Garrett Salpeter (00:01.59)
Fit Nation. Welcome back to the undercurrent podcast. And I'm joined today by Michael Coates. We're going to talk about personal injuries. So we're, as we do every so often, shifting into a more business oriented topic. And I'm excited to talk about this with Michael because I met him at a seminar in Las Vegas. He was also there at the Parker chiropractic big annual event.

And I got to talk to him for several minutes. I was very intrigued with his perspective. Tell you a little bit about him just before we dive in. Michael is a California licensed attorney. Over the last decade, he's established himself as a national authority on this field of personal injury law and lean recovery and negotiations. He's an innovator and advocate, a coach and instructor and mentor. And through his experience, he's seen the good and the bad in the personal injury business. And he's now...

Transitioned from being an attorney to helping hundreds of providers recover millions of dollars from law firms of all shapes and sizes His company is called personal injury made easy and they give providers Clinic owners and staff a true business advantage in the PI space by providing methods strategies tactics and tools that are unmatched as is Michael's expert coaching as the country's top lean negotiator, so I think

having gotten to talk to him before, everything in that bio is true and I'm excited to dive in. Welcome, Michael.

Michael Coates (01:32.192)
Hey, thank you for having me here, Garrett. And you know, when we were in Parker and you were doing in the new fit method, and you know, so I stripped down, you know, I had him working on my shoulder issue. And I literally right after when I was felt better, I said, okay, I gotta learn more. You've got me. This is working and you need to get this in personal injury, okay, for injury care. So anyway, I'll let you proceed, but I do at some point hope that we do hit in here about.

new fit and your method being applied to say auto collisions, for example, which is kind of the most 80 plus percent of PI cases. You can slip and fall, you get product liability. But that's the most. And I think it'd be really good for the listeners to understand how your product is also actually would go about not only in the PI space on the rehab side, but I know you're really great for as you get for post -surgical rehab specifically as well.

Garrett Salpeter (02:23.318)
Mm -hmm.

Garrett Salpeter (02:29.11)
Yes, for sure, for sure. So we'll, we'll be sure to cover that. And I think that, uh, it would be great for us to start with sort of framing up the conversation here and a lot, you know, we were talking at Las Vegas, at the event in Las Vegas about how, you know, I know dozens personally of clinic owners that use the newbie. We have hundreds of practices that are using it. And I don't know the degree to which people are using.

are actually treating personal injury patients. So I've talked with a few to see and the most I've heard is people are, you're just treating a few, because it's usually existing patients who happen to get in a car accident or someone that gets referred in and they do a little bit here and there, but it's not a big part of what they do. And they also have reservations. So I wanna start by calling out some of the biggest reservations that people have about treating personal injury patients.

I want to run those by you because I think that you have a very interesting perspective, but to share those, a lot of practice owners seem to be hesitant to take on personal injury cases because of concerns about payment delays or whether they'll get payments at all, and also patient motivation and this perception that a lot of personal injury patients are just trying to stay in therapy as long as they can to run up their bills and make the injury seem worse or aren't motivated to get back.

So there's sort of these general concerns. So to kick off the conversation, can you share your perspective on those?

Michael Coates (03:58.944)
I'm happy to, Garrett. Maybe let's do this in a point. I'm a big movie fan and I like Clint Eastwood, of course. So I like the old movie, Good, Bad, and the Ugly. So I think if we talk a little bit not only about the bad and the ugly of PI to start, what I'd like to then after that, let's shift also to the good and the great. So when you talk about the kind of the bad and the ugly, this is definitely an area where you're waiting to be paid. It's a deferred payment arrangement until a case concludes.

But the beautiful thing about that, by the way, flipping that on the other side, once you've kind of waited that period out on your initial PI flow, so let's say it's 20 % of your practice, once it starts coming in, it comes consistently and it's on top of your other revenues for work you actually completed before. So it's really a wonderful driver for revenues as well. So I don't get worried about, I think about time.

to get paid because when you can wait to be paid at your highest level that we'll talk about, waiting to be paid more profitably is always worth the wait. Okay, so the other difficult thing when you mentioned about patients, without any question, like in anything in life, there are people that just try to scam a system. Personal injury is no different, but you know what? That's actually very few people and very few patients that are really doing that. Most,

they are literally injured from the PI case. And so they're coming in legitimately to get treatment for that injury. And so I think sometimes you've always got to keep your antenna up to try to weed out what might be kind of a scam situation. And in the end, I would never worry about someone how long they're being treated because, Gary, who has control of that? It's not just the patient, it's you, the provider, right?

You listen, who here raised your hand if you wouldn't want massages for five years? Okay, you know, me, I would. Okay, so at some point, depending upon what you're doing, you gotta cut it off. Like they've reached MMI, you know, maximum medical, and you gotta just cut things off from the injury care. And that's all within your control of how long you do it on a lean or letter of protection. So I think when you think about the bad, and by the way, some more bad and ugly. Let's talk about some things that aren't there. Some law firms.

Garrett Salpeter (06:17.622)
you

Michael Coates (06:26.368)
get pretty damn nasty in how they approach you when you want to get paid your bill, not just the attorney, but you're dealing with law firm staff. It's one of the greatest frustration areas in PI because it's not just waiting to be paid, but it's that then you're kind of battling attorneys and law firms who advocate for a living. That's what they do every day. And you guys are healers and givers. So I think that's the other.

side of that coin. But for all those things we've talked about, I think when we shift over to the good and great, it's so much outweighs the negative. It's not even close.

Garrett Salpeter (07:07.51)
And so that all makes sense. I want to touch on one thing you said there. You said that if this pipeline, you know, you have to wait for your first personal injury payments to come through, but it's worth the wait to get paid at the most, you know, at your actual highest, most profitable rates. You also said, you know, it makes sense if 20 % of your business is...

personal injury, is there an ideal among your clients to practices that you consult with and work with and train? Is there a ratio that is best? Is that 20 %? Is it different? How do they, how do practice owners think about what's a good percentage? What's an ideal target of my percentage to have in this vertical?

