Turning Struggles Into Entrepreneurial Success with Travis Robbins

Welcome to the control your cash podcast I’m your host Tim urick and it is our pleasure to have Travis Robbins from Robins Rehabilitation West Travis welcome to the show we are doing lovely no so uh Travis tell us about a little bit about your journey tell us how you got interested in physical therapy uh and and tell us about some of the struggles and the the the you know the the successes that you’ve had yeah I got more struggles than successes probably which is um is good um I I do uh coaching and Consulting now for pts and I get to teach them all the stuff I did wrong so that they make sure they don’t do that but I have a very typical Physical Therapy Story how we got if you talk to 10 physical therapists eight of them are going to say uh I had some kind of injury in high school or college and I went to a PT and I thought that was pretty cool and I could do that you know for the rest of my life.

I had some injuries in high school and I went to PT and it was actually uh the physical therapist that I saw uh went to my high school and I said where’d you go to college and he said I went to itha college so I went and checked out that College and I said this is good if I can get in here I’ll go here and kind of ended up following in his footsteps and now it’s cool now that we do a ton of that at work in that like our aid program so the kids that work our front desk all of almost all of them have 40 degrees are trying to get into PT school and they if you talk to 10 of them eight of them would say the same story that I said and just trying to get experience in the field so um I just kind of thought it would it was great in terms of the medical side of stuff um so it’s you get to spend time with your patients.

I don’t know if you’ve been to a doctor’s appointment recently but um You probably don’t have a relationship with your doctor whereas if you talk to somebody who went through Physical Therapy they probably have some kind of relationship with their physical therapist like if you if you need someone that knows a guy like hey do you know a guy for like HVAC or Plumbing or a guy that’ll get a raccoon out of your house like ask a physical therapist because we have met everybody from every line of work there is and we actually have a relationship with them because we spend on average somewhere around 16 hours of time with them during their course of care so um so I did that and uh got out of school and I got a job in Boston.

My uh fiancée at the time—my now wife—and I always wanted to live in like a bigger city, so we tried that for a little bit. Our first job I ever got was in Boston, and we found out it’s very difficult to live on a physical therapist’s salary in Boston. So, we ended up moving to the Poconos, uh, which I did not know was a place. I only moved there because my twin brother, who’s also a physical therapist, was in New Jersey at the time, and he said, “Hey, you gotta check out these cheap houses in the Poconos.”

And this was in 2002, I guess, yeah, and I was like, “All right, I’ll check it out.” And then I went up there, and I drove through the Poconos. I stopped at a builder, and I bought a house, like, on the way home to Boston. I said, “I don’t—I gotta find this guy. He should run sales for me. I don’t know how the heck he did it, but he sold me a house.” And I was like, “Yep, let’s just do this.” So, I often make decisions quickly. It doesn’t always work out for me, but this one definitely worked out.

So, I was in the Poconos, and then I was trying to find a job. I was going to work for the place my brother worked in New Jersey—it was a small private practice similar to what I have now—and then that didn’t work out. So, I open up the newspaper—this will date me, right? So, I told this story the other day, and it was hilarious. Someone said, “Wait a second, you found a job in the newspaper? Like, I didn’t even know that existed.” So, I opened up the newspaper and looked for a job, and I found a job in the newspaper in Allentown, Pennsylvania, which I had never been to.

And I went and interviewed there. It was for NovaCare, a large corporate PT place. And um, I worked there for a little while. I looked for a smaller private practice in our area, but I just couldn’t find one. So, at the time, I was 24, and I was like, “Well, I don’t have a huge mortgage. I don’t have any kids. I can eat bologna sandwiches. Why don’t I just try this private practice thing?” Because I always kind of wanted my own practice.

And the one piece of advice I could give people is like, if you’re going to open up your own business, do it early. Like, do it when you’re young because once you get older and you have, like, these financial burdens of mortgages and kids and stuff like that, it’s just kind of harder to get away from that. So, I opened up the practice—that was almost 23 years ago now—and I’m still doing it.

Tim: Wow, that’s amazing. So, uh, tell us about some of the struggles that you had in, you know, starting your own business. What were some of the challenges?
Travis: Yeah, this will give you an idea of how much I knew about running a business. I still remember my first patient that I ever saw. I rented, uh, so I worked at that NovaCare location. I found, uh, there was a doctor that had some hours there, and he said, “Hey, there’s this chiropractor in town that’s looking to have physical therapy in his practice. You should talk to him.”

