Norene Christensen on building Four Pines Physical Therapy with MHA
The founder of Four Pines Physical Therapy talks about payroll worries, the Outside-In Assessment, running three Wyoming clinics on KPIs, and choosing U.S. Physical Therapy as her partner.
In Norene's words
The starting point
"Oh my gosh, I need to learn how to run a business."
I was four, five years into business realizing I was not remotely profitable. I kept wondering where the money was when payroll came around, payroll taxes came around. In hindsight, I was pretty much doing everything wrong, and I knew I needed help, and that's when I went to PPS up in Vancouver and met Paul Martin.
Dave Pearce, Dave, who has been my consultant for many years, we started talking maybe around 2017, '18 of "Hey, what's your thought? Where do you wanna go?" And then we really started putting together a plan.
The cost of getting help
What every practice owner is afraid of when you're like your consultant's gonna cost 2,500 a month. This consultant's 10,000 a month. You're looking at your P&L and your bank statement wondering where payroll and payroll taxes are coming from, wondering where the money is, and then you're gonna pay all this money for a consultant.
And I think that's what gets in everyone's way, because they're like, "I know I need this, but I can't afford it." And my response to them is, in a way, you have to spend money to make money, and the ROI is ridiculous because we are not taught how to do this. And having the guidance from a skilled business consultant is so important.
Going online, doing some research before I started with Martin Group, I can't say I'm that smart. I think I'm more trusting. I did have a great conversation with Paul at PPS and then we had some follow-up calls, and as scary as it was because I was like, "How am I gonna pay for this?" It all made sense for me in order to achieve the goals I was trying to achieve and having a healthy business that I could grow.
Our conversation at PPS in Vancouver really made me sit back and think of, "Norene, you just really can't do this on your own. You need help. You need support." Admittedly, I don't believe I spoke to anybody else, and if I did, they didn't impress me enough to remember who they are.
I wouldn't say it was blind faith, but it was blind faith of stepping forward because I don't believe my business would have survived had I not moved forward. We wanna take care of our community, and you can't do that when your doors are closed.
What I expected my first conversation with Martin Health Group is probably inappropriate to say because I for sure was thinking that they were thinking, "What left field did she come out of and why did she even believe she could do this?" But they had full belief in me. So I really went in vulnerable and willing to learn. I was nervous but I was open-minded to learn and just soak in what they would provide for me.
Running the business on numbers
Where things landed compared to what I expected was beyond what I thought I would ever do with the practice.
I was so well-supported. I've had two consultants. One retired, and he was the first consultant, was really about the patient experience and growth. And then my current consultant was like, all right, let's really dive into the operations and understand numbers don't lie. What the numbers are, how we can drive the business using the KPIs.
I'm very open with my employees, so they know professionally what they were accountable for and what the expectation was. And just everything was clear and we were able to move forward to growing into multiple clinics.
What's different in my week, my role, my team, is I have an amazing leadership team who understand the dashboards, who understand how to teach and support and report to the team, and support them to be successful in achieving their KPIs.
And also coming across that, look, it's not just about KPIs, it's about patient care, it's about culture in the clinic. But as professionals, we are accountable for these things to help keep the doors open for the practice and allow the practice to be healthy and grow or survive the economy crash in 2010 and survive COVID.
Leadership is solid. And I feel like I can easily glance at the dashboards and say, "All right, this is why these numbers occurred the way they did. Okay, now how do we change that if we need to change it, or was it just a blip?" Because nothing's smooth. It's all undulating, and what storms can you weather and what storms do you need to fight? And so I think it brings clarity in leadership, which is super helpful instead of just wondering, where is this coming from and why, and how do I deal with it?
Through the downturns
Was there a moment where I thought it might fall apart? Not since I started working with Martin Group. Somehow I lost a huge amount of team members during the economy crash, but I believed that we were gonna get through it and rebuild, and then when we rebuilt, it was a hockey stick growth that I wasn't expecting.
