This week I interviewed Holly Jones, PT about her fee-for-service PT practice in Oklahoma.
Give us the background of your Fee-for-Service PT practice? What are the general logistics: setting type, treatment length, employees, rates, etc.?
One on one manual therapy for treatment for all types of pain (I also specialize in women’s and men’s health, but that population has greatly decreased since I went to a cash practice). Treatments are scheduled every 20 minutes; however, I treat until the patient is done. Some sessions are longer, some shorter; the average session lasts 20 minutes. I tend to see patients once a week to once a month to several times a year, depending on the level of compensation of their musculoskeletal system. My fees are: $90 for the initial eval (scheduled for an hour) and $60 for subsequent visits. When a patient needs education and/ or exercise, I will recommend that they schedule a “double” for 40 minutes, receiving first manual therapy, then education/ exercise, and the charge is $120. I am the sole practitioner, and have 1 full-time office person who schedules, takes payment, cleans, etc.
What were the key factors that made you believe a Cash PT practice was viable for you; and that it would be viable in your area?
First, there are other colleagues in my area (Oklahoma City) that have already been successful with a cash practice. Also, I’ve been in private practice for 12 years and began the cash practice 18 months ago. My steady goal during these past 12 years (more consciously in the last 5 due to ups and downs of referrals with the steady increase in POPTS) has been to have word of mouth as my main referral source. Word of mouth referrals increase autonomy with the patient, giving the therapist the freedom to be able to refer them appropriately to other specialists and to be able to focus 100% of attention on their care, without distraction. At first my focus on building word of mouth referrals began as a way to simply survive as an insurance-based private practice. Going to cash was the next step toward more autonomy.
What was your biggest fear about moving into the Self-Pay realm? How did you deal with this fear and move forward anyhow?
I felt crystal clear guidance to do it. I’d always wanted to do it, but would look at the demographics of my patients and “put it on paper” and it never was something I seriously considered I could actually do. Then, I felt like God was giving me “nudges”, where I was feeling cornered more and more. One persistent nudge was the realization that I was not being honest with myself or the patient when I would put them on a piece of exercise equipment “just to get that additional unit”. How many times I’d hear from a patient: “why do I need to do that? I can do that at the gym!” I’d justify it to myself that I had no choice; due to poor insurance reimbursement and high overhead, I had to do this to keep my business running. But I hated it. And then, the final straw was when my former office manager informed me that I could buy the new software for billing with the upcoming new ICD9 codes at a discount at $3000. That was in November of 2011. That was the final nudge. I went into my office and I heard still and clear: “It is time.” I knew that I could keep going the way I had and probably be OK, but if I didn’t follow God’s guidance, I would miss out on the “juiciness” of life! I have to thank my husband and friends and my office manager, who left on her own accord to pursue another career line, for being consistent “atta-boys”.
What is the biggest ongoing challenge of running your Cash practice?
Getting used to the variability of my patient schedule. With cash, many patients will schedule at the last minute. Also, my cancellation rate has increased. I do have a strict 24 hour no show/cancellation policy and patients abide by it; it’s just obvious that when one is paying upfront, they will only come in when they really need it.
The flip side of that is that it continually challenges me to strive to be the best therapist I can be. I also understand why patients cancel; if I were feeling great 24 hours before a scheduled appointment, I’d do the same thing myself! So it just ups the bar to be of the highest quality, for that patient who has had an excellent result to tell their friends and family.
How do you go about “selling your services” to a prospective patient if they are “on the fence” about going out-of-network?
Most patients have already made that decision by the time they get to me. However, my fees are relatively low at $60 per visit and they don’t spend excessive time in my clinic; they get treated quickly and usually no more than once per week. So, like you wrote about in your recent article, their medical dollars are maximized, as well as their time, which to many, is just as valuable as money.
If you had one final piece of advice for someone considering starting (or converting to) a private-pay practice, what would it be?
Tune into your gut and follow it. Be on a sound financial footing. Have faith in your potential!
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Thank you, Holly, for sharing your experience with us! It’s always great to hear from other successful cash-practice Physical Therapists. If you have any questions or comments for Holly, please share them in the comments section below.
Click Here to learn how to start your own Cash-Based Practice
Hi Holly,
One of these days I’ll need to start doing these interviews via audio, so it’s a bit more real time, but I now have a few follow up questions I didn’t ask before via email …
1) Please explain the logistical process of transitioning from an in-network practice to being completely out-of-network with all 3rd Party Payors. Did you drop contracts one at a time, all at once, etc? What factors did you consider when deciding the order of dropping contracts, and were there any ‘lessons learned” in that process?
2) How did you go about maximizing client/patient retention as you became an out-of-network provider, and your services were no longer covered for former patients looking to come back for more treatment.