I said, “Oh, great.” So, I went and talked to him. He says, “Yeah, you can—I’ll give you this like 200 square feet in the back of my chiropractic office, and you can just do physical therapy there. And we have staff here, like admin that’s here already, so they can, like, answer the phones for you and stuff, and you can try that.” I said, “Yeah, sure.” And that’s kind of how I started. I rented 200 square feet in the back of a chiropractor’s office, which is also a very common story that you’ll hear from physical therapists who start their own practice.

So, I remember my first patient. I went to the waiting room and said, “Hi, I’m Travis. I’m going to be your physical therapist today.” And she said, “Great. Do you take my insurance?” And I—I had no idea what that even meant. Like, I went to my first day of work and didn’t realize that I had to have contracts with the insurance company in order to see their subscribers. So, I was like, I looked at my front desk who had done, um, billing and collections for chiropractic offices, which is very similar for physical therapy. And I was like, “Do we take her insurance?” And she’s like, “I don’t know. You never gave me any of your provider numbers.” And I said, “What’s a provider number?”

So, I didn’t make a dime for the first six months because I—for some of the insurances, I was able to backdate it and say, “Hey, I would love to be a subscriber—or I would love to be a provider—for Blue Cross Blue Shield.” And it’s way different 23 years ago than it is now. Now that would not fly for sure. But I talked to some people on the phone, and they said, “Yep, you can—we’ll backdate it, and maybe we’ll pay you.” Some of them paid; some of them didn’t.

But that process was six months where I didn’t get paid a dime from the insurance companies. So, I would work at the hospital on the weekends, I would pick up shifts at other places, just to, like, make some kind of money before that money came in. But to go back to the question you asked 20 minutes ago, you know, “What were the struggles?” I mean, any PT that opens up a private practice—it’s a little bit different now because information is a little bit more available—but we don’t know what we’re doing.

Like, we like to treat patients; we’re good working with people. But the, like, billing and collections, the negotiation of contracts with insurance companies—we don’t know how to do that. And that’s usually kind of where we get taken advantage of. We just kind of take what we can get. But that initial one of just not knowing how to run a business, but not even knowing how physical therapy works with insurance companies, was a huge struggle.

Tim: Yeah, and I would imagine, like, sales and marketing were probably something else that you had no experience with, right? With a degree in physical therapy, I mean, they don’t teach you how to market yourself.
Travis: No. I mean, the only thing I—I mean, I had worked in physical therapy clinics before. So, I would see patients come in, and I would say, “Oh, how did you end up here?” “Well, my doctor sent me.” “Okay, well, there must be some kind of relationship with the doctor in this PT office.”

So, I knew to go out to doctors. I actually just did this a couple of weeks ago. The first doctor I ever called on, 23 years ago, is a podiatrist. I don’t remember how I got his—I think I used to get some patients from him at my old NovaCare office; that’s how it was. His name is Brad, and he’s still a podiatrist, and still in the same location he was 23 years ago. And we were just talking—he asked me how the kids were doing, and his kids are growing up, same age as mine—and we were just kind of blown away with, like, how quickly 23 years went.

So, initially, marketing back then was, you went out and talked to physicians. At that time, physicians were kind of privately owned. There were lots of them that were privately owned. And now, in 23 years, there are almost none that are privately owned. The hospital has kind of eaten all that business up. That’s not unique to my location either—that’s pretty much across the board.

It’s rare you find physical therapy clinics that rely heavily on doctor referrals anymore because the doctors that we used to work with, they love to say, “Hey, I would love to send you, Travis, but I’m at the hospital now.” Like, they will get in trouble if you send out of the network. I remember a doctor said, “You know, just write a script, and they can go wherever they want.” He said, “I’m telling you, it doesn’t matter. If I put why the patient wanted to go to Robbins Rehab, and it says ‘patient preference,’ I’m going to get a call from administration after lunch. You can sit here and wait for me—it will happen every single time. So, I can’t even put that on there anymore.

So, that’s a whole other issue. But the marketing has changed—has changed more to, um, like direct response marketing. So, we go to the general public first. We have to educate them on, “You don’t need a prescription for physical therapy,” which is kind of a big hurdle because they just kind of assume, “Oh, I really could use some physical therapy, but I gotta go to my doctor. It takes six weeks to get into my doctor. You know what? I hope it just goes away, and maybe I don’t need to do that.” But they don’t even know you can come. Like, if you called my office today and said, “I need PT,” we would get you in today—we don’t need a prescription from the docto

So, the marketing has changed in terms of how we used to do it. Now, before, we would do that in, like, a newspaper. Like, we would run a lot of newspaper ads. And still, in some markets, newspaper ads do work because my demographic—typically, you know, 55 and older—still reads the newspaper, if they exist in your community. But a lot of it now has gone to digital marketing.

