Episode   |  141

Modernize Your PT Marketing Strategy: From Referrals to Direct Access with U.S. Physical Therapy

Cardinal’s CEO, Alex Membrillo, sits down with Teresa Stockton, Director of Marketing, and Kimberly Valva, Director of Operations and Business Development, to explore how U.S. Physical Therapy is transforming patient acquisition in a world where referrals are no longer the only game in town.

Episode Highlights:

Teresa Stockton: We’ve given our clinics the ability to post content on their pages directly. We work in partnership with them and our clinics that publish do really a great job. Patients and people in the community want to see local content, their therapists, not just a stock image and an article, they want to see what’s happening in the day-to-day life of that clinic. When we switched to that, it really boosted the performance plus, we have a 4.9 star average rating across our clinics.”

Episode Overview

In this episode of Ignite, our host, Alex Membrillo, takes listeners behind the scenes of a transformative journey in the physical therapy industry. Joined by Teresa Stockton, Director of Marketing, and Kim Valva, Director of Business Development and Operations at US Physical Therapy, the trio dive into how one of the largest publicly traded physical therapy networks in the country pivoted from a historically referral-driven business model to embrace the power of direct-to-consumer marketing.

With over 700 clinics across 44 states and 135 unique brands, US Physical Therapy is no stranger to complexity. Teresa and Kim share how changing laws and the onset of COVID-19 forced the company to rethink its patient acquisition strategy, rapidly developing digital expertise to maintain growth. They discuss their early experiments, like boosting posts on Facebook and learning Google Ads from scratch, to their current state of sophisticated multi-channel marketing.

The conversation highlights the incredible synergy between digital marketing and field sales teams. Teresa and Kim explore how US Physical Therapy successfully tracks results, measures same-store growth, and ensures alignment between their in-house marketing team and the boots-on-the-ground efforts of their 75 sales reps. Along the way, they discuss the challenges of managing hyper-localized content for 135 brands while maintaining consistency and navigating the evolving landscape of AI and digital search.

Packed with insights on how to secure leadership buy-in, track ROI, and balance incremental growth with strategic innovation, this episode is a masterclass for healthcare marketers and executives alike. 

Related Resources

Announcer: Welcome to the Ignite Podcast, the only healthcare marketing podcast that digs into the digital strategies and tactics that help you accelerate growth. Each week, Cardinal’s experts explore innovative ways to build your digital presence and attract more patients. Buckle up for another episode of Ignite.

Alex Membrillo: All right, guys, we’re about to have some fun. We’re going to have a three-way call like we’re in high school. This is going to be really good. We don’t often do these, but it is going to be really fun because we get a variety of input and we don’t just get input on this one from marketing leadership, but we also got marketing ops. This is going to be really cool. Physical therapy is a really interesting space to me because it has historically been so largely referral-driven, still is, but entering more in the DTC market. Teresa and Kim, I have a good blend of like where it’s been and where we’re going to be going. Teresa and Kim. Teresa, we’ll start with you. Introduce yourself, where do you work, what are we going to be talking about a little bit today, then we’ll go to Kim.

Teresa Stockton: I’m Teresa Stockton. I’m the director of marketing at US Physical Therapy, and we are going to be talking about our move into direct-to-consumer marketing, direct access.

Alex: I love it. Has it worked?

Teresa: Yes.

Alex: [shouts] [unintelligible 00:01:06] and Kim’s nodding for all of our five listeners that are just listening to this one. Kim, you also work there?

Kim Valva: I also work there. Kim Valva, Director of Business Development and Operations. I’ve been with US Physical Therapy for almost 13 years.

Alex: I love it. 13, Teresa, 17 years?

Teresa: 17.

Alex: Well, we’ve got livers, y’all believe in the mission. Why do you believe in the mission so much? When [unintelligible 00:01:26] stayed that long, they believe it why?

Kim: People.

Alex: [unintelligible 00:01:29].

