Episode 25
Allison Jones
Good morning, good afternoon, and good evening. Welcome to the Therapy Matters Podcast. Your one-stop resource for expert insights and advice on everything therapy and rehab. I’m your host, Alison Jones, and today I’m joined by Tony Mariano, owner of Total Therapy Solutions. Tony, it’s great to have you on the show today. Thanks for joining me.
Tony Maritato
Hi, Alison. Thanks so much for having me.
Allison Jones
It’s great to have you here. Before we dive into it, I want to give the audience background on who you are. So take a minute and tell the audience about your background—and total therapy solutions.
Tony Maritato
Yeah. So I hit kind of the key topics, you know, the things that make me a little bit different. I was a practice owner before I was a physical therapist. I grew up down in Sarasota, Florida. I started the physical therapy practice in 2002. It takes me a second because I’m so used to saying 22. I started in 2002.
Before that, I was a strength coach and personal trainer. I fell in love with physical therapy. I was working in a rehab center at a hospital, and I talked to the director and I was like, Scott, how do I start a physical therapy business? And he told me, Well, first you go to school and become a physical therapist, then you work for a couple of years, then you build connections, then you start your practice.
And I was like, There is no way I will wait to do that. So within a year, I quit my job at the hospital as an exercise tech and rehab tech. I opened a personal training studio. Within a year, I hired and recruited a physical therapist, and we started Total Therapy Solutions. We grew to three locations in Sarasota, Florida.
Then we moved to Ohio. We added two more locations at the biggest. We were at five locations employed. Otis was our administrative team. Then my original partner decided we would get married, we would have a family, and then we started to consolidate. So as of today, 2024, we’ve sold some of our locations, We’ve closed other locations. We’re down to two brick-and-mortar physical therapy clinics.
And we love life. We have a great family. We have a lot of free time. We do what we want to do. And I am still passionate about treating patients in the physical therapy clinic.
Allison Jones
That’s fantastic. But you’re not just the owner of Total Therapy Solutions. You’re also the founder of Choose PT First. Tell me a little bit more about that.
Tony Maritato
Yeah. Wow. So Choose PT First is a physical therapy directory website. One of my goals for over a decade has always been to connect the right patient with the right therapist. You know, I’m sure your listeners have evolved and grown as clinicians, and they’ve changed their focus over the years. I used to treat a lot of persistent pain.
I used to treat a lot of patients with fibromyalgia. Now my focus is total knee replacement. And it was important to me not just to connect me with the right patients, but the right patient with the right therapies. So I created this directory. Choose first dot com in my effort to help nationwide connect therapists with patients, and it gives therapists a platform just to share their information, ideas, and treatment philosophies so that a therapist can choose if they want a manual-based therapist, they can find one.
If they want an exercise-based therapist, they can find one. They can choose based on insurance participation, on specialty. That was really the goal behind it.
Allison Jones
You do a lot to help your patients. You’re very passionate, and you can hear that sort of in what you’ve discussed already; you’re very passionate about taking care of your patients and finding the right solutions. But you’re also very passionate about the therapy community and helping them. So tell me a little bit about what you’ve been doing to help therapists grow and help their practices and businesses thrive.
Tony Maritato
Yeah, I approach that in a couple of different ways. As an independent owner-operator, I know that we’re always trying to balance time with the patient versus time building the business. And when my wife and I decided we would go into private practice for ourselves, we had one or two primary goals. The goal was we wanted time and freedom because we knew we were going to get married and start a family, and then we wanted that financial security.
Like neither of us, my wife nor I needed a bigger house, better house, newer car. We didn’t need millions of dollars. We just wanted enough money to feel safe, to feel secure, and to be able to spend time with our family while they were young. And so I want to deliver that to other clinicians as well. And I figured the best way I can do that is to share my experiences.
I don’t ever claim to be a guru. I don’t claim to be all knowing and have the answers. I absolutely don’t. But what I do is I try to leverage social media, video, audio, talked of great people like you to share the message and just, you know, help in any way that I can. Sometimes the way that I help best is by allowing therapists to see what I do and them not doing what I do, not making the same mistakes that I made and just kind of accelerating their growth.
But I do that through YouTube. I do that through Facebook, I do that through LinkedIn and other social media platforms. So I would probably say about 25% of my total time is spent in patient care. About 75% of my time is built around creating content and sharing information and connecting people with the resources that they need.
