First, a bit of personal news … I got engaged!
And now for the post …
Spoiler alert: this is gonna be one that many may disagree with, and very rightfully so.
The first conversation that a prospective patient has with whoever is answering the phone at your practice is certainly a very important one. I’ve heard a lot of discussion about how to guide that conversation and even claims that it’s most ideal for the clinician to be the first one the patient speaks to. I would say it’s most ideal for scoring the business, but not necessarily ideal use of the clinician’s or business owner’s time.
Make sure you talk to the right people
Along those same lines, I’m often asked the question: “When a prospective patient calls [who doesn’t know you are out-of-network], how do you convince them to forgo using their insurance and pay privately to get your treatment?” I cover some of the main talking points in this post, but I’ve learned a few things since I started my practice and I would like to add this to the answer I gave in 2011 … I actually try to do very little “convincing” of patients who call without already having the idea that my services are worth paying more out of pocket than my insurance-based competition.
You will spin your wheels and get quite frustrated over time if you’re constantly dealing with these types of prospective patients who need to be convinced to go out-of-network to see you. Instead, I try to make sure that as few people with this mindset call as possible. I know that may sound crazy but I’d much rather have two conversations with people who understand the value of my treatments and are ready to book an eval before we even speak, than have 10 conversations with unsure people and be successful convincing 3-4 of them to book appointments.
Even though scenario #2 gets me more patients, I think it would wear me out over time and I’d rather focus my time on simply getting more of the scenario #1 people calling in the first place. I do this by posting my rates clearly online and explaining exactly why I charge what I do, and the added value I am able to provide by being completely out-of-network. Getting people to my website so that they can actually read those things and make the decision to call (or not call) has a lot to do with Blogging, Youtube, and Social Media. (*Note that many are also word-of-mouth referrals who go directly to my site to read about my practice before calling, or not calling)
Though it seems to work for some practices, I personally steer clear of doing free consultations just to get someone in the door. This approach actually generates a lot of business for some practices I know of, but I still don’t do it and here’s why: though it may earn me a few patients here and there I wouldn’t have had otherwise, I’d have to deal with plenty of people who just don’t have the mindset to pay more for a higher value service; and that is not the type of patient I (or anyone) should to be trying to attract to a cash-based practice.
This is all of course just my opinion and reflective of my own mindset about this business model, but I think you’ll be happier long term if you work harder on attracting people with the right mindset to your practice rather than convincing people to change their mindset about the value of top-notch healthcare and what they’re willing to pay for it.
Focus on the value of your physical therapy services
I’ve written and spoken numerous times about “value” and tried to compel those listening to consider the mindset they have about the value of physical therapy. However, the “value” topic is not limited simply to the value of good healthcare services. The stance I take above is reflective of the value I place on time.
Providing great treatment will not necessarily lead to private practice success on its own. Being a successful healthcare entrepreneur, and especially one that thrives in the niche cash-based realm, requires employing a wide variety of non-clinical business skills and tactics. Making sure you are using your time efficiently and effectively is one of those, and I would venture to say one of the most important ones.
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Focus your time on getting the right patients to call; NOT on convincing those with the wrong mindset. #CashPT [Click to Tweet]
So, it is a matter of working with people who are seriously interested in improving their physical status, and they don’t let the idea of paying up front for the service get in the way of making that happen. Motivated patients, what we all want to make our outcomes better and truly be meaningful health care providers. We can spend the time in a quality fashion with them. All that works hand-in-hand.
Yes, absolutely. Thanks for commenting!
Great post as usual. Congrats on engagement!
Thanks Zack. I appreciate it!
Thanks for sharing! And congratulations on your engagement!!!!! Best wishes!!!!!
Thanks so much, Katherine!
I agree with your tack and follow similar guidelines. I differ a little in that I offer courtesy billing for those interested in using their out of network benefits. That means I submit the claim but they still pay upfront and they have to wait for reimbursement.
I am a fan of Joseph Brence’s MIP model of care delivery in which Motivation-Input-Plan outline the approach to yielding successful outcomes. Certainly finding the motivation behind a potential customer’s behavior contributes to their overall outcome, functionally and satisfaction-wise. Some of this can begin to be teased out in the initial conversation one has with a customer, and one has to be careful to understand when the selling becomes too much. But I think the confident clinician and business person will understand how to promote their strengths and personality without overstepping their hand.
Thanks for commenting, Bob.
Yes, I saw Joseph do a presentation on MIP and I loved that they included “motivation” … What if it’s an injured young athlete and they’re freaked out about returning to a scenario that caused them so much pain? Right? Very insightful that they included that as a main theme in their model.
Just curious, is your clinic 100% out-of-network? And if so, did you transition from formerly being in-network with some 3rd Party Payors? I ask because I was wondering if you courtesy bill for your clients because you were already set up with the staff and systems to do so from a former version of your practice.
I am out of network with everyone except Medicare, but even then, I only saw one Medicare patient last year. I started the practice out of network and cash based from the get-go. I do see injured professional ballet dancers whom I bill through WC and they are the only ones for whom I wait for payment. This is the compromise I accepted in order to continue being able to serve this group, whom I have a strong connection with. The reimbursement is actually reasonable ($122-132/session).
So I guess I have to ask… is it worth the overhead cost of having someone send in all those out-of-network claims just to provide that courtesy to your patients? Not to mention the headache I’m sure you’re given by the insurance companies denying the claims?