Michael Coates (07:50.688)
Yeah, I'd say the ones that are on the low side are generally between 10 % to 20 % in what they do. It's that kind of, like you say, patients referring, coming in, they don't really have a push for PI. I think when you have more of a push for PI, you're getting more to the 30%, 40%, sometimes even 50 % in PI. And you have some that become full PI clinics. I am...

not an advocate for that because I think what it misses is the symbiotic relationship, especially for you who are watching that are the rehab providers, the chiropractor, the acupuncturist, the physical therapist, the cat providers, as I call them, for your product to be the physical therapist and the chiropractor. I think that for the rehab provider, it really is a matter of how you treat over time. And I...

Gosh, you know what? Could you repeat the question there? And I'm sorry, Garrett. I totally forgot that you totally went right off the rail. What percentage? Oh, you have the percentage. Okay.

Garrett Salpeter (08:49.462)
Yeah.

Well, good. Well, we do have... I'll mention there are some acupuncturists also, so no reason to exclude them. But, yeah.

Michael Coates (09:01.376)
Oh, okay. Okay. So, okay. So you're gonna have like when you have any business, you're gonna have different practice segments, which you do. And realize that each feeds the other. So you've got injury care and a portion in a sub -segment of injury care is personal injury, right? Other injury care might be sports incidents, whatever, you know, someone's getting, having an injury. The other side for the rehab providers is gonna be the wellness care and the maintenance care.

But every patient that is injured at some point, the injury is resolved or stabilized and they've got to shift to the other side of your practice. You don't want to lose them and shift them to somebody else. You want to keep that patient that they become somebody that you're able to help over an extended period. And one of the great things of injury care, it is a term care plan. You don't come in for an injury for a day. Injury is over time.

That's a great thing for any practice because it's a multiple visit scenario. And that's, I think, what you're also training a patient when you help them that way, when they shift to the other side of the practice to wellness or maintenance care. That also should be a term care plan and filling those patient visits slots. And so I'd say it's not a matter of a specific percentage. I think it's as you grow. I'll give you something else that might come into play. Let's say you're in California. I don't know how many of you are.

listeners here are from California, but starting January 1 of next year of 2025, the minimum auto coverage is doubling. So that means that right now as of today, when a personal injury patient comes into your practice, physical therapy, chiropractic office or acupuncture or MD pain physician, they're worth a minimum of $15 ,000 in coverage. Starting January 1 of next year, 2025, it's 30 ,000.

That's significant. And I think especially for the rehab providers that are really usually the first entrance point for PI. So I think it's an advantage that if you are a smaller percentage, you should be increasing it. But I think you should always maintain that balanced practice. And as you go to increase on the PI side, remember it's going to help you as your marketing for all of your practice segments.

Michael Coates (11:21.088)
I think the problem that practices do is they ignore it. It was like, field of dreams, if you build it, they will come. That's not how business works. And you guys are great heaters, but you know what? You often suck as business people and we wanna make you better. And personal injury as a foundational segment is one awesome way to be a better and more profitable business owner.

Garrett Salpeter (11:45.558)
Okay, that all makes sense. And also, if you get more people in the door, not only can you help them, but each of those is a potential referral source. They have family members, they have friends who can refer people into your practice as well when they have a positive experience. There's so much value from establishing positive relationships with patients also.

Michael Coates (12:06.24)
Well, let's go on top of that because let's hit some of the more of the positives. So that one is that PI becomes this entrance gateway of new patients, right? Just people that have never been exposed to the magic of what you do, regardless of your specialty, right? People have one thought of what a physical therapist is, what a chiropractor is, what an acupuncturist is, what a pain physician is. They don't really know till they experience it. And it's oftentimes it's an attorney or some other physician that is referring them.

to you. So when that occurs, that is one incredible opportunity. Why would you not want to further that, fertilize it, facilitate it? Because when you have it, you've got that ability to educate them while you're treating them, while you're helping them. And they see the magic of what you do and the magic of your staff, your service, all the other things that make you different.

So that is an amazing part that is great for PI, like chiropractic, I will tell you, it is the number one lead medical specialty in the entire country and they lead in only one area. So in one area where someone, the first person they see is a chiropractor, that's personal injury. Now let's shift to physical therapy. I think it is the biggest area that the physical therapy industry has been missing out on. They have almost ignored personal injury to their detriment.

I mean, I've had members of my program, you know, they were getting 52 % on average on their full bill pay, some of them 10, 15, 17 ,000. You know, later on, they were getting 80 to 100 % of all those bills in PI, which they weren't getting anywhere close in health insurance. So that's the other benefit. You can only fit so many patients in a day. Would you not want to have higher per patient averages for the patients you see?

So if you see less, you actually can make more, even within your limited, let's say, visit that you've got per day. Another area, especially for new fit, you know, for new fit, I think physical therapy has got better codes for what you do, but chiropractic is going to have a harder time probably building this. And personal injury, if you, the provider, deem it medically necessary and can support that, it gets paid.

Michael Coates (14:28.768)
So like laser treatments and other things actually get paid in PI and it doesn't in other in health insurance. And you've got patients that got to pay cash, usually a hell of a lot lower. That leads to another huge win for PI. It pays you not at the ever lowering and pushed down health care reimbursement rates for a network. It's often your full out of network rate, your full retail tilt that you get.

