Ep. 101 - Virtual Physical Therapy Was Written Off as Impossible. Ashok Gupta Proves It’s Not.

What happens when two physical therapists sitting on their couch realize the entire delivery model for their profession is broken? On Working Healthcare, host Meredith Hirsh talks with Ashok Gupta, Doctor of Physical Therapy and founder of TheraNow, about building a virtual physical therapy platform that now serves major hospital systems across the country. Ashok traces the journey from a website launch that drew zero visitors to a pivotal moment treating a hospital CEO recovering from hip replacement surgery — and how that single patient relationship changed everything. They dig into the economics of PT reimbursement, the PTA staffing debate, rural access failures and what a CMS innovation initiative is finally doing to kill the clipboard. The real question Ashok raises isn't whether telehealth works — it's why a system with the tools to change keeps choosing not to.

Contact Ashok Gupta:

Website: theranow.com
Facebook: @theranow
Instagram: @theranow101
X: @realtheranow
YouTube: @theranow-therapistondemand4024

LinkedIn: /dr-ashok-gupta-dpt

Contact Meredith:
Website: meredithhirsh.com
Instagram: @workinghealthcare
Facebook: WorkingHealthcare
LinkedIn: @meredithfhirsh
YouTube: @WorkingHealthcare

Transcript

SPEAKER_00 0:00

If you're getting value from working healthcare, I have a quick ask. Follow the podcast and leave a five-star review on Apple Podcasts, Spotify, or wherever you listen to the podcast. That simple action helps more physicians and leaders find these conversations and better understand how our healthcare system actually works. And that matters because we can't fix what we don't understand. I just interviewed a shakupta. He is a physical therapist, and he went from treating physicians across rural America to building a virtual physical therapy platform that challenges how care is delivered and scaled. In fact, over 70% of physicians now use telehealth at nearly triple the pre-pandemic levels. We talk about his journey and how he exposes the healthcare system's resistance to change. Even when the access of need is obvious. Hold on. Ash Gupta, welcome to working healthcare.

SPEAKER_01 1:28

Thank you for having me. It's my pleasure.

SPEAKER_00 1:31

What made you realize that the way we deliver physical therapy in America was not working?

SPEAKER_01 1:39

Right. One day, me and my wife, both doctor of physical therapy, practicing uh all day long, sitting on a couch watching TV, and we realized like, uh, we need to do something. If the telehealth can help mental health and telehealth can help uh urgent care and physician services, we have been from Manhattan to Midwest, and then down here, South Texas. That means uh, and we have seen the consistent problem of access to care, patients driving two hours and three hours to get care, and then sometimes not even getting a care. So, how can we use the same known technology of telehealth and then apply to our problem in physical therapy and rehabilitation space? And uh took a few more minutes to think about it, and then we've looked at each other and then said, I think we can do that. 80% of the time we don't touch the patients. That means 80% of the population we will be able to treat online. And that was like nine years ago. And in today, after thousands and millions of referrals, uh, we are actually not anymore an option, we are one of the mainstream options and that usually patients uh choose to go forward with.

SPEAKER_00 2:52

Take me back to the beginning. You're from India, massive cricket and soccer fan. What enticed you to study physical therapy?

SPEAKER_01 3:03

Growing up, I was pretty athletic. I was in cricket and then slowly drifted away from the sports. But somehow cricket was like one of the sports that I followed, um, and then stayed in. And then slowly at the time, cricket, like India was like getting better and better every day. It hadn't won like cricket World Cup for a long time. And like I'm almost getting to the point where uh we're starting to see the reason behind that was like a health of the athletes. And you start seeing on the TV there's a sports happening, there is like a some of the doctors and a physical therapist, and in India that's called as physiotherapist, would jump on the field and start helping athletes. I want to say passively, I wouldn't cannot pinpoint that that is when I saw on the TV this happened, and then I can, but that passively started to build in like I need to be in a healthcare. Uh, and then if not an athlete on the front, but then I can help the other athletes actually be better. Slowly, probably that shaped the vision of it. And then when time came, like to pick, I gotta be a doctor. Um, we already had an engineer in a house. So um pick the right path, I guess.

SPEAKER_00 4:11

It's funny. I joke to my Indian friends, I'm Jewish, so we have a choice to be a doctor, a lawyer, or an accountant. And I said that to one of my Indian friends, and he said, Well, at least you get to choose an accountant. We have to be a doctor, a lawyer, or an engineer. So you had an engineer covered in your family.

SPEAKER_01 4:29

You nailed it. Yes, exactly. Uh, that's the true fact. We don't have a lawyer yet, so maybe one of my daughters.

SPEAKER_00 4:35

There you go, one of your daughters. I ran away from law school. But going back into physical therapy, you studied in India, you moved over to America, and that's where you got your doctorate. What brought you to the US? And then why did you think it was so important to get a doctorate in physical therapy?

