Greg Todd [00:00:00]:
Cost effective ways to streamline documentation. You know, I know you have your program and really cool stuff, but what are some things that any of us that have clinics could do, we could actually do today to just streamline the process?
Mary Koska [00:00:13]:
Well, for my population pediatric OTs, I can tell you the number one thing that I find that they do that they don't need to do is educate in their evaluations. So we write. We're notorious for writing books. I mean, spending hours writing up our evals because we want everybody to understand every little thing that we understand about the kid. And it's overwhelming. It's overwhelming. So as I work with people, the big aha is usually that statement, you don't have to educate in the report. You can educate with handouts.
Mary Koska [00:00:50]:
Doesn't mean don't educate him.
Greg Todd [00:00:51]:
Gotcha. Okay.
Mary Koska [00:00:52]:
But you can educate with handouts. And so we educate. We have a list of things over the first four to six weeks of therapy that it's like a drip.
Greg Todd [00:01:09]:
This is Secrets for Success. Welcome to the Secrets for Success podcast. I'm your host, Greg Todd. I'm actually doing a series called Rapid Fire Value, and I'm bringing one of my amazing clients. You've actually worked with me for four years. Four years, nearly five.
Mary Koska [00:01:27]:
2120 was the.
Greg Todd [00:01:29]:
Yeah, yeah, 2120 challenge. Yeah. So Mary Koska's on the podcast. Welcome again to the podcast. I had you on here a year. Like a year ago, right?
Mary Koska [00:01:37]:
I think so.
Greg Todd [00:01:38]:
Yeah, about a year ago. So anyways, thank you for being on. So what I'm. I'm trying to do with this is I. I want to show people the value that people that I work with bring to the world. Like, I work with you guys, but you work with all these other people. Right. So in your case, you have ohana ot, which is your practice.
Greg Todd [00:01:58]:
But one of the things that I believe you could really help not only my audience with and so many others with, is something that we deal with every single day, which is like, we gotta write stuff about the patients that we treat. And so, you know, you have another company called Docufast. You help lots of people with being more efficient and effective with their time, not just for them, but for their practitioners. And do you mind if I ask you some questions? Because this is obviously a big deal for people. All right, so the first question is, how can I reduce documentation time without sacrificing quality? Because I know for myself, you mean.
Mary Koska [00:02:39]:
Quality of the documentation or the care.
Greg Todd [00:02:41]:
The quality of the documentation.
Mary Koska [00:02:44]:
Well, that's pretty easy. You just have to know what you need to be writing about. Because people will actually write lengthy, lengthy notes and not even have in the note what needs to be there.
Greg Todd [00:02:56]:
Right.
Mary Koska [00:02:57]:
So the length doesn't dictate the quality at all.
Greg Todd [00:02:59]:
Gotcha.
Mary Koska [00:03:00]:
So, for example, people might write a very lengthy play by play description. They came in, they said this, we did this. But there might be nothing that documents progress on the goals.
Greg Todd [00:03:13]:
Right. I, I think for me.
Mary Koska [00:03:15]:
Or clinical expertise.
Greg Todd [00:03:17]:
Yeah, for me, I, I believe that whenever I would have longer notes, it would justify to me that it's good enough. And I think a lot of us feel that way. I mean, I'm not treating in a clinic anymore, but, but I, I, I think we think being verbose is going to be the key to us not getting audited or us having insurance continuing to allow us to treat the client. But that's not the case.
Mary Koska [00:03:45]:
I have a friend that's expert witness and he would see documentation get shredded apart. And he said people got into more trouble with the longer notes because there was just more stuff in there that didn't need to be in there, that was distracting from the core of what needed to be in there.
Greg Todd [00:04:04]:
Oh, interesting. Okay, you have a occupational therapy practice, and besides documentation, that's like the only thing you do. Like, you, you run a company and you're dealing with a lot of staff. So can we talk about staff or like, can we. Okay, I want to just talk about, you know, documentation. So how have you been able to help to prevent burnout of your staff? I'm assuming documentation has something to do with it. Not, because that's not. To me, I call documentation like the, that's like the hangover.
Greg Todd [00:04:40]:
Right, Right. Working with the patients is the fun stuff. Right. But documentation is the hangover. But what are other things that you are doing to help your staff avoid burnout? And, and I think you do a really good job with that. So I kind of want to.
Mary Koska [00:04:53]:
So not going into the document, I mean, because that, cause I do think that's a huge piece because I talk to practice owners all the time. And so in our clinic, nobody takes any work home and they leave. If they stay late, it's because they're just chatting and hanging out, or maybe they're wanting to brainstorm on a kid, but the actual work is done. They don't take any work home.
Greg Todd [00:05:14]:
That is not the case for a lot of narcissists.
Mary Koska [00:05:17]:
It's not, it's not. Because if you have a really efficient system, then they can be done within the session or right at the end of the session. But there's a whole lot of other things that we do. What's unique in my clinic for pediatrics, it's unique. I know it's not that unique for, like, outpatient ortho, but we have techs, we have aids that help, so a lot of things can be delegated to them so they don't have to eat up as much time doing things like making a picture schedule or setting up or cleaning up. So having that support staff makes them not as tired at the end of the day. I always say their job is to help the therapist not be so wiped out at the end of the day.
