E740 | Growing From 10K To 100K A Month With Jeremy Dupont

In this episode, we dive deep into the transformative journey of growing a cash-based physical therapy practice, scaling from $10,000 to an impressive $100,000 in monthly revenue. Join us as we explore the challenges, strategies, and mindset shifts necessary for success in this competitive industry. Whether you're just starting out or looking to scale your existing practice, this discussion is packed with valuable insights.

Key Segments:

1. The 0-$10K Phase: Facing the Challenges

The episode kicks off by addressing the initial hurdles that new practice owners face. We discuss the importance of learning sales and marketing techniques, breaking free from the mindset of waiting for patients to come to you. The speakers emphasize the need for confidence and a scrappy, proactive approach to build a sustainable practice.

2. Transitioning to $50K: Building a Foundation

As practices begin to grow, the conversation shifts to the critical phase of hiring the first staff member and managing a denser schedule. We explore how developing a continuity-based care model can lead to better patient retention and why transitioning from a clinician role to a sales and marketing leader is essential for growth.

3. Scaling from $50K to $100K: Data-Driven Decisions

The discussion progresses to strategies for leveraging data and metrics to inform business decisions. Our hosts highlight the importance of digital marketing and the necessity of delegating clinical operations to trusted staff, allowing practice owners to focus on strategic growth.

4. Key Strategies for Scaling

We share key strategies for building a strong brand and culture that attracts top talent, along with implementing systems and processes to ensure operational efficiency. Balancing attention to detail with empowering staff members is crucial for sustainable growth.

5. Focusing on Lifetime Value

The episode emphasizes the importance of shifting focus from immediate revenue to long-term patient relationships. Understanding and optimizing the lifetime value of each patient can justify increased marketing expenditures and drive long-term success.

6. Leveraging Technology and Data

We highlight the necessity of adopting a robust Customer Relationship Management (CRM) system to track key metrics and automating administrative tasks. With the right data-driven insights, practice owners can make informed decisions that propel growth.

7. Transitioning to Leadership

Finally, we discuss the transition from day-to-day clinical responsibilities to a strategic leadership role. Effective communication, feedback mechanisms, and empowering staff are vital components of building a thriving practice.

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Podcast Transcript

Danny: [00:00:00] Hey, real quick, if you're serious about starting or growing your cash based practice, I want to formally invite you to go to Facebook and join our PT entrepreneurs Facebook group. This is a group of over 6, 000 providers all over the country. And it's a pretty amazing place to start to get involved in the conversation.

Hope to see you there soon. Hey, are you a physical therapist looking to leverage your skillset in a way that helps you create time and financial freedom for yourself and your family? If so, you're in the right spot. My name is Danny Matei and over the last 15 years, I've done pretty much everything you can in the profession.

I've been a staff PT. I've been an active duty military officer, physical therapist. I've started my own cash practice. I've sold that cash practice. And today my company physical therapy business helped over a thousand clinicians start growing scale their own cash practices. So if this sounds like something you want to do, listen up, cause I'm here to help you.

Hey, what's going on? Doc. Danny here with the PT entrepreneur podcast. And today we're back again with our friend, Jeremy DuPont owner of ripple. Which is a cash based practice in the [00:01:00] Boston area, as well as Patch, which is a digital marketing company that helps cash based practices and hybrid practices scale with paid ads and tracking effectively and making sure that you're making the right marketing decisions not just paid, but also, you Internally marking to your own people as well to really help grow lifetime value with your clients.

One thing that, we were chatting about the other day and I thought would be an interesting conversation to share with everybody was this path from a hundred from 10 K a month to a hundred K a month, which in a cash based practice is not a ton of people have done that.

It's definitely, there's more and more people that are doing that across the country, but we see a lot of people get stuck in between there. And if you grow to a business that's doing 50 million or 50, 000 in revenue on a monthly basis, like that can be a great business to own.

But really to be able to scale up, there's a few things that. You really have to do. And for us, we get a chance to uncover the secret of that, the, the breadcrumb trail of how to get there from Jeremy. And, he's fortunate enough to say yes, to want to share that with everyone else.

So Jeremy, I appreciate [00:02:00] your time. I know you're a very busy guy. Yeah,

Jeremy: no, I'm this is these are a lot of the conversations I have with like patch like potential patch members as well. Like, how do we get from this sole provider maybe of one part time PT to I think a lot of clinic owners have the goal of, a couple staff members because that's going to give them the time flexibility, the location flexibility, you can treat as much as you want to.

I think it's good. And I think there's, there's loads of lessons, especially like from different revenue ranges as well. Like you've got to change what your role is at the clinic as you continue to grow and scale. And I think, we'll obviously talk about it, but I think that's one of the biggest things that I was able to do was, change who I was as we continue to grow.

And I think it's a lot of, things that clinic owners don't realize they have to do, but they're just super important.

Danny: Yeah. Yeah. And I, and we spent a lot of time talking about the start in a lot of ways because it's so hard. And I just think that's this, that's the phase that really rules people out.

It's going to it [00:03:00] will let you know whether you have what it takes to go past that. If you are unable to get to a 10, 000 a month, you're unable to go full time within your own practice and you're really never going to be able to scale it any, anywhere past that.

And. The biggest things for that stage, which we'll quickly just touch on, and we're going to move on, because I really want to talk from like 10 to 50 and 50 to a hundred is you gotta just learn how to sell. You gotta learn how to market. You gotta get out of your office. You gotta be okay with people turning you down and you gotta get scrappy.

Like you just, like the people that I see that really struggle in this sort of this phase from zero to 10 are people that are they, Just sitting in their office, hoping somebody is going to come in. They they undervalue themselves. They really lack their confidence to be able to try to start a business.

And unfortunately there's definitely people that just don't want to work for a high volume clinic. They decide, I think I can make a cash practice work and they completely underestimate just how challenging that is. I think you gotta get super scrappy. You gotta be okay with people turning you down.

And you got to learn how to sell you don't know how to sell [00:04:00] yourself where you can learn how to sell your practice to employees and or to other people that are going to come into work for you. So I don't know anything you want to add to that, like phase quickly burned through it, even though it is very

Jeremy: hard stage to get through.

