Greg :
This is the new economy. This is the new opportunity that exists for all of us. You have a problem. You struggle through trying to find a solution for the problem. You finally figure out the solution, and you crack the code. It takes you years, it takes you lots of pain, lots of heartache in order to figure it out, you do. But then there's this other part. So now you figured it out for yourself.
Greg :
If you are willing to serve and talk to other people, you find out what are the other problems that they're having. You then realize that they were having a problem that you were having. You know, the solution to how to fix that problem. They don't, you know, the pain and the time that it took you to figure that out. They are currently going through that, and they would be happy to pay you to be able to figure that out and collapse the time because the time is costing them so much money. This is secrets for success. Welcome to the Secrets for Success podcast. I am your host, Greg Tod.
Greg :
Thank you guys for joining me, as always. Today I have a special guest, and when I say a special guest, a very special guest. Mary Koska, the owner of Ohana Occupational Therapy and the CEO of Docufast. Thank you so much for being on this podcast. Thank you for coming all the way from the other side of the earth to come and join me here today. I appreciate you.
Mary:
I'm excited to be here. Thanks for having.
Greg :
Awesome. Awesome. So, Mary, you've been in my world now for three and a half, nearly four years. Why don't you give people that have never heard of you, give them a little backstory of your journey as an occupational therapist?
Mary:
Sure. So I graduated in 1988, and I went across to the other end of the earth, to Washington state, in the mountains right away, and have stayed in this town of Leavenworth ever since then. And so my first career was a rural rehab hospital that was in the town. And then I did a couple of years of travel ot, and then I fell in love with working with kids in that. And then I worked in a variety of different school settings for 17 years. And the first five were driving, I don't think you know this, 1000 miles a week.
Greg :
1000 miles a week?
Mary:
The heck, yeah. It was an education service district. So what it was is that the really rural schools, like the indian reservations and just the ones that were way far north, that couldn't just have a therapist there all the time. They contracted days. So I did that for five years. And then when I was pregnant with Lukash, there was a position that opened up in my town, I only had to drive 5 miles, or not even five, like 2 miles to work. So that was great. So then I didn't have to do all that driving anymore.
Mary:
And then I worked in my local school district for twelve years. And then during that time, I really fell in love with the sensory kids, because they would be some of the most challenging kids having meltdowns and not functioning well in the school setting. And then I would take classes and learn stuff, and then it was like magic, and it worked. And so I just kept developing a passion for those kids, passionate about all the kids, but that was something special because it would be, you could take a kiddo that's just completely going ballistic, throwing furniture or biting other people or whatever, and just help them calm down and get self regulated. And it was just a powerful thing to learn and see. And so I just had a craving for really helping those kids. I started dreaming of an ideal setting, because schools are not an ideal setting. You're treating in the hallway.
Mary:
I've treated an electrical room. I mean, any school therapist listening to me, we can make a list. Like, you just grab a spot, you don't have your own space and equipment and all that in most places. And so I started kind of dreaming of what I wanted. And before I started ot school, I was definitely planning to have my own clinic someday. But it was just kind of a confidence thing, I guess. And then we always talk about pain is kind of what moves us sometimes. So I had just a really bad boss situation.
Mary:
I always had really great bosses, and I had one that was just something I had never experienced before. And so I finally decided to move on. But then an opportunity came up to work, birth of three, and where I got to work with parents and do home visits and the pets. It's really fun to work with a baby on one leg and their dogs laying on the other leg, and it's super fun. So then I really fell in love with that. And then I'm like, oh, I don't really need to try to build my own practice because this is really great. And then they closed. So that actually taught me a lot.
Mary:
That was devastating. They were in our community for 50 years, and they closed.
Greg :
What did it teach you?
Mary:
What do you mean?
Greg :
What did it teach you when they closed?
Mary:
Yeah, I was very aware of everything they did wrong. They weren't even collecting copays. I think what happened is, when they started, the money was better and they didn't have to operate like a business.
Greg :
Right.
Mary:
It was a nonprofit, and so they never really had to operate like a nonprofit where the community really knows you. And they do big fundraisers, so nobody really knew about them. And then they changed their name, like, three times. It was amazing. I mean, it had OT/PT speech, nurse, and a physician, but it wasn't run well.
Greg :
Okay.
Mary:
And so there were a lot of things that I was just. It's kind of, like, all sunk in later, but it was just a lot of things. But that's the first thing I can think of. They didn't even collect copace.