That is truly significant for the profit of any practice. And the last thing I'll just kind of note here, besides I think medical collaboration like you talked about is really important for referrals and understanding, is there is fast pay and PI. And the fast pay and PI, well, one would be attorneys that actually are more aggressive and resolve things sooner right after treatment. And there's a lot of those that are really good at that. But the other is med pay and PIP, personal injury protection.

for a lot of the LOP states out there, letter protection states, and then med pay for the regular lien states. Those are off the auto policy and are there, it's where the patient who's the driver generally, they're getting prompt treatment in exchange for prompt payment. And that again should be paying at your full out of network rates up to whatever that PIP or the med pay is. So there is a way to get monthly,

cash as you're treating. In fact, you submit those bills on a monthly basis as you treat to get paid. So Garrett, as you can see, I mean, there are downers in PI, but I think that there are so many more uppers and we only touched on some of them. To me, it's not even close. And you're just crazy if you don't grab onto personal injury and explore that and seek to get the right processes in, to be properly paid and to grow that.

Garrett Salpeter (16:22.87)
When I hear you talk about it, it made a lot of sense the first time we got to chat in depth. It makes sense now, even perhaps a little more clearly talking through it for the second time here. And I want to go back on, first of all, I want to emphasize one thing you said there, which is this is something that's very well known in chiropractic.

So it's very, very well established in chiropractic. You said that they are the number one profession that works with personal injury cases. So many chiropractors listening to this may be familiar with it. You also said that it seems to be one of the biggest opportunities and that it's biggest area missed so far by physical therapy. So there likely are a lot of physical therapists listening to this who hopefully they're leaning in and their ears are perking up.

Michael Coates (17:12.48)
physical therapists and acupuncturists. It's been missing on both of them and they're just not something they're used to. And I know it's unfortunate, but the physical therapy industry doesn't even seek to... Because I've offered to publish even on the national publications for physical therapy to help them educate them. They just don't show an interest from a leadership level. They're so missing out. Chiropractic embraces it and different states have different percentages and state laws do impact.

But it's something that physical therapy, and I will say also acupuncture is truly missing the dime and a, not a dime, it's turning a dime to a dollar.

Garrett Salpeter (17:51.606)
Yeah, okay. So that's a really helpful perspective. And then when I asked you that initial question about, you know, these are some of the perceptions and you were addressing them. You know, you mentioned something else that was very important, I think relevant here that I want to draw out, which is that a lot of times it's difficult for practice owners, for clinicians, for healers to...

feel like they can negotiate or to be able to effectively negotiate with attorneys who do this for a living. And I want to hear your perspective on how practice owners can establish these positive productive relationships with attorneys so that they can get these reimbursements that you're talking about, not get ripped off or negotiated or run into those traps. How can they positively handle those relationships with attorneys?

Michael Coates (18:51.296)
Well, you just froze, Garrett. I don't know if I'm hearing you. Your image froze completely. I'm not hearing you now.

Garrett Salpeter (18:57.91)
So it looks like mine froze. Yeah, so we'll go back and edit this afterwards.

Michael Coates (19:05.504)
Yeah, you froze and then even your visual started to be a little hazy there. You want to just say that again, the question again, or you want to?

Garrett Salpeter (19:12.182)
I'll pick a few.

Garrett Salpeter (19:16.278)
Yeah, I'll say the question again. I'll pick it back up at 19, 20 here. So one of the things that you talked about in the beginning was the, this dynamic where sometimes practice owners who are healers and clinicians sometimes have difficulty negotiating with attorneys when it comes time to get paid, you know, attorneys being professional negotiators, having a totally different skillset. How can.

practice owners optimize those relationships, both from the perspective of connecting with attorneys who can be a good referral source, and then also maintaining those relationships so that they're positive, so that people get paid effectively. What are your thoughts and sort of the best practices on optimizing those relationships overall?

Michael Coates (20:03.808)
You know, it's a funny thing, they're fighters, you know, that's what I did. And that's what they're trained to be, but it's the one industry where when you push back, where most normal person would get maybe mad or hold it against you for a long time or something, but not law firms. They deal in pushback every day. It's what they deal with with adjusters. So in fact, you'll find that attorneys,

If you can do it the right way, and there are techniques and methods to negotiate that can, I call it, it's called ROI versus ROR, return on investment, which is what you're getting paid, and ROR, which is return on relationship, and that's growing relationships. There's ways to do that that can do both in how you present things, right? That work with attorneys, and even though you're pushing back, you find that you actually get paid more and get more cases as well. How'd that happen?

You know, one of the things attorneys, now very few matters go to trial. Like less than 4 % of any patient you see is gonna actually go to a personal injury trial. You know, 80 % are gonna, are going to not only settle, but settle at maybe an earlier stage than even getting close to trial. So there's only sometimes maybe depositions are occurring and you're getting more towards trial. But I'll tell you, a lot of attorneys wanna know, will you be good at a deposition? If someone's gonna question you,

on what you did and how you did it, and also how much you got paid. And they want people that can stand up to a defense attorney, which is what I used to do. In my early years, I was a medical malpractice defense attorney and a personal injury defense attorney before I shifted to the business side. So I dealt with PI attorneys all the time back then. And I can tell you, if you can withstand the attacks that I would use to do to go to challenge a physician, that's the kind of provider.

that attorneys wanna keep sending their guys to. Because when they do have something that matters, they need one that can support their bills, that does get paid what they're supposed to get paid so that they can withstand the attacks. There's also, you'll find all these processes that if you do things early on, like that first patient visit, there are things you can do that can really harm a case. Let me just give you one example, but there's a lot of them. There's a lot of states out there that are now,

Michael Coates (22:28.608)
if you know negligence law, but it's called comparative fault, but it's modified comparative fault. So if you're in Texas, now Florida, other states, if your patient is over 50 % at fault, they get nothing from the PI case, zip. So they've got to pay you the bill of yours. Now imagine that patient's coming in, you know what a lot of providers do? I've seen guys brag about, I've got these matchbox cars up here.

I have patients take these cars off and they show me how the accident occurred and I videotape it and I go, oh my God, they may have just created a liability situation because they're not an accident reconstructionist. The patient may have demonstrated something different from what they told the adjuster before. Now you've got a liability problem that didn't exist before because of how you went about your documentation. Like it's ridiculous, but it happens.

