Joe: 00:13

Welcome back to another episode of the Freedom Talks podcast, everybody. This is your host, Joe Ogden. And today, we have a very special guest. We actually have the owner of Freedom Physical Therapy, Mike Caraginas with us today. Mike, good morning.

Mike K.: 00:25

Good morning, Joe. How are you doing?

Joe: 00:27

Really good. It don't only took me I've been doing this podcast now for, I think, a year, and we've been talking about having Mike on a podcast for a year. So it finally has come to fruition that Mike has joined us, and he even came into the clinic.

Mike K.: 00:39

Yes. For sure. And you you can't tell, but I'm shackled to the chair. So I have to be here. We're we're ready to go and have some fun.

Joe: 00:45

And Mike was on time too. You think he was even early.

Mike K.: 00:47

I was early, which is also rare.

Joe: 00:50

Mike, let's start out with I think a lot of people know that you own Freedom, but let's kinda backtrack and just give us a little background of how you became the owner of Freedom or even how you just got started at Freedom because it's been, what, 30 Yeah. Was it 30 years this year?

Mike K.: 01:05

30 years. Yep. Early early 19 nineties. Well, it's a great you know, it's been a fun fun journey. That's for sure, and I always feel like I've been fortunate to have a lot of, sort of key people and mentors, and people have kinda planted positive seeds in my head.

Mike K.: 01:20

But, you know, when I graduated from Madison, I I originally worked at Saint Michael's Hospital, which for those that are around the area, they might remember St. Michael's. Still, I think, was

Mike K.: 01:30

an amazing hospital

Mike K.: 01:30

back in the day, so very sad to, you know, not see it be around anymore or in existence. But, really kinda spent the first I think it was almost 5 years, yeah, of my career, either at the hospital or an outpatient center there, and, learned a ton. I have no regrets with that. They were incredibly supportive of my education, which really helped foster beyond PT school, helping me finish my athletic training certification, a manual therapy certification, and then eventually, my master's degree, which it just, just, you know, as you keep doing these things and you're learning more, right, it broadens your horizons and makes you think. And and it sort of came a point in my career where it was pretty obvious if I stayed at the hospital, there wasn't a lot of upward mobility for me.

Mike K.: 02:20

So I was sort of at a crossroads in a decision and, happened to be taking a spinal course and, ran into Peter Stathis,

Mike K.: 02:29

which

Mike K.: 02:29

and as most people might know or or some do, you know, Peter Stathis founded Freedom Physical Therapy back in the early 19 nineties. Peter had had a prior career as a as a dancer, out in New York, and, you know, was phenomenal with that for about 10 years and then decided to go back to school and became a PT. So, some people know I'm I'm a 100% Greek, and the only reason I mentioned this is because Peter also, was Greek. So we met at this course and we started talking and, you know, we were joking a little bit that we should get together and open up a restaurant like most Greeks probably do. But instead, he said, well, you know, I'm working part time at Columbia Hospital, and, I started renting a small space and doing some private practice as well.

Mike K.: 03:15

And I said, well, you know, I'm at a point in my I'd like to make some changes. So if you'd ever consider having a partner, you know, I I would be willing to meet and discuss this. And so that's kinda how our relationship started in the early 19 nineties. And, about 6 months after that course, out of the blue, he sort of called me and said, hey. You know, this thing I've been doing on on my own is blossoming.

Mike K.: 03:38

I'm quite busy. If you'd like to come in and see some patients at night or something, I'd be willing to make space for you, and we can work on an arrangement. So, anyway, long story short, I would work at the hospital kinda from 6:30 in the morning till 5. That was my typical day, 4 days a week. I just happen to be on a 4, 10 hour schedule at St.

Mike K.: 03:57

Michael's. And then I would go over to the space where Peter was at, which happened to be still also in Fox Point, from 5:30 to 9:30, 10 at night. And shockingly, the referral sources over the years that I had developed were incredibly supportive. Many of them are now, you know, sadly retired, but very grateful for them and and, you know, people it was amazing. So, anyway, long story short, it only took maybe 6 months or so.

Mike K.: 04:23

My evenings were completely packed. So then I was at a crossroads of, well, I can't keep working 16, 17 hour days. So, I you know, Peter's like, hey. Do you wanna do this? Let's let's, let's move, take over a bigger space.

Mike K.: 04:38

And that's kind of what we did. So around 1997, we became 5050 partners, and then that's when we incorporated Freedom in the current spot. We are now at 6908 North Santa Monica Boulevard. And then our journey began. You know, from there, we kinda kept growing the current location as we know.

Mike K.: 04:59

And then probably about and I should know the exact date, and I sadly don't, but I think about maybe it's been 9 years. I'm not sure. When, Peter had decided to, you know, kind of move move into a different direction. So, I had purchased the other 50% from Peter and have been the sole owner ever since. And, you know, as most people know, we have several locations and all that good stuff over the years that we've developed as well.

Mike K.: 05:27

Sorry. Longer than longer answer than you wanted.

Joe: 05:29

No. That's fine. And now we have Grafton, Mukwonago, Brookfield, which we talk about every podcast. How did that how did those kinda, you know, come into the picture? Yeah.

Joe: 05:39

Because Grafton and Brookfield are They've been around. For what? 20 years?

Mike K.: 05:43

Yeah. 2002, I believe. So yeah. So we we, Peter and I will be became partners in 97. And then 5 years later, we opened up Grafton and Brookfield at the same time, which was a little bit daunting.