Greg Todd [00:06:04]:
Gotcha. Gotcha.
Mary Koska [00:06:05]:
So that's a big piece. And then, you know, we just do a lot of fun, fun things. I think if your staff is in heaven laughing together, then. Then they're going to get burned out. So we do, you know, we have celebrations every month. We have a couple retreats a year. We have get togethers. We just really make sure that we're bonded and having fun together.
Greg Todd [00:06:25]:
I always love when you do your retreats because. And you kind of give us a retreat report on how the retreat went. I'm like, man, you know, not to get too biblical, but I am going to say this. There is a book in the Bible is Ecclesiastes, and it was written by King Solomon. And King Solomon said, this is supposedly the wisest man that ever lived and was consulted to all the kings at that time. And he wrote Ecclesiastes after he wrote the book of Proverbs. And he said, really, at the end of it, life is. Life is.
Greg Todd [00:07:06]:
A lot of. It is meaningless. But what's really the most important is that you actually have fun in your work. And I was like, wow. Yeah. And I really could say that for your practice, I feel like you guys have a lot of fun. And you, you, yes, you work hard, but you do a lot of cool things and a lot of fun. So I think you're doing it right.
Greg Todd [00:07:28]:
Yeah, that's awesome.
Mary Koska [00:07:29]:
Yeah. I even had him breaking boards.
Greg Todd [00:07:31]:
Wow, look at that. That's awesome. That's awesome. Okay, let's talk about this. How can you create a work environment that. And I guess we kind of already hit this, but, like, how can we create a work environment that. That our staff doesn't dread coming to the workplace? So, yes, you're doing the retreats, doing that, but what are other things that you're doing inside of your work environment? And one of them, I know, is documentation, like, very quality and efficient documentation. But what are other things that you guys are doing to create that type of environment?
Mary Koska [00:08:06]:
Well, I'm just thinking about something we're doing right now. Peer reviews, I think are a big thing because I think what makes not a good work environment is when little issues start to bubble up and when tensions start to rise. And so peer reviews have been a really good tool because for one thing, they find out everything that their peers love about them, but they also get some tips for growth. And I know for me it was a huge thing because like for years it just kept, they kept saying, like, you need to listen more. And I've always been a talker and not the best listener and so it's helped me grow a lot. But I think you're going to have a better work day and look forward to coming into work when you know where you stand with people. And I actually take like for Christmas, we make up a thing that says like what we love, it would be like what we love about Greg. And it's just all the main words that people use and it ends up being like something that I frame and they have in front of their desk.
Mary Koska [00:09:08]:
So they just know how much they're loved by their co workers.
Greg Todd [00:09:13]:
That's awesome.
Mary Koska [00:09:13]:
And so that makes you look forward to coming to work because you know where you're at with people.
Greg Todd [00:09:18]:
Okay, I like that, love that.
Mary Koska [00:09:19]:
And also, I mean, I just feel like I have the ideal work environment. I worked in a lot of other environments where I didn't have the tools to do my job, the space to do my job job, have the parents, they're, they're, you know, with, have enough time with the clients. So having a private practice basically just made my ideal working environment.
Greg Todd [00:09:39]:
Okay. So as an entrepreneur, when I'm talking to you guys, I am telling you that I don't believe in work life balance. As an entrepreneur, I believe in seasons. Right. I believe that sometimes I have a season of lots of work and very little play. Sometimes I have a season of very little work and lots of play. That's not how most employees look at it. They want a work life balance.
Greg Todd [00:10:06]:
And I would love for you to share some strategies for how you've been able to improve work life balance for your staff.
Mary Koska [00:10:17]:
Well, it's interesting. We do a 410 schedule, which is a lot. Sometimes, you know, it's a long day and sometimes on those days it's hard to feel that way because it's a big day.
Greg Todd [00:10:28]:
Right.
Mary Koska [00:10:29]:
But we have every single weekend, we have three day weekends which I absolutely love. So my staff are all pretty active and so, you know, they go on camping trips and just they're really active and have a lot of fun on the weekends. So we kind of have this balance of work hard, play hard.
Greg Todd [00:10:48]:
Yeah, yeah.
Mary Koska [00:10:48]:
But that's kind of the crew I have, they like, they like that most of them, you know, and some, some maybe work a little bit less hours because that's not, not really a good fit for them. But, but most of them, that's what they prefer.
Greg Todd [00:11:02]:
Okay. Your staff seems to be quite motivated and engaged. A lot of people feel like their staff is not motivated and engaged and maybe at times it might be due to high documentation demands. What would you say to them? What are some things that they can do to keep their staff motivated and engaged?
Mary Koska [00:11:26]:
Listen to them. You know, that's the big lesson that I've learned is survey them. Listen to them. One of the things that we do, we usually do it twice a month is we do a clinical mastermind which actually I don't know anybody else that does it. And I modeled it after, after our business masterminds that I would have. What I have them do is they have to come in with a share like something that's working to share with other people and then an ask of the group and then so that gives them an opportunity to brainstorm the harder kids, which now I forgot what your question was.