And there are a lot of those. So there are things you do that can harm PI cases where attorneys want to stay away from you, but they're also value drivers. And I really emphasize, find the things that make you a value driver. Besides, you won't hurt the case. But that you can literally do things that help not so good attorneys. And there are a lot of those out there. Like just think of every profession. There's good, great, and then not so good and not very good at all. And that happens in the law field.

but you can help guide men and women who are attorneys be better. Even the good ones be more great and the great ones are gonna thank you by how you approach PI. And it is a unique niche. It's not the same as how you approach your other patients. Because there's no other thing you do that really you get viewed by non -medical experts so much. Adjusters, attorneys, juries.

judges.

Garrett Salpeter (24:24.566)
So since you mentioned that, what specifically are some of the differences that practice owners, that clinicians, is it in terms of how they document? Is it in terms of how they structure a plan of care? Can we just drill down on that a little deeper since that was interesting?

Michael Coates (24:40.128)
Sure. Well, first of all, by the way, we may not hit this, but all of you should go. You may not have heard this called the No Surprises Act, federal law that went into effect over two years ago that you all are supposed to be complying with on all your patients, pretty much. Look it up at CMS .gov forward slash no surprises and you'll see what I'm talking about. You're really supposed to give a good faith estimate of your plan of care in advance of care, especially the rehab providers, but anybody that's setting an appointment in advance of care.

And it may not be that first appointment, but certainly by the second, you got to lay out everything you do, the days you're going to do it, what you're going to do it, how much it costs. That scares a lot of providers in injury care because you got to lay out a pretty nice size bill. But in PI, attorneys like that. They can use that to settle. So if you get where you're not only compliant with no surprise, but use the good faith estimates the right way, you can be a value driver to a law firm. You can actually get more of the surgical rehab.

because they've got to comply with it, including putting in the rehab part on a surgery. And if you're in compliance with No Surprise, Zach, one of the few providers that probably are right now, they're going to use you because you're going to make it easier for them. Some of the value drivers are certainly documentation and how you document. A key in PI is you becoming like a storyteller with your notes. It's not reports.

You know, people put too much of an emphasis on like a final report and they're really discharge reports. Those can actually get you more in trouble because they're form, they're long, and you know, most of them even know what's even being said in those. It's the notes that you keep. And what you're tracking are the activities of daily living. How did that injury, how are they doing in life before it versus after, and you're demonstrating the recovery back? And I, when I coach on it, um,

I tell you to focus on find the thing that matters to that patient the most. You know, mine might be, I, every day, man, I would come back and I play softball with my little girl and we throw the ball around. Well, if I can't do that at all and I've lost that, that is really impacting me and my child and causes me a lot of angst, not only physically, mentally and emotionally. But if I can demonstrate where I can get back to actually doing it like I used to do, that's a great way for non -med providers to understand,

Michael Coates (27:08.768)
the injury and the recovery and what it took. So, you know, there's a lot of things, that's just a couple. Another really important one is being able to support your fees and your billing. People think you just give a, oh, I've got this list of my fees and I give that out. That's not compliant with No Surprises Act, it doesn't help anybody. It'd be like I go to buy a car, here's a list of all the parts and the price next to the part. What the hell does that mean? Which parts are in my car, right?

So where you want to not only support and there are third party, there are ways you can do to support your fees and get that support and your bills to the attorney to use with the adjuster who's going to be trying to trash what you did and how you did and how much you charged. So as you learn those methods, that can be really helpful for getting you paid and stopping some of those attacks that also the law firms will try to use against you.

Here's the funny thing. They'll do that after the fact that case is settled, yet you didn't hear a word during the entire time that there was any problem with your treatment or your bill. That's because they're really false attacks. You just got to learn how to do that and how to address it. So for those that are listening, if you want to really dive into that side deeper, I do throughout the year a virtual online negotiations training. It's called Negotiation Psycheto, a method that I developed called the disruptive method. And I...

Teach and train that with these online workshops, day and a half workshops. I got one April 19th and 20th coming up. If you go to negotiations, aikido .com, you'll see it there. That's the next one that's running, but look whenever the following one is. And it really is gonna get you and I think your staffer really up this negotiation game to see the problems that are done, like you're talking about, Garrett, and then how to address many of those and to get a method.

Garrett Salpeter (29:03.862)
And we'll share a link to that URL in the show notes here because I might have trouble spelling Aikido That's got a nice ring to it sort of like Mississippi MISSI

Michael Coates (29:11.52)
A -I -K -I -D -O.

Michael Coates (29:20.8)
Oh, by the way, well, you know why I picked that, by the way, I did that because if you think about, you know, it's a martial art and Aikido is based on using, so the opponent you're in oftentimes in Aikido is somebody bigger, stronger than you. So you'd think, oh my God, I'm gonna lose. Not the case. Aikido uses the size, energy and tendencies of the opponent to your advantage, offensively and defensively. So I thought, what a beautiful thing to use with healers against fighters, right? And literally,

You guys have the advantage and don't realize it. You know, I said for the rehab providers, so you, the chiropractor, the acupuncture, the physical therapist, in PI, you literally can get paid 100 % of your bill, like 80 % of the time, or think of it another way, 80 % of your full retail rates as a norm, not an exception. What would that do for your practice versus those piddly ass...

healthcare in -network reimbursement rates that pay you nothing, right? And you think battling with attorneys is hard? How about battling with insurance companies and the paper game back and forth? Oh, I didn't get this. Oh, resubmit, resubmit. And you're battling for the lowest pay per code. I think it's ridiculous.

Garrett Salpeter (30:37.206)
Yeah, that's a great point. When you frame it up like that, which is truthful and legitimate, it makes these personal injury cases and working with these attorneys, relatively speaking, even more attractive there. So yeah, that makes it.