Greg :
You said when you got out of OT school, you said, someday you're going to have your own business. That someday ended up being. How many years?
Mary:
14 years ago. I'm trying to do the math. 35 years in OT school. I mean, I've been ot for 35 years.
Greg :
Okay, so someday ended up being 21 years. Yeah, 21 years. It took you to start your own business, and really, the reason why you ended up doing it was because of pain.
Mary:
Yeah. Like, I was going to do it. And then I got this other opportunity. I formed the LLC and started taking classes, and then I had this other opportunity, which I loved, but then they closed. And then what actually happened is I continued to treat some of the kids just for free. I had this one little girl who had later diagnosed with autism, but she was also blind, and she was just making amazing progress. And I'm like, I'm not going to stop working with her. So I just kept working with her for free until the insurance contract came through, and then I could bill, but I had to go back to rehab because I had to make some money while I was building this thing.
Mary:
And so that was 17 years since I had worked with adults. And I was terrified. And I got there, I was like, nothing's changed in 17 years. What the heck? The same reacher sock aid? Didn't they invent any cooler stuff since then?
Greg :
It's all the same.
Mary:
It's all the same. I couldn't believe it. And then I had an eye opening experience, like, oh, what I was doing is a thousand times harder. Adults is, they get paid more, but it's a lot easier than working with kids. Yeah. So the only thing that was really cool, that was new, is the sit to stand transfer things. So you weren't doing so much heavy lifting. That made a big difference.
Greg :
I think there's a lot of interesting things that you've said so far. Number one is Mary always knew that she wanted to be an entrepreneur one day, and she wanted to have her own practice. But whether it was confidence. It was this. It was that someday ended up being 21 years. So we talked about that. But there was another thing that you said, and it made me think of a situation that just recently happened to me as well. And you're like, you learned a lot of things throughout that time, not only how to be a great occupational therapist, but you also learned business practices of things to do and things not to do.
Greg :
And it's interesting that you brought up the nonprofit organizations that you're working for that end up going out of to. Okay, I'm going to say it on the podcast, but I was recently in Canada, right? And I was speaking at an event, and it was a nonprofit event, and the event did not go the way that they wanted it to go. And I say that to you all listening to the podcast, because I think it's really important that whether you have a desire to have a business, have a for profit business or a nonprofit business, you need to actually know how to run a business, or you will go out of business, whether it's nonprofit or for profit. And so I would say that even though there was a longer period than maybe you necessarily wanted, you learned so many different things along the way, which eventually led you to opening up Ohana. So Ohana has been open up for how many years now?
Mary:
14 years.
Greg :
14 years.
Mary:
I want to go back just for a second, because the reason that I stayed in school so long was because I was raising my kids. And so it was kind of like take the easy road because school schedule and all that kind of stuff. So even though I had that passion and drive, that kind of kept me there. But what I wanted to say when I went to the rehab, it was the complete opposite, because the company that was running it knew how to run a business. And so I learned a lot about how to be productive and coding and how to be efficient. And some of the stuff was kind of out of what I felt was okay, but it was like the complete opposite. So I really learned a lot. I learned about what makes sense, what doesn't make sense.
Mary:
My private practice has been 14 years.
Greg :
Awesome. So you came into my world in 2020. I'll never forget this, because you bought the 21 20 program from me, which was a 21 day challenge. And then after that, you went into my smart success healthcare program. Do you remember the first week of the program? Do you remember this?
Mary:
I have a feeling I know what story.
Greg :
You're okay? Yeah, I'm going to say it. It's great. No, there's so much media, the emojis the emojis again, I think I said, like, I'm doing this class, right? And the students would get two to three recorded videos a week. But then I would do this live training back then, I did it in a Facebook group. On Facebook Live. I would play music and I would say, drop 100 in the chat section.
Mary:
Right?
Greg :
And this lady, Mary Cosma, is like, what does that mean? Right? So I don't know if you fully understood emojis at that time, right? Am I right?
Mary:
Well, all these people are writing 100%. 100%. What does that mean?
Greg :
Anyways?
Mary:
But I'm never afraid to ask my question.
Greg :
That is 100% true about you. And I think this is so amazing because of what we're going to talk about next, which is the fact that, yes, you do have an occupational therapy century integration facility, and she serves a lot of people in her community, and her staff is absolutely amazing.
Mary:
They are.