So, I don’t know—I mean, I know basic metrics and numbers, like—but I don’t know how to create a Facebook ad or an Instagram ad. We lean on experts to do that in our industry. Yep. So, we have six main buckets that we pull from in our practice. The good thing now is that I have been around for 23 years. So, we want at least 65% of our new patients that are coming in to have either come to us before or were referred by someone who came to us before.

When you’re starting out brand new—and that’s what we were talking about before we got on the call—starting out in a brand-new area, we have seven locations. You know, we tend to add on in areas that are close to where we already are because we still have a foothold in that area. We have some people—the first thing we’ll do is a zip code search. Like, “All right, how many of our past patients come from these zip codes?” “Okay, we can reach out to them. If they need physical therapy, they’ll come back because they already know, like, and trust us. They’ve come to us for PT, and we’ve fixed their problem before.”

Now, you have to be good at physical therapy. You can’t have, you know, crappy physical therapy—people aren’t going to come back. But in people that have been around as long as we have, we want a majority of our patients coming from those two buckets. That doesn’t mean it automatically comes—you still have to do some marketing to them through email newsletters. We’re doing a new thing now where we have a magazine that we’re sending out to our patients that have come to us for two or more plans of care.

So, if you come to us once, there’s a good chance that you’re going to come back. It might not be immediate, but if you come to us two or three times—or more than that—you’re probably a pretty big fan of us. So, we market to that group of people differently. So, past patient friends and family physician referrals—we do get physician referrals. Some of them will send out of the network, even though the network doesn’t like it. There are some private physicians that are left that are kind of holding on. So, we do have some of that.

Workers’ compensation—we see a small percentage of that. We would love to see more of that population, but that’s a very political bucket to pull from. You’ve got to—it’s all who you know, relationships, and contracts like that. And then, general public. So, general public is anybody that has no idea who we are, and they saw a cold ad for us and said, “Yeah, I would like to try physical therapy with you guys to try to see if you can help me with my problems.

Tim: Wow, that’s amazing. I mean, it seems like, obviously, over the past 23 years, everything evolves, and it changes a lot faster than it used to, right? So, it’s the kind of thing where you have to evolve and change almost just to keep up. And if you’re really good at it, you could be on the forefront. And, you know, I know there are some things that you’ve been involved with, like the NLP team. If you could talk a little bit about how that was developed—the NLP team—and what insights you’ve garnered or learned from that?
Travis: Yeah. So, that was in 2017. I had met some other private practice owners. Private practice owners are really, um, generally not that great at networking. Like, the first private practice owner that I met other than myself was at least 10 years after I opened up. You would think we would try to kind of get together and try to fix problems together. But there is kind of a competitive nature to that, too. It’s like, well, you know, I have a place that’s two miles from you, and, you know, I have another place that’s eight miles from another person. Like, if we get together and help each other out, I don’t know—that might be a competitive disadvantage.

But I was completely wrong on that. The more stuff you share and the more you help people, the more comes back to you. So, I started a mastermind in 2017 with other private practice owners from all over the U.S. We had met online at that time—you know, Facebook and Facebook groups and that kind of stuff were really big. So, you could meet other private practice owners from all over the country. I wish I could go back to 2003 and have shown what would happen in 2017. Like, Facebook wasn’t a thing, social media wasn’t a thing. That’s how I kind of created this company.

I met these guys, and my wife would always call them, “Oh, those are your internet friends, right?” So, these practice owners—from all over, from Tennessee, Texas, Illinois, Indiana—we got together, and we did, like, a Zoom call like this. That was around the time when Zoom was really getting popular too, to where you could do calls like this and help each other out. So, we did virtual calls. And then, eventually, we did a live in-person event in Chattanooga. We just rented an Airbnb, right around the time Airbnb was getting popular, and we just got together. We threw our numbers up on the board, and it was like the metrics that we looked at to try to find out, okay, what are things that, you know, someone is doing right and things that people need help on.

It was crazy how it was eight of us. We threw our numbers up, and we would look at statistics and ask some questions and say, “Wow, you’re doing this really well, and I don’t even look at that,” or “I don’t do that really well, and here’s where you’re struggling.” But guess what? Arand does that really well, and he speaks on how you can help that out. It accelerated our learning curve so fast. So, when we met in 2017, within about 18 months, everybody at least doubled the size of their practice, which was crazy because all of us had been doing it for a very long time.