Mike K.: 05:55

I mean, that was actually, you know, for a small business like ours, a big undertaking. But how that worked, one thing we've always tried to do is be very involved in the communities that we're at. So, many people, you know, who've been clients here know Jeff Verhagen, who's been running our Brookville location for for years and doing a great job at it. Jeff and I went to Madison together.

Joe: 06:18

Oh, I didn't know that.

Mike K.: 06:19

Yeah. And he, I wanna say. Right? Wait. Jeff would correct me.

Mike K.: 06:23

I believe I'm a year older than Jeff, and he reached out as you know, we we didn't really know each other at school. So it was it's been a awesome story, but he his resume came across, my name Peter's desk, probably early, what, 2,001 maybe, and that him and his wife were relocating back to the area. Both are from the Brookfield area, had family here, and and, so, we're like, jeez. You know, Jeff, you know, let's let's get you started at Fox Point. Let's get to know each other, work together.

Joe: 06:56

And you guys were looking for a business guy at the time too, right, if I remember from Jeff correctly?

Mike K.: 07:00

Correct. And Jeff has his MBA as well. You know, for those that know, he's a phenomenal therapist and a great human being. And and so I I don't know exactly how long he probably worked with us here at Fox Point, but I maybe 18 months. And then, we just said, hey.

Mike K.: 07:16

Let's let's do this. So we opened up a place in Brookfield, and then Grafton became an opportunity because I grew up in Grafton. So it was always a dream of mine to at least have something in my own hometown. My parents were still living there, of course, and, so then some then we opened up Grafton as well, and we found an an amazing individual early on, to to run our clinic. But as most people know now, Michael Verplenke, who's been with us also for 20 years, runs that and does a phenomenal job, in Grafton.

Mike K.: 07:48

So that's that's how those 2 sort of came about.

Joe: 07:51

And I think, I've been wanting to interject this because I don't think Mike I don't think you and I have ever actually talked about this. Mike's kinda setting the stage for I I think freedom and I've talked about this on other podcast with people. I think freedom does a fantastic job at hiring the correct human being for the most part when it comes to having the right image, when it comes to having therapists here in front desk, and not even image, just the right personality to fit the Freedom model. When I applied to be a therapist here at Freedom, Mike and Freedom at the time was trying to hire someone with experience more than 3 years, pelvic health, and someone who is certified in dry kneeling and manual therapy. I sent Mike an email out of the blue and said I'm a new grad.

Joe: 08:33

I don't treat women's health, but I work really hard. Is there any chance that we could just sit down for an interview? And I think not even 2 days later, we sat down in Fox Point that Mike was late for, and I thought that it was gonna be completely ruined. But you and Scottie and you guys hired me right on the spot.

Mike K.: 08:50

Yeah. Yep. Yep. Yeah. That is true.

Mike K.: 08:52

Yeah. I mean, and Joe for those that know Joe, he's been one of the greatest things that that has happened to us here. And and, I mean, some of, you know, some of this also, you know, I don't know. It's not necessarily words of wisdom, but it's also about relationships. And, you know, Joe had an opportunity to work with a a physical therapist, Mike Cook, who's in the what's he?

Mike K.: 09:11

Waupaca?

Joe: 09:11

Waupaca. Yeah.

Mike K.: 09:12

Waupaca area. Mike and I used to work together at St. Michael's Hospital back in the day, and, Mike and I have always stayed in touch and been been been friendly and all that kind of good stuff. And, you know, when Mike Cook called up and if you get if you know Mike Cook, he's very particular about how he likes to treat and very particular about the people he works with, and, you know, he just basically said we'd be crazy if we didn't didn't hire Joe. So part of that too is just having really good relationships over the years, and and when there's people you trust there and they, you know, they're sincere, that that made it easy.

Mike K.: 09:46

And, you know, I don't know where Joe's going with the question too other than the fact that one thing about Joe, which is something we really look for is we really just want people that are hungry to learn and, be educated and be humble at the same time, and and, you know, provide great care. And and Joe checked all those boxes. I you know, I what I tend to probably shy away from is I I think our management team does too is is when you interview someone that thinks they've got all the answers already. And, I mean, I'm 58. I don't know what, 34 years as a PT.

Mike K.: 10:18

And as as the staff knows, I I still go to classes all the time. I mean, there's just so much to continue to learn and know and grow. So, yeah. I don't know. It's been awesome.

Mike K.: 10:27

So we appreciate that you're here.

Joe: 10:29

It's been it's been really helpful for me too. I think that continuing to learn here that's promoted at Freedom is something that's been helpful for all of us. I mean, do you guys track CEUs and and who takes it?

Mike K.: 10:41

We do. Yeah. We do. I mean Who

Joe: 10:42

takes the most?

Mike K.: 10:43

Who takes You?

Joe: 10:44

Yeah. I think I do. All your conferences, Polycones?

Mike K.: 10:46

Probably do. I'm yeah. I'm I'm a I'm a, I remember one of my mentors, doctor Stanley Paris, he said, are you what are you looking for? The holy grail? He goes, my god.

Mike K.: 10:54

I've never seen somebody consume, you know, so many courses. So I'm I don't think I've answered that yet. I think I'm just always you know, part of it is the networking and meeting people. Right? Part of it is, you know, if I can just bring one piece back, for for our patients, you know, my patients and the staffs, I I just I don't know.

