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This is a return to a very popular post I did in 2013 about what I consider a huge problem for the physical therapy field: the undervaluation of our services… not just by patients, referral sources, and (of course) 3rd party payors, but by physical therapists themselves!
This is an important topic and conversation we need to have over and over again, because the low-value mindset is so widespread among our colleagues and the general public alike. It is up to us to solve this issue. Please get involved in the solution.
More specifically, I discuss these cash-based practice topics:
- An Aside: Why my practice may be a “HIPAA Covered Entity” after all! State Laws can be stricter and supersede Federal Laws, and you need to know how to figure out if that is the case for your practice.
- Why I feel like our services are undervalued.
- Why so many PTs seem to have a low value mindset about what we provide.
- How we can begin to change this low-valuation problem across the board.
Resources and Links mentioned in this episode:
- The original post: The Chronic Undervaluation of Physical Therapy
- Have a Question? Click Here to Ask Me
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[Click to Tweet] @DrJarodCarter “If we don’t view our services as highly valuable, then our patients, referral sources, & payors won’t either”
Get involved in this conversation!
Let us know what you think about this topic by leaving a comment below, and sharing this post with your friends and colleagues.
Hi Jarod,
I totally agree with your statement of PT services being under valued. The problem that I see is that most PT clinics provide very mediocre service. I have been interviewing PT’s to join my practice, which as you know, is a fully hands on, one on one practice, and what I am finding is that most PT’s see a minimum of 3 clients every 30 minutes when they are in a clinic that bills 3rd party insurance. Most of the clients that end up in my practice are actually shocked to have a PT actually work on them for more then 5 or 10 minutes. They tell me that the PT that they have had in the past was worthless and they may as well have been in a gym. The PT’s hook them up to machines and count exercises. These PT’s lack hands on skills. They come out of school with some background but then do not get to practice them in their clinics. The DPT students that I have been talking to have even told me that their clinical instructors in their internships would not even let them practice the skills that they were taught in school. Austin has a DPT program with a manual therapy certification. Good luck to those students coming out getting into a clinic that will actually utilize those skills.
What do we need to do about it? We have to be willing to stop working in those clinics that provide the mediocre service and validate the poor outcome that is seen for PT patients receiving that care.
I have never wanted to be one of those PT’s that was counting exercises and running around doing paperwork while the techs were actually providing care. I had to pay for my own CE and strike out on my own in order to get away from that model of care. My clinic still bills health insurance but we have slowly been breaking away and pushing for more cash pay clients. You are right. There is this prevailing belief out there among patients that they should only be paying 20.00 for treatment. People are willing to leave a credit card guarantee for their hair and waxing services but have a totally different attitude about doing the same for Physical Therapy services even when they know that they have a dedicated therapist working on them for a 60 minute time period.
Dr. James Dunning who owns the Spinal Manipulation Institute and teaches manipulation and dry needling says that our PT model is broken and we need to shut it down and start all over again. DPT’s have a title without any real authority or increase in autonomy. Sorry if I am sounding all negative. I have been fighting this battle for a long time. I think my skills are worth paying for but I certainly can’t say that about all PT practices in general. The solution…..PT’s need to stop working in those clinics that are not providing the type of care that we got into this profession to do.
Well put, Jody! Thank you so much for the detailed and thoughtful comment. Great point that it’s not just about the decisions of practice owners, but also the decisions of staff PTs in terms of where they are willing to work. We ALL have a part and responsibility to change the low value attitudes and treatment approaches so common in this field
Part of the struggle is the patient expectation that they are paying huge sums for health insurance premiums, and in the past their insurance has covered medical services with little to no out of pocket expense. Also the old Seinfeld episode of getting a prescription from their dentist for a massage might speak to some further misinformed individuals (or writers) of what PT really is about.
You make a good point. I have found the need to continue clarification of this issue with supporting staff, especially our receptionist, who typically is the one having to ask for payment. It is difficult asking for money, but to not do so lessens the value of our services in the eyes of the patient and quite possibly our staff.
Thanks Tom. I would say that not asking for $ “most definitely” affects your staff’s opinion of the value of your services. And their opinions/feelings will have an affect on how they speak about your services, which will in turn affect the views of your patients.
When someone asks me what a session costs, I tell them $150 with complete confidence and not a hint of hesitance or apologetics in my voice. Staff must speak in this way as well, when they are asked the same question or are asking for payment after treatment.
Yes, it is a struggle for all of us that are now paying for health insurance that is almost virtually worthless. Especially if you are healthy and don’t want to join the prescription drug med club. I have always provided health insurance for my employees. I actually read the plans before I purchased them as I was not just going for a cheap price. Because we also accepted insurance at Hands On, I knew that patients and employers were purchasing insurance without really looking at what it covered. When we had to let people know what their benefits were, they were often surprised. Some don’t even know what a deductible is. Over the years, I’ve watched the premiums go up and the benefits go down. This was happening on a personal level as I was looking for insurance for my employees, as well as across the board with even large employer plans that we were accepting in our office.
Yes, people are mad that they are paying big premiums for almost no coverage. That is happening to us all. People have to be willing to take their health and wellness into their own hands. Most of what we see with musculoskeletal pain and dysfunction is chronic and due to repetitive activities, sitting at computers, poor body mechanics, etc.
We try to educate our clients about wellness being their responsibility. We are trying to move away from accepting health insurance and going to a more cash pay model. It’s proving to be difficult as people have come to expect us to take their insurance. We are slowly dropping insurances as they lower their reimbursements and increase their requirements for payment. If any of you have dealt with Orthonet and Cigna/Ash, you may know what I mean. It’s just not worth it to deal with those entities. We have started some cash based programs….Wellness/Maintenance Plan, Discounts for paying for multiple sessions and an Accelerated Treatment Program.
