Insights from the Frontlines of Therapy Industry Changes

In this episode of the Therapeutic Industries Podcast, I sat down with Anant Desai, the Head Coach of Interface Rehabilitation, and Gheith Effarah, the Chief Operating Officer. We kicked things off by exploring Anant’s fascinating journey from being a physical therapist since 1975 to founding Interface Rehab in 1995. Anant shared how his decision to adopt the title of “head coach” instead of a traditional executive title has cultivated a collaborative and approachable atmosphere within his organization. His journey from his early days in the U.S., through growing a rehab company, to eventually establishing Interface Rehab showcases his deep-rooted passion for therapy and leadership.

Our conversation delved into the evolution of the therapy industry since the early days, with Anant and Gheith reflecting on significant changes, such as the shift toward managed care, Medicare Advantage plans, and the changing demographics of patients with more complex needs. They discussed how these changes imposed more pressure and challenges on providing rehab services but underscored the core mission of caring for the geriatric population. They highlighted the spectrum of changes in patient care requirements due to longer lifespans and increasing obesity rates, emphasizing the growing demand for therapy services, particularly outside traditional nursing homes, as assisted and independent living facilities expand.

An important focus was how contract therapy can alleviate management burdens for facility owners, enabling them to concentrate on core operations. Anant and Gheith outlined the benefits of contract therapy, such as sharing liabilities, improving documentation, and enhancing care standards through external oversight. They also touched on recruitment challenges and the need for more modern therapy equipment in long-term care settings, discussing how the proper resources can lead to better outcomes and fewer injuries among therapists. Overall, the discussion painted a vivid picture of the dynamic and evolving landscape of rehabilitation services and the critical role Interface Rehabilitation plays in meeting these growing demands.

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Transcript:

Laszlo Bayer: Established in 1995. Interface Rehabilitation provides therapy solutions to facilities that don’t have a therapy department of their own or a therapy department that are in need of staffing. They’re understaffed, and they need extra therapists there. They are a much-needed resource in the current climate facing the long-term care environment. So with that being said, with us today is Anant Desai, the head coach at Interface, and Gheith Effarah, the Chief Operating Officer. Guys, welcome to the podcast.

Anant Desai: Thank you Laszlo.

Gheith Effarah: Thank you. Happy to be here. Nice to see you again.

Laszlo Bayer: Yeah, it’s been some time. So Gheith, actually, I want to start with Anant, the head coach, now. What does a head coach mean? What’s the definition of that?

Anant Desai: I changed my title from President to Head Coach when Phil Jackson won Lakers three times, when the Lakers hit the Three-peat. That kind of dawned on me. Wow. Head coach. So here I am, not throwing my weight around, but coaching everybody around me, and they’re coaching me, learning from each other. So, I decided the appropriate title for me would be Head Coach. So I changed it then, while back. And ever since then, it has really worked very well around me.

Laszlo Bayer: That’s such a great story, and I totally agree with you. I think that you have now become an approachable person, right?

Anant Desai: Absolutely.

Laszlo Bayer: For anybody who wants to talk to you, I’m gonna go talk to the coach.

Anant Desai: Yes, absolutely. And many, many staff members, that’s what they call me. Hey Coach, how are you doing? That’s how they address me, and I love it, and that’s what my role is, coaching everybody around me and learning from each other. Absolutely.

Laszlo Bayer: Wow, that’s fantastic.

Anant Desai: Thank you.

Laszlo Bayer: You know what, I’d like to get a little bit of your background and kind of find out how you get this started. What was the inspiration to go, oh, I’m gonna start a company that’s going to provide this service?

Anant Desai: Right. Well, I have been a physical therapist since 1975. Came to the United States in 1976 and worked in various settings. Acute hospital, nursing home, home health, outpatient clinic, you name it. I worked in different settings. Then, in the late 80s, I had a chance to be the right hand person of another rehab company to that owner. I was the right-hand person, and we grew the company from 500,000 in annual revenue to 12 million in annual revenue. Then he sold that company to somebody, and that’s the time I sought an opportunity to start my own rehabilitation company. And that’s one of the nursing homes in Long Beach. The owner just asked me, Anant, why don’t you start your own company? I’ll give you my facility as your first contract. And that was the catalyst. And I started Interface Rehab. I came up with the name Interface Rehab on January 01, 1995. So on day one, I was the chef, bottle watcher, and all of the above, right? And now today, we have grown from one facility in Long Beach to a hundred-plus facilities throughout California and Nevada, and we have about 700 employees as of today.

