I started my Cash-Based PT practice in Austin about 1 ½ years ago, and though it was a lot of hard work to get the ball rolling, I’ve never been so happy to be a Physical Therapist. When you remove the red tape and headaches of the Insurance and Medicare systems, an amazing new world opens up … you get to focus on helping people, and do it on your terms. This list could certainly be much longer, but here are 5 reasons I went in this direction.

1.  The future of Insurance and Medicare reimbursements doesn’t look bright.

It’s no secret that Medicare and Social Security are in serious trouble and the situation is not exactly getting better. For those that think the recent Health Care legislation is going to make the differences we need, here are a few excerpts from a great article on the topic in The Wilson Quarterly…

Not even its strongest proponents claim that the new health care law, the Patient Protection and Affordable Care Act, will solve our long-term health care spending problems … in 2030, it is expected to amount to only a half-percentage-point reduction in total health care expenditures as a share of GDP, not enough to produce a substantial change in the long-term financial prognosis.

The authors go on to say that:

The hard work of cost containment has not even begun. According to President Obama, the new law took into account “every idea out there about how to reduce or at least slow the cost of health care over time.” Barring some breathtaking new developments, perhaps in prevention or low-cost technology, future belt tightening will pose even more unattractive choices.

In analyzing the current health care reforms, it was said that:

By far the biggest “savings” in the Obama health care law come from a cut in payments to private physicians, hospitals, and health care providers generally. All take a big hit under the new law – and much commentary has focused on whether political pressure will lead Congress to reverse these reductions. The long-term trend seems clear, though: Taxpayers in the future will not pay providers as much as they do now.

Besharov, D., Call, D., (2010, Autumn). The Global Budget Race. The Wilson Quarterly, 34, 38-50.

2.  I refuse to allow reimbursement concerns, rather than a patient’s needs, to guide treatment.

Early in my career while working in insurance-based PT clinics, it was not uncommon to hear something like “just remember that United Health Care only gives a flat $75 per session, regardless of what you do with the patient.” Ironically enough, it always seemed like my patients who needed the most-intensive treatment had the lowest paying insurance. I was never directly encouraged to do less than what the patient needed in any of my former positions, but I do know that it happens out there … and that’s a very unfortunate scenario for both the PT and the patient. It’s also a scenario that doesn’t exist in fee-for-service physical therapy clinics (at least not that I know of). In my practice, all treatments are the same length of time and they pay the same amount regardless of what type of treatment I give. I just do what they need the most. It’s simple, and I like simplicity in my life and my clinic.

3.  I don’t like paperwork.

Do I need to say much more here? In a cash-based PT clinic your documentation still obviously needs to meet the minimum standards of our profession and your State Board, and it should be sufficient in guiding you to give the best possible treatment. But not more. You don’t have to jump through all the hoops that insurance companies and Medicare hold in front of everyone else on a daily basis. Documentation aside, all the paperwork involved in getting reimbursed is also gone. You get paid when the patient leaves the treatment room!

4.  I like my patients a lot, but that doesn’t mean I want to see 15 of them every day.

How many patients you might see in your own Cash-based clinic would of course be up to you and how you prefer to treat patients. One of the big draws to see me rather than the insurance-accepting PTs in my area is the extended one-on-one treatment time I offer. I spend a full hour with each patient, focus mainly on Manual Therapy, and try to limit myself to 5 patients/day. If they’re willing to pay an ‘after hours’ charge ($200+/hr) I’ll see a 6^th patient. This keeps my hands from wearing down too quickly, and leaves me time for marketing and admin duties. This way I also don’t need to bring on (or pay) an office administrator, and still make a nice living with just 8-hr days. It’s beautiful.

5.  I never thought getting paid for my services should be a struggle.

Those of you with private practices or in management positions know exactly what I mean here. One missing address or signature, one wrong or incomplete code, one unit past the allowable charges for that carrier … Denied! It’s a system where you have to hire someone else to help you get paid, and those who are supposed to be paying you will use ridiculous reasons to avoid doing so. No thanks … I think I’ll pass.

Have any other reasons YOU moved, or would like to move, to a cash-based practice model? Tell us about it by posting a comment below.

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