SPEAKER_01 4:54

Uh people would say the doctorate, like a lot of time we do education for like to be able to get the license of professional ability to practice certain things. Uh, my personal situation was a little bit different, means uh up to 2010 in US, you could have like a bachelor's on physical therapy uh or master's in it and master's of physical therapy, and then get a full practicing license. When I finished my master's in 2009, it was equated to what is actually US education. And I was able to come here and start working in 2014 as a physical therapist. I had no reason to go back to school and then get a doctorate into, but I always felt like there's more to learn. I've learned the healthcare in India. I've made sure that like I go through the same vigorous process of like uh getting the like how you have a lawyer's have a bar exam, like we have NPTE to standardize the entrance of all physical therapists, get the license. Went through that process, but I always felt like I want to see the healthcare, how it is actually like education-wise here in US. And um, although it didn't add anything, it didn't actually like pay me more, or like it wasn't like a salary bump you're gonna get, but we always had that next to it. So we both me and my wife, we both actually went through the process of getting a doctorate while we were working eight hours a day uh and doing the bridge programs, got the degree. Um, now in a retrospect, I believe it was a good decision. Um, that we were able to actually like improve our knowledge base and also understand like both worlds, like how uh a country like India offers a healthcare education versus like in US, like how do you actually learn things and then deploy it?

SPEAKER_00 6:37

One of my closest friends in undergrad wanted to study occupational therapy, and she had to go through all of the same training and programming as an undergrad student as the medical students, and she was so focused on organic chemistry and getting an A because she could not even get into the program if she was not a 4.0 student. Is it that difficult to get into physical therapy programs now? I mean, this was the 90s.

SPEAKER_01 7:07

It is hard and it is a lot expensive at the same time, and it is time consuming. On an average, like between pre-med and a doctorate of physical therapy, uh, someone would spend seven years minimum, like if you're going no gaps anywhere. Uh, it's not very easy. You will probably come out with 100, 200 grand uh in debt by the time you're done with it. So it is expensive, it is hard to get in, it is a little time consuming. But on the other side of it, there is a reward as well. You're you have a very good, stable job. Yeah, plus at the same time, at the end of the day, you get to feel that you're contributing to the society, you're helping people actually get back on their feet, and you're changing lives in many directions. And one good thing is like we're not uh spending a minute per patient, so we don't really know what who are we connecting to, and then patients like cycling in and out of our system. We get to spend as a rehab professionals, we get to spend time with patients. Our average session is anywhere between 30 minutes to 60 minutes long.

SPEAKER_00 8:09

We work with a lot of physical therapists because we work in the world of rheumatology. I've heard from my patients when they go to PT that oftentimes they don't see the physical therapist, they see the PTA. And I understand that from a business perspective because my physical therapy friends will say, I have to have PTAs. The reimbursement for physical therapy continues to decline. I know that we were looking at bringing it in our office in about 2010. And I don't recall the exact year that literally there be there was a 25% cut in physical therapy reimbursement. So the more PTAs you have, obviously the more patients you can treat, but the more the way that you can actually make this a viable business proposition. So tell me a little bit about the PTA process versus the physical therapist that's overseeing the care.

SPEAKER_01 9:09

Right. I think you're touching a very specific industry points. So uh, and you're right, like uh this traditional medicine was like physical therapists or physicians would be the one delivering their own care under their stream. And then there will be assistants and then nurses, uh PAs or physical therapy assistants, and then same goes for codas and OTs, would be uh like someone assisting the plan of care. And as we have a shortage of staff, plus the business uh occupant, uh business economics doesn't really make any sense. Um, amount of an expense at the cost of uh imagine that we were just talking about 200 grand in debt. I cannot expect that person to come out and be inexpensive uh to match the reimbursements that we get from the payers. Uh, so usually the business uh mindset comes out with like, what's the easiest way to do it? All right. Initially, the thought process was like the assistants would assist the clinicians to do their job. Now, when you start getting paid the same amount from the CMS for performed services by one versus the other, but the cost of having the assistant is like almost literally half, usually business owners would go the other direction. At what cost, though? Um, this we recognized I I love a lot of my assistants. Like I've worked in all settings. I've worked with in the settings where there were no assistants at all. Uh, and then I also worked in the settings where I always I was the only myself was the only supervising PT. And then I had like a six to eight other assistants of mine helping me doing eight X of the volume that I could actually personally treat myself. So in that way, it was great. But there is a shortfall too, is like a level of quality of care that we are able to provide the patients. The patients having an experience of a little bit different when the PT himself or continuity of care with the one therapist versus like you actually see the first time the therapist, and then you see them like 30 days later the next time for the documentation visit. It's a very different experience. And learning from this, when I started my own company, I said, like, one, uh, I want to put myself in the shoes of the patient and make sure what works right for the patient. So we have like around 400 plus therapists at this time under there now. And we only hire physical therapists licensed in estate. We do not like to move patients between therapists and then not like to use one of the most experts, I would say, in a rehab or kind of kinesiology or uh physical medicine, physical therapists, to use them to just document on the computers rather than having them to deliver one-on-one care. So we gotta live with the insurance world of documenting, and then actually that's how you get paid. But then allowing them to do treatments actually helps us get the best results.