Mike K.: 11:12

There's a lot to know. So, and you never know which so one thing I've always said about physical therapy, it frustrates me when a therapist says they're bored. I'm I I just don't know how you can possibly be bored in this profession because we're so fortunate that we can treat literally every part of the body, all kinds of age demographics, cultural demographics. Right? I mean, you know, it's it's, you know, you you can mix it up, change it up, work with a completely different population.

Mike K.: 11:39

I saw and and, you know, so and specialize, which is what we've really tried to do at Freedom.

Joe: 11:43

Especially here at Freedom, which is kinda what I wanted to talk to Mike about today too because Mike, in his career, has seen all types of clinics. You've worked in different types of clinics. You now, you know, talk with different types of providers. Kinda give us a little bit of, you know, kind of the background on what goes into running a private practice because for those who aren't, you know, patients or been in a physical therapy clinic or know what it's like, you know, we don't have any guaranteed contracts with, providers. We work really hard, I think, for the referral sources we get and to have the opportunity to treat patients that we do.

Joe: 12:17

Mhmm. What are what is kind of some of the background or, you know, things that go into running a private practice in today's world, so to speak?

Mike K.: 12:25

Boy, that's how much time do we have, Joe? I think about this often because it's chain you know, it's it's

Joe: 12:32

And it's probably changed since

Mike K.: 12:33

you Yes. Changed so much. I mean, you know, when we started this thing in in the nineties, back then, you know, there the consumer, right, had a lot of independent choices. Right? Most doctors most most of our clients who have aged with us have been so loyal to us.

Mike K.: 12:52

You know, they're they're gonna know what I'm talking about. You know, their own doctor had a shingle. They had their own practice. They were independent. They weren't necessarily beholden to a hospital system or a a a venture group, right, or a lot of what we've seen.

Mike K.: 13:06

So, relationships always matter, but they really matter. Like, back, you know, 30 years ago, if you wanted to go out on your own, you needed to have some pretty solid physician backing because that really was the lifeline. That's where all of your referrals came from. And keep in mind, you know, social media really wasn't the things per se, YouTube and Twitter and Facebook and advertising. And and in general, when it comes to most private practice PT facilities, you're never gonna have a large enough budget to to market and and spend on advertising.

Mike K.: 13:39

So you really relied on relationships. So 30 some years ago, Peter and I, you know, I think also what worked for us was great synergies. And and the the thing that I remember specifically was, if we drew a line in the sand and made Fox Point the center, you know, Peter had a lot of great referral sources south of Fox Point, and most of my referrals were north of Fox Point, so to speak. So when we joined, it was like, my god. Right?

Mike K.: 14:05

We we doubled our referral source just by bringing our our heads together, which was, I think, a brilliant plan. We've also were smart about never really keeping our eggs in one basket, meaning, I don't know how many referral sources we have now, but it's probably 600 or more. But a lot of clinics would get into trouble because they had 1 or 2 main docs that were their primary referral sources. And if one of them left or retired You're done. Yeah.

Mike K.: 14:30

50% of your practice dried up. And then as time evolved, I mean, I think the one mantra that I think I'd hope if you asked every every even every employee at Freedom, you know, you know, how how do we wanna treat our customers? We try to keep it really simple. Right? It's to me, it's a simple how how would I want my mom to be treated or my wife or my kids, to be treated assuming assuming you love them and you're happy with them?

Mike K.: 14:55

It's a simple solution. You know? So I think we also did just a really good job. I mean, you can't please everybody, obviously, but I think we've tried to do a really good job of establishing long term relationships with our patients. You know, they become freedom part of the freedom family.

Mike K.: 15:09

That was also our goal. I don't know if it was a Greek thing or or what, but I know we both relieved strongly in that night and I certainly still do today, as I think most of our staff does. So now fast forward 30 years. Right. And I know all of you listening, you have to know how there's been a ton of consolidation over the years.

Mike K.: 15:29

Right. I mean, if you think about it, you kind of have only a couple major hospital system players in in Wisconsin, right, without mentioning names. And as we know, most physicians are no longer independent. They all work for those systems. And, you know, it's not really a secret, and we would probably do the same.

Mike K.: 15:48

The systems work hard to keep all their roofs in house. Yeah. So even sometimes when you had these amazing relationships, once a lot of our doctors started to sell their practices and go with the hospital systems, sadly, those were practices and go with the hospital systems,

Mike K.: 16:03

sadly, those referrals really dried up. And that

Mike K.: 16:04

was, you know, was sad. Right? Because you really would hope all of us wanna offer our patients what's the best possible choice or solution for your problem. Right? And if it's not freedom, we're gonna help you find another that's also been our mantra.

Mike K.: 16:19

Like, we don't wanna profess to know it all and fix it all. So as you fast forward to this now, thank god we had been been embedded in the communities, which was also, I think, part of our strategy. I think we feel very strongly, like I mean, I you know, after I left Madison, I bought a house in Fox Point, lived in Fox Point for 10 years. Peter was in Shorewood. So we were both very community focused here, when we opened Brookfield.

Mike K.: 16:43

Jeff, as you know, and his family was in Brookfield, and then Mike Verplank and his family, they're all in Grafton. So I think the community concept, I think, is huge. You I think to have your key people living in the very space that they're working is huge. And then after I had bought Peter out, you know, I don't know what obsessed me. It was not necessarily the smartest thing I ever did, but bought him the Mukwonago Clinic from a woman, mainly because I just fell in love with Mukwonago.