Kim: No, 100%.

Alex: Love the people. It’s so rewarding too. You see patients actually like a lot of different types of health care. You don’t physically see the chains, but you see people alk out that weren’t walking in so that’s really cool.

?Kim: [unintelligible 00:01:41] things, we actually get to see it from a business perspective. We see somebody join US Physical Therapy with one clinic and they grow to 10 or they come to us with 10 clinics and they grow to 20.

Alex: Oh, I love that. You’re passionate about the affiliates also growing their local businesses too? Me too, I love entrepreneurship. Very fun. US Physical Therapy. Teresa, tell us how big, how small, and what size are we? Are we house of brands, et cetera?

Teresa: Oh. We have just over 700 clinics across 44 states and about 135 brands that we’re managing.

Alex: Dang, bro. That’s big.

Teresa: [unintelligible 00:02:11].

Alex: Y’all are what? Three? Are you the third biggest in the country?

Kim: I’m not sure. I would say we’re probably about the third biggest, but we are publicly traded. We’re in a world of our own, we’re one of the largest publicly traded national companies. Teresa said, 700 clinics in 44 different states and we’re truly a partnership model. When people join US Physical Therapy, they retain a percentage of equity.

Alex: I love it.

Kim: Really [unintelligible 00:02:35].

Alex: A percentage of their voice that they want heard on all website changes.

Kim: That’s [unintelligible 00:02:40].

[laughter]

Teresa: It is true partnership. We work really really closely with our clinics, but it makes everything better.

Alex: I believe that. Okay, house of brands, how many URLs, how many websites do you guys have to deal with?

Teresa: One for each brand plus our corporate office, our Houston location.

Alex: Oh boy, man, y’all have no shortage of things popping up every day then. You got the fire hose out to deal with any immediate thing the affiliates want to talk about, plus keeping an eye on the strategic refocus.

Teresa: We have a strong team.

Alex: Yes, yes. That’s good. Share the credit. I love that. Oh, well, let’s jump, I’ll skip around, what is the internal team look like on the marketing side?

Teresa: Yes. We have a team of nine, including myself. We have print designers, web designers, advertisers, we have a content writer. We just gamut.

Alex: Really?

Teresa: Yes.

Alex: In-house writer, in-house advertiser, I like it. Y’all are at the size where that would make sense. Very cool. Do you utilize outside resources? You ever go to upwork.com, find contractors, agencies, anything like that?

Teresa: We have outside tools that we use, but most of the work is done in-house, and [unintelligible 00:03:44] clinics can choose to go outside as well.

Alex: They can. Do they have their own marketing partnerships oftentimes where they’re doing thin boots on the ground or digital on their own?

Kim: We also, in addition to the in-house marketing team, we have about 75 sales reps that are boots on the ground.

Alex: Got you. Very cool. All right, guys. Don’t take their model, don’t do everything in-house, agencies are cool. Not everybody do it, please. Teresa, you started 17 years ago, how did you guys acquire patients back then?

Teresa: We were strictly physician referral-based. Kim can talk more about that.

Kim: Yes, yes. Over 70 sales reps, 16 years ago, 13 years ago, when I started, when Teresa started, we were boots on the ground in and out of doctor’s offices every single day trying to influence referral patterns.

Alex: Man, man. That’s tough. I bet at times it feels like pushing rope because you’re trying to influence the referral patterns, but like they won’t do. That was tough. What made you guys want to start going direct to consumer? What brought that change and when?

Teresa: It was the laws started changing. In 2015, that’s when everyone had some form of direct access in 2019, Texas, that’s where we’re based out of. We’re based out of Houston. We have a good group of clinics here at 2019, Texas Direct Access laws changed to allow us to treat before sending back to a referral. Just that ability alone started letting us look into it and develop a strategy.

Alex: People always want to know like where did you start? When that changed, where’d you guys start?The smaller groups always want to know how did USP, where’d they go?