SPEAKER_00 11:57

I think what you do at TherraNow is a really interesting concept, specifically as it relates to physical therapy. Why was there such a need? I know that you and your wife are watching TV and you're like, we definitely need to do this in the physical therapy world. You're about a hundred miles east of Dallas. So you're in Texas, and I know you have a lot of experience in rural medicine. What made you realize we have got to create a better system to deliver physical therapy to patients?

SPEAKER_01 12:32

Right. Um, there's obviously demand and supply. That's the easiest answer here. We have a lot more people needing physical rehab and medicine than the number of people that can deliver. So that's very straightforward. There's a difference between that. But physical medicine has its own problem in a way. Reason is like you go to a normal doctor's visit, you spend two hours in a waiting room, but you spend maybe 20 minutes with the doctor. Uh, and that means like one physician or clinician can actually see a lot more patients because barely you're spending between 10 to 20 minutes per patient. But on an average session of a clinician, a physical therapy, occupational speech therapy is somewhere around an hour long. Now you can barely see seven or eight patients in a day. And that's where this big access issue is. Even if I have a clinic down uh the street, but they don't have availability for me until maybe next month. Average hospital systems that I work with have average wait time for an evaluation to get started is 15 to 20 days, almost three weeks. So you have you go to a doctor today. You can get a doctor's visit probably in the next week, but getting a physical therapist appointment for an evaluation, usually on an average across the nation is two weeks.

SPEAKER_00 13:50

I think it really depends on what your specialty is. If you try to get a neurology appointment, at least where I am, good luck. If you want to see a physical therapist that may be in network with your insurance, if you are not of Medicare age, good luck. So it definitely depends on the specialty. And others are totally bombarded, as you stated. Physical therapy is also more difficult in rural medicine. So let's talk about the rural aspect of physical therapy because you see that throughout Texas. I know you do firsthand.

SPEAKER_01 14:27

Yep. No, definitely. Um, it is uh I just want to say it's like the problem is everywhere, it's just a little bit more highlighted uh in the rural areas because we all understand that there's an access issue because a staffing issue. I'll give you a contrast to this. I worked at the VA in Manhattan. People would think this is one of the biggest cities in the world. Uh, that means that access to everything should be very readily available. Average veteran um coming to my appointment would had waited minimum three to six months to get my appointment. One because of the VA system, and then two is because the lack of services that we have in the area. Uh, the second thing is I'm on a 23rd FDR, not like a remote uh Texas part.

SPEAKER_00 15:12

Yeah, I was thinking you aren't remote, and I'm thinking lack of services, it must be just a supply and demand issue.

SPEAKER_01 15:19

Correct. And uh there are other environmental factors too. So what we hear in the remote areas talk about is like you have to drive at least 20 to 30 minutes to get anywhere from one place to the other, right? Uh on the other hand, from one mile distance could also take an hour in Manhattan. So average patient in Manhattan to come to our clinic spent one hour to two hours on their ride to get to the appointment. So now see, like the problem is everywhere. It's the access problem, uh, the wait time problem, demand and supply problem. It's just like it's highlighted just in a tiny bit little different way. I drive here at 80 uh miles an hour.

SPEAKER_00 16:01

I know they allow that in Texas. It's so exciting, but I live in Florida.

SPEAKER_01 16:07

But the point here is like you may spend 20 minutes, but I'm uh you may it may sound like I drive 20 miles to get to my appointment, but you spend 20 minutes to get there. Same thing. Uh you go uh in Manhattan one mile away or five blocks away, but you have to jump in a car, it'll probably take you the same an hour.

SPEAKER_00 16:27

Definitely. Palm Beach County, where we are, is the largest county in the state of Florida. And about two years ago, Florida Blue canceled the contracts of 70% of the rheumatologists that were in network. Currently in network. So 90% of rheumatologists were out of network for Florida Blue plans for their Medicare disadvantage plan. And it doesn't matter, as you said, are you 20 miles away? If our average patient age is 76 and we are 20 miles away, but again, it could take an hour to get there. How much are you limiting access to care by the insurer? Right. It's definitely an issue. Let's talk about insurance because you started this company in 2019. I love the fact that you and your wife work together. My husband and I work together. It's sort of fun, right? But it makes it a little difficult. Let's just be honest.

SPEAKER_01 17:28

Um just stay in our lane, right?

SPEAKER_00 17:32

Exactly. Stay in your lane. In 2017, pre-COVID, how did it go over when you were like, hey, we want to offer physical therapy virtually?

SPEAKER_01 17:44

I'll tell you the the most important thing is like how naive you are. Um, we could think back then as like, we'll start this website. The day we launch it, there will be so many people that we have to make sure our servers are up and running. And we need the best in the class servers so that like when the people show up on the website, it shouldn't crash. That was our thought process back then. Uh, and we focus a lot more time and energy in building a website and the platform that would handle millions of people, and then we launch it, and then not even a one cricket shows up onto the website.

