Megan Walker: Hello and welcome to Healthcare Online, our special podcast for Allied Health Specialist gps and gps. And our special guest is Damien Adler Co. Founder of Power Diary. Hi Damien, how are you?
Damien Adler: Very well, thank you. How are you? Me?
Megan Walker: Very good, thank you. Now, if you're feeling like deja vu folks, it is the second time we've spoken with Damien in.
Probably as many weeks because we had such an action packed conversation. Damien and I really had to put the brakes on hard. We covered. What Power Diary can do. Of course, we looked at improving the value that you offer to your team members to retain them without having to, you know, go on that race to the bottom of constantly paying more and more.
We looked at efficiencies to stream operations. We talked about no show policies and the importance of running a practice that doesn't create practitioner stress. So that was a lot that we covered. So that was episode 14. So if anyone's interested in going back and having a look at that, it is where you are finding this one.
So today we are going to cover part two. We had a such a long list dam. We were overly ambitious.
Damien Adler: We were,
Megan Walker: we we're gonna talk about. The tension that I see so many practitioners, therapists, and clinicians face when charging, you know that that fear of charging, that creeping feeling of self-worth that comes in, that muddies the waters there, fair charging for the value delivered.
We're going to be talking about NDIS charging and the changes that we've seen around that. Diversification and going national, not just local. So, Damien. What do you reckon? That's all that sounds. I think we may
Damien Adler: have set ourselves an ambitious target again, but I think, I think we can do it.
Megan Walker: I love it. I love it.
So let's start with that self-worth that comes up now. You and I have both been in this space a long time. You're a psychologist, you're now got Power Diary. You know, I've been in this space for 27 years. It is such a common conversation that I'm sure you have had as well as I've had of I can't possibly charge.
X amount. I am a healthcare professional. I'm in this to help. The greater good money is dirty, evil and wrong. My services should be free. So can you start with a reframe around that self-worth getting in the way of running a business?
Damien Adler: Yeah, look, I think that the first thing to sort of pull up there is around this idea of that the healthcare should be free.
You. I happen to think it would be fantastic and I would actually support like, you know, higher taxes and more like, you know, directly paid for healthcare, right? Because I think healthcare is super important, but given that isn't the case and isn't, you know, and the government, you know, it's really at a government level to kind of fix that, right?
That if there are people that struggle with accessibility and so forth due to costs, that's actually something that sits at a government level. And we can do things via our associations and so forth on that, but it can't sit with the individual practitioner. And I think it's important that as practitioners we kind of separate ourselves from that, that ideal and say, what is the reality of, you know, where of what we where we operate.
And then look at it realistically based on that, right? And not try, because it, it's impossible to do right thing. If you wanna say, we're gonna, these, we're gonna make it super accessible because we have a limited amount of time, you know, essentially to sell. If we think of it in those terms. And therefore the return we get on that, that's, you know, what we're primarily where most income is coming from.
Although, as we'll talk about in the, there's also other ways of expanding that, but we need to sort of separate those things out and understand that yes, we operate in a system where healthcare is run as a business. We didn't create that scenario, but that is the reality we're in. And then we need to look at a clear eye and.
Say how we see people charging. Sort of unnecessarily discounted rates across the board to everyone, right? Which means that their, their charitable instinct is being sort of diluted by indiscriminate application of that, right? It's getting applied to across everyone. It's much better, in my mind, right, to charge what is fair and reasonable, which is usually a lot more than what clinicians subjectively feel that they should be charging or
pay that.
Altruistic and do some pro bono work or do some You can target that right at the yeah, the, I guess the population that truly is gonna benefit the most from it. Right. And that actually has a, a bigger impact and it leaves it in the control of the practitioner because they can determine how much time they.
Specifically, you know, pro bono or heavily discounted work. They want to, but those options only become available when the charging overall is at a level that you can run a healthy, financially successful practice and not be stressed out about money. Because if you are, if your practice is struggling and you're uncomfortable with raising rates and things like that, yeah, then your ability, your power to actually help those that might actually benefit.
It is impaired anyway. Not sustainable. I love that. That my take.
Megan Walker: I love it. I saw an example once, and I wanna hear your thoughts on this. It was a GP practice, so I know you are predominantly in the allied health world. But it was a situation where they said we have a thousand dollars hardship budget a month.
Right. So if anyone needs to bulk bill, we can draw from it. It was quite a big practice. A lot of clinicians. And then once that hardship budget is up, we actually cap it. And say, we've reached the limit on what the practice can sustain. Yeah. We hold that over to next month. Have you seen examples like that or, you know, capped amounts that people have in their practice?