The overhead cost is just my extra time, which is valuable, but I have a system down now so am more efficient. The percentage of patients that I do courtesy billing for is probably 10% or less and fluctuates.
As far as the insurance company goes I do not worry about what they reimburse the patient. That is a contract between the patient and them. No headache for me. If they deny reimbursement it’s because the patient hasn’t met their deductible.
Oh okay … it sounded like you automatically sent out-of-network claims in for all of your patients with health insurance, not just a small percentage of them… that sounded like an enormous task!
Thanks again for your input.
Ah, yes. I thought the same thing. This makes way more sense.
I just provide receipts and I agree it is up to the patient at that point but I do try to do what I can the occasional time insurance comes back with their games (denying on a “technicality”…not a benefits reason.)
Bob-
Please see my comment below. Clearly I don’t know how to work technology/reply properly…
Thanks!
Bob-
To piggy back on Jarod’s reply, I am interested to know how much run around you get from their insurance after submitting the claim for your client? My patients self submit with receipts from me, but I STILL get occasional mail from their insurance providers with the run around (can’t find Dx Code, can’t find DOB…things all right in front of their eyes, but they just are playing a game) I usually take the time to try to follow up for the patient, but I would imagine I’d get a lot more of this hassle if I was the one submitting for them. I am interested in your thoughts/experience.
Great post Jarod as always and congrats!
Yeah, it’s amazing how many of the insurance companies will claim that something isn’t on the receipt provided to the patient, when it is right there clear as day! This is one of the reasons we left the system… they deny and claim missing information even when it’s obviously there, and enough people give up trying every year that they end up making millions from these methods!
As I mentioned in my reply to Jarod I don’t get any run-around from insurers. The claim forms are filled out properly on my end so if they don’t reimburse the patient it’s not something I am in control of. It’s not a function of the insurer playing games, as far as my experience goes.
I set up the expectations with the customer on that initial conversation (if they ask) to let them know that they MAY get reimbursed from their insurer but it’s up to them to find out what their OON benefits actually are.
Hi Jared,
Congratulations on your engagement. Wonderful news.
I have spent many hours recently reading through all of your blogs after discovering your website. I was thrilled to find out that there are SO MANY other PT’s out there with my same mindset. What a relief. I began searching when my eyes were suddenly opened to the fact that it is illegal to treat Medicare patients and take money for it. Who would’ve ever thought? I always assumed that people could spend their money wherever they want. And since I wan’t in network with any insurance and never had been with Medicare, did not know the rules. Isn’t that an infringement on the legal rights of an American? I do not see why this is so difficult to change. Seems as if when they drew up that documant they just forgot to add Physical Therapists and Chiropractors and said “oh well!’
I find it terribly exciting to be becoming know as the “therapist in town” that really listens to patients, and gives me a full hour hands on treatment and not just exercise.” I specialize in Manual therapy, which I feel greatly enhances quick recovery. No more 2x/wk for 6 weeks, just to use up their insurance. I love it.
Thanks for being out there so I can read all the wonderful things you are addressing.
I have alway loved being a PT. It is SO rewarding, but I especially love it the last 9 years I have been in an independenat cash based private practice.
Congrats on your successful cash practice, Brenda!!
And yes, I believe that the law as it currently is, goes against free-market capitalism and should be considered unconstitutional. If someone wants to pay out of pocket for my treatment, it should not be against the law for me to provide treatment services to that person. Though it’s ridiculous, it’s not so simple to change the law. They tried last year and it got nowhere.
Hi Jarod,
Thanks for your blog, your thoughts on the future of PT practice have inspired me and I have been preaching a cash based approach at my program to whoever will listen. I will admit that I haven’t read everything on your site, and forgive me if this has been addressed elsewhere, but 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? That seems like a pretty steep bill that they would be racking up. Do you find that your patients basically self select themselves to conditions which require less one-on-one treatments? And as a followup, and I know you’ve addressed this before, do you think that there is a socioeconomic limit to where your type of practice can survive?
“what do you do with patients that need a lot of treatments?” — That’s a great question and I think it will make for a good blog post, so keep an eye out for my response to that one very soon.
“Do you find that your patients basically self select themselves to conditions which require less one-on-one treatments?” — I haven’t seen this too much, BUT I guess if it is happening, I would not be seeing those patients who decided to go elsewhere for treatment because they were likely to need a large number of treatments.
“do you think that there is a socioeconomic limit to where your type of practice can survive?” — to a degree, yes. If someone is living in poverty, but have health insurance, they are highly unlikely to choose a cash-based practice. However, the majority of my patients would be considered part of the middle class. As I have described in many different posts, it’s more about a patient’s mindset and the value that they place on what they consider the best possible treatment, than it is about the size of their bank account.
If a patient needs significant amounts of treatment then there can be the hesitation on what the outlay is going to be but if you are in a setting like mine where I operate within a movement studio then they can transition when appropriate to one of the movement teachers with whom I can manage things going forward. The cost for a movement instructor is less expensive and helps keep the customer within the system and reinforces the clinicians authority as a comprehensive resource.
Great input, Bob. Thank you!
I just finished writing my detailed answer to Collin’s question, “what do you do with patients that need a lot of treatments?” and it will publish as the next blog post this Thursday. Thanks again guys.