As this website and its impact spreads, more interview requests roll in and I’m really enjoying it. Dave Chase, CEO of Avado.com sent me a number of “Healthcare Innovator” interview questions, and I have included a few of them below.

How do you make the lives of patients palpably better?

Well, I specialize in using hands-on Manual Therapy to quickly resolve the pain and movement limitations of my patients. Since each clinic visit includes a full hour of one-on-one treatment, I am able to provide much faster results on average when compared to clinics where practitioners see 2 or more patients an hour and often use technicians and assistants to provide care. When people can do what they need/love with less or no pain, life is better.

How are you lowering overall costs?

I have worked in both insurance-based clinics as well as cash-based clinics and have a good idea of the differences in level of care and the time required to achieve the best possible patient outcomes. Being a fee-for-service clinic, the out-of-pocket cost of my treatments is higher up front when compared to a clinic where they are just paying a co-pay (though if they are still paying down a deductible, my clinic is often less costly up front than others). However, I would estimate that my patients require, on average, at least 25% fewer visits and usually closer to 50% fewer visits than they would at an insurance-based PT clinic. When factoring in the additional copays, gas, and especially the time away from work for those extra needed visits, total costs for my services are often lower than they would be at the standard PT clinic. On top of this, the majority of my patients are insured and can send Self-claims to their insurance companies. They often receive some level of reimbursement or at least an application towards a deductible. Qualitative “costs” should also be considered and many people feel that even if the total financial costs are higher, it is worth it in order to get better faster.

How do you engage and activate the patient in their care?

Though the majority of the in-clinic treatment time is devoted to hands-on treatment, every session involves education on and progression of a home program of stretches and exercises. I make it very clear that their compliance will not only speed up the current episode of care, but that continuation of the program beyond our treatments will help reduce the chance of recurrence. I find that the patients attracted to a fee-for-service clinic tend to be much more compliant and motivated to quickly improve. When each session costs more out of your own pocket, you won’t be skipping your exercises to watch the newest episode of Family Guy.  

How do you provide rapid access to care (either face to face or non face to face/asynchronously)?

Whether I’m booked a few days or a few weeks in advance, I always make “after-hours” treatments available if no regular-hour appointments are quickly available. The hourly rate for these sessions is higher, but the care is always available. The biggest block to quickly getting onto my schedule is usually not how busy I am, but rather it’s the fact that people in Texas do not yet have Direct Access to Physical Therapy. Though a prospective patient with a pain/injury can go directly to a Chiropractor, Nurse Practitioner, Personal Trainer, or even a Massage Therapist, they have to have a Medical referral before I can start treatment with them. When you ask about lowering overall healthcare costs, I can confidently say that this is a huge problem and constitutes millions in unneeded expenses to consumers, insurance companies, Medicare and Medicaid every year.

How do you demonstrate high tech and high touch?

Well, I’m definitely high touch but not very high tech. Because I am a solo-practitioner, only see 5 patients a day, and I am outside the regulatory mandates of the Medicare system (I am not a Medicare provider), I’m in no hurry to move to EMR. The volume of patients is so low that the need for an electronic system is just not there and certainly not worth the cost at this point in my practice. In the future as I add staff, and if any legal mandates come along that also affect Direct-Pay practitioners, this may change.

How do you simplify rather than complicate the process of getting care?

I remove insurance companies from the equation. If a patient wants to involve their insurance company with self-claims, they can choose to do so later, but it will not be something that complicates the process of them receiving as much of my care as they need.

What is the biggest obstacle to expanding what you have done more rapidly? If you could have any assistance, what would it be and where would it come from?

The biggest obstacles: 1) Not enough hours in the day. 2) I have the mindset that you shouldn’t live too much of your life in your clinic.

If I really wanted to expand faster I would increase free-marketing techniques (blogging for higher search engine rankings, networking, article submission in local magazines, etc.) and also employ paid-marketing techniques. I would also consider employing a local university marketing intern to implement these strategies since they would be quite time-consuming and overwhelming to add on top of an already-full patient schedule.

Who else is innovating in the healthcare arena that is an inspiration to you?

The list of inspiring innovators in the overall healthcare arena is extremely long, but I would like to mention Brian Forrest MD for his specific contributions and leadership in the arena of Direct Pay Medical Practices. Though there are obviously a lot of differences between Cash-based Medical Practices and Physical Therapy Practices, he is certainly still an inspiration to me.

Interested in the cash-based private practice model?

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