Mike K.: 17:10

To me, Mukwonago, again, has a very awesome community feel to it. You know, it's it reminded me of Grafton way back in the day. I see huge growth potential out there. And the reason also, which has taken time because we were totally unknown, so where I'm going with this, but our key people like Wes and Abigail, who've been there with me for, you know, especially Abigail from from day 1, were community people, and they're they live right in the area. So I so I think again.

Mike K.: 17:39

So fast forwarding now, you're talking about the relationship with your patient, your consumer that's been coming in all these years and wanting to maintain that relationship. I think community feel being in a community that you love and, you know, you you you wanna go to the grocery store and run into people you know is a value. And then I think, you know, the people we bring in, we wanna make sure they also love the community they're in. So we also try when we hire, we try to make sure people are in the vicinity of where they're working. So, boy and and now, I mean, if you don't know social media and how to use it, I think it's tough again in to make it in private practice.

Mike K.: 18:14

I just think we are now forced more than ever to go direct to consumer, which has been cool. And the fact that we are one of the few professions, I don't know if most consumers know that, that have, at least in the state of Wisconsin, have direct access. Right? That was a game changer for us. Because back in the day, people had to go through the physician first.

Mike K.: 18:32

Now they can come direct to us with their musculoskeletal problems, which is all you know, with with that also comes great, what's the word? Not not risk is not the right word, but, I can't even think of the right the the term is always sometimes at the top of my head. But, you know, respect for that ability to be able to see people off the street. So you really need to kinda know your stuff because if it's not appropriate to be in the clinic, you gotta make sure they get back to their physician or whoever to help them with what's going on. So so I don't know, Joe, if I'm am I too long winded?

Joe: 19:04

No. You're doing fine. But I I mean, I think too that's where the, you know, direct to consumer and I have no problem. I speak very honest about this, and I haven't changed my tune with this since I've graduated. For those that don't know, Mike, technically speaking, just do you have your master's in PT?

Joe: 19:25

Or just just

Mike K.: 19:26

bachelors of health science? A bachelor's in PT Bachelor's master's of health science.

Joe: 19:29

Technically speaking, Mike has just bachelor bachelor degree in physical therapy. Now it's required to have a doctorate. Now that direct access is a thing, and I I I really think on social media, marketing directly to the consumer is king, and it will be for a long time. Yep. That with that doctorate, I I wish there was more responsibility put on therapists for being really good at what they do and making sure that they really advocate for assessing patients.

Joe: 20:01

Not that we do a bad job or anything, but I wish there was a little more pressure on that because, essentially, we are now front door,

Mike K.: 20:10

Prim primary primary providers. Mhmm.

Joe: 20:14

And expect again, especially now, I think it's it it in the private practice world, it is, in my opinion, also returned to the wild west a little bit in a sense of we fight really hard to care for the patients that we do.

Mike K.: 20:29

Yeah. Yep. I I would agree. Yeah. Yeah.

Mike K.: 20:31

Because it's frustrating sometimes, you know, you know, imagine for us. Right? This is one thing too. I wish even just like our local doctors would better understand, you know, what an amazing referral source our practice is for them. I mean, right, we have, what, about 28 therapists now.

Mike K.: 20:47

That means, you know, if you work with us, we'll work with you. We've got 28 potential referrals.

Mike K.: 20:53

Mhmm.

Mike K.: 20:53

You know, patients that are are professionals that could refer to you. So it has been a challenge because our our struggles have been sometimes we'll have a relationship with a patient, and then we have to send them to a surgeon. And then the surgeon will you know, maybe the person needs a procedure or whatnot, and then then all of a sudden that person Disappears. You know, it disappears in his in house at their physical therapy. So, you know, we've also had to work hard to make sure as a consumer, as a patient, you have a choice.

Mike K.: 21:21

You know? Now if you're not happy here, that's a different discussion. We're never gonna obviously force anybody to

Mike K.: 21:26

be

Mike K.: 21:26

anywhere they don't wanna be. Or, again, I said it earlier, if we're not the right choice for your diagnosis, by all means, we just want you to get the best possible care. But so that has changed. You know, we we really have to work hard to like, to your point, Joe, to me, what is frustrating, I think, and and and I feel bad because I'm friends with lots of people in academia. It is the hugest missing link right now in the PT education.

Mike K.: 21:53

When I I'll never forget again. I refer reference back to doctor Stanley Paris, who the young people probably don't really know him, but doctor Paris, was an amazing influence on our profession. I felt super fortunate to be trained by him and learn from him, but he was really the one pushing way back in the day, the 2020 vision for physical therapy, which was autonomous practice. We were to become the doctors of the musculoskeletal system. Right?

Mike K.: 22:18

The prime as Joe was alluding to, the the primary care physician, even though we're not MDs, of the musculoskeletal system. But the only way to do that in most cases is, and the goal also, if you're gonna go to school for 7 years, and I don't know, when I talk a lot of my therapists about a 150,000 or so in debt, was to be able to hang a shingle out, like, to be able to open up a private practice like chiropractors do, like dentists do. But there's sadly been, in my humble opinion from what I can tell out there, no real support on the concept of marketing and networking, financial planning, business development. And I and I just think that's super it's unfortunate. So as a result, if you're not getting that training, you don't probably don't know what you're missing.

