Cash-based practices tend to have a much higher percentage of their patients come from non-physician referral sources (aka “Direct Access Patients”) … even in NON-Direct Access states. It’s a big problem when most of your prospective patients are calling without already acquiring the legally-necessary PT script to begin treatment. I own a successful cash-based practice in Texas where we cannot initiate any form of treatment without a PT script. However,  only about 10% of our patients come from direct physician referrals. So how do you get the legally-required referrals for the other 90%? This blog post covers 4 great ways to get PT scripts in a non-direct access state.

I want to provide some planning advice for those considering or just beginning a cash-based practice in a non-direct access state. First, do not use practices in direct access states to determine your expected growth rate and scalability. Your practice’s growth may be slowed by these state laws and it’s important to know that going in. I mention this not to worry you, but simply to inform you. There are many successful cash-based practices in Texas, like my own physical therapy clinic in Austin, so it is possible to do well even without direct access. 

With that in mind, here a few strategies for helping your patients get referrals when they have called to start treatment but do not yet have a PT script:

1. Asking Family and Friends

When I get prospective patients on the phone for the first time, I make it a point to ask them if they’ve already seen anyone for this issue and explain that physical therapy requires a referral in the state of Texas. If they haven’t seen a physician or if the patient is unwilling to make another office visit to get a referral, I point them to other potential referral sources.

For example, in Texas you are not limited to only accepting referrals from MDs and DOs. Physicians assistants, advanced nurse practitioners, dentists, podiatrists, and even chiropractors can refer patients to PT. Additionally, these referrals sources can be licensed anywhere in the U.S.

This allows me to ask patients if they have family or friends working in those professions, in any state, who would be willing to write them a PT referral. Many patients may not know a physician in Texas. BUT they may have an uncle who is a chiropractor in Georgia or a mother-in-law who practices dentistry in Kansas! If you are from outside of Texas, you will need to check your state practice act to see who you can legally accept referrals from.

2. Building Relationships with Physicians

In states without direct access, there is a lot to be gained through networking. If you can build good relationships with physicians, you have options on where to send your patients for quick cash-pay referrals. For cash-based physical therapy, it can be especially beneficial to get to know “direct primary care” or concierge physicians in your area. With an agreement, they might allow for one-time visits for PT referrals. The patient can have a quick visit to make sure the MD feels they are appropriate for PT and they’re out the door with the referral in hand. As a bonus, they get the referral at a low cash-pay rate.

3. Telehealth Platforms

Another option in Texas is using a telehealth platform. My clients download an app on their phone and for $25 can set up a quick telehealth visit. The physician can then send the patient a PT script if it is appropriate. This is a very cost- and time-effective method for patients who might otherwise not be willing to get a referral with an office visit. Check your state practice laws to see if telehealth referrals are an option in your state, and if so, reach out to telehealth groups in your state to see if you can arrange a similar situation.

4. Verbal Orders

Finally, depending on your state’s practice act, verbal orders over the phone may be an option to quickly begin treatment. This works best if the prospective PT client is a patient of any physicians with whom you have a good relationship. You may be able to call them with your findings from the PT evaluation and get a verbal order to begin treatment.

These 4 options are truly lifesavers when it comes to getting quick, easy referrals for your patients. No, they won’t salvage every client who doesn’t want to jump through hoops to start PT. Still, these methods will help you capture a lot of prospective business that would have otherwise been lost.

What more can you do?

One other thing you can do to ‘hook’ your patients is offer a free consultation or initial evaluation. In Texas, physical therapists may offer evaluations without a referral. Getting people in the door and building a personal rapport with them gets them excited about utilizing your services. When patients feel an emotional connection to your practice, they will be more willing to go out of their way to get a referral. Once they have the referral, they can begin treatment and start getting better!

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