I mean, we had one guy that was, uh—he’s our elder statesman. He’s been doing—he’s been in private practice for over 30 years. So, he has seen a lot of different stuff. So, the point of that is, if you want to accelerate your learning, you want to try to find somebody that is already where you want to get to and just kind of cheat off their paper. And guess what? When you get somewhere, you just want to try to give that back to somebody.

So, after we doubled the size of our practices pretty quickly, we were like, “You know what? This seems to be helpful. Like, it was helpful for us—can we help other private practice owners?” So, we started to, like, okay, we put together a Facebook group, and then we did some coaching and consulting—everything from Zoom calls, like one-on-one coaching calls. We do live events, so we rent out houses in Orlando, and private practice owners come down for, like, two days. We have workshops and get to work across the table with them to try to find out what’s going on in their practice.

We do in-person coaching. Like, I’ve flown to other practices and done a drop-in coaching. I watch their practice for two days, and that’s really one of the most intimate levels of it, where I can actually see what’s going on in your floor. And that has been something that has been super helpful. So, that’s what we’ve been doing since 2017, just trying to help other private practice owners. We’ll never say that we know everything, but between the eight of us, there’s probably nothing you have a problem with or have run into that at least one of us hasn’t already gone through. And then, we just tell you what to do.

So, that’s not just for physical therapy—that’s any industry. If you can find somebody that has already gone through what you’re going through, the learning curve is accelerated.
Tim: That’s amazing. So, Travis, I’ve always told my kids, and I share this a lot with my clients, “There’s no such thing as a wasted experience.” Could you sort of share some insights that you’ve received when you were working with somebody you were coaching? Maybe you were teaching them something, but you also picked up something from them?
Travis: Oh, yeah. My coaching clients—I always tell them it’s a shame you’re paying me because, like, a lot of times, I learn more from you than you learn from me. No matter who you are or what you’re doing—whatever industry you’re in—we’ll stick in physical therapy. If you went into any physical therapy clinic, there’s something that they’re doing that they usually don’t even notice that is, like, in the top 3% of any private practice that you would go into, and they just kind of don’t realize that.

In terms of specifics, it can just be specific metrics that we track. It can be, like, initial evaluation arrival rates. So, last year, we looked at initial evaluation arrival rates. Not to get too into the weeds for people that aren’t physical therapists, but every new patient that comes in, that sets up a new plan of care—they hurt their ankle, back, whatever—and they set up an appointment, we looked at what the arrival rate of that patient was. In previous years, it would always hover around 90%.

What we assumed was, “Okay, if 10 patients scheduled, nine of them came. That one patient—well, they canceled, but they probably just rescheduled to the following week, or they were on vacation, or their kid got sick, so they’re definitely rescheduling.” Well, we went back and looked at it, and this was last year, and we found out that that wasn’t happening. They canceled, but then we didn’t have any systems in place to kind of follow up with them and try to make sure, “Okay, yeah, you were sick, but we want to make sure you get scheduled back in.”

We looked at it—we’re never going to get 100%, right? Some people cancel an appointment—maybe they were hospitalized, maybe they found a place that was closer to their house, or their cousin said, “Oh, you should go to my physical therapist. Don’t go there—cancel that appointment.” We looked at that. We don’t have a super large practice, but if we could turn that number from 90% to 94%—so not a huge jump, just like some other systems—we ran the numbers. How much money do you think that cost us in 2023? How much money do you think we lost by not getting that number from 90% to 94%?
Tim: I know I’m putting you on the spot here, Tim.
Tim: Yeah, I’m going to say it might have cost you 10%.
Travis: Yeah, it’s a quarter of a million dollars

Travis: So, a quarter of a million dollars that could have been in our bank account—not to get to 100%, that’s not realistic, that’s just not going to happen—but to move from 90% to 94%. And I got that from a client. I was looking at their numbers, like, “What is this?” And they said, “Oh, yeah, we keep track of our initial evaluation arrival rate. We’re really big on that.” And I thought, “Is that really important?”

You know, when it comes to metrics, there are people that love to dig into it. And, like, Arlan and Kevin have so many numbers on their wall, it looks like the New York Stock Exchange. That’s great for some people. Some people just need a more condensed version of it. For me, when I coach, I’m like, “We want to have the most important ones.” So, if I can get your most important metrics down to, like, 10 that you look at—which would be difficult—that’s better than having 100.