Laszlo Bayer: Wow, that’s fantastic. So, Gheith, you joined Interface in 1998?

Gheith Effarah: So I actually knew Anant in another life. So when we worked for the same company, I was working for this inpatient rehab for county and was happy, but then I wanted more responsibility. So I see this ad for DOR, a nursing home, and I’m like, huh, nursing home, do I want to do that? So I actually interviewed with Anant, you know.

Laszlo Bayer: Oh, wow.

Gheith Effarah: And he kind of talked me into taking on a DOR position, and that’s kind of how we got to know each other. Then, you know, after the same company got sold and Anant went his way, I went my way, and then a few years later I was applying for PDPM, PPS was coming up.

Laszlo Bayer: Yes. Yes.

Gheith Effarah:  And I was thinking to myself, well, I don’t want to just be in the one building. I want to maybe learn more. Maybe I should be a manager at this time. So I kind of reached back to an old friend, Anant, and I said, Anant, can you be my reference? I want to apply for this manager position. I think I want to be kind of on the leading edge as we learn PPS. And he said, Yeah, happy to do it. Of course. Oh, wait, by the way, I am looking for a regional mentor. And I was like a regional mentor, not a mentor. We kind of talked about the difference. And that’s kind of how it got started is I was applying for another position using him as a reference, and he kind of said, Well, wait a second. Why not join my company? And that’s kind of where I’ve been since 1998.

Laszlo Bayer: Wow. Fantastic. So here we are in 2025, and you can take turns answering this question. I’m pretty sure you’re gonna answer it the same way. So 2025, what changes have you seen in this industry since the early days?

Gheith Effarah:  So.

Anant Desai: If I may go first.

Gheith Effarah: Yeah

Laszlo Bayer: Go ahead.

Anant Desai: A lot of things have changed, and a lot of things have remained the same. What has changed? The reimbursement system has changed. The title 22 surveyors’ expectations have changed. The CMS their expectations have changed. They have introduced so many new guidelines, five-star ratings, quality measures, and so forth and so on. So a lot of changes from that perspective. What has not changed is taking care of what I call them, grandpas and grandmas, our geriatric patients, residents in a nursing home. That approach hasn’t changed. We are still taking care of them the old-fashioned way, making them independent. And because of the reimbursement pressure and the growing percentage of managed care, Medicare Advantage plans and managed care they are really dictating nowadays how many days of therapy you can provide for any of the diagnoses. So there’s a lot of pressure to provide rehab and achieve the goals that we would like to achieve. So a lot of things have changed and a lot of things have remained unchanged.

Laszlo Bayer: Yeah right. So Gheith

Gheith Effarah: Yeah, and that’s kind of where I see it, is the things that Anant said, but also in the industry, the percentage of the managed care has increased significantly. You know, before it was a small amount, and now in some areas it’s the majority, and that puts a lot of pressure on us getting people in and out in a quicker time and getting them safely home.

Laszlo Bayer: Right.

Gheith Effarah: So that’s a little bit where before the facilities, the rehab department had more control. We were more of the gatekeepers. Now, it’s kind of going to an outside case manager, and that’s been a challenge. The other thing that’s changed is the new, Therapist are always great, but we do find that the therapist coming into the field now, they’re a lot more focused on that balance of life work kind of balance and kinda fitting work in versus kind of just the old horses in the past, it just kind of we’re just work horses and just got things done. So we find that we have to also spend more time mentoring, working with our new folks, getting them to have that passion for patient care, you know. So there have been some changes. It still revolves around the residents, still revolves around the patient, and that’s why I think healthcare is so unique because it still revolves around that most important person, but it’s some of the, so I guess the roots have kind of stayed the same, but the branches have changed.