SPEAKER_00 18:20

That reminds me of what my son went through when he started his company. Like, we're gonna spend all of this time on cybersecurity and setting up our platform, and nobody shows up.

SPEAKER_01 18:32

Right. So that's where you learn being like a first-time entrepreneur. Uh, there's so many things you do wrong. But one good thing I'll tell you is like there is a blessing in disguise there. Being naive, you do not understand how big of a problem you're gonna run into. And then you're so delusional that uh you say, Ah, I'll take care of it. And then you start picking up a fight with something like a healthcare in America. And you today you see, if someone told me to do this all over again with this mindset today, I'm like, no, there's no way I'm gonna do it. So you're not gonna be a serial entrepreneur. I will be an entrepreneur, I can't be anything else. Um, but I would take uh I would at least size it up properly. Means I wouldn't actually like say, oh yeah, I started in 2017 thinking of this will be a part-time company. I'll continue to do my eight-hour job and then be able to run it. That naive um we were back then. And now we understand no, we have uh hundreds of employees to run this. And then back then we thought like we can keep our job and then also run it on the side. And then as far as we can keep say a few hundred patients, that will be more than enough.

SPEAKER_00 19:43

Because as an entrepreneur, you also have to fundraise. How was that?

SPEAKER_01 19:48

Oh, that's interesting. Uh, I'm gonna start it with this. We tried and we failed. You're not a good salesperson, huh? Now uh I want to say there's a deal. If that cannot be closed, you put me in the room, I'll I'll close it. Um, back then I was a clinician who wanted to be an entrepreneur and not a sales guy. Not until 2021, I realized like there's no other, and I I don't know where I read it, but I read like the unless the CEO and a founder of a company is a salesperson of that company, nobody is going to be able to sell what you have built. And I switched my perspective from that point on. I'm like, okay, I'm gonna have a couple more guys to focus on what I'd focus on today, and I'm gonna be focusing on the sales. And then there is another milestone in my company came in like last year when I realized, okay, we have built the company to this level where we have a good traction, we have proof of work, we have like a large hospital system, like quite a few of them, but we are not like a household name. To get it from this stage to this stage, the next step is marketing. So there's building, there's a sales, and then there's marketing. And then I literally said, I'm retiring. I told my entire team, like, I'm retiring, I'm not gonna be working. The whole idea was like, I will not be working on the in the business, I will be working on the business, and then I'll take the steps towards marketing and then making therror now as in a household company. And then since January, that's what all I'm doing right now is like making sure we are visible and we are people are aware of what we do and how we're impacting lives.

SPEAKER_00 21:31

But you started this in 2017, and that was 2026. I mean, we're in 2026, and that's when you really stopped seeing patients. So, walk me through how COVID changed your entire company because you shared your story about a Texas hospital and trying to get in and trying to get in, and now you're on platforms with a lot of insurers and a lot of hospital systems. What was that? I want to say that brought you to that edge.

SPEAKER_01 22:04

I would say uh COVID specifically. A lot of people ask like telehealth and COVID there go hand in hand. Um, and absolutely, there couldn't have been any bigger change in this world that could have actually changed telehealth for good. Um, and did did that did that help? Yes, absolutely. It changed the regulations. Uh, so and regulations were changed for everybody, not just for me or my company or Therra Now. Uh but what changed for Therra Now over the period of time was the persistence. We kept pivoting and trying until unless we found our product market fed. And then COVID came in 2020, but our product market fed actually came in 2022. That's when we really found out, like, okay, this is the way the company is going to work. So it took us a long time to really like first, we were trying to do telehealth in an environment where it doesn't regulations doesn't support it. It's like a Napster before Netflix, uh, right? So it's a timing thing. We were a little too early for it. COVID came, the regulations supported it. We were still alive in the game. That was a win. That's the biggest win at that point of time that we were still in the game. And uh 2022 is when we really refined our product to really find what the product market fit is. And that's what we have been doing since then. And now I'm very much like a no person for things that we don't need to do. Then, yes, let's try this also, let's try that also. That's my perspective, but my team still says like no, you keep coming up with the features and ideas every day.

SPEAKER_00 23:39

So, what is the no? What ideas do you reject?

SPEAKER_01 23:43

If you are a clinic and you come and say, Therina, we want to work with you, we'll say no. Uh, you are a physical therapist and say, give me your software, I will say no. If you are uh any physician IPA practice and then say, we want to create a virtual physical therapy clinic in our practice, I'll say no. Because we know only and only way we can impact a large population. And then the best way it works is when we partnered with large hospital systems because they are the only one that can support our tech stack. They are the only one that can actually support the population uh of the masses and the size that we can really help with. And um, so since 2022, only people we work with is a large hospital systems.