Allison Jones
Excellent. So tell me a little bit about that, the type of content you’re creating today.
Tony Maritato
Mostly it revolves around video, and the reason why is because I can always pull the audio out of the video. But video kind of in my world gives me the best opportunity to create connections either with potential patients or potential therapists or even potential businesses. You know, I will have my one of three YouTube channels will have I think we just crossed 9 million views and I’ll get daily calls from people all around the country, even sometimes across the globe.
And they’re talking to me or leaving messages on my answering machine like they know me, like I’m their best friend. And that’s because they’ve consumed so many pieces of video content. They’ve listened to my audio, they they’ve heard my inflections and the things that I think are important. And I’ve shared ideas that resonate with them so that we’ve built this connection, even though I’ve never met them, never talk to them directly, but mostly video.
And then I take that video and turn it into audio and turn it into written content. I’ve spent a lot of time trying to understand and learn SEO and how the various platforms work, so feel free to ask me any questions about any of the specifics.
Allison Jones
Yeah, and you’re doing all of this. So when we talked about this because because I, I’m, I’m, I’m in marketing, so I have marketing background. So this is very, you know, very interesting, very compelling to me. You’re doing all of this organically. You’re not paying for any of this marketing reach right now. Correct.
Tony Maritato
Correct. You know, it’s one of those things where for choose first, as an example, the only reason why I have a $1 a day budget on Google ads is because I have heard that an element in Google SEO is that if you’re a real business and we want to prove that we’re a real business with real people, Google wants you to see you paying for ads.
So I have a $1 a day budget on Google for paid ads. Outside of that, everything is organic. I’ve never run any paid Facebook ads, anything on YouTube. And what I find is that if I do it organically, it makes real connections. If I let the algorithms work for me, the way they’re intended to work, it puts my content in front of the best possible audience, the audience that’s going to consume that content, that’s going to resonate with that content.
Whereas I find that if I try to force it, Seth Godin, one of my heroes in marketing, talks about push verse, pull marketing. So if I try to push the message, it connects with the wrong people and I feel like I’m just wasting the money on that. Whereas if I put the information out there and I allow people who are looking for those answers to come find it, it just works so much better.
I get so many better connections that way.
Allison Jones
And now can any anybody in the therapy space, any physical therapists, can they take this approach? Can they do this.
Tony Maritato
100%? And I’m the first one to say, like, if you were to talk to me about organic reach for my website, my physical therapy website, ten years ago, I would have laughed. I would have said, You’re crazy. It’s ridiculous. I will write articles, I’ll write content. Nobody will ever find it. I’m going to drown in a sea of competition.
But that was really before I started to understand the difference between writing the content or recording the content that I want consumers to see versus providing the content that they’re already looking for. You know, and that was the switch for me. I mean, I had a website since 2003. I probably got a total of 100 visitors in a year if I was lucky.
But then as soon as I made that switch, as soon as I realized, wait, I should provide answers to questions that people are already searching on Google instead of trying to write information that I think they should be searching for on Google. All of a sudden everything exploded. All of a sudden now I could take a website from brand new in the sandbox, brand new URL to 20,000 visits a month in less than a year, because I can create content that people are searching for and I can create content that Google wants to deliver to those searchers because it’s valuable content, it’s unique, it’s different, it’s got original photos, it’s got original audio and
video, and it shares a perspective that hasn’t been shared by Web M.D. and all the big players that are already in the space.
Allison Jones
Now, does it have to be high production value?
Tony Maritato
Not at all. And this, you know, I’m sure many of the people listening are watching. You see those handheld, shaky videos Just before you and I got on, I was looking at my total knee replacement YouTube channel. And out of the five top performing short videos on that channel and these videos have 265,000 views, 263,000 views. All of them have over 100,000 views out of the top five.
All five of them are just 15 to 30 second clips, me holding a regular iPhone recording my patients knee. In this case because I focus on knee replacements and am I explaining to my patient, I’m not even on the video, I’m behind the camera, but I’m explaining to my patient what they can expect. It’s usually their first visit to a physical therapy clinic, and all of these videos have gotten hundreds of thousands of views collectively, over a million views, and it’s low production quality.