Laszlo Bayer:  Have the pressures of you know, the baby boomer’s you know, retiring in mass numbers now. I think it’s gonna pick up until 2030. What kind of pressure is that put on the industry with these folks coming in that are older, right? People are living longer.

Gheith Effarah: Yup

Laszlo Bayer:  Is that not only living longer, but you’re seeing a different type of patient. I think with the obesity rates going up, they’re heavier, which causes other problems such as diabetes and other comorbidities. Is there more demand on the long-term care environment on the nursing staff, the rehab staff, just in general?

Anant Desai: Gheith, would you like to take first?

Gheith Effarah: Absolutely. Yes. Yeah, Laszlo, there has been. We’re still an impacted profession, maybe even more so after we came out of Covid With Covid, we were hit with several issues at one time. The graying of America is a real thing. It’s happening. It continues to increase. With Covid, though, it got about 10% or so of our labor, if not more, out of the market.

Laszlo Bayer: Right

Gheith Effarah: So we had to go out of Covid in a real high-stress situation where you had the demands, but you didn’t have the staffing. So we were asking a lot more of our folks. But the other thing is just in general, all of your post-acute needs have increased. So not only is it just the nursing homes, there’s a greater demand now in assisted living. Independent living. That’s kind of where we’re seeing a lot of the growth is so much regulations in the building of new nursing homes. But you’re seeing just a plethora now of assisted living, independent living, just going crazy because of the need and the graying of America.

Laszlo Bayer: Right, right.

Anant Desai: Yeah, I would’ve answered the same. There is a silver tsunami, as we call it.

Laszlo Bayer: Yeah, that’s a tsunami.

Anant Desai: And there is a lot more demand of therapists for them. So nursing homes have remained the same, meaning we hardly see any new facilities coming up, right? I do see some, but not as many as assisted living and independent living. So those retirement homes are mushrooming like crazy all around us. In general, I personally don’t agree with that statement, but in general, people have a stigma about nursing homes. They’d rather go to assisted living or independent living. So, the acuity of residents in those assisted living and independent living facilities is even higher. Acuity is higher and higher, right? So and home health has been mushrooming like crazy. So yes, you’re right, Laszlo, the demand graying of America, the silver tsunami, they are out there.

Laszlo Bayer: Right.

Anant Desai: But the focus from nursing homes has changed to A-L-I-L and home health.

Laszlo Bayer: Right, right. What I’ve seen in the industry to this point is that they’re trying to rebrand. They’re trying to rebrand what long-term care is, and they rebrand it by calling it the healthcare resort.

Gheith Effarah: Yeah

Laszlo Bayer: I see you laughing, Gheith.

Anant Desai: Right. Or they call them rehabilitation centers and what have you, changing the names, but away from the nursing home.

Laszlo Bayer: Exactly. Exactly. And what’s interesting is that you know all of these ancillary services that they’re now providing, and now we have an in-house cafeteria, there’s a movie theater here, you get your hair done over here. And I think it’s all about being inclusive. If the family member comes and visits, they don’t stay for 10 minutes anymore like they used to, and say, We’re out of here. They want to invite them in. And I think that’s a good thing to a degree. But the bottom line is, how quickly can you get me better and faster and have me recover to my previous level of function? I think that is really the bottom line.

Gheith Effarah: Absolutely. Absolutely.

Laszlo Bayer: So that being said, can you tell me what the advantages are of contract therapy?

Anant Desai: Okay. Many, many, many force, many force. Number one, the owners, operators can focus on the core business of facility management and not have to worry about the rehabilitation department. We take care of hiring, training, taking care of their vacation, whatever the need is. Anything and everything about rehabilitation, right? We take care of everything. So that’s number one, a major load off of their shoulders. So they can focus on their facility needs, number one. Number two, they don’t have to pay for 60 days. So they’re able to roll that cash management payroll for 60 days, right? versus if they’re in-house, they have to pay every two weeks.

Laszlo Bayer: Right.