Greg :
Okay. Yeah, but you weren't some technological wizard. No, but 2020 happened, and during 2020, that's when you came into my world. We also had this thing called Covid that happened. And lots of crazy things started happening in our world where we were now in lockdown. And there were a lot of therapists, because as therapists, whether you're a PT and ot or whatnot, we're service based providers. And now many of us weren't able to deliver care in the way that we always deliver care. And here you are, non emoji.
Greg :
Mary Koska, you developed a group, and in that group, here's what you knew how to do prior to even meeting me is you are an amazing servant, and you started serving people through a Facebook group. Right, right. So can you kind of describe to people what happened during that time?
Mary:
Sure. So, literally, the lockdown happened, and I was just like, okay, we're going to telehealth tomorrow. Because I'm like, we can't afford to not have, you know, be seeing our kids. And my whole staff's just like, okay, you get 48 hours. And luckily, Reina Olivera had just written a book on telehealth, so I knew I had this book, so I handed it to one of my staff. I'm like, figure it out. And so then we got on the doxy and figured it out. But we were doing telehealth within 48 hours of when we were locked down.
Mary:
And of course, we didn't know how to do it. But what I told my staff is kind of the same thing. Serving. I said, you know what? We just need to connect with everybody, even if we don't know how to do therapy yet. We need to check on everybody and see if they're okay. And the stories that came out of that, just that level was amazing. Like, for example, one mom, she had a whole bunch of kids. Remember the toilet paper thing? She couldn't find any toilet paper.
Mary:
Well, we had just ordered a case, and so I said she had been to, like, six stores, and she said, I can't get any toilet paper. And I said, come to the clinic. We have a case. And so that was a need that we met early on. And then another one's husband had just had a massive head injury. I'm like, when we were doing telehealth, I'm like, are you okay? And she's like, well, not really. My husband's 3 hours away at the hospital in Seattle. Her son has autism, and she had nobody to leave him with.
Mary:
So a lot of the stuff in the beginning was just finding out. So I found a respite care for her. So a lot of it was just checking on people. So my staff was afraid of it. But I'm like, we just need to be there for them. We can figure out how to do therapy soon.
Greg :
Okay, this is a big deal. This is called the secrets for success podcast, and I believe you just gave a massive gem to people. You didn't have any master plan here. What you did was that we were going through a really crazy time that nobody knew how to handle and process. But what you did is you defaulted to saying, we have to serve people right now, right? And people need us in whatever way, whether that is they just need toilet paper or that is they need a place for their husband to be able to go. It didn't matter. You were just willing to serve, right? So besides that, you also use that time as an opportunity to serve other providers.
Mary:
So the group. So what happened then is then we're like, I think you kind of know what it looks like. Sensory ingredient. It looks like you're training for little ninja warriors. It's insane. Lots of equipment and movement, and we're like, how do we do that? In telehealth, somebody had dropped, is there an activity? Telehealth activity group? It was in one of our big pediatric ot groups, and I looked real quick, and there wasn't, and I made one probably within five minutes. Within less than an hour, there were 300 people on it. Within six months, there was 12,060 countries.
Greg :
Wow.
Mary:
And it was the most amazing thing because we literally were all just helping each other. I would film I have permission from almost all my family, so it's very easy for me to share what they're doing. So I would literally just hold my camera up and show what activities were working. We had to do a lot of really innovative things, and actually, I found it really fun because it was very creative. But one of the stories. I don't know if you've heard this story. Do you know the Pakistan story?
Greg :
No.
Mary:
Okay. So I was asked to speak on a. I guess it was like a podcast or whatever. It was like a Zoom call that was recorded into a group by one of the gals that was in the group, but she was in Pakistan. She said, none of the moms are willing to do telehealth, and so can you get on and talk about how it's working and what we're doing and all this stuff? So she interviewed me, and during the interview, all these Pakistan. I don't know if you say, like, pakistani moms were just like, much love, mary. Thank you. Okay, we'll try it.
Mary:
I mean, I have goosebumps remembering this story, because it just by having a conversation and saying, it's not perfect. But I gave some funny stories about it, and then they were kind of like, okay, we can try this. One of the funny stories was this kiddo is, like, hiding under his bed, and he wouldn't come to interact. I just told the mom, I'm like, okay, take the phone and just point it under the bed, and I'll talk to him. And we got him out from under the bed and started doing some things. There were a lot of cool opportunities because you were able to do things in their home, whether it was learning how to help out with chores or just different things, it was very interesting.