Michael Coates (30:54.432)
Well, and I think that it was shifted into Newford a little bit. You know, when you've got technology and things that will work, that will heal the patient, your role in PI is, you know, think of like a sports game, let's say it's football. You know, the attorney is like the agent. So like when Roger's got that contract with the Jets, not only was Roger's really happy, so was his agent, right? The 10, 15%. Well, that's what an attorney is in PI. They're focused on the financial recovery of...

a lawsuit, you as the healer are like the team trainer. You gotta get the player back on the field, right? So that's your role and you gotta stay in that lane, right? And you gotta control the recovery, not let attorneys direct medical care, right? This is where you are there. When you find great things like what New Fit has that can really help, not just, you know, a lot of people treat it as like a bandage on the problem, but you wanna get to more of the source of the problem and to heal the source. So I think...

you know, when I came across what you guys did, why I thought it'd be so great for PI, because I think it'll really do a lot more to help more patients heal for the longterm as well.

Garrett Salpeter (32:07.35)
Yeah, I appreciate that mention there and that is totally true. I think that's where that cynical sort of perspective comes in of, well, do these patients really want to get better? And like you said at the outset, many of them do. There are some, there's a few bad apples, but don't let them spoil the whole bunch. And most of them...

You know, I've been through accidents and do legitimately want to get back and improve their quality of life, get back to the activities they want to do, you know, those, those sorts of things there. And we have a tool that can help them do that a lot more effectively and efficiently. So it's a, it's a great fit.

Michael Coates (32:48.128)
Well, but it's better than that. Like, again, I'm gonna go back to what I said. In PI, they really trust you. What do I need to do? Because to them, they're gonna get compensation from the PI case. They're putting their trust in you, the provider, to lay out the plan. And they actually have higher patient health outcomes because PI patients more stick to the plan because there's a financial aspect to it, right? That their attorney wants them to stay on plan too. So if you deem this will help them.

Garrett Salpeter (32:53.686)
Mm -hmm.

Michael Coates (33:17.12)
They're going to do this and you can get paid for that in the PI at whatever is the best, you know, the top rate for when you're charging for the new fit application. So it's gonna help you in your billing, you know, and there's ways to be within the market. And by the way, so you all know, when you're billing in the marketplace in personal injury and people try to throw at you, oh my God, but you're way above Medicare or, oh, you're not at the lowest, you know, you're not in network health insurance.

That's not the standard in PI. It's what reasonably what the market, what the out of network rates are. And billing experts will testify, reasonableness is even at 90 % of what the billing rate is. So don't think you have to be average. You can be in the upper range and you're completely reasonable and justifiable. Again, as part of an art to this, you got to learn these things and that can sit back into processes, but it matters. I just want you guys to see better.

that if you think and realize PI could be a benefit to your practice, you should say yes, take a step forward, learn more about this. It's there to benefit your patients, is there to benefit your staff, is there to benefit your profits and your practice.

Garrett Salpeter (34:34.902)
I'm sold, Michael. I hear you and it all sounds great. I want to talk real quickly about some of these negotiation Aikido mechanics. And obviously we're not going to cover a day and a half course, but just to give people a taste of what's in there, I want to share an example and just see how you would coach us through it. So we've done at our clinic in Austin, just a couple.

of PI cases over many years and a couple, not per year, a couple total over many years. And the first one that we did, it was an existing patient who we had a good relationship with and she was in a car accident. And then she asked if we would do this next phase of her plan of care under a letter of protection. And we agreed, you know, in part, because it's someone that we liked and had a positive relationship with and in part, because we thought it could be a good learning experience. And then.

At the end of that, the attorney said, well, we only recovered say half of what we were expecting. And so we're only going to pay half of your bill. And for us, it was, uh, you know, something, something, something to that effect. And for us, it was, uh, it was a fairly small plan of care and it was, it wasn't a big part of our business. So we didn't really fight that hard, you know, in retrospect, we certainly wish I had taken your course and known more about it in advance, but you know, I think we.

we might have counter offered or we ended up taking close to or whatever they offered there. It was a few hundred dollars difference, not a huge deal, but is that type of strategy something that's common or how would you, is that something that you just, everyone tries or is that something that was unusual and we just fell for it or what's your perspective?

Michael Coates (36:22.848)
Yeah, yeah, you fell for it. It is incredibly common. I mean, sometimes you'll get, providers will, sometimes you'll just get a check in the mail and the letter says, pursuant to our agreement, this will, you've agreed to accept this as full and final satisfaction. You never spoke to them. You have no idea that it even settled. And they say that you agreed it, but once you deposit it, it was his full and final on the check, there's a legal doctrine called accord and satisfaction. Once you deposit that check, you don't get any more. So they try that game. They'll use,

whatever to pull at your heartstrings or they'll sometimes even cite law that doesn't apply. When you don't know that it doesn't apply, you just think that's the way that it is and you just agree. I see this all the time around the country. By the way, there's a lot of really good attorneys that really do care for providers and the patients that will treat you right. It's just that there's a significant percentage that are the more difficult or, and sometimes it's a matter of,

You'll see like the guys that advertise a lot, they're very high volume firms. So they're really trying to just close out, they put things off, they blow off the little cases and then try to just get rid of them quickly as they can. And they try to make their money, have just at least their client happy so they don't get slammed on Yelp and they put the burden on the medical providers. So like, for example, when you just showed that what they probably didn't tell you, did they tell you the...

How much the case settled for? Did they tell you how much they were getting paid in attorney's fees? What the attorney's costs, what each of the providers were getting, what the patient was gonna be getting? I bet they didn't tell you any of that, right?

Garrett Salpeter (38:01.686)
At this point, I don't remember, but I think a lot of that was hidden. There was not much transparency.