Anant Desai: Number three, so many four different kinds of liabilities, they pass it on to the contract therapy. For companies like ours, first of all, workers’ camp is not their responsibility. Rehab therapies, workers’ camp is our responsibility. Second, any labor law-related issues, labor law in California, labor law is very tough. That comes to us, right? Number three, any other regular patient care-related liability, right? Every contact with a resident with a patient is a liability. So that particular liability, let’s say you are transferring a resident, the resident fell, the patient’s family comes after the facility suite, whatever, then you have to take care of it all where whereas in contract therapy, you are sharing that risk, right? Those are the three major liabilities. And there is a fourth liability. I’m blanking out right now, but these are the major liabilities. You are shifting to the contract therapy company versus keeping it on your own. Right.

Laszlo Bayer: Right.

Anant Desai: Overall, there are a lot of other things I can go over. I will leave some for Gheith, but the mentality of the staff, if they’re in-house, we have seen time and time again, they become very complacent. The facility staff, facility will ask the rehab staff to do everything in any attending meetings all day long, versus taking care of the patient care therapist, they nobody have. So we find them getting complacent, and the utilization could be in place versus being a contracted therapy. We are accountable to produce, you know, whatever needs to be done, whatever a patient needs.

Anant Desai: Patient needs. So there are a lot of pros and cons. Again, you have to look at it from whom you are asking, how they’re looking at it, but there are a lot of advantages. Gheith, go ahead and fill in the rest while I remember the fourth line.

Gheith Effarah: You know one of the things we noticed, because we regularly take over things that were in-house and they decide to go contrast, one of the things that I noticed the most is that everything is reliant on the DOR in an in-house program, if you’ve got a great DOR, you might be able to run it well and everything go good. As soon as you have staff instability, everything breaks down. So we are always amazed at when we go in and we look at all the opportunities and all the things that could have been done, we look at the documentation and how all of a sudden we see how it needs to get improved. We look at the change of conditions, the long-term residents, and how maybe they can be improved. We look at the quality. So what winds up happening when you bring in a contract company versus when you’re in-house? When you’re in-house, you’re a little too protective, everything is in-house. You now bring somebody from the outside, you’re sort of bringing an independent person coming in and reviewing everything you’ve got. So the quality and the requirements and the standard, believe it or not, actually goes up. That is one of the things that I hear a lot. The two things that I hear are cost and control. And we have to kind of explain to the owners and the providers that, as cost goes, sometimes it isn’t about costs. It’s what can we do for you? Can we increase the caseload? Can we put more attention to more of the long-term? Can we bring more staff to build your caseload? And as far as control, we always tell people, think of us as like sugar and milk. We’re going to blend right in. You know we’re going to go ahead and be part of you. We’re going to assimilate with you. It’s your staff, but we’re signing the check. So we never want them to feel that it’s, Hey, I have this contract company, this vendor. No, no. We want to blend in completely, but provide you all the additional support and resources that maybe you can’t have if you’re just an in-house program relying on one person primarily.

Laszlo Bayer: Right.

Anant Desai: So Laszlo, the fourth liability, which owners and operators take on, if there are in- house any denials from Medicare, any denials in the future, if they’re in-house, they have to eat it all up, the denial cost versus if they have contracted, then we are sharing the risk. So, quote and quote the risk sharing on four different major liabilities is much more risk sharing with contract therapy overseas in-house, right? And they also calculate their permanent cost in a different way, not counting the time it takes to recruit, the time they’re paying the recruiters. A lot of peripheral costs may not be added to the mix. So it is a little skewed comparing the cost of in-house and contract therapy. But if you really compare apples to apples overall, not because we are a contract therapy company, but overall, you come out ahead by contracting.

Anant Desai: Again, it depends on what kind of contract therapy company you’re dealing with. You usually come out ahead with interface rehab. Thank you.

Laszlo Bayer: You just led me into my next question, which was all has to do with recruitment, right? I mean, there’s a cost involved in recruiting therapists, right? You attend these different shows, you’ve got to you know arrange for the booth and have personnel and people and hotel rooms and meals. And I’m very familiar with that because of the shows that we’ve attended. But because it’s a competitive thing here, you’ve got what I call the mega providers. The mega providers are N Sign, Life Care, and Pax. I mean, there are hundreds of facilities in multiple states all over the country. And so they are also out there trying to recruit. So how do you approach recruiting a potential PTA or, you know PT or OT, ODA, whatever?