Damien Adler: I haven't seen it as publicly done like that. And, you know, it's a really interesting idea. But I've certainly seen a lot of people do that behind the scenes, right. Where they'll look at and fact, one of things you can do, like in our system.
patient type and you can put, so you can run reports and go, okay, how many of these services or are, are we running concurrently? And therefore you can keep like a really good eye on like what the ratios are of those things. But I think that the broader point of that practice is doing, which is.
You know, the take home there is making a clearly defined thing that they're doing, you know, and capping it so they've got a, a a constraint on it, right? So that they're not compromising the success of the practice and the viability of the practice. But also, you know, allowing themselves to provide those services in a way that, you know, that reaches the people that.
Really do, you know, really do need it and gonna benefit the most.
Megan Walker: Yeah. Nice. Boundaries. So I have another thought for you. One of the most popular posts I've ever put on social media was along the lines of, what story are you telling yourself about your client's financial situation?
Yeah, yeah. Because I'd had so many people say, oh, my clients will never pay $200 an hour for a session. They can't afford it. They're all struggling. It's difficult Financial times. My clients will not pay that. And can you give us a reframe around, well, I know personally I've had financial hardship in my life and a medical situation's come up and I found that money, I reprioritize things like that was my decision.
That was my call. Reframe a statement.
Damien Adler: No, look, I, I agree that this is a trap that people fall. we don't really truly know like the circumstances of our, our, our clients. And we also don't know how resourceful they are and, and in the experience that like we had directly in the clinic, but we also see it when working with, with customers People are quite creative when, when it comes down to, so for instance, when we put prices up, when we had our psychology practice, we would get people that we were concerned about, that we might lose and whatnot. But it's amazing how, if they truly couldn't afford it, how other people will come. Like, so it may be family, it might be workplace.
There's other often ways that people go, Hey, I don't want that to dis, you know, to be discontinued, or, you know, we'll support that. Or where people have been able to do simple things like we rearrange the appointment timing, so it falls on a pay cycle and they get the rebate or whatever it might be applicable and they do it, but.
So I think the idea that it's usually an anxiety that does not come into fruition in the way, like, it does not manifest in the way that people think it will when they put the prices up and it's gonna be this mass drop off, I think that, you know, that people have a way of prioritizing, you know, the things that are important to them.
And, you know, there, there's some, different context, but they kind of will talk about like, people for instance, that, that are smokers, right? And how even with all the tax and people have found a way, continue smoking, right? Which is. Extreme example, when people are motivated, like they can often find ways to do things. So I think it's somewhat of a distraction.
We need to kind of go back to the core thing about what can I control? Well, you know, I need to be able to run a practice, sustainable, successful and that sort of. Gives you the financial reward for the risk you're taking and your experience and the qualifications and so forth. Let that be the kind of guiding principle there.
Right. And then, you know, see, let other things fall when they do. But the other point that I would make, because I think sometimes increasing prices, you can more than losing existing clients, there can be a dip.
Before people had a chance to experience the practice and, and value it, they may not like, they may be put off the, the thinking goes that way, and I think there can be, you know that the more that you increase prices, it is going to appeal to a smaller group of people. There are hard limits, right? That eventually there will be some limits.
It's usually way further out than what people think, but.
Increase your charges by 25%, right? And let's say worst scenario, you got 25% less referrals. You are still well and truly ahead, right? Yes. Because you are getting the same money, but you are only working 75% of the, of what you are now, right? And so with that remaining 25%, you can do whatever. You can have fun and do have better work life balance if that's what you.
But you could also apply that to build other things that might generate income. So it might be, you wanna write the book, it might be to develop an e-course, for instance that you know, that is going to provide ongoing, recurring revenue to, to your practice. So even if there is. That does not mean that you made a mistake in doing that.
It's about being, assessing that and seeing where it kind of, where it lies. But dropping referrals and having more time through other things, that's still a win.
Megan Walker: Yeah, absolutely. A huge win. Now I wanna ask you a question about NDIS charging, and this is a whole can of worms. Yeah. So I'm more thinking from the angle that.
We have seen prices jump up in a, in a big jump. I remember, you know, 17 years ago when I first started this business, we had dieticians that couldn't survive as private practices. They weren't, yeah, because they were the max that they could charge. You might have been $80 a session. It was sort of like they were earning 60 to $80,000 a year if they went out and worked for themselves.
There wasn't any re rebate available. This was pre, EPCs, prec, pre mental health care, all of that. It was if you want it, you pay for it. And the most you'll ever be able to get back on an appointment is through your private health. Yeah, no doubt. You remember those days.