SPEAKER_00 24:24

I believe and I believe it was the University of Texas who you first started working with.

SPEAKER_01 24:31

Oh, that's the most interesting story.

SPEAKER_00 24:33

Yeah, that's the story I want to hear.

SPEAKER_01 24:36

Right. Um, a lot of companies, and I think most entrepreneurs can pinpoint the day their lives change, right? And this is like one of those uh life-changing days uh in the street uh story up there right now. So uh taking you back to 2019 and 2018, we started to target everybody, whoever we can. Uh, we did Uber physical therapy, we wanted to do um work with the hospital settings, we wanted to work with the value-based care, we wanted to work in the physicians. Whoever would actually like want to work on telehealth space, we would try to sell ourselves to them. And then obviously, during this process, as I said, we worked with the hospital uh in one of the groups, like University of Texas uh hospital system. We are doing joint replacement um post-rehab and pre-rehab. We created a small pilot study, amazing physician. Uh, Dr. Confletti supported the entire effort and then saw amazing results out of it. There was bundled program, comprehensive joint replacements. Uh, CMS came out in 2016. That is where we really got a little bit of attraction, but no money. We were actually putting money out of pocket because there was no reimbursement model. But we saw apples to apple comparison, the cost of care went down 60%. Uh, patient satisfaction level was like 93 on 100 NPS. And um, our patients actually uh length of stay also went down to one day on the post-hip and knee replacements. So amazing results, but still no business to work with because there's no uh model to get you paid. 2020 comes, March, you uh we get hit with COVID, and we all thought like this is that moment when every hospital will start using us. But reality is when the COVID hits, everybody and every hospital is thinking about how to get more nurses, how to get the physician visits, how to keep patients uh uh infection control is the primary thing, not physical therapy. For that period of time, instead of helping, everybody shut down their doors to even talk about the business with us. They're like, we'll talk about this later. So, but somehow, because we are uh in Texas and then uh we have been already working some relationship with the AES UT, I was able to finally get a meeting with the CEO of the health system. Uh at the time it was owned by the Ardent Health System, even today. So before that, it was a not for uh it was a different uh organization, but then Ardent came in, bought it, different leadership, different perspective to things and COVID. I'm talking to CEO and Vicky Briggs. Um, and I'm like, this is the time the COVID has changed, we are able to produce value, and these are the numbers. And then she said, Yeah, actually, but we are not sure. We have so much on our hand, we need to focus on these things. And um, and she was like, and plus I'm going on a leave uh for a little bit because I have a knee a hip replacement next week. I'm like, okay, Shock, you gotta stop selling now, and all you gotta do is is like uh be show the value of what you have built.

SPEAKER_00 27:44

Oh, yeah, I could totally see this light bulb going off in your head.

SPEAKER_01 27:47

No more sales fish, no more partnership deal. All like Vicki, you need to let us take care of your. She is like, I have 30 clinics, I have so many therapists. Why would I have my my service, my my treatment be done by you guys on virtual? Um, but she is amazing, amazing leader. And then she's like, Okay, I'll give it a try. And um, I'm like, everybody, we at the time, I think we had like 10 or 15 therapists at a max. Um, so I was like, this is my patient. I will be the one to treat it. This is where your background clinician practice comes into play. Uh, I'm like, I will be the one treating. We provided her pre-rehab session. So the appointment is like her surgery was like, I think Friday or Thursday, and then this is Tuesday, we were doing a pre-rehabilitation session. She enjoyed it. I'm like, I don't know. Did we offer enough value that she will get us the post-rehab uh referral or not? Surgery happens, and then that afternoon we get the referral for the post-op rehab. I'm like, finally, that did work. Now I start actually, I had created a very clear values there. I know I'm trying to sell Terana to her, but when I'm treating, I'm gonna be her clinician. I'll talk no business. So we treat, do the first session, the second session, the third session, the fourth session. I do not bring up a word. We talk for 45 minutes on our session when she's exercising. I'm helping her and all that stuff, all remote and virtual on Terana platform. I do not bring business at all. And then finally, on this maybe sixth session, she brought up like, okay, tell me more about how we can get this to all my patients. I'm like, I was that's what I was waiting for. You're the king networker.

SPEAKER_00 29:33

You're the king networker. That's what it takes to be an entrepreneur.

SPEAKER_01 29:36

No, what it takes is like a customer whose CEO needs a hip replacement next week. That is what it takes to tell how to therapy.

SPEAKER_00 29:45

For Theron. And it's funny, I uh my husband is probably the rheumatologist for half of the physicians within our community. And that is the best sales pitch ever, right? So we walked up on the Bima at services one evening, and the rabbi said, Thank you for allowing my husband to be able to walk again. I I I couldn't pay for that advertising.

SPEAKER_01 30:12

Absolutely. Means uh you don't have to be a clinician, we have one extra uh marketing tool, which is just provide good care. You keep providing good care, your company will automatically continuously grow on your own.