There’s no audio, there’s no editing, there is no fancy cameras or lighting. It’s literally an iPhone recording what I’m telling a patient so that if they have questions about it, they can go back and reference that video. And that is really at the root. One of my favorite people, Gary Vaynerchuk, Gary Vee, he always talks about creating or not creating but documenting.
Don’t create content. Don’t try to have high production. Just document what you already do. You know, none of us, we weren’t in physical therapy to be popular on social media. We’re not comfortable in front of a camera. But if we can just document the little things that we say in the clinic every single day that adds huge value to people that will never have the opportunity to be our patients.
Allison Jones
Excellent. Yeah, I like that point. You’re not you’re not trying to be a TikTok star, right? Right. You’re just trying to be you’re trying to connect and try to be real a real person with you’re with your patients. So something else that so so you talked about your recording, your patients. So there is, you know, HIPA privacy. So how do you get around the issue of recording a patient?
How do you get that patient permission so you’re not violating HIPA privacy rules?
Tony Maritato
Yeah. So just like anything, we have consent forms. When I start a new plan of care, I’ve got consent, I’ve got HIPA privacy notice, I’ve got all of that, but I’ve got a specific media release that informs the patient that I will be recording these sessions whether I choose to or not. A different topic, but I will be recording.
This is an educational video. I’m going to share this on social media. And one of the main things that we have to be sure that is we always give the patient the right to refuse to. We give the patient full informed consent so that they can make an informed decision. And if down the road they decide, no, I don’t want that shared, they need to have the ability to come back to us and say, I want you to take this down.
I don’t want you to put this out there anymore. So I’ve got an attorney reviewed HIP, a consent form that includes a media release, and I make sure that any kind of content that I share is informed. I inform the patient about it, and I have that informed consent on file.
Allison Jones
Excellent. And and typically, I know we chatted about this before, but typically patients are excited to do this for you.
Tony Maritato
They they really are so many therapists are so fearful that patients are going to get upset or they’re going to get angry or I’ve really never had a single patient that said, you know, I don’t want you to share this. And most of my experience is patients are happy to share it because they know that other people are going through similar experiences and they know that it will help other people that will inform and educate other people.
And the reality is I never show somebody in a bad light. I’m not trying to make is not about the person, it’s not about the patient. It’s about the education, the information and the condition that we’re working on. So just my experience, I’ve never had anyone respond negatively and truthfully. Most of the time I get patients that come back in and they’re like, Tony, my video is up to 4000 views.
I can’t believe it. They were so excited and pumped up for it. And then of course, we get the secondary benefit that they have the opportunity to share that video to increase its reach, to share it with their local community. You know, everybody has a circle of influence. And so when they share it with somebody, then usually I pick up more referrals from their immediate circle.
Allison Jones
So it’s just a little bit of viral marketing that your patients are doing for you.
Tony Maritato
Absolutely. We’re celebrating what they’re doing. You know, who could feel bad about doing something to make themselves better? It’s just it’s such a positive message. And I really do believe, like seeing somebody, you know, working on improving themselves just makes you want to go out and do the same.
Allison Jones
Absolutely. Absolutely. All right. So, Tony, we’re going to we’re going to pivot just a little bit. So I want to get I want to get your feedback. I want to get your opinion about, you know, what what do you see as the biggest challenges or the biggest opportunities that are out there right now for folks that are in private practice for therapy?
Tony Maritato
I just think the future is so exciting. We have tools in our hands that weren’t even imaginable when I started 22 years ago. You know, it’s one of those things that I love that you switched from challenges to opportunities because that’s really what it is. I have got the ability to reach any human on the planet through social media platforms, but I also have the opportunity to bring the cost of care down to practically zero for anyone human on the planet.
You know? And when I look at the future of physical therapy and I look at the negativity and the frustration that I hear across social media within the professional circle, I think a lot of that comes from the fact that so many of us, me included, we’re banging our heads against the wall. We’re trying to change things that really are probably not going to change.
They’re not within our power to change. So rather than trying to go through the wall, why not just go around it? Why not just look at a parallel or an adjacent space, look at what is it that we really want to do? I want to help people. I want to make people feel better. I want to educate and inform.
Well, how else can I do that? I can leverage video, I can leverage audio, I can leverage async, harness treatments, telehealth. There are so many opportunities, so many resources, and most of them are actually free. My YouTube channel reaches 9 million people and I pay nothing for that access. I put a little time in, but that’s it. In fact, my YouTube channel pays me about 1500 dollars a month, just an ad revenue.