That's exactly like what my thoughts are on it too. And thinking back, this is a couple of years ago now, but And even in the bigger stages as well, definitely less, but I was taking discovery calls on a Saturday morning. I had somebody book, like I might've been at a brewery or something like that.

It's I'm going to take this discovery call really quickly because that's just like leads were gold at that time. Like we needed, I had hired a couple of PTs. We're trying to get things as busy as possible. So like that scrappiness, there's a, like it's the correct way to describe it.

I think again, just having total open flexibility on a discovery call. If somebody fills out a form, you're following up with that person immediately. There's no 24 hours, 72 hours when you're reaching out to new patients and you're just, you're on 24 seven. And eventually you can get past that, but in those beginning stages, it's just, what you've got to be, especially you're bringing on this [00:05:00] first hire.

It's like, how am I going to get this? person's schedule full. It's again you know what you said as well you've got to learn how to sell. That's one of the biggest things. I think that's the biggest growth lever that we had is I removed myself from like the clinical side of things.

I stopped really treating except for the core, like 10 people that I've been seeing for years. And I looked at my role as I'm the sale. I'm ahead of sales for our clinic. I'm going out. I'm doing all the local relationships. I'm taking every discovery call anytime somebody, downloads an ebook or they fill out a form on our website or anything along those lines.

I'm following up with them not just one time, but like almost embarrassingly. So I'm constantly following up these people. And I think that's just the mindset you have to have, especially at those beginning stages.

Danny: Yeah, it's been, it was interesting for me to watch from the vantage point that I had, because, having a chance to work with ripple early on through PT biz, it was interesting to see you're somebody that obviously was a good [00:06:00] clinician, but seemed to lean more towards the business owner angle of it than the clinician side. And when this is the difference that I see with a lot of people, many people that we have a chance to work with a really loud people that go into this variation of a business, they're fantastic.

Clinicians, they're amazing clinicians and they just want to be able to use their clinical skillset in a manner. That's like very pure with, with a patient, not dealing with insurance, having the time to do the things they want to do, having the time to educate people. And they love that.

I would actually let myself into that category over the business side. Like I was far more of a clinician. Like I, that's all I wanted. I wanted to function in an ideal clinical situation. That's what I wanted. And eventually I it took me a very long time to uproot myself. From that, because it's what I focus on is what I was good at.

But for the health of the business, it's not where you need to stay. And you moved away from that fast and moved more towards, running the business. And I think that if anybody's listening to this, if you want faster progress, that's basically what you have to do. You have to hire great clinicians and become a great business owner.

And most of us [00:07:00] get stuck with, I just want to treat patients. I love to treat patients. And that's totally fine. Because if you want to build a business that allows you to do that, And you bring on some other people. You can totally do that. You can still treat at a high level of, in terms of your hours of the week, but you're really going to sacrifice long term growth speed in particular by doing so, because you're somewhat, you're not someone you're the bottleneck of your business because.

No one else is going to do the business side. You can't hire somebody to do that. If you partner with somebody, yeah, you could probably do that. They'd have to be some very forward facing business owner. But in that case, why would they not just do their own thing? That's a very difficult person to find.

For you giving that up, like what was the time domain for you to where, cause you were super, you were busy, like your schedule is busy. And then to go from my schedule is maxed out to I'm treating like 10 people, how long did it take for you to get to that point?

Jeremy: Yeah, it was pretty quick.

As soon as I hired my first PT, which was a few months into when I like, I signed the lease on my standalone space. And they were in the [00:08:00] door, a couple of months after that. And I think that's immediately where my mindset shifted. It was like, I'm responsible for this person now.

Like I need to make sure that they have patients, they have an awesome experience here and, we've got to figure out how to get new people in the door here. So I think my brain switched. Pretty much immediately there. And then we were lucky enough. We hired somebody else very quickly after that first PT hire too.

So I really had to, if I want to fill two people's schedules, then I've got to lean into, that's where I started really diving into the sales and marketing side of things. So I was, six months into the standalone space. I started to make that switch. And I think it's just that's the most important thing in the 10 to 50 range as well of revenue per month is, I see it.

A lot of clinics get stuck in they their staff, BTS have a, maybe not a poor experience, but not like a stellar experience. So they're sticking around and they're on this wheel of, I had this part time person they're leaving. I've got to find somebody else.

And [00:09:00] I think, everybody knows right now. It's impossible to hire right now. It's very hard. So making sure that you don't have churn for your staff is crucial to getting past that 50 K mark. If you can get people to stick around. It's like a cheat code because then you can continue building on that.

But if you have to find and replace people every six months, it becomes very hard.

Danny: Okay what's your secret sauce to keeping people around? Because I feel like you, you have done a good job of that. I feel like we did a good job of that at our clinic as well. And that did allow us to really grow faster.

And people are going to, people are going to turn over to get a better job option. Maybe they're moving, whatever. Just people that are like disgruntled and they leave because you've done something wrong. That's very frustrating. So what would you say like the, the key success that you found with staff, happiness, retention, all of that were at Ripple?

Jeremy: Culture was the biggest thing. That was what I wanted from the jump to is, I'm a very laid back casual person, but, fairly intense when it comes to the actual business side of things and like the product that we're putting out there. So that's like the culture that I wanted to build within Ripple, but [00:10:00] I made sure this is, this was not like my bag at all.

This is not what I like to do, but I was lucky enough, like the first staff clinician that I hired. She loved the clinical education side of things and all the staff that we brought on board also loved that. So they got a lot of their like career growth without actually like being promoted within the company.

They do twice a week clinical education meetings once a month. We do a team outing that stuff is so important, especially again. And I think for PT's brains that focus on education and growth as a clinician for staff is super important. And so we implemented that. Almost right off the bat and our staff loves it.

So I think something along those lines has to be included in what you're doing. If you're just, people are coming in, they're seeing their 20 patients a week, and then they're leaving. That's where people can start to look for other options.

Danny: Yeah, that's a great point, man. I think that the mistake that a lot of people make.

Is the first hire in particular, what happens is you're already time poor [00:11:00] and now you're even more time poor. When you bring somebody on, you, you have this period of time where it really sucks. You're working so hard to build scheduled density in your own schedule.