Greg Todd [00:12:03]:
But yeah, like how to, how to navigate through not just their work life balance, but just, just the demands of the work.
Mary Koska [00:12:12]:
The demands.
Greg Todd [00:12:12]:
And, and you're doing that through the clip.
Mary Koska [00:12:14]:
So I would say, I would say the thing that's that my staff love their kids and care about the families and care about just doing like a phenomenal job. So the challenge I have is they're so hard on themselves.
Greg Todd [00:12:30]:
Gotcha.
Mary Koska [00:12:31]:
And if they have like. And all of our kids are challenging because we're seeing, we're seeing the kids nobody else knows have help. Right. And so what I find is that they're having, you know, if they have a really hard kid and they're having trouble, they're not making the kind of progress they want or whatever it is, that's when it gets hard for them. And so giving them the support is where, where it really help makes a difference. So what you're doing, I've got 36. Yeah, I've got 36 years of experience. And so what we, we have a system, a daily check in system that really helps.
Mary Koska [00:13:12]:
And this is pretty unique. I don't. Other than people that I've taught, I don't know anybody that does this. So it has all their kids and they check off how the session was. Like if it was excellent, good, good with challenges, or very hard, their highlight at the end of the day. And then, like how they felt at the end of the day, they felt energized, they felt good, productive, they felt tired, or they felt completely wiped out. And I actually started this process because I didn't realize that one of my therapists was getting burned out. But it was really a scheduling thing.
Mary Koska [00:13:42]:
She had too many of the hard kids clustered. So we look at it from lots of different points of view. Like we're looking at it for scheduling to make sure not all one person's getting the hardest kids, or that they're not on the same day or they're not on, you know, just spread it all out. But the other thing is, then I can go back and I can say, hey, do you, you know, do you want to brainstorm on this kid? Do you need some help with this kid? Or was it just, just a tough day? And so, and then they have a place at the bottom where they can ask questions. So even if I'm gone, like, you know, I was just on a trip to Okinawa, I can come back and I can know exactly how every single session went for these guys, and I can come back and offer support. And I have a lead, an excellent lead, OT Kylan. And so we're both able to support them in that way. And then we meet with them one on one at least once a month anyway to just help them.
Mary Koska [00:14:35]:
So they've got the clinical masterminds, they've got the daily sheets, and they got the one on ones. And that's something I never had. I never had like somebody to help me when I stumped on a kid or what to do. And they have so much support that way.
Greg Todd [00:14:48]:
I think that could help not only extremely ambitious therapists, like what Mary has, but even for, you know, younger therapists that may not even be as motivated and whatnot, there is nothing worse than feeling like you don't have any support when you're stuck with somebody. So I think those are brilliant things. Now let's move to documentation a little bit. Cost effective ways to streamline documentation. You know, I know you have your program and really cool stuff, but what are some things that any of us that have clinics could do, we could actually do today to just streamline the process?
Mary Koska [00:15:26]:
Well, for my population, pediatric OTs, I can tell you the number one thing that I find that they do that they don't need to do is educate in their evaluations. So we write. We're notorious for writing books. I mean, spending hours writing up our evals because we want everybody to understand every little thing that we understand about the kid. And it's overwhelming. It's overwhelming. So as I work with people, the big aha is usually that statement, you don't have to educate in the report. You can educate with handouts.
Mary Koska [00:16:03]:
Doesn't mean don't educate them.
Greg Todd [00:16:05]:
Gotcha. Okay.
Mary Koska [00:16:06]:
But you can educate with handouts. And so we educate. We have a list of things over the first four to six weeks of therapy that it's like a drip. So we're going to give them this handout on this day. This handout on this day. And if they're seeing different people, it's been checked off. So we know, oh, we gave them the prop handout. They know about activities they can do for that because it's too much to get it all at one time anyway.
Greg Todd [00:16:33]:
Right.
Mary Koska [00:16:34]:
And so I'd say, like, the biggest hack is at least for PEDs OTs. We want to educate so much, but we overwhelm them and then we end up writing up too much and it's too long of a report. So if you just separate it and do it as a handouts, that's really good.
Greg Todd [00:16:52]:
I like that.
Mary Koska [00:16:52]:
It's a big time saver.
Greg Todd [00:16:54]:
Yeah. Okay. So I know there are quite a few people that know that their documentation kind of stinks. Okay. And they could do things a lot better. And I know that you have, you know, a program that actually helps with that, but I'm sure that there's a lot of people that are like, okay, I know I need to do this. I actually want to do it, but how am I going to get my people on board with this? So what's some tips and advice that you have for those that know that they need to put some new documentation strategies in play, but they're trying to get everybody on board?
Mary Koska [00:17:31]:
Well, it starts at the top. And I can tell you that most practice owners don't have a good system in place because they're not confident. And I have a very distinct moment in my career, 20 years into my career, working in a birth to three. Looking at my note. You know how you said you felt like, oh, it's good enough, it's long. I was looking at my note and I'm like, I don't have any way to know if this is good enough. I have never had anybody Tell me anything about if my notes were good or not. And I'm like, how do I not know? And so that kind of began my quest of really learning and finding out.