You're much younger than I am, Damien, you
Damien Adler: remember those days? Probably not as much as you might.
Megan Walker: So would you agree that one thing NDIS and other schemes have done is create a more fair. Playing field in pricing in terms of covering more of the hard costs and the realities in private practice. Tell me your thoughts.
Damien Adler: Absolutely. And I think the best indication of this is when you look at what the professional associations have in terms of their recommended fees, right?
Because they usually, I think, do a pretty good job of dialing into you know, roughly what the cost are, what's reasonable. They're looking across other industries and other comparable professions. And I mean, I don't always agree with where they land, but it's usually a much better job than what the individual practitioner does, right.
Assessing you. Typically the recommended fees are much higher than what people feel they can get. You know, they can actually get away with charging. Now, NDIS is you know, I think it's better aligned, you know, with the true cost of running these, these services. And I think to draw people into private practice and make sure these services are available and to encourage people into the industry and.
it needs to be viable and it needs to be a return on the, you know, the effort, the education, and the risk that, you know, goes with running, you know, a practice and, and all the stresses that kind of go with that, right? So it's gotta be that, so I, I sort of more see that that price jump that we see, it's, that's more actually of a correction.
Yes. You know, rather than it being something distortion. Now we know that okay, there are. Cases. And there's certainly examples and there's things where, like anything where people do the wrong thing, right? And you see, you know, NDIS has been clear examples of where it's been, you know, misused and there's been fraud and so forth.
So let's put that kind of, you know, aside and say, yes, we rec, you know, that needs to be dealt with. But overall, the fact that that. You know, charges more and has sort of, you know, that's not like, it's not outta the, you know, the realms of what it actually costs to run a practice and to engage and provide a great, you know, qualified, registered, you know, service.
Yes. So I think there's that. The other, you know, part of it to think about, I think is that the actual compliance. Costs and the administrative costs around performing work under, you know, n ds, they don't pay. You know that all that.
Hidden. Because, you know, chasing out plans and making sure that things are aligned and the funding's there and it's tracking it, and I mean, it's a, it's a complicated piece of machinery there that needs to be managed. And if it goes wrong, it's the practitioner or the practice that wears it, you know, like the number of times people provided services and.
Broadly what?
Reasonable return, you know, on that. So that's kind of my, you know, the hot take on, on, on that.
Megan Walker: just always strikes me as really funny that we have these more emotionally charged conversations around pricing for health practice. If this was another type of professional service, an accounting firm, legal firm, architect.
It wouldn't have that emotional charge to it, it would be in this hourly rate. We are keeping the lights on, paying for stamps, paying for carpet washed every year, paying for fire extinguishers like the. It is such a fact-based businesses, those other professional services. But when we say health practice, well
Damien Adler: it just, yeah, it's that, that's right.
Well, if you look at the legal profession, you know, and you look at the, the charges, you know, that you see, like, you know, we get, you know, we'll get a bill for whatever our, you know, council has done and you look at. Some of the charges on there for things like photocopying, and you're like, what? You got someone handwriting this stuff?
Like, you know, like, but that's, that's the, that's, you know, that's what do you do? Like that? That's it. I, I think in health, that's right. And it's a combination of things where community expectation is one thing, you know? And then the very sort of people that get into healthcare obviously are typically motivated, you know, to help others.
And alistic wanna make a positive impact. Put two things, but, but sort take goes gap too. Speak to the government, speak to your local representative, right? About increasing the funding available. If it's a Medicare rebated service about increasing the rebates, if it's not a Medicare rebated service, but should be then talk to your local representative and make it an issue right, with, with them, because that's really where the change, you know, will sort of come about.
Government will fund without, I won't go on too much of a tangent here, but the government, like, you know, if you think about what they'll spend on medication, right? Subsidizing medication and some of these biological interventions, which okay, great, but actually if we did some preventative work or we did that in, in the allied health setting we can see in a research we're gonna get like an economically good outcome as well as a.
So it's all about though, making sure that where there are those things we point the energy and the heat and the concern in the right direction. It shouldn't be at practitioners and it shouldn't be a practitioner turning on themselves. Yeah. And feeling, you know, but turn onto the, the government of the day and like, hey, make it an issue.
And enough people do that. That's where change comes about.
Megan Walker: Yeah. Wow. Okay. I, so I could listen to you talk about this for ages because sometimes I don't have the words and I, I hear the tension from people, you know, bringing up these issues over and over again. And I think, why does it have such a different feeling to it than other businesses?
But I really like how you brought together all of those, those factors that altruism is such a big one. So we're not having a go at anyone. We're just trying. No, we're not.
