My experience at the Private Practice Section annual conference this year was quite different from last year, primarily because I was a presenter at this year’s conference. As opposed to attending a lot of sessions and consuming information from the speakers, I spent my time preparing for my presentation and then consuming the questions, hopes and fears of the attendees. It was a great learning experience and also confirmed much of what I already try to teach at this site.
My presentation on cash-based physical therapy
My session (Essential Knowledge for Creating Cash-Based Treatment Services in Your Practice) was very well received. The room continued to fill in as some pre-session announcements were made and as I was introduced. So by the time I stood up and turned around to face the audience, there was standing room only! Gulp.
My presentation took about 50 minutes of the allotted 1½ hours, and then something really cool happened… People stayed and continued to ask questions for the entire remaining 40 minutes!
Throughout the conference I detected both hope and fear among the practice owners with whom I spoke. Those emotions were evoked by a number of topics far beyond the scope of this blog post; but regarding my area of expertise: Practice owners are getting pretty fearful about declining reimbursements and pretty excited about the possibility of dropping some of those contracts and developing cash-based revenue (though there’s certainly some fearfulness about trying this as well).
Last year, one of the keynote speakers at the 2012 PPS conference was making the argument that private practices would have to move in one of two directions in order to survive the current and coming changes in the healthcare landscape: Get big or get niche (this is my way of paraphrasing it).
From my own experience and research, my conversations at PPS, and a sense of what is already occurring in the insurance/Medicare realms, I would have to agree with last year’s keynote. You have a few options for your current/future practice if you want to thrive over the next 10-20 years:
1) Niche down your practice, offer something unique, and maximize your Non-3rd Party Payor revenue streams.
2) Build your own behemoth of a business that has the bargaining power to maintain decent reimbursement rates.
And if #1 or #2 won’t work for you:
3) Position your practice to be as attractive and valuable as possible for purchase by one of those behemoth businesses.
The small- and mid-sized practices that are not offering anything substantially different or better than the larger practice groups are going to get squeezed until they can longer breathe. If you own such a practice, it is time to work toward one of the above three options before it’s too late.
I may catch some flack for these comments, and that’s okay. I’d be doing my profession a disservice if I didn’t say these things. For decades, the practice of physical therapy (in many cases) has been quite lucrative even when the therapy provided was not all that impressive or unique. Those days are ending.
Consumers of healthcare are becoming much more aware that they have a choice.
Deductibles and co-pays are getting so high that the choice to go out-of-network is becoming easier if it is for service they perceive as better than their in-network options. Do you think deductibles and copays are going to decrease over time? I don’t. I think practices like mine are going to become a progressively easier choice for consumers in the future; and I look forward to helping as many of my colleagues as possible set their practices up for success with the coming changes.
What’s your business plan for the future?
Interested in the cash-based private practice model?
Click Here to learn how to start your own Cash-Based Practice
Niche Down or Get Big – @DrJarodCarter lessons from #PPS2013 and predictions for the future of private practice [click to tweet]
Good stuff Jarod. I’m 3 months “in” with cash-only and I’m busier than I thought. The biggest hurdle I find is teaching the public what PT really is. I’m specializing in the running/triathlete population and wellness coaching and I have to convince folks what I do is different (not just estim, exercises and 5 minutes of “massage”). Folks who have had “PT” before with just basic treatment lump all PT into this. Community outreach has been the most effective in getting folks to think differently. Keep preachin’ it brother!
Way to go, Charlie! That’s great news!
Let’s get together for an interview in the next year so you can share your “1st year insights” with our colleagues.
Jarod I’m glad your presentation was well received. I started my own practice in January of this year and it is solely cash based. It took a bit for people to accept it and educating the public has been huge. It truly is all in how you educate and market your services. I have been pleasantly surprised with how busy I have become and it has been accomplished without a huge marketing campaign. Word of mouth and results speak for themselves. I am really looking forward to growing this in year two.
Well done, Steve! Seems like our cash-based club grows stronger every week! Please keep me updated on your progress.
Dr. Jarod,
I wish I could have seen your presentation! I’ve read you book and really enjoyed it. I also recently became an APTA Private Practice Section Member and intend to start a cash-based practice this coming year.
In spite of the numerous challenges in health care, I believe there still is opportunity if we are creative, innovative, and are willing to make necessary and appropriate business plan paradigm shifts and changes.
Unfortunately, there is a lot fear out there and a tremendous amount of uncertainty in health care. As physical therapists, we have so much to offer; I’m hopeful and optimistic PT private practice will continue to survive and thrive in the changing political and economic environment. Thank you for the hope, guidance, and options you have outlined. Best wishes!
Dr. Louis Voigt Smith, PT, DPT, OCS, CredMDT
President, Backsmith Inc.,
Wish he could have been there too! I’m so glad that you liked the book, and I hope that it and this website will be a guide for your upcoming cash-based practice. Best of luck!
Jarod,
As always thanks for the great info. I’m sorry I missed PPS this year, it is definitely on my “to do” list for next year.
I am 7 months into my cash-based practice adventure and I am very pleased with how things are going so far. There really are people out there who are looking for good quality care and attention and that’s been comforting to find out.
Well done Justin! you’re absolutely right… people are looking for “something better” and are willing to pay for it. The longer this website continues, the more comments I get from colleagues who have started cash practices and it’s so exciting to see the success people are having in this model. congratulations!