So I’m not even just getting it for free. I’m actually getting paid for it. It brings clients into my practice. It does so many things for me. So I think the real future, the real excitement in physical therapy is not trying to change what’s always been done. You know, the practice of 1982 needs to stay in 1982. We need to develop the practice for 2024 and the future.
And I think obviously that’s going to include technology, artificial intelligence. It’s changing the way we do things to achieve the goals that we’re working toward.
Allison Jones
So yeah, So what are some of the what are some of the bottlenecks that are holding up other other folks from going in that direction and from from sort of developing or adopting the model that that you so successfully have adopted?
Tony Maritato
I think we we’re certainly limited on time. You know, I am fortunate. It’s easy for somebody to listen to me saying what I say. And they’re like, well, you’re doing 20% patient care. And it’s totally true. But what I would encourage is I would say, just like any patient, if a patient came in to me, first thing I do as I do an evaluation, where are we starting?
Right? Where are we starting? What are your strengths? What are your deficits and what are your goals? Where do we want to get to? For most clinicians, Zoetis Otis Spears, anybody listening to this podcast, I think they’re probably struggling to keep their head above water. I think they’re working as hard as they possibly can. Their documenting their treating.
They don’t have an extra minute or two in the day and they don’t have the mental the ability to separate that mental focus from I am 100% focused on this patient and patient care, too. Now I’m going to split that focus to creating content while I’m treating the patient. So I acknowledge that, like that’s the bottleneck. We’re just doing too much for too little compensation.
So what I try to do is I try to say, okay, let’s let’s look at where you are right now, your strengths, your weaknesses, and how can we add income, because I think that’s a big bottleneck for most of us. How can we earn more without necessarily doing more? And one of the things that I’ve always promoted is, once again, if I go into an exam room and I set to evaluate a patient for the first time, if I just take a little camera right, little GoPro, a little iPhone, I set it up, I get hyper concerned.
I inform the patient that I’m going to record myself explaining this information to you. I’m going to share that information with the patient. Why not document that information, share it across platforms that then allow other people access to that information and will compensate me for that. So the example I share is if I do an evaluation for a patient one time, I might make 100, $150 for that.
If I’m an employee, I might make $50 for that. But if I record that, the information, I tell that patient about their total knee replacement that they just had 24 hours ago is information that is valuable to over 800,000 people in the U.S. getting a total knee replacement every single year. I will let YouTube monetize that information with ads and YouTube will pay me.
I think it’s 55%. I don’t remember of that ad revenue. So now that one visit, that one hour of my life that I would have been paid once for, I can be paid hundreds of thousands of times for. And that is where once we can start to increase the revenue generated for each hour of our time that we’re putting in now, we start to build capacity.
Now we could start to do less. Maybe instead of treating 60 patients, I could treat 40 or 30 or 20. I could do a better job with it. I’m making more money doing less actual patient care, but more focused patient care.
Allison Jones
I love that. And you know what I’m going to tell you, my dad just had a total knee replacement, so I’m definitely going to point him to your YouTube channel. Please do check it out. So you mentioned you mentioned I and this is this is this is a hot button topic in in a lot of different industries, but certainly in therapy as well.
Some people are looking at it as as an opportunity. A lot of folks are looking at it as a threat. What do you think is the issue with incorporating not just air but but technology in general into therapy practice.
Tony Maritato
I think is one of those things that we we all are resistant to change, right? If I try to change my daily routine, there is going to be friction. There’s going to be resistance. I’m not totally sure how it works. Full disclosure for anybody watching, I still use paper documentation in my practice. I have access to electronic medical records.
I could get any EMR I want, but my team, my staff is so comfortable with paper documentation they can walk around with their chart, they can document while they treat their resistance to that change. Right. And so I understand. I see it. I’m also a 49 year old dad. I don’t want to do things differently. I’ve got my routines, I’ve got the way things should be done.
But when I look at new tools, new technology, I really try to see where can this add value and when. I can take a technology that takes my gibberish, takes my words and can consolidate it into a concise, short, specific message, I think there’s huge value in that. So when I look at artificial intelligence, I know we’re going to go through a lot of bumps in the road.