And then all of a sudden you're at a point where you can't see anybody more, you're close to it and you need to hire. So you got to go through this whole process to find that person. Then you have to interview them and then, figure out the comp model of what you're going to offer them.

Then you have to train them, not just train them clinically of what you want them to do, which maybe if somebody is more seasoned or not, but either way, you have to train them on the processes and the culture of your actual clinic and how you want things done. And it is. The most time poor you're ever going to be like, I think that one stage is actually the, is the hardest in my opinion just because of the lack of time that you have, and you're already really been redlining it for a while.

And to have that person then leave is really frustrating. Oftentimes though, it's because once you get them to a point where they are at least somewhat self sufficient. You want to take a breather and you're like, shit, man just, I don't want to deal with anything. You go do your thing over here.

I'm [00:12:00] going to do mine. Let's get into a little groove of that. And then if you do that for too long, then, you basically have just left them on their own. There's no mentorship. There's no checking in. There's no followup. There's no culture that you're developing. If you do that. They're going to get frustrated.

That's absolutely going to be the case. And that is what I see more often than not is what clinicians are doing. Not necessarily. They're trying to do that. They just are tired, man. They're just like, they've done a lot, and they don't realize that you have to keep doing more.

And if you don't, then you're going to have staff

Jeremy: turnover. Yeah. I think a lot of what we did is just like understanding, the people that are frustrated with maybe their in network job. It's what weren't they getting at that in network job? How do we make sure that we do that here at Ripple?

And again, I think that's a lot of what I hear from PTs that are working at an in network practice is. There's no career growth there. You're just in there. You're clocking in, clocking out, seeing your patients, doing your documentation. There's no like team culture at all with any of that.

There's, maybe there's a couple of staff meetings, but it's around productivity versus [00:13:00] being a good physical therapist. And so I think we took that and just flipped it on its head and say, like, all right, what are we going to do? And how are we going to do this a little bit differently?

And I think it works quite well for us.

Danny: Yeah. Yeah. The culture is key, right? Like culture, you can, it's one of those sort of things. Everybody knows what a good culture and bad culture feels like, but it's hard to define. I do think clinical excellence is, it needs to be a core tenant of what people are doing.

You do have to talk about the business side, right? You have to be able to have conversations about people committing to a plan of care or how to write a homework email, how to actually like. Interact with somebody, how to use someone's name whenever they come into your clinic, little things like that, where you show communication, a little, like the little details across entire business.

And I love this quote, Walt Disney has his quote whenever he started first day opening Disneyland. And somebody asked him, like, how did you engineer magic into this place? And he says, there's no magic and magic. It's all in the details. That's, I think about that all the time because of just like how accurate that is.

And not just him, but how many [00:14:00] other. Successful entrepreneurs have a very similar view of services, products, like everything. And if you are not focused on those details across the board with everybody, then you don't develop a brand, which I think is actually a really important thing to do as you're building your business.

And that goes hand in hand with your culture because your brand and your culture Your brand is the external visibility of what the culture is. The culture is the internal what's happening on a day to day basis and what you're developing. And people want to be a part of a, like a high level team.

They don't want to just, check in, check out, not necessarily that you want them to do a bunch of stuff in weird hours. You don't want to do that. But you do want them to have a standard. You want people that are held to a standard. They want to know where they function, but let them, be independent within that and not micromanage them.

All of those things are a hard thing. They're hard things to actually piece together and to figure out. So what would you say, like the defining characteristics of a strong culture are to you and what you tried to engineer in particular into ripple? [00:15:00] Yeah,

Jeremy: I took a lot from like other service space industries, to be totally honest with you.

I looked at like a good restaurant, like how does a good restaurant like function and what is that like that high level service. And we pull a lot from that book you talked about, be our guest. It's all about like the Disney experience. And I think that like culture and brand really go hand in hand with all of that stuff.

What is the, What does the PT clinic look like when we walk in? What does it look like when we walk out? That's, part of our culture. What does it smell like when we walk in? How are you greeting somebody when they walk in the door? What is the, we talk like we don't have patients.

We have guests, everybody's a guest at ripple and we're trying to give them the best experience that they deserve. They can have. So we really leaned into that. It was funny. One of our quarterly meetings that we had, this might've been a year ago now, but I showed like a clip from the bear, the TV show.

And it was like the upfront that they had there. And it was all about It's the details that matter. And if the fork is here and not in the right spot, then people are going to notice that we need to be, we [00:16:00] need to be happy and kind, but we need to also be on our shit as well and have everything dialed in.

And I think I think we can pull a lot from that. And that's how I look at, again, like service based businesses. They're all, functionally they're the same. So if we can pull from what works really well over there and implement it into what we're doing, it's. It's again, like our culture is, it's fun, it's casual, it's easy going, but we're also providing the best service in Boston.

And I'll believe that. And again, if you can if that's your, those are your core values that's built into your culture, that's how you're going to get people to stick around as well. They're going to buy into that mission. And it's just so important.

Danny: Dude, I love pulling stuff from the service industry in particular, the restaurant world because of how hard it is to run those businesses.

Like it's so hard. There's a great there's another great book called setting the table. Danny Myers, the guy that he has a number of restaurants in New York city and I believe he does shake shack as well. But one of my buddies in a, I'm in a, I'm in a poker group. [00:17:00] We play like once a month.

And one of my, one of the guys that's in this group, he actually has a couple like Michelin designated restaurants in Atlanta, not like the Michelin star, but less fancy restaurants that have some variation of a designation. I don't actually know all about it, but all I know is I go in his places and he is like a Jewish deli restaurant here in Atlanta.

And it is, everything is so like perfectly laid out. All the staff looks. Like similar the way in which they communicate. I just like to sit there and watch how they do like a form of of management of the room that is group based it's like teamwork based. And and it's so fascinating because you don't really know, who your waiter is, but then there's all these other people like doing little things, picking things up that, that it's not their job necessarily.

They just know that if it's out of place, they do it right. And that is a really interesting, very difficult culture to to engineer. And also incredibly, you think it's hard to hire a physical therapist, try to hire people for kitchen staff, wait staff and retain them. It's such a hard business to run.