Mary Koska [00:18:07]:
But what I have is a rubric. So it's like, if these seven things are in your note, then you're good. Then you're good. It doesn't matter how many words. But that is. Did I answer the question?
Greg Todd [00:18:20]:
Yeah.
Mary Koska [00:18:20]:
I'm trying to think of exactly what the question was. But that, to me is a big thing, is just having knowing. You need to have, you know, some numbers in there, like reps or percentage or, you know, not just words, but you have to show some, like, measurable progress on the goal. Show that you worked on the goal. That's in the plan, right? What goal did you work on? What was the progress? What was your part? That's a big thing people leave out is they leave out the therapist's intervention. Cause we just kind of take it for granted, like, how much we don't forget in rehab. But, like, it's just the basics. Like, did you do tactile cueing, verbal cueing? You know, did you grade the activity? Did you.
Mary Koska [00:19:09]:
How much physical assist did you provide? It's pretty simple to show skilled care, right? But for some reason, especially in peds, we kind of just forget to put that part in. So show the progress. Show the, you know, the skilled part. And.
Greg Todd [00:19:26]:
And that's what gets the staff to get on board to do this new document.
Mary Koska [00:19:31]:
Oh, that was the question. Sorry, I got a little off track. So my point was it starts at the top, because if you're not confident, how are your therapists going to be? So you have to create the samples. You have to create the rubric. You have to say, this is the clear expectation. But as far as people not wanting to change, like, say you create that so you're confident, and you're like, this is how. How what I'm expecting. And they're still fighting, and then they're still fighting.
Mary Koska [00:19:58]:
Now they're fighting because of fears. There's a lot of different fears, but it's the basic thing of, like, our brains don't like to change, you know, but they have fears of not sounding professional, not doing it the way I was taught in school. What if we're audited? But the first thing they have to do is figure out. The first module in my program is for them to figure out where their fears are coming from. And mine were coming from, like, 10 different places. So I had one gal that she was up till 1 to 2 in the morning every night doing her notes, because I have them do a time audit. Like, how much time are you actually spending on documentation a week? And how many weeks of your life is that in a year? And her number was just astronomical. And she realized her fear or her overcompensation was because her boss went to jail for fraud.
Mary Koska [00:20:58]:
He was a chiropractor. And she didn't do anything wrong. But he billed PT when she wasn't even there. And he didn't throw her under the bus. He admitted his guilt and all of that. But because of that, she was constantly overcompensating. Overcompensating, even though she never did anything wrong. So people have to kind of find out what are they afraid of before they can change.
Mary Koska [00:21:26]:
And it's always some kind of fear based thing.
Greg Todd [00:21:30]:
I think there's a mindset thing as well. And this was for me when I was treating. And that is if I decrease my documentation time, that means that my care sucks.
Mary Koska [00:21:45]:
That's interesting.
Greg Todd [00:21:46]:
Yeah. If my documentation time is less for some reason, like. And I know I'm not the only one. I know a lot of people feel that.
Mary Koska [00:21:55]:
So, you know, I think the care gets better. I know it gets better.
Greg Todd [00:21:59]:
I mean, it just makes sense logically that I would have more time to work with the person.
Mary Koska [00:22:03]:
But the reason why it gets better is. All right, say, you know, you've seen all these people, so you gotta look at your note from last time to see what you were gonna do, what you're gonna do this time.
Greg Todd [00:22:13]:
Yep.
Mary Koska [00:22:14]:
Well, if you gotta wade through tons of stuff to read, it's a lot harder than just being able to at a glance be like, oh yeah, okay, now we're gonna do this so you, so you can you stay more focused.
Greg Todd [00:22:28]:
Right.
Mary Koska [00:22:29]:
When you're concise and you're more focused, your quality is better. I used to think like that because we'll have like our kids will have 15, 20 goals that we'll, we'll write and we meet them all usually within about 40 sessions. But at you, because you have that. Sometimes you think, oh, I gotta work on six goals in this session. But what I learned is that what you really need to do is focus in on hard on two goals and make sure you hit those goals consecutively for at least four sessions in a row or five sessions in a row. And then you can start meeting them very quickly.
Greg Todd [00:23:08]:
Gotcha.
Mary Koska [00:23:09]:
But we are more scattered naturally. And we were like, a little bit of this, a little bit this, little this, and Then we don't move as fast. That took me a long time to learn that. I kind of didn't believe it. I was being coached that way from one of my coaches before, and I was just. I was really in disbelief that my kids would get better faster that way. But they really do, because when. And it doesn't mean you can't do other things in your session, but the main point is that you're consistently focused on one goal.
Greg Todd [00:23:38]:
Right.
Mary Koska [00:23:39]:
So, for example, if I'm. If I've got a goal, if I've got a goal for them to be able to have prone extension for 30 seconds, but I'm not truly addressing it every session, I'm not going to get anywhere. Or if I'm going to have a goal of them being able to sit for 15 minutes doing tabletop activity. Well, if I. We don't actually have that opportunity every session, or if I'm not focused on that, it's not going to happen.
Greg Todd [00:24:05]:
So two main things.
Mary Koska [00:24:06]:
Two main things.
Greg Todd [00:24:07]:
Four sessions in a row, at least. At least four.