Kim: What ended up happening is we were allowed to see these direct access patients, so we started dipping our feet in a little bit, probably started with some Facebook, with some email newsletters, but everybody knows what happened after 2019, 2020. We were completely shut out of our doctor’s offices. Our sales reps couldn’t get in anywhere. We had no choice but to become digital experts and fast.

Alex: It’s a good reminder. I forgot how much I loved COVID for digital advertising, just for digital advertising. It was good for the business, that’s it, I don’t want another one. Very lonely. I sat in this office by myself with my volleyball for a year and a half. That sucked. Direct access becomes a thing, COVID helps accelerate it. Where did y’all go? You had Meta, you had some email newsletters. What are you finding that you’ve started growing into more with direct access, advertising and marketing?

Teresa: To start, I would say to just let our patients know that it was an option. We relied heavily on email, but we’ve been into all the channels. Heavily with email to get in touch with patients directly. Let them know about the laws have changed, you can come here, we can see you all of that kind of stuff, but we use every social channel available to us possible. We were just going after everything.

Kim: I think I started noticing this boosting option on Facebook. At that point, with COVID, I decided I was going to become certified in every single digital media channel that had a certification and a course. [chuckles] At one point, Teresa and I also ordered Google Ads For Dummies because we were part of [unintelligible 00:06:36].

Alex: [unintelligible 00:06:37].

Kim: We had no choice, we had to become the experts as fast as possible. I think once we started with boosting some ads and seeing the immediate return, we knew we were going all in.

Alex: Yes. I love it, I love it. Hey, when I started this thing 16 years ago, I bought the SEO For Dummies Book and whatever, and now I’m like the dummy. Anyways, so I got it. You bought the book and you started doing some PPC advertising and things like that. How did you guys get buy-in from leadership when this happened? Yes, laws change, COVID all that, did you guys sit around the table with the rest of the C suite and say, “Guys, like we need to get this done. Did you present numbers, a forecast, a strategery, some kind of a business plan?” Everybody always wants to know, “How do I get buy-in from my leadership team to do more D to C stuff?

Kim: I think we have probably the most supportive leadership team that you’ve ever come across in this space. We said, “We’ve got a problem and we have an idea and a solution,” and that we’ve built up enough trust over the years where they trusted us to go ahead and make a run with it. Once they started to see the numbers come in, let me measure everything on a safe-for-growth percentage. Everybody has an expectation of growing at least 5% month over month, year over year. Again, we are a publicly traded company.

Alex: [unintelligible 00:07:41].

Kim: Once they started seeing the results come in, they gave us a little bit more and allowed us to do something else that was a little crazy. We kept going until we got to the point where we’re at right now.

Alex: Yes, yes. You had trust from the leadership team and then the results backed it up. In the business result, guys, y’all heard what Kim said. It was same-store growth. She didn’t say like leads and impressions, net new patient appointments, same-store growth. The actual business was growing revenue, top line. Being publicly traded, that does add a level of scrutiny even beyond private equity back groups like, “No, the numbers are posted like on the web [laughs] every single quarter. You have to hit numbers and it really has to grow,” same-store growth.

How did you guys, something in your field in a PT field we often hear is, “Yes, we’re growing, but we think it was mostly referrals. It was mostly our liaisons.” How did y’all bifurcate and say, “No, guys, this was a large part of the digital stuff that we were doing?”

Teresa: That’s a great question. We track our appointment requests online as well. When we do digital marketing, we ultimately try to filter everything into the appointment request form on the clinic website. We were just getting started 2020, 2021 and 2023, we grew that by 34%. We’ve already hit our ’20, we’ve already surpassed 2023 this year in 2024. We’re able to put like a dollar amount to that [unintelligible 00:08:54].

Alex: I love that. Your online appointments are tracked back to the advertising?

Teresa: Yes. For pay-per-clicks, yes. We do ask on the forums like, “How did you hear about us?” 54% are still referral, but that could be physician, friend, family, any type of referral, but the rest is found growth, like organic or pay-per-click growth.