SPEAKER_00 30:25

You have to believe in your product. That's what I say, right? If you are going to be the CEO of a company, you have got to live and breathe and really believe that you are the best.

SPEAKER_01 30:36

Absolutely. Couldn't agree more.

SPEAKER_00 30:38

And you got up to 400. You have 400 PTs right now, right? Under Theranow.

SPEAKER_01 30:43

Yes, that's right. 400 plus. Actually, we are growing every day. Uh, and we hire on an average like one to three therapists every single day. And so we're keeping up with the demand. And I'll tell you like, this is where the tech uh at core, um, even though I personally am a clinician, but Theranow at core is a tech company. We do offer physical therapy service via the technology, but core part is like so whenever we see a problem, our average time to hire and onboard a therapist was 14 days. So earlier this year, actually, like uh not earlier this year, last month, we came up with like, okay, we got to fix this. Like, we are having a lot more patients. We can't be the one with two days of a wait time. We should be always be available. Patient's choice, they want to do it next week, totally fine. We should be available to have sessions later that day or next day. That should be our latest availability. But um, so we changed uh we built the tool 100% asynchronous hiring. None of the ATS softwares out there, application applicant tracking systems, offer something like that will fit our model. I don't really need to talk to you to find out your license in the state, I can verify that. Your availability is what is needed, and I need to see how presentable you are on your uh video camera because that's how you're gonna be treating. So instead of like having you come on a phone call and doing a screening and interviews, we created a tool where you record your video and then upload it, and that's your interview. Either you get a selected or you don't. Once you're selected, you complete entire onboarding process, verification process, and uploading documents and doing your trainings also there. And uh next day you're training. So last uh to last week, we had a one of our candidates apply for the job in the morning at 8:30. In the evening by eight o'clock, they were fully onboarded and had its appointment scheduled for the next day.

SPEAKER_00 32:36

How do you assess the quality of medical care that the physical therapists offer?

SPEAKER_01 32:43

So, one of the things is is like when you go to school for three to four years, right? Like seven years in total, uh, you can there's a standardization test out there. We all know that everybody has a basic knowledge of physical therapy. Whoever has a license, definitely license is the easiest way to recognize like this person knows what they're doing. But as a person and as a clinician, what is your practicing uh style? That matters a lot. That needs to match the culture of the company, also, right? So, uh, and again, I'm gonna go back to our tech roots uh of it. So, what we did was like we uh we all went to school, learned bedside manners. And when the COVID hit and virtual came, everything became web side, right? Nobody taught us that. Everyone built their own style, everyone had their own background, everyone built their own professional attire. Um, they're everyone built their own style of delivering care on a camera. Some people really got really very good at it, and then some did not care much about they joined from the car, they can join from the soccer field and then thinking like, oh no, as it's a video call, it says like anytime anywhere. No, it's not anytime anywhere. You have to have like a certain things that are on it. So, what we really did like we tried to train our clinicians a lot more on a website manner. That was our step one. And then we were like, Well, how can we solve this by technology? So we created a very simple tool that analyzes the patient-clinician interaction and scores it. So the way it works is uh right now, uh, you know, we uh everybody is talking about ambient AI and ambient listening and then for scribing. That's the purpose, a totally different rule or uh reasoning, why to use AI. We took it to the next level. We already had that feature built a year and a half ago. So we all our clinicians are already using ambient listening, focusing on you as a patient rather than typing, because by the end of the session, the note is already written, pretty much 80 to 90 percent of it. We just make a tweak a little bit and then we are able to submit it. Amazing results on that. What we did was like now we created another AI model uh to recognize the interaction between patient and the therapist, and then rate it on a different rubrics. Rubric, like how well did you introduce yourself? How well did you actually like explain the entire virtual program to the patient? How well did you explain them like what your care plan is and why it is important to the patient, and how what is their role into the care plan. So once we built this, AI is able to analyze your session and give you scores on it and gives you evidence of why did I score you four and five in the introduction module? Because this is what you said, where you could have said this. Now, some people can take this as a very good tool. Some people can take it as like, oh, that's too much of information. So we said, like, it's not something we're gonna push hard on the therapist, we're just gonna make fun out of it. So, across all of our therapists, we created a leaderboard. We said, your scores are only visible to you, but the top five in the entire network are visible to everybody. So you can see what the difference between you and them is. How competitive, how competitive are physical therapists? In a fun way, right? Like I can see how Meredith actually like introduces herself to the patient when the patient actually shows up on the call and and learn, and I can see her scores are like 90 on 100, and I'm just 66. If I want to get better, I have a way to find that how better. How can I get better at it?

SPEAKER_00 36:15

Do those at the top echelon get reimbursed or compensated at a higher rate?