Michael Coates (38:08.352)
Right, okay. So one of the things in the disruptive method and the U is for like uncover the facts, right? And so it's dig, dig, dig, because when you get the facts, you get the treasure that gives you the amity go back, right? You'll see, you'll uncover hypocrisy. You'll uncover things that are not right. You can uncover preferred relationships. You can uncover costs that are improper. I mean, I've seen costs on attorneys bills where...

thousands and thousands on just paying Uber charges, their personal Uber charges of their client. Those are personal advances. They don't get ahead of the medical providers. That's something the patient should be paying out of proceeds. And patients generally, the order of payment in PI is the attorney, the providers, and then the patient. Okay? That's generally the order in most states. So, you know, so I'd say if you went and dug for the facts,

and then how you present them. The I disruptive is inject advantages strategically and you learn how to inject, when to inject and what to inject back at them. You'll learn again, you can increase respect for you, increase your bill at the same time and you actually get more, not only more money, you're gonna get more matters out of it.

Garrett Salpeter (39:26.87)
So that sounds like it makes sense. It also might be a little bit off putting if people think I'm gonna have to negotiate every time I got a bill come in or every time I want these patients. So I know from our conversation already today and our previous conversation, that's not necessarily a case. So can you talk a little bit about how to successfully strategically establish relationships with PI attorneys so that you can...

you can not have to angle and you end up having a good pipeline and a good relationship. So you minimize the need to do that so often.

Michael Coates (40:04.256)
But let's deal on the hag a little bit because, you know, again, however you're getting paid, I mean, if you're just pure cash and point of sale and the patient's paying you, but it's usually really low rates that they're paying you on cash and they don't want to do larger things because they want to avoid bigger bills, right? So think of what your staff deals with insurance. Think of when you're intaking an insurance patient and you're getting all the insurance station, you're dealing with the insurance back and forth.

All the time that is done, you do that to get paid, don't you? Yes. You have less paperwork and PI than you have an insurance. You're just doing like the leaner letter protection. You don't need patient financials. When it comes time to be paid, I mean, there are ways, like for example, like my program members, we've got preset emails that they just use to get the information they need. So it's just cut and paste and send, right? And then get the information and there are ways to utilize it. The time you spend is not what you think.

It doesn't take a lot of time. And generally when you're doing it, as I always recommend, part of the method is use the email to negotiate and use the phone for relationships. Do not negotiate with a law firm or a law firm staffer by phone. Email, the paper trail. You can do things at your leisure. There are ways that could be like cut and paste. You can utilize to go back really easy. Set the trail and you've got the advantage there.

because attorneys will be more truthful in writing than they will orally. Phone is where you want to say, like let's say to the attorney about what really happened in this case. Maybe it was a really bad result. And this guy really is gonna get you more patients coming in. Hey, next week let me send you three, whatever that is. That relationship you get by the phone, but you don't negotiate there. So I want you to first don't believe,

that there's a lot more work because you've got to negotiate with an attorney. It is actually less work than your normal insurance patient for your staff and you. It's just that it becomes concentrated at the time that the case is resolved.

Garrett Salpeter (42:14.454)
Okay, that's a good reframe. And that makes sense. And also, I really like what you said there about negotiate by email, build relationship over the phone. That's a good...

Michael Coates (42:25.312)
Well, and you know, listen, you're gonna have some trusted attorneys, right? The people that you do develop these relationships with. I will say this, your biggest danger as provider is not the one attorney that your patient brings to you, because that's the attorney on the case and they brought them to you, because that's a risk of one bill. But the person you trust, let's say you've got 30, 40, I've had providers that have had hundreds of open matters with a single attorney, hundreds.

that is potential practice killer. In fact, one was only being paid, I think after the first five matters resolved, 20 % of his bills. He was a Cairo neuro. 20 % and looking at another 400 ,000 in receivables that they may lose out on would kill his practice. So, but by quickly shifting and putting in like, again, even though he didn't have the processes that made things better, was able to now through following the techniques,

getting paid 80 to 100 % of the rest of it saved the practice. So it really does matter that it didn't take much. And when you have a lot with even a trusted firm, you got to be careful to make sure that you're getting what they say and don't assume. And then when you do, you'll find that you get it back on track where maybe you'd have spent more time on the first few, but the rest is like rope.

Garrett Salpeter (43:51.222)
Okay, so there's some concentration risk. If you have all of your patients coming from one attorney, do you recommend that practices establish relationships with multiple PI attorneys to avoid concentration risk?

Michael Coates (44:06.303)
I mean, think of stock investing. If anybody was a stock manager, they'd say, no, you don't put all your money in one stock. You diversify the portfolio and that makes a safer portfolio that you have less risk. Well, like anything else, I think for any business in America. So let's put back on, put off the provider hat. Let's put on the business hat. Any business in America, you want to diversify your customer or client base.

and that is safer for you because if not, you lose the big guy. Now you've got a real problem when you've expanded staff, expanded operations, and that goes. So you wanna continuously build relationships and you wanna build relationships that matter. I laugh when I've seen law firms that continually screw some providers and when the provider stands up and finally learns, they can say, no, no more.

And now with the remaining ones getting paid right, they say, well, I'm not sending any more patients to you. The provider says, well, I've got two words to respond to that.

Thank you. They just made them a profit, not coming from a law firm that literally is gonna try to screw them on every matter. It made them more profitable right away. It's like sometimes saying no is your best response. But again, when you learn how to do this right, even the more difficult firms you'll find, you can get profitably paid. And the ones that you have the good relationships, those are the ones you expand more, right? And bill. And that's not difficult to do.

but it's not by saying, I think people think and providers think, oh, when I sit down with an attorney, we are great with our patients. Boy, do we get them healthy. Do you think there's any provider that doesn't say the same thing?

Garrett Salpeter (45:59.926)
Right, not a big differentiator.

Michael Coates (46:02.56)
No, so one could be new fit, right? And that's a new method. I mean, that could be a differentiated, but there's other things that are specific to PI. Like I said, we don't diagram accidents. We don't have our patients in the lobby without seeing us. Circle body parts are put pain scale ratings. We provide fee and bill support for you to use with the adjusters. All the many things you can learn that can set you apart to where you become more of the go -to provider. And...