Alex: Yes, yes, yes. Teresa, I think you should claim some of that 54% for yourself because we did a study with a large physical therapy group and we found even when people had a referral, they oftentimes did not choose that referral. They’re still going to Google and choosing somebody else that may be showing up better or more often, and then they’ll still say referral [unintelligible 00:09:31]. Anyway, so I think 54%, you could carve out some of that and take the rest for digital, baby. You guys you have to support both the digital acquisition stuff and the field teams. How do you balance that? Do you assign it out to other people? Do you give priority to one or the other? How do you guys go about thinking through that?

Kim: I think when we look at it, we’re still getting physician referrals and everything that we do from a digital space is incremental. It was easy to get buy-in from our sales rep. They’ve made that [unintelligible 00:09:59] from the old pharmaceutical sales rep model over to this hybrid agro-marketing and a sales rep. They’ve also got buy-in from their local directors and Teresa can talk a little bit more about performance on social media and what it means to come from those local people who are treating in the clinic.

Teresa: Yes, we have given our clinics the ability to post content on their pages directly. We work in partnership with them and our clinics that publish do really a great job. Patients and people in the community want to see local content, their therapists, not just a stock image and an article, they want to see what’s happening in the day-to-day life of that clinic. When we switched to that, it really boosted the performance plus, we have a 4.9 star average rating across our clinics. It really makes our job easier here because our clinics do such a great job and our sales team locally.

Alex: Yes, 1+1=3. When the field teams are doing great and we’re doing great on digital, it helps the field team. The field teams aren’t threatened at all by the digital stuff. They’re not like, “Ah, we’re going to start getting cheaper leads than I can get. No?” They’re like, “Good-

Teresa: [unintelligible 00:10:58].

Alex: -I’m glad we have more brand awareness. It makes my life easier.”

Teresa: We’ve never changed their commission structure. It doesn’t matter how we get a patient in. A patient in is a patient in. That’s why they’re 100% bought in. If it comes through some type of Google search, if it comes through a Facebook ad, or if it comes from a physician, a new patient is a new patient.

Alex: Yes. All right, very cool. That’s an important business metric, guys. Don’t change the comp structure. Then they’re like, “Yes. All right, cool. I love your digital stuff. Pressure’s off.” [laughs] I like it, so that’s good. Everything is assisting each other. Do you guys do anything digitally that is direct to the provider kind of advertising? Do you buy or build a list of all the providers and then serve ads or serve email journeys, newsletter, anything to supplement what they’re doing when they go in office?

?Kim: We have not. We have been mostly focused on patients, which is what we’re facing.

Alex: Very cool. We’ve seen some of that be effective, but it’s just like a layer on. It’s a 30,000-foot thing, like to make sure the providers are always seeing ads for USP. The referring providers are always seeing USPT ads and it makes the liaison stop. I would think easier when they go in and they say, “Oh yes, I’ve heard it, I don’t remember. Okay, very cool.” What do y’all have publicly traded? A lot of scrutiny on same store growth, practice capacity needs, any challenges you guys have seen this year? We’re getting stuck, is it either market driven or advertising driven or liaison? Any big growth challenges to hit capacity goals this year you’ve encountered?

Kim: I would say we’re hitting new milestones every single quarter on a visit per day, per clinic basis. I think in terms of challenges, anything that we do, we have to repeat 135 times [chuckles] while-

Kim: -maintaining that local presence and the local integrity and making sure that everybody’s staying true to their communities that they serve.

Alex: All right, guys. Kim’s hit every record every single month. There are some groups out there that are not as good as Kim and USPT and they struggle to hit a capacity need or something. What would you say, like the lever you go to when we’re not hitting a number in some store at some point, what levers do you go to that have a quick injection of assistance?