So when, anytime I get [00:18:00] a chance to chat with him about how they run things and the things that they're doing, it's you can take little pieces of customer experience or culture that you see or things that you like in other businesses and you can apply them to your own business because it's your culture to define, right?

It doesn't have to be that, but I like that because of just how challenging those industries are. And they're very forward facing. They're very service business like ours is as well. We're just having a different product, right? A different service, but. I think for the average person, if there's a yoga studio you like, or a gym, or if there's a restaurant or anything, you can just use that as a way of modeling things that you want to do within your own business.

And it does take time to think through that. Like it takes time. It takes effort, but it doesn't really take a ton of money. That's the thing this isn't the thing that's going to cost you a ton of money, but it's going to take a lot of mental bandwidth. Time and creativity. And you have to really think about what you want because you can't have somebody, I can't come in and define your culture for you.

It's just, it doesn't work that way. It happens on a day to day basis. But I would say from what you're saying, from a retention standpoint, from 10 to 50, if you keep having [00:19:00] people drop off, it's you're trying to run up a hill and somebody just tripping you, every couple of steps, and then you fall back to the bottom and then you get frustrated and you keep going.

And it feels like it never stops if you have that consistent

Jeremy: turnover. Yeah, a hundred percent. And that's, I think that's the biggest thing, like within the, that 10 to 50 ranges, if you have happy staff, you're able to like, just ruthlessly follow up with your local market and any new leads that are coming in the door, two or three providers can get you to, to that point like pretty easily and removing yourself from that.

If you have an awesome culture, you're, providing some sort of clinical growth within the company. And it's just like an overall awesome experience getting to that 50 K mark. Like those are the big things. And then I think you, you start talking about, growing past that.

It's, Leadership starts to come into play and there's a lot of other factors, but getting to that 50 K mark it's really about finding the right people, making sure that they're super happy [00:20:00] and they're feeling fulfilled. You have a dialed in brand and culture and this local presence within the community.

And you're, you're selling all at all times and you're making yourself available. Those are the most important things at those beginning stages.

Danny: What about building someone else's schedule? So I find that the sticking point for a lot of people is they bring a staff member on maybe even when they have a second staff member but what happens is let's say that first staff member, they have a busy schedule, but it's not enough for two schedules, so they have some overflow.

But that overflow is, let's call it 20 percent of their schedule, make 25%. And what they started to do is divert patients, new patients to the new staff member and away from themselves, which is logically the right thing to do. No doubt about that. But what happens is they have no change in lead generation.

They have no increase in, in volume and they eventually just divert. Basically [00:21:00] 1. 2 schedule density over to two people. And they're paying for this other person to fulfill when it puts them in a really low profitability stage. And for a lot of people, like this is going to happen to some degree for a period of time, obviously, but getting them from.

25 percent of a schedule to 85 percent of a schedule aside from obviously delivering a great product and service. What things really helped you get over the hump to get that first and that second person schedule to the point where they were actually like seeing a lot of folks and very profitable.

Hey, sorry to interrupt the podcast, but I have a huge favor to ask of you. If you are a long time listener or a new listener and you're finding value in this podcast, please head over to iTunes or Spotify or wherever you listen to the podcast. And please leave a rating and review. This is actually. Very helpful for us to get this podcast in front of more clinicians and really help them develop time and financial freedom.

So if you do that, I would greatly appreciate it. Now back to the podcast.

Jeremy: Yeah, there's a couple of different ways to look at that. I think the most important [00:22:00] thing, if you're bringing on this, like second provider is making sure that you're your first staff PT, they have to have the continuity portion of their like caseload dialed in.

If they're just seeing people for an evaluation, they're taking them through a 10 pack of sessions and then everybody's churning from there. Like it's going to be very hard to fill that second person schedule because you're going to be feeding two mouths in. They're both starting from zero technically so before you bring in, that's again, it gets back to like ripples culture and like the mantra of we have is people aren't in here for.

8 or 10 sessions. We're here to change people's lives, and if you don't buy into that philosophy, then you're just not a good fit for what we're trying to do here, which is obviously totally fine. But that's a really big part again of our hiring process. So we make sure that. People buy into that thought process of I would rather see somebody for six months versus three months because yes, I'm going to get them out of pain and back to what they want to do.

But how do [00:23:00] we make their lives better? And how do we get them to this bigger goal that they never thought was possible? That's where the continuity piece comes into play. And if you can get your staff members to buy in on that, all of a sudden they might need 12 a month to stay full. They go down to needing five or six evals to be full and that's again.

That's just a math game there that becomes a lot easier to bring a second provider on. So I think that's the number one thing. And that's what I talk about with all of our clinic owners inside a patch when they're trying to grow and scale is you got to make sure you have this continuity piece dialed in.

Then you get into the marketing side of things. This is where ads come into play. This is where email marketing is super important. This is where, making sure you're not only doing workshops, but you're converting people on the workshop side of things, there's the, the whole box of marketing starts to open up there and you need to start using those tools and looking at ad spend as an investment versus, Oh, this is another thousand bucks that is just going on my P and L [00:24:00] as a liability.

Cause if you can change your mindset on that, that makes everything a lot easier. So I would say those are the two most important things.

Danny: Yeah, it's funny. You talk about ads as a liability, but we actually have a metric where we, if we are not spending enough money on ads it's a, we actually track that it's a negative thing for our KPIs because we know that, where we're at it, we have a certain KPI threshold as far as ROI is concerned.

And if we're hitting that, then we want to get up to a point where we find equilibrium, where it starts to basically flatten out. If you're thinking about this with ads, let's say you're spending $500 a month on ads, but we're seeing a return on investment that is at or above where we want to be, that means we have room to grow.

So maybe what you need to do is bump that up, not maybe what you need to do is bump that up to a thousand, bump that up to 1500, 2000, maybe 3000, and you won't know until you start to hit those thresholds. But it scares people because they think of it like buying a scratch off ticket, and it's not. You know what it is it's.