Anant Desai: Right? Well, you know, as they say, the devil is in the details. We believe that healthcare is very much a local business, right? And we compare compensation not just as one leg of the table. That is just one part of the context. The hourly rate is just one of the benefits. But you take all four legs of the table, the other four legs, hourly rate, all the benefits we offer line item, the training and the support we provide, how close you are to your home base, and the people you work with. So there are a lot of other non-tangible factors, which we are able to provide to the therapist. And so many of them, they’re with us for a long time. And Gheith is a living testimonial. He’s been with us since 1998, and there are so many. My CFO has been with us since 1995, from day one. And so many staff in the field, they have been with us for a long time. So we really take care of them. They’re not employee numbers, they are our family members.

Anant Desai: People see the difference, and that’s where we come out ahead. And by the way, talking about recruiting, we have four full-time recruiting specialists. So they also help us by trying to get the gems we need for our services. So we are well-positioned. And one more, we have a full-service immigration department.

Laszlo Bayer: Oh, got it.

Anant Desai: We have an advantage. So many other companies they are so scared of immigration. Oh, we don’t deal with them. So a lot of these therapists who are from other countries they gravitate towards us because we have a full-service immigration department, and we are very comfortable and very proficient at that, you know. So we really have, of course, we do have a lot of openings currently, but it is a constant process, and we are able to compete with the bigwigs very easily.

Laszlo Bayer: Well, yeah, I learned very quickly that therapy and therapist, it’s kind of a transient type or can be a transient position depending upon the needs of the therapist and what their life is like and what you know life demands. I mean, sometimes it can’t be helped, whatever their situation is. The other thing that’s interesting to me, I don’t know. You know, I’ve had a lot of experience dealing with administrators, and I would much rather deal with an administrator who has a therapy background than an administrator who has no therapy background and is just simply interested in the bottom line. That being said, have you seen much change in the type of equipment that these facilities provide their therapists? I mean you know everybody has the therapy mat table, a standing frame, stair stepper, parallel bars, but there’s a lot better technology out there in a lot of different ways. But I’m finding that these administrators, the ones that are strictly counting the beans, they’re not interested in doing anything for their therapy department, buying equipment that will help the therapist protect themselves from lifting, from making dangerous transfers, especially with larger patients. Although even the small geriatric grandma who weighs 90 pounds can be very difficult to transfer. And a lot of times, that’s where the injury occurs because you’re assuming you can move this patient. And a lot of times, injuries don’t occur just like that. They’re cumulative. They happen over time. And so I’m wondering why there are so many administrators who are resistant to upgrading their therapy gyms?

Gheith Effarah: Yeah, you know, I think part of it is, like you said, they focus too much on the budget and what they need to do. And it’s kind of like what I’m not was saying about you know when they have too many things to juggle, maybe they lose sight. But when they can focus on the core responsibilities, one of the things that I noticed is that administrators are just happy with getting the Title 22 equipment. What’s the basics? Just the mat, a basic mat, pulleys, parallel bar, stairs, and mirror. I’m happy, I’m good to go. Therapy. Now you figure it out. So it’s nice. We know for ourselves, we’ve had to go above and beyond like we brought in this particular biometric equipment, where it works on balance and gate analysis. So we have it in a few of our buildings. I always smile when I walk into a building and I see a Birmingham. I’m like, okay, good. This is a good thing. But I don’t know. It’s a bit frustrating sometimes as a therapist. You just have to think outside the box. You have to go to them and say, This is how this equipment will help you. Not tomorrow. Today, for example, if you give me this particular chair, we’re going to reduce the falls. If you give me this particular hip kit, we can continue doing more therapy. So a lot of times we have to kind of work with them to show them how it’s cost-effective and how it’ll benefit them, not just in the future, but today as well.

Laszlo Bayer: Right, right. Yeah. I think that there are different aspects of the market that really prohibit long-term care in that investment. When I really think about it, because of their budgets and their costs, last year we were fortunate enough to put over a hundred Barihab’s in Encompass rehab hospitals in the country.

Gheith Effarah: Excellent.

Laszlo Bayer: And I realized that a rehab hospital has a bigger budget. They just have more money. That’s just it. And that’s why with Rancho, Los Amigos has about 50 of our tables.

