A major part of my mission is to restore dignity for both patients and clients in the rehabilitation process. This a monumental task and one that will take time. The task is also very complex. One small part of the solution is for therapists to provide services of sufficient quality that consumers will use discretionary income to purchase our service.
I understand that this only serves a very small portion of the market….but that is where change begins: shifting behaviors from an entitlement as an insurance premium payer to savvy consumers of a quality service. I'll post later about other means of delivering care at affordable rates. For now, consider my answers to this colleague's questions over what I'm doing "right now" to begin to shift consumption patterns and beliefs:
Hello Matt. I saw your article in IMPACT and was curious about your cash-based practice. I have often wondered about doing the same but was not sure exactly how to implement and, I have many fears. Would you be willing to answer some of my questions?
First let's address the fears…they are symptomatic of a normal human response to change. Acknowledge them, study their source and then study my answers below. Your fears may point to substantive issues of a need to improve you and your products, or they may just be the usual fit pitched by the amygdala and your hippocampus about having to rewire you : ) ….pay attention and use the discomfort to grown and learn, not freeze.
1. How did your referring MD's respond to your switching to this type of practice?
This is a great question as it reveals a mindset that pervades our profession: "I work for the referral source." I've built my practice on customer driven model instead… I work for the consumer and they direct their healthcare team. It is an empowerment model of the Dynamic Systems Rehabilitation (DSR) Method. I receive my referrals by word of mouth….did so for 15 years in a town of 3500 and have continued to do so here in AZ with 3.5 M neighbors and competitors. As autonomous providers we want the power back in the consumers hands and out of the payers and referral sources. This is part of the restoration of dignity, to include PT's not being lunch providers and logo paperweight distributors.
I did send out explanatory letters to the physicians as professional colleagues so they could answer patients questions and advocate for my service. It was only one small part of the entire transition. See this page for how we make it easy for clients to discover our value as they shop for PT…we encourage them to do so with this simple shopping list because no one in town can beat us if they shop well.
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Question to Ask
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The Other Clinic
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DSR Clinic
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What percentage of the time will you spend with a therapist vs. aide or trainer?
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____%
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100%
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How long will you be with the licensed therapist each session?
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___ minutes
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60 minutes
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Will you get the same therapist each session?
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Yes No
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Yes
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How many other patients will the therapist be responsible for while you are there?
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____ patients
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Only you.
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Will the therapist have more than 20 years of experience?
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Yes No
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Yes
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Will you be in a private room or curtained/open booth/gym?
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Yes No
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Private Room
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Your time cost: How often will you have to travel, wait and return?
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Usually once/wk
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Your direct cost per hour of therapist contact time? ie, $30 co-pay for 15 min = $120/hour.
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$125/hr for the full hour
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Do they guarantee your satisfaction on the first visit?
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Have your pen and this Printable Worksheet for your convenience ready when you do your shopping!
2. Approximately how much time is spent with each patient?
50-55 min with no other patients to supervise or manage while I'm with the client.
3. What do you charge?
$150 for a 90 min eval and treatment first session. $125 for hour follow ups. We have money back guarantee for the first visit.
Now here is the crux of the entire cash practice model: YOU have to deliver something worth paying for…simple capitalism. If you do what everyone else does in town, why would they pay vs use their insurance?
The consumer is savvy. Do you have a product you would pay to consume? This where the DSR Method shines…not only does it deliver the best of science-based PT, but it develops and delivers the other two pillars of EBM: clinical mastery and what patients value. They won't pay for you to be harried, distracted and running in and out….they want a dignified, professional relationship….and they pay for it, often at quite a personal sacrifice (my clients aren't rich).
4. Do patients submit the receipt to their insurance? If so, do you provide a completed HCFA?
Yes they do. We provide a custom receipt that contains all of the information required for reimbursement. On rare occasion a client will require a HCFA and we'll generate those in batches for them. This only happens a couple times a year though.
5. Did your referrals increase or decrease?
They have continued to grow, despite this unique "economic opportunity". Our service self-selects who comes. My experience is they are more engaged, have higher expectations of me, and do their homework with better adherence to our shared goals. They also show up on time (I don't extend their visit if they are late) and they pay for the full hour. They also tend to know more people like themselves and those are the people they refer….hence generating a positive systems feedback loop.
Any other information you can provide would be appreciated. Thanks
That's probably more than you bargained for when you wrote, but we must change fast and with confidence. Stay tuned for more on business delivery models of the future for rehabilitation professionals.
What has your experience been with cash-based practice?
