In this episode, Barbara and Andy discuss:
- Using telehealth in this Pandemic and which one is best
- Key performance indicators to use in a medical practice
- System to scale a medical practice
- How to choose influencers
“Doctors and health professionals need goals- weekly, monthly, quarterly, yearly goals and they need to know their bottom line” — Andy Zapata
Connect with Andy Zapata:
Connect with Barbara Hales:
Show website: www.MarketingTipsForDoctors.com
Barbara: Welcome to another episode of Marketing Tips for Doctors. I’m your host, Dr. Barbara Hales.
Today, we have with us Andy Zapata. He has had a distinguished 18-year career in the healthcare business. He’s an expert in startup businesses as well as exponentially growing small-, medium-sized medical centers in healthcare industries. For the last 18 years, Andy has dedicated his life to helping people of all ages suffering from pain and illnesses by creating a space where patients could celebrate their wellness breakthroughs with their medical professionals.
He has had the pleasure of working with the finest physicians, physical therapists, hospitals and medical institutions in the United States. Andy has extensive knowledge of the business of urgent cares, occupational medicine, primary care, physical therapy, pain management and medical spa industries. He has worked as an inspector for the American Association for Accreditation of Ambulatory Surgery Facilities for Medicare. Welcome to the show, Andy.
Andy: Wow, Barbara! What an introduction. Thank you so much for having me today on your podcast. I’m very excited to be sharing this moment with you and hopefully educating your viewers on some of the things and techniques that I’ve learned to really make our practices successful. So Barbara, thank you so much.
Barbara: Well, it certainly seems from this that you have experience in just about every type of medical health facility and type of various medical professionals. So in today’s day and age when it’s really challenging to see patients with the COVID and the quarantine and do we use telehealth and which ones, how do you recommend that doctors and health professionals grow their practice?
Andy: Wow! So that’s a short question but is a very loaded question. I mean, you know, at the end of the day, if I can give a simple answer, right, because I get asked this every day by entrepreneurs and professionals in the healthcare space, but the first thing that I would recommend is we have to figure out a way to get you out of working in your business and working on your business, like that is the number one step and goal you should have so that you can scale your practice because you, as a professional, only have certain hours during the day.
Eight, 10, usually that’s your amount of hours. And you can only see so many patients during that time. So if you’re looking to grow your practice, if you’re looking to scale your practice, there has to be, you have to be working on your practice and not in that office. You have to be outside of the office figuring out how to get more sales, how to get more patients, how to influence your community so they can trust you and refer you to more business.
And so we do that by different ways, right? The first step is like how do you get out of your business. The second step is how to get more sales. And there’s a whole process to getting more sales, right? There’s metrics. There are numbers. There are key performance indicators you got to meet. There are goal settings. And then there’s, you know, what happens when you meet the people that send you their business, right? So any medical practice whether you’re urgent care, whether you’re a diagnostic center or you’re a physical therapy center which is what I’m doing now, whether you are a pain management which I just sold my pain management center last year, how do you scale a business?
Rules to Scale a Business
Number one rule: Do not work in your practice. Number two rule: Figure out how to get more sales, how to get more patients in there, right? And so what happens when you get more sales meetings, for example, Barbara? Let’s say you step out of your practice, you hire a practitioner or a doctor or a nurse to take over your practice and now you’re focused on getting more sales.
There’s a system that we use. And I want to give you all my secrets today, Barbara so that your viewers can really take this and learn because I really want to give you the maximum value. So how do I grow? And I’ve sold, by the way, Barbara, over 100 medical practices between urgent cares and pain management and MRIs and home health centers and physical therapy centers which is my specialty. Like combine them, all of that, I’ve sold over 100 physical therapy centers, bought and sold combination, in my 18 years that I’ve been doing this. And now, I’m scaling that even faster, right? But what happens once we figure out how to hire a professional so that you can have more clarity and time to focus on scaling?
Then we have to focus on the numbers. Who and what industry is sending you those referrals? And then we talk about ecosystem mergers with those people. So for example,, I’m a physical therapist or I’m an occupational therapist but I own a physical therapy center. I need to meet doctors that refer my business. I can go meet doctors one-on-one and get referrals. And there’s a process that you do and a conversation that we call kind of like a GPS when you talk to those doctors. And talking to doctors are not just about asking for referrals because everybody asks for referrals.
