Greetings from CSM 2014 in Las Vegas! It has been a blast so far!

One of the commenters on my last post brought up some very good questions, and I felt that one deserved its own blog post:

A question that often comes up when I talk about a cash based system is “what do you do with patients that need a lot of treatments?” I realize you could argue just how many visits are necessary for any patient, but for the sake of argument how do you handle someone who might really benefit from >12 sessions of PT?

Setting expectations for patients

In a cash-pay practice, what do you do if you can tell a patient is going to need a really high number of treatment sessions?Though it is often difficult to precisely predict how many visits a patient may need, there are certainly those who come to my Austin-area physical therapy clinic who I know are going to need 10 or more treatments. In these situations, I think it is ever more important to be completely honest and upfront about the likelihood that multiple treatments will be needed. Expectations need to be set early on.

I have a reputation for getting people better quite quickly and though that is usually a very positive thing, it can also result in people with severe or chronic issues having unrealistic expectations about needed treatment. It’s important to get a feel for where the patient is coming from and what they are expecting so that you can make sure their expectations are realistic and in line with yours.

I also try to (tactfully) get an idea of how financially tough or easy they would consider having to pay for multiple treatments. Notice here that I used the term “consider.” There are extremely wealthy people who would “consider” paying for just three treatments with me (or even one treatment for that matter) quite difficult to do. On the other end of the spectrum, there are people with very little money who would consider 10 treatments ($1500) an absolute bargain if they were confident I could get rid of the pain that no one else could; or get them back to the activity they love but can’t currently do; or give their child a shot at an athletic college scholarship, etc.

Communicating clearly about costs

So in short, once I have evaluated the patient and know they will likely need a lot of treatment, I may say something along the lines of:

Though I am generally known for getting people better in just a few visits, what you are dealing with is going to take much more treatment than that. There’s no way to predict exactly how many sessions we’ll need, and everyone responds a little differently, but I would estimate that you will need at least _____visits. In these situations where a lot of treatment is going to be needed, I feel it’s really important that I’m clear about that upfront given I don’t directly bill insurance.

Based on their response to a statement like this, both verbal and nonverbal, I can get an idea of what else might need to be said or done. For example, sometimes people will respond by saying something like: “no problem, I just want to get better and I’m glad I’ve found someone who has a good idea of what is going on and what it’s going to take to get me back to running.” Some might physically cringe at my statement and explain that they are not sure they can afford more than a few visits. In which case I would say, “No problem. I completely understand. So let’s start with a couple visits and see how far we get, and if you’re not making progress at a pace that will get you to 100% by your limit on these sessions, I can refer you to other physical therapists in the area who take your insurance. You probably won’t get full-hour sessions one-on-one with them, but they are very good and will take very good care of you.”

So it’s really about being clear and honest, setting realistic expectations, getting a feel for what the patient is comfortable with, and moving forward or referring out appropriately.

Before I end, I’d like to add one more thing. In my Cash-Practice Guidebook, I have a subchapter titled Don’t Judge a Wallet by its Cover. There is a funny story that goes along with this interesting title, but I’ll just make the point here to never prejudge what kind of money someone has, or what they are willing to spend it on. If you do, you might end up turning away business and future referrals.

Interested in the cash-based private practice model?

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