Mary Koska [00:24:10]:
At least. And a lot of times it's about eight.
Greg Todd [00:24:13]:
Yeah.
Mary Koska [00:24:13]:
But if we're not progressing, if we're not seeing progress, then we move to something else. And whenever my staff are wondering, well, what goal should I pick next? I say look at it, and the next one you think you're going to meet should be your next goal.
Greg Todd [00:24:27]:
Okay, gotcha.
Mary Koska [00:24:28]:
Because. And then sometimes they've already met some of those goals and we just have to give them credit because once they start getting those foundational skills, then they just start naturally meeting a lot of goals.
Greg Todd [00:24:39]:
Right, right, right. So here's my next question. What should people consider before investing in their next documentation software?
Mary Koska [00:24:51]:
Like an emr, you mean? Yeah, I have yet to find the best one, by the way.
Greg Todd [00:24:56]:
Yeah.
Mary Koska [00:24:57]:
Okay. There's a lot of things.
Greg Todd [00:25:00]:
Well, let's talk about.
Mary Koska [00:25:01]:
I could tell you about my dream EMR that doesn't exist yet.
Greg Todd [00:25:05]:
I want to hear it. So, hey, if I have any EMR people that are listening, here you go. Or someone that wants to create a SaaS, a software, and you've always want. It's like, you know what? I think I'd create a emr. Listen up, because this lady helps so many people that aren't practice owners. Okay. What's a perfect emr?
Mary Koska [00:25:25]:
There's a lot of them that are close, but not close enough for me to be happy. Some basics. Absolutely. To speed things up, you have to be able to have checkbox, dropdown, menu and customization and Be able to eliminate anything you don't need to look at. So one of the really I shall not name to not throw them under the bus. But one really popular EMR that a lot of pediatric therapists use, you can't get rid of the stuff you don't need. So it takes you down all these rabbit holes and makes you feel like you need to fill in boxes that you don't need to fill in. So it has to be customizable so that you're only looking at what you need to look at.
Mary Koska [00:26:08]:
You have click boxes and drop down menus that sort of, you know, so you can just go do, do, do, do right. And be very quick. For me personally, my dream EMR has, has a way that I can. More like a flow sheet where I can see side by side the last four sessions, see the progress. So I can just kind of see like, oh, that's the goal we were targeting and this is how we were doing. Because the problem with slowing people down is reading narrative, reading a lot of narrative instead of being able to spatially look at things. So that's one thing. Obviously it has to be super great with billing and all of that has to be really clean.
Mary Koska [00:26:54]:
I like the flexibility of the one I'm using now. The reason I chose it is because the billing can happen through the front desk instead of the note.
Greg Todd [00:27:06]:
Gotcha. Okay.
Mary Koska [00:27:07]:
So it gives me the. So the billing doesn't get hung up by the notes being behind. But our notes don't get behind anyway. We just have a system in place. So the therapist is still telling them how many units to bill. But it's the only one that I know that you can do it this way. And that's what I like.
Greg Todd [00:27:25]:
Well, if any of you were listening, there you go, you have it.
Mary Koska [00:27:29]:
Yeah, yeah. So you know, obviously you need to be able to have templates and all of those things and not a lot of clicking around, not so many clicks. It's when you're just like, it's just.
Greg Todd [00:27:45]:
Now you don't have the perfect emr. We're not going to name it. It's obviously good enough, but good enough to deal with, but not the perfect.
Mary Koska [00:27:53]:
I'm actually doing a hybrid of things right now because I use Jotform so that from my eval, my reports, because I can do the customization and then I upload that into my EMR to your emr.
Greg Todd [00:28:06]:
Gotcha.
Mary Koska [00:28:07]:
Which is an extra step. I don't do it. My support staff does it.
Greg Todd [00:28:10]:
Right.
Mary Koska [00:28:10]:
But I can write my evals in 10 minutes.
Greg Todd [00:28:14]:
Gotcha.
Mary Koska [00:28:15]:
And you know, to me, I'd rather, I'd rather be that fast and then have somebody upload it.
Greg Todd [00:28:21]:
Right.
Mary Koska [00:28:22]:
But yeah, that's so I. But my tempest in my system. I'm really just saying, like this is how to be concise. This is what needs to be in there. It's templates.
Greg Todd [00:28:33]:
Right. Let's talk a little bit more about documentation and staff. I think documentation inefficiency creates so much unnecessary staff turnover. Have you seen that?
Mary Koska [00:28:48]:
Not in my. Not in my clinic.
Greg Todd [00:28:50]:
Not in your clinic, no. With the clients, the people that you. You have such a big network of pediatric therapists.
Mary Koska [00:28:58]:
The clinic owners that I talk to. Yeah. They've had a lot of staff that leave due to just burnout of having to take work home. And they're coming to me because they don't want to be like that anymore.
Greg Todd [00:29:12]:
Okay. I know we've talked about these numbers a little bit. Remember the other day we were talking about $50,000 of what people are losing. I mean, in order to bring on. I think you've shared with me with your clinic. When you bring on someone, it takes about six months, am I right?