But how do you walk into a doc’s office with the mindset of serving? How can I serve you, doctor? How can I help you? Just like I did on this podcast, Barbara, how can I serve you? And if you go in with that mindset to every single referral source that you have, things start changing for you because you’re not just asking, you’re giving, and then maybe you receive. So that’s been our approach to marketing.
And then there’s another layer to this, Barbara. What would you say would you rather met, 100 doctors this month, or would you rather meet one person that has influence over 100 doctors and let him make the warm introduction? What do you think is more powerful? What do you think is going to be more effective when you are going to meet those 100 doctors this month? I’m going to go with the influencer who has influence over 100 doctors.
So, who are the influencers for the doctors and attorneys? Well, let’s talk about it. The Florida Bar? That’s an influencer. That’s an industry that everybody belongs to or association that everybody belongs to and they have influence over the lawyers in that association, right, in that demographic region. Or like the medical association, the Florida Medical Association, for example.
So how do you merge with the Florida Medical Association so that they can introduce you to their associates or members? And so we talk about ecosystem mergers at the highest levels so that you can build your practice rapidly. Yeah, I can go meet 1000 doctors this year or I can meet 10 people that have influence over 100 people each and I just have to have 10 sales meetings, right, and then have lower sales meetings with those doctors.
And then what happens in those meetings? So there’s a system and there’s a process and a protocol that we use and we call that integrity-based human influence. Let me say it again. Integrity-based human influence. Because we understand what people want. We understand what doctors want. We understand what attorneys want. And again, it’s whether you’re in urgent care, whether you’re in practice, whether you’re a chiropractor, whether you’re orthopedic, whether you’re MRI or diagnostic center, everybody wants the same thing. They want to have value somehow. They want to be heard. They want to be seen and they want to be understood, that their needs are being met. And so with that in mind, we go in there with, how can I serve you, I see you, I hear you, and what you say matters to me. And so this is the technique that we use when we go market. And things are incredible for us.
Like you know, we don’t spend any money on outdoor billboards, we don’t do commercials, we don’t do AdWords, we don’t do Facebook campaigns. Every single one of my practices is almost (0:09:01). And that’s incredible because when you build those relationships with those referral sources, the relationships we’re building do not about give me, give me, give me. They’re about how can I serve you. And what that does, Barbara, it builds an emotional rapport. It doesn’t build rapport.
Building rapport is something different. How do you build a real connection with somebody and how do they allow you to build that connection? And it’s all with questioning in a certain sequence and a certain pattern that we call integrity-based human influence. Barbara, back to you.
Barbara: Well, the question that I have for you is in seeking influencers. If the associations are the influencers, how do you get them to recommend you as opposed to other specialists in your field that may also belong to that association?
Andy: Yeah. Great question, Barbara. And you know, we talk about reciprocity. Reciprocity is one of the main elements in our formula. And so the question is, what can I do for the influencer to give him some value so that he can see the value in introducing me to those members of his association? And there’s always some type of value that you can do, always. We just have to talk about it and see basically what it is that he needs. I would go into a conversation with that member and say, hey, so what are your challenges? Simple question.
What are your challenges? And he’s going to tell you what his challenges are as a member of the association or president of the association or influencer. Like everybody has challenges because everybody has goals. And so we just ask them, hey, what are your challenges? And then somehow, someway, see if there’s any way that you can fulfill or help those challenges that he’s having. And that’s when the reciprocity starts and I give you value and I receive value. And so again, when you go in there with the idea of giving value, then you shall receive.
Barbara: Besides the medical associations, what influencers would the typical doctor have at their fingertips?
Andy: Guys like me that know hundreds of thousands of doctors. So, one doctor wants more business. Whether you’re a doctor, primary care, orthopedic, whatever it is, it’s the same system. Guys like me have their own podcast. Guys like me that are out there influencing other physical therapy centers. Guys like me that are in there helping other physical therapies or medical centers excel. But attorneys that have their own podcasts or doctors that have their own — Like there are hundreds of different avenues that you just have to think a little bit, get a little creative, as to who has leverage over other people. And you know, everybody has leverage. Doctors, we call them ecosystems.