Mike K.: 23:04

So once you're working somewhere, unless I think you work for a private practice, you just don't aren't gonna get that exposure.

Joe: 23:10

Yeah. And I mean, I just talked with a couple people, you know, kind of about this private practice realm, so to speak. I think there's a lot of questionable things that happen in the private practice world Mhmm. Because reimbursement's a little different in the private practice world, but it also puts people in some bad situations.

Mike K.: 23:30

Mhmm.

Joe: 23:31

Not that that happens everywhere, but I do think because there's that lack of business marketing

Mike K.: 23:37

Yep.

Joe: 23:38

That just kind of general education to let providers know that this is what you could do, that you then get in a situation where it's not Right. Appropriate. Yeah. Let's Yeah. Let's kinda talk about kind of the and when we talk about this, for those that are listening, we're not talking bad about any other place.

Joe: 23:58

This is just the true objective reality of the insurance model, the insurance world. Let's talk a little bit just about the difference in reimbursement and some of the financials when it comes to people that may have a high deductible, whether they come to Freedom, a small private practice versus, a different place.

Mike K.: 24:14

Yeah. Boy, that's yeah. This is something we've talked about for years to try to I mean, right, I think all of us would agree health care is an enigma. It is so hard to really understand. I mean, I've been working in it for how many years, and I'm sometimes you still shake your head at how things are done and and and or why things not done a different way.

Mike K.: 24:32

But then as a consumer, you know, how are you supposed to understand who's in network, who's out of network? And even when you're in network, this has been the message we we've been trying to deliver, but it's it's been hard. So I'm gonna do the best that I can. As we all know, let's just if we use physical therapy as an example, like Joe was saying, and assuming you're we're in your particular insurance plan. Right?

Mike K.: 24:56

That that's means that we are in network with the insurance that either your employer's paying for or you're paying for. And then within that network, right, there's Freedom Physical Therapy. There's other private practice, PT, OT clinics, and then there's hospital simp simp, systems and who who has who offer physical therapy, and then there's, what would you call them? The venture groups, the larger, physical therapy entities that have hundreds of clinics. So all of us might be considered in network.

Mike K.: 25:25

But what the consumer, I don't think understands and and why why would any of you, is that all of us shockingly tend to have different contracts with the payer. And without, you know, speaking specific numbers because, you know, I don't wanna, you know, stir stir the pot, so to speak. But in general, I'm sure if I had just about every private practice owner, in the physical therapy and probably the physician realm out there, most of our contracts pay us about a third of what all the larger payers and, you know, players in town get paid. Right? So not uncommon that in private practice, you're getting about a third of the traditional reimbursement for a visit that, let's say, a hospital system would.

Mike K.: 26:13

So what does that mean for you? Right? So let's see if I can try to make this simple, and I'm just throwing out numbers and examples. I don't want them to be construed as accurate numbers, but let's just say to work with round even numbers. If you needed to come in because you had a knee scope and you need to have some physical therapy to rehab that knee, depending on your insurance.

Mike K.: 26:34

Right? Because even with all of the different insurances we have, we get paid differently from Blue Cross, then United, from Medicare, to Aetna, to Cigna. Well, Cigna is not around anymore, but, you know, it's a lot to juggle as a business because you got different numbers coming in from different payers. But if we just took simple numbers, let's say you have a $5,000 deductible, most of us these days have 3 25100 to maybe 6,000 as high as $10,000 deductibles. So after your knee surgery, it was recommended you have, let's just say, 10 physical therapy sessions.

Mike K.: 27:09

Most of us private practices, let's just pick a number. Let's say for for that course of treatment, we would get paid a $100 a visit. But if you went to a larger system that obviously offers multiple services, right, they have more leverage to be able to negotiate things, differently and get paid differently. So let's say you went to hospital therapy, it's possible, that they would get reimbursed at $300 a visit. So what does that mean to you as a consumer?

Mike K.: 27:38

So if you came for 10 visits to Freedom Physical Therapy and you had a high deductible plan, your out of pocket cost with us would be about $1,000. But if you did therapy at another system, while they're still in network, might have a higher negotiated fee schedule, those same ten visits could cost you $3,000. Right? So 3 times as much. So, you know, you may not care at the end if if you're a family that meets your deductible at some point and everything's at a 100%.

Mike K.: 28:09

I mean, we're all gonna pay that deductible at some point, right, if you're if you're using health care. But the point is that that's where the challenge for us comes in. The the way we're getting paid in the reimbursement, sadly too, only continues to go one way, which is typically downward trend. And as most of us know, consumer pricing is up 20%. Things have been up for us supply wise post COVID at least 20%.

Mike K.: 28:32

And in some cases, like gloves and outlet quadrupled in price, and they've never really come down. So and then as we all know, wages have gone up. So, again, it it makes it a challenge. I mean, you have to be very efficient if you're gonna have a private practice. But I think it's important for people to just know that just because someone's in network doesn't necessarily mean the cost to you is the same.

Mike K.: 28:55

It could be significantly more, and then you just you know, you have to be smart about that. And and that's where the transparency comes in. You know? I mean, we'd like to think we can't give people exact estimates. We but we can give you a ballpark of what a per visit's gonna be here, which is what we all should be able to do.