Mary Koska [00:29:31]:
To get them so in my. So yeah. So just numbers my. In my clinic because we do so much training, because we do so much with primitive reflexes and sensory integration. Unless somebody has been doing that kind of work, the average pediatric OT, even if they have 20 years experience, we have to train them still. So it's really. And that's why we started our residency program, because you're like merit, you're doing a residency.
Greg Todd [00:30:00]:
Yeah.
Mary Koska [00:30:00]:
So call it that.
Greg Todd [00:30:01]:
Yeah.
Mary Koska [00:30:02]:
But they don't get to full caseload until about three, four months. And so, you know, you're kind of losing money those first few months. It's six months to be like where you've made up that difference.
Greg Todd [00:30:15]:
Okay.
Mary Koska [00:30:16]:
And so turnover is really expensive. But then you have to add in. If you're doing relocation bonus. If you're doing a sign on bonus. I figure it takes. It costs me about 20,000 with every new hire minimum or more, plus the lost revenue while you're trying to fill that spot.
Greg Todd [00:30:37]:
So if you took the 20,000 for a new hire.
Mary Koska [00:30:40]:
Mm.
Greg Todd [00:30:40]:
And you took that amount for lost revenue, what would you say that total amount is?
Mary Koska [00:30:46]:
It depends how many. How many months? But it could easily be another 8,000amonth.
Greg Todd [00:30:53]:
8,000Amonth?
Mary Koska [00:30:54]:
I would say easily.
Greg Todd [00:30:56]:
So let's just say you guys, that.
Mary Koska [00:30:58]:
And I'm talking about the 8,000. I'm talking about like, all right, if somebody's highly productive beyond their expenses, they're going to. They're going to be bringing in between like 60 to 100,000 to your clinic to write, you know, to pay for everything in your clinic.
Greg Todd [00:31:16]:
Gotcha.
Mary Koska [00:31:16]:
Beyond what they cost, it depends how productive they are and how much they cost. Right. But on the high end, it's. It's usually it could be like around 100,000. Could be as low as 50 to 60. It all depends. Okay, so divide that by 12 is what I. Where I came up with that number.
Greg Todd [00:31:33]:
Okay. I hope everybody's really listening to this, because this is right now. I mean, we talked about this agnosium. So many of you as practice owners, you are losing money. And your biggest issue and you know it is staff recruitment and staff retention. It's one thing to recruit, it's another thing to retain. And if we can say that documentation is a huge component of. Of us retaining people.
Greg Todd [00:32:02]:
I need you guys to listen up to everything that Mary has said so far. We've got to make it seamless. You've got to make it as simple as possible. There is no perfect EMR out there yet.
Mary Koska [00:32:14]:
Okay, so maybe somebody's going to make it.
Greg Todd [00:32:16]:
Yeah, maybe somebody's listening. That's going to make it. Okay. But. But we need to. We need to look at the things that we have control over. Right. I've talked to you guys in our group about contributing factors and determining factors.
Greg Todd [00:32:29]:
Okay. All right. There's certain things that can contribute to someone coming and going. Okay. They can contribute. It is our responsibility to take away as many of those contributing factors as possible. If you're just being lazy with your documentation and making it harder on people just because you don't want to change, you're losing people. And according to what you have said to me, it's somewhere between on the low end, $30,000, and on a high end, a hundred thousand dollars, depending on how long it takes you to replace that person.
Mary Koska [00:32:59]:
Yeah. If it took you a year.
Greg Todd [00:33:02]:
This is brutal. So, yes, I know it's hard to change. I know it's hard to bring something in new. But these are reasons why people are leaving you. And the reality is that most practices, whether it's PDOT practices, outpatient, really doesn't matter. Most people aren't addressing the documentation issue. And it is the fastest way that you can get people back more of their time. Because we all know everybody's seeing patients.
Mary Koska [00:33:35]:
It's really not their fault because it's not easy stuff to find out. The insurance contracts do tell you what needs to be in a note, but it is buried deep, right? So it's not. I mean, it's easy. Like I've made it easy. I wish I had something like what I provided. But you know, it took, it took a lot of like just learning because I find I've, I've won all my appeals and I've learned a lot through doing that. And sometimes it's just the stupidest little things that they kick a note back for.
Greg Todd [00:34:08]:
Well, you, you, you said something earlier and you're like, none of my staff take home their work. So I would like to ask you this question. How did you create this culture? Because you didn't. It's like you've created a culture of fun. And I don't want to act like Mary's like the, the perfect. I mean she, she's, she's really good. All right. She's got problems.
Greg Todd [00:34:26]:
All right. But you've created an amazing culture, made a culture of fun, but you've also created a culture of efficiency.
Mary Koska [00:34:33]:
Like what I can tell you something that I've done to help.
Greg Todd [00:34:38]:
Oh, yes.
Mary Koska [00:34:39]:
Is that I have a checklist. I think it's like 25 things of what, what a great session looks like.
Greg Todd [00:34:47]:
Okay.
