Payment, Reimbursement, and Grandpa the Mailbox Guy

This episode of PT Breakfast Club starts with Jimmy McKay reporting from Prompt HQ after a trip to Portland for APTA’s Payment Summit and House of Delegates.Jimmy explains how he got in trouble for live tweeting the House of Delegates, why he likes the word “payment” more than “reimbursement,” and what it felt like watching the profession debate policy language in real time.Dave Kittle pushes hard on the bigger question: has payment advocacy actually moved the needle for physical therapy? If insurance companies and Medicare are not meaningfully increasing payment, should more PTs stop waiting and build direct-to-consumer cash-pay offers?Tony Maritato adds the counterpoint: maybe some advocacy success is measured by slowing the decline, not producing giant wins.Then the show turns into a business strategy clinic thanks to Grandpa the Mailbox Guy.For $320, he solves the whole mailbox problem. No hourly rate. No overexplaining. No “here are the 17 steps.” Just a clear result at a clear price.The crew applies that lesson to PT, including grab bar installation, home safety consults, cash-pay evaluations, AI content ideas, therapist recruiting, viral video formats, and what practices should do when a clinician calls out sick.The takeaway: keep it stunningly simple. The customer does not want your process. They want the problem solved.