And then with COVID, again, everybody knew what their accountability was and what the needs were for the company. So when we had to tuck and roll and do things, the only two therapists I lost were gonna leave anyways. So I look back and go, "I really didn't lose any team members."
After COVID, it was a whole another hockey stick growth. So I can't say anything fell apart. There were challenges, but what was cool is we came out of those challenges even stronger than we went in.
Advice to other owners
Get out of your own way. Unfortunately, it's scary to think, "Oh my gosh, I have to pay this money for this person." But this person knows the industry in and out, they understand reimbursement challenges in every state, and they can support you and educate you and help you be successful in growing. And the ROI of that investment is exponential compared to what you're paying for the service.
I definitely wouldn't be where I am now without the guidance of Martin. Without Martin Healthcare Advisors, I would not be where I am now business-wise.
We really didn't have the internet. I didn't know. But I really wish I started with a consultant at the beginning. You're a great therapist, patients love you, you get people better and improve their lives, so you think you can go out and do your own thing and run a business. That's two different animals. You can't just do that, as much as you'd like to think you can.
As scary as it was to spend the initial investment to begin working with them, the ROI has been amazing. And there is no way that I would be where I am now without the guidance and support from Martin.
Working with Paul, working with Tom, working with Dave, I always felt they had my best interest in mind all the time. I almost felt like I had this shield of protection, knowing that they were in my court, and they weren't gonna really let me make a bad decision.
The conversations were always, I think, politely direct, politely black and white, and here's the different things that can happen. Ultimately, it's your choice. And I really appreciated that, and that gave me the confidence to push.
The partnership
I had one direct contact before I went to market, and Dave just stepped right on in, and we had those conversations. I backed out of the deal. It did not make sense to either one of us. And that acquirer came back around when we did go to market and sang a very different tune and was very complimentary on what I'd done with the business during those five years since we had talked, and really stepped up to the plate strongly.
And that was the acquirer I ended up going with. But they brought to the table 10. They know my culture. They know what my goals are. They know what I'll tolerate and not tolerate, and I'm not a very tolerant person outside of, like, I wanna protect what I've grown. They were very picky on picking 10 companies to bring to the table and then help me get it down to four, and then I got it down to two, which was a very difficult decision back and forth.
And ultimately it was my decision, but there were a lot of supportive conversations to help me make the final decision, and I'm super happy with who I partnered with. Nothing has changed for my therapists, which is really nice.
From discussion to close was less than a year. It was less than four months. It was very focused. Martin has so many connections that I think it's easy to get to that point with him.
The outside assessment of my company wasn't that bad because I keep everything, so it was very easy for me to pull all my documents together that were asked for. It was time-consuming, but it was easy. I know some owners, they don't keep folders on their computers and scan stuff in and keep a history of stuff, so it can be a bit of a scramble to find so many years of P&Ls and balance sheets and EMR stuff and legal stuff and accounting stuff, all the things.
Martin acted as that middleman, so they had the folders for me to upload to. They organized it and provided it to the potential acquirer, which made it nice because then I can just put everything into a folder and then it was organized to be sent out.
The Outside-In Assessment
The Outside-In Assessment from when I first started working with Martin Group was really interesting and eye-opening because they came to town. They took two right-hand turns and a left-hand turn to get to the clinic. Really don't need a map around here. They interviewed the whole team one-on-one. They reviewed our billing practices, our registration practices, and I'm thinking things are good.
And there was one employee that Paul immediately identified and said, "Why is this person on your team? He is so caustic and opposite." And I could agree. And actually the next day the guy gave notice.
Our billing practices were not efficient and aligned for efficient collections, and our collection processes of over the counter, getting payment at time of service, things like that, we weren't doing. And so they really helped streamline and make everything more efficient.
I had no dashboard. I knew how much I charged, how many patients I saw, how many new patients. That's all I followed. So getting the financial dashboards, the KPI or the operations dashboards, were super helpful in putting my business on the right track.
Shared with Norene Christensen's permission. Transcript lightly edited for readability.
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