Mary Koska [00:34:48]:
Every single little thing. So just time wise, how you run your session, what you do when you know, things like making sure you address the two goals involving the parent at the end so that you can finish up, you know, so you can write your note, get it done, like have them play around of the game that's at the end of the session or whatever, you know. But I mean, it's like in detail, right? And the, our clinic is run so like on time, like nobody waits. And our, the thing is our kids can't wait because a lot of them melt down and stuff, right? So from the time they walk into the lobby to the time they're in, their session is never more than like five minutes. So everything just runs like on the. I don't know, it's kind of like, I'm going to say like military, but that's not really like the best way to say it, but it's. Oh, you know, one thing that we do is we have a really cool system, kind of like a bell system, but it's a song that plays as a warning like three minutes before it's time to leave the room. Really?
Greg Todd [00:35:57]:
Oh, wow.
Mary Koska [00:35:58]:
Yeah. So we have like this gentle Hawaiian music that comes on and then everybody knows that. Like.
Greg Todd [00:36:04]:
Okay, so it's like on the hour It's.
Mary Koska [00:36:06]:
Well, it's like three minutes before that, before the end of the session. And then the end of the session, it's moana, make way, make way. And that means you better be making your way to the lobby.
Greg Todd [00:36:15]:
Right. A lot.
Mary Koska [00:36:16]:
And then. But that. But it's a little bit before the session would normally. Normally end because most of our kids struggle with transitions. So transition is part of the session. So we allow, like, another five minutes is the transition, because they don't want to stop, they don't want to end. They're figuring out, like, one way, one more way to sneak in a little more fun. And the parents, all of a sudden, they have 10 questions.
Mary Koska [00:36:38]:
So we allow that transition time and we explain it to them is part of the session. And that's where a lot of people get off track in peds anyway, because these kids don't transition well. So we have that as part of it. So the Bell system comes a little early just to get everybody moving, and then that way the rooms can get cleaned up and everything.
Greg Todd [00:37:01]:
You guys, this is a culture of efficiency. I mean, I've. I've run.
Mary Koska [00:37:06]:
Yeah, we are 85. We're like 85% productive.
Greg Todd [00:37:10]:
Yeah, this is pretty impressive. I mean, I thought we were doing a good job, but maybe you're doing better than me. Okay, can I ask you two more questions? Is that cool?
Mary Koska [00:37:21]:
Of course.
Greg Todd [00:37:22]:
All right. So there are people out there, they're struggling. They know they need to do something. They know that internally they need to fix some stuff, and they know that documentation might need to be one of those things. So my question is, what are some of the signs that my documentation process might need an overhaul?
Mary Koska [00:37:51]:
Well, I think, like, if. If it's not efficient.
Greg Todd [00:37:55]:
Yeah.
Mary Koska [00:37:56]:
I mean, if. If people are taking it home, you.
Greg Todd [00:37:58]:
Don'T take it home. Work.
Mary Koska [00:37:59]:
I mean, the thing is, like, I have this calculator, and that's. That's how I know that people can save anywhere from 30 to $100,000 a year, because they do this calculator with them all the time. And so it depends how many staff you have and how much time, but if you're taking two hours, most people are taking, like an hour and a half, 90 minutes to write an eval up in OT Peace. I don't know if you know that. 90 minutes.
Greg Todd [00:38:23]:
90 minutes, and you're doing it in.
Mary Koska [00:38:24]:
10, 10, 10 to 15. And so that's the difference. And notes. You know, a lot of clinics, they're not taking as much time, but, you know, if you take 10 to 15 minutes to write a note compared to three to five. That's still a really big difference. That's the difference of being able to kind of do it at the end of your session real quick before they go, versus having to block out an hour at the end of the day to do all your notes, you know, if it's taking you longer if you can't get it done. So the difference with that if they're paying their stuff to document is that much money for the average size small.
Greg Todd [00:39:03]:
Clinic, that's nearly eight times more time compared to what you're doing. 10 minutes versus 80 to 90 minutes.
Mary Koska [00:39:12]:
Well, I was the other extreme when I started my private practice because I got SI certified and the test for that takes like three hours to do it, 17 tests and takes two hours to score, and takes two, three hours to write up. So I was spending like, what is that, like 10 hours or something? And I'm like, I'm getting paid for what, a half an hour, 45 minutes for that time. So I just very quickly was like, I can't do it the ideal way. So I had to learn how do I gather the same information that I need in an efficient way, write it up in an efficient way. And, and the quality of my therapy is still just as good, but so I have written like 44 page evals before. But you know what, for a long time I had this little phrase in there. This is a summary of Al write up if you need more detail. Because I had trouble letting go of what I was letting go of.
Mary Koska [00:40:11]:
And if you need any more information, let me know. Two years went by, not a single person, not a single doctor, not a single parent ever asked me for more than I gave them. And I forgot that phrase was in there. And then one day a parent said, a mom said, oh, is there more stuff? I mean, she didn't care. She just saw that in there. And then I'm like, oh, it's time to take that out. And our top referring physician, she diagnoses the. She's the main person that would diagnose a child with autism in her in our valley.
Mary Koska [00:40:41]:
And she was showing her medical assistant our clinic, she was touring it and I was putting this course together and I thought, oh, this is a great opportunity to ask her if there's anything she'd like to see me do differently. And I asked her about the evals because she sees a gazillion of them from me. And she writes super long, detailed, and takes all her work home and writes big Reports. So I thought, I'll just ask her anything you'd like me to do differently in my reports. And she just thought about it and she's like, nope, they're good. She goes, I just wish you were in REMR so we didn't have to upload it.