SPEAKER_01 36:22

I wish we could. Uh, the bad part of healthcare is like, as far as you have a license, everybody gets paid the same way. But obviously, like there are a lot more ways you can compensate your best employees or best clinicians. Is like they get um, so we are a therapist-built company, right? Like, so all my leadership is all clinicians, everybody is a clinician, and all of us at one point were treating patients for Therano. So this is this is where like we pick those therapists, and then we actually offer them like, do you want to be a little bit more? Uh, then just helping your patients yourself, like, but helping off. And then so uh slowly some of the therapists like only treating, they don't really want to be the tech or they don't want to be administrative, but the others are, and then that's what my leadership team is today.

SPEAKER_00 37:13

What is the compensation similar to for a physical therapist who does virtual health as opposed to a physical therapist who goes into a clinic every single day? I'm just in my mind trying to think what you give up compensation-wise to have the ease of being able to work from home. We did not implement virtual visits in our clinic. We offer too many ancillaries. It does not make sense and it is financially not viable for our practice. So I'm thinking about that on the physical therapy perspective.

SPEAKER_01 37:49

Right. No, that's a great question, actually. Like, and I know where it's stemming from. A lot of time, the very first thought process is like, if we are um if we have to run a big clinic where you have a brick and mortar, balls, equipment, and every single thing that should cost more and that should actually get reimbursed more. Telehealth is like a little bit lighter, less expenses, probably. So it should get paid less. Uh, it would be true if it was event-based reimbursement. This is where a lot of people don't actually get the nuance of the therapy. In the therapy world, we don't get to uh get paid to just see you, we get paid for the time. So um every minute is a paid minute. So now think from this perspective, is like you would think the reimbursement is only for running the business. And then uh, you remember those days like when the doctors used to spend 30 minutes of the patient and then the reimbursement started going down, they made it 20, then 10, nowadays like five.

SPEAKER_00 38:47

But if you look at psychiatrists, right, or mental health care, they get paid by the time too. And we could get time-based care, but if I build based on time, I wouldn't be in business.

SPEAKER_01 39:00

Correct. Yes, because there you have two options, you're able to compare and then go there. But physical therapy has no other option. So now my expense is exactly the same when you are actually like in the clinic or virtually. I'm so much glad that all the insurance payers and CMS understood the point that the most expense in the clinician uh in this medical medicine, in the physical therapy, is not any product. We are not doing surgery, so we don't need OR and all the it's the clinician's time, is what you are actually like is a product. And if the product is going to have the same expense, we got to make sure that the reimbursements are the same as well. So the call reimbursement, if you come and see me in my clinic, I see you virtually, or I come to your house and see you. For CMS, the reimbursement is exactly the same.

SPEAKER_00 39:48

I love that you brought up CMS because that is the reason why we had to reschedule our initial interview. We were set to meet a couple of weeks ago and you reached out and you're like, hey, I have a really great opportunity to work on this program with CMS. Tell me about this program.

SPEAKER_01 40:05

Right. That's yeah, that's one of the exciting things. Like sometime as a company, you may have to look at how you can contribute to healthcare uh or the industry that you are in, then how it is directly going to bring you an ROI. Uh, most of the time, the smaller you are, you're usually focused on today, and then how you can actually like buy something and then sell something. This was one of the uh exciting projects we worked on. CMS last year, under the Doge um initiatives, came up with the point like we need to make healthcare more technologically advanced. And then started a small group called as Health Tech Innovation Group. And a few of those good tech startups and other companies and healthcare providers, payers, and hospital systems did start participating. And then Therana, being uh tech forward, always like we said, we want to be there and you might help. And then we we participate in Health Tech Innovation Group. Not many companies, but very few uh group of uh companies actually participate in. And then as per the initiative, the idea was like last year when this whole group started out, by um April this year, we will be releasing an MVP, minimally viable product, around a big initiative change, like where the patients are given the authority to take their medical information and then share with anybody else. In the short term form, clip kill the clipboard. Every time you go to the doctor's office, you fill out the same piece of information and then over and over and over again. It's so frustrating. So I love it. Like Amy Gleason at the um Doge runs this entire program uh via the CMS administration and Dr. Oz led it to this point where on April 9th, um, we released the first wave of MVPs. And um there are multiple products in it, multiple features in it. One of this one that excites me the most is the kill the clipboard. So instead of when you walk into the doctor's office, instead of like sitting down there and then actually filling out all those forms one by one, writing that same information, whether it's your demographic or the same questions, what you could do now is actually like own your own health record with the CMS on a Medicare.gov. You're able to actually like go in. And there are a lot of other non-Medicare applications that are also coming up, including Terra now, uh, where you can log in, you can actually pull all your data from all health systems wherever you have been to, and also the CMS, and then have it all on your app and take a look at it. You can learn from it, you can talk to the AI chatbot uh and then understand it how it actually like works for you if you have any questions that you didn't actually get a chance to talk to your doctor. And then for the kill the clipboard side of the feature, you can take a QR code out of it, share and QR code or link however you want to share it. When you go to the doctor's office, they turn the camera around to you, and you scan their QR code and all your information in there.