As long as you're tracking it, it's intentional marketing that you're investing into your [00:25:00] business to then drive a increase in revenue on the return through the services that you render. And that's where people get a little sketched out. And especially after a month I hear this and there's I tried this and it didn't work.

And if I really dig into it, it's Hey, you haven't tracked anything you also, you didn't even give it enough time to see, what your messaging should be, the threshold, or maybe you don't even know what you're doing. Which is where somebody like a patch fits really well, where they can just do it on your behalf.

But. The marketing side is huge. And especially on the growth side, I think it's very hard to grow purely organically without any sort of digital ads past that 50, 000 a month. I think you're getting to that for sure. You can do that. Just off of a really good local marketing and workshops, referral, relationships, all that, and delivering a great service.

But what you said, I think is the most important thing is the continuity side, because. And dude, I can speak to this. I had months where like we had a year where we had over 500 new patients. It was like 550 new patients. And it was me and one other full time physical therapist. And by the end of the year, we'd [00:26:00] actually hired a third person.

But you're talking. 40 plus new visits per month. And we were just, we had no continuity offer in place. And what a huge failure that was because we were playing this super hard game of just constantly trying to just get more. We're like, okay, now we've got to get 70 new patients this month, right?

Like, how are we going to do that? And just trying to get 40 to 50 in a cash based practice is really hard. You have to be really down in your marketing. You have to have multiple channels and you have to invest a lot into it. And. Once we flip to where we were doing more continuity based work, where it was like, okay, what else can we help people solve?

Like our PTs want to do this work. We're just not actually bringing it up. All of a sudden we went from needing, yeah, 12 new evals to down to six and they're, they were happier because these recurring visits are, They're easier for easier to fulfill. They're less challenging on your brain.

They're less challenging on documentation. And they get to really develop a long term health and wellness relationship with people that a lot of them really so with continuity being said, what's your benchmark that you want to see patch not patch, but ripple be [00:27:00] at as far as recurring revenue services, what percentage of actual visits do you want to be at?

Jeremy: We look and I think we're a little higher than the standard clinic because we've been doing this for a couple of years now, and it's really built into what we do. 50 percent is where we want to be with that. I think, for benchmarks for other clinic owners, 30 to 40 percent is probably the range to shoot for.

But with the goal of eventually getting to that 50 percent mark, and that's where like your business systems start to come into play. If you don't have a formalized continuity offer, it makes it really hard to sell that. And that's a big part of our onboarding process too, is like, how do you. How do you sell this second package that you've already made one sale?

What does that look like when you get to this three month mark with patients? We have offers where, you know, we, someone can continue on with us once a week. If they want to continue on with us, they can come in twice a month or they can come in once a month and having those options makes that sale a lot easier for people.

Because if someone might've been on the fence, maybe I'll stick all, I'm going to continue on [00:28:00] once a month instead. And then maybe we can get them in a little bit more over time. Or they come in once a month and it's, an awesome service and they have that touch point with you. But we see most people continue on a twice a month rate and we used to do just a once a month ongoing, or just continue to sell packages and our visits just from that little swish there.

Increased a fair amount just by offering twice a month versus once a month. Because a lot of people that in the past bought the one time a month, they probably would have bought twice a month or once a week moving forward. We just didn't have that option for them. I think like systemizing that and making sure you have an actual process in place is probably the most important thing.

Danny: Yeah. How do you like to anchor that with pricing with continuity for, so let's say like once a month is equivalent to, let's say someone does a 10, 10 package of visits and the price point is 50. 200 bucks per visit or something like that, right? As you're anchoring continuity, do you prefer let's let's decrease The price point because we're shooting for volume for [00:29:00] density purposes Is it going to be equivalent to what the package price was at?

What have you seen from a pricing standpoint that might be best practice you could share?

Jeremy: So the way I look at it is, I want everybody on the initial package to buy a 15 pack with us. The way that breaks down is we do three monthly payments. You're buying five sessions at a time.

That's about a thousand dollars a month. So a little bit over 200 bucks in that ballpark. So they fulfill their, we kind of building ourselves as overhead in these people's budget for three months at a thousand dollars. They finish up their 15 sessions in 12 or 13 weeks.

And when we go to sell the continuity, if they've been coming in on a once a week basis, if they're going to continue with us on a once a week basis, it's actually the price point is 10 cheaper than what they were paying before. So just like sales psychology wise for people, they're like, Oh, I'm going from a thousand bucks a month.

I'm saving 10 bucks a session. It's only 600 a month. In their brain, now they're saving money. [00:30:00] So it makes that sale a lot easier. And we do that with all of our packages. So our continuity rate is call it 10 percent cheaper than what our actual package rates are, and that just makes converting them that much easier.

And there's no cost to acquire that person either. So I'm happy to take a little bit of a haircut on that because I've already got them in the door. Chances are, if they're with us for six months. They're having an awesome experience. They're going to start sending their friends our way. We want people to stick around for longer than three months for those reasons, because that's, we're going to be able to give them a better product, a better service.

And then they're going to start referring everybody. They're going to, this is going to be the best hour of their week. It's, it just makes everybody's lives a lot easier. So yeah, I think anchoring that, that continuity is a little bit cheaper is just such an easy way to go. Yeah. And also

Danny: the downsell, side of it is powerful.

Just thinking like continuity for people, it's so important and being able to position this correctly [00:31:00] can make a massive difference, especially in that schedule density that we're talking about. I think it's so helpful. The other thing too that you're spot on about is a big shift I see for people when they go from 10 to 50 and then 50 to a hundred in terms of, monthly revenue, a hundred thousand dollars is what we're referencing, right?

So between 50,000 and a hundred thousand, I see a shift in the business owners that goes that from focusing on the front end to focusing on lifetime value. And and what that allows is, let's say you say, okay, front end plan of care is worth $3,000 to our practice, but we know that. 50 percent of people are going to stick around for X number of months.

And this can be really hard whenever you're first getting started. Cause you may not actually know what your lifetime value is. There's actually no way to know because you haven't had your business long enough, but as you get more time under your belt, you get more data under your belt. You start to be able to calculate that.

And if one of two people is going to stick around for an additional, let's call it year this, they're going to work on some other sort of performance based things. Whatever it might be, all of a sudden you've basically like four X, your lifetime [00:32:00] value with that person or really doubled the total lifetime value.