Kim: The first thing I tell my clinics to look at if they see a dip is let’s take a look at your reviews and how you’re doing in your local market, because if they’re not performing online digitally and they can’t match what their competitors are doing, then there’s going to be a drop.

Alex: Especially with still a considerable amount of business coming from referrals. People will check that.

Kim: Absolutely. Yes, we can put money towards a problem, but if you can’t back it up, then it’s not going to be as effective.

Alex: I love it. Teresa will get the call. we need more patients as you’re going to say, “You need to treat your patients better. I’m not doing anything for you.”

[laughter]

Teresa: I think that one of our regional presidents always says, she’s changed her mindset from being a clinician to being a regional president. With that, she took that diagnostic ability and took it from treating patients to treating your business that way. You almost have to diagnose what’s going on, ” Why are my referrals drop?” Analyze your referral sources, analyze your payer mix, and look at all those things and make your kind of treatment plan based on that.

Alex: Yes. Kim, is your background in marketing, Kim?

Kim: My background is in sales. I started as a sales rep for one of US Physical Therapy’s partners in Phoenix, Arizona. Moved up to operations business development about seven years ago.

Alex: I love it, and you know the marketing side pretty well. I did a vote on LinkedIn a few weeks back, “What should marketing be called next year?” Everyone says growth because it’s so much more than just like running cool ads and making sure [unintelligible 00:14:20]. You have to know like everything Kim just said of payer mix and making sure referral partners are there, making sure this is incredible, the amount of things you have on your plate.

Anyways, there’s no tip here. It’s just great. I’m astounded by the amount of hats you guys have to wear and how you have to think about the business, “No, don’t go out and get an MBA, but yes, you have to like take it upon yourself to learn the business that you’re in. Marketing for the sake of marketing doesn’t drive the business forward where we all lose our jobs.” Anyways, I digress. Going into the next year, guys, what are we accelerating? What are we excited about? Then we’ll talk about the antithesis of that. What are we looking forward to?

Teresa: On my side, we are excited to tackle the AI team challenges that are coming out with Google and online search that we’ve really been doing our research and looking at our clinic performance just so that we can make sure that when all those changes officially happen and start pushing forward, we’re ahead of the curve.

Alex: That’s scary, they’re coming for us. They’re coming for us, Teresa.

Teresa: I know.

Alex: We all should be a physical therapist. They’re not coming for that job anytime soon, they’ll be fine. That’s fine. Looking at AI, Kim, what’s on your mind? What are you looking at next year?

Kim: [unintelligible 00:15:22], I would say probably just to continue to support the marketing team and what they’re seeing. We look at them as the professionals in that marketing space and then helping them drill down that message to our clinicians, to our clinics, our partners, and our sales reps.

Teresa: Yes, absolutely. Is that like in terms of value prop and you’re trying to say, “Hey guys, we are special in these ways. Don’t forget USPT, our affiliates, we are special in this way.” To help convert more, Kim, where does that come from? What are we trying to do?

Kim: There’s so many things that we’re trying to do. On the business development side, we’re trying to form more partnerships. We’re trying to work with more existing entities that are already out there that are looking for some backend support. Then for our existing partners, they want to grow, again, maybe from that 20 locations up to 30. They want to hire more PTs. You know where PTs are looking before they come for a job interview? Your social media.

Alex: Yes, yes, yes, yes. They want an inside glimpse and so do patients and people are like posting a Facebook post. It’s a waste of time. You don’t have to do it a ton, but you have to show an inside glimpse of this place guys or people aren’t going to physically want to walk in. Are either of you guys like do y’all assist on the talent recruitment side, we heard that’s a struggle, finding enough PTs? There’s only so many graduating yet everybody wants to do more advertising. Do y’all help with recruitment or talent?

Kim: We do. We’ve recently, as a company, expanded our TA department and growing into an education department next year. Teresa and I do work closely with them. We’ve got some new websites that are coming out and some new technology tools that we’re excited to bring to our partners.