SPEAKER_00 43:02

So I think that's an incredible idea, but so many things are going at me saying, Well, first of all, you're offering this initiative to people who are Medicare agent higher. Really? They're gonna use a QR code, they're gonna be able to know how to chat with AI. That's my one question. The other would be because I would love it. I find medical practices to be so resistant to change. I go into my own doctor's office and I'm asked to fill out the same three pieces of paper every single time I come in to visit. I will tell you, I had to see a doctor two days later and I still had to fill out the form. I said, nothing has changed. And she's like, Well, we just need to make sure. I'm like, really? Has my gender changed in two days? Has my address changed in two days? And so I think it's an amazing, increasing. Incredible idea. I would love to have it. Maybe they should start in pediatrics and not with the geriatric population.

SPEAKER_01 44:09

I'm glad. Like, see, we share that level of frustration as a clinicians, as a practice owners. And also imagine, like with the patient level, like larger. Everybody shares this level of frustration. I think this is the first time we're all talking about it and doing something about it. In this first wave, almost 50 companies, including Terra now, we are able to release a product. And we are tackling this problem from different directions. One is like you talked about the same information over and over again. How many portals do we have to log into? Oh my goodness. I know. How many usernames and passwords?

SPEAKER_00 44:41

Yes, I was just gonna say, how many passwords do we have to log into? Yeah.

SPEAKER_01 44:45

So we're tackling uh under this project, we're tackling this problem from all directions. Like, one is like, how can we just consolidate identity verification? So now if you go as of today, you go to Medicare.gov, you can actually have options to username and password. But at the same time, you can log in with your clear account, username and password. Good thing with that is like you can go to IRS website, login.me. You can have id.me, sorry. Id.me, you can log in at majority of the government websites with id.mean username and password. All you need to do is like have an account on id.me once, and then you're able to log into social security.

SPEAKER_00 45:24

IRS. Pay your taxes. That's what I most recently used it for.

SPEAKER_01 45:29

Right. But slowly you're gonna start seeing this expand more and more. Now, Medicare.gov, if you have been paying taxes, you're doing using id.me already, you already have an account. Now you go to the Medicare.gov, log in with that. Behind the scene, it is actually like verifying who you are, connecting to your CMS record, and then putting you into the right Medicare.gov. You don't have to remember username, you don't have to remember your password. So that's one way to look at it. Like the technology helping the frustration of like everything that we're dealing with. Kill the clipboard is actually a multi-directional approach. Not only giving the patients access to their own information, like downloading the app, pulling the data, at the same time, uh, under the TEFCA regulation, what all the app builders and the EMRs and EHR builders are able to do is like we are able to pull the information from these different sources as well. So you don't have to tell me what happened with Dr. Joe yesterday in that clinic. I already have that information in my software, even though me and Dr. Joe are totally unrelated organizations.

SPEAKER_00 46:31

That's what I'd like to see, and that's what EHRs were supposed to provide. And there's no interconnectivity. I also think as the advertiser that I am, there has to be a way to roll this out and to educate the population that this is available. I go on to id.me all of the time, and I didn't even realize until you said it that yeah, that's where I go to pay my taxes. That's when I log into CMS. I didn't even realize why they were utilizing the same platform. So there definitely has to be an educational process involved. So I want to wrap this up because I could talk to you all day. I just think you're fascinating. I love the entrepreneurial spirit in you. Ashook. If you could create one change within our American healthcare system, because you are on the cutting edge of change, what would that be?

SPEAKER_01 47:28

I would just make it a little bit faster. Um the worst thing we can do to anything is drag it. In healthcare, that it's not that like we have a lot of innovation happening. We have a ton of innovation happening. But by the time you try to go and implement it, in the I I know safety is very, very important. Um, patient safety, people's safety, data safety, uh system safety is very, very important. But we sacrifice for the safety piece of it and bureaucracy that comes around that. And a lot of time, like actually, it's not even about the safety, it's just a bureaucracy and red tape in the healthcare that makes any and every effort of yours. I could have built this nine-year-long company in three years if it was not in a healthcare.

SPEAKER_00 48:14

And I love that you said that because I have two guests following you, and we are talking exactly about that the resistance to change within our healthcare system. We have the tools, we just resist it.

SPEAKER_01 48:30

Absolutely. Nothing new needs to be done. We don't have to implement any new thing. All we need to do is just be a little bit more open to the change. Things will work and some things won't work. But the things that will work will have a larger impact than things that did not work.

SPEAKER_00 48:47

Ashuk Gupta, thank you for joining me on Working Healthcare. If this conversation hit home or made you think a little differently, don't keep it to yourself. Share the episode, tag a friend, or post about it on social media. Connect with me on LinkedIn to keep the conversation going in between episodes. If you've got a question, an episode idea, or someone you think I should feature, send me a note at MeredithHirsch.com. Thank you all for the five-star reviews. They help more listeners find the show. New episodes drop every Tuesday. Subscribe so you don't miss what's next. Tune in weekly as we explore the inner workings of healthcare because you can't fix what you don't understand.