I know we’re trying to figure this stuff out, but I definitely think being able to access millions and millions of medical records to provide me with better suggestions on how I can help my patient improve their patient outcome, I just can’t see how we say no to that. Allowing AI to come in and look at what we do, look at how we’re doing it.
Make recommendations on how I could have done it better. I just need to table my insecurities. Know that every time new technology has come out, yeah, a lot of people lost their jobs, but a lot of new jobs were created. And I just I’m completely excited. I think that this is something that 5 to 10 years from now, we’re not even going to recognize the stuff that we used to do.
Allison Jones
Yeah, it’s that whole concept of blending technology with personalization, right? So yeah, a more personalized approach to care.
Tony Maritato
The more time I can allow AI to do what I AI does better than me, the more time I have to build real human relationships with my patients. And that’s ultimately the goal for all of us.
Allison Jones
Absolutely. Absolutely. So ultimately, Tony, what are you trying to accomplish with your practice in your business?
Tony Maritato
I think and we can touch on this in a couple of different ways for my practice, you know, I’ve always been of the mindset that I can always make things better. I love cooking. I cook every meal, every single day. But as much as I love cooking, I struggle to follow a recipe because I always feel like I could make it better, I could tweak it, I could improve it.
I could do something different, and I ruin a lot of meals that way. But I also sometimes do something magical in the kitchen. And so when I’m talking about my business, my practice, or what I do is I look at it as a platform. It gives me resources, it gives me the freedom to kind of tinker and create something new, something different.
And I think that when I look at my particular patient demographic, which is different than others, my patients are typically driving themselves to therapy unless they just had a knee replacement or rotator cuff repair. They’re typically dressing themselves, bathing themselves, feeding themselves. They’re typically doing all of these things. And so when I look at what used to be done before modern technology, before YouTube and all of the resources we have today, I don’t think we need to do things the same way.
And so my goal for my practice is how do I drive down the cost of care globally, but then how do I increase the value of care for the things that I think I do best? And for me, it’s connecting with the human in front of me, delivering the services that they really need, not just the physical therapy intervention, but maybe for this particular case, we need to talk about mindfulness.
Why are you doing these things that you know aren’t necessarily in your best interest, but you feel compelled to do it? Maybe we’re going to spend time talking about sleep. Maybe we’re going to spend time talking about nutrition or accountability. Many of these things are not covered by insurance, and that’s fine because a lot of my patients are more than happy to pay out of pocket for these services because they realize they need to make a change and this is the way they’re going to make that change.
So that obviously opens the door to a hybrid practice model to increase profitability without trying to fight the insurance company to raise reimbursement rates. I don’t care. I don’t care what the insurance wants to do. Let them run their business. I’m going to run my business. And my business is to provide the best possible outcome for the patient in front of me.
Allison Jones
Excellent. I love that. So any final thoughts for our audience today?
Tony Maritato
I think the main thing is, you know, know yourself like I spend a lot of time, probably too much time trying to reflect on why I make the decisions that I make. Did I respond that way out of fear, out of insecurity? Am I doing this because it’s really in the best interest of what I’m trying to do or my patient or my family?
Like we need to think about all of those things. And the better we understand ourselves, I think the better we can understand the actions we take, the decisions we make, and the better we can then direct those decisions to achieve the goals that we want to achieve. Because like I said, I mean, I share a lot of information and I share a lot of ideas, but I also know that I have my own insecurities and I make a lot of bad decisions.
And every single time I make a bad decision, I try to learn from that decision so that I avoid making that bad decision again. Usually it takes a lot more than just one lesson to learn it, but that’s really just the better you know yourself, the happier you can be in the long run.
Allison Jones
Absolutely. So, Tony, where can where can people find your YouTube channels?
Tony Maritato
So I’ve got a couple of YouTube channels probably for this particular audience. The most interesting one would be learn Medicare billing. That is a therapist focused YouTube channel. But if you want to kind of sneak peek behind the curtain and see what I put out to the general population, you could look at total therapy solutions or you could look at choose first.
Those two YouTube channels are patient facing YouTube channels.
Allison Jones
Excellent. Well, we appreciate that. We are out of time for for our session today. But I do want to thank you for joining us and providing a lot of great insight for our audience. So thank you. And thank you to our audience for tuning into the Therapy Matters podcast here. One Stop resource for expert insights and advice on everything therapy and rehab.
We look forward to seeing you on the next episode.
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