Greg Todd [00:41:15]:
Wow.
Mary Koska [00:41:15]:
That's all. I mean, but I thought, wow. Because she's person that writes a lot. Yeah, she writes down like every little detail of what she sees. So yeah, it took me years to kind of be okay with how I do it or, you know, to. It's just letting go of the known and what you think is right.
Greg Todd [00:41:36]:
Right. Okay. Well, thank you. I do have one more question for you. You just came back at the time of this recording, you just came back from a four week trip to Okinawa, Japan.
Mary Koska [00:41:52]:
Yeah, well, I was in. I was traveling for like three weeks before I came here. And then. This is one week.
Greg Todd [00:41:57]:
This is one week.
Mary Koska [00:41:58]:
Yeah, I was like a full. About two weeks in Okinawa.
Greg Todd [00:42:01]:
About two weeks. Okay, so you've been away from your clinic for nearly four weeks.
Mary Koska [00:42:06]:
Yeah, this. When I go back, it'll be four weeks.
Greg Todd [00:42:08]:
Four weeks. And your clinic hasn't burned on yet. Okay.
Mary Koska [00:42:14]:
There were good things happened and bad things happened. But I will say that with one thing that happened, they handled it really well. Like, I was really impressed.
Greg Todd [00:42:29]:
So I'm assuming everybody that's listening to this wants that and we don't need to go through all of that. I think we've gone through a lot in this, in this, you know, rapid fire episode. But what would you say to that person that has a practice? They're like, geez, I kind of want that. I want the staff that is excited to hang out with each other. I would love to have the staff that would do retreats. I would love to have the staff that want to actually hang out on a weekend and go camping. I want to have the staff that's efficient and effective and I want to be able to build all that stuff that she's built. But we know that that's taking time.
Greg Todd [00:43:09]:
So what would you say would be the first step, first step to building an efficient quality based practice that's eventually going to still serve people at a high level, but do it in a quality based way. What would you say is the first step?
Mary Koska [00:43:28]:
Well, it's hard to say what the first step is, but I would say in general, have really clear expectations and put systems in place and invest in your staff, invest in taking in, Invest that time into doing the fun things. So like when we do a retreat, half the day is fun and half is work. But, you know, obviously, like, most people can't afford to do that right away, but at least take one, one staff meeting, one once a month to celebrate them. Celebrate the birthdays, celebrate the anniversaries. Like acknowledging people, making sure they're valued, like making sure that they know that you care.
Greg Todd [00:44:21]:
I think there's two big things you said. Invest in systems and invest in people. If you want to have efficiency, but you want this thing to be sustainable. Efficiency only happens with systems, and efficiency and being sustainable happens with systems, but also happens with people. And so I think that's two amazing things. Invest in systems, invest in people. I'll do a soft little not ask. But if any of you are interested in starting with the system of documentation and you are spending 60, 70, 80, 90 minutes on doing your evals and you want to tighten that up, I personally feel like it is probably the fastest fix to getting things tightened up, because it's something that you have to do with every single client, right? Every single client you're doing that with.
Mary Koska [00:45:20]:
So, yeah, it's a daily thing. I think the thing that makes. That's so gratifying to me is just over and over, I hear, life changing. Well, life changing, because it is. It is. And. But the thing is, like, I. I never planned.
Mary Koska [00:45:38]:
I don't like documentation. I never planned to, like, be this, like, person that's helping everybody with documentation. I just got good at it because I don't like it.
Greg Todd [00:45:47]:
Right.
Mary Koska [00:45:47]:
So I. I didn't want to spend any more time on it. But I'm also very perfectionistic. Want it to be high quality, want it to, you know, pass an audit. And, you know, I'm very much that way, too.
Greg Todd [00:46:00]:
Right.
Mary Koska [00:46:00]:
So. So anyway, I just. It's just this. It's just a problem I solved for myself. But it came out of that. It came out of the. The group that I did, the Facebook group, when I was helping people through the pandemic and everything. And then I realized, you know, I'm like, what else do you need help with? And that's how it kind of evolved.
Greg Todd [00:46:21]:
Oh, that's awesome.
Mary Koska [00:46:22]:
Because that's how I found out that people were struggling and, like, oh, I can help you with that.
Greg Todd [00:46:26]:
Love it. Love it. Well, you guys, I hope that helped you. Hope that helped you in some way with regards to your practice staffing, documentation, how to keep people motivated, how to create a culture. I think we talked about a lot of different things. Here's what I'M going to do in the description section, you're going to see Mary's Docufast program. That's her main documentation system. That's her system of how she has gone from 90 minutes on an evaluation assessment to now 10.
Greg Todd [00:47:00]:
And what's so cool is that she's been able to not only do it for herself and her clinic, but she's helped lots of other practice owners do this as well. So, anyways, you'll see that somewhere and. And you can check out more of her stuff. So. Thank you, Mayor, for being home. We appreciate you.
Mary Koska [00:47:14]:
Thank you.