Greg :
I think it's just amazing how, when you have a willingness to say, okay, I just want to help you where you're at, regardless of the situation. It wasn't perfect. It wasn't this. But the reality is that there are pakistani therapists, and there's tons of therapists here in the states. But you were the one therapist that was willing to say, I will try. I will try to help.
Mary:
The big thing is, I was willing to show what I was doing. Here's what it actually looks like. That's what one of the gals I ran into at a conference, she was just so appreciative of that time, and she said, I was a new grad, and you were actually showing us everything you were figuring out. And we actually figured out a lot of things that worked really well, and it was just such a fun time. And then Adam, the OT, he's an Irishman in Dubai, and he's so creative, and we had so much fun. I interviewed him, too, and we were talking about how we were doing it, and it actually was just a really. Even though it was a crisis time, but it was a really positive time because we were all helping each other, right.
Greg :
And connecting with people that you probably would have never connected with.
Mary:
Never connected with. And then I just started realizing, like, well, how else can I. What do you guys need help with? Because I realized that I'm this seasoned therapist 35 years, and a lot of them were really young therapists. So then I just started asking, well, what else do you need help with?
Greg :
And is that when docus was created from that?
Mary:
Yeah. So it started out with some master classes, like, well, how do we get kids to engage? How do you get them to interact with you in telehealth? And then it was like, well, how do you do in a vowel? And then how do you do this and how do you do that? And then it just morphed into just learning that they were struggling with documentation. Their number one struggle was the same struggle, whether it was telehealth or in the clinic, was they were really, really struggling with documentation. I was like, oh, I've got that figured out, because I hate documentation. So I figured it out a long time ago. Like, I don't want to spend any time on it that I don't have to, but I want everything to go through for insurance. I want it to be excellent. I want it to drive.
Mary:
The most important thing is I want it to drive Quality of care. I want to have a system in place where when I look at my stuff, I'm like, bam. I know what I'm doing. If somebody else picks up my kiddo, they can look, and they can just take off and not miss a beat. So I needed a really good system to run my business efficiently because I was realizing I'm writing. I don't know if you know how bad we are. We'll spend 2 hours writing a report.
Greg :
Wow.
Mary:
Because we want everybody to know all the cool stuff we know about this kid that we've figured out, and we want to kind of prove ourselves that we want people to understand the child. So we just write novels. We're terrible.
Greg :
But there's no code for getting paid for documenting, correct?
Mary:
No. So what I quickly realized, running my own practice is I'm doing this state of the art Therapy, and I'm writing these state of the art reports, but I'm getting absolutely no money for spending 2 hours writing a report. Zero money. And then I had two kids I could have helped, right? So it was crazy. So I had a coach at the time that he's outpatient PT, and he was really explaining. He knew a lot about how insurance Companies Work and how to get on their shortlist, the shortlist, long List thing. Like, you fight everything, and then they move you to the shortlist, and then they don't keep Denying claims. He knew.
Mary:
He knew people in the Industry. He knew so much. So I learned a lot from him. And then he'd give examples, but they were outpatient pt. And I'd be like, you don't understand. I'm peed. I'm Peed's Ot. It's like the cancellation thing, too.
Mary:
He's like, they're not all sick, mary. So I was trying to meet these standards that he was setting, but I'm like, no, but we can't. Well, we have under 10% cancels, and we have notes that take three minutes to write and reports that take 15 minutes to write. But it took me a decade to get there because I just kept peeling off layers and really understanding what was needed, what wasn't. I've interviewed people who've been through audits. I learned a lot through appealing any denials I had, and I've won 100% of them.
Greg :
Wow.
Mary:
And what would happen is, on peer reviews, I'd say I learned things like to ask specifically for a peeds ot a real peer to talk to. And then they would tell me stuff. They would help me understand something that I needed to have in the documentation. So it's a lot of research and then just peeling off the layers and then finding efficient systems, because people are like, well, if you didn't write it down, you didn't do it. Well. I don't know if you've ever watched a pizzot sessions, but we do a lot of things, right. Short attention spans mean you do a lot of things. So there's other ways you can have an activity log that you refer to.
Mary:
But just knowing what needs to be documented for insurance and for yourself for doing a good job is really what you need to know.
Greg :
I think there's a couple of things that are really important here. This is the new economy. This is the new opportunity that exists for all of us. You have a problem. You struggle through trying to find a solution for the problem. You finally figure out the solution, and you crack the code. It takes you years. It takes you lots of pain, lots of heartache in order to figure it out.