I will say this, do realize if you're an NPI and you're building relationships, not all cases are winners. So you're looking at the aggregate overall. But let me give you an, I think like, I don't know if I commented on this or not, but there is a three office physical therapy practice. So they were getting 52 % as they follow a business method called traction, which I love by the way.

follow a lot of traction. It is. And so they tracked for three years their personal injury results. Very specifically, in incredible detail, they were getting 52 % of their full out of network rates in PI, which most practices say, hey, that's awesome. We're making a good profit. After one year in the program when they learned how to put better processes in place,

Garrett Salpeter (47:00.822)
Yeah, so we, it's great.

Michael Coates (47:28.416)
and how to address this, they went from 52 % to 72 % within 12 months.

Within 12 more months, they're at 80%. They not only more than doubled their gross revenues, they're like five times their net. And as a business owner, don't think of just your gross revenues, you gotta think of your net revenues, how much you keep in your pocket at the end of the day. Oh, not only that, they probably tripled their PI cases coming in. What, I got a lot more money and more PI cases? How wonderful.

And I think for the physical therapist, you guys have a real advantage over others. And the reason for that is, orthos, neuros, surgical centers are more used to, post -surgery, sending those patients to you, a physical therapy clinic, to get healed. So when you can also identify, I do PI and grab that bag and you're able to do things the right way for the attorneys, right? And be part of that lean or LOP network.

you really have that advantage, right? And to getting in the business. And remember, when you do that with a clinic or with a, say, an ortho, neuro on the PI side and they love you, they're gonna be sending you other patients that aren't even PI on the rehab that is needed.

Garrett Salpeter (48:50.038)
That makes a lot of sense. So you've alluded a few times to the types of content that you cover. So personal injury made easy is dot com is your URL and your program. So is there training, you know, beginning to end in terms of how to network with and establish relationships with attorneys and then these things in your office, like you talked about not having a patient, you know, circle areas or do things in the waiting room without, without guidance or, or do recreate.

you know, accidents with matchbox cars and, you know, how to take notes and how to, you know, some of these procedural things and then all the way through negotiating if need be at the end of, you know, when it comes time to collect at the end of the plan of care and things like that. Is that, you know, is that the extent of what's covered and what do those, what does that curriculum look like overall and how do people interact with you?

Michael Coates (49:40.224)
Oh, yeah, if you're asking on the business advantage program we have, I'm happy to go into that a little bit. So the Negotiations I Keto training is for anybody who wants to just sign up and do it. All the business advantage members get that for free. And whenever they do and they get all the recordings for rewatch, whatever they want to do and participate. But the business advantage program focuses on, I call personal injury the high profit highway. For the things that we talked about.

And if you want a high profit practice, you want to be on the high profit highway for all those advantages. There's three segments to that road. The program covers all three. So the first segment, like when you take a trip, you know, you have, I say, what am I going to pack? Right? What's the weather going to be like? What should I pack? And, you know, in a lot of trips you go, oh my God, I forgot my wallet at home. Turn around and go back or whatever it was. I forgot something. When you put the right processes in place, as you all know, your medical offices, you're more efficient, you're more effective. That works for

any medical office segment, but especially also for PI. So the business advantage members learn what's not only unique for PI, but it will help you in your overall practice on those processes, okay? The middle part of the road, that's the windy part, going up the mountain, ice, weather conditions, rain comes in, sleet, potholes, obstacles you see and don't see, that's getting paid. Now that happens even in insurance and other things, but in PI...

You're dealing with law firms, med pay insurers, PIP insurers, all those things. So we focus on how to address being properly paid in PI and to make that easier for you, right? And then the last segment of the road, so you get through the winding part of the road and you get on the other side of the mountain, you're in that great straightaway. You ever driven, you know, you put the convertible top down, the wind's in the hair, you got your tunes blasting, pedal to the metal, you're on that straightaway, that's growth.

That's where you're expanding relationships that matter with the right law firms. You're expanding with those who know you best, your patients, your best referral sources. How do I create, identify and arm raving fans and how to address medical collaboration in this space with peers to really also super fill up the patient base. So the program covers all of that and it can be a lot to chew like anything and I know...

Michael Coates (52:06.24)
providers are very busy. So two things, one is we really support staff being involved and take care of the staff so that they're learning and bringing it back also along with the provider. But you can pick what chunk matters to you now. So this is where you can get into what matters to you right away. Hit that first, get the others later, because I really believe progress is perfection. So as a coach, within this, now we have a bunch of tools, videos, online trainings.

I coach the providers every week. So it's something which is there to help, to support. I really believe in staff when you up their skill level, in today's medical staff who are leaving, and a lot of times hard to find good trained people, they want to build their skill levels. If you don't, they're gonna leave. If you don't build those skill levels, and if you build them, they're gonna be happier and they're gonna stay.

Garrett Salpeter (53:03.414)
Yes, a lot of agreement is in there.

Michael Coates (53:05.152)
No, so by the way, so you can go to personalinjurymadeeasy .com and you'll get the link to go see more about the Business Advantage program. On there's also about Negotiations Aikido, but you can go directly for that at negotiationsaikido .com and get that specifically if you'd like. I'd love to talk with you and see if there's a fit. You know, in the end, I wanna make sure it's, you know, I don't help the unethical. I do however you're doing, but that's not, I'm not trying to help those guys or gals.

So if you really want to practice right, integrity is one of our core values and it's in everything that we do. So we're really a believer in that. We're really a believer in the science behind things because that's what personal injury needs. And we're really a believer in the team approach. Team on your end, the team on our end and the team within our community and working all together.

Garrett Salpeter (53:59.03)
Awesome. I appreciate that perspective and really your experience and your overall approach to this field. I think it's just cool to be able to have been working as an attorney, have that experience and now be able to, to coach people through practices, through this from the other side. You know, you bring a lot of great wisdom and experience and I've certainly enjoyed my conversations with you. I've learned a lot. It inspires me to even.