Alex: Very cool. It takes an army, so you guys are going to be helping. You said education, what does that mean?

Kim: [unintelligible 00:16:46], continuing to bring different opportunities to our existing physical therapists, but then also expanding on our student programs.

Alex: I got you. I got you, I got you. Get them so that we attract more students coming out and so that we return-

Kim: [unintelligible 00:16:58].

Alex: -the existing ones, and so they get better at delivering care. Yes, but also it’s a retention play I imagine. Very cool. I love what Teresa said. It’s just coming back to me, a lot of times we want to look at the next fancy marketing thing for next year but reviews are so paramount still. Everyone scrolls, not everyone, people look at PPC enough, and obviously we drive a ton of patient volume through PPC, but they will go look at the maps.

If you’re in the maps with great reviews, they’re going to more likely click on your PPC and not someone else’s. I love the focus there and the focus on AI, very smart. Guys, anything that you would say did not work this year, you will not be bringing into next year?

Teresa: I don’t know.

Alex: Anything going into next year, you would want to do less of or give more resources, something else instead of?

Teresa: I know that we do want to put more resources towards our advertising. I don’t think we would have to take resources away from what we’re currently doing, but we do have a plan to push that programs more.

Alex: I love that. You guys are so optimistic, USPT is humming, this is cool. I love [unintelligible 00:17:57], you know a lot of groups have struggled over the last couple of years. They’ve struggled to deliver patient volume, when they do find it, it’s not been cost-effective enough. They’re wondering where to scale next. This has been aligning, you guys are killing it. Teresa, Kim, any anything else you want to run by our viewers?

Teresa: Yes, I think the great thing is because we’re internal and [unintelligible 00:18:16] operations, I’m marketing and we work so closely together that it’s really made both of our lives easier. When a clinic is struggling or they just have questions, it’s very easy for us to combine and have the operations and the marketing team collaborate and come up with ideas together. It’s not unusual for us to be one-on-one with those clinics and just go through with them together on what our next step should be. I think that’s been a big driving force of making having a good year overall.

Alex: I love that. We call it MOps, marketing, and ops alignment. What a case study and making ops your BFF as a marketer. When you guys are in lockstep, the business moves together. Oftentimes, they are not BFFs and they are battling each other and ops doesn’t want you to market in that zone or is wondering why you’re not filling capacity. It’s like, “Well, we didn’t align on goals and I don’t know what you want,” and they don’t get along and the business breaks down. Here is the case study on when marketing and ops get along very well. How often do you guys meet? Do you work in the same building? Houston, right?

Teresa: We are.

Teresa: We call each other every day.

[laughter]

Alex: I want every provider group out there when they hire their next marketer, ask if they have a best friend, that person has to be the ops leader.

Kim: We do have an official call once a week that’s on both of our schedules, but things come up and we’re moving and we get crazy ideas. We do end up on the phone every day and again, I think that working relationship just means so much.

Alex: Yes, absolutely. Man, we could go on and on about this. You guys are so intelligent in your marketing. You have actual business goals, you know what they are, you’ve tried a different mix, you have leadership that’s bought in, you know what you do with advertising and the referrals are working really well, you’re working on talent recruitment, engagement, and retention. You guys have all of the bases covered. This has been really fun. I want to talk to our grantee. We’re going to do more of these three ways. This was awesome. It’s so fun getting to bounce off each other. Teresa, this is Teresa’s first podcast ever and she crushed it.

Teresa: Yes. [laughs]

Alex: [shouts] Yes.

Teresa: Thank you, thank you.

Alex: Absolutely. Thank you for joining us tonight, Kim, Teresa, we appreciate it.

Kim: Thank you so much.

Teresa: It’s been so fun.

Announcer: Thanks for listening to this episode of Ignite. Interested in keeping up with the latest trends in healthcare marketing? Subscribe to our podcast and leave a rating and review. For more healthcare marketing tips, visit our blog at CardinalDigitalMarketing.com.

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