“Do you take my insurance?”
In a PT business, it’s the first question most potential patients ask me and rightfully so. Insurance is expensive and incredibly confusing/frustrating for patients and healthcare professionals alike. My hope is that this blog gives you a better understanding of the cash-based model and if it is/isn’t the right fit for you.
My mission for founding Kinetic Performance and Rehab was simple. I wanted to get out of the rat race that is high volume traditional PT clinics. I wanted to provide personalized individual care to people instead of treating them like a statistic. I wanted to serve those who have been told to stop doing activities they love by a “healthcare” provider and help get them back to training and life at the fullest. A cash based model gave me the ability to do these things.
What is cash PT? In a world of chaos, this model is simple. A patient pays a flat fee per service (typically per hour visit). After the patient is seen, they are provided with an insurance invoice with ICD and CPT codes that they can self-submit for direct reimbursement from their insurance company. For some individuals this amount may be zero and for others they may get reimbursed for a significant portion of the visit. Either way, this money should count toward your deductible for the year.
What are the benefits of cash pay PT vs. a traditional model?
Glad you asked friend.
1.Patient centered care
-In a cash model the focus is quality over quantity. There are no company visit quotas or double, triple, quadruple booking patients. All care is 1v1 with the same Doctor of Physical Therapy every visit.The same professional that evaluated you is the one who treats you. Unfortunately, this is a rarity in the PT world. Because we spend so much time with patients, we have a chance to listen and get to the root “why” for each person. You won’t catch us typing away at a computer the entire visit trying to keep our head above the insurance paperwork tidal wave. Instead, cash PT’s are focused on you and making every minute of your session valuable, beneficial, and meaningful.
-The second but equally important patient care factor is access. In today’s healthcare world it is not uncommon to wait 4-6 weeks to get in to see a provider. Cash PT clinics are often able to get people scheduled within 1-2 days because they are not jumping through hoops of insurance authorization or trying to manage 80 visits/week per PT. In the time it takes you to just get scheduled for your first visit in a traditional model, your rehab plan could be completely or nearly finished with a cash PT.
2. Fewer visits and incredible time savings
-The most valuable resource we have is our time. Unless you’re friends with Doc Brown and Marty McFly and have a delorean tucked away in your garage, you can’t get your time back. Patients in a cash model will typically be seen once a week for 4-6 weeks compared to the traditional route of 2-3 visits a week for 4-6 weeks. The time savings can be huge when you add in commute time. Unfortunately, patients often fail to see the big picture when it comes to their care. It’s a common sentiment that more visits is a better value for the money right?
Wrong.
Let’s put this into context.
In the younger/active population that I work with, the average copay in my area is between 60-80 dollars/visit. Cash PT typically ranges from 125 to 250 (based on cost of living/area) a visit with an average of about 150 per visit. My average discharge rate is 4.5 visits in my cash practice, but let’s round it to 5. The average discharge rate statistically in a traditional model is between 12-13 visits. In my old job, I couldn’t qualify for a raise until I got my average discharge rate over 12 visits but that’s a story for another day. So based on averages, a cash patient could expect to spend 750 dollars throughout a plan of care, while spending 720-960 dollars with a 60-80 dollar co-pay in a traditional model. There are certainly instances where cash PT is more expensive, but you’ll be surprised to see how comparable prices are when you consider the entire plan of care. In this population you’ll find that the overall cost of care between the two models is within a couple hundred dollars whichever way you slice it. The real question is, "What is your time worth"? What could you do with an extra 2 or 3 hours a week?
3. Does your PT understand your lifestyle and goals?
-We live in a world where it’s less and less common to find healthcare providers that embody health and wellness. We’ve taken the “do as I say, not as I do” approach and patient outcomes have suffered. Since cash PT practices are often very niche specific, you are likely to find a provider that understands the demands of your activity. Cash PT providers are typically athletes themselves and better able to navigate you through injury and prepare you for return of your specific activity.
-When I was a young whipper snapper, I herniated a disc in my lumbar spine. I had pretty terrible symptoms and my right leg started to go numb and was very painful. I went to see an MD who told me that I should never lift anything over 100 pounds again. Ever. I was 25 and an avid Crossfitter and weightlifter. Fortunately for me, I didn’t listen and in the following years have PR’d every lift without back pain or subsequent injuries. I know many patients have had the exact same conversation with a healthcare provider. “Just stop doing XYZ forever”. Cash PT’s that focus on a specific niche can help you train through your injury and help you get back to the specific activity you love. They can do this because they understand both the rehab process AND the specific demands of your sport/activity.
4. Support Local Business
- When you support a cash PT practice, you’re supporting small business in your area. Since cash clinics are driven by word of mouth local marketing and local business relationships, these businesses are then able to support other local businesses in their network. Today many private traditional PT clinics and healthcare clinics are owned/backed by large equity groups who pay employees pennies on the dollar to maximize their profit and portfolio. When you pay cash for healthcare, a good portion of that money goes directly to the person providing your actual care. Real people with real families that live, work, and play alongside you and are investing back into your community.
5. Incentive, Incentive, Incentive
-Most PT’s are wonderful people who truly want to help. However, there is minimal incentive for most PT’s in a traditional model. I have worked for multiple private practices in multiple states and my compensation was never based on patient outcomes or success. Instead, I was paid the same whether my patients achieved their goals or not. Sadly, in nearly 4 years in traditional outpatient PT I was never congratulated or rewarded for a successful patient outcome. I was chastised for discharging fully recovered patients “too early”, not billing enough units, and passed up for raises (as mentioned before) for the same reasons. I was certainly incentivized, but only to keep patients longer and bill their insurance more. PT’s in a cash model are directly incentivized to provide an exceptional patient experience and get you better faster. If I cannot do these things in my practice, I will not be able to stay open. Which provider do you think is thinking about your shoulder when they lay down at night? Who is more likely to go above and beyond to get the desired patient outcome? Who is going to advocate harder for their patients? I think you know.
Cash based PT is not for everyone. Actually, it’s not for most people and that’s ok! The world needs both in and out of network options for patients. The in-network model has it's place and makes sense for most post operative and medicare age patients. However, cash PT is a valid option for active adults that are motivated, time sensitive, and working toward returning to high level activities. These are individuals that our current system doesn’t know what to do with and they fall through the cracks. My mission is to fill that ever-widening gap in my city.
Stay Kinetic Friends.
Dr. Levi Kerby is a physical therapist, orthopedic certified specialist, and owner of Kinetic Performance and Rehab in Winston-Salem, NC. He enjoys fly fishing, guitar, various forms of fitness, and treating active and motivated individuals.
If you're dealing with an injury or pain, you can contact Kinetic Performance and Rehab directly below.
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