3) How did you maximize referral source retention/levels as you went from insurance-based to cash-based? Were you highly reliant on Physician referrals before the transition? What kind of drop in Physician referrals, if any, did you experience?
What kind of treatments are you doing in only 20 min. sessions? Are they more like manipulations that a chiropractor would do? I see a lot of hand patients, and their sessions are like 90 minutes or more with all the active exercises, manual therapy, including scar mobs, joint mobs, etc. How do you manage these patients? Did you get your manual therapy training in a specific specialty such as Barnes MFR methods?
Jarod,
I dropped all insurances at one time, after giving patients and the insurance companies 90 days’ notice. This may sound risky or unconventional, but I simply had to act on faith completely or not at all.
The transitional process was pretty seamless and there was no fallout, such as forgetting an insurance I’d been contracted with. We sent everything to insurance companies via certified mail, and were glad we did, as some insurances who thought I was still in network said they’d never received our letter.
As far as maximizing client retention, all was out of my control when it came to the patient deciding whether they’d stay or go. I referred patients to other colleagues when asked, and really just tried to focus on continuing to do an excellent job of getting the patient out of pain; great results being the best marketing tool.
When my practice transitioned to cash, I had a significant drop in previous patients…there were those I’d seen for years that never came back. Then, months later, there were those that returned after trying other clinics out. But the most positive aspect of this has been the influx of new patients…motivated, engaged in their care, and a complete pleasure to treat, because of their positive attitude. It has been as if closing the “insurance mindset” door has opened a door to this type of patient. Soon after making the decision to go to cash, I “randomly” met individuals, who then referred other individuals, almost as if by “coincidence”. This has definitely been a slow, steady “build it and they will come” experience.
My physician referrals, which were about 70% of my referral base, plummeted, with the exception of about 4 physicians, who refer occasionally.
Nowadays, 95% of my referrals are word of mouth. Initially, I had a 30% drop in patient visits; this has improved to 25%. Although my patient population completely shifted to different people, my retention has never been below 70%.
Looking back (and forward), I see myself in a slow, steady growth period in a practice with a newly-established paradigm. I would not have done anything differently, and am thankful for the stress reduction in my practice, and the ability to focus 100% on patient care, and the peace of mind…which keeps happy patients telling other potential patients, and so on!
Dropped them all at once … WOW! You have some serious guts! Well done.
“It has been as if closing the ‘insurance mindset’ door has opened a door to this type of patient.” – I love this statement and couldn’t have framed it better myself. I write a lot about mindset of both the practice owner and the patients, and it truly is a different population you are targeting when you have a cash PT practice.
Thank you again so much for all the wonderful information.
David, I appreciate your question. I have taken courses from Ed Stiles,DO for the past 12 years. He teaches how to screen the body, to find the key area, to know where to treat. I credit his teachings for enabling me to not only survive in private practice in a POPTS-filled environment, but also to transition to a cash practice. The 10 years I practiced prior to taking Dr Stiles’ courses, I had success with patients, but it seemed as if my treatments were “all the same”, and took a lot of time, following a complicated protocol. Knowing specifically where to treat on the patient has simply saved me time. A typical 20 min treatment includes screening by palpation, and treating the area of greatest restriction, with the technique most appropriate (whether it be for joint dysfunction, connective tissue, myofascial, etc) for that area, followed by rescreening and treating until no further restrictions are found. The key area may or may not be the area of diagnosis, such as the hand.
By producing a global change to the entire system, this produces a physiological change to the area of pain/weakness, negating the need for many of the stretches and strengthening exercises I would have done previously, due to the correction of the length/tension relationship of musculature in that area. An example of this is how correction of the ribcage can alleviate lymphedema in the upper extremity.
In the case where the hand is one of the key areas, I still see them in the 20 min slot. Occasionally, I will see them twice a week, especially post-surgical patients. When I teach them a home program, I see them for a separate 20 min appointment, usually back to back for a 40 min session. This may take 2 sessions for exercise instruction, followed by revision/progression of 1-2 more visits a few more weeks later.
If a patient needs to work on ROM after a treatment, I instruct them to do that in the clinic. Although I rarely use modalities, I will have my tech do the appropriate modality (speaking mainly of the post- surgical patient). So that patient may spend 60-90 min at the clinic, but the one on one time is still usually a 20 min session. I do not charge the patient for anything outside of the one-on-one time, including modalities. Thank you for a great question.
Holly isn’t Ed Stiles DO one of the guys who promote cranio-sacral therapy?
Todd-
Yes. Interestingly, I was always taught that the cranium is fused and practiced that way for 10 years. Since incorporating cranial into my treatments, my results have improved dramatically.