Damien Adler: No, it's, yeah. No, totally.
Megan Walker: And in terms of growth, and this is our sort of our last. Kind, kind of conversation and path that we're gonna go down is I've often thought that I've seen practices over the years exposed to high risk practices that I worked for affected by Bush fire and, you know, had to close completely other practices, affected Lismore, floods close completely, and, and all of these different horrible situations that.
Happened over a long period of time kept, I didn't realize, leading me down this path of healthcare courses and, and especially with covid, like what is going to sustain the practice if one of these big impacts hits? And some of these things are highly unlikely. But what's your thoughts, Damien, on diversifying so that you don't have all of your eggs in one basket, so that if four other physios open in the same street you want.
You know, basically run out of business. Tell us your thoughts about that diversification, thinking to drive sustainability of the practice.
Damien Adler: I, I, I'm a very visual person, right? Like in how I think. And so the way that I think about this, like, diversification is almost like the foundations that are holding up a building, right?
So we think of the sort of, look, imagine a building kind of on, on stilts. You're actually, you're in Queensland, right? So Yep. Plenty of that. Right? Exactly. So if we think about like a building being held up by, by stilt. So diversification is really. How many like stilts, how many posts are holding up that practice?
So in the worst case scenario, you have one center waiting, right? That might seem pretty strong, right? But one, you know, and that's where you have businesses that have sort of one modality on premises, maybe even solo practitioner or, but you.
It might be a thriving business on one level, right? Because that might be, you know, but it is still one thing and anything kind of impacts that, right? And takes that out for whatever reason. Could be all the things that you mentioned or something we didn't see coming, like covid. Then that whole practice becomes very, you know, is that the, the thing that's holding up get, that gets taken out.
Right? Yes. So each of the, the, you know, each pillar that we can put in place, you know, they don't, and priorities, but having multitude. Keeping the practice, you know, supporting the practice means that if the importance of any one of those is then reduced and it makes the practice far more right? Versatile.
So when we think about things like online courses, when we think about expanding to doing telehealth, right, when we think about expanding to have other people potentially providing services, employing or engaging other people in the practice. So diversifying those kind of income streams. If so happens to any one of those things, then the rest is there to kind of, support and even our own practice.
It. And Medicare was the sort of dominant. Thing and a lot of practices were solely focused on Medicare, and we took a decision early on that we would expand out. We would still have, we used to call Medicare the bread and butter. Okay. That's sort of like a primary, you know, support but still government funded.
It was the early days of Medicare, so subject to government change, which actually did happen. They reduced it from 18 maximum down to 10 sessions under for psychologist. but we also nurtured relationships with local organizations, nonprofits. We did a lot of corporate work. We did picked up EAPs.
We did a whole bunch of other things so that if something fundamentally changed with say Medicare or with particular modality. We would have other sort of supports that we already had the relationships built. We already had income streams and we could sort of turn them up if we needed to. So doing training for, for sort of NGOs government and sort of larger companies if we needed to, we could dial that right up.
Right? Mm-Hmm. And do become like a training organization if we really had to. You know, each industry will be different in each context, but when you sort of sit down and think about it, and. Here's my foundations. What's holding it up right now? If it's just me? Yes. You know, if it's one practitioner, like yeah.
Okay, so what can you do to kind of shore that up? It may even be things like making sure actually you have income protection insurance, right? To shore that. 'cause when you look at it as a, from a risk sort of assessment management point of view, you might think, okay, maybe some of these things I don't wanna do, but I do need to sho up a few of these things from an income point of view.
It can be things like insurance, but if you're thinking practice wise, it could be all the other things as well, like we've had practices in that. We've been around for a long time now, and so we've seen a lot of stuff happen over the years. We've seen people flooded out, you know, whole regions just flooded, gone.
Right. We've seen practices that have burnt down. We've seen practice that have been. Like that. And we're seeing unfortunately, of course you see our practitioners pass away, you know, that are running, you know, and getting, getting ill, so you can see the resilience. Often comes down to how many other things that kind of have in place that, that support it.
And the ones that are, well positioned, you know, they sort of sail through a lot better than of course, ones where it's a solo support. Something takes that out and then they're in real trouble very quickly.
Megan Walker: Yeah. So well said. I love your stilt analogy, especially the, the Queenslander reference.
It's so true. Like, take it out. What, what legs is standing on Literally. Yeah. Yeah. Years ago, and, and this is kind of a I'll, I'll start wrapping this up 'cause we, we've gotta be, we've gotta be good today, talk all day. But no, I did have a situation. I, I'm sure I've told you about this quite a few years ago, there was a big practice in a regional area quite a specific area of physiotherapy.