So, doctors are an ecosystem because they have leverage over their patients and then there’s always a bigger ecosystem on top of that and a bigger ecosystem on top of that and a bigger ecosystem on top of that. And so, it’s how we value those ecosystems and where you want to spend your time, right, because, yeah, a doctor is very important to our organization. I love them. Without them, I wouldn’t survive. But a doctor has an X amount of value to me versus somebody that has influence over somebody over them. So where do I want to spend my time, right? Because my time has a dollar amount to it. So where do I want to spend my time, the 40 or 50 or 60 hours that I work to dedicate to building relationships? And so that’s when — I’m sorry. And that’s when you start tweaking the performance, micro-distinctions.
Barbara: Most doctors really are not savvy enough to analyze exactly how successful or effective their possible marketing or referral system is. And you mentioned analytical tools. Which analytical tools do you recommend for a professional office?
Software for Doctors
Andy: Oh, yeah, great question. There are thousands and thousands of software, you know, nowadays. And mostly, they all do the same thing, right? They all are going to tell you how many patients, how many schedules, how many discharges, how many missed calls, you know. Any software really works because when it comes down to it, it’s very simple. It comes out — I mean, I can get a little bit more detailed but when it comes down to it, it’s how many patients, new patients, or how many patient visits did you see this week and this month. That’s all medical practice comes down to.
How many visits or patients did you see this month, this day, this week, this year? And that’s going to represent your gross revenue, right? And so how do you get the maximum amount of patients?
Well, number one, you start with ecosystem mergers, what we call ecosystem mergers. You start at the top of the food chain and then you go into other referral sources. For a doctor, it could be other doctors. For an organization like urgent care, it can be employers. It can be insurance companies. For an occupational medical center, it’s employers and case managers. For primary care, it’s other doctors and physical therapy centers and all the ancillary services underneath them that they refer businesses to. They should be requesting meetings with every single ancillary service that they have to build a stronger relationship.
See, in my opinion, doctors are very good practitioners and they dedicate their lives to providing amazing healthcare but they haven’t dedicated their lives to analyzing their business. And so if you can tweak that and have some time dedicated to just analyzing your business and strategizing your growth, your practice is going to change.
Barbara: You have a lot of experience at selling various types of health facilities and when doctors first go into their own practice, they should probably be thinking about what their practice is in the long term in terms of, you know, like selling it in the future which most doctors don’t even give a thought about. How do you evaluate what a practice is worth when you go to sell it? And what can a doctor do to improve that line so that he or she gets the most value out of it when it comes to selling it?
Andy: Yeah. So you know, buying and selling medical practice is very tricky and I’ll tell you this. In my experience when I’m evaluating practice, the number one factor that I look at, besides gross revenue, is how influential is a practitioner in his practice. Like will the practice survive with Dr. X? Is he the main character in his business? Because if he is the main character and everybody depends on him for everything, then your practice isn’t worth anything. It could be making $10 million and I’m going to tell you I’m going to give you zero for your practice.
Why? Because the minute that that doctor leaves then everybody leaves. Every single patient will not come back. So the best practices are the practices that survive on the business model and not the doctor’s name. We’ll start with — That’s the number one thing that I would look at.
And then I look at gross revenues, expenses, EBITDA, and net profits. And can I sustain this after the doctor leaves? And so that’s how I start evaluating and there’s a multiple for every organization of your EBITDA. And you know, sometimes it’s two, sometimes it’s three, sometimes it’s seven, sometimes it’s 10 times multiple depending on the size of the organization. And that’s how we start evaluating.
So my opinion on this — And then there are two types of evaluation. There’s the earnings evaluation or there’s the asset evaluation like maybe the assets are worth more than the actual earnings and maybe I want that building or maybe I want that patient load. Even though it’s not making money or as much money, maybe I can benefit from those patients by offering another service and improving that medical practice.
So you know, when somebody says how much is my practice worth, it’s really a loaded question and I help them navigate these things because it’s like, well, it depends who you’re selling it to and what they want out of it and what their potential is. But most of the time, buyers are going to come in here and, I don’t want to say haggle but negotiate on earnings. You know, what’s your earning? And even if you’re making $10 million and your earnings are zero, your net profit is zero, they’re going to say, well, your practice is not worth anything. But you have to really do your due diligence inside that practice to evaluate it and see if it’s going to sustain after the doctor leaves.
