks to Josh Payne for coming on and sharing his experience. Wasn’t that great? I hope you guys learned a lot from his ups and downs, and of course, a big thank you to our sponsor for today’s episode Net Health, so you can expand your visit capacity, get paid for your services with no money left on the table, ramp up patient engagement so you keep them coming back. And finally, eliminate worries about documentation and compliance. And the good news is you don’t have to do any of it on your own. There’s one solution that brings it all to the table. It’s ReDoc powered by xfit, which is a cloud-based, fully-integrated EMR and billing solution. To learn more about ReDoc, check them out at nethealth.com/healthy
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