Mike K.: 29:11

And that's one way a consumer could try to make an educated decision. I don't know if that

Joe: 29:15

Yeah. No. Answer. I mean, I think that's something that we talk to a lot of people about, and I wish they were I think health care, especially in the US, I think it's really hard to navigate the insurance route, which is unfortunate. Yep.

Joe: 29:25

But I guess that's a different rabbit hole to go down and Yes.

Mike K.: 29:28

That what's

Joe: 29:28

going on. But I think it's important too that, you know, we're not we're not taking home 1,000 of dollars every hour from people, you know. We're if anything, we're making less and less money over time. Not that that it's what it's about, but this is our living. This is what we do.

Joe: 29:45

I mean, we Yeah. Give a lot of value for not ton of reimbursement for what we do.

Mike K.: 29:50

Right. Yeah. I I think that's I mean, I think that's the you know, we always say, you know, physical therapy is, in in our humble opinion, probably one of the most cost effective health care opportunities out there for people, because it is in the grand scheme of things, relatively low cost and has clearly shown in so many cases to save the health care system massive financial dollars, you know, because not everybody just because they have a torn meniscus and a torn rotator cuff and a herniated disc, studies continue to pour out. You don't always have to have surgery. You know?

Mike K.: 30:24

Will therapy take longer? Yeah. That's the drawback. You know? It's gonna take a little bit longer for you to get to potentially the same result you would get with surgery.

Mike K.: 30:33

Now I'm not condemning surgery. Obviously, there are times when it's necessary and appropriate, but, you know, it's important to know that physical therapy is a very wonderful conservative option, and we have occupational therapy too, which has been great. So, you know, if we're all looking to save health care dollars in the grand scheme of things, it it certainly makes sense to explore some of these conservative options, but they but they tend to take take longer. And and, you know, it is it's always a hard conversation, right, even with employees, because I always say this. I always feel like our staff here gives every day, and mainly because of what Joe was talking about.

Mike K.: 31:12

You know? I I I sometimes, you know, and this is just a, I I do think, honestly, we bring a lot of value to the table. And if we were in a different profession, that value would be paid significantly different than what we're getting now. But at the same token, most of us got into this business to help people, and that that is why we're here. So it just you just have to be really smart about how to run a business like this because the the margins are are are are slim.

Mike K.: 31:40

So for whatever. But, you know, the old adage I also say, right, no money, no mission. So it does frustrate me sometimes when you hear, you know, people complain about the cost of this and that. It's like, well, if we don't make a profit, freedom doesn't exist. I mean, it can't.

Mike K.: 31:54

You know, we're we're not a nonprofit. So at some point, you know, you do have to make money at at what you're doing, which I know is never a popular conversation. But,

Joe: 32:04

but it's the truth. Yeah. And that's what I kinda, you know, try to preface this with is Yeah. If you don't make money and and, again, I I would argue we're not rolling

Mike K.: 32:14

Right.

Joe: 32:15

In money. Yep. If you would know better than I would, but Yeah. Our goal is to treat people the best we can.

Mike K.: 32:23

Yeah.

Joe: 32:24

We have to make money to do that, to keep things going and keep things updated. And that I mean

Mike K.: 32:28

Yeah.

Joe: 32:29

I mean, I've been in other places. I feel like it's really valued here to invest in your therapist when it comes to continuing edit. I mean, I haven't I personally have never had an experience where Scott looks at my stuff and says, oh, we're not gonna pay for that.

Mike K.: 32:42

Right.

Joe: 32:43

Like, encouraged. Yep. Be the best therapist you can. We'll we'll pay you for your time.

Mike K.: 32:48

Yep. Knowledge is power and right if if I think consumers are getting smarter about health care too. I mean, they're they're coming in, right, armed with doctor Google, you know, and, Which is a great tool.

Mike K.: 32:59

It is.

Mike K.: 32:59

You know, they've they've got sometimes, sadly, it's a lot of misinformation

Joe: 33:02

Yeah.

Mike K.: 33:02

Fear and scare tactics. So now you spend 2, 3 visits calming people down because they're freaking out about what's going on, but they are coming in more educated. So you you like, you know, to your point, you you know, you have to know, enough, yeah, enough to know again when it's something we can handle and then when it's not, you know, because we've been here for so long, we just got great relationships with physicians and and other providers, you know, in the community, acupuncture, massage, chiropractic. I mean, I I feel like we're super eclectic and certainly not territorial. I mean, we we, you know, we just want right?

Mike K.: 33:34

At the end of the day, we want whatever person's walking on our door to get the best care that they can. And, again, if we're not it, then we're gonna help you find who who can help you if we if we can't. And and oftentimes, it's teamwork. As as as, you know, we work with a lot of dentists for TMJ and headache issues, and and it's the dentist. It's the PT.

Mike K.: 33:52

It's the massage. Maybe it's even chiropractic. Maybe it's neurology. I mean, you're you know, some of these some of our patients are seeing, right, multiple providers each has their

Joe: 33:59

specialty to help, you know, get them

Mike K.: 33:59

better. And that's, I mean, that's one thing

Mike K.: 34:01

and we'll probably run out

Mike K.: 34:01

of time to talk about TMJ, but that's one thing I learned

Mike K.: 34:03

going back to Mike

Joe: 34:04

Cook when I was a student with him is that you need to get on the phone and call providers. Don't just rely on the patient to communicate back and forth. Like, as a provider, you have to call these doctors to touch base with them. Yeah. I think you take it to a whole new level, which has been nice to see that it's okay to email them.