Gheith Effarah: Amazing.

Laszlo Bayer: So they see the value, the rehab hospitals see the value. And I know that there are a lot of long-term care facilities, although N Sign has been really good with us, and Lifecare was, you know, a big purchaser early on. But what I’m seeing is hopefully a trend that the industry will start to realize that in the long run, they will be saving money. They’ll be saving money with less workers’ complaints. They’ll be saving money with less injuries to their therapists. Their careers will last longer rather than shorter because of MSDS. So it is about the frontline, it’s about those frontline soldiers that really represent your company, that represent any other company that does long-term care, because they’re the ones that come in contact with the patient.

Anant Desai: Right. And Laszlo, I would not throw all administrators in one basket.

Laszlo Bayer: Oh, no, no. I didn’t mean to do that. I think.

Anant Desai: Same here. I want to clarify that there are administrators, owner operators, or the corporations, they really believe in providing equipment, state-of-the-art equipment. Like we have some facilities where we have even a mini car in the rehab gym, OT to reach the car transfer, and what have you. So, again, I think it boils down to what Gheith mentioned earlier. If you want to hit the nail on the head, it boils down to how good you are able to convince the administrator or the decision-maker about their equipment. What’s in it for them? What’s in it for the facility? How is it going to help bring the revenue or decrease the cost, right? If it really, I mean sell, sell, but with the proper benefits rationale, then that’s what counts. And, of course, the budget is still the key. There is no budget. There is no matter how much good the equipment is, you can’t pursue. But there are a lot of corporations and facility administrators. They’re pro rehab and they do help us with great equipment and what have you, whatever we recommend you know, but you have to sell it. The idea had to be sold.

Laszlo Bayer: So if somebody wants to get in touch with you and basically find out more about the services, how would they do that? Would they just go onto your website and request a meeting or call you directly? Or how would someone go about that?

Anant Desai: That would be one of the ways. We are also members of the CAF. They can look us up at a CAF. We are also members of Leading Age of California, and they can contact us directly. And my cell number, if I may give it out here.

Laszlo Bayer: Absolutely.

Anant Desai: 714-336-9634. Text me, call me directly, and we will pursue your interest, what you’re looking for, and how we can enhance your goals. Absolutely. Any which way, you can reach out to us. Yes, thank you.

Laszlo Bayer: When are you moving to Oregon?

Gheith Effarah: Well, let’s talk. That’s one thing I do want to just commend Anant about is like you said, when he went to head coach, he became more coachable. Anybody in our company at any time can pick up the phone, call on, and he’ll pick up. There’s no secretary. There are no multiple levels. And I think that’s amazing, and you just don’t see that. But I think that also creates the culture. Like when Anant was saying that local is logical and it’s a local industry. You have to make people feel not just believe, but truly believe and feel that, Hey, if I have an issue, I’m gonna be heard, you know. And I think that’s the same thing with our clients, they don’t want to be just a number. They want to know that somebody will respond to them. ASAP so.

Laszlo Bayer: Right? Totally. Well, to me, the bottom line is based on outcomes, right?

Anant Desai: Absolutely.

Laszlo Bayer: Who can get me back to my previous abilities to be mobile and independent as soon as possible? And it’s about who can deliver the services I need in a friendly, clean environment. So, you know, we have to look at this population as consumers, as well as patients. So if they are consumers, we have to appeal to their sensitivities of smell, right?, cleanliness of those things. And that, again, falls on the facility, the facility manager. And it’s a team effort to provide that kind of service. And I know that you know any facility would be fortunate to have you on their team. I wish you guys great success. Thank you so much for being a part of the podcast.

Gheith Effarah: Absolutely.

Laszlo Bayer: I hope to see you guys in Oregon sometime soon.

Anant Desai: Absolutely.

Gheith Effarah: You never know. You never know.

Laszlo Bayer: I know. You never know.

Anant Desai: Great.

Laszlo Bayer: Alright. Thank you so much

Anant Desai: Good to see you, Laszlo.

Gheith Effarah: Laszlo, Thank you. Good to see you

Anant Desai: Stay play.

Laszlo Bayer: Good to see you. Thank you.