And then, you know, four people, four senior physios in that practice left and popped up in the area. So we went from one big one to then five practices with a not enough. Client base in that drivable area. So there's all sorts of things that weren't great about that situation, but something that really stuck in my mind from seeing that.
And each one of them rang me and said, we need marketing help. And I was like major conflict of interest. You got the one that you actually just left, you know, how is your restraint of trade? Anyway, separate conversation for another day. But something that, that just stuck with me forever was. If you don't have enough clients in your local drivable area and you want to niche down in a particular, you know, space, then sitting there and going, well, I've only got three clients this week.
There it is, is not enough to keep the doors open. So telehealth and what you mentioned and even choosing your niche, but thinking of it nationally, I've always been a huge advocate of. Tell me your thoughts on thinking beyond that drivable area.
Damien Adler: Yeah, absolutely, and I think to, to put even more to. It really surprised us actually in Covid, right?
Because like when we were sort of assessing and looking at things, we were thinking, well, yeah. Sort of looking at it and going, okay, I can see obviously mental health, psychology, counseling that's gonna pivot online pretty well, right? But we were more concerned about like the physios and massage therapist, but you know, the ones that a very tactile kind of, you know, experience and.
That we were particularly concerned about in terms of their, their wellbeing. What was amazing, you know, is to see that under the, the pressure of that, how creative people were, you know. And it was amazing to see that like, you know, they tried things outside their comfort zone, thought we thought about what they're delivering, right?
What they're, what, what is the core active ingredient in what they're providing, right? And so with a physio, you know, or an osteo or you know, where you'd think surely it's very tactile. But then they were able to pivot to demonstrating exercises, doing more video content. Deliver services or tangential things.
Right. Which I mean, I wouldn't, if I had sat there and tried to brainstorm it, I wouldn't have come up with that, you know, outside of the real need to do it. And then seeing, it was really inspirational to see these, you know, and, you know, talk to these different practices that they worked, how to pivot.
Right. So that was under, you know, the necessity as mother of, you know, invention. Think about that outside of, a crisis and, and go, yeah, what is out? If you've got a situation like that, you're geographically isolated or often we'll see someone, a health practitioner is in an area where there aren't many patients, but they're there because their spouses has got a job that that requires 'em to be there.
You know, and they're sort of a little bit stuck, but when you think about that expanding outside of that it can work so well. I think it's that going outside your, your comfort area or what you are comfortable with, you know, what you're used to. I should, you know, that's often very, you know, we can do our core stuff without really thinking it's kind of easy enough, but kind of what, you know, what could I do or what would happen if I absolutely needed to.
What other services could I provide? And it works so well and better than what, you know, because often people find, and they think that they kind of have to think about what they really enjoy, you know, and what they, what they really, you know, and have a whole different way of delivering it or packaging like what they do.
So, no. All, all for it. And I think, you know, this is the beauty of that. Technological age that we're in too, that you can have, you can have a satellite and get links. You be running batteries right?
And you can, you can operate, you can run your health practice, you know, from the side of a mountain if you want. Fantastic. And that, you know, that's unique in, in, in, in, in history of course. So, yeah. I think it's exciting and you know, it leads to more robust practices.
Megan Walker: Yeah. So good. You, you made me think of a a physio practice that had, locked up at home, locked back, locked up too. Guess where you can go? You can come and see us during covid come in for a, you know, release and assessment and a chat, and most importantly, a chat with a human being. You're so clever,
Damien Adler: right? Yeah. Give it to it. And away you go.
Megan Walker: Mobile Manny Petty from the podiatrist.
Anyways, that's getting into, I'm gonna get a backlash from saying that. Damien, thank you so much for such a great conversation. I love the fact that we fundamentally talked a lot about. Emotional responses to money in a way seem to be our, our theme for this, this chat, which was, is gonna be so helpful for so many people.
Where can folks go and find out more about Power Diary? You've got a free trial as well. Tell us about that.
Damien Adler: Yeah, absolutely. You can jump onto our website com and start a free trial. We've also got our team members there that you can jump on a chat or book a call in with them. And, you know, we can help out any way.
That we can help automate your practice. Away you go. Been around for a lot of years now has been, you know, like this sort of con, these sort of conversations in helping people with these sorts of things. I mean, it's, it's, you know, really what I love doing. So, thank you very much for, for having me on.
Absolutely been fun as always. Absolute pleasure, money. Talk with Damien. We can start our own a, b, c radio lookout. Thanks Dam. Really appreciate your wisdom and we'll talk to you soon.
Thank.
