Check Your Ego At The Door
- haileycrawford3
- Apr 30
- 6 min read
Chad Madden is the Founder of Madden Physical Therapy in Harrisburg, Pennsylvania. Chad is also the co-founder Breakthrough PT Marketing and is the most sought after marketing expert in Private Practice PT. He received his Master’s Degree in Physical Therapy at College Misericordia in Dallas, PA and is the author of 3 Books: Pain Free Motion™ for Your Lower Back: Relief without Medications, Injections and Surgery; Killer Marketing Secrets; Back to Normal.
Episode Highlights
2:45 – Student to therapist to marketer to business owner. “Two or three years into my career, I opened my own practice and quickly discovered there's a lot more to it than just high quality of care, treatment protocols, diagnostics, etc. I really started focusing on marketing because if we created enough demand for our services, we could solve a lot of other problems along the way. I always believed that if I had the patients coming through first, then I could work on the revenue cycle later on. I did a deep dive, and it was a unique situation in central Pennsylvania, where my clinics are. In the early 2000s, we had three hospital systems that started to buy up the local physicians. For a hundred years, PT relied solely on physician referrals and that went away overnight. There's a really good study from January 2018 in the Journal of General Internal Medicine: between 2003 and 2014, there was a 53.6% decrease in physician referrals to PT for back pain and a dramatic rise in physician referrals within the healthcare system to specialists. Do you want $118,000 spinal fusion or a $1,200 plan of care in your chiropractic office or my PT office? We're providing a tremendous outcome for the dollar and that's a threat to some people that have a lot invested. Anyhow, my original plan was to have two clinics and help other practice owners expand their marketing. In November of 2012, I received a cold email, which I typically wouldn't respond to, that was unbranded and weird. It basically said, ‘you're a practice owner and I want to hop on a 15-minute call to learn more about your business.’ I agreed to do it eventually. That cold email came from Carl Mattiola, CEO and co-founder of Breakthrough. Carl asked me some questions about my practice and, at five minutes in, I asked what we were doing here – he didn’t know. He had an impressive professional background and a life-changing experience with conservative care and just wanted to give back to that industry. He found me via Google Earth in his hunt to talk to private practice owners. I was #17 on his list, but the first owner that talked about my goals instead of my pain points. Anyways, he created software called Clinic Metrics that still exists today and is used in 200 practices, but he started referring people to him for that and to me for marketing. I started working with private practice owners and I hated it. He told me I just don't know how to teach, so I took a lot of courses in how to teach, to create awareness and to drive home the point in terms of what we're doing there. Today at Breakthrough, we provide a ton of free information for PTs and chiropractic practices.”
13:55 - Four Key Areas of Pain Points. “When we think about a private practice, there are really four key areas. Most of us were trained as a clinician to know how to diagnose, treat, create a treatment plan, etc., but are not aware of these four key areas.
Personnel: how to hire a team, how to grow, how to terminate, how to do a review, how to incentivize, etc.
Finance: how to run revenue cycle management. If we're expecting to collect $100,000 and we only have $60,000, how do we solve that problem? Most of us have no idea where to start looking.
Marketing: most of us in private practice believe that if we provide high quality of care and rely on word-of-mouth referral, we're going to have more demand for our services. That's not real and is traced back to an AMA guideline from 1903, which said that physicians could not advertise because they wanted to differentiate themselves from charlatans snake oil salesmen. They quickly went back on that, but the issue is that it became like an urban legend that it still has legs over a hundred years later. How do we think about that?
Operations: there's a lot of confusion around systems. Most private practice owners believe that, because they're treating 40- 60 hours a week, they need systems, yet they have no idea how to create or correct processes that make up the system. They want to work on the business rather than in it, but they have no idea how to do that. That smacked me in the face about six months into private practice and I had to go learn how to do all those four things.
When I'm talking with other owners, there are a lot of self-limiting beliefs typically early on, especially if they haven't tried to do anything above and beyond themselves, but it's all about ego.”
19:41 - Biggest pain point. “Devastating personal loss. In Q4 of 2009, I lost $98,000 in my practice. That was income minus expenses, so this is cash accounting. It was not a quarrel and there was no fudgery at all. I almost lost my practice, my marriage, and almost everything across the board. It was absolutely devastating. I made a mistake in scaling, and it was pretty brutal.”
27:52 – Increased demand for services. “There are basically five ways that a private practice can increase demand: the five new patient channels.
Reactivations: that's a patient, you saw last year that comes back for her another reason a year later.
Word of mouth referrals: there's a very simple three step process that we teach. It's reproducible. It works extremely well all over the U.S.
Other professional licensed individuals referrals: functional med doctor, naturopath, chiropractor, etc. referring to PT.
Partners: who are the 10 largest organizations in your area that offer that type of insurance to their employees? In my area, it's Highmark. I should know who the top 20 largest employers are because we can have that partner or organization promote our services to their employees. That tends to be a very nice way to improve our payer mix, our bottom line, and the demand for our service.
Cold traffic marketing: this can be legacy media, media types, TV, print, etc. or online with Facebook, Instagram, TikTok, Google, YouTube, etc.
In the beginning, we do an assessment to see where you're at today. Most practices at that 300-500K are doing very little to generate demand for their services and typically have one that's working really well for them, but they don't have the time to dedicate to it. We then build up from there. In a larger practice that have 10-50 million a year in revenue, they typically have the patient reactivations down but want a bigger pond by cold traffic marketing. Again, that's the highest hanging fruit. Reactivations are the lowest hanging fruit. At Breakthrough, through software, automation, and AI, we can help any practice develop increased demand for their services.”
32:09 - Time commitment for Breakthrough’s initial assessment. “A good one's an hour. We talk with thousands of practices, and we have a checklist down. We cover where your new patient's coming from, what are you doing today, and what's happening consistently? We then do a strategy call, where we talk about your next step or the three things you should be focusing on to improve patient demand. This is when people make a decision. They either want to move forward with us or not.”
34:03 - Invest back in yourself! “Since my PT school graduation and the first 15 years after, I have invested over $200,000 in additional business courses and coaching in order to learn. I ended up building a practice to a $20 million level in terms of valuation. It’s a huge investment. When I had that $98,000 loss in a Q4 2009, the thing that bounced me out two years later was buying a $500 Jeffrey Gitomer package and actually investing back in myself. Understanding how to market direct to consumer got me back on track and helped our practice grow. We did 600% practice growth within 30 months and ultimately became Breakthrough. It was the willingness to invest time and money back into my own education.”
36:16 – Biggest lesson learned! “Going back to those four key areas of finance, marketing, personnel, operations, I expanded the space, our ability to deliver, and then anything else. We went from 4,000 to 8,000 square feet, and I opened a second office. Disaster, but I thought I was invincible. For two years, I was splitting time between those two practices rather than hiring adequately and making sure we had the team in place. I did not ramp up our marketing and frankly didn’t know how to do that. We have since opened up four other de novo clinics and went from zero to profitable in 90 days in each. Within six weeks, we were over 100 visits in every one of those locations. Lesson was learned!”
Episode Resources
Comments