Joe: 34:28

It's okay to call them when you have questions. It's okay to ask for more and just say, hey. This is what I'm seeing. Is there anything that you do that can complement what we're doing here and really make it that collaborative team effort, which I would go back also to the school part. I do think they touch base that, you know, we should be this team effort, but they don't really go into how we do that.

Joe: 34:52

Right. And I I think freedom and you would be at the top. You do it the best of, like, really making sure that all providers are involved with care and not just sitting on your pedestal and saying Mhmm. I'm the one that's gonna get them better.

Mike K.: 35:05

Yeah. We've got the answer. No. I I I think what has changed, which is why I said, it's empowering, but, again, with this empowerment comes great responsibility. That's what I was looking for.

Mike K.: 35:16

Yeah. And what I mean by that is I I don't think I ever thought when I graduated from PT school that and I I even when I lecture, I use the word quarterback, that especially with your chronic pain, which freedom, one thing I think we do better than a lot is one way we've had to stay on the map beside having all the niches we have, like TMJ and workers' comp and and pelvic floor and, you know, women's health and, vestibular. Yeah. Men's health, thanks to Joe, is been just dealing with people who have lifelong chronic issues. And and often, they're you know, health care is still very much so a silo effect.

Mike K.: 35:55

So I just look at them and say, you know, if this was some in my family that I love, what can I do here? And and I kind of have enjoyed becoming their quarterback, meaning taking them in, doing a super as best we can, thorough evaluation. And then to your point, Joe, okay. Well, who are you seeing for this? Okay.

Mike K.: 36:11

What are they doing? Let me reach out to you know, let's make sure whatever providers they're seeing because often patients come in and they they can't keep track. Everybody's giving them different opinions, so you gotta help them prioritize. And then, you know, I'll I'll never forget back in the day, like, first time I started asking for radiological images. And, you know, I'd get a lot of pushback, like, I'm I'm sorry.

Mike K.: 36:34

You're a PT. You don't know how to read radiological images. Like, no. I'm not gonna send you this stuff. You know?

Mike K.: 36:40

And if I'm like, well, first of all, this is the patient's property, not yours. You know? So then I have to sidestep that process, get the patient to get the records. Because, again, going back to doctor Paris long time ago, he talked about, you know, you you wanna try to get as much information on this patient as you can because how a radiologist might look at an X-ray and how a surgeon might look at your lumbar X-ray is different than how I, as a physical therapist or if I was a chiropractor, is gonna look. Because we've had patients come in with, you know, all we're getting is low back pain.

Mike K.: 37:10

And then you get the report and you find out, well, they've got a what's called a spondylolisthesis. They've got a slippage at one level. Right? They've got multiple herniated discs.

Joe: 37:18

Yeah.

Mike K.: 37:18

Well, now that's a lot different than just low back pain. Yep. And then we have to decide which of those structures is contributing to the pain and then which manual techniques are appropriate, much less which exercises. Yeah. So it's it's forced us, I think, to, yeah, be adept and skilled at multiple levels in the health care system.

Mike K.: 37:38

But I, again, I think to Joe's point, I'm not sure that's being preached to the out you know, the the you know, e even years ago, it wasn't preached to me. Again, I would always say, had it not been from some awesome mentors I had that made me see this and develop this philosophy. So I just hope to my my goal with this is to elevate our profession. So Yeah.

Mike K.: 37:58

In our

Mike K.: 37:59

I can't do it with everybody, but if within our own group, I can keep making all of our therapists see the value of their education and the and the empowerment that they have and what they can contribute back to society, to me, that's priceless. Yeah.

Joe: 38:13

You know?

Mike K.: 38:13

So I I don't know. That's what I wanna keep promoting is bettering our profession so people actually respect what we have to offer. Because I sadly I don't even think like, you know, I don't even think people know that most of you have gone on for 7 years and now getting No.

Mike K.: 38:26

I'm

Mike K.: 38:26

sorry. Residency and fellowship.

Joe: 38:28

It's going even farther.

Mike K.: 38:29

I mean,

Mike K.: 38:29

you yes. Some of you are going 8, 9 years. My god. You know? And anyway.

Mike K.: 38:32

So I

Joe: 38:33

mean, that's I mean, I can't speak of other universities where I went to Carroll. I've said this since the day I graduated. My our orthopedic was very, very strong. I think all schools are known for Yep. One of the classes to be really strong.

Joe: 38:47

From what I've heard, Madison's really good at their neuro. Mhmm. Yep. But I agree with you. I I I think it's one thing to be very skill based, but it's a whole another thing to really cement it in that we you need to cement yourself and really be strong.

Joe: 39:02

Draw a line in the sand that we need to be strong at this and be good at it, and advocate for ourselves. I think that's where the profession struggles a little bit Right. That we allow for some of the negative

Mike K.: 39:15

here.

Joe: 39:16

Yeah. Complacency too that

Mike K.: 39:18

And I think maybe it's a it like, I don't know, perception that just because you went to college and you went through whatever, just whether it's financial money management or they're only gonna teach you so much. I mean, you're you you know, you're not gonna have all the tools,

Mike K.: 39:32

you know, and best example of that, again, and not to

Mike K.: 39:32

you know, I know we're gonna run it short on time, but, like, example of that, again, and not to you know, I know

Mike K.: 39:35

we're gonna run it short on time, but, like, when it

Mike K.: 39:35

comes to the the TMJ model that we've created here, temporomandibular joint pain, headache, migraine. When I went to school, we talked about TMJ in 15 minutes, and then we were told you'd never have

Mike K.: 39:44

to know about it. Now that's one of

Mike K.: 39:44

the lifelines of our minutes, and then we were told you'd never have to know about it.