If you include the people that don't come back in for a follow up. So what I'm getting at is, instead of just saying, okay, we, this is worth 3, 000. If you focus on the backend, it's worth six. So now when I go to market. I have a different number that I get a chance to compare that to. So if I want to say, all right, I'm going to spend 3, 000 on ads and it's going to cost me a hundred dollars to get somebody in the door, you might balk at that if okay, maybe it's.

Only, 3000 our lifetime value. Even then that's still like an amazing ROI, but but if you know that six, all of a sudden you're like, whoa, okay, I can spend more and we can spend more than everybody else around you because you have a bigger lifetime value. You get to win the game more because you, if you can advertise more, whoever's out there, more advertising, whoever can.

Pay more to acquire somebody and afford to do they're going to get more visibility. They're going to get more reps in front of people. And in the long run, they're going to end up with more volume. That's just basically the math behind it. So the shift from front end to lifetime value, like [00:33:00] what was that transition like for you and what would you say were some of the things you really had to get in place to be able to focus more on that?

Jeremy: Yeah, I think, just starting to understand that and it's one of those light bulb moments when you start to think about, especially at ripple, like our lifetime value is infinite basically, because people just don't leave, which obviously is it's awesome. But, when I started to realize that, and I started to get into the ad side of things and understanding what is my cost per acquisition look like?

I was a clinic owner, I started like with a 500 ads budget and I was very scared and I was very nervous to do that. But then my mindset started shifting of I'm more than happy to spend a couple thousand bucks on ads to bring more new people in the door to, try to see what does our lifetime value look like with these like non referral people?

Luckily for us, it stayed pretty much the same because we have an awesome product in place. But that's just that's the biggest mind shift. There of, once you can understand and you have those good metrics of what [00:34:00] does, how long are people sticking around for? What is the frequency they're coming in for?

How long does it take for somebody to finish a 10 pack of sessions if that's 12 weeks versus. 24 weeks. That's a very big difference in how you can actually market and invest on the ad side of things. So you just, those metrics are just so important to know, especially we're talking here now, of getting to that 50 to a hundred mark, you have to have that stuff dialed in because local marketing is going to get you to that 50 K.

But to get to 75 million run rate, 100, 000 a month, you have to start investing in ads. There's just no other way to do it. Totally agree. What do you

Danny: think about data? Because for me I pretty much probably know what you're going to say, but one of the bigger changes we made, especially within our own practice, but even with, within especially because of how digital virtual, everything is.

When we really started to invest and [00:35:00] spend time in clean, crystal clear data that like I'm talking data that is I can tell you all my KPIs in in, give me three seconds and I'll pull up exactly where everything is at and I'll let you know whether it's trending in a good way, but not negative way, whether how we're doing that month, that quarter and the year.

And. The decision making from that has been a gap, absolute game changer. I don't think people put as much of an emphasis on this as they should until they realize it's a problem. And by then they have to dig themselves out of a pretty significant hole. So what would you say, as far as data is concerned from 50 to a hundred, like how important was it?

And what did you feel like? You started to use or track or implement that really made a big difference in your ability to get clear data to make better decisions from.

Jeremy: Yeah, I was obsessed with that data. Like I, every day, every hour I was in, we use our CRM to track all of this stuff.

That was like one of the biggest shifts that we had going from, I think I [00:36:00] started investing in our CRM when we were at the 30 K mark. And so we, we've had a good amount of data inside of there. And once I figured out what all the data meant, I think that's a really important part too, of like, all right, we have all this data, but what does it mean?

So you being able to make like business decisions out of it. It's, yeah it's just so valuable understanding, especially in the sales and marketing world too. It's not one size fits all with all these things. You have to understand like, how is your clinic actually functioning and, what changes do you need to make in order to adapt to your demographic or your community and what you're seeing on your end.

That's one of the biggest things that we started to do inside of patch is like each month I go through everybody's like CRM account and I look at all of their top level KPIs. So how are you converting on the phone? Where are your leads coming from? How many leads are you getting?

What does your package conversion look like? What does conversion into continuity look like? What is your, if you're running ads, what's your, what's your cost per acquisition? What's your ROI on the ads? Because if you're. [00:37:00] Not doing that on a, at least monthly basis. But if you're doing it every six months, a year, you can have this really big problem festering and have no idea what's going on.

And then it's almost too late to dig yourself out of that hole. Or you got to do some major operation shifts in order to change those things. So I think that's one of the best things that, that I was able to do at ripple was just trial and error, different marketing and sales tactics and really getting real time feedback on is this marketing campaign working? And if it's not, we can dial in and see what exactly, what part of that isn't working, and then we'll switch it for the next campaign that we're going to do. And that's something that you've got to be super agile with those things. And that's where data comes in and play.

Yeah.

Danny: And it's just, but it's just so boring. You know what I mean? I think that's it. I think that's what gets people is they're just like I don't want to do this. It's organization of numbers and contacts and all that. And. I definitely didn't want to do that whenever I had a practice like and again, I come at this dude, I am 100 percent I consider myself a clinician when I meet people at a [00:38:00] birthday party for one of my kids friends.

I tell them I'm a physical therapist and then it gets awkward and they asked me where I treat patients and I'm like I don't really treat anymore except for in my garage for friends and family. But it's identify with that. That's the thing that I want to really get at. If it's if it came down to working on a CRM or like sitting in on a patient visit to mentor staff, I go that route all day.

Fortunately for me, I married somebody who's very data driven. She's very. And that was it was a game changer for us when we started to really let Ashley focus on implementing some technology that helped track things and create a better customer experience. So I would say if you're listening to this and you fall into the camp that I come from, which is just like clinician all day, don't really care about these other things.

Like the bigger picture is if you want your clinic to be able to help more people. You have to understand how to organize your business. And if you don't, you're, it's also very sketchy to run that business. I remember just being very stressed all the time because you just don't [00:39:00] know, and each month you look back and you're like, we did pretty good.