Greg :
You do, but then there's this other part. So now you figured it out for yourself. If you are willing to serve and talk to other people, you find out what are the other problems that they're having. You then realize that they were having a problem that you were having, you know, the solution to how to fix that problem. They don't, you know, the pain and the time that it took you to figure that out, they are currently going through that, and they would be happy to pay you to be able to figure that out and collapse the time because the time is costing them so much money, lost treatment hours, working way over the clinical hours that they should not having the clarity and the confidence that what they are putting on paper is actually going to hold up, isn't going to get us paid, et cetera, et cetera. And that's what you ended up creating with docus. And it's just so cool to hear the actual story. So how many people have actually gone through that program? Practice?
Mary:
Do you have a 111?
Greg :
111 people?
Mary:
Yeah. And when you were talking, it was reminding me of a moment I was 20 years into my career. This is before I had my private practice. This is when I was at birth three center, and I was sitting there at my computer, just did a note, staring at the computer going, I wish there was a way to know. That was a good enough note. How can I be 20 years into my career and not know?
Greg :
Right?
Mary:
Because there is nothing out there to tell us. Zero. There's no guidance, there's no rubric. I made one for myself, but I just thought, isn't that crazy? Like, to be that far into your career and have no way of feeling confident about what you're doing in your.
Greg :
Documentation, what you're solving such a big problem for people. So that's what you do. And you help people with figuring out how to document in an efficient manner. That's not taking up a bunch of their time, which when it takes up a lot of time, it's stressing them out as the practice owner, it's stressing out the therapist, and you're helping them with a massive, massive, massive.
Mary:
Well, and it affects the viability of the company because we have such narrow margins already.
Greg :
Right.
Mary:
If you do one more visit a day, because you don't have to spend that documenting, that adds up so quickly.
Greg :
Right. So for people, you've had 111 clinicians, practice owners go through this program. And it looks like from what I hear people rave about this thing.
Mary:
Oh, yeah. They all say, it's changed my life. I got my life back. I haven't had anybody unhappy with it.
Greg :
Okay, well, that's awesome.
Mary:
Yeah.
Greg :
So if someone is interested in saying, hey, you know what? Documentation is taking up a lot of time in my practice, and I want to know the right things that we need to do so that we do get not only reimbursed, but we're not wasting as much time. And we feel confident, and we're not feeling that uneasiness if we're doing the right thing or the wrong thing. What we're going to do is this. We're going to put a link in the show notes of the podcast for people to be able to connect with you.
Mary:
Right? They can actually book a call, and I can actually just do a deep dive and just help them. And then if this makes sense for them, they can learn about it.
Greg :
Awesome. Mary, before I finish the podcast, there's something that I need to say about you. You are always cool. Except for today.
Mary:
Except for this morning.
Greg :
Oh, my gosh, you guys, this morning we did a. I don't know if she's not a dramatic person. Except for today. I was like, wait, who is this? Who took Mary's phone? Who took her phone? Which drama queen is this anyways? One of the most amazing things, mary is in my inner circle, and she's been in my world for the last three and a half years. And I just have to say this. You've had so many things that have happened behind the scenes, whether it's with your son, it's with your husband, muscular.
Mary:
Dystrophy, two family members with cancer, my dog. We won't go there. Yeah, it's been a lot.
Greg :
It's been a lot. And what I really, really appreciate about you is your ability to show up with grace under the pressure. And trust me, even though, yes, technically, you are a client of mine, I learn so much from all of you. But that's what you teach me. You teach me how to be cool. How to be cool even when the pressure is high.
Mary:
You teach me how to have this.
Greg :
Morning, except for this morning, somebody took your phone and was a total drama queen this morning. But for the three years, three and a half years minus one day, what you have been able to show me is how to have duck legs. Duck legs.
Mary:
What are duck legs?
Greg :
Duck legs. When you see a duck, isn't a duck cool underwater? Oh, but they're going, and that's what you are. So anyways, I just want to thank you for that. And how can people find out about you? Are you on Instagram, Facebook? Yeah.
Mary:
Where can people Mary Koska underscore ot for Instagram, Facebook. Just my name, Mary Koska. And they can Facebook message me.
Greg :
I appreciate you so much. Thank you for being on the secret sports success.
Mary:
Thank you. Thanks for having me.