Sometimes, with me and my brain, I just get overwhelmed by too many numbers. So, that was a statistic I just wasn’t looking at because I didn’t see—I didn’t think there was any value in it until I went back and actually ran the numbers at our annual offsite meeting. We take our leadership team and go to, typically, the Poconos for, like, three days, and we’re like, “Okay, what are we going to work on and try to improve this year in our practice?” We looked at that number, and we improved it to 94% this year, which was exciting.
Tim: Wow. Good for you. That’s a milestone, for sure.

Tim: You know, when you think about, “The riches are in the niches,” they say, right? So, just these little details that, if you follow and track and work on improving, could add significant value on an overall basis to your business.
Travis: Yeah. Physical therapy—typically, physical therapists are very subjective when it comes to the business side of stuff, which is kind of funny. Because whenever you go into physical therapy, there are two main sections of an initial evaluation—a daily visit. Whenever you go to a physical therapist, there’s going to be a subjective version of what went on.

So, you’re going to ask the patient, “How are you feeling today?” That’s hard to quantify, you know? It’s like, “I’m feeling better than before.” “I’m feeling at, like, 96.5% of what I should be.” Like, it’s very hard to do. There’s a subjective version, and then there’s an objective version. The objective version is range of motion, muscle strength testing, special tests. So, it’s things that we have to put together to kind of present a case to the insurance company: “This person needs physical therapy.”

Objectively, something I can measure that is standardized—that’s an issue that’s happening. That, in theory, is creating their subjective complaints. If we can fix the objective things that are going on, their subjective complaints—which is the reason they’re coming in—will improve. No one comes into physical therapy and says, “I don’t have any pain or anything. I was just looking to improve my range of motion.” Like, nobody does that.

Travis: So, it has to be this system where we kind of have to defend to the insurance company, “Hey, you should pay for this because we feel like they need it.” It’s the same thing on the business side—there’s a very subjective side of business. I remember evaluating physical therapists. I’ll give you a quick story. Our Allentown location—it’s always been our first location, so it’s always been our biggest and most productive, most profitable. There are a lot of different reasons for that.

But there was a time when all of our numbers dipped—this was way before 2017, when I met these guys and they taught me everything I know. We had a new PTA that started, and I said, “Huh, maybe it has something to do with that PTA—new clinician.” So, I talked to the patients that were seeing the clinician, and I said, “Hey, how’s this—I’m not going to say his name—but how’s this new clinician doing?” I didn’t hear anything like, “Oh my God, he’s terrible, it’s awful.” They were just kind of like, “Yeah, he’s a nice guy, and he’s pretty good.” I didn’t hear anything subjectively from my patients that suggested there was a problem.

I didn’t have any objective measures to try to find out, “Is this a good PTA or not?” That’s where the systems we have in place now come in. The number one metric we look at is successful graduation. Successful graduation is: if you come to me for an initial evaluation for a plan of care—you hurt your back—we set up your goals at the beginning of the treatment. We say, “Okay, these are your goals.” Typical goals would be: “I’ve got to return to work and be on my feet for 10-hour shifts, five days a week.” That’s a very objective thing—“I’ve got to be able to do that without any pain.”

Travis: “Great, that’s one goal. What do you like to do outside of work?” “Well, I used to hike, and I don’t really do that anymore because of my back pain.” “Okay, how far did you hike?” “I don’t know, like two or three miles.” “How many times a week?” “Three times a week.” “So, if you could hike three miles three times a week, you’d be happy?” “Oh my God, that would be amazing.” That’s what you want to hear from a patient when you set up the goals.

They start a plan of care. They go through however many visits it takes to hit their goals. They hit their goals, and there’s agreement on both sides of the table: “Physical therapy really helped me out.” What do you think the national average is in outpatient physical therapy for graduation rate? They call it discharge rate—I don’t like the word “discharge.” That’s another podcast, probably. But essentially, it’s the success percentage of physical therapy.

Tim: I’m going to guess low, like probably 60%.
Travis: Yeah, so 11%.
Tim: Eleven?
Travis: One-one. Eleven percent. That’s my industry’s success rate. We average above 85%. We shoot for 80%. We have one clinic that’s at 92% this year—that’s going to be our record.

Tim: Well, Travis, it’s been—it’s amazing how fast time has gone by. It’s almost an hour. I really appreciate your time. Any parting shots for our audience?
Travis: Yeah, I would just talk to people about the power of coaching. If I could do anything over again, I would get coaching sooner. I would ask for help. A lot of people have a hard time asking for help. The faster you realize that, the better you’ll sleep at night.
Tim: Awesome. Thank you so much, Travis Robbins, Robbins Rehabilitation West.