I guess we do more of that. It's There's not really much strategy with that. It's literally, it's very reactive. And when we started to get better visibility on things we were doing in real time, and also looking at trends of what we needed to do we started to realize, Oh crap, we don't have to do all of this stuff.

This over here is working, or this is. An area we're deficient right now, and we need to improve that. And all of a sudden we could be more specific with how we were spending their time and effort. And that is where we started to compound like crazy. And I look at it more like if you don't have visibility, you can't apply leverage.

So if you're trying to apply leverage in some way, which could be advertising, it could be people, it could be. Like where you spend your actual time with staff as well to solve problems. But if you can be more leveraged with focus that attention on like very specific things, that's where I really saw a lot of progress.

So what about you guys would leverage? So like leveraging time, leveraging other people, leveraging [00:40:00] technology, what would you say the key things that you applied leverage to that really helped you scale up to that over a hundred K a month range?

Jeremy: Yeah, the biggest part of leverage that we had in like the, the quicker growth that we were able to achieve came from like our advertising side of things.

And that's not possible, obviously, without a CRM. That's, the biggest thing is that because it's all of our data. But then, I, I spent Pretty much all of my time, learning Google ads and understanding like what is the deal with ads? Like, how does this all work? So as soon as, I started to lean into that, we could use the technology to do all of the work for us to get new leads in the door.

That was, number one for sure. I think the other part again, where I was super lucky with Ripple, where I had time to focus on those things was I leveraged my staff to lead the clinical side of things. I didn't want really anything to do with the clinical side. I didn't care about any of that stuff.

And I had, promoted my clinic director. She ran all those those Team [00:41:00] meetings that we do on a twice a week basis. And, she ran more than she runs all the day to day now. And I'm able to just focus on how do we continue to grow this thing? How do we get more leads in at a cheaper cost?

How do we get people to stick around more? And I think that's I talk with so many clinic owners about this stuff in there. Almost like nervous to promote with from within and to give somebody a little bit more responsibility to start leading team meetings or do some of the con ed side of things. And, we have two locations now and we have a lead PT at each location.

And then the clinic director that kind of sits above all that stuff. If you want to scale, you have to have those people in place. So I was able to leverage, we have an awesome staff. So being able to leverage them. Freed me up to do, this other side of the business where it's run the business, bring, the new patients in the door and they handle all the day to day side.

Danny: What about what about finance? Because I feel like that's another area similar to data. It's basically the same as [00:42:00] financial data, but how did your view of that, your Time attention you spend on looking at your business financials and then also where you're reinvesting capital, like what changed for you going from, 10 to 50 and then 50 to over a hundred, as far as how much time and effort you're putting into that,

Jeremy: I think my situation is probably a little bit different there because we have grown so quickly in the first three years because, I had these like top line revenue goals since I started. It was like, how do I get this thing to a million dollars a year? So I sacrificed the profit side of things to bring people on board.

I was more than happy to, leverage myself for a couple months to bring a new staff PT on with the opportunity for them to have a full schedule, three months, six months from now. But, without understanding what my P and L looked like and how those metrics were working, then, I would be running in the dark.

And I think that's where a lot of people get scared to bring people on because they [00:43:00] don't really understand, can I afford to bring this person on I was going to start in part time and then hopefully they get busy and then they'll become full time. I think that's just the wrong way to look at it.

So there's that side of it with growing staff and then, going back to the ad side of things too. It's understanding like what is, what percent of our overall budget is going to our marketing and how can I continue to increase this number? Because if we can increase our marketing spend each month, I know that's going to bring new people in the door.

So we're very meticulous on that too. So

Danny: at the stage that you're at now, what would you say the most important activities that you're focused on are and what percent of your time are you spending on each of those?

Jeremy: For me, it's really just making sure there's enough new people in the door.

That's my main role for Ripple right now. And again ensuring that, the clinic director we have in place is Happy and everything's going well, there is really the two things. And it, again, it's a nice spot for me to be because I live [00:44:00] in another stage. I'm not down there all the time.

My biggest focus again is just ensuring ads are properly set up. We're doing the right marketing campaigns. Everything is good from a high level. And then, making sure the person that's running the day to day. It's all squared away and they don't need anything there.

Again, a pretty good spot to be.

Danny: Also you bring up a great point. You don't even live in the area where your practices, right? When we talk about the ability to build a business, the, we have the hit by the bus test rule, right? And if you're, if you got hit by a bus, your business would.

Still be making money and it would still be seeing people and you have systems in place. Other people can run if you wanted to hand off the things that you're doing now, which I think is really a very hard thing to do to be able to build to where you're removed enough to where you don't have to, you don't have to live there.

The 1 thing that I do see with people that remove themselves is that sometimes the culture can be so defined by the founder that when you remove that person the culture can change. And [00:45:00] really start to diminish some. How did you really help not let, not really let that happen as you started to step away from the day to day of being at the office?

Jeremy: Yeah, I think it's, from the time where I was in the office every day, it's, the, just ensuring that, what I was doing on a daily basis was rubbing off on like our core staff members. So now they understand Hey, these are our values. This is how we do things here. This is the mission.

So that, they're in line with all of those things. And again, we have, our lead PTs that are running that and we go through the onboarding process. We set up this foundation where these core, upper level staff members are bought in on that. So now everybody else that comes through the door.

It's also going to abide by that. So that's where it's, it's very tricky. You've got to pick those right people to elevate in your company to live the brand and make sure that, they would be doing things as you would be doing, I think a big learning lesson for me though, is it's not a hundred percent going to be perfect.

It's not going to be exactly what you [00:46:00] want at all times. That was a big learning lesson for me. But that's okay. And it's not always going to be perfect. It's not always going to be 100 percent what you want it to look like. But as long as the product is still there, as long as the clinical side of things is up to the level you want it to that's a really good spot to be.

Danny: What would you say? So making that compromise? I agree because that's also Anybody you bring on your company, you have to have standards, but you also have to be okay with it's not going to be exactly like you, as far as how you're doing things. And that's totally fine because people are different.

And sometimes we want things the way, the exact way that we want them, but it doesn't necessarily mean that is the best outcome either for people, the, what the, their, your clients wants. How would you say you ended up dealing with the balance of. Like the details are important.