Jody, as someone who has been a patient at your clinic and knows the incredible value of what you provide, I’m confident you guys will be able to transition out of every insurance you want to over time.
I’m currently writing something titled The 5 Characteristics Common to All Successful Cash Practices (which will be sent to everyone on my email list for free), and one of the things discussed is the fact that when you transition from insurance-based to cash-based, it’s not really about convincing current and former patients to transition with you … it’s more about marketing to a new segment of the population who are willing to pay more out of pocket to receive the highest quality care. You will still have plenty of former patients who remain clients and self-bill, but many of your cash-pay clients will need to be “new business” that you generate with the right marketing strategies.
Well put Jody! You are completely right. Awhile ago I was doing prn work and had to leave the clinic for that reason.
Wow Jody that was a home run post. I have been a PT for 23 years now and truly have seen how doctors, patients and PTs all devalue the service of physical therapy. It probably has something to do with the medical model that is being shoved down our throat. You sit with a doctor for five minutes and get a prescription to make all our problems go away. Thank you pharmaceutical companies! But it also has something to do with our society not really knowing how to take care of themselves as far as nutrition, exercise and general mental health. I believe that we, PTs, need to be a bit more like the chiropractors are, putting more on being healthier through nutrition and staying away from being over medicated. We, in the current model of medicine, our trapped by the fact that most of us are under the thumb of the AMA because we rely on them for referrals. Even if you have a cash based practice your patients are still being influenced by the gate keeper’s influence because we have been trained to put all our trust in the all knowing physician and not take responsibility of taking care or our own body.
Thanks for the comment Mark. To add to your sentiments, this is yet another reason we all should be active in the legislative efforts for better access to Physical Therapy without physician referral. Especially those in states like Texas who still do not have any access to PT treatment without referral.
Sorry, my grammar and spelling needs to be checked. It’s early on a Sunday morning and I am not writing my best.
No worries at all! I’m pumped you took the time to join the conversation on a Sunday morning!
PT’s are at disadvantage in Texas as many ‘modern’ chiropractors have set up their practices that resemble outpatient physical therapy clinics. We have one nearby that is pretty popular. If you look at their website http://www.finish1.net, take out the word ‘chiropractor’, it looks like an OP PT clinic. This is only one example. I had one person tell me ‘why should I go to you, when I can go to these guys and pay $65’. So in addition to the apparent devaluation, we have this giant hurdle of direct access as well the evolution of the ‘modern chiropractor’ – which is basicly direct access therapy in a lot of people’s minds here. Not sure if anyone else has been experiencing this or seen similar.
There are popular chiropractic offices around here too, but my suggestion to you would first be to create a really good answer to the question “why should I go to you, when I can go to these guys and pay $65″… I looked at your website, and it seems your rates are actually a little lower than theirs, so that would be part of your answer right there.
It seems like those guys are pretty broad-based to athletes in general, and also do a lot of nutrition counseling; so I would suggest you go deep in one or two niches and dominate those markets… Runners, cyclists, high school football players, cross fitters, etc. etc. I’m guessing there are vibrant markets of passionate athletic groups you can tap into if you really focus the right types of marketing towards them.
Don’t worry about other practitioners and whether or not they are performing things similar to us physical therapist… All you’ll get out of that is frustration. It is always going to happen, and the best way to combat it is to simply be better. If you deliver a superior product, and market your services skillfully, word will spread and you’ll have no problem keeping your schedule full.
Also, on your rates webpage, I would change the sentence that says “we do not accept insurance” to “We do not directly bill insurance on behalf of our patients, but we can provide you with the paperwork necessary to send himself claims for reimbursement.” I would also expand on exactly what the patient will receive for the two services listed, and especially make it patient-focused … i.e. not just saying they will receive manual therapy and therapeutic exercise, but adding on statements like “so you can get back to the activities and sports you love faster” etc etc
Excellent comments everyone.
As with many things, I think that our problem is multi-factorial: Clinicians having their referrals handed to them in corporate, hospital-based, or popts situations so that more patients are merely more work; Clinics willing to accept low reimbursement just to have some patients, or to keep a referral source (ie md’s) happy; Clinicians not having any training whatsoever in business skills in contrast to massage therapists and chiropractors; Lack of skill in providing a clear, discernible product; Lack of skill in determining the time and cost to resolve the patients problem (ie financial ambiguity); And, a very poor public and professional understanding of what we can and do provide. As Dr Dunning likes to say, “We have no protected niche, like dentists for example”.
Well here is a recommendation from my 26 years of practice. I believe that we do in fact have a very exclusive niche that I invite everyone to consider and use if they wish. We are the experts in Human Function. Optimizing human function to be more precise. I know the APTA is starting to use the term Human Movement but don’t you think we really do more? I do. Optimizing Human Function gets to the core of what we are trained to do and makes it easier to describe us to the public. Let’s face it, you put 100 people in a room who say they do manual therapy and I bet they’ll all be different or use different approaches. So, define your niche so that you can spell it out in 30 secs or less and be willing to say No to sub par fees.
Awesome points, Kirk!
Thanks for sharing!
I wholeheartedly agree with the conversation here. It’s not just PTs that struggle with undervaluing their own services either. Here’s a blog post I came across and thought I’d share. http://www.ducttapemarketing.com/blog/2014/12/04/get-paid-your-worth/
They have some other interesting stuff too.
Thanks for sharing , Brian!