Barbara: Well, nowadays, it’s more difficult to find practices that are just a single doctor or practitioner running it, you know, especially in the time of mergers where many practices get together to improve the expenses as well as the bottom line. But for argument’s sake, let’s say we have a single practitioner office and we want to keep the value of that office after he leaves. So, when they are two or three years out before that doctor is ready to retire and sell the practice, what do you recommend? Do you recommend that that doctor start getting partners in or people that work for him? How do you approach that problem?
Andy: Yeah, employees. I would start requesting that he hire employees and create leaders in the organization so that you can focus on scaling your practice. And I’ve seen a lot of doctors try to exit and they don’t have the trust in the staff that they hire to really let go of the reins. And part of that trust is not knowing how to train or not knowing how to train leaders. And so you have to be able to train leaders.
You have to be a leader yourself to be able to motivate and train leaders so that you can sit back and just manage the organization, not necessarily the practice but just the scope of scaling, right? And so that’s what I say working on your business instead of in your business. But you have to trust your staff. You have to motivate, you have to trust and you have to be okay with some mistakes. Obviously, if it’s medical, I mean, there are deadly mistakes that can happen and very dangerous mistakes so that has to be discussed with the doctors. But you have to be okay with like your managers and your staff making mistakes because they’re learning as well. And if they’re engaged and they’re motivated, your staff will do wonderfully. But they have to be part of the growth.
They have to have goals, weekly, monthly, quarterly, yearly goals. And that’s how you maintain them, in my opinion, that’s how you maintain them focused and engaged. Because when an employee or staff member, manager, doctor feels engaged, that he’s part of something, of growth and if they can visually see it, that’s where everybody contributes to that growth. And so everybody in my organization has weekly, monthly, quarterly goals, yearly goals. And we reward everybody on those goals whether it’s Starbucks $5 gift cards or whether it’s a pizza party, whether it’s a big bonus at the end of the year. But one thing that I learned is in order to scale you must learn how to lead leaders. If not, you’re not going to do it.
Barbara: So, do you have a program where you teach or coach health professionals to do this?
Andy: You know, Barbara, I do and I don’t. It’s kind of like, you know, I do because I coach my franchises on how to scale and succeed in their brand, in our brand which is Physical Therapy NOW Franchise. I do have a program. It’s internal. But you know, for the last year, I took in a few people that have not been part of the organization and they’re very successful. I’m proud to say that it’s not a business model that I have per se.
Really, I’m focused on building Physical Therapy NOW Franchise and helping my franchisees maximize their investment. And that’s where 99.9% of my time is. And I did some as favors and I did so as like let me see if this works in other industries because I’m proving my concept. And I’m proud to say that I’ve proven the concept in multiple industries and multiple healthcare companies, some of them that are not even mine, you know, just friends and associates that I have helped them scale with the same principles of integrity-based human influence and knowing their numbers and knowing their KPIs and talking about, you know, bottom-line numbers. What is it?
Barbara: So for physical therapists who may be listening as well as alternative care health professionals who may be saying, wow, you know, Andy Zapata is just the person I need to speak to, how can they reach you?
Andy: Oh, Barbara, thank you for that. And so yeah, so my website is physicaltherapynow.com and you can send an email there and it’ll get to me or you can just email me azapata, that’s A as an Andy, Z-A-P-A-T-A at physicaltherapynow.com, physicaltherapynow.com and that’ll go straight to my email and I’ll respond. And if you will mention Barbara Hales, then you have a special VIP that I highlight and I’ll call you, you know, the same day.
Barbara: Well, thank you so much for being on the show with us today. It’s been very interesting, Andy.
Andy: Well, Barbara, let me just tell you it’s an honor to be here with you and thank you for creating a space where we can discuss how to help more doctors excel in their business because, you know, it is the most, how can I say this, concerning that doctors spend so much of their time helping people and then they don’t develop the skills to help themselves in their business. And so it saddens me to see that but I’m excited to share everything I know with people. And so thank you for creating a space where we can discuss this and help, you know, hopefully, thousands of doctors and professionals out there that are in the same space.
Barbara: Well, I hope so. You know, it’s really scary that nowadays doctors are in jeopardy of actually going bankrupt. And what they need to know is having a mentor and marketing to guide the way would really do wonders. So, thank you for highlighting that. This is another episode of Marketing Tips for Doctors with your host, Dr. Barbara Hales, speaking with Andy Zapata. Until next time.