Mike K.: 39:49

Now that's one of the lifelines of our practice. I don't think people most know that their

Mike K.: 39:49

own dentist. And if we had 10 dentists here sitting, and they know I mean no disrespect by the by this, even in the dental program, they learn all about the teeth. They don't learn at all about how to treat the temporomandibular joint, which is right

Joe: 40:05

It's right there.

Mike K.: 40:06

Right there. Right. One of the most important areas. I mean, we chew, talk, yawn. Right?

Mike K.: 40:10

Everything. Swallow, everything, is there, and and they don't even learn about that in school. You have to go on. So I guess that's my only other message too. Like, I don't even I don't care what profession you're in and what degree you come out with.

Mike K.: 40:23

I think you're forced to, you know, either either I I hate to use the word complacency because that's not fair. I get not everybody wants to learn a whole lot of things, but I think to be as good as possible at your craft, you have no choice but to go on and learn more.

Joe: 40:37

No. I agree. And then, again, I don't necessarily think it's, you know, to poke fun or or or put down anybody, but, I mean, I agree with you. And I think that's something that's really strong here is I at least if I can speak of Fox Point, and I can't speak of the other clinics, but I feel like here well, because we also have more therapists Mhmm. Everyone's always taking something

Mike K.: 40:57

Yep.

Joe: 40:57

Which I mean, I'm pretty competitive as Scottie always says. Yes. PTs are very competitive people. Yep. When I see other people taking classes, I'm like, god.

Joe: 41:05

I I need to be doing something, or what am I bringing to the table?

Mike K.: 41:09

Yeah.

Joe: 41:09

And how many times have you come back from a course and said, I learned this. I mean, we just had it yesterday or Tuesday in our marketing meeting. You're like

Mike K.: 41:16

Yeah.

Joe: 41:16

Just took this concussion class. I can't believe how good it was. I learned this, this, and this. Yeah. And I think we feed off of each other here at Fox Point, which is comes back down to you and Yep.

Joe: 41:24

You know, Scott, managing here that the culture here, I think, is Yeah. One of the best places that I've been at. Well, I

Mike K.: 41:30

appreciate that. No. We've been lucky in in, you know, all the clinics are like when we did that when we hosted the concussion course last weekend, we had representation from each clinic. I mean, that's, you know, that's huge. So and I so I think we're gonna be pumping out one of the best concussion protocols, out there.

Mike K.: 41:45

I mean, it exceeded my my expectations. And and maybe that's the other you know, when you talked about business owner prep I mean, that that is I I feel the onus as an owner. I would never profess to know more than any of my other therapists here, but I have to know enough of what's all available out there to help keep driving us and and to, you know Joe is amazing at men's pelvic floor. I don't know much about it. Right?

Mike K.: 42:10

But I know enough to be dangerous and and so excited to know we have an expert like you, that is now here to compliment, right, Nina and Anne and Heather, and I'm gonna miss a few names, Erin and, Abigail. They're pulling off our our our women's health

Joe: 42:26

as well.

Mike K.: 42:27

I mean, it's, it's I don't I just I don't I love what we do. We're passionate about what we do. I hope our patients sense that and feel that because, I don't wanna just, you know, punch in a timer and say, update to 5. Yep. I'm out of here.

Mike K.: 42:41

I mean, most of us here, which people probably don't know, we're thinking about this even after we go home.

Joe: 42:46

Yeah. Right.

Mike K.: 42:47

Which, you know, hopefully, is a testament to our commitment to anybody who walks in the door.

Joe: 42:52

Yeah. Well, Mike, thank you for coming in, especially on your day off, and all the kids are home too. So Mike came in special to kinda talk about the private practice realm. We're gonna try and get Mike on for to talk more specific about some specific TMJ questions that we've been getting because Mike is the expert. He probably won't tell you this, but he's probably one of the top five people in the world for physical therapists that treats the jaw.

Joe: 43:15

So there's nobody better to pick his brain about some questions that we've been seeing. If anybody listening has any specific team Jay questions, please let us know so I can incorporate them when we talk to Mike again. Hopefully, it doesn't take a year to sit him down again. Yep. Nope.

Joe: 43:29

I'll pin him down again. I'll keep the handcuffs here.

Mike K.: 43:31

Keep it moving. And and real quick shout out because I appreciate that my my oldest daughter, Grace, was able to be here. So say hello, Grace.

Mike K.: 43:38

Hi, everyone.

Mike K.: 43:39

So Good. Thanks. Just excited that she was able to kinda be here and and support this as, I feel fortunate that my whole family always is very supportive. So that's huge. And and all the employees at Freedom, I'm I don't know.

Mike K.: 43:52

I'm blessed in a lot of lot of ways.

Joe: 43:55

We gotta keep it moving. Well, thanks everyone for listening to another episode of the Freedom Talks podcast. If anybody has any questions or comments, please let us know. And remember, we have 4 clinical locations either here in Fox Point, Grafton, Brookfield, or McGowanago. Thanks for listening.

Mike K.: 44:10

Great job, Joe.