We want to make sure we focus on those things, but also not be so stringent that people feel like you're micromanaging them.

Jeremy: Yeah. I think I went from the point of walking into the gym and the kettlebells being like a little out of place in the rack, not put in exactly as I want [00:47:00] it to be. Those things I started to let go.

It's you know what, that's fine. Like it's this the place is clean. It looks good. Like just because the weights aren't flipped with the numbers up, like that's going to be okay. So I gave up those battles that I tried to win at the beginning of all that. And, started focusing on energy of things that actually mattered.

So again what does the service look like? Someone walks in the door and you walk by them and you don't say hello. That's something we got to fix and, I think feedback in the moment with those things is just so important as well. This is when you find something that, your staff members are not up to the standards that you want, you don't wait till you're one on one next month to bring all those things up.

You give feedback in the moment, and then, maybe something else comes up that you can talk about it in those one on one meetings. So that's the culture that we put in place, and I think it works well.

Danny: So spot on. In fact, it's funny. The last time I was at the clinic that we sold, I actually was like, put, I put away like a barbell and I fixed something in the gym as well.

It's just like [00:48:00] habit and it wasn't even it actually looked great. It looked, the place looked awesome, but I was just like, wait a second. This is over here. It's just funny that, I don't know, you take this pride to ownership that is different than everybody else. And it, it is hard to give that up.

I do think the thing, the last thing you brought up and we'll leave it here is the leadership side of things. The ability to have these uncomfortable conversations in a positive way, and not necessarily normally mean to your staff, but you also have to hold a standard even just like for us, punctuality is a, It is incredibly important.

It is one of the things that we can control for the most part. And our our culture is if we're a minute late, we apologize. I'm so sorry. I'm late. Like we want people to be like, you're a minute late. It's fine. Like you're basically on time and, but it's not on time. And that is, that's like a standard.

I've had to have that conversation with a number of people in multiple companies that, we've, that we've been a part of just to make sure that they understand that this is not okay. And. If everybody is going to be held to the center, including myself and [00:49:00] everybody else. So how do you feel like on the leadership side, how do you balance holding standards and also not being a dick in a way where they may not see that it matters as much to you as as to them as it does to you.

Jeremy: Yeah, I think it's always relating back to what are we trying to accomplish here as a clinic and getting back into our mission and our values of this is what this is the service, the product that we're trying to play out for everybody here. So if you're veering from what our core values are, we trying to accomplish here?

And, that's not something that we want here. And that's a conversation that has to be had. I think getting back to, what I said beforehand of, you shouldn't wait to give feedback. It should be on the immediate, you're not waiting for your one on one to give it. You can very quickly pull somebody aside and say, hey, I noticed this here's my rationale on why I think, you could do a little bit better in this situation.

Get them to understand, get them to understand where you're coming from. And just like the timeliness of things like that, it's, I think people respect that and they appreciate it. The other side of it [00:50:00] in, as you grow and you have more employees is you've got to ask your employees, like, how do you want to be managed?

Like what does that look like for you? Cause some people, for me, like you, you shoot me straight direct. That's how I want to receive feedback. Other people want it received a little bit differently. That should be part of the onboarding process for sure. It's what do you, what is your, like, how do you want me to manage you?

There are certain things that I have to do, if I'm have to give you feedback, what does that look like?

Danny: Yeah. Yeah. That's good. Cool, man. This was this was fun. It's always fun to talk like high level business stuff with with people that are running, really well run clinics.

And for Jeremy right now, if you guys are obviously if you're interested in learning more about ripple, if you live in the Boston area, like where can they where can they like learn more about your clinic or if they're listening and they're like, it sounds like a great clinic to work for where do

Jeremy: they learn more?

Yeah. So on Instagram, we're just at ripple Boston. You can look up, look us up there. We're trying to be active on LinkedIn as well. Follow us on LinkedIn. We're posting up on there a bunch ripple base camp. com is where you'll find us online. Yeah, that's where we're at. And on the

Danny: other [00:51:00] side the vast majority of what Jeremy does these days is is actually a company called patch, which is a marketing company.

And really it's probably, in my opinion, I think it's the best marketing company in our space as far as being able to like, get results, but do so in a way where you actually understand how these clinics run and the mess and getting the messaging, which is something I found very hard when you're trying to outsource marketing to to agencies or vendors.

Because they work with so many different types of businesses, right? They're working with a donut shop in a restaurant and they're working with a retailer. And then, they're like, yeah, we can work with a local physical therapy group. And I've actually had, I've hired and fired three different local marketing agencies in with our practice in Atlanta, because I ran into the same problem of them, just not understanding it.

And then eventually I had to learn it myself which took a long time. But if you are. Interested in getting, marketing done the way that Jeremy has found success with with ripple and really building a practice to a point where you can live in a completely different state and the business is still churning and growing.

I guess a pretty, pretty rare thing. A [00:52:00] lot of it has to do with the fact that you're tracking the right things, you're actively marketing to get people in the door and really have focused on the right variables of of the business, which is cool to see. So if people are interested in learning more about patch.

And what you're doing with that, where can they go find out more?

Jeremy: Yeah. You find me on Instagram, just at underscore Jeremy DuPont. I'm obviously super passionate about this stuff. So been posting a bunch about sales and marketing on my, our my Instagram page and then, patches URL is just at the the patch system.

com so you can find us there as well.

Danny: Cool. All right. Guys, check it out. Hopefully you gained some valuable insight from this. That'll help you on your journey from 10 K a month in revenue to a hundred K. That's the goal. We want to help as many practices get there as a, as we can.

And I'll leave you with this. There is strength in numbers. There's safety in numbers. And if you're, if it's just you and one other provider and you're just cool with that's okay. If that's, if you want to like a kind of bigger lifestyle business, that's all right. But when that, if that person leaves, half your workforce is gone, and that can be a really frustrating place to [00:53:00] be.

Knowing that personally haven't done that and having seen it happen to many other folks. Sometimes it's a catalyst where people are like, okay, damn, I do need to grow past myself a bit more than I thought. So hopefully today this helps you get a better idea of the things to focus on.

So Jeremy, thanks for your time, man. Appreciate it.

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