Is this something we want to consider doing more of at our practice in Austin? I mean, you know, we have our fully functioning, successful clinic here and something that I'm even intrigued.

Michael Coates (54:40.512)
Hey, my daughter now lives in Austin, so do it so I can come out and I see you when I go see her. Now, but remember, look, I'm not here to teach you how to treat. You know how to treat patients, okay? This is business training. The Business Advantage program is to give you a business advantage, not a treatment advantage. You know that. So I wanna give that to you and Dr. Garrett wants to give that to you. So again, that becomes, those are all personal decisions. Oh, by the way, I've got a book coming out.

Garrett Salpeter (54:44.438)
There we go. That's right.

Michael Coates (55:09.056)
called Personal Injury Made Easy, lo and behold. Should be out shortly, get it on Amazon. And there are those that like to learn by books. This is not gonna be a short book. This is gonna be a long book. It's a lot of value in it. But you only learn so much in a book and you got questions. That's why I think these other things are there to support what you do. However it is, I'm a huge believer in learning. It never stops. I've been doing this for a long time. I continue to learn.

Everybody has, I think, coaches when I've all my life, whether sports, when I played division one water polo, as an attorney had coaches and partners to help teach me and mentors and I did throughout business. So, you know, it's not just one, it's find those people in particular niches that will help you to raise you up and get you there faster. Coaching and services like mine or other people is about making you better, getting you there faster and making it easier. So you can do it.

however you've been doing it before, or you can do it that way and to try to get to that high profit practice in a little bit easier and faster fashion that you thought.

Garrett Salpeter (56:19.446)
Amen to all of that. That's great. Tiger Woods has a swing coach and all the best golfers do all the best. Yeah.

Michael Coates (56:27.52)
He had nine at one point, nine coaches on different things. I think it was.

Garrett Salpeter (56:32.054)
Yeah, I've got, I've got multiple coaches in different areas of business and life. Uh, yeah, a hundred percent. I agree with you there. And I know that you know, your stuff and, and definitely for people listening, if you're intrigued at all, I think Michael could be a very effective coach in this domain here. So I appreciate you coming on Michael and sharing your perspective on the personal injury world. I imagine that at least a few people listening to this are going to be intrigued in, in exploring this.

And if anyone listening to this does have experience using the newbie in a PI practice or practice with some PI emphasis, please reach out and let me know. I want to hear about your experience as well. And.

Michael Coates (57:14.112)
Oh, and by the way, feel free to reach out to me at michael at pimateasy .com.

Garrett Salpeter (57:20.406)
Awesome, awesome. Thank you for sharing that too. So we got your website, we got your email. Are you on social media at all? Any other channels or?

Michael Coates (57:29.28)
Well, yeah, LinkedIn, Facebook, we've got an Insiders Facebook group where I post things all the time. I got a tip Tuesday. I'm always posting tips or what's going on. So if you go to Personal Injury Insiders, Personal Injury Made Easy Insiders, happy to get you into that private Facebook group as well.

Garrett Salpeter (57:48.31)
Awesome, thank you for extending that to our community here. And yeah, thanks again for coming on. Oh, yeah.

Michael Coates (57:53.76)
Oh, one last thing for Negotiate Psycheto, because I don't want to, I don't know when you're publishing this, but while this one's coming up soon, there is still an early bird special to get in. And if you're watching it for the first time when you see it, you can always email me and see what the best pricing can get to get you into I Keto. Cause I really like to have your people in there, but act fast because I got kind of limited spots for that to make it a really good, cause it's an interactive training in there. But I'd encourage you to go to Negotiate Psycheto.

Sign up right now, take advantage of the special, save you some money, and that'd be great.

Garrett Salpeter (58:28.246)
I think this is, by the time this comes out, it'll be April 19th, a few weeks from the day we're actually having this conversation. So.

Michael Coates (58:34.528)
That's the first day of the next session.

Garrett Salpeter (58:37.014)
Darn it. Alright, so... Sorry for listening to this.

Michael Coates (58:42.144)
But that's okay, there'll be one after, I think we're looking for that next one in July to do that. But, you know, so there's always something more. Again, this is something I'm committed to you for the long term to help you. And you'll have people that will be in Aikido every time I do it, because there's always more that you learn, more things I will cover in different aspects and scenarios. And like anything else, to master any skill, mastery takes some time, but you can be better.

Garrett Salpeter (59:09.014)
It does.

Michael Coates (59:10.816)
right away. And I literally mean, when you do attend something like that, the very next day, you're making more money. One matter will make you more than it costs you for negotiations to I -Keto. One patient matter and one bill, you'll get more. That this will help you on all of them.

Garrett Salpeter (59:29.078)
That's a good time to value is a good metric. How long, how long when you invest something, how long until you see value from it? So literally the next day, that's, that's pretty damn good time to value, Michael. Excellent. Uh, thanks again for coming on. I think this was a very compelling conversation and I'm excited to continue to find ways to, to collaborate and also eager to, to see what, what clinics within New Fit Nation are already doing this or are going to, to start and.

hear about all that experience. So great things happening. Thanks again, Michael, and thank you everyone for tuning into this episode.

Michael Coates (01:00:04.416)
Look what I have. Now, don't forget, if you haven't bought the book and read it, get the New Fit book, because it's pretty awesome. So just all the New Fit tribe out there, look, you've got a great product and service. I'm hoping to see this more and more applied in PI, because I think it helps the patient. It will help the provider. It'll help the industry. So I can only encourage you to use more of the New Fit in it, and then profit buy it as you do it.

Garrett Salpeter (01:00:12.726)
Oh, thank you.

Garrett Salpeter (01:00:32.15)
Excellent great words on which to end. Thanks again Michael and everybody for listening and we will see you on the next Episode of